The Chief Psychology Officer

Ep85 Presenteeism: Why Working When You Shouldn't Is Hurting Your Brain

• Dr Amanda Potter CPsychol • Season 4 • Episode 85

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Ever pushed yourself to work through illness or stayed late just to be present at work and be seen? Your brain might be paying a devastating price.

Presenteeism, means showing up physically but functioning below capacity due to illness, injury, or simply staying longer than necessary. This costs UK businesses a staggering £100 billion annually. Yet unlike absenteeism, it remains largely unmeasured and unaddressed in most organisations.

The neuroscience reveals why this matters so deeply. When we work while unwell, our brains operate in conflict, diverting precious cognitive resources to manage pain or stress before productive work even begins. The anterior cingulate cortex, which processes both physical and social pain, lights up when we fear letting colleagues down—driving us to show up when we shouldn't. Meanwhile, receiving praise for "pushing through" triggers dopamine rewards that reinforce this harmful pattern.

Most alarmingly, chronic presenteeism physically changes your brain. The hippocampus can actually shrink under prolonged stress, affecting memory and learning capacity. Neural connectivity in the prefrontal cortex weakens, reducing judgment, concentration, and emotional regulation. What many attribute to "just getting older" might actually be the cumulative effect of insufficient recovery.

The good news? Our brains possess remarkable neuroplasticity. By prioritising psychological safety, resilience training, and supportive policies, organisations can combat presenteeism while enhancing performance. Leaders play a crucial role by modelling healthy boundaries and creating cultures where wellbeing and productivity coexist rather than compete.

Ready to transform how you think about rest and recovery? Connect with us on LinkedIn or visit thecpo.co.uk to continue this vital conversation about creating workplaces where people truly thrive.

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Angela Malik:

Welcome to the Chief Psychology Officer podcast, the show where we dive deep into the psychology behind leadership, behavioral change and high performance. I'm Angela Malik and today we're talking about presenteeism. In this episode you'll learn what presenteeism is, how it impacts a business and its employees, the neuroscience of presenteeism, risk factors and what businesses can do to overcome presenteeism. But before we jump in, make sure you hit subscribe so you never miss an episode. And if you want to keep the conversation going, connect with us on LinkedIn. Just search for Dr Amanda Potter or Angela Malik Plus, check out thecpocouk for more resources and if you like what you hear, please give us a rating so we can reach more people. Welcome, amanda.

Dr Amanda Potter:

Thank you, angela. I think a five-star rating is what I would like, so let's hope we are five-star today.

Angela Malik:

That would be great.

Dr Amanda Potter:

Yes, I know what's the point of doing it unless we do it really well, absolutely. If you don't ask, you don't get Exactly, that's definitely my motto.

Angela Malik:

So let's dive in, Amanda. What is presenteeism?

Dr Amanda Potter:

Well, I think it's a great podcast to do, because presenteeism is rife. It's an issue for organisations and it's where workers are physically present at work but they're not operating at their maximum capacity because of illness or due to injury or another condition. It could also be staying longer than you're being paid for or than you're required in order to show that you're working hard and to justify your presence or role within an organization. To help feel like they're important in the face of the employer.

Angela Malik:

Those feel like two fairly important in the face of the employer. Those feel like two fairly different concepts. Do we see much overlap between the two?

Dr Amanda Potter:

What's interesting is I think they are quite different, but actually the impact is quite similar, in that neither of these things result in positive performance. Actually, the performance tends to go down. So the two types of presenteeism either showing up when you're sick or staying longer than you're required and therefore not performing to your best of ability results in lower performance due to errors, reduced quality and, ultimately, lower motivation.

Angela Malik:

That's really interesting because lately a term that has sort of popped up into the workplace conversation is task masking, which you might equate it to presenteeism, that is, going the extra mile to look like you're working hard when you're actually hardly working. But I say it's interesting because you say performance is impacted. But the studies for this type of presenteeism let's call it say that 70% reported zero impact on their output. Nearly half said they're still above average workers. Obviously these are workers reporting on their own productivity, but it's just interesting that there's a disconnect there between the two outcomes.

Dr Amanda Potter:

So they're saying they're working hard, but they're not.

