Preventive Stress Management in Organizations [2 ed.] 1433811855, 9781433811852

Table of contents :
Contents
Preface
Introduction
1
Stress in Organizations
2
Organizational Demands, Risks, and Protective Factors
3
Individual Differences in the Stress Response
4 Individual Consequences of Stress
5 Organizational Consequences of Stress
6 Stress Measurement, Assessment, and Surveillance
7 Preventive Stress Management: Principles, Theory, and Practice
8 Organizational Prevention: Protecting People
9 Organizational Prevention: Nurturing Relationships
10 Primary Prevention for Individuals: Managing and Coping With Stressors
11 Secondary Prevention for Individuals: Modifying Responses to Inevitable Demands
12 Tertiary Prevention for Individuals: Healing the Wounds
13 Preventive Stress Management: Challenge and Opportunity
References
Index
About the Authors

Citation preview

Prevent Stress Title Page 2ndEd_Prevent Stress Title Page 5/27/12 4:16 PM Page 1

Preventive Stress Management in Organizations

Prevent Stress Title Page 2ndEd_Prevent Stress Title Page 5/27/12 4:16 PM Page 2

Preventive Stress Management in Organizations Second Edition

James Campbell Quick, Thomas A. Wright, Joyce A.Adkins, Debra L. Nelson, and Jonathan D. Quick

American Psychological Association Washington, DC

Copyright © 2013 by the American Psychological Association. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, including, but not limited to, the process of scanning and digitization, or stored in a database or retrieval system, without the prior written permission of the publisher. Published by American Psychological Association 750 First Street, NE Washington, DC 20002 www.apa.org To order APA Order Department P.O. Box 92984 Washington, DC 20090-2984 Tel: (800) 374-2721; Direct: (202) 336-5510 Fax: (202) 336-5502; TDD/TTY: (202) 336-6123 Online: www.apa.org/pubs/books E-mail: [email protected] In the U.K., Europe, Africa, and the Middle East, copies may be ordered from American Psychological Association 3 Henrietta Street Covent Garden, London WC2E 8LU England Typeset in Meridien by Circle Graphics, Inc., Columbia, MD Printer: Maple-Vail Book Manufacturing Group, York, PA Cover Designer: Minker Design, Sarasota, FL The opinions and statements published are the responsibility of the authors, and such opinions and statements do not necessarily represent the policies of the American Psychological Association. Library of Congress Cataloging-in-Publication Data Preventive stress management in organizations / [edited by] James Campbell Quick . . . [et al.]. —2nd ed.   p. cm. Includes bibliographical references and index. ISBN 978-1-4338-1185-2 — ISBN 1-4338-1185-5 1. Stress management. 2. Job stress. 3. Organizational change. I. Quick, James C. HF5548.85.P762 2013 658.3'82—dc23 2012002985 British Library Cataloguing-in-Publication Data A CIP record is available from the British Library. Printed in the United States of America Second Edition DOI: 10.1037/13942-000

Dedicated to Walter Bradford Cannon, MD, SD, LLD (1871–1945) Student of William James, Harvard College George Higginson Professor, Harvard Medical School Discoverer of stress and the fighting emotions Man of science and man of deep faith

Contents P r e f a c e   xi I n t r o d u c t i o n   3

1 Stress in Organizations  11 What is Stress?   12 The Stress Concept: A Historical View   16 Stress in Organizations   19 The Power of Prevention   22 Preventive Stress Management in Organizations   23 Stress: Challenge, Threat, or Hindrance?   25

2 Organizational Demands, Risks, and Protective Factors  27 Physical Environment   29 Technology—Crosscutting Effects   31 Functional Environment—The Content of Work   33 Contextual Environment—Organizational Culture   and Relationships at Work   38

3 Individual Differences in the Stress Response  43 Cognitive Appraisal   44 Types and Levels of Stress   45 Individual Differences in the Stress Process   46

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4 Individual Consequences of Stress  59 Behavioral Distress   61 Psychological Distress   63 Medical Distress   68 Eustress, Hope, and Optimism   72

5 Organizational Consequences of Stress  73 Organizational Health   74 Costs of Organizational Distress   76 Positive Paths to Psychological Health and Eustress in Organizations   85

6 Stress Measurement, Assessment, and Surveillance  87 Clearly Articulate a Vision   89 Select an Assessment Strategy, Measures, and Techniques   90 Establish a Baseline   97 Individualized Assessment   99

7 Preventive Stress Management: Principles, Theory, and Practice  103 Guiding Principles of Preventive Stress Management   103 The Theory of Preventive Stress Management   107 The Practice of Preventive Stress Management   108

