Stress Management in Work Settings: A Critical Review of the Health Effects
Originally published here: http://journals.sagepub.com/doi/abs/10.4278/0890-1171-11.2.112
First Published November 1, 1996 Research Article
Abstract
Purpose.
To review critically the research literature on the health effects of worksite stress-management interventions.
Search Methods.
Stress-management interventions were defined as techniques that are designed to help employees modify their appraisal of stressful situations or deal more effectively with the symptoms of stress. Stress-management studies that were worksite based, assessed a health outcome, and were published in the peer-reviewed literature were included in this review. The main search method was the one described in the lead article to this special issue of the JOURNAL, but supplementary sources included prior reviews of the research literature and expert contacts. Sixty-four studies met the criteria for inclusion in this review.
Summary of Findings.
A variety of stress-management techniques was used in worksite studies, including muscle relaxation, meditation, biofeedback, cognitive-behavioral skills, and combinations of these techniques. The most common techniques used were muscle relaxation, cognitive-behavioral skills, and combinations of two or more techniques. Outcome measures to evaluate the success of stress interventions included physiologic and psychologic measurements, somatic complaints, and job-related measures. Nearly three-fourths of the studies offered the training to all workers and did not specifically recruit high-stress employees. Over half the studies were randomized control trials, but only 30 % conducted posttraining follow-up evaluations. The effectiveness of stress interventions varied according to the health-outcome measure used; some techniques were more effective for psychologic outcomes (e.g., cognitive-behavioral skills), whereas others were more effective for physiologic outcomes (e.g., muscle relaxation). Biofeedback was the least frequent technique used in work settings and also seemed to be the least effective technique. Meditation produced the most consistent results across outcome measures but was used in only six studies. In general, studies using a combination of techniques (e.g., muscle relaxation plus cognitive-behavioral skills) seemed to be more effective across outcome measures than single techniques.
Conclusions.
The large number of different stress-management techniques coupled with the wide range of health outcome measures used in stress intervention studies makes it difficult to draw firm conclusions about the efficacy of each technique and each outcome. Also, the quality of the methodology varied substantially among studies. Nevertheless, the most positive results across the various health outcomes were obtained with a combination of two or more techniques. None of the stress interventions was consistently effective in producing effects on job/organization-relevant outcomes, such as absenteeism or job satisfaction. To produce changes on these types of measures, stress interventions will need to alter or modify the sources of stress in the work environment. It can be said that stress management in work settings can be effective in enhancing worker physical and psychologic health, but the choice of which stress-management technique to use should be based on the specific health outcomes that are targeted for change.
References
| 1. | Shilling S, Brackbill RM. Occupational health and safety risks and potential health consequences perceived by US workers. Public Health Rep 1987;102:36–46. Google Scholar Medline |
| 2. | Employee burnout: America’s newest epidemic. Minneapolis, Minnesota: Northwestern National Life Insurance Company, 1991. Google Scholar |
| 3. | Warshaw LJ. Stress, anxiety and depression in the workplace: report of the New York Business Group on Health/Gallup Survey. New York: The New York Business Group on Health, 1989. Google Scholar |