Angela Malik:

They're essentially looking busy, doing busy work.

Dr Amanda Potter:

Looking busy. It's got to have an impact on productivity, surely?

Angela Malik:

Yeah, I'm wondering if so when I was reading up on this. I'm wondering if it actually has to do with they're still hitting targets, but actually they're hitting those targets more quickly than they would otherwise. And then, because of this whole quiet quitting concept that's coming through, they aren't asking for more tasks or they aren't seeking to kind of fill the gaps, and now they have to look busy because they've finished something that you know. They were given eight hours to do. They finished it in five, let's say. Now they've got three hours to look busy. Gosh, it's interesting. It's not quite what we're talking about today, but it's related.

Dr Amanda Potter:

That's so interesting. I'm going to go out and ask all our team are you task masking? Could you imagine They've got these amazing lists of actions? Yeah, I don't think they've got time.

Angela Malik:

No, I don't Honestly in our company. I really doubt it.

Dr Amanda Potter:

No, me too. There's so much that we should be doing and could be doing. So there's also this concept of absenteeism you hear a lot about that in the context of mental health awareness by employers where, of course, presenteeism is about being physically present but not engaged or productive, and it's usually due to health issues.

Angela Malik:

So you say that absenteeism is tracked, but what about presenteeism?

Dr Amanda Potter:

It's, of course, much easier to track absenteeism than presenteeism. Therefore, I don't really have any examples. It appears that most of our evidence is anecdotal. It's about what clients talk about when it impacts culture, the environment and behavior. How big of a problem is this? But if you look at the published literature statistics from two authors called Lohaus and Haberman in 2019, so six years ago they said that in any organization it can be between 30 to 90% of the workforce at some point have actively engaged in presenteeism. That's a really massive range, I know. And down to stress and pressure is the argument from them.

Angela Malik:

So this has to be costing businesses quite a lot in the long run, especially if they're an organization that's currently experiencing 90% presenteeism.

Dr Amanda Potter:

Absolutely so. If we take the US, the published number is about $150 billion a year and in the UK it's 100 billion. When you think about the size of the US economy versus the size of our economy, relatively it's a big difference. The impact in the UK, statistically, is much greater.

Angela Malik:

Apparently Is presenteeism a global issue. Does it happen around the world? Are there differences?

Dr Amanda Potter:

There are differences. So if you think about each society, they each have a different challenge. For example, in Japan, which has an aging society, there are health implications of presenteeism when people are moving towards their end of career, but the desire to be seen to still be relevant and still be important, the motivation for that is still very high and therefore it may result in presenteeism.

Angela Malik:

So with that example, it seems quite clear to me that it's work culture that plays a huge role here. What are the risk factors for presenteeism?

Dr Amanda Potter:

So it has a really toxic impact on the environment or the culture or climate, because we talk about climate with psych safety, it means that there is a blurring between the personal life and the home life. It can result in that overwork and burnout. It can result in a strain on personal relationships at work because we get irritable and impatient, and of course, there's a productivity impact as well in terms of errors, quality and all of those things too. And that's why, of course, we need psych safety, because we need to be able to say to somebody are you well enough to be in the office?

Angela Malik:

but I suppose if the climate in the office is one of there's too much work or there's not enough people to do the work and there's a fear of letting people down or of even being let go if you take too much time, that's got to play a role definitely and and I can see that I do remember the first time I showed up when I shouldn't was working for Dr Rob Irving, who was the leader at Whitehead man, who's now been bought by Corn Ferry.

Dr Amanda Potter:

It was one of my first ever jobs and I turned up with a shocking cold flu type thing. He said to me what are you doing here? I don't want you in the building when you're that poorly. A you're going to share it and B you're not going to be able to focus and concentrate. And he sent me home and I dragged myself into central London because I did not want to let him down and he immediately said get out of here. So I was completely wrong. Actually, I needed to just ring. I didn't want to let somebody down. I didn't want them to think that I was flaky or not reliable.

Angela Malik:

I can understand that. I think that a lot of people probably do show up when they shouldn't because they don't want to let people down. Yeah absolutely. In the context of remote or hybrid or in-office work, does it make a difference for presenteeism?