8 Organizational Prevention: Protecting People  115 Organizational Health Center   117 Job Redesign   119 Career Development   123 Ergonomic Office Design   126 Work–Life Programs   128

9 Organizational Prevention: Nurturing Relationships  131 Resonant Leadership   132 Goal Setting   135

Contents

Social Support   138 Teamwork  141 Diversity Programs   144

10 Primary Prevention for Individuals: Managing and Coping With Stressors  147 Managing Personal Perceptions of Stress   148 Managing the Personal Work Environment   156 Managing Lifestyle   161

11 Secondary Prevention for Individuals: Modifying Responses to Inevitable Demands  165 Relaxation Training   166 Spirituality and Faith   171 Emotional Outlets   173 Physical Fitness   176 Nutrition  180

12 Tertiary Prevention for Individuals: Healing the Wounds  183 Emotional Health in the Workplace   185 Psychological Interventions   186 Health Care   191 Traumatic Workplace Events   193 Creating a Personal Preventive Stress Management Plan   193

13 Preventive Stress Management: Challenge and Opportunity  199 A Proactive Agenda for Preventive Stress Management   200 Looking Within: Be the Leader   203 r e f e r e n c e s   205 i n d e x   231 a b o u t t h e a u t h o r s   245

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im and Jonathan Quick began a dialogue about stress in the midst of graduate school and medical school, respectively. Jim was studying organizational stress, and Jonathan was studying preventive medicine. Jonathan envisioned the translation of the public health notions of prevention into Jim’s organizational stress work. As they say, the rest is history. Shortly after completing graduate school and medical school, the brothers set forth in their 1984 book the theory of preventive stress management. From there, their work was expanded and enriched through a complex array of colleagues and collaborators. Debra Nelson’s early interest in women’s stress began a process of collaboration that has reverberated through the years. Tom Wright and Joyce Adkins first connected with the team through their foundational work in occupational health psychology, when they both served on the first editorial board of the Journal of Occupational Health Psychology in the early 1990s. Tom’s cutting-edge scholarship and research method skills in character, character-based leadership, positive psychology, and positive organizational behavior strengthen the scientific dimension of this edition of the book. Joyce’s passionate advocacy for organizational health and clinical insights strengthen the applied practice dimension of this edition. We believe that the ideas resulting from our blended knowledge, expertise, and professional perspectives can make work and life better. We hope to accomplish three things with this edition of the book. First, we have updated the material throughout with the latest research, science, and theory in the domain of stress and prevention. Hence, we aim to place this edition on the leading edge of the field. Second, we work to bring forth the positive, strong side of the stress message. The successful xi

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management of stress is what enables us to live and live abundantly, with vitality. Stress is the spice of life, as well as, of course, the kiss of death! Its latter dimension has been well-known for half a century. Its former dimension is still emerging. Third, we have moved some important elements of the book, especially a rich index of assessment instruments and resources, to a website (http://pubs.apa.org/books/supp/ quick) that can be more quickly and easily updated to stay current. There are at least three new discoveries or issues since the last edition of the book, published in 1997, that are key to a good understanding of the story of stress. First, the discovery of the tend-and-befriend response has enriched our understanding of women’s multifaceted capacities under stressful conditions.1 This is a hugely consequential discovery and understanding from which men and women can both learn about responding to stress and recovering from distress. Second, the emergence of bullying and incivility in organizations as a major source of stress in the past decade is of concern. This should not be confused with legitimate challenge stress, which helps us grow, learn, and become stronger over time. Rather, we need to call it what it is: demeaning and abusive.2 Finally, the emergence of positive psychology, positive organizational behavior, and positive organizational scholarship since the turn of the century has added nicely to the array of skills for preventive stress management. These skills include building healthy organizations through resonant leadership and maintaining healthy relationships with practices of gratitude and forgiveness.3,4 We want to thank Linda Malnasi McCarter and Susan Herman at the American Psychological Association for their very much appreciated editorial support and development of this edition. We are deeply thankful to Lee Brown for his extensive and careful research support as well as manuscript review and coordination activities. We thank Wayne Martin, LCSW, for advanced understanding of the psychophysiology of stress, especially resonant heart rhythms. We thank M. Blake Hargrove for his thoughtful, critical reading and comment, along with his own emerging research in the domain of stress. We thank Glenn Hadsall of Bottle Rocket Corporation for his great graphic skills and artwork. Jim thanks the University of Texas–Arlington for the 2010–2011 faculty Taylor, S. E., Klein, L. C., Lewis, B. P., Grueewald, T. L., Gurung, R. A. R., & Updegraff, J. A. (2000). Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Psychological Review, 107, 411–429. doi:10.1037/0033-295X.107.3.411 2 Nelson, D. L., & Quick, J. C. (2013). Civility and incivility. In Organizational behavior: Science, the real world, and you (8th ed.; pp. 288–292). Mason, OH: South-Western/ Cengage Learning. 3 Boyatzis, R. E., Smith, M., & Blaize, N. (2006). Developing sustainable leaders through coaching and compassion. Academy of Management Learning and Education, 5, 8–24. doi:10.5465/AMLE.2006.20388381 4 Thompson, D. A., Grahek, M., Phillips, R. E., & Fay, C. L. (2008). The search for worthy leadership. Consulting Psychology Journal: Practice and Research, 60, 366–382. 1

