Combating Workplace Stress using Cognitive Behavioral Therpay

Occupational Stress and Scientific Monitoring

Literature Review

2.1 Introduction

The definition of the term “occupational stress” is derived from the definition of its two constituent words. In this context, occupational refers to anything that is related to the workplace while stress is defined as a natural body reaction from physical, mental or emotional strain in an individual. Thus, occupational stress can be defined as any mechanism by which the body attempts to adapt to the workplace environment. These include normal mechanisms for dealing with workplace stress, commonly known as the fight or flight response as well as any expected or unexpected reactions in response to the workplace. These include eyestrain because of staring at computer screens for too long, emotional and physical stress, depression, anxiety, aggression, cognitive impairment such as degraded memory or reduced concentration span, etc. All of these reactions can lead to poor work output, increased employee turnover, higher absenteeism, cardiovascular disease, injury or even death (Patterson et al., 2005).

Occupational stress can also be defined as a hazard under the relevant occupational safety and health legislation that can cause any harm to employee health and to which employers have a duty of care to assess, identify and control as much as possible. It can also be defined in other words as the consequence of an individual being unable to cope with pressures in the workplace (Rees, 1997). These undesirable outcomes come about either because of poor fit between the person’s abilities and the requirement of his or her position or because of workplace conditions being otherwise unfavorable. Because the well-being of employees is inextricably associated with organizational performance and productivity, occupational stress demands timely investigation to identify ways to mitigate these effects (Osibanjo and Salau, 2016).

Although unemployment levels in the United States have steadily declined in recent years, there has been a corresponding increase in the amount of occupational stress levels being reported by American workers. A survey sponsored by Everest College and conducted by Harris Interactive found that fully 83% of all employed workers in the United States report being stressed by at least one job-related factor (an increase from 73% for the previous year), with inadequate pay and inordinately excessive workloads being among the top factors reported by U.S. workers (Work stress on the rise, 2013). Based on the findings that emerged from this survey, John Swartz, the regional director of career services at Everest College, concluded that, “More companies are hiring, but workers are still weary and stressed out from years of a troubled economy that has brought about longer hours, layoffs and budget cuts” (as cited in Work stress on the rise, 2013, p. 3).

Although a growing body of research confirms that pay levels are no longer among the most motivational factors for workers, compensation levels remain at or near the top of job-related stressors today. In this regard, the Harris Interactive survey found that inordinately heavy workloads tied with inadequate compensation levels as being the top job stressors at present, and both of these variables showed significant increases over the previous year (Work stress on the rise, 2013). Other job-related factors that were found to exacerbate occupational stress levels included poor relationships with coworkers, the amount of time required to commute to and from work, being compelled to work in a career field that is not aligned with their personal interests, poor work-life balances and a paucity of career advancement opportunities (Work stress on the rise, 2013).

It is also noteworthy that there were some significant gender-related differences in the occupational stress levels reported by American workers, with nearly twice as many female workers as male workers (18% vs. 10%) reporting inadequate pay levels as their primary job stressor (Work stress on the rise, 2013). In addition, younger workers were more likely than their older counterparts (i.e., Baby Boomers) to report being stressed as a result of their employment (Work stress on the rise, 2013). In sum, younger American women (aged 18 to 29 years) are the most stressed at work but other categories of workers remain at high risk of occupational stress as well (Work stress on the rise, 2013). Although everyone experiences the negative and positive effects of occupational stress uniquely, there are some common types of stress that are typical responses to unmitigated workplace stress as discussed below.

2.2 Types of stress

Stress is the human response to any types of demand, and such responses can be either positive or negative (Sharma, 2015). From a biophysical perspective, stress can be regarded as being a mental, physical, or emotional response that results in mental or physical tension (Sharma, 2015). Occupational stress can also be defined as the adverse psychological and physical reactions that occur in an individual as a result of their being unable to cope with the demands being made on them (Omolara, 2008). Stress that happens due to a person's employment is termed occupational stress. The terms workplace stress, job stress and occupational stress are used interchangeably (Dollard, 2003). Regardless of what it is called, occupational stress levels are notoriously difficult to quantify and measure, making the evaluation of stress-management interventions especially problematic. In response, researchers have developed a number of different categories of job stressors to facilitate the process as discussed below.

Job stressors have been classified into various categories by different investigators over the years. For example, El-Kot and Burke note that researchers during the second half of the 20thc century identified five discrete categories of job stressors as follows: (1) stressors intrinsic to the job, (2) from one's role in the organization, (3) career development, (4) relationships with others, and (5) organizational structure and culture. Other researchers have identified four main categories of job stressors: (1) from task demands, (2) role demands, (3) physical demands (from elements in one's physical setting or environment), and (4) interpersonal demands; in addition and more recently, work-family demands have also been included in the categories of job stressors by some organizational behavioral researchers (El-Kot and Burke, 2011).

More succinctly, as posited by Nordstrom et al. (2001), there are two major types of stress that can occur in a person. These are physical and mental stress. Physical stress refers to any physical reaction of the body toward various triggers. Physical stress is a major cause of emotional stress since the two manifests in each other. Mental stress, on the other hand, refers to mental exhaustion. According to Keegel et al. (2009), mental stress refers to mental strain as a result of a harmful agent that can lead to illness. It is reasonable to posit that sustained mental strain due to occupational stress can have such serious effects.

The two different types of stress have different signs and symptoms, some of which are more readily discernible than others. For example, physical stress can be seen when the person’s heart rate becomes high and they begin to breath faster. In certain situations, the person can also start to sweat profusely or even have cold feet, hands or skin. Another common sign is that the mouth of the individual dries up and they may also; feel tired and fatigued more frequently. There may also be muscle spasms, shortness of breath, tightening of muscles and tension of the body (Iavicoli et al., 2001).

Other common signs of physical stress include the person eating more or less than normal constantly feeling nervous. This is often detected in signs such as twitching of muscles, fiddling, talking rapidly or too much, grinding teeth, nail biting, pacing up and down restlessly, or other uncommon repetitive habits. In other extreme situations, the person may develop diseases or conditions such as migraines, asthma, stomach and skin problems, aches and pains, flu, etc. These signs come about as a result of the physical well-being of the person being off balance (Crouter and Manke, 1994).

As noted above, younger American women currently suffer the highest levels of occupational stress in the country, and these individuals are also at higher risk of experiencing adverse effects from job-related physical stress as well as the deleterious effects that can result from occupational mental stress (Chitnis, 2014). In this regard, mental stress is often seen when the person has sleeping disorders that make them either sleep less or more than usual, constant feeling of worry, anxiety or confusion, frequent mood changes such as frustration, depression, anger, defensiveness, irritability, irrationality, impatient, restlessness or overreaction. Other common signs of occupational stress include dependence on harmful substances such as drugs, alcohol or cigarettes (Okechukwu et al., 2010). In certain situations, the person may also develop a poor memory or the inability to make decisions. In extreme situations, a person may even develop irrational fears of normal situations such as seeing sunlight, washing under running water, venturing outdoors, etc. All these signs come about because of the mental situation of the person being adversely affected by job-related stressors.

2.3 Signs of occupational stress

Occupational stress usually starts out as acute stress that occurs from the increasing demand and pressure of the work situation. It can lead a person to emotional distress that is seen in anger, anxiety, depression, or irritability. It can also lead a person to physical problems such as muscle tension, aches and pains, frequent headaches, jaw and back pain. These normally come from the person being exposed to a lot of manual work in the workplace such as walking or standing for long periods. Such activities may also lead to elevation of blood pressure levels, sweaty palms, rapid heartbeat, dizziness, cold feet and hands, chest or back pain, migraines or shortness of breath. Occupational stress can also be seen when a person develops stomach or bowel problems including heartburn, diarrhea, constipation, flatulence or irritable bowel syndrome. These may be as a result of physical or mental stress in the workplace (Eldon and Shani, 1991).

Occupational stress may also have other signs such as loneliness or isolation of an individual, agitation or the person being unable to relax, pessimism, loss of concentration, constant worrying, procrastination or neglecting personal responsibility or other nervous habits such as pacing, grinding teeth and nail biting.

2.4 Effects/Consequences of job stress

As put by Hulshof et al. (1999), occupational stress is quite normal. However, when it becomes excessive, there are certain adverse effects that it may cause. These effects can be divided into three distinct categories. These are effects on the individual, to family and to the organization. At all these three levels, occupational stress produces a wide range of expensive, debilitating and undesirable consequences (Ross, 2005) as discussed further below.

2.5 Consequences to the individual

Workplace stress can lead to various effects on the individual. These may be mild or severe depending on the extent of the stress. They can be divided into two major groups, which are physical and psychological effects. In this regard, El-Kot and Burke (2011, p. 11) report that, “Individuals reporting higher levels of job stressors generally indicate lower levels of job satisfaction, more absenteeism, lower job performance, greater intent to quit, and lower levels of psychological and physical health.”

The major physical effects are unwanted feelings and behaviors, which include fatigue, stomach upset, headache, muscular aches and pains, disturbance of sleep or sleeping disorders, eating disorders and other chronic or mild illnesses. Others include low motivation, low work-life balance, low overall quality of work life, absenteeism, low morale, low productivity, unsound decisions, intention to get a better job, occupational burnout, alienation, increased substance abuse, sabotage or solitude. Psychological problems include anxiety, irritability or short temper, psychological distress, passive-aggressive behaviors, loss of self-confidence, loss of self-esteem, feelings of fatigue and futility, impulsive behavior, loss of contact with reality, job and life dissatisfaction, and emotional fatigue (Spector, 2002). More troubling still, the consequences of unmitigated negative occupational stress on the individual extend to all types of sectors and industries among both white- and blue-collar workers (Chaudry, 2012).

When occupational stress is not kept in check, it may become chronic and lead to signs such as trauma or even depression. A person may also change their beliefs or views regarding a particular aspect of life because of their active self-examination often without professional helps. Other adverse effects include heart attack, cancer, violence, suicide or even paralysis (Manon Mireille and Barling, 2004).

In a study that was conducted in the US (Smith et al., 1992), it was found that electronic monitoring of employees in the workplace led to increase workplace stress and thus many either experienced high boredom levels, anxiety, depression, health complaints, psychological tension, anger, and fatigue. The researchers also found that these companies had high employee turnover because of this monitoring (Smith et al., 1992).