Dr Amanda Potter:

Well, what would you expect, Angela?

Angela Malik:

I would expect it's a lot harder to practice presenteeism if you're in person. You'd have to really work hard to kind of look busy. So my suspicion is that remote has a higher rate.

Dr Amanda Potter:

Well, I think it's down to motivation. Actually, Remote has a higher rate. Yes, because we can kind of be logged on, so it's easier to have presenteeism through just logging on to your system and so you can stay logged on for longer hours and so on. So that's second type of presenteeism. But actually it's the motivation that we don't want to be forgotten. We want to be seen as valuable, important, necessary. So therefore people more likely when they're remote to engage in presenteeism.

Angela Malik:

As a CEO, Amanda, would you say presenteeism is a concern for you as a leader. I hope not.

Dr Amanda Potter:

I know that we're pretty good in terms of how we support people when they're poorly. We encourage them to take time and to step away from their deaths. If they're struggling, they've got a headache or something. So I don't think so, but you can tell me, Angela, you're one of the team.

Angela Malik:

I mean I don't know, because we're remote, I don't know what my colleagues are doing, trapping them.

Dr Amanda Potter:

Yeah, no, I don't believe so. I wonder if it's something that you hear a lot from clients. Are they concerned about presenteeism? A few of them but it made me think of Simon Rogerson, the founder of Octopus Group, who said on episode 64 that for him, he believes that presenteeism is a disaster. What do you think is a disaster about presenteeism, Angela?

Angela Malik:

Hmm, I mean. For me, it's the fact that it's hard to track, it's hard to measure, and if you can't measure something that's potentially that damaging to the business, then it can easily become a huge challenge for the organization. You have to identify the problem first before you can address solutions.

Dr Amanda Potter:

I completely agree. Given that we've said that the performance can go down, errors can go up, quality can go down and it's also not great for the long-term health of employees, I think this actually is quite an important area.

Angela Malik:

So we'd be remiss if we didn't talk about the neuroscience.

Dr Amanda Potter:

I think that's the real reason for this podcast actually is the neuroscience.

Angela Malik:

I think so.

Dr Amanda Potter:

It's so interesting and I can't wait for us to share it with the listeners what happens in the brain during presenteeism. So if we show up to work when we're unwell whether we're battling a cold or if we've got burnout or we're in pain, so you might have muscular or chronic pain or we're suffering from anxiety or depression we are operating at a reduced capacity because we're asking the brain to function in an internal state of conflict and, neuroscientifically speaking, that comes at a cost. What is the cost? The brain doesn't just simply receive a pain signal. It actually constructs the pain experience and this happens primarily in the anterior cingulate cortex, the ACC, the insula and the somatosensory cortex.

Angela Malik:

So when you're physically unwell, particularly in pain, I used to get hip pain, since before I lost weight I definitely got a hip pain. It's made a big difference losing all the pounds I lost. When I was feeling like that, my brain was diverting resources to monitor and manage the sensation of pain. So in other words, all of my cognition reserves were being spent trying to kind of focus on that pain before I even got to open my laptop and start working. So then, by the time you do get to work, you've already spent loads of cognitive resources. What are the implications for that in terms of our performance at work?

Dr Amanda Potter:

So pain increases our mental fatigue, even low level persistent discomfort like a headache, or it might be that you've got a stomach ache or my hip ache those small irritants can actually reduce our ability to concentrate and it can increase our irritability as well. And that's because our brain is running these multiple processes in the background constantly.

Angela Malik:

Just having to filter it out all the time to do our work Exactly. We talk about burnout and chronic stress quite a lot on the podcast. Does the brain process these in the same way as the pain experience?

Dr Amanda Potter:

So when you're working through depression or anxiety or stress, there's a number of key areas in the brain that are impacted and we talk about them a lot on this pod.