| 4. | Kohler S, Kamp J. American workers under pressure. Technical report. St. Paul, Minnesota: St Paul Fire and Marine Insurance Company, 1992. Google Scholar |
| 5. | Emotional stress in the workplace: new legal rights in the eighties. New York: National Council on Compensation Insurance, 1985. Google Scholar |
| 6. | Fischbach TJ, Dacey EW, Sestito JP, Green JH. Occupational characteristics of disabled workers, 1975–1976. (DHHS NIOSH Publication No. 86–106). Washington, DC: US Government Printing Office, 1986. Google Scholar |
| 7. | Social Security Bulletin. Annual statistical supplement, 1989 (DHHS Publication No. 13-11700. Baltimore: US Government Printing Office, 1989. Google Scholar |
| 8. | Sauter SL, Murphy LR, Hurrell JJJr. A national strategy for the prevention of work-related psychological disorders. Am Psychol 1990;45:1146–58. Google Scholar Crossref, Medline |
| 9. | Murphy LR, Hurrell JJ, Sauter S, Keita G, editors. Job stress interventions. Washington, DC: American Psychological Association, 1996 Google Scholar |
| 10. | Selye H. The general adaptation syndrome and diseases of adaptation. Journal of Clinical Endocrinology 1946;6:217–30. Google Scholar Crossref |
| 11. | Cannon WB. Bodily changes in pain, hunger, fear, and rage. Boston: CT Branford, 1929. Google Scholar |
| 12. | Lazarus RS. Psychological stress and the coping process. New York: McGraw-Hill, 1966. Google Scholar |
| 13. | Kahn RL, Wolfe DM, Quinn RP, Snoek JD, Rosenthal RA. Organizational stress: studies in role conflict and ambiguity. New York: Wiley, 1964. Google Scholar |
| 14. | Hurrell JJJr., Murphy LR. An overview of occupational stress and health. In: Rom WM, editor. Environmental and occupational medicine, 2nd ed. Boston: Little, Brown, 1992. Google Scholar |
| 15. | Cooper CL, Marshall J. Occupational sources of stress: A review of the literature relating to coronary heart disease and mental ill health. Journal of Occupational Psychology 1976;49: 11–28. Google ScholarCrossref |
| 16. | Quick JC, Quick JD. Organizational stress and preventive management. New York: McGraw-Hill, 1984. Google Scholar |
| 17. | Caplan RD, Cobb S, French JRPJr, Harrison RV, Pinneau SRJr. Job demands and worker health: main effects and occupational differences. (DHEW NIOSH Pub. No. 75–160). Washington, DC: US Government Printing Office, 1975. Google Scholar |
| 18. | Holt RR. Occupational stress. In: Goldberger L, Breznitz S, editors. Handbook of stress. New York. The Free Press, 1982. Google Scholar |
| 19. | McLeroy KR, Green LW, Mullen KD, Foshee V. Assessing the effects of health promotion in worksites: a review of the stress program evaluations. Health Educ Q 1984;11:379–401. Google Scholar Link |
| 20. | Murphy LR. Occupational stress management: a review and appraisal. Journal of Occupational Psychology 1984;57:1–15. Google Scholar Crossref |
| 21. | Frew DR. Transcendental meditation and productivity. Academy of Management Journal 1974;17:362–68. Google Scholar Crossref |
| 22. | Shoemaker JE, Tasto DL. The effects of muscle relaxation on blood pressure of essential hypertensives. Behav Res Ther 1975;13:29–43. Google Scholar Crossref, Medline |
| 23. | Peters RK, Benson H, Porter D. Daily relaxation response breaks in a working population. 1. Effects on self-reported measures of health, performance, and well-being. Am J Public Health 1977;67:946–53. Google Scholar Crossref, Medline |
| 24. | Peters RK, Benson H, Peters JM. Daily relaxation response breaks in a working population. II, Effects on blood pressure. Am J Public Health 1977;67:954–9. Google Scholar Crossref, Medline |
| 25. | Sarason IG, Johnson JH, Berberich JP, Siegal JM. Helping police officers to cope with stress: a cognitive-behavioral approach. Journal of Community Psychology 1979;6:593–603. Google Scholar Crossref |