Preface

development leave, which was instrumental in providing time for revision research and writing. Jim and Jonathan thank their wives, Sheri Schember Quick and Tina Quick, for editorial comments, critical feedback, and collaborative support over two decades of work together.

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Preventive Stress Management in Organizations

Introduction

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tress is an inevitable and integral component of the growth, development, and performance of individuals, groups, and organizations. Stress-induced energy is one of our best natural assets for managing legitimate emergencies and achieving peak performance. We believe, however, that the distress and strain that all too often result from traumatic events, or from nontraumatic but long-term difficult circumstances, such as long work hours, are not inevitable. Stress does not have to kill us; the successful adaptation to stress enables us to live with vitality and vigor. This book sets forth a framework for understanding stress—specifically, the way in which individuals’ assumption of personal responsibility transacts with groups and organizations in the process of successfully adapting to stress and stressful events. Our framework is called preventive stress management. Preventive stress management is an organizational philosophy and set of principles grounded in public health that uses specific methods for promoting individual and organizational health while preventing individual and organizational DOI: 10.1037/13942-014 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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distress. Preventive stress management consists of a set of basic ideas about how an organization can operate to its fullest potential and what approach leaders can take toward managing the demands of organizational life. The approaches outlined in this book may be implemented by leaders in any organization. The implementation strategy and specific methods should be designed to fit the organization and should consider both organizational and individual methods of preventive stress management. Let’s look at an example of how preventive stress management works. One case example comes from the closure of a 13,000-person aircraft maintenance and logistics depot in Texas over a 6-year period. The CEO of the industrial facility used preventive stress management theory and practice to ensure the healthy transition of workloads to other parts of the United States while at the same time supporting all of the 13,000 employees who would be transferred, retired, or laid off. The CEO’s first action was to create a senior position on his staff for a fulltime psychologist to serve as the organizational clinical psychologist for the facility. The CEO informed all of the senior leaders about the importance of successful stress management during the transition and closure process and introduced the psychologist as the senior leader who would coordinate and oversee all assessment and prevention efforts. The organizational clinical psychologist recruited for the position built a board composed of all departments concerned with people in the organization. The board met monthly and coordinated monitoring activities for the health and well-being of all leaders, supervisors, and employees throughout the large depot. A major educational initiative was undertaken to inform everyone about stress, its impact on the mind and body, and the early warning indicators of possible problems. The educational message normalized stress responses under high-stress conditions like those that affected this large workforce. Along with the major educational initiative, the organizational clinical psychologist set up a referral and support system with the idea that about 1% to 3% of the employees would be at high risk of a stress breakdown because of the closure decision. Several hundred employees were screened into the support system and were provided with the best psychological services, financial counseling, family-support coaching, and other services needed to ensure their well-being. Training and educational seminars presented all employees with a range of preventive stress management actions that they could undertake to help themselves, such as planning and goal setting, regular exercise and relaxation or prayers, good nutrition, and regular interactions with loved ones and friends. Individual executive coaching with key leaders throughout the organization ensured that they knew what to look for in keeping all of their employees healthy and productive. Not a single fatality occurred through this very stressful process, either

Introduction

through suicide or homicide. The other two indicators of successful preventive stress management were no incidences of workplace violence and over $33 million in cost avoidance of formal complaints, as estimated by human resources. Clearly, preventive stress management practice began with the CEO and then ran through the leadership and employees of the entire organization.

Who Should Read This Book The primary audience for this book is psychologists who work with leaders and organizations. The audience includes consulting psychologists, occupational health psychologists, organizational and industrial psychologists, and clinical psychologists. Many of these professionals have practices through which preventive stress management is one asset in their inventory of products and services that help people live healthier lives. The secondary audience for this book is organizational members, both leaders and employees, who work where the rubber meets the road. These leaders and employees can assess the information and skills of preventive stress management to improve their work and personal lives while having a positive impact on others around them in the organization.

