Introduction: Occupational Stress and Its Management.

In this introduction to the special issue, the current key issues in the area of occupational stress and its management are summarized. These include the link between stress and ill health, job stressors and strain outcomes, work-life balance and individual worker characteristics and the experience of occupational stress. The editors argue that the concept of occupational stress and its corollary, coping, may not be useful concepts for moving forward and that the implicit adoption of a psychomedical model for understanding workers' reactions to work demands has hindered progress in this field. Finally, there is a lack of good research on stress management interventions, but on the basis of current evidence, it is concluded that there are few benefits to workplaces implementing many such programs. It is speculated that the concept of occupational stress has had its day and that a return to a focus on occupational stressors and worker fatigue, where the field originated, might be more productive. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediators of change in emotion-focused and problem-focused worksite stress management interventions.

Ninety volunteers in a media organization were randomly allocated to an Acceptance and Commitment Therapy (ACT, n?=?30) group that sought to enhance people's ability to cope with work-related strain, an Innovation Promotion Program (IPP, n?=?30) that helped individuals to identify and then innovatively change causes of occupational strain, or a waitlist control group (n?=?30). Both interventions lasted 9 hr, spread over 3 months. Improvements in mental health and work-related variables were found following both interventions. As hypothesized, changes in outcome variables in the ACT condition were mediated only by the acceptance of undesirable thoughts and feelings. In the IPP condition, outcome change was mediated only by attempts to modify stressors. Discussion focused on the importance of understanding the mechanisms underpinning change in occupational stress management interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occupational role stress in the Canadian forces: Its association with individual and organizational well-being.

Studies on workplace stress have been conducted in various occupational environments. However, published reports exploring occupational stress in the military are rare. This study examines occupational stress in the Canadian Forces within the framework of social role theory and its relation to employee health, job satisfaction, and organizational commitment. Ss were 1,068 Regular Forces military members who completed a survey questionnaire. Of interest were the psychological resources (e.g., individual coping skills, workplace leadership, and perceived organizational support) that have the potential to alter the perception of work stress and/or alleviate its association with individual and organizational outcomes. Regression analyses indicated a negative association between occupational role stress and both individual (strain) and organizational (job satisfaction and organizational commitment) well-being. No moderating effects were found for coping strategies, workplace leadership, or perceived organizational support, although these factors had direct relationships with both individual and organizational well-being The results are discussed in terms of the potential of organizational resources and role stress to cascade across organizational levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effort-reward imbalance and overcommitment: Predicting strain in academic employees in the United Kingdom.

The Effort-Reward Imbalance (ERI) model of job stress has gained support in predicting strain, mainly in heterogeneous groups of employees. This study tests several hypotheses relating to the ERI model in a homogenous occupational group: academic employees working in universities in the United Kingdom. Based on previous research findings, it is argued that this model is likely to reflect current working conditions and concerns in this sector. Eight hundred forty-four academic employees (59% male) completed questionnaires assessing the ERI components (i.e., efforts, rewards, and overcommitment), psychological and physical symptoms, job satisfaction and leaving intentions. Significant main effects of high efforts, low rewards, and high overcommitment were found for all strain outcomes. Some evidence was found for the hypothesized two-way and three-way interactions. The pattern and strength of the predictors of strain varied considerably, with the models accounting for between 14% and 43% variance in strain outcomes. The validity of the ERI model as a predictor of a broad range of strain outcomes in academic employees in the United Kingdom has been confirmed. How the findings might be used to inform interventions to increase well-being in academic employees is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Job stress in the Australian and international health and community services sector: A review of the literature.

We reviewed 25 international and 10 Australian studies published between 1999 and 2004 for evidence of individual and organizational impacts of stress in the health and community services (HCS) sector. Several HCS occupations showed high levels of distress compared to Australian population data. Results were consistent with the Job Demands-Resources model: High demands (e.g., workload, emotional) combined with low resources (e.g., control, rewards, support) were associated with adverse health (e.g., psychological, physical) and organizational impacts (e.g., reduced job satisfaction, sickness absence). Australian-specific issues included rural and remote work and the complex role of Aboriginal Health Workers. Strong associations between modifiable work factors and adverse outcomes provide a rationale for primary preventive policy development by occupational health and safety regulators and workers' compensation authorities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress prevention in bus drivers: Evaluation of 13 natural experiments.