| 26. | Carrington P, Collings GH, Benson H, . The use of meditation-relaxation techniques for the management of stress in a working population. J Occup Environ Med 1980;22:221–31. Google Scholar |
| 27. | Gray-Toft P. Effectiveness of a counseling support program for hospice nurses. Journal of Counseling Psychology 1980;27:346–54. Google Scholar Crossref |
| 28. | Guzicki JA, Coates TJ, Goodwin DL. Reductions in anxiety and improvements in teaching associated with cue-controlled relaxation. Journal of School Psychology 1980;18:17–24. Google Scholar Crossref |
| 29. | Manuso (in Schwartz G.). Stress management in occupational settings. Public Health Reports 1980;95:99–108. Google Scholar Medline |
| 30. | Patel CH, Marmot MG, Terry DJ. Controlled trial of biofeedback-aided behavioral methods in reducing mild hypertension. BMJ 1981;282: 2005–8. Google Scholar Crossref, Medline |
| 31. | Forman SG. Stress-management training: Evaluation of effects of school psychological services. Journal of School Psychology 1981;19:233–41. Google Scholar Crossref |
| 32. | Drazen M, Nevid JS, Pace N, O’Brien RM. Worksite-based behavioral treatment of mild hypertension. J Occup Environ Med 1982;24: 511–14. Google Scholar |
| 33. | Forman SG. Stress management for teachers: a cognitive-behavioral program. Journal of School Psychology 1982;20:180–87. Google Scholar Crossref |
| 34. | Ganster DC, Mayes BT, Sime WE, Tharp GD. Managing occupational stress: a field experiment. J Appl Psychol 1982;67:533–42. Google Scholar Crossref, Medline |
| 35. | Seamonds BC. Stress factors and their effects on absenteeism in a corporate employee group. J Occup Environ Med 1982;24:393–7. Google Scholar Crossref |
| 36. | Steinmetz JI, Kaplan RM, Miller GL. Stress management: an assessment questionnaire for evaluating interventions and comparing groups. J Occup Environ Med 1982;24:923–31. Google Scholar |
| 37. | Alderman M, Techlenburg K. Effect of relaxation training on personal adjustment and perceptions of organizational climate. J Psychol 1983;115:185–91. Google Scholar Crossref, Medline |
| 38. | Bowers PA. The effects of a stress management program on the knowledge, attitudes, symptomatology, and behavior of workers employed by an urban electronics industrial plant: a demonstration project. Occupational Health Nursing 1983; March:13–17. Google Scholar |
| 39. | Friedman GH, Lehrer BE, Stevens JP. The effectiveness of self-directed and lecture/ discussion stress management approaches and the locus of control of teachers. American Educational Research Journal 1983;20:563–80. Google Scholar Link |
| 40. | Manuso J. The Equitable Life Assurance Society Program. Prev Med 1983;12:658–62. Google Scholar Crossref, Medline |
| 41. | Murphy LR. A comparison of relaxation methods for reducing stress in nursing personnel. Hum Factors 1983;25:431–40. Google Scholar Link |
| 42. | Seamonds BC. Extension of research into stress factors and their effect on illness absenteeism. J Occup Environ Med 1983;25:821–2. Google Scholar |
| 43. | von Baeyer C, Krause L. Effectiveness of stress management training for nurses working in a burn treatment unit. Int J Psychiatry Med 1983–84;13:113–26. Google Scholar Link |
| 44. | Charlesworth EA, Williams BJ, Baer PE. Stress management at the worksite for hypertension: compliance, cost-benefit, health cave, and hypertension-related variables. Psychosom Med 1984;46:387–97. Google Scholar Crossref, Medline |
| 45. | McNulty S, Jeffrys D, Singer G, Singer L. Use of hormone analysis in the assessment of the efficacy of stress management training in police recruits. Journal of Police Science and Administration 1984:12:130–2. Google Scholar |
| 46. | Murphy LR. Stress management in highway maintenance workers. J Occup Environ Med 1984;26:436–42. Google Scholar Crossref |