Themes in Preventive Stress Management As mentioned previously, our model of preventive stress management is rooted in public health, particularly the notions of health promotion and disease prevention (Mensah et al., 2005). With those building blocks as a foundation, the organizational prevention methods we review in this book protect people by altering the structure, function, and relationships throughout the organization by either managing demands on people or enhancing support that people receive. Along with organizational prevention, we highlight individual prevention, which aims to change the individual’s cognitive and behavioral ability to manage various demands and the individual’s skills in responding to inevitable and necessary demands. Preventive stress management is a distinctively proactive model of organizational change. The intent is that individuals and organizations anticipate and avert most crises by shaping events, instead of reacting

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to events after the fact. The three stages of prevention involve organizational or individual interventions directed at the stressor, the stress response, and the resulting symptoms of stress. Preventive stress management draws on positive psychology and strengths-based intervention with individuals by first recognizing that every individual has core strengths. Through executive coaching, professional development, and leadership education, individuals gain insight into their own strengths, interests, passions, and abilities. Individuals often overcome stress and adversity when they draw on their strengths and innate capacities. Positive psychology is anchored in the recognition that building on strength can be the best pathway forward for individuals, even in times of stress, threat, and trauma.

How This Book Is Organized Stress is directly or indirectly linked to seven of the 10 leading causes of death in the United States and all developed countries. We began to understand the contribution of stress to disease and illness by the late 1900s. What was overlooked in that discovery was the positive role of stress that leads to eustress. Eustress is the exciting, joyful, inspiring, and stimulating side of stress. Chapter 1 lays the groundwork for preventive stress management by examining the stress process itself. The stress process begins with organizational demands and stressors that trigger the stress response, whose intensity, duration, and frequency are influenced by a number of individual difference modifiers. The process ends in either healthy (eustress) or unhealthy (distress) individual and organizational outcomes. Chapter 2 explores the causes and origins of stress in organizations, framing an understanding of stress as a process with a beginning in organizational life. Chapter 3 examines specific vulnerability as well as strength factors that can shield and protect the individual from stress. Chapter 4 discusses individual consequences of stress. These consequences may be either healthy and eustressful or unhealthy and distressful. The eustressful consequences for individuals include health, vitality, productivity, and well-being. As noted, Nelson and Simmons (2011) have advanced this positive agenda in the domain of stress while at the same time recognizing that distress cannot be ignored. Individual distress takes three forms: behavioral distress (e.g., substance abuse, accidents, violence, appetite disorders), psychological distress (e.g., burnout, depression, family problems, sexual dysfunctions), and medical

Introduction

distress (e.g., cardiovascular disease, headaches and backaches, peptic ulcer disease, some forms of cancer). Chapter 5 describes the consequences stress can have for organizations. Eustressful consequences include organizational health, vitality, productivity, and well-being. Again, organizational distress cannot be ignored and falls into two categories: direct costs (e.g., participation and membership problems, job performance problems, health care costs, compensation awards) and indirect costs (e.g., communication problems, faulty decision making, violence). At the end of Chapter 5, we explore the positive paths to organizational eustress as embodied in the American Psychological Association’s Psychologically Healthy Workplace agenda. The theory of preventive stress management, by resting on the public health notions of prevention (Mensah et al., 2005; Wallace & Doebbeling, 1998), calls for the measurement and assessment of the stress process using advanced epidemiological notions of surveillance. Organizations and individuals must observe carefully and be fully mindful of the causes and consequences of their own stress. Public health and preventive medicine help us do that by bringing attention to the measurement and assessment process. Without data and surveillance information, there is limited potential for health promotion, health protection, and/or preventive intervention. With data and surveillance information, the stage is set for positive action. Chapter 6 covers this. In Chapter 7, we lay out our theory of preventive stress management, which has been revised since the previous edition of this book. The theory is still anchored in the public health notions of prevention but now builds on emerging agendas in positive psychology, positive organizational behavior, and positive organizational scholarship. Together, these currents are creating new opportunities and skills for turning stress into eustress. The fundamental principles have not changed over the 33-plus years since the conception of theory and practice. However, there is greater emphasis now on health promotion and eustress while not ignoring or discounting distress for individuals or organizations. Primary, secondary, and tertiary prevention as a framework has been maintained, and new, more positive skills and interventions that have emerged in the 13 years since the publication of the first edition of the book have been infused in the chapters that elaborate these interventions. Chapters 8 and 9 retain the best methods of the first edition while incorporating new organizational interventions. These new interventions include an organizational health center concept led by a chief psychological officer. The U.S. Air Force has implemented this concept, for example, within the Air National Guard system with directors of psychological health in each of the 50 states, driving the concept deeper

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into the combat organizations with directors of psychological health in units such as the 149th Fighter Wing, Texas Air National Guard, based at Lackland Air Force Base, Texas. These directors of psychological health can help commanders implement another new organizational intervention: resonant leadership, which is featured in Chapter 9. New and positive interventions for individuals are also incorporated into Chapters 10, 11, and 12, beginning with the positivity ratio and gratitude expression as primary prevention interventions for individuals. Whereas primary prevention concerns managing the demands and source of stress in organizations, secondary prevention concerns strategies for altering how a person responds to inevitable and necessary demands and stressors. Tertiary prevention is intended to help heal individuals in distress. Traumatic events do happen in organizations and distress does occur. Healing the wounds may not be easy, yet positive outcomes from bad experiences are possible.