The research aim was to select, compare, and analyze interventions and preventive actions from international bus companies to decrease bus drivers' occupational stress and sickness absenteeism. Through networking, international surveys, and literature study, 13 "natural experiments" were identified with an acceptable research design rating. Interventions were both work and person directed. Principles of worker participation were often followed. The variety in intervention programs, outcome measures, case evaluations, and methodological flaws makes it difficult to present a general picture of program effectiveness. However, analyses on more objective and more subjective outcomes do point at positive effects. This study suggests that stress prevention that combines adequate interventions and proper implementation may be beneficial to both the employee and the company. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Work organization research at the National Institute for Occupational Safety and Health.

For 25 years, the National Institute for Occupational Safety and Health (NIOSH) has conducted and sponsored laboratory, field, and epidemiological studies that have helped define the role of work organization factors in occupational safety and health. Research has focused on the health effects of specific job conditions, occupational stressors in specific occupations, occupational differences in the incidence of stressors and stress-related disorders, and intervention strategies. NIOSH and the American Psychological Association have formalized the concept of occupational health psychology and developed a postdoctoral training program. The National Occupational Research Agenda recognizes organization of work as one of 21 national occupational safety and health research priority areas. Future research should focus on industries, occupations, and populations at special risk; the impact of work organization on overall health; the identification of healthy organization characteristics; and the development of intervention strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical management of carpal tunnel syndrome: a 12-year review of outcomes

Carpal tunnel syndrome (CTS) is a disorder frequently encountered by occupational health care specialists. The health care management of this disorder has involved a diverse set of clinical procedures. The present article is a review of the literature related to CTS with an emphasis on occupational-related CTS. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycLIT, and NIOSHTIC databases from 1985-1997 were searched for treatment outcome studies related to CTS. Treatments of interest included surgery, physical therapy, drug therapy, chiropractic treatment, biobehavioral interventions, and occupational rehabilitation. A systematic review of the effects of these interventions on symptoms, medical status, function, return to work, psychological well-being, and patient satisfaction was completed. Compared to other treatments, the majority of studies assessed the effects of surgical interventions. Endoscopic release was associated with higher levels of physical functioning and fewer days to return to work when compared to open release. Limited evidence indicated: 1) steroid injections and oral use of B6 were associated with pain reduction; 2) in comparison to splinting, range of motion exercises appeared to be associated with less pain and fewer days to return to work; 3) cognitive behavior therapy yielded reductions in pain, anxiety, and depression; and, 4) multidisciplinary occupational rehabilitation was associated with a higher percentage of chronic cases returning to work than usual care. Workers' compensation status was associated with increased time to return to work following surgery. Conclusions are preliminary due to the small number of well-controlled studies, variability in duration of symptoms and disability, and the broad range of reported outcome measures. While there are several opinions regarding effective treatment, there is very little scientific support for the range of options currently used in practice. Despite the emerging evidence of the multivariate nature of CTS, the majority of outcome studies have focused on single interventions directed at individual etiological factors or symptoms and functional limitations secondary to CTS.     

Stress Management Interventions in the Dutch Domiciliary Care Sector: Findings From 81 Organizations.

This study evaluated the effectiveness of a large-scale job stress reduction program implemented in the Dutch domiciliary care sector. The employees of 81 organizations were interviewed twice (only nurses in executive jobs; total sample size exceeded 26,000). Organizations that implemented many interventions were expected to be more successful in reducing job stress than were other organizations. It was found that (a) levels of job stress decreased during the observed interval; (b) organizations with many suboptimal scores on selected work characteristics took, on average, more measures to reduce job stress than others; (c) organizations usually implemented a wide variety of measures; and (d) work-directed (but not other) interventions were linked to job stress reduction. The effects of these interventions, however, were weak. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reasons for clinical research: Characteristics of contributors and their contributions to the Journal of Consulting and Clinical Psychology.

A representative sample of contributors (333) to the Journal of Consulting and Clinical Psychology was asked to report on their motivations for conducting studies that had been published in that journal. Results indicate that the primary motivation of these clinical researchers was to build on prior theory and research through the gathering and analysis of new data to answer socially significant applied-clinical questions. More immediate pragmatic considerations (e.g., tenure, funding, degree or job requirements, and availability of Ss) were reported to be of secondary, but nevertheless significant, importance. Most respondents described the training model in which they had received their doctoral education or oriented toward an integrated scientist-practitioner approach rather than one that focused primarily on research, therapy, or assessment training. It was also found that these clinical researchers rarely conducted investigations in the context of community service or consultation interventions or in order to replicate past research. Results are discussed in light of current controversies in clinical psychology concerning the optimal model for training and the relevance of clinical research. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biobehavioral outcomes following psychological interventions for cancer patients.