2.6 Consequences to family

The individual’s family also experiences undesirable consequences because of occupational stress. Consequently, of occupational stress, the individual may also carry some of the stress to their home thus causing stress to the other family members. The person may also fail to provide for the family because of losing their job or spending too much money on substance abuse or treatment. There are also other adverse effects to the family. These include dealing with sickness or even death of the individual (Windle and Dumenci, 1997). In certain situations, occupational stress may also break marriages and families because of the family not being able to cope with the individual’s dysfunctional responses. The couple may also be adversely affected in their sex life because of stress. Occupational stress also increases domestic pressures such as financial worries and childcare responsibilities thus affecting the quality of life outside their work (Suraj-Narayan, 2005). Other effects include taking work home, which reduces the amount of time spent with family members, job relocations that may split families and a lack of leisure activities (Suraj-Narayan, 2005).

2.7 Consequences to the organization

At the organizational level, there are also consequences of occupational stress that are felt. These are majorly divided into two subgroups, which are organizational symptoms and costs. Organizational symptoms include discontent and low morale that may also spread to other members of the workforce, low productivity, poor quality of service to customers or clients that may lead to loss of customers, bad publicity especially when an individual suffers chronic effects of workplace stress, high accident rates that lead to huge insurance compensations, premature retirement, high staff turnover, poor internal communication, increased internal conflict, diminished cooperation of staff members or a dysfunctional workplace climate (Huffman and Cohen, 2004). Indeed, the research to date suggests that as much as 50 percent of all workplace absences attributable in some fashion to occupational stress (Akpochafe, 2012).

Organizational costs include reduced performance or productivity of workers that leads to decreased added value to the product or service thus diminishing client satisfaction, high costs as a result of increased employee turnover, increased staff retraining and training costs, increased insurance premiums as a result of frequent insurance claims and payouts, increased health-care costs and sick pay to employees, increased disability payments as a result of workplace accidents, increased cost of repairing damaged equipment, and bad publicity which also diminishes revenues greatly (Béjean and Sultan-Taïeb, 2005). Because occupational stress have been swhon to have a direct impact on employee performance, it is not surprising that there is also a corresponding decline in the overall productivity level of affected organizations. Such declines in overall productivity have a concomitant effect on companies’ profitability and can even result in an increasingly negative perception of a company (Sharma, 2015). Consequently, the adverse effects of occupational stress ultimately combine to adversely affect employee relations as well as organizational performance and profitability (Sharma, 2015).

According to a study conducted by Daniels (2004), occupational stress has been found to cost the UK economy and estimated $4 billion every year (Brun and Milczarek, 2007). These costs are majorly from insurance claims related to occupational stress. With such huge payouts, the researchers found that there is reason to concentrate on the sociocultural variation in their findings. They also found that this huge sum was also coming from loss of customers, high employee turnover and negative publicity because of occupational stress. In the European Union as a whole, it is estimated that roughly 20 million Euros is lost each year as a result of work-related stress (European Commission, 2002, Milczarek et al., 2009).

2.8 Positive effects of workplace stress

Though occupational stress is often associated with negative effects, there are certain positive effects that come from workplace stress. However, experts put a caveat on positivity of stress stating that it only happens when stress is balanced and moderated. This is what they commonly refer to as ‘good stress’ (Shigemi et al., 2000). For example, Sauder and Murphy (2016) report that there are some misperceptions concerning stress and its effects of humans that indicate that all such stress is harmful. A growing body of evidence, however, confirms that some level of stress is an essential part of the human condition and people tend to respond favorably to some types of stress. According to Sauder and Murphy (2016, p. 6), “Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs.”

Notwithstanding the potential deleterious effects of unmitigated and relentless workplace stress, it is clear that without some levels of stress, employees would become complacent with corresponding declines in their job satisfaction and morale levels – just as too much workplace stress can cause these unwanted outcomes. In sum, Sauder and Murphy (2016, p. 7) conclude that, “The importance of challenge in our work lives is probably what people are referring to when they say ‘a little bit of stress is good for you.’”

One of the most significant outcomes of “good stress” is increased creativity. Consequently, of an individual experiencing workplace stress leading to loneliness or solitude, the person may have a chance to broaden their mind and embrace new ideas thus leading them to increase their creativity considerably. To some individuals, stress is also a motivating factor. When these individuals are stressed out, they find a good way to handle it by channeling their emotional and physical responses towards working harder or rectifying any wrongs they had done for example procrastination (Smith, 2003).

Stress is also recognized as a cognitive enhancer. Workplace stress improves some aspects of intelligence by giving the mind a boost associated with increased focusing. When a person is stressed, they may be able to recall or memorize things better and their concentration levels may also; increase. It also enhances the physical performance and endurance of an individual. When the person is able to channel their stress towards physical activities, it leads to release of adrenaline. This causes the heartbeat and metabolism to increase. However, these return to normal levels a few minutes after the activity. Therefore, the person will have increased reflexes and reactions that build endurance, prevent and fight fatigue and tiredness.

Researchers have also shown that stress helps to improve immune responses. In a study report presented by Striker et al. (1999), it was found that stress helps to increase production of the stress hormone, cortisol, which increases the body’s immunity. This also has some negative aspect since cortisol overloading may lead to abdominal obesity, which increases the risk of cardiovascular and cerebrovascular disease and diabetes.

Stress may also help an individual to solve their problems. Consequently, of stress, the individual may be able to look at something differently which allows them to solve issues between them. Moderate anxiety has been shown to help people in decision making by spurring them to the right direction.

2.9 Causes of workplace stress

Given its enormous impact on organizational performance and productivity, it is not surprising that a growing body of scholarship has been devoted to the causes of workplace stress in recent years. Studies by the American Psychological Association have identified the main causes of stress in the United States as shown in Table 1 below.

Table 1

Current leading causes of stress in the United States

Cause

Factors

Job Pressure

Co-Worker Tension, Bosses, Work Overload

Money

Loss of Job, Reduced Retirement, Medical Expenses

Health

Health Crisis, Terminal or Chronic Illness

Relationships

Divorce, Death of Spouse, Arguments with Friends, Loneliness

Poor Nutrition

Inadequate Nutrition, Caffeine, Processed Foods, Refined Sugars

Media Overload

Television, Radio, Internet, E-Mail, Social Networking

Sleep Deprivation

Inability to release adrenaline and other stress hormones

Source: American Institute of Stress (2018), ‘2014 Stress Statistics” at https://www.stress.org/

As can be seen from the breakdown of the leading causes of stress in the United States today shown in Table 1 above, job-related stressors such as poor relationships with coworkers and superiors as well as inordinately heavy workloads form the primary cause of stress today. Likewise, the second-leading cause of stress in the United States is also job related, with the loss of employment or benefits representing the second-leading cause of stress in the country.

Moreover, the numbers of Americans that are experienced these types of job-related stressors is staggering as shown in Table 2 below.

Table 2

U.S. stress statistics

Category

Data

Percent of people who regularly experience physical symptoms caused by stress

Regularly experience psychological symptoms caused by stress

Feel they are living with extreme stress

Feel their stress has increased over the past five years

Cited money and work as the leading cause of their stress

Reported lying awake at night due to stress

Source: American Institute of Stress (2018), ‘2014 Stress Statistics” at https://www.stress.org/

As can be seen from the data presented in Table 2 above, more than three-quarters (77%) of American workers report experiencing stress-related physical symptoms and nearly as many (73%) report regularly experiencing job-related psychological symptoms. In addition, one-third of American workers report feeling as if they are living with extreme stress and nearly half (48%) report feeling as if their level of stress has intensified over the past 5 years. Given these disturbing trends, it is not surprising that many American workers also report suffering from various job-related stressors as set forth in Table 3 below.

Table 3

Stress impact statistics

Category

Data

Percent who say stress has a negative impact on their personal and professional life

Employed adults who say they have difficulty managing work and family responsibilities.

Percent who cited jobs interfering with their family or personal time as a significant source of stress.

Percent who said stress has caused them to fight with people close to them

Reported being alienated from a friend or family member because of stress

Annual costs to employers in stress related health care and missed work.

$300 billion

Percent who say they are “always” or “often” under stress at work

Source: American Institute of Stress (2018), ‘2014 Stress Statistics” at https://www.stress.org/

While some types of job-related stress may be conducive to higher levels of creativity and serve as a motivational factor, the data presented in Table 3 above makes it clear that many American workers suffer from occupational stress. In fact, nearly half (48%) report that stress has had a negative effect on their personal and professional lives, and more than half (54%) report that stress that caused them problems with their interpersonal relationships. In addition, almost one-third (30%) report feeling that they are frequently or always under stress at their jobs, and more than one-third (35%) report that their jobs have interfered with their family or personal affairs resulting in elevated stress levels. Beyond the human toll exacted by job-related stress, the economic impact is also enormous, standing at about $300 billion a year in health care costs and missed work.

Research by the American Psychological Association has also identified a number of physical symptoms that are caused by occupational stress that are congruent with the most frequently cited symptoms in the relevant literature as set forth in Table 4 below.

Table 4

Percentage of American workers citing job-related stress: physical symptoms

Category

Data

Fatigue

Headache

Upset stomach

Muscle tension

Change in appetite

Teeth grinding

Change in sex drive

Feeling dizzy

Source: American Institute of Stress (2018), ‘2014 Stress Statistics” at https://www.stress.org/

As can be seen from the data presented in Table 4 above, more than half (51%) of American workers report experiencing fatigue as a result of job-related stress, and nearly as many (44%) report suffering from headaches. More than one-third of American workers (34%) also report experiencing upset stomachs, muscle tension (30%) and almost one-quarter (23%) report changes in their appetites due to job-related stress. Smaller percentages of American workers also reported suffering from bruxism (e.g., teeth grinding), changes in their libidos, or feeling dizzy. In addition, many American workers also report experiencing a wide array of psychological symptoms due to job-related stress as set forth in Table 5 below.

Table 5

American workers citing job-related stress: psychological symptoms

Category

Data

Irritability or anger

Feeling nervous

Lack of energy

Feeling as though you could cry

Source: American Institute of Stress (2018), ‘2014 Stress Statistics” at https://www.stress.org/

As can be seen from the data presented in Table 5 above, fully half of American workers report suffering from irritability or anger due to job-related stress and 45% each report feeling nervous or experiencing a lack of energy. In addition, more than one-third (35%) reporting feeling as they could cry at any time due to job-related stress. These recent statistics underscore the fact that getting up and going to work each day can be a death-defying experience for many if not most Americans today.