How to Get the Most Out of This Book This book can be read cover to cover, or in other ways. For practitioners already familiar with causes and consequences of stress, we invite you to consider skipping through the first six chapters and diving right into preventive techniques. Readers new to or considering practice in industrial and organizational psychology or related fields might consider spending some time in the first six chapters, especially Chapters 5 and 6, or even Chapter 13 for research ideas. We invite you to read the sidebars in the chapters to get an overview and feel. Consider placing yourself in the prevention process at various stages. We invite you to our book’s companion website (http://pubs.apa.org/books/supp/ quick/) to consider assessment tools and resources or groups to complement the book. Do you know a resonant leader (see Chapter 9)? Was he or she an inspiration? Well, there is no best way to use this book; these are just some of the possibilities.

References Mensah, G. A., Dietz, W. H., Harris, V. B., Henson, R., Labarthe, D. R., Vinicor, F., & Wechsler, H. (2005). Prevention and control of coronary heart disease and stroke—nomenclature for prevention approaches in

Introduction

public health: A statement for public health practice from the Centers for Disease Control and Prevention. American Journal of Preventive Medicine, 29(5S1), 152–157. Nelson, D. L., & Simmons, B. L. (2011). Savoring eustress while coping with distress: The holistic model of stress. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology (2nd ed., pp. 37–54). Washington, DC: American Psychological Association. Wallace, R. B., & Doebbeling, B. N. (1998). Maxcy-Rosenau-Last public health and preventive medicine (14th ed.). Stamford, CT: Appleton & Lange.

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ver time, stress has been one of the most widely studied topics in the psychological, sociological, psychiatric, and organizational behavior literature (C. L. Cooper, Dewe, & O’Driscoll, 2001; Hobfoll, 1998). What is new and what has exploded in the recent past is our understanding of the stress response and its role in health and disease processes. If one examines the top 10 causes of death in the United States, one won’t find the word stress specifically listed. However, as noted by Benson and Casey (2008), stress has been linked to the Number 1 and Number 3 killers in the United States—heart disease and stroke. If that isn’t enough of an incentive to become more aware of the role of stress in health and well-being, there is also a growing body of evidence that stress is linked to cancer, lower respiratory disease, depression, anxiety, asthma, rheumatoid arthritis, and such gastrointestinal problems as irritable bowel syndrome (Benson & Casey, 2008). Stress is directly linked, in the cases of heart disease, stroke, injuries, suicide, and homicide, or indirectly linked, in the cases of cancer, liver disease, and DOI: 10.1037/13942-001 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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emphysema, to seven of the 10 leading causes of death in the United States and all developed countries (J. C. Quick & Cooper, 2003). Although there is no single cause for either stress or distress, an important contributing factor to contemporary distress in the workplace is global economic competition, which has led to increased downsizing and job outsourcing (Hargrove, Cooper, & Quick, 2012). According to recent figures from the Bureau of Labor Statistics (2011), the number of mass layoff events in just April 2011 (each involving 50 or more employees from a single employer) was 1,750. This resulted in almost 200,000 new unemployment insurance claims for that month alone, further significantly straining the already distressed U.S. economy. According to Brown and Siegel (2005), a number of these downsizing efforts resulted from the outsourcing of jobs to overseas markets. This sounds daunting, and some professionals would have us believe that we are hopelessly locked in an age of anxiety or extraordinarily stressful times. Consistent with the emergent positive movements, positive organizational behavior, positive organizational scholarship, and positive psychology (Wright & Quick, 2009a), we offer a different and more optimistic view that performance achievement and health are mutually supportive in the context of work organizations. This chapter presents an overview of stress as an important issue for successful organizations to consider in the ever-changing 21st century. The first section is presented because, frankly, there is no universal and scientific definition of the word stress (Kahn, 1987). The second section presents a historical overview of the stress concept from its identification in 1915 through the present. The third section places stress in the context of work and organizational life. Incorporating a positive-based approach, the final section presents the preventive stress management model, which has its foundation in the public health notions of prevention and epidemiology.