Psychological interventions for adult cancer patients have primarily focused on reducing stress and enhancing quality of life. However, there has been expanded focus on biobehavioral outcomes--health behaviors, compliance, biologic responses, and disease outcomes--consistent with the Biobehavioral Model of cancer stress and disease course. The author reviewed this expanded focus in quasiexperimental and experimental studies of psychological interventions, provided methodologic detail, summarized findings, and highlighted novel contributions. A final section discussed methodologic issues, research directions, and challenges for the coming decade. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of occupational stress management intervention programs: A meta-analysis.

A meta-analysis was conducted to determine the effectiveness of stress management interventions in occupational settings. Thirty-six experimental studies were included, representing 55 interventions. Total sample size was 2,847. Of the participants, 59% were female, mean age was 35.4, and average length of intervention was 7.4 weeks. The overall weighted effect size (Cohen's d) for all studies was 0.526 (95% confidence interval = 0.364, 0.687), a significant medium to large effect. Interventions were coded as cognitive-behavioral, relaxation, organizational, multimodal, or alternative. Analyses based on these subgroups suggested that intervention type played a moderating role. Cognitive-behavioral programs consistently produced larger effects than other types of interventions, but if additional treatment components were added the effect was reduced. Within the sample of studies, relaxation interventions were most frequently used, and organizational interventions continued to be scarce. Effects were based mainly on psychological outcome variables, as opposed to physiological or organizational measures. The examination of additional moderators such as treatment length, outcome variable, and occupation did not reveal significant variations in effect size by intervention type. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Environmental and policy interventions to promote physical activity

BACKGROUND: Because most adults in industrialized countries do not meet physical activity guidelines, population-wide interventions are needed. Environmental and policy interventions are based on ecological models of behavior and have the potential to influence entire populations. Ecological models are particularly applicable to physical activity because the behavior must be done in specific physical settings. Cross-sectional data indicate that environmental and policy variables are associated with physical activity behaviors of young people and adults. METHOD: Seven published evaluations of environmental and policy interventions to increase physical activity were reviewed. RESULTS: Two studies showed that placing signs encouraging stair use can be effective. Quasi-experimental evaluations provided limited evidence that broad environmental changes can be effective. Large-scale policy interventions are currently being conducted in several countries. PROPOSED MODEL: A model describing the development of policy and environmental interventions is proposed, in the hope of stimulating more research in this area. Advocacy or planning groups identify and work with agencies that control policies and environments that can be altered to increase physical activity. Educational and policy/environmental interventions are seen as complementary. CONCLUSION: Lack of conceptual models and the inherent difficulties of evaluation have hampered research on environmental and policy interventions. Further research is needed, and practitioners and researchers should work together to evaluate programs.     

The effectiveness and practicality of occupational stress management interventions: A survey of subject matter expert opinions.

96 stress management subject matter experts (SMEs) (aged 27–67 yrs) evaluated 6 widely used occupational SM interventions (relaxation, physical fitness, cognitive restructuring, meditation, assertiveness training, and stress inoculation) on the basis of 10 practicality criteria and 7 effectiveness objectives. Relaxation was evaluated overall as the most practical intervention, while meditation and stress inoculation were judged as the least practical. Physical fitness was chosen to be the most effective intervention, while both meditation and assertiveness training were rated overall as the least effective. The findings also revealed that the SMEs considered history of success and duration of effect, rather than "relevance to program objectives," as the most important factors when selecting stress management interventions. Incongruence between effectiveness ratings and actual choices of interventions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of autocorrelation on the results of visually analyzing data from single-subject designs

OBJECTIVE: Single-subject research designs are used to conduct clinical research and outcome evaluation in occupational therapy. Confusion exists regarding the best method to analyze and interpret single-subject data. METHOD: One hundred graphs displaying the results of published single-subject research were examined to determine the influence of autocorrelation on the visual inferences made by the original investigators. The graphs were selected from 20 articles published over 10 years in seven rehabilitation journals. The data were extrapolated and lag 1 autocorrelation coefficients computed for both the baseline and treatment phases. RESULTS: Data analysis focused on two issues: (a) whether a relationship existed between the amount of autocorrelation present in a graph and the conclusion on the basis of visual analysis and (b) whether the amount of autocorrelation varied across different phases of the single-subject graphs. When a significant degree of autocorrelation was present, researchers using visual analysis were more likely to conclude that there was no clinically significant change in performance. Autocorrelation values were significantly higher in the treatment phases of the single-subject designs. CONCLUSION: Additional research is needed to establish a set of decision rules to assist clinicians in using visual analysis to evaluate the results of single-subject research.     