Although there is a general consensus among researchers that the overarching causes of workplace stress include various workplace conditions and the manner in which workers interact with these conditions (Sauter and Murphy, 2016). There remains some debate among researchers, however, concerning the precise role played by individual factors such as personality, coping skills and resilience on the effects of workplace stress (Sauter and Murphy, 2016). Employee resilience to workplace stress is defined by Nilakant and Walker (2014, p. 80), as being “the maintenance of positive adjustment under challenging conditions such that the organization emerges from those conditions strengthened and more resourceful.”

While additional research is needed concerning these individual factors and their role in employee responses to workplace stress, it is reasonable to posit that certain types of working conditions are the source of stress for most individuals (Sauter and Murphy, 2016). This assertion is congruent with the guidance provided by the U.S. National Institute for Occupational Safety and Health which has recognized that while “views differ on the importance of worker characteristics versus working conditions as the primary cause of job stress,” the overarching theme that emerges from the research to date concerning occupational stress is that “certain working conditions, such as excessive workloads and conflicting expectations, are stressful and negatively affect most people” (as cited in Sewell, 2009 p. 37).

What is known for certain at present is that there are many causes of stress ranging from work demand, supervisory style, organizational culture and support, work hazards, general work environment, role conflict, workplace changes, individual factors, job involvement, work flexibility, workplace incidents, etc. Six major causes of workplace stress have been identified by the Health and Safety Executive of the UK (Health and Safety Executive, 2013) as follows:

2.9.1 Unreasonable demands: This cause includes issues such as workload, work patterns and the work environment;

2.9.2 Excessive control: How much say the person has in the way they do their work;

2.9.3 Lack of support: This includes the encouragement, sponsorship and resources provided by the organization, line management and colleagues;

2.9.4 Lack of proper workplace relationships: This includes promoting positive working to avoid conflict and dealing with unacceptable behavior;

2.9.5. Lack of understanding of role of job expectation: Whether people understand their role within the organization and whether the organization ensures that they do not have conflicting roles; and,

2.9.6 Unmanaged workplace changes: How organizational change (large or small) is managed and communicated in the organization (Workplace stress management standards, 2017, p. 2).

These causes of workplace stress are also similar to those identified by the Occupational Safety and Health Administration in the US (Occupational Safety & Health Administration, 1995) and are discussed further below.

2.10 Unreasonable demands

Workplace demands include issues relating to workload, work environment and patterns. Occupational stress may occur when the employees are unable to cope with their workplace demands. Consequently, of this, the person may feel that they are unable to match the skills and abilities. Therefore the employees develop stress as a way of compensating for their inability to meet the workplace demands (Tarafdar et al., 2007). This cause of workplace stress is consistent with the definition provided by Sharma (2015) which states that occupational stress can be defined as “the adverse psychological and physical reactions that occur in an individual as a result of their being unable to cope with the demands being made on them” (p. 53).

2.11 Excessive control

Control applied by employers and supervisors is also a contributing factor to workplace stress. When employees are excessively monitored in the workplace, they develop boredom, dislike, low motivation and low morale, which lead to workplace stress. Consequently, of this excessive control, the employees are unable to use their skills, creativity and initiative towards the success of the organization. The employees also become discouraged to develop new skills since they are demotivated and unwilling to take new challenges in the workplace. A study by Kirk-Brown and Wallace (2009) found that the extent to which employees feel they lack personal day-to-day control over their job responsibilities will likely be the extent to which these employees are at greater risk of developing occupational stress. For instance, Kirk-Brown and Wallace (2009, p. 30) advise that, “Perceptions of personal control alleviate the negative impact of job demands. Control refers to the worker's ability to reframe events or situations as less threatening.”

2.12 Lack of support

When employees lack encouragement, resources and sponsorship from the organization, supervisors and colleagues, they develop stress. This is because they are unable to achieve the performance measures attached to their jobs and they experience challenges and other issues that they are unable to resolve. Therefore the employees are discouraged to put their best efforts towards the success of the company or organization (Verbeek et al., 2004).

2.13 Lack of proper workplace relationships

Workplace relationships create conflict that employees are unable to resolve. These include bullying, harassment and other undesirable behaviors. When the organization lacks policies and procedures to prevent or resolve such unacceptable behavior, they seem out of control and employees develop stress because of this.

2.14 Lack of understanding of role of job expectation

When employees do not understand their role within an organization or when they are not appreciated or valued within an organization, they develop internal conflicts since they do not understand their importance and job expectations. Employees thus do not make efforts to ensure their work is done to the best of their ability and they become demoralized and demotivated to work.

2.15 Unmanaged workplace changes

Resistance to change is one of the major causes of workplace stress. This is especially so when the change involves large aspects of the organization such as an overhaul of management or standard operating procedures. Such changes may be overwhelming for the employees and when change management is not done, the employees will not be aware of the reason for the change and thus will resist it leading to workplace stress as they feel uncomfortable with the new status quo (Vahtera et al., 1999).

2.16 Factors that affect job performance from stress

An unfortunate concomitant of virtually any type of employment is some level of stress. In some cases, the stress that employees routinely experience is motivational and contributes to greater levels of creativity, but in far too many cases job-related stress is like a silent killer. In fact, left unabated, job-related stress can have a profoundly adverse effect on job performance. In this regard, Lynott (2011, p. 26) emphasizes that, “Stress is a constant presence in the workplace, and never more so than in difficult economic times such as these. Occasionally it erupts into headline-making instances of deadly violence. More often, however, stress simmers just beneath the surface, silently eating away at morale [and] productivity.”

In sum, it is apparent that to the extent that workers are stressed out due to job-related factors will likely be the extent to which their job performance is affected, and there has also been a growing body of scholarship devoted to these issues in recent years. For instance, in a study conducted by Abu Al-Rub (2004), it was shown that there is a U-shaped or curvilinear relationship between workplace stress and job performance. The study showed that workers who had moderate levels of occupational stress performed worse in their jobs compared to those who have extremely low or high levels of workplace stress. In a different but similar study, it was shown that there might be four different relationships between workplace stress and job performance. These are curvilinear or U-shaped, negative linear, positive linear and no relationship (Jamal, 1984).

These two studies cited above identified various factors that emanate from stress and directly affect the employee’s job performance. One of the major factors was lack of resources. When the employee lacks the necessities to conduct their job, they are unable to perform in their roles. The second factor was work overload, which made the workers to be overwhelmed and lack direction with their work. Third was lack of communication between the employees and supervisors. This meant that the employees lacked direction and were unable to conduct their day-to-day activities. It also created a disconnect in passing of duties thus making supervisors to be recognized as commanders rather than co-workers.

Another study found that employees who were under stress were 50% more likely to err in their work while another study showed that this could be as high as 70% depending on the level of stress. Data from the Bureau of Labor Statistics also shows that for every day that a worker undergoes stress they may end up being out of the workplace for roughly 20 days. To employers, this represents a huge reduction in job performance.

Other studies conducted in the early 50s (Lazarus et al., 1952) and late 60s (Wilkinson, 1969) show that occupational stress affects tracking, verbal reasoning, signal detection and sentence formation of employees. This may also adversely affect the client-employee relations thus reducing the quality of service or product given to the employer. More research (Cohen, 1980, Glass and Singer, 1972) has supported these statements by adding that stress creates perpetual distractions that prevent tolerance, increase frustration, decrease clerical accuracy and increase workload either perpetually or eventually through procrastination. All these factors lead to poor job performance.

According to Michie (2002), individuals differ in their stress risk and vulnerability to adverse effects of stress. Individuals, they may tend to react emotionally to situations, which results in them disconnecting with the workplace thus reducing their job performance. Others may experience fatigue or tiredness that prevents them from performing their tasks. In another study by Michailidis and Asimenos (2002), it was found that occupational stress negatively impacts the degree of satisfaction of the employee with their own achievement. This also negatively affects personal growth, skill utilization and participation in decision-making thus reducing job performance.

2.17 Management of stress

Stress management has been the subject of many workplace changes in order to control the levels of stress to improve work performance. It is in the best interests of organizations of all sizes and types to manage workplace stress to the maximum extent possible due to the documented adverse impact that unmitigated stress can have on employee job satisfaction and physical well-being (Randall and Buys, 2013). Likewise, the management of workplace stress is also important due to the increased workers compensation claims that are associated with elevated levels of stress (Randall and Buys, 2013).

Several techniques have been applied to improve the general well-being of employees with varying levels of effectiveness. In addition, few of these methods have received attention from researchers therefore the amount and quality of evidence on the various techniques varies greatly. Management of stress builds on the models of stress, especially the demand-control-support model that states that for stress to be managed effectively, it is important for there to be a reward and efforts to promote balance. In addition to this, the organization must have sufficient systems to ensure organizational justice by ensuring management of stress and any programs adopted are undertaken by all employees including the senior management (Johnson and Hall, 1990, Karasek and Theorell, 1990). Researchers agree that there are two major models of workplace stress management. These are the transactional model and health realization or innate health model.

2.18 Transactional model

The transactional model suggests that stress results from an imbalance between the demands of an individual and the resources available or when pressure exceeds the ability of the individual to cope. It was developed by Lazarus and Folkman (1984) who posited that stress management is best when the individual accepts that stress is as a result of the inability of the person to cope. Therefore, stress management is premised on mediating the stress response to allow the individual to control stress levels and increase their coping ability.

According to the transactional model, the person must also identify the factors that affect their ability to control the stress in order to identify the right intervention methods that effectively target the identified factors. The authors of this model argue that stress is a transaction between the individual and their environment thus by identifying and controlling the mitigating factors, stress can be managed effectively. The transactional model proposes the individual to be taught how to manage their stress or how they can adequately develop coping skills to improve their lives and be able to handle all manner of stressors.

2.19 Health realization or innate health model

This model was put forth by Sedgeman (2005) and Mills (1995). The authors argue that stress is not founded on the presence of an actual stressor. The model does not focus on the individual’s appraisal of the stressor rather on their thought process, which determines their response to the situation. The authors of the model argue that stress is managed by self-appraisal, which filters all factors of insecurity of negativity and creates a feeling of well-being by putting a grip on negative or insecure thinking. The individual will thus be able to disengage from the stressor and introduce natural positive feelings that ultimately reduce stress.

2.20 Organizational level management

Michie (2002) posits that for the effective management of workplace stress, there must be organizational level interventions. The need for organization level stress management is because the workplace itself is the stressor. Therefore, the organization must introduce interventions at the structural level including hiring more staff, reducing or increasing work schedules appropriately, or creating a conducive environment or at the psychological level including social support, effective supervision rather than invasive supervision and increasing employee participation in decision-making. Likewise, Cooper and Cartwright (1999) report that, “Physical characteristics of the job [such] as excessive heat and noise may produce strain among workers and increase the probability of accidents. Shift schedule, a structural aspect of work, can engender significant level of physical and mental discomfort if not ordered correctly.” The emphasis here is on the organization being the source of stress management practices rather than the individual and it has been shown to be effective (Gardell and Gustavsen, 1980, Williams et al., 1998).

