Managing stress as a working load

Stress management involves recognising pressure, changing avoidable demands and finding workable responses to demands that remain. For medical writers, this includes personal routines, the physical and social workspace, client relationships and employers’ responsibilities.

Stress and its effects

Stress is not always harmful: positive stress can support focus, productivity and alertness, while persistent or excessive stress and accumulated small pressures can become overwhelming. ^{1, 2} A 2012 account distinguished motivating “eustress”, such as excitement about an interesting writing assignment, from short-lived acute stress and ongoing chronic stress. ² That account linked chronic stress with anxiety, sleep loss, cognitive impairment, coronary heart disease, diabetes, raised blood pressure and stroke, and worsening irritable-bowel symptoms; cortisol was suggested as a possible link to heart disease and diabetes. ² Workplace stress was also linked with reduced productivity and burnout. ²

A physician’s April 2020 account described emotional and physical stressors acting through the cerebral cortex, thalamic nuclei, hypothalamus, pituitary and adrenal cortex and medulla, with effects including central adiposity, increased heart rate, interleukin-6, arrhythmias, blood pressure and coagulation. ^{3, 4, 5} She also described psychological and behavioural effects, including coping through alcohol. ⁵ Her suggested response was to avoid stressors where possible and otherwise change the response through stretching or meditation, including breathing. ⁵ She explained these practices as activating the parasympathetic system against excessive sympathetic and hormonal activity, and described the effects of stress management as lower blood pressure, heart and breathing rates, better lung capacity, digestion and sleep, fewer gastric problems, calmness and stronger immune function. ⁶

Recognising pressure through reflection

A 2017 freelance-pressure exercise recommends answering three questions every Monday morning. ⁷

1. How much pressure is present? Rate it from 1 to 10, with 10 the maximum, to step back from reacting to crises and recognise when additional action may be needed. Tiredness, procrastination, outbursts and sleep problems are suggested signs that a release is needed; suggested responses include exercise, films or books, expressing concerns, short breaks or naps, and longer breaks such as holidays, alongside positive routines rather than reliance on drugs, alcohol or tobacco.
2. What is within personal control? Identify concerns that can be changed or influenced and direct effort towards those tasks. An executive coach’s example was a highly regarded client afraid of failing: he recommended detaching from the result while preparing thoroughly, separating time to consider risks from time to act, and permitting imperfection. The approach also cautions against blaming others or trying to control their opinions, and recommends recognising a job well done without depending on approval. A healthcare worker’s example used meditation, breakfast and snacks as a stable routine within otherwise unpredictable days.
3. Why do the work? Revisit purpose regularly because daily distractions can obscure it; a sense of purpose can sustain perseverance during difficulty. Rather than assuming there must be one purpose, identify enjoyable activities and either pursue them or take steps towards them.

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There is no single stress-management technique that works for everyone; suitability for the individual matters. ¹¹

Leapers’ 2025 framework names three areas: active awareness, behaviours and boundaries, and community and connection. ¹² Regular reflection can identify how experiences affect wellbeing, including anxiety created by late payment or financial uncertainty; observed patterns can guide changes such as improving sleep, finding collaborators or planning time off. ^{12, 13}

Stress in freelance medical communications

A 2021 account identified deadlines for publications and congresses, client pressure, long on-site hours, staff conflict and retention, business development, balancing paid and voluntary work, and overwork as sources of stress in medical communications. ¹⁴ It contrasted agency measures to protect employee health with freelancers’ lack of a manager, human-resources department or ready-made team for support. ^{1, 14}

Its freelance stressors were grouped as follows. ^{15, 16, 17, 18, 19}

1. Workload: uncertainty about future work; comparison with apparently busier peers; finding time to finish current work; sustaining the pace without burnout; and making time for development while delivering projects.
2. Finances: paying bills, tax and pension contributions, and meeting commitments if burnout prevents working.
3. Work–life balance: fitting in work, exercise, family and friends; switching off; fearing loss of work during holidays; and combining voluntary commitments with paid work.
4. COVID-19: disrupted childcare or schooling, isolation at home, changed workloads from cancelled congresses or shifted projects, and exposure risk at meetings.
5. Reliance on others: a long-standing client changing roles, a client losing an account, and lack of statutory sick pay or holidays.