Individual and group cognitive-behavioral treatment for work-related stress complaints and sickness absence: A randomized controlled trial.

Work-related stress is widespread and can lead to long-term absenteeism and work disability. Cognitive-behavioral treatment (CBT) has demonstrated effectiveness in treating psychopathology but has only rarely been tested in clinical samples with work-related stress. A randomized controlled trial was conducted to investigate the efficacy of CBT-based stress management training (SMT). Eighty-two patients on sickness leave with work-related stress were randomly assigned to (a) individual SMT, (b) group SMT, or (c) care as usual (CAU). The SMT comprised 12 sessions conducted by a psychologist. Complaints of burnout and distress were measured at baseline, and at 4, 7, and 10 months. Absenteeism was measured during the whole research period. Across treatment conditions, complaints and sickness absence reduced considerably between baseline and 4 months. Thereafter, complaints remained approximately stable, whereas sickness absence further reduced. Hardly any significant group difference emerged, and no consistent pattern could be discerned in favor of any treatment condition. In subgroups with low depressive complaints, though, individual SMT resulted in larger reductions of some complaints than CAU. In conclusion, this study adds to the evidence that CBT-based interventions as currently practiced are not successful in treating patients with clinical levels of work-related stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized clinical trial of alternative stress management interventions in persons with HIV infection.

Research in psychoneuroimmunology suggests that immunosuppression associated with perceived stress may contribute to disease progression in persons with HIV infection. While stress management interventions may enhance immune function, few alternative approaches have yet been tested. This randomized clinical trial was conducted to test effects of three 10-week stress management approaches--cognitive-behavioral relaxation training (RLXN), focused tai chi training (TCHI), and spiritual growth groups (SPRT)--in comparison to a wait-listed control group (CTRL) among 252 individuals with HIV infection. Using repeated measures mixed modeling, the authors found that in comparison to the CTRL group, (a) both the RLXN and TCHI groups used less emotion-focused coping, and (b) all treatment groups had augmented lymphocyte proliferative function. Despite modest effects of the interventions on psychosocial functioning, robust findings of improved immune function have important clinical implications, particularly for persons with immune-mediated illnesses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occupational stress, safety, and health: conceptual framework and principles for effective prevention interventions

The authors present an overarching conceptual model of occupational stress, safety, and health, incorporating multiple factors from diverse disciplines. They examine specific implications of the model for the development of prevention interventions (e.g., context-specific interventions and primary, secondary, and tertiary prevention). They review prevention interventions and describe and analyze 4 case studies that address exposure to environmental, ergonomic, and psychosocial stressors and a combination of physical-environmental and psychosocial stressors. The authors examine lessons learned from these interventions in light of the conceptual model (e.g., role of top management and integrating research and intervention).     

Influence of health locus of control and parental health perceptions on follow-through with school nurse referral

This paper reviews articles published during 1970-1997 from 48 epidemiologic studies on occupational and environmental risk factors of ovarian cancer. Current evidence is characterized by poorly focused data for occupational and environmental agents, vulnerability to biases, and an almost complete lack of quantitative exposure-response data. The moderate amount of data on nurses, teachers, professionals, dry cleaning employees, women in agriculture, the pharmaceutical industry, pharmacists, waitresses, and cooks show very little, if any, evidence of excess risk. Hairdressers, beauticians, and women employed in the printing industry may be at increased risk, but the data are insufficient for strong conclusions. Some case-referent studies suggest a modest-to-moderate excess in association with genital talc application. Few high-quality studies have been carried out, and no chemical agents have been studied extensively, with the exception of exposure to talc. Ovarian cancer may have occupational and environmental etiologies intertwined with cultural, behavioral, and life-style factors and genetic susceptibility, but current knowledge is insufficient to quantify occupational and environmental etiologies reliably. Well-designed analytic epidemiologic studies with sufficient power are needed.     

Stress treatment: Two aspirins, fluids, and one more workshop.

Early stress research focused on the physiology of the stress response and its relation to health and disease. Recently, there has been widespread application of stress management programs (SMPs) aimed at reducing an individual's stress. We describe and summarize the methods and results of 62 published reports on SMPs from numerous fields. Programs crossed all levels of prevention and most often took place in university, medical, or worksite settings. A meta-analysis of the quantitative results of a sample of these studies yielded mildly encouraging results. However, serious methodological and theoretical issues must be addressed with future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)