2.21 Definition of supervision

Supervision is defined as the regulation or control of behavior through laid out rules or restrictions. According to various authors, there are different aspects of supervision that need to be looked at in defining it. These include taking up of ideas and practices that provide the right environment to follow the laid out rules and restrictions, overseeing that employees are provided with the right tools and resources to succeed in their tasks, providing advice and support, organizing work tasks in a great order to make decisions.

2.22 Categories of supervisory models

Supervision models can be categorized into three categories based on their defining characteristics. These categories are the psychotherapy-based supervision models, developmental models, and integrative models (Smith and Witt, 1993).

2.23 Psychotherapy-based supervision models

These models dwell on the natural extension of the therapy itself and inform the observation and selection of data for supervisors (Holloway and Wolleat, 1994). One example of these models is the psychodynamic approach to supervision which states that psychodynamic supervision can be divided into three categories which are supervisor-centered, employee-centered and supervisory-matrix-centered (Loganbill et al., 1982). Employee-centered supervision came from Sigmund Freud, which states that supervision focuses on the employee behaviors. In this case, the role of the supervisor depends on the employee’s behavior. Supervisor-centered focuses on the supervisor’s content and process to assist employees in management of resistance, resolving anxieties and other problems. The supervisory-matrix-centered approach means that the supervisor’s role is not that of an uninvolved expert rather they should participate and reflect upon employee duties and behaviors (Haynes et al., 2003).

Another example of these models is the cognitive-behavioral supervision model which states that the supervisor’s major task is to teach the employee the theoretical aspects of their work (Liese and Beck, 1997). Another model is the person-centered supervision model, which states that the supervisor should ensure that the employees have the right tools, skills and resources to perform their tasks. Therefore the supervisor is a collaborator in the success of the individual by providing an environment to engage the employee towards success (Lambers, 2000).

2.24 Developmental models

Developmental models define progressive stages of development of the employee from a novice to an expert with each stage consisting of discrete skills and characteristics. According to these models, the supervisor takes a developmental approach to supervision by accurately identifying the current stage of the employee and facilitating their progression to the next stage (Zimmerman and Schunk, 2003). One of the most popular developmental models is the integrated development model developed by Stoltenberg (1981) and Stoltenberg and Delworth (1987). The model describes three levels of employee development. The first is entry-level where they are full of anxiety and fear of evaluation. The mid-level is where the employees experience fluctuating levels of confidence and motivation while the third level is that of security and stable levels of motivation. Another model is Ronnestad and Skovholt’s model which states that employees develop in six phases (Ronnestad and Skovholt, 2003). The first three are based on the integrated development model while the other three are the novice professional, experienced professional and senior professional phases, which define the relative experience gained by employee in their career.

2.25 Integrative models

Integrative supervision models rely on several theories and techniques (Haynes et al., 2003). A good example of these models is Bernard’s discrimination model developed by Bernard (1979) and revised by Bernard and Goodyear (2009). This model states that there are six foci of supervision. The first three are foci, which are intervention, conceptualization and personalization while the last three are roles, which are teacher, counselor and consultant. According to the model, the supervisor responds using one of the nine ways resulting from the three roles x the three foci. Another model is the systems approach model (Holloway, 1995) which argues that the supervisor and employee have a mutually involving relationship with seven dimensions. These are supervision functions, supervision tasks, employee, trainee, supervisor, and the institution (Mimura and Griffiths, 2003).

2.26 Supervisory tasks

A supervisory has different tasks to conduct depending on the exact workplace setting. However, in general, they begin by familiarizing themselves with the current job descriptions of the employees. A supervisor cannot be able to conduct any task without being able to understand the requirements of each of the employee’s positions. Mino et al. (1999) argues that there are four major supervisory tasks. These are coaching, mentoring, advocating for the organization and advocating for the employee.

2.27 Coaching

As a coach, the supervisor is involved in working with the employees to establish goals, plans and timelines for accomplishment of tasks. The supervisor thus provides ongoing support and guidance for the employees to complete their tasks with ease. The supervisor helps to demystify job tasks, which may make an employee, feel that they are unable to meet the goals of the position they are in. As coaches, supervisors also take into consideration other aspects of employee life such as training, utilization of personal strengths and weaknesses. The main thing is for the supervisor to provide effective supervision that enables employees make better decisions and perform their tasks better.

2.28 Mentoring

As a mentor, a supervisor understands that an employee needs to have a good work-life balance and tries to uphold that. The supervisor thus uniquely provides advice to employees in various aspects relating to their job and life in general. The supervisor makes the employee look at him or her as a model for personal development and direction. This affirms the age-old phrase of leading by example.

2.29 Advocating for the organization

A supervisor is the organization’s chief advocate to the employees. The supervisor ensures that employees conduct their tasks with utmost zeal to ensure that they meet their job performance standards and goals. The supervisor also ensures compliance with organizational policies and programs that come from the management. Though employees may be confused or frustrated by actions by a supervisor, there is need to check employees to ensure they meet their expectations. The supervisor must thus be strict but tactful.

2.30 Advocating for employees

Supervisors act as intermediaries between the organization and the employees. Thus as they advocate for the organization, they also need to advocate for employees. Employee requests to the management need to be taken into consideration. The supervisor also ensures fairness and justice in the workplace in aspects such as promotion. The supervisor also explains situations facing employees to the management to ensure that they are not being treated unfairly or against their will (Manning et al., 1996).

2.31 Other roles

Apart from these four major roles, supervisors also play other roles in the organization. One is that they resolve employee conflicts and complaints. Here, the supervisor helps employees to address and resolve any workplace concerns they may have. This includes mediating between employees or between the employee and the management. Another role is to approve records and requests by staff members. Supervisors approve all work related aspects for employees such as attendance or time off requests.

2.32 Frequency of supervision

For supervision to be effective, it needs to be as regular as possible without invading the privacy of employees. Invasion of privacy involves too much close supervision or regular monitoring of employee emails, texts or other aspects. The frequency of supervision varies from one organization to another with most deeming that it depends majorly on the employee’s experience. New employees need to be supervised more often compared to more experienced ones. In addition, junior level employees need to be supervised more often than managers or other senior level employees (Leigh et al., 1999).

2.33 Confidentiality and supervision

Confidentiality is a key issue in employee supervision. Supervisors and employees need to define a clear and mutual understanding of the boundaries of confidentiality in respect to supervisory tasks. This will enable a safe and effective working relationship to be developed between the supervisor and the employee. Confidentiality involves the supervisor showing the employee that they mean what they are saying and that they are willing to follow through on any agreements they make with the employee. The supervisor must also demonstrate that they are non-judgmental and that nothing can make them break the confidentiality agreement. On the other hand, the employee gains the supervisor’s trust by being as honest and open as possible to the supervisor in work-related tasks. In so doing, a positive working relationship will be built founded on trust and this will foster a new thinking process and development of learning (Grzywacz et al., 2002).

In the day-to-day running of supervisory tasks, the supervisor may need to involve other individuals. When this is required, the supervisor needs to protect and honor the confidentiality agreement with the employee. This is done by requesting the employee to allow them to include another individual and explaining to the employee why it may be necessary to involve another individual. When consent is given by the employee to involve others, the supervisor should only divulge the minimum information required by the other individual that allows them to provide their support in the developing situation.

2.34 Advantages of supervisory support

Many organizations emphasize the important of supervisory support for employees because of its advantages. Among the largest advantages is its positive effect on worker morale and job satisfaction. Supportive supervision helps to reduce occupational stress, which helps employees to handle their opportunities thus reducing the influence of other factors that affect job performance or lead to less than satisfactory products or services to clients or customers. According to Kadushin (1992), the supportive supervision helps to prevent potentially stressful situations thus removes employees from stress and reduces stress on the worker. This helps employees to adjust to the work environment and increases morale and job satisfaction.

Supportive supervision also enhances communication in the workplace and creates a sense of cohesiveness. This is because the employees feel the supervisor is there to help rather than discourage or criticize. Therefore, workers will be able to take responsibility for their own actions and be willing to justify them. This greatly improves organizational communication. Another advantage of supportive supervision is that it allows for sharing of ideas and resources in the workplace. Since the employees see the supervisor as more of a collaborator than foe, they are encouraged to give their ideas towards the success of the company or organization. Supportive supervision also helps to ensure that the company sticks within the outlined policies and procedures. Consequently, of fostering communication between members of staff and supervisors, the employees will be more likely to follow company policies and procedures since they are able to relate closely to them.

Supportive supervision also has other advantages such as fostering professional and personal development that comes from motivation of employees, reduced occupational burnout because of employees having flexible work schedules, quality service and products to clients and consumers, as well as improving organizational culture since staff feel they are supported. Supportive supervision contributed majorly to ensuring organizations provides high quality services and products as well as ensuring consistent outcomes by employees.

2.35 Effective supervision

Effective supervision is a critical aspect for any organization looking forward to develop positive outcomes for its employees. As a result, organizations therefore need to make a positive and unambiguous commitment towards having a strong supervision culture for their employees. This can be achieved through developing a clear policy on supervision as well as encouraging practice that supports this policy. Another way of achieving this is to have effective training for its supervisors and having strong leads through the senior management team. Another important way of achieving effective supervision is to ensure realistic performance objectives are set which are monitored regularly to check compliance.

Effective supervision helps greatly to reduce workplace stress. This is because among its major advantages is that it helps in effective workload management. By having clear and realistic performance objectives, the organization is able to know what is expected from each employee and thus plan for the achievement of these objectives through effective management of each employee’s workload. Further, effective supervision contributes to the well-being of employees by reducing workplace stress levels which are positively correlated with increased employee productivity and negatively correlated with unplanned employee turnover, reduced productivity and employee well-being (Reuben and Chiba, 2017).

In addition to the foregoing, effective supervision also helps to ensure sufficient planning of employee tasks as well as other important considerations for the organization. By embedding effective supervision to organizational culture, the organization is able to ensure it competently monitors employee performance and thus plans ahead based on this.