Angela Malik:

So the first is the prefrontal cortex, which is responsible for decision making, and when we're stressed our focus becomes underactive, so we are less able to concentrate and focus on problems. The amygdala, which is our emotion threat detector, emotion center, becomes overactive and means that we're reactive to situations, we're sensitive to criticism, we're prone to procrastination, overthinking and hyper focus. Then there's the default mode network, which we talk about a lot in a good way, because it helps us with creativity. We activate the default mode network when we're relaxed and walking or showering and so on, but actually that mind wandering can actually get noisier, so it actually comes in and through to a greater extent and we start catastrophizing when it becomes noisier, meaning it's harder to stay present and stay engaged. So essentially, the brain is spending so much energy just coping, just being present, that there's very little left for those higher order functions, that cognitive thinking like problem solving or strategic thinking, or creativity and innovation. Each of those things require a high level of energy and there's just not any energy left. It's interesting that you say the prefrontal cortex is affected, which makes focus underactive, but then, because the amygdala is activated, then we're prone to hyperfocus. But I suppose it has to do with intrusive hyperfocus. Right, you're focusing on the threats and not on the work that you need to complete. Very true, this is already quite an argument for prioritizing work-life balance and ensuring that we take the rest when you need to complete. Very true, this is already quite an argument for prioritizing work-life balance and ensuring that we take the rest when we need it.

Dr Amanda Potter:

I completely agree. Even with a mild illness like a headache or a stomachache, we pay a cognitive price. So low-grade inflammation from viral infections can impair memory, reduce motivation, affect our mood, increase irritability, as I've mentioned.

Angela Malik:

And what happens if we don't take the rest that we need?

Dr Amanda Potter:

So if we're not giving ourselves the time to reset, this results in a chronic flood of cortisol and that continual state of cortisol can disrupt our sleep, because of course we know that melatonin and cortisol don't coexist in the brain and when we wake up we have more cortisol and that dissipates during the day and then our melatonin increases, it impairs our memory and it reduces our learning. So our neuroplasticity, which is our learning, in other words, we just need to rest and recover.

Angela Malik:

Ever wonder what's really driving your team's success or holding it back? With BeTALENT's psychometric tools, you'll get evidence-based insights that transform potential into action. Ready to see what your team is truly capable of? Visit thecpocouk to learn more about our BTalent Resilience Questionnaire and our other tools. If you'd like to take the conversation further, contact me on LinkedIn. That's Angela Malik M-A-L-I-K. Contact me on LinkedIn. That's Angela Malik M-A-L-I-K. So is it just a fear of being seen as unreliable or letting others down that keeps us showing up, even though we're not performing at our best?

Dr Amanda Potter:

If it was that simple, that would be great. But actually it's the fact that we're all of us are deeply social as humans and we have real need to be liked and to be part of something that's important and our brains are therefore wired to avoid any form of social rejection or judgment because we feel it like a physical pain. So the interior king gillip cortex, which processes social pain, it lights up in the same way as it does when we're physically hurt. So we want to avoid that pain, avoid that hurt. So we show up, so that we feel included, so we feel part of something that's important. That's really interesting.

Angela Malik:

There must also be something happening in the brain, though, that keeps us going back to work, even though the impact is so negative. Does the neuroscience support that For some?

Dr Amanda Potter:

wrong emphasis. What I think we need to consider is the role of dopamine, because dopamine is the motivation and reward transmitter. So when we go to work, even though we're sick or poorly, or if we continue working beyond our hours, if we achieve something in that time, it triggers a dopamine reward response. So, checking off a task appearing dedicated, receiving praise, persevering through illness, and someone acknowledging how hard you've worked or how much you've delivered despite being sick or poorly, those little neurochemical dopamine rewards reinforce behavior and teach us, through neuroplasticity and learning, to do it again. And we create habits not good habits, but we create habits and that's ultimately unsustainable because it has such a negative impact on our long-term health. But our short-term reward system is telling us to keep going.

Angela Malik:

What came to mind as you were talking about that, amanda, is the fact that Kishaya, who did the neuroscience research for this episode even brilliant work recently sort of worked through an illness to get some work done for us, for Candice and me and it was great She'd done it so well and we were really impressed that she'd done it despite feeling unwell, and just whacked that right out of the ballpark for us and then publicly praised her for that. And now I'm wondering. I'm wondering if maybe that was a misstep, because, yes, we were very happy with the work that she'd done and we were so grateful for everything that she does at Be Talent. But should we have been rewarding pushing through the pain?