What Is Stress? Stress is a creatively ambiguous word with little agreed-on scientific definition (Kahn, 1987). The concept of stress is a wonderful overarching rubric for the domain concerned with how individuals and organizations adjust to their environments; achieve high levels of performance and health; and/or become distressed in various medical, behavioral, and psychological ways. Therefore, because we use the term stress as a rubric, we are comfortable allowing it to maintain its creative ambiguity at that level. However, at the operational level, it is important to define the scientific terms within the domain of stress, and we do so to give more precise and clear meanings. The specific terms to be defined are stressor or demand, the stress response, eustress, and distress or strain.

Stress in Organizations

The stressor is the physical or psychological stimulus to which an individual responds.

The stress response is the generalized, patterned, unconscious mobilization of the body’s natural energy resources when confronted with a demand or stressor.

Stressor, Demands, and the Stress Response The stress response begins with a stressor or demand, which serves as the trigger for a series of mind–body activities. The stressor is the physical or psychological stimulus to which an individual responds. Demand is another term for stressor. There are differences of opinion with regard to whether stressors and demands may be universally defined or whether they must be specifically defined in the context of a particular individual’s experience. We think that it is best to define stressors and demands in the context of the experience of the individual because of the variations in the way individuals appraise levels of stress and cope with stress. However, we understand the validity of identifying stressors or demands for specific populations. That is discussed further as we introduce the role of our positive approach to public health in preventive stress management. The second term that is important to define in the domain of stress is the stress response. The stress response is the generalized, patterned, unconscious mobilization of the body’s natural energy resources when confronted with a demand or stressor. The mobilization occurs through the combined action of the sympathetic nervous system and the endocrine (hormone) system. These systems are activated by the release of catecholamines, primarily adrenaline and noradrenaline, into the bloodstream. The stress response is most often manifested in elevated heart rate (even tachycardia), increased respiration and perspiration, and a bracing response characterized by the tightening of the large muscle groups throughout the body. Although these manifest signs of the stress response are the most visible, it is the four less visible psychophysiological changes that may be more important to understand. All of these actions are designed to prepare a person to fight or to flee, hence the description of the stress response as the fight-or-flight response. In addition, some individuals appear to display a freeze response. The four mind–body changes that constitute the stress response are as follows. First, there is a redirection or shunting of the blood to the brain and large muscle groups and from the extremities, skin, and vegetative organs. This aspect of the stress response repositions the body’s resources where they are needed for a legitimate emergency. Second, there is an enabling of the reticular activating system in the ancient brain stem, which leads to a heightened sense of alertness. This activation sharpens vision, hearing, and the other sensory processes and attunes an individual to the environment more fully. Third, there is a release of glucose and fatty acids, which are the fuels that sustain an individual during this period of emergency. Fourth, there is a shutting down of the immune system and the body’s emergent and restorative processes, such as digestion. While the immune system as well as emergent and restorative processes are essential to long-term health and

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well-being, they are of secondary importance during periods of emergency. This complex of four basic mind–body changes prepares a person to do what is essential during a stressful situation. The stress response is highly functional when properly managed, leading to eustress and elevated performance. There is also a downside to the stress response, for individuals, and for organizations, which is called distress. Distress occurs when the stress response is not well managed or when it goes awry. We next discuss eustress, followed by distress.

Eustress and the Yerkes–Dodson Law Eustress is good stress, from the Greek root eu for good (Selye, 1976a, p. 15). Hans Selye suggested thinking of eustress as euphoria + stress, hence eu-stress. Eustress is the medical way of identifying healthy stress, with eu being the prefix for normal or healthy. Eustress may be defined as the healthy, positive, constructive outcome of stressful events and the stress response. Some of the positive, healthy effects of an optimum stress load on performance have been known since 1908 and are expressed in the Yerkes–Dodson law, shown in the graphic in Figure 1.1 (Yerkes & Dodson, 1908). As the figure shows, performance increases with increasing stress loads up to an optimum point, and then the stress load becomes too great, resulting in depressed performance. The optimum stress load that maximizes performance varies by individual and by task on the basis of several considerations. Individual considerations include susceptibility to stress, fatigue, psychological and cognitive skills, and physical capacity. Task considerations include complexity, difficulty, duration, and intensity. The interaction, as reflected in the person’s familiarity with the task, also

F i g u r e 1 . 1  Hi Performance

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Lo Lo

Stress Level

The Yerkes–Dodson law.

Hi

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affects the shape and size of the particular Yerkes–Dodson curve. Too little stress and arousal often fails to stimulate performance, just as too much stress and arousal can interfere with performance, especially of complex tasks. Workplace confirmation of this proposed curvilinear relationship has been found for both performance (Wright, 1989) and employee turnover (Wright, 1991). High-performing workers who are underused were more likely to voluntarily quit their jobs than those workers who were more optimally used. These findings clearly indicate that an optimal use of employee skills and abilities can benefit both the employee and the organization through enhanced employee performance and optimal retention. Consistent with this approach, a key focus of this book is positive-based strategies for enhancing eustress so as to create high levels of health, wellbeing, and performance.