2.36 The relationship between stress and supervision

Occupational stress is often associated with employees not being able to cope with certain situations in their workplace (Gnilka et al., 2012). These may include strict supervision. When an employee is not able to cope with the supervision level in the organization, the experience stress, which may lead to the negative aspects, mentioned earlier. Bordin (1979) also stated that when supervisors are unable to motivate their employees, the strength of the working alliance is greatly compromised making it harder for employees to discharge their duties. Bordin (1983) also adds that the supervisor’s attitude creates personal development in the supervisee which helps them to cope with the workplace and thus reduces occupational stress. It also helps them to appraise their work demands and whether they have the necessary resources and ability to cope. Thus it helps them to exercise emotional, social and physical control which effectively prevents the negative psychological outcomes that are associated with stress (Finney et al., 2013).

2.37 The impact of leadership on stress

Over the years, organizations have moved from charismatic leadership to introduce shared or distributed leadership with more ethical values such as authenticity, fair leadership and ethics being emphasized. This is because the organizations have understood the negative effects of poor leadership, which include abusive supervision, high employee turnover, poor job performance, and passive-avoidance leadership. It is estimated that organizations all over the world spend a total or 36 to 60 billion US dollars every year on leadership development activities (Leigh et al., 1999). This indicates that they are beginning to understand that leadership is a critical component in organizational success and in reducing occupational stress. Effective leadership helps to build the right psychosocial work environment that fosters employees to utilize their ability towards the success of the organization. Poor leadership on the other hand creates poor supervision which creates occupational stress on the employees (Blix and Lee, 1991).

2.38 Qualities of effective leadership

Virtually anyone who has worked in any type of capacity (which is to say most people) can readily testify concerning the importance of the quality of leadership in the workplace. Effective leaders can make the difference between organizational success and failure by virtue of their effects of their leadership on their employees and the incidence of occupational stress that results. A study by Reuben and Chiba (2017) found that there is an inextricable relationship between effective leadership and employee well-being. Based on these findings, Reuben and China (2017, p. 37) conclude that, “Effective leadership styles are therefore required to develop high-quality work environments that are conducive to workers' well-being and which ultimately contribute to achieving organizational goals.”

Effective leadership is characterized by various qualities. First is self-confidence where the leader is able to take on any new projects or roles, which may be outside their normal area of comfort and believe that they are able to work really well. The second quality is good morals. Effective leaders lead by example meaning that they defend their own beliefs and ideals, which are based on the organization’s policies and procedures. Third is decisiveness, which means that the leader is able to weigh all the available options to make a clear decision. Fourth is flexibility, which means that the leader is able to change their schedule as priorities of tasks change or as new tasks come in. Another important quality is dependability, which means that the employees are able to depend on the leader or supervisor to take care of any problems or conflicts that arise. Patient is also an important quality since the leader needs to be able to listen carefully to all things. Patience should be coupled with fairness or justice meaning that the leader should listen to both sides of any story or issue before giving their judgment or decision. An effective leader should also be a risk-taker meaning they should be able to challenge the process or system by finding innovative ways for the organization to change, improve and grow and improve.

2.39 Role of a supervisor in the workplace

Supervisors have various roles and responsibilities to play in the workplace. One is discipline. Supervisors are expected to ensure that staff members stick to company policies and procedures at all times. This ensures that employees are kept focused on productive activities and maintains a level field for all employees. The supervisor also has a role in employee development where they are expected to help employees build skills in areas where they are lacking. This helps to develop and improve the performance of work. Supervisors are also expected to be peacemakers. Among their key roles is to resolve workplace conflicts in an amicable and fair manner. They need to listen to both sides of the story to determine who is right and find an amicable way to resolve the conflict. The conflict should be resolved in a way, which the involved parties understand. The supervisor also plays a role in ensuring that the organization’s employees are productive by ensuring they have the right skills and resources to perform their duties. They also identify areas for training of employees and in certain situations conduct the training by themselves.

2.40 The adverse effects of workplace ambiguity

It is difficult to quantify the adverse effects of ambiguity in the workplace in creating stress, but it is clear that employees want and need timely and accurate guidance concerning what is expected of them as well as their overall role in contributing to achieving larger organizational goals. When these issues are unclear, employees can experience elevated stress levels (Kirk-Brown and Wallace, 2009). Indeed, Osibanjo, and Salau (2016) emphasize that role ambiguity can exacerbate workplace stress levels, and this process is further intensified when workloads are especially heavy. Certainly, most people have been compelled to work harder than normal from time to time depending on the exigencies of their organizational needs, but working harder than normal and working harder than normal without direction are entirely different issues. As a result, it is reasonable to suggest that the extent to which role ambiguity is allowed to persist will be the extent to which occupational stress levels are correspondingly increased.

Job stressors such as role ambiguity have been studied in a wide array of cultural settings and the following variables have been most frequently identified as being positively correlated with role ambiguity: (1) tension and fatigue, (2) absenteeism, (3) leaving the job and anxiety, and (4) both psychological and physical strain (El-Kot and Burke, 2011). In addition, role ambiguity has also been positively correlated with: (1) role conflict: task/skill variety, (2) locus of control, (3) education, and (4) propensity to leave the organization (El-Kot and Burke, 2011). The variables that have been identified as being most frequently negatively correlated with role ambiguity include: (1) job satisfaction, (b) physical withdrawal, (3) supervisory satisfaction, (4) job performance, (5) job involvement, (6) decision making, (7) job involvement/engagement, (8) organizational commitment, (9) tolerance for conflict and group cohesion, and (10) reported influence (El-Kot and Burke, 2011).

Taken together, it is apparent that ambiguity in the workplace can have profound implications for occupational stress levels, but there are other variables involved that make determining which factors are most operative in the process especially complex. For example, other researchers have identified significant negative correlations between role ambiguity and the following variables: (1) participation, (2) task identity, (3) feedback, (4) job satisfaction across sub-levels, and (5) commitment and involvement. Finally, studies have also shown that role conflict and role ambiguity are consistently correlated El-Kot and Burke, 2011). Finally, the antecedents of role ambiguity include the following: (1) working in organizational boundary roles, (2) being a service employee, (3) objective role requirements of the employee, (4) limited participation in decision making, (5) limited use of goal setting by supervisors, (6) number of subordinates, and (7) level of formalization in the organization (El-Kot and Burke, 2011).

Therefore, identifying the most salient variables that create heightened workplace ambiguity levels and implementing interventions that are specifically designed to ameliorate them to the maximum extent possible helps to create a balance between the employees’ behavioral strains and productive behaviors. This is because it helps to prevent counterproductive workplace behavior, which may be directed by the supervisor. It also helps to remove psychological strains which may lead to issues such as anger, anxiety, frustration, depression, intention to quit, job dissatisfaction, cynicism, exhaustion and reduction in professional efficacy. These workplace ambiguity variables include role ambiguity, avoidance of uncertainty, or the authoritarian leadership style. They affect the perceived job control thus helping to moderately prevent workplace stress. The best human resources strategy for addressing role ambiguity in the workplace is to ensure that employees’ job descriptions actually reflect the work they do rather than some abstract version of what an organization believes they should be doing. As Bamber (2011, p. 59) points out, “One of the main ways in which an employee’s roles and responsibilities are made clear at work is through their job description.” In some cases, developing a timely and accurate job description may require a desk audit to ensure that all tasks and responsibilities that are being handled by workers are included in their job descriptions (Bamber, 2011).

2.41 Supervisor - The importance of feedback

The research to date concerning the importance of supervisory feedback confirms that this process is essential for mitigating role ambiguity in the workplace and reducing occupational stress levels. As noted above, however, there are numerous variables that can exacerbate role ambiguity, but supervisory feedback can serve as a useful way to address many of them either simultaneously or based on priority of the severity of the stressor levels (Clarke and Cooper, 2004). From one perspective, supervisory feedback represents a type of social support in the workplace that has been found to be an essential component of job satisfaction and lower occupational stress levels (Clarke and Cooper, 2004). In this regard, Clarke and Cooper (2004, p. 24) report that, “In an organizational setting, social support is often provided by immediate colleagues and first-line supervisors; supervisory support is defined as the degree of consideration expressed by the immediate supervisor for the subordinates and co-worker support as the degree of consideration expressed by co-workers.”

Research by Clarke and Cooper (2004, p. 24) identified four different types of social support in an organization context as follows: (1) instrumental support (i.e., giving direct help, often of a practical nature); (2) emotional support (i.e., showing interest in, understanding of, caring for and sympathy with a person’s difficulties); (3) informational support (i.e., giving the person information that may help him or her deal with problems); and (4) appraisal support (i.e., providing feedback about the person’ s functioning that may enhance his or her self-esteem).

Therefore, ongoing and meaningful feedback from supervisors and from coworkers is important because it fosters communication within the organization and serves as a form of social support. In addition, timely supervisory feedback helps to create working relationships between the supervisors and employees since the latter feel that they are involved in the decision-making process and their views are valued. Absent such feedback, employees are left wondering if they are satisfying and/or exceeding their performance objectives and achieving organizational goals. These outcomes also directly contribute to workplace ambiguity which has been shown to be an antecedent of occupational stress time and again.

The feedback channel is an important way of increasing productivity and performance of employees in the workplace. It also acts as a motivating factor for employees since it is inclusive rather than alienating for the employees. Based on their analysis of the various antecedents of occupational stress, Mijakoski and Karadzinska-Bislimovska (2015, p. 180) conclude that, “The presence of proper feedback, adequate supervisor and coworker support, as well as appropriate team work, leads to high job engagement and low level of depersonalization, while their absence increases the level of cynical attitude towards work.”

Moreover, timely and honest supervisory feedback is also a crucial aspect of performance management since it maintains an open and honest relationship between the supervisor and employee thus the two-way dialogue will enable performance appraisals to be conducted honestly and thus improve the ability of the employees to meet the expectations of the company or organization.

2.42 Prevention and fighting with stress at work

Given its documented exorbitant economic costs and the enormous human toll that is exacted by the condition, the prevention of workplace stress is an important consideration for all organizations. As Osibanjo and Salau (2016, p. 261) point out, “High levels of workplace stress can become harmful for individual employees and the organization as a whole. Hence, to enhance corporate image and achieve competitive advantage, stress management and coping strategies become imperative.”

Occupational stress can be prevented or minimized by introducing education and training programs for employees to understand and relate to occupational stress. It can also be prevented or ameliorated by changing the organization’s policies and procedures to ensure that all risks of occupational stress are mitigated and sources of stress eliminated. Another way of preventing occupational stress is to establish employee assistance programs to support employees undergoing occupational stress (Randall and Buys, 2013).