| 47. | West DJ, Horan JJ, Games PA. Component analysis of occupational stress inoculation applied to registered nurses in an acute care hospital setting. Journal of Counseling Psychology 1984;31:209–18. Google Scholar Crossref |
| 48. | Sharp JJ, Forman SG. A comparison of two approaches to anxiety management for teachers. Behavior Therapy 1985;16:370–83. Google Scholar Crossref |
| 49. | Firth J, Shapiro DA. An evaluation of psychotherapy for job-related distress. Journal of Occupational Psychology 1986;59:111–9. Google Scholar Crossref |
| 50. | Higgins NC. Occupational stress and working women: the effectiveness of two stress reduction programs. Journal of Vocational Behavior 1986;29:66–78. Google Scholar Crossref |
| 51. | Murphy LR, Sorenson S. Employee behaviors before and after stress management training. Journal of Occupational Behavior 1988;9:173–82. Google Scholar Crossref |
| 52. | Tunnelcliffe MR, Leach DJ, Tunnelcliffe LP. Relative efficacy of using behavioral consultation as an approach to teacher stress management. Journal of School Psychology 1986;24:123–31. Google ScholarCrossref |
| 53. | Agras WS, Taylor CB, Kraemer HC, Southam MA, Schneider JA. Relaxation training for mild hypertension at the worksite: I. The poorly controlled hypertensive. Psychosom Med 1987;49:250–63. Google Scholar Crossref, Medline |
| 54. | Bruning NS, Frew DR. Effects of exercise, relaxation, and management skills training on physiological stress indicators: a field experiment. J Appl Psychol 1985;72:515–21. Google Scholar Crossref |
| 55. | Chesney MA, Black GW, Swan GE, Ward MM. Relaxation training for mild hypertension at the worksite: I. The untreated hypertensive. Psychosom Med 1985;49:250–63. Google Scholar Crossref |
| 56. | Larsson G. Routinization of mental training in organizations: effects on performance and well-being. J Appl Psychol 1987;2:88–96. Google Scholar Crossref |
| 57. | Sallis JF, Trevorrow TR, Johnson CC, Hovell MF, Kaplan RM. Worksite stress management: a comparison of programs. Psychology and Health 1987;1:237–55. Google Scholar Crossref |
| 58. | Butcher P, Davis H. A personal effectiveness and stress management course for community health workers: a pilot study. Patient Education and Counseling 1988;12:13–27. Google Scholar Crossref, Medline |
| 59. | Keyes JB, Dean SF. Stress inoculation training for direct contact staff working with mentally retarded persons. Behavioral Residential Treatment 1988;3:315–23. Google Scholar |
| 60. | Long BC. Stress management for school personnel: Stress inoculation training and exercise. Psychology in the Schools 1988;25:314–24. Google Scholar Crossref |
| 61. | Bertoch MR, Nielsen EC, Curly JR, Borg WR. Reducing teacher stress. Journal of Experimental Education 1989;57:117–28. Google Scholar Crossref |
| 62. | Fiedler N, Vivona-Vaughn E, Gochfeld M. Evaluation of a work site relaxation training program using ambulatory blood pressure monitoring. J Occup Environ Med 1989;31:595–602. Google Scholar Crossref |
| 63. | Vaughn M, Cheatwood S, Sirles AT, Brown KC. The effect of progressive muscle relaxation on stress among clerical workers. American Association of Occupational Health Nursing 1989;37:302–6. Google Scholar Medline |
| 64. | Barkum M, Shapiro DA. Brief psychotherapy interventions for job-related distress: a pilot study of prescriptive and exploratory therapy. Counselling Psychology Quarterly 1990;2:133–47. Google ScholarCrossref |
| 65. | Cecil MA, Forman SG. Effects of stress inoculation training and coworker support groups on teacher’s stress. Journal of School Psychology 1990;28:105–18. Google Scholar Crossref |
| 66. | Goodspeed RB, DeLucia AG. Stress reduction at the worksite: an evaluation of two methods. Am J Health Promot 1990;4:333–7. Google Scholar Link |
| 67. | Larsson G, Setterlind S, Starrin B. Routinization of stress control programmes in organizations; a study of Swedish teachers. Health Promotion International 1990;5:269–78. Google Scholar Crossref |