^{15, 16, 17, 18, 19}

An IPSE report cited in 2021 found that 48% of freelancers described becoming self-employed as very positive for mental health and a further 32% at least somewhat positive. ^{14, 20} The same report found that 53% said finding work harmed mental health and described irregular income as difficult; job-related stress was associated in respondents’ accounts with reduced productivity (48%), feeling depressed or anxious (48%), lost sleep through worry (47%) and low confidence or energy (46%). ²⁰

EMWA’s 2023 Freelance Business Survey added wellbeing questions and had 223 respondents, predominantly representing European freelance writing. ^{21, 22} Reported work-related stress frequencies were “sometimes” (53.8%), “most times” (6.7%), “always” (1.8%) and “never” (6.3%). ²³ In a question allowing several triggers, workload and deadlines were most common (71.8%), followed by work–life balance (57.7%), finding clients (24.8%), finances (21.5%), retaining or losing clients (12.1%) and COVID-related issues (1.3%). ^{23, 24} Active stress-reduction efforts were reported by 54.7%; activities included physical activity (91.0%), home activities (67.2%), social activities (51.6%) and mindfulness or meditation (32.8%), with several choices permitted. ^{23, 25, 26} Other responses included travel, music, psychological assistance, pet therapy, fewer working hours, client selection and saying no. ²⁵ The authors described stress as mostly manageable and suggested physical activity might help explain this; 62.8% rated work–life balance an important freelance skill. ^{23, 27, 28} They concluded that respondents adapted through activities to relieve work-related stress. ²⁹

In Leapers’ 2024 survey of 715 freelancers, 45% reported worsening mental health during the year, 90% experienced low confidence at some point and 31% were unable to work for at least three days because of poor mental health. ³⁰ In the WE3 Salary and Insight 2024 survey of 712 employed and freelance medical-communications professionals, nearly a third were neutral or disagreed that medical communications was a good industry to work in; the 2025 MedComms Freelancing Barometer, with 344 freelancers, found 26% neutral through very dissatisfied with freelancing in the field. ³⁰

A 2025 account described continuing stress from unpredictable workload, financial concerns, work–life balance and burnout risk, with economic instability, client budget restrictions, restructuring and AI uncertainty becoming prominent after the pandemic. ^{31, 32} AI worries included replacement, devaluation of skills and adapting to generated content, alongside hopes that it could remove unwanted chores without taking away enjoyable work. ³³

A support plan for the self-employed

Leapers’ five recommendations in 2021 combined reflection, community, rest, communication and proactive support. ^{19, 34, 35}

1. Treat personal wellbeing as a business asset. Set aside even 15 minutes weekly to record events, feelings and positive or negative effects on work; a recurring diary slot, such as Friday afternoon, can reveal recurring worries or stressors worth changing.
2. Find support rather than working entirely alone. Join sector, skill or freelance communities, or build a network of peers and collaborators who can advise or cover work during a break.
3. Protect rest and boundaries. Establish switch-off times, end-of-day routines, availability schedules and regular time away, with food, exercise and sleep supporting wellbeing. Plan leave, tell clients and consider reciprocal cover; when leave is impossible, seek work that remains motivating.
4. Communicate with clients. Explain preferred ways of working, availability and other factors affecting wellbeing; Leapers reported that more than half of stressors in its research arose from work with others, including payment, communication, behaviour, workload and boundaries.
5. Act before a crisis. Build support and healthy habits proactively; seek emergency help when unsafe or at risk, or speak with confidential support services or a general physician when struggling. Those doing well can also support other freelancers.

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Leapers described itself in 2021 as a free, open community supporting self-employed people’s mental health and reported helping over 70,000 people in its first four years. ¹⁹ Its 2025 guidance emphasised that communities, policymakers, unions, service providers and hirers share responsibility for better working practices, while freelancers’ ability to refuse work varies with their finances. ³⁶

Deep breathing, meditation, exercise, time in nature and healthy eating were among a seasoned freelancer’s stress-management practices reported in 2022; she used mostly three-to-ten-minute guided meditations. ³⁷ Another practitioner’s routine combined five actions. ³⁸

1. Exercise: twice-weekly online Pilates provided accountability; home exercise videos replaced a gym where inconsistent mask-wearing during COVID was uncomfortable.
2. Hydration: two large glasses of water before and after lunch prompted bathroom trips that also provided opportunities to stretch and look farther than the monitor.
3. Regular meals: food delivery or takeout helped when cooking time was limited, and prepared vegetables provided snacks.
4. Regular hours: work email and the computer were left alone after finishing work.
5. Hobbies and contact: online gatherings, local hikes, walks, colouring, dancing and gardening supplied social contact and creative outlets.