An in-depth study of occupational stress and efficacious interventions by Richardson and Rothstein (2008, p. 69) defined job stress as “a situation wherein job-related factors interact with the worker to change his or her psychological and/or physiological condition such that the person is forced to deviate from normal functioning.” There is an inherent notion contained in this definition that work-related stressors represent the overarching source of stress and that individual responses to elevated work-related stress can manifest in psychological, physiological, or a combination of these outcomes (Richardson and Rothstein, 2008).

Measuring the efficacy of stress management interventions is accomplished in different ways depending on the focus of the intervention. In some cases, researchers have evaluated the effectiveness of stress management interventions based on their effect on quantifiable outcomes such as employee productivity levels, absenteeism rates, blood pressure levels and weight gain or loss (Richardson and Rothstein, 2008). In other cases, researchers have evaluated the effectiveness of stress management interventions using more subjective criteria such as employee engagement, morale or job satisfaction levels. Regardless of the evaluation strategy that is used, there remains a significant amount of controversy concerning which stress management interventions are most effective in various situations and why (Richardson and Rothstein, 2008).

Various types of stress management interventions either seek to modify work-related stressor factors, provide employees with assistance and support in mitigating the adverse effects of such stressors, or a combination of these strategies (Richardson and Rothestein, 2008). Based on a conceptual framework developed for the design, implementation, and evaluation of stress management interventions, interventions can be designed to address three main points in the stress cycle: (1) the intensity of stressors in the workplace, (2) the employee’s appraisal of stressful situations, or (3) the employee’s ability to cope with the outcomes (Richardson and Rothstein, 2008 p.70).

The constituent elements of stress management programs differ but they generally include interventions that can be categorized as primary, secondary or tertiary initiatives as described below:

2.42.1 Primary interventions: These types of stress management interventions seek to change the main sources of job-related stress. In this regard, Richardson and Rothstein (2011, p. 70) report that, “Examples of primary prevention programs include redesigning jobs to modify workplace stressors, increasing workers’ decision-making authority or providing coworker support groups.” In other words, primary interventions are those intended to seek out the source of job-related stress and “nip them in the bud” before they can exact a stress-related toll on workers. For instance, according to Bamber (2011, p. 42), “.Primary level interventions are aimed at changing the work environment itself to reduce or eliminate the cause of the stress at its source.” In some cases, though, changing the work environment in substantive ways is not feasible due to the types of occupations that are involved (e.g., acute-care nurses, combat infantry troops, firefighters, among others) or due to the expense that may be involved (Bamber, 2011). In these types of cases, researchers believe that secondary interventions are more appropriate and effective at addressing job-related stress as discussed further below.

2.42.2 Secondary interventions: These types of stress management interventions are designed to minimize the severity of stress symptoms before they can cause more serious health issues with workers (Richardson and Rothstein, 2011, p. 70). Secondary level interventions are also designed to educate workers concerning various types of coping strategies or skills that can serve as buffers against stressful workplace environments and provide them with the tools they need to develop the resilience they need to respond in healthier ways to job-related stressors (Bamber, 2011). According to Sidle (2008, p. 111), “Cognitive-behavioral approaches are secondary interventions that help employees rethink their beliefs about challenging situations. Specifically, individuals learn to recognize how their pessimistic and often distorted thoughts of gloom and doom lead to stress. Next, they learn to replace their overly pessimistic thinking with more realistic or more optimistic thinking.”

2.42.3 Tertiary interventions: These types of stress management interventions such as the aforementioned employee assistance programs are intended to treat workers’ stress-related health problems with appropriate mental health care practitioners (Richardson and Rothstein, 2008 p. 70). According to Bamber (2011, p. 42), “Tertiary level interventions are appropriate when secondary level interventions are ineffective and the individual is experiencing stress syndromes which are impacting on their capacity to be productive in the work setting, or even to remain at work.”

Although primary and tertiary interventions may be most appropriate in certain circumstances, secondary interventions are the most commonly used workplace stress management programs used at present, and these types of interventions are typically targeted at helping individual employees develop improved methods for managing and coping with job-related stressors. Some of the most popular secondary interventions for managing and coping with occupational stress include various cognitive-behavioral skills training that educate workers concerning the effects of their thinking on their stress levels, deep-breathing exercises, meditation, relaxation, physical fitness exercises, time management skills, maintaining a daily journal and setting goals, or, here again, a combination of these strategies (Richardson and Rothstein, 2008). According to Richardson and Rothstein, cognitive-behavioral skills training can be an especially efficacious and cost-effective intervention for job-related stress. For example, these researchers report that, “Meditation, relaxation, and deep-breathing interventions are designed to enable employees to reduce adverse reactions to stresses by bringing about a physical and/or mental state that is the physiological opposite of stress” (Richardson and Rothstein, 2008 p. 70).

Although the research to date indicates that primary and secondary level stress management interventions can be effective in resolving mild to moderate levels of stress, these strategies may be less efficacious in treating more severe and debilitating stress levels that are linked with occupational stress (Bamber, 2011). Moreover, the more severe and debilitating levels of stress associated with occupational stress can affect workers’ ability to perform their jobs or even to continue their employment. In these types of cases, evidence-based tertiary level interventions are needed to assist workers in managing their stress levels (Bamber, 2011).

While formal tertiary interventions are usually provided by primary care and mental health practitioners, there are several self-help methods available that can be used in conjunction with these interventions. For example, beyond the foregoing, there are some other, relatively simple steps that employees can take to mitigate the effects of job-related stress. In many cases, these steps can be applied in the workplace as needed. In this regard, Frandsen (2010, p. 61) suggests that people who are experiencing occupational stress should employ various self-care measures, including the following:

· Start each day with a relaxing ritual such as 15 minutes for meditating, journaling, stretching, or reading something inspirational;

· Adopt healthy eating, exercising, and sleeping habits;

· Establish boundaries to avoid overextending;

· Take a daily break and set aside time to completely disconnect;

· Nourish self-creativity by choosing fun activities that have nothing to do with work; and,

· Learn to manage stress.

Although these straightforward stress management interventions all provide some degree of benefits, the research to date indicates that cognitive-behavioral based interventions provide consistently greater effects compared to other types of interventions. Interestingly, though, to the extent that additional treatment elements are added to the cognitive-behavioral interventions was the extent to which the efficacy of these interventions was reduced (Richardson and Rothstein, 2008). These findings suggest that there is no “one-size-fits-all” stress management intervention strategy that works equally well in all circumstances but rather reinforces the need for individualized treatment strategies that are based on the unique needs of the targeted employees.

In addition, a number of evidence-based interventions have been developed that are specifically designed to help prevent the onset of occupational stress and better manage the condition if it does arise among helping professionals where the workplace environment cannot be easily changed such as acute care nurses as set forth in Table 6 below.

Table 6

Description of evidence-based interventions for workplace stress

Source

Description of intervention

Cohen-Katz et al. (2005)

This intervention consisted of an 8-week mindfulness-based stress reduction program that was geared towards improving relaxation, self-care, work and family relationships as well as identifying better ways of dealing with difficult emotions in the workplace.

Hayes et al. (2005)

Interventions included a mentoring program designed to support minority nurses entering oncology; oncology nursing grand rounds, spirit rounds, and reflective practice rounds; narratives for individual reflection on practice; ambulatory nursing retreats for reflection and renewal; and individual meetings with a psychiatric clinical nurse specialist for new graduates.

Adams & Putrino (2010)

An expressive writing workshop encouraged self-care by presenting participants with information on ways to ground expressive writing and participate in expressive writing exercises.

Bauer-Wu (2005)

Retreats were held outside the work setting with participants’ choice of four experiential break-out sessions: “Keeping the Hope,” which used art, imagery, and story to restore hopefulness as a self-care practice; “Coming Home to Your Body,” which used therapeutic movement; “Being Peace,” which used mindfulness meditation to foster peace and balance in everyday life; and “What Matters Most,” which fostered self-reflection and expression through collage and writing. Retreats also included free afternoon time with the opportunity for all participants to receive a massage; an evening of live entertainment with singing, dancing, and laughing; and a morning Yoga class or the option to take a walk or sleep in.

Lambert & Steward (2007)

The overnight retreat began with dinner and an evening of fun and laughter using room and table assignments to pair staff that normally do not interact. This was followed by a full day of team building facilitated by an expert. Topics included understanding team dynamics, personal behavior styles, communication with others, and creating safe environments that foster candid communication.

LeBlanc et al. (2007)

The intervention included a start-up program that was followed by 3-hour programs delivered on a monthly basis for a period of 6 months with an introduction and questionnaire on work situations, communication, and feedback. In addition, program topics included building social support, balancing job-related investments and outcomes, solving problems through team action planning, and identifying potential problems and solutions for dealing with change. Program counselors met with participants prior to the program to gather information on the organization’s structures and policies as well as management’s perception of the main source of job stress.

Medland et al. (2004)

Day-long retreats held away from the clinical areas included interactive and informal presentations on wellness, bereavement, developing stress management skills such as relaxation, journaling, cultivating team effectiveness, and art-making activities. Participants also viewed a videotape on positive management philosophy and discussed a framework for incorporating stress management and self-care into practice. Practice changes to decrease burnout and increase ongoing focus on staff support at the facility were implemented based on ideas generated.

Source: Summarized and adapted from Henry (2014, p. 212)

While some occupations are inherently more stressful, other authorities have also evaluated the efficacy of stress management interventions to identify those that work best under different circumstances with other occupations as well. A recapitulation and summary of these studies are provided in Table 7 below.

Table 7

Recapitulation and summary of the efficacy of various stress management interventions

Source

Method

Results

Kim, JH (2007)

Meta-analysis of 46 experimental studies. The studies were classified according to the sample characteristics, the types and methods of the interventions, and the types of outcome variables. Six intervention types were distinguished: (1) cognitive-behavioral intervention (CBT), (2) relaxation techniques (RT), (3) exercise (EX), (4) multimodal programs 1 and 2 (MT1, 2), and (5) organization focused interventions (OTs). Effect sizes were calculated for the outcome categories across intervention types: psychosocial outcome, behavioral-personal resources, physiologic, and organizational outcome.

The results of this study showed that individual worker-focused interventions (ITs) were more effective than OTs. A small but significant overall effect was found. A moderate effect was found for RT, and small effects were found for other ITs. The effect size for OTs was the smallest. The interventions involving CBT and RT appeared to be the preferred means of reducing worker's psycho-social and organizational outcomes. With regard to physiologic outcomes, RT appeared to be most effective. CBT appeared to be most effective in reducing psycho-social outcomes. The effects of OT were non-significant, except for the psycho-social outcomes. Based on these findings, the author concluded that all of these stress management interventions are effective, but that interventions involving RT and cognitive-behavioral therapy are more effective than other types.