Distress and Strain Individual distress (strain) is the degree of physiological, psychological, and/or behavioral deviation from an individual’s healthy functioning.

Organizational distress (strain) is the degree of deviation that an organization experiences from a healthy, productive level of functioning.

Distress is rooted in the Latin prefix dis, meaning bad (Selye, 1976a, p. 15), and refers to the unhealthy, negative, destructive outcome(s) of stressful events and/or the stress response. Strain is another word for distress, and we use the two terms interchangeably. Individual distress (strain) is the degree of physiological, psychological, and/or behavioral deviation from an individual’s healthy functioning. Individual distress and strain are expressed in commonly seen disorders such as cardiovascular disease (physiological), depression (psychological), and/or violence (behavioral). Stressful events and the stress response are not the sole causes of these forms of individual distress and strain, yet they are important contributing factors in the onset of the distress or in the acceleration of the strain process. Individual distress and strain have important implications for organizations because they can manifest themselves in various forms of organizational distress and strain. For example, although an accident on the job is a form of individual distress for the employee, it is also a type of organizational distress for the company in the form of medical costs, lost work time, and replacement work costs. Organizational distress (strain) is the degree of deviation that an organization experiences from a healthy, productive level of functioning and may be expressed in direct costs, such as absenteeism and dysfunctional turnover, or in indirect costs, such as low morale and poor working relationships. As we see later, individual and organizational predispositions are important in understanding individual and organizational distress. Although some individuals may be predisposed to physiological distress because of their unique vulnerability, other individuals may be predisposed to psychological distress. Likewise, although some organizations may have cultures that foster absenteeism in response to distressing working conditions or workloads, other organizations may have cultures

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that foster apathy and low levels of productivity while individuals are on the job. Hence, the individual’s and the organization’s unique vulnerabilities become important ingredients in understanding their experience of stress and expression of distress and strain. The work of Fredrickson and her colleagues (Fredrickson & Levenson, 1998; Fredrickson et al., 2000) clearly demonstrated the potential power of a positive approach to preventive stress management. More specifically, they found that feelings of sadness (psychological distress), fear, and anxiety arouse an individual’s autonomic systems, producing heightened blood pressure and heart rate. Conversely, positive feelings of happiness and well-being can be effective in lowering surges in cardiovascular activity, both in intensity and duration. Fredrickson’s research documents that not all stressful events need turn out badly as distress.

The Stress Concept: A Historical View The stress concept has its foundations in medicine and physiology in the early and middle parts of the 20th century. It was elaborated on later by several prominent psychologists. Over the past 30 years, a public health dimension has been added to the stress domain, reshaping how the stress concept is viewed and understood.

Medical Foundations The identification of the Yerkes–Dodson law actually preceded the identification of the stress response. Following a line of medical investigation in laboratory animals, Walter B. Cannon extrapolated from his basic findings and hypothesized around 1915 that there was a complex of psychophysiological activities occurring within the body under stressful conditions that he labeled the emergency reaction. His later discussions of the stress response viewed it as rooted in “the fighting emotions”— hence his later labeling of stress as the fight-or-flight response. Following these basic discoveries and working largely independently, Hans Selye became curious about the general syndrome of “being sick.” Selye’s systematic investigations into the effects of environmental stress on humans and other animals began in 1932 and showed that a chief effect was the release of adrenal-gland hormones, normally leading to an appropriate adaptation to the stress-causing situation (Selye, 1976b). The adaptation mechanism may malfunction, leading to one or more diseases of maladaptation. Selye’s (1973, 1976a) framework is summarized in the general adaptation syndrome (GAS). The GAS has

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three primary stages: alarm, resistance, and exhaustion. The alarm reaction can be associated with what we have defined as the stress response and what Cannon labeled as the emergency reaction. The great power of Selye’s contribution centers in the resistance stage of the GAS, for it is from this stage that so much distress proceeds or, to use Selye’s terminology, the diseases of adaptation. In the resistance stage, the individual struggles with the demand or stressor and in many cases struggles with himself or herself. Selye did more than anyone else in this century to raise awareness of the role of stress in our health and disease processes. Although Cannon and then Selye were primarily focused on the medical and physiological dimensions of stress and the stress response, with particular attention to the sympathetic nervous system and endocrine system activities, they were not unmindful of the role that fear, anger, rage, and other emotions might play in the process. However, it was for later psychologists to elaborate on the psychological dimensions of the stress concept.