Dr Amanda Potter:

No, according to this research, we shouldn't. In fact, we start doing it right from school. How many of us are parents who listen to this podcast and other podcasts, who question our children when they show up at the breakfast table feeling poorly and questioning whether they truly are poorly, and then send them to school sick because we've got to go to work and we've got so many other commitments? And if we do that, what we think about it, we're socializing our children to view presenteeism as an achievement, to show up at school even though you're sick.

Angela Malik:

I think that's a really interesting point yeah, and it sounds like the same thing as managers in the workplace role modeling, poor work-life balance and essentially teaching the team to show up even when they shouldn't. Yeah, and.

Dr Amanda Potter:

I think we're getting better at that, sarah and I, taking rest when we need it. Both of us are in our fifts and find that working long hours, early mornings, traveling it takes it out of you. Actually, I personally, when I go and do a big client event one day, I do find I'm exhausted even the next day. If I've been on stage all day, I do find the next day I do need to look after myself. I need to get outside, I need some fresh air, I need to get out with the dog, I need exercise, need to reset, recharge yeah, rest and recharge Physical activity, but still recharging.

Angela Malik:

So how does all of this affect our brain in the long term?

Dr Amanda Potter:

So this is where I think it gets pretty serious and scary actually, because presenteeism doesn't just reduce productivity in the moment. It actually has a physical impact on our brains and our function. So we're talking about measurable long-term impacts on cognitive performance, on emotional regulation because of the amygdala, and even our mental health and our resilience. So, whilst it feels like it's a good thing to do in the short term to be present, particularly if you're doing it every day, the example with Koshyar to do that one piece of work, I hope, isn't typical of normal ways of performing. For kashaya, hopefully it was just a one-off, but we should check that because actually we're talking about consistency is the consistent presenteeism that's the issue and that's because of the hippocampus, which is the brain's memory center, that's a key to learning and consolidating information, and under that prolonged stress which underlies presenteeism, the hippocampus can start to shrink.

Angela Malik:

And then, as a result, really, you've got forgetfulness, trouble learning new skills, difficulty recalling details, yeah, and difficulty acquiring and retaining new information.

Dr Amanda Potter:

So if we go back to the prefrontal cortex, which is our CEO of the brain, that governs our focus, our impulse control from the amygdala looks after planning, decision making, and all of that becomes less efficient. So our memory goes and our ability to problem solve goes, and all of that's down to neural connectivity. Because that weakens, our judgment starts to get reduced, our ability to concentrate reduces, we're slower with our thinking.

Angela Malik:

I definitely see that in myself when I'm tired and our reaction times are slower, but also my impulsivity, my emotion reactions are quicker. So this baseline of cognitive function, you know, we might start thinking gosh, I'm getting really old. I hear myself say that getting really old, it's not that I'm God, I'm getting really old, it's not that I'm just trying too hard, I'm pushing myself too much. I see what you mean about it being a bit scary, because our brains are so important to what we do and who we are. And, yeah, I feel like I want to monitor that in myself a little bit more as well.

Dr Amanda Potter:

I've got much better. I used to, as Sarah would know, and before we really truly established Be Talent. So I am talking 15 years ago and I've mentioned this on the pod that when my son was young my ex-husband, who's a brilliant dad he and Ben would spend Saturday mornings together because Chris used to work away from home a lot and so that was their morning, and so they would go off and do fabulous things and always had something planned, something adventurous and exciting, and I would sit at home working on a Saturday morning. It's interesting actually now, on reflection, talking about it on the pod, I created the habit because of the PhD, because I didn't stop studying until my 30s, because I went straight from undergraduate to postgraduate, to PhD, so I was used to giving up my Saturday mornings to study and then I just continued with Be Talent. I just worked every Saturday morning, continuing to focus from 6am to 12 noon, just getting as much work as I could done.