Sidle (2008)

Systematic literature review of current best practices in stress management interventions.

Even though they are more effective than other stress management interventions, managers may consider the cognitive-behavioral techniques more challenging than other approaches to implement. Typically, cognitive-behavioral interventions require the hiring of a professional to lead a group session. Consequently, managers may gravitate toward interventions that are easier to implement and require a smaller investment of resources (e.g., relaxation training); however, relaxation training interventions are one of the most popular approaches to stress management. Indeed, relaxation techniques are perceived as one of the easiest and least expensive approaches to implement, primarily because they can be self-taught with DVDs or the internet.

Richardson and Rothstein (2008)

Meta-analysis of 36 experimental studies representing 55 different stress management interventions. The total sample size of the meta-analysis was 2,847; of the participants, 59% were female, mean age was 35.4, and average length of intervention was 7.4 weeks.

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.

Kowalski and Harmon (2009)

Mixed-method action research was used to evaluate the effectiveness of a multi-year cognitive-behavioral stress management intervention called the Workplace Stress and Aggression Project with 3,000 employees at 11 pilot sites in Department of Veterans Affairs’ tertiary health care facilities.

The cognitive-behavioral stress management interventions that were implemented pursuant to this initiative were found superior to the other types of stress management interventions that had been used by the Department of Veterans Affairs and the researchers conclude that cognitive-behavioral interventions represent the best approach for mitigating and treating stress management in the workplace.

Stough et al. (2014)

Citing the enormous costs and adverse effects of occupational stress, these researchers emphasize the need for time- and cost-effective interventions that have proven efficacy in mitigating stress levels. To this end, Stough and his associates report that nutritional interventions, especially using B group vitamins, has become increasingly recognized as a viable stress management intervention. The study was a randomized, double-blind, placebo-controlled, parallel-groups clinical trial involving 200 subjects randomized to a control group or receive Blackmores Executive B Stress Formula or placebo daily for a period of 6 months.

This study examined the effects of B group vitamins on workplace stress and mood variables with a sample of full-time employed older adults who subjectively report feeling stressed. The findings that emerged from this study confirmed that efficacious interventions targeted at reducing occupational stress levels using dietary supplementation with B group vitamins is an economically viable and sustainable intervention.

Cooper and Cartwright (1999)

Emphasizing the urgency of the need, these researchers use a content analysis of relevant studies to identify interventions that have been proven effective in reducing workplace stress levels.

Based on their analysis of the stress management interventions developed to date, these researchers conclude that although individual counseling and stress management training can serve as useful components, organization-wide initiatives are needed to ensure that workplace stressors are addressed from a structural point of view.

Reid and Romans (2014)

Noting a paucity of timely and relevant studies concerning occupational stress levels among African Americans in general and African American males in particular, these researchers evaluated the degree to which acculturation strategy (traditionalist beliefs, traditionalist behavior, assimilationist beliefs and assimilationist behaviors) measured by the Measurement of Acculturation Strategies for People of African Descent (which has known validity and reliability) affects perceived job stress as measured by the Job Stress Survey in a sample of 87 employed African American professionals.

The findings that resulted from this study failed to identify a relationship between traditional acculturation strategies and occupational stress levels suggesting that the subjects who use traditionalist strategies may either experience less stress and more support. This finding reinforces the importance of traditional acculturative coping strategy as a protective resource against perceived stress. Individuals with traditional acculturative coping strategies may be more aware of and understanding of threats to self-concept, which is also protective. Based on these findings, the researchers also emphasize the need for additional studies using race-related variables.

Ekman (2015)

Using a case study approach, this researcher cites the lack of relevant research into occupational stress levels among law enforcement authorities including those tasked with juvenile justice. The qualitative three-phase case study focused on a 16-hour mindfulness meditation strategy called Cultivating Emotional Balance pilot stress management intervention for 50 juvenile justice officers in two settings in San Mateo County, California.

The results of this study showed that empathy training using vignettes, the mindfulness skills including breathing exercises, and the motivation exercises were especially effective in reducing occupational stress levels among this population of juvenile justice officers. The results of this study indicate that strengthening empathy levels and providing juvenile justice officers with tools such as relaxation and meditation are especially valuable additions to stress management interventions.

Randall and Buys (2013)

Using a systematic review of the relevant literature, these researchers provide a comprehensive background concerning the severity of occupational stress and the toll it exacts on individuals and organizations. Like the Ekman (2015 study reviewed above, this study also focused on mitigating occupational stress levels among law enforcement officers.

These researchers found that stress management that are designed to address individual factors by providing employees with training and tools such as teaching them to control stress responses using behavioral self-control, biofeedback, meditation and abdominal breathing, progressive visualization and cognitive processing are regarded as effective evidence-based treatment strategies. These types of interventions are designed to minimize stress responses by controlling thought, physiological and behavioral responses to job-related stressors. Likewise, interventions such as cognitive behavioral therapy also have demonstrated efficacy.

McCraty et al. (2003)

The purpose of this randomized experimental study was to examine the effects of a workplace-based stress management program

on blood pressure, emotional health, and workplace-related measures in 38 hypertensive employees of a global information technology company. The subjects were randomly assigned to a control group which received no intervention or a group that received the stress-reduction intervention. The treatment group participated in a 16-hour program, which included instruction in positive emotion refocusing and emotional restructuring techniques intended to reduce sympathetic nervous system arousal, stress, and negative affect, increase positive affect, and improve performance. Learning and practice of the techniques was enhanced by heart rate variability feedback, which helped participants learn to self-generate physiological coherence, a beneficial physiologic mode that are associated with increased heart rhythm coherence, physiologic entrainment, parasympathetic activity, and vascular resonance. Blood pressure, emotional health, and workplace-related measures were also evaluated assessed before and 3 months after the program.

This study found that the treatment group exhibited a mean adjusted reduction

of 10.6 mm Hg in systolic blood pressure and of 6.3 mm Hg in diastolic blood pressure. 3-months post-intervention. The reduction in systolic blood pressure was regarded as significant in relation to the control group. The treatment group also demonstrated improvements in emotional health, including significant reductions in stress symptoms, depression, and global psychological distress and significant increases in peacefulness and positive outlook. Reduced systolic blood pressure was correlated with reduced stress symptoms. In addition, the trained employees demonstrated significant increases in the work-related scales of workplace satisfaction and value of contribution. These results indicate that a brief workplace stress management intervention can produce clinically significant reductions in blood pressure and improve emotional health among hypertensive employees. The implications of these findings are that such interventions may produce a healthier and more productive workforce, enhancing performance and reducing losses to the organization resulting from cognitive decline, illness, and premature mortality.

Kinman and Jones (2005)

This study investigated lay representations of work stress using semi-structured interviews with 45 individuals from a range of occupations. The meaning of occupational stress, its antecedents and outcomes, and ways by which it may be managed were examined. Dominant factors were established through the use of thematic content analysis. Similarities and differences were found between lay and professional discourses on work stress.

The results that emerged from this study indicate that lay representations of occupational stress are multi-faceted. There remains a lack of consensus, however, concerning how participants interpreted the concept: a diverse range of personal, environmental, and societal factors was highlighted. A different (and arguably more complex) range of definitions of job stress and the manner in which it impacts on individuals was revealed than has been reported in previous studies. The causes of stress at work were perceived as being predominantly organizational, but the impact of stress on the employee was more salient than organizational outcomes. Secondary and tertiary stress management techniques were thought to be more effective than interventions designed to prevent stress at work. Interviewees with line management responsibility were more likely to emphasize individual responsibility for managing stress, most others maintained that the individual and the organization are equally responsible.

Saksvik et al. (2003)

The study evaluated seven different individual and organizational stress management interventions. Data for the study was obtained from a sample used as a part of the evaluation of a Norwegian national intervention program called `Health at Work.’ The study was conducted in three

Different enterprises (two from the public sector (the Norwegian Postal Service and a municipality) and the local government of a district that included a mid-sized Norwegian town and one from the private sector (a shopping mall). Interviews were conducted in 22 post offices, 12 organizational units (i.e., care homes and local administrative units) of a Norwegian municipality, and in 10 shops in a shopping mall. The interviews took place before and after the interventions. The following key process factors were identified: (1) the ability to learn from failure and to motivate participants; (2) multi-level participation and negotiation, and differences in organizational perception; (3) insight into tacit and informal organizational behavior; (4) clarification of roles and responsibilities, especially the role of middle management; and (5) competing projects and reorganization.

Based on the results that emerged from this ambitious study, these researchers conclude that quantitative techniques alone often fail to capture the magnitude and the meaning of accomplishing interventions within organizations; however, quantitative investigations are crucial in documenting the significance of improving occupational health in order to influence those stakeholders who have the power to initiate change.

Gyllensten et al. (2005)

This qualitative study of two males and three females examined the attitudes of finance organizations towards workplace stress and stress interventions. Semi-structured interviews were used and seven individuals, each representing their organization, participated in the study. Interpretative Phenomenological Analysis (IPA) was used to analyze the data that resulted. The goal of IPA is to explore the insider views of the participants, and this was the aim of the current study. In IPA it is assumed that there is an association between what the participant says and what they think. IPA seeks to capture the meanings of the participant’s accounts, and this is done through a process of interpretative analysis. An additional benefit of IPA is that it facilitates the discovery of rare themes within the area of investigation.

The overarching finding that emerged from this study was that subjects held strong views that people who seek counseling for occupational stress, irrespective of the severity of their conditions, may be perceived as having some type of mental illness. The stigma that is associated with this perception is believed to prevent many employees who are most in need of efficacious stress management interventions from seeking assistance in the workplace. The findings underscore the need for additional education of employees to ensure that they recognize the signs and symptoms of job-related stress and feel comfortable in seeking assistance for these problems.

Biron et al. (2016)

These researchers used an adapted study design to evaluate the effectiveness of an intervention exposure and to create an artificial control and intervention groups. This study also included longitudinal data (i.e., two assessments) with added process measures at time, two gathered from three complex participatory intervention projects in Canada in a hospital and a university. Structural equation modeling was used to explore the specific working mechanisms of particular interventions on stress outcomes.