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Workspace and immediate responses

A 2012 workplace-stress checklist paired pressures with possible responses. ²

Stressor	Suggested response
Noise	Close the door or use noise-cancelling headphones.
Harsh or unsuitable overhead lighting	Use several inexpensive lamps.
Irregular hours	Identify whether they are self-imposed; otherwise discuss them with a manager.
Excessive workload	Learn to say no, particularly when freelancing.
Unclear job role	Obtain a clear definition.
Unrealistic objectives	Discuss them with the manager.
Job insecurity	Recognise that this may be outside personal control.

²

A further practical checklist recommended the following. ³⁹

1. Prioritise tasks and decline nonessential ones.
2. Delegate responsibilities.
3. Allow time for quality work.
4. Limit distractions.
5. Work remotely if that is an option.
6. Try committing to a dreaded task for ten minutes, after which stopping may feel preferable or carrying on possible.

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Other suggested responses were closing the eyes and breathing, pausing before reacting to email, delaying an angry draft until it could be reviewed calmly, asking what an action achieves and why, and using a calming mantra. ⁴⁰ Exercise was suggested when quieting the mind proved difficult; chair exercises included arching the back on inhalation and bending forward on exhalation, flexing the feet, stretching the arms overhead and making small neck circles. ⁴⁰

One writer in 2012 described using feng shui’s placement principles to face the door with a wall behind, introduce water imagery in the room’s designated career area, soften lighting and add plants and natural objects. ^{41, 42} She reported greater inspiration and productivity, easier deadlines and new responses to distractions, attributing the improvement probably to deliberately arranging and becoming more aware of her surroundings. ⁴¹ Suggestions from her conference discussion included low-maintenance office plants such as philodendrons, spider plants and cacti, classical music, morning prayer or meditation, and professional help with feng shui design. ⁴³

A 2011 workplace-kindness account reported an estimate of $300 billion annually in business costs from workplace stress and violence, including absence, lost productivity, turnover, and medical and legal costs. ⁴⁴ It recommended kindness towards oneself through self-care, towards colleagues through mutual care and respect, and within the wider community, with simple workplace examples including less gossip, smiling and accompanying a colleague to her car after hours. ⁴⁴

The Wheel of Awareness

Daniel Siegel’s Wheel of Awareness uses a wheel metaphor: known experiences such as sensations or thoughts occupy the rim, knowing occupies the hub, and attention forms a spoke; the exercise differentiates experiences from each other and from awareness, then explores awareness itself. ⁴⁵ In his account published in 2020, he reported improvement among patients with mild-to-moderate depression, anxiety and trauma, greater equanimity among those facing life-threatening illness, and relief from burnout, with similar reports from therapists he trained and their clients. ⁴⁵ He also reported collecting experiences from the first 10,000 workshop participants. ⁴⁵

The practice combines focused attention, open awareness and kind intention. ⁴⁵ Siegel distinguished research on these three-pillar practices from the Wheel itself, which he said had not been studied in the same way, and recommended daily practice. ^{45, 46}

Employers’ responsibilities

Surveys cited in a 2023 workplace account found that more than three-quarters of US workers had experienced at least one mental-health symptom in 2021, and more than 80% identified the workplace as contributing to a mental-health challenge; most sought employers supporting mental health. ⁴⁷ Businesses should normalise discussion and support workforce wellbeing, while staff writers can discuss whether their roles suit homeworking with employers. ⁴⁷

The US Surgeon General’s workplace mental-health framework, as reported in 2023, centres five essentials on workers’ voice and equity. ^{48, 49, 50}

1. Protection from harm: prioritise physical and psychological safety, enable adequate rest, support and normalise mental health, and put diversity, equity, inclusion and accessibility into policies and practice.
2. Connection and community: foster inclusion and belonging, trusted relationships, collaboration and teamwork.
3. Work–life harmony: increase autonomy, make schedules flexible and predictable, increase access to paid leave and respect time outside work.
4. Mattering at work: provide a living wage, involve workers in decisions, recognise contributions and link individual work to the organisation’s mission.
5. Opportunity for growth: provide training, education and mentoring, clear and equitable paths to advancement and relevant reciprocal feedback.

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Each essential is grounded in two human needs; the framework names safety, security, social support, belonging, autonomy, flexibility, dignity, meaning, learning and accomplishment. ^{48, 49, 50}