Angela Malik:

But the impact actually is on our long-term cognitive ability. I over-committed actually to the business for years and years. I'm way better now. I really value my personal time and if I think about it, I mean I'm so much happier now with the balance and if I think about the neuroscience of it, when we give ourselves the space to recover, what we're doing is we're giving our brain the ability to adapt, because otherwise our neuroplasticity is hindered, which is all about our neural connections and learning. So if we rest and recover, we're able to form new connections, we're able to rewire our brains, we're able to learn, we're able to change. So if we don't, then presenteeism can quietly chip away our creativity, our flexibility, our learning, our innovation, ultimately, our intellect but I'm hoping, though, that you'll say that because of neuroplasticity, we can actually reverse the causes. So if someone has sort of engaged in long-term presenteeism and does actually just need to take a good long break and recover that they haven't done permanent damage no, I mean, the brain is plastic, isn't it?

Dr Amanda Potter:

that's what's so brilliant about it neuroplasticity. It's all about our learning capacity. Yes, we can absolutely do that and we know through all of the research that where the energy goes, where the attention goes, the energy flows. Thank you to Dr Ian. I nearly said it wrong, but that's his, isn't it? Okay, of course, when we start re-changing our energy and our focus, we start changing the rewiring. That sounds very positive.

Angela Malik:

I'm pleased to hear it. So how can an organization overcome presenteeism?

Dr Amanda Potter:

So how can an organization overcome presenteeism, to try and stamp this out, because of the physical impact, cognitive impact for individuals and because of the risks of mistakes and quality being reduced and also just the toxic culture it creates. So psych safety is going to be absolutely key. So encouraging people to speak up if there's an issue, to take time off when they need it that's the absolute first one. So psychological safety is one of the answers, and also the absolute first one. So psychological safety is one of the answers. And also educating people around resilience. So training managers to look out for signals of stress and presenteeism and training them on resilience.

Angela Malik:

Now, of course, they're two topics that we focus on a lot in our business and we roll out a lot of workshops and we have our products that cover both of those areas. The next one for us really it's about policies and process, so making sure they've got the right policies sick day policies, flexible working policies and that they've got the right processes around mental health support and training. So for me, there's kind of three buckets. I suppose it's the processes and infrastructure support, it's resilience and it's site safety. And I suppose, as part of that, it's all good having a policy, but because presenteeism is so difficult to track and often it'll be the individual who knows whether or not they're engaging in that, as opposed to the organization, it must be quite important, then, to make sure that the workforce is actually educated on what those policies are and aware that they can use the sick days. That's what they're there for, that's what the policy is created for.

Dr Amanda Potter:

Absolutely, and I wonder the difference between organizations whether sick days feel like they are real in some organizations versus others. Can they really take them? Yeah?

Angela Malik:

absolutely Depends on the culture. I guess that's the culture of the organization and I guess how line managers are kind of operating around requests for time off.

Dr Amanda Potter:

It would really vary line manager to line manager, I'm sure.

Angela Malik:

So, amanda, as we come to the end of this episode, do you have any final thoughts on presenteeism?

Dr Amanda Potter:

I suppose my final thought was wow, the neuroscience bit was amazing, really understanding, just recognizing that the decisions that we make have such a significant impact on us and our thinking capacity and our cognitive ability. So back to healthy habits, which I know I bang on about and I talk to all clients about is so important. But how can we get those healthy habits embedded into organizations and into our workday? It comes down to our leaders. Our leaders are responsible to be role models. So, as a leader, I should be a role model. I need to take breaks, I need to encourage my team to take breaks and we need to encourage everybody to separate home and work, particularly if they're remote or hybrid, and not show up when they're sick.

Angela Malik:

Thank you, Amanda. It's been a really fascinating conversation. I loved the neuroscience in this episode and, of course, I'm reminded once again of the key role I know we talk about all the time of psychological safety and of resilience in the workplace and how that influences employee well-being as well as high performance. Presenteeism seems to impact and be impacted by both of these things, so it's great to know that there are ways to overcome presenteeism and build a happy, healthy workplace culture. In the meantime, To our listeners, if you're left with any burning questions on presenteeism, get in touch with us at hello at betalentcom or connect with us on LinkedIn to continue the conversation there. Thank you so much.

Dr Amanda Potter:

Amanda. Thank you, angela, and thank you everyone for listening. I hope you have a wonderful and successful day.

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