| 68. | Stachnik T, Brown B, Hinds W, . Goal setting, social support, and financial incentives in stress management programs: a pilot study of their impact on adherence. Am J Health Promot 1990;5:24–9. Google Scholar Link |
| 69. | Kunkler J, Whittick J. Stress-management groups for nurses: practical problems and possible solutions. Journal of Advanced Nursing 1991;16:172–6. Google Scholar Crossref, Medline |
| 70. | McCue J D, Sachs. A stress management workshop improves residents’ coping skills. Arch Intern Med 1991;151:2273–7. Google Scholar Crossref, Medline |
| 71. | Firth-Cozens S. Occupational stress, clinical treatment and changes in job perceptions. Journal of Occupational and Organizational Psychology 1992;65:81–8. Google Scholar Crossref |
| 72. | Francis ME, Pennebacker JW. Putting stress into words: the impact of writing on physiological, absentee, and self-reported emotional well-being measures. Am J Health Promot 1992;6:280–7. Google Scholar Link |
| 73. | Gronningsaeter H, Hytten K, Skauli G, Christensen CC, Ursin H. Improved health and coping by physical exercise or cognitive behavioral stress management-training in a work-environment. Psychology and Health 1992;7:147–63. Google Scholar Crossref |
| 74. | Pruitt RH. Effectiveness and cost efficiency of interventions in health promotion. Journal of Advanced Nursing 1992;17:926–32. Google Scholar Crossref, Medline |
| 75. | Alexander CN, Swanson GC, Rainforth MV, Carlisle TW, Todd CC, Oates RM. Effects of the transcendental-meditation program on stress reduction, health, and employee development—a prospective-study in two occupational settings. Anxiety, Stress and Coping: An International Journal 1993;6:245–62. Google Scholar Crossref |
| 76. | Reynolds S, Taylor E, Shapiro DA. Session impact in stress management training. Journal of Occupational and Organizational Psychology 1993;66:99–113. Google Scholar Crossref |
| 77. | Reynolds S, Taylor E, Shapiro DA. Session impact and outcome in stress management-training. Journal of Community and Applied Social Psychology 1993;3:325–37. Google Scholar Crossref |
| 78. | Robinson RC, Mitchell JT. Evaluation of psychological debriefings. Journal of Traumatic Stress 1993;6:367–82. Google Scholar Crossref |
| 79. | Toivanen H, Helin P, Hanninen O. Impact of regular relaxation training and psychosocial working factors on neck-shoulder tension and absenteeism in hospital cleaners, J Occup Environ Med 1993;35:1123–30. Google Scholar Crossref |
| 80. | Toivanen H, Lansimies E, Jokela V, Hanninen O. Impact of regular relaxation training on the cardiac, autonomous nervous system of hospital cleaners and bank employees. Scandinavian Journal of Work Environment Health 1993;19:319–25. Google Scholar Crossref, Medline |
| 81. | Tsai S, Crockett MS. Effects of relaxation training, combining imagery, and meditation on the stress level of Chinese nurses working in modern hospitals in Taiwan. Issues in Mental Health Nursing 1993;14:51–66. Google Scholar Crossref, Medline |
| 82. | Doctor RS, Curtis D, Isaacs G. Psychiatric morbidity in policemen and the effect of brief psychotherapeutic intervention—a pilot study. Stress Medicine 1994;10:151–7. Google Scholar Crossref |
| 83. | Freedy JR, Hobfoll SE. Stress inoculation for reduction of burnout: a conservation of resources approach. Anxiety, Stress and Coping: An International Journal 1994;6:311–25. Google Scholar Crossref |
| 84. | Vines SW. Relaxation with guided imagery: effects on employees’ psychological distress and health seeking behaviors. American Association of Occupational Health Nursing Journal 1994;42:206–13. Google Scholar Medline |
| 85. | Murphy LR. Occupational Stress Management: Current Status and Future Directions. In: Cooper CL, Rousseau DM, editors. Trends in organizational behavior, Vol 2. Chichester, England: John Wiley, 1995. Google Scholar |