The results of this study showed that higher exposure to interventions aiming to modify tasks and working conditions reduced demands and improved social support, but not job control, which in turn, reduced psychological distress. Exposure to interventions aiming to improve relationships was not related to psychosocial risks. Most studies cannot explain how interventions produce their effects on outcomes, especially when there are multiple concurrent interventions delivered in several contexts. This study advances knowledge on process evaluation by using an adapted study design to capture the active ingredients of multi-component interventions and suggesting some mechanisms by which the interventions produce their effects on stress outcomes. In addition, these findings also provide an illustration of how to conduct process evaluation and relate exposure levels to observed outcomes.

Pignata et al. (2016)

These researchers used the social-exchange theoretical framework to examine the effect of employees’ awareness of stress reduction interventions on their levels of psychological strain, job satisfaction, organizational commitment, perceptions of senior management trustworthiness and procedural justice. The researchers present longitudinal panel data from 869 employees who completed questionnaires at two time points at 13 Australian universities.

The results of this study showed that employees who reported an awareness of stress-reduction interventions undertaken at their university scored lower on psychological strain and higher on job satisfaction and commitment than those who were unaware of the interventions. The results indicate that simply the awareness of stress interventions can be linked to positive employee outcomes. The study further revealed that senior management trustworthiness and procedural justice mediate the relationship between awareness and employee outcomes.

Bowen et al. (2014)

This study used an online survey to collect opinions from architects (n = 3,025), civil engineers (n = 1,842), quantity surveyors (n = 1,449), and project and construction managers (n = 3,359) in South Africa.

The results of this study showed that a majority of the respondents experience high levels of stress at work. Architects (more than engineers, quantity surveyors, and project and construction managers) and female (more than male) professionals feel stressed. Psychological effects of workplace stress include the feeling of not being appreciated by others for a job well-done, feeling dissatisfied with one’s own performance at work, and feeling tense at work. Physiological effects include disturbances to usual sleep patterns, difficulty in relaxing after hours, and difficulty in concentrating. Sociological effects include a strain on family life, social activities, and social relationships. A wide range of positive coping mechanisms are used by the respondents, including physical exercise, spending time with family and friends, traveling, watching television and movies, surfing and water sports, jogging, archery, meditation and

prayer, yoga, cycling, shooting, fishing, hiking and camping, golf, gardening, squash, cooking, reading, card-playing, model-building, wining and dining, photography, woodwork, gaming, listening to music, participating in martial arts, motorbike riding, 4 × 4 driving, and trying to get more sleep.

Lemaire and Wallace (2010)

These researchers used a mixed methods strategy to explore factors related to physician wellness within a large health region in Western Canada. The study focused on the coping strategies that physicians use in response to work-related stress. The qualitative component explores physicians’ self reported coping strategies through open ended interviews of 42 physicians representing diverse medical specialties and settings (91% response rate). The major themes extracted from the qualitative interviews were used to construct 12 survey items that were included in the comprehensive quantitative questionnaire. Questionnaires were sent to all eligible physicians in the health region with 1178 completed surveys (40% response rate.) Questionnaire items were used to measure how often physicians draw on the various coping strategies. Feelings of burnout were also measured in the survey by 5 items from the Emotional Exhaustion subscale of the Revised Maslach Burnout Inventory.

The major themes that emerged from the data analysis included the coping strategies that the subjects used in the workplace (i.e., working through stress, talking with co-workers, taking a time out, using humor) and after work (e.g., exercise, quiet time, spending time with family). Analysis of the questionnaire data showed three often used workplace coping strategies were positively correlated with feeling emotionally exhausted (i.e., keeping stress to oneself (r = .23), concentrating on what to do next (r = .16), and going on as if nothing happened (r = .07)). Some less often used workplace coping strategies (i.e., taking a time out) and all those used after work were negatively correlated with frequency of emotional exhaustion.

Based on these findings, these researchers conclude that physicians’ self reported coping strategies are not all created equal in terms of frequency of use and correlation with feeling emotionally exhausted from one’s work. The researchers also conclude that these findings can be integrated into practical physician stress reduction interventions.

Harkness et al. (2005)

This study used discourse analysis to explore the way in which employees understand work stress. Twenty-two female clerical workers in a Canadian city participated in focus group meetings where they talked about and made sense of their experiences of work stress. The women’s accounts were analyzed using discourse analysis methods (i.e., an examination of how talk is constructed).

The findings that emerged from this study showed that simply talking about being stressed provides a socially acceptable way of expressing discomfort and regaining a sense of importance that is lost through feeling under-valued and underappreciated in the organization. In contrast, admitting to being unable to cope with stress was considered to be ‘abnormal’. The stress discourse fosters a sense of helplessness and ambiguity by not acknowledging external influences on clerical workers’ experiences, such as their place within the power structure of the organization, and by limiting their sense of agency and control over problems experienced at work. The implications of these findings for organizational culture and interventions include the need for employers to be conscious of the messages being sent to employees about how negative emotions or distressing experiences at work are to be addressed (i.e., how ‘stress’ is to be managed). The recommendations that were provided by these researchers included the need for the examination of alternative discourses that aim to improve conditions at work.

Howard (2008)

Using a systematic review of the relevant literature and a case study of supervisory interventions for occupational stress management, this researcher drew on concepts from the field of positive psychology such as work engagement, sense of coherence, self-efficacy, flow and resilience

has begun to provide detailed understanding of workers’ happiness, health and betterment

Based on the findings that resulted from this study, Howard concluded that the relationship between supervisor and supervisee needs to be one in which trust and empathy are built from the outset. In addition, it is also important to consider when to apply these methods. There are many opportunities for the supervisor to do so. Opportunities may include case discussion, video- or audio-tape review, reviewing success, learning needs assessment, evaluation processes, professional competence reviews, and teamwork analysis. Dedicated sessions may be

seen as important from time to time, especially when reviews of the supervision have been planned. A dedicated session could also become an opportunity for a celebration of achievement.

Gunn (2013)

The study used a case study and historic prospective mixed-method design, comprised of six home care units in a Norwegian municipality (n = 138 respondents; response rate = 76.2% or 17 informants. The study included quantitative estimations, register data of sick leave, a time line of significant events and changes, and qualitative descriptions of employee appraisals of their work situation gathered through semi-structured interviews and open survey responses.

The findings of the study showed that the work environment interventions were in general regarded as positive by the home care workers; all units, though, were simultaneously subjected to substantial contextual instability, involving new work programs, new technology, restructurings, unit mergers, and management replacements, perceived by the home care workers to be major sources of stress. These findings suggest that concurrent changes induced through rationalization resulted in negative exposure effects that negated positive work environment intervention effects, causing an overall deteriorated work situation for the home care workers.

Rinaldi et al. (2010)

This randomized, controlled study evaluated the effectiveness in the improvement of the psychic and symptomatic stress-related disorders by means of radio-electric stimulation on some auricular reflex points with a device named the “radio-electric asymmetric conveyer” (REAC). The study was conducted on 124 subjects with psychological distress symptoms that were assessed by the Symptomatic Check List-90 pre- and post-intervention. After randomization, two groups were created: a group treated with effective REAC and a group that underwent the same treatment with disarmed REAC (the placebo group).

The findings that resulted from this study showed that there was a significant reduction in SCL-90 scores in the treated group compared with the placebo group. The results of the psychometric tests showed that the subjects who underwent effective therapy showed a statistically significant (p < 0.05) reduction in their level of stress and psychological disorders compared with the control group. The reduction of the levels of perceived stress and the reduction of the psychic and symptomatic stress-related disorders assessed by SCL-90 tests, obtained after one cycle of reflex auricular protocol REAC treatment, showed that this treatment can be useful in the cure of psychological stress-related symptoms.

Jay et al. (2014)

The purpose of this single-blind two-armed parallel-group randomized controlled trial with allocation concealment study was to investigate the effect of an individually tailored biopsychosocial intervention strategy on musculoskeletal pain, stress and work disability in lab technicians with a history of musculoskeletal pain at a single worksite in Denmark. The study subjects received an individualized multi-factorial intervention or “usual care” for 10 weeks at the worksite. Inclusion criteria: 1) female laboratory technician

(18-67 years of age) and 2) Pain intensity ? 3 (0-10 Visual Analogue Scale) lasting ?3 months with a frequency of ? 3 days per week in one or more of the following regions: i)

upper back i) low back iii) neck, iv) shoulder, v) elbow and/or vi) hand. Exclusion criteria: 1) life-threatening disease and 2) pregnancy. Stress, as measured by Cohen´s perceived stress questionnaire is not an inclusion criteria, thus participants could participate regardless of their stress levels.

The study’s findings showed that the intervention was considered to be a cost-efficient training program with easy-to-use exercises and a

minimal amount of necessary equipment based on the assumption that work site post-intervention implementation may have a higher success rate if the program design, including exercises, is transparent, inexpensive and easily integrated.

Ergonomic counseling aimed at reducing physical exposure to compromising body positions are considered the standard prescription/conventional approach on prevention and treatment of musculoskeletal disorders in various work environments; however, increasing

employee physical and mental capacity by means of individualized strength-, mobility/motor

control- and cognitive training at the work site may represent a useful approach for reducing

chronic pain, stress and work disability in laboratory technicians

Smith (2008)

The purpose of this randomized controlled study was to evaluate the immediate effects of a single music relaxation session in adults in an occupational setting by measuring anxiety levels at the completion of employees shift. Data from 80 customer service specialists (n = 40 females, 40 males) were obtained from a call center in Queensland, Australia. A randomized controlled trial was conducted comparing the discussion group as the control condition to music relaxation as the experimental condition.

The findings that emerged from this study showed that study subjects who received the music relaxation intervention experienced a significant immediate decrease in state anxiety compared to the discussion group, where participants reported little change in state anxiety post intervention. These results support the hypotheses (i.e., that the music relaxation intervention would produce a significant decrease in participants' self-reported state anxiety measurement immediately after the intervention) and provide support for the use of music relaxation in an occupational environment to decrease anxiety after one session.

Bora et al. (2016)

Using a descriptive research design and drawing on primary and secondary data, these researchers identified relevant occupational stress factors and hazards experienced by female police officers in the workplace from the perspective of ergonomics and design intervention feasibilities, including assessment of the prerequisites for a stress-free workplace environment for police women The primary data were compiled from survey-based personal interviews and individual responses to a subjective assessment questionnaire. Secondary data were amassed from the office of the Commissioner of Police, journals, newspapers, articles and other published sources. The questionnaire was administered to female police personnel (n = 30, selected by purposive, non-probability sampling) of different ranks posted in the Pan Bazar Police Station (Guwahati, Assam, India).