| 86. | Jacobson E. Progressive relaxation. Chicago: University of Chicago Press, 1938. Google Scholar |
| 87. | Bernstein DA, Borkovec TD. Progressive relaxation training: a manual for the helping professions. Champaign, Illinois: Research Press, 1973. Google Scholar |
| 88. | Birk L. Biofeedback: behavioral medicine. New York: Grune & Stratton, 1973. Google Scholar |
| 89. | Benson H. The relaxation response. New York: William Morrow, 1976. Google Scholar |
| 90. | Meichenbaum D. Cognitive-behavior modification. New York: Plenum Press, 1977. Google Scholar Crossref |
| 91. | Spielberger CD, Gorsuch RL, Lushene RE. Manual for the State-Trait Anxiety Inventory. Palo Alto, California; Consulting Psychologists Press, 1970. Google Scholar |
| 92. | Derogatis LR. SCL90, administration and scoring procedures manual-I for the revised version. Baltimore, Johns Hopkins University School of Medicine, 1977. Google Scholar |
| 93. | Murphy LR. Workplace interventions for stress reduction and prevention. In: Cooper CL, Payne R, editors. Causes, coping, and consequences of stress at work. Chichester, England: John Wiley 1988. Google Scholar |
| 94. | Pierce JL, Newstrom JW. The design of flexible work schedules and employee responses: relationships and processes. Journal of Occupational Behavior 1983;4:247–62. Google Scholar |
| 95. | Jackson SE. Participation in decision making as a strategy for reducing job-related strain. J Appl Psychol 1983;68:3–19. Google Scholar Crossref |
| 96. | Wall TD, Clegg CW. A longitudinal study of group work redesign. Journal of Occupational Behavior 1981;2:31–49. Google Scholar Crossref |
| 97. | Murphy LR, Hurrell JJ. Stress management in the process of organizational stress reduction. Journal of Managerial Psychology 1987;2:18–23. Google Scholar Crossref |
| 98. | Murphy LR. Managing job stress: an employee assistance/human resource management partnership. Personnel Review 1995;24:41–50. Google Scholar Crossref |
| 99. | Reynolds S, Shapiro DA. Stress reduction in transition: conceptual problems in the design, implementation, and evaluation of worksite stress management interventions. Human Relations 1991;44:717–33. Google Scholar Link |
| 100. | Newman JD, Beehr T. Personal and organizational strategies for handling job stress: a review of research and opinion. Personnel Psychology 1979;32:1–43. Google Scholar Crossref |
| 101. | Ivancevich JM, Matteson MT, Freedman SM, Phillips JS. Worksite stress management interventions. Am Psychol 1990;45:252–61. Google Scholar Crossref, Medline |
| 102. | Stoner CR, Fry FL. Developing a corporate policy for managing stress. Personnel 1983; May/June:66–76. Google Scholar |
| 103. | Heaney CA, van Ryn M. Broadening the scope of worksite stress programs: a guiding framework. Am J Health Promot 1990; 4:413–20. Google Scholar Link |
| 104. | Latack JC, Havlovic SJ. Coping with job stress: a conceptual evaluation framework for coping measures. Journal of Organizational Behavior 1992;13:479–508. Google Scholar Crossref |
| 105. | Steffy BD, Jones JW, Murphy LR, Kunz L. A demonstration of stress abatement programs on reducing employees’ accidents and their costs. Am J Health Promot 1987;1:25–32. Google Scholar Link |
| 106. | Jones JW, Barge BN, Steffy BD, Fay LM, Kuntz LK, Wuebker LJ. Stress and medical malpractice: organizational risk assessment and intervention. J Appl Psychol 1988;73:727–35. Google Scholar Crossref, Medline |
| 107. | Murphy LR, Schoenborn TF, editors. Stress management in work settings. New York: Praeger Publishers, 1989. Google Scholar |
| 108. | O’Donnell MP. Design of workplace health promotion programs. 4th Edition. Rochester Hills, Michigan: American Journal of Health Promotion, 1995. Google Scholar |
| 109. | Murphy LR. Managing job stress: an employee assistance/human resource management partnership. Personnel Review 1995;24:41–50. Google Scholar Crossref |