The Psychological Elaborations There have been three psychological elaborations of the stress concept during the middle and latter parts of the 20th century. The first psychological contribution to the stress concept came from Robert Kahn and his colleagues, who examined the social psychological processes of role conflict and ambiguity (i.e., role stress) in organizations (Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964). The second psychological contribution to the stress concept came from Richard Lazarus and his colleagues, who focused on the processes of cognitive appraisal and coping (Lazarus, 1967). The third psychological contribution to the stress concept came from Harry Levinson, who framed a psychoanalytic view of occupational and executive stress (Levinson, 1975, 1978).

Role Stress in Organizations Kahn et al. (1964) extended the stress concept by incorporating a social psychological theory into the stress domain. Their focus in studying organizational stress was on the role-taking process in organizations and on the constructs of role conflict and role ambiguity, with later attention to the notion of person–environment fit within the realm of one’s social role. The core contribution of their research was to enable us to understand how the conflict and confusion that occurs in the social process of an organization can lead to individual distress and strain, with its associated organizational costs. Hence, rather than focusing on the individual, this line of elaboration focuses on the network of relationships in any organization, be it a small business, a family, a military unit, or a religious order.

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Cognitive Appraisal and Coping Lazarus and his associates extended the stress concept and introduced the notions of cognitive appraisal and coping (Lazarus, DeLongis, Folkman, & Gruen, 1985). Lazarus’s basic line of argument was that individuals see the same demands and stressors differently on the basis of their cognitive appraisal of them; some individuals see a specific demand or stressor as a threat, and other individuals see the same demand or stressor as a challenge or opportunity. From this perspective, the focus shifts away from the actual demand or stressor to the individual’s perception of that demand or stressor. Lazarus argued that it is not possible to fully separate the individual’s perception of and response to a demand or stressor from the demand or stressor itself. This psychological elaboration of the stress concept led to an interactionist framework for understanding eustress, distress, and strain (Lazarus et al., 1985). The implication of this conceptual model is that individuals may engage in either problem-focused or emotion-focused coping strategies to manage their stress.

The Psychoanalytic Perspective Levinson (1975, 1978) took a still different approach to elaborating the stress concept, with particular attention to an executive’s psychodynamics. He defined stress through the use of two basic concepts: the ego ideal and the self-image. The ego ideal is the personality element that embodies an individual’s idealized self. This unconscious or semiconscious element of the personality arises out of parental models; a person’s hopes and fantasies about self-perfection; and the desirable characteristics an individual sees in heroes, heroines, and mentors. This perfect or idealized self stands in contrast and tension with an individual’s self-image. The self-image is composed of both positive and negative attributes that an individual understands to characterize himself or herself. For Levinson, stress is the tension or discrepancy between the ego ideal and the self-image—the greater the discrepancy, the greater the stress.

The Public Health Dimension With the identification of work-related psychological disorders and distress as among the top 10 occupational health risks in the United States, the stress concept moved into the public health domain (J. C. Quick, Murphy, & Hurrell, 1992; Sauter, Murphy, & Hurrell, 1990). Starting in the mid 1970s, we began translating the public health notions of prevention into a stress framework, leading to the development of the preventive stress management model (J. C. Quick & Quick, 1984). Over

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the last 10 years, innovative and exciting work from positive psychology and the positive organizational movements has allowed us the opportunity to further refine and delineate our preventive stress management approach. One such approach involves the examination of the role of employee character strengths in both individual betterment and organizational health (Wright & Huang, 2008; Wright & Quick, 2011). One promising strategy for organizations to optimally select the potential business leaders of tomorrow is to consider those individuals who not only are psychologically well but also exhibit spiritual vitality and ethical character. More specifically, Wright (2010b) suggested the need for socially conscious organizations to prioritize the hiring and promotion of job applicants with either a verified history of making ethically based choices or a high potential for making ethically based decisions. Having socially conscious employees work in an ethical environment provides a more optimal employee–organization fit, resulting in reduced stress for all stakeholder participants (Wright, 1991).

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Job stress is

Stress in organizations is of concern to both managers and professionals because of the costs associated with job strain and job distress, which are the adverse consequence of job stress. Organizations pay a price for dysfunctional work behaviors, either violent or nonviolent (Griffin, O’LearyKelly, & Collins, 1998). The direct costs include dysfunctional turnover and absenteeism, health care costs, and compensation awards of various categories. The indirect costs include poor morale and job dissatisfaction. However, again, not all stress at work is bad, nor is all job stress destructive. Consistent with the positive organizational movements and a positivebased eustress focus (Luthans, 2002; Wright, 2003), we suggest that job stress does not necessarily lead to distress or strain.

the mind– body arousal resulting from physical and/or psychological demands associated with a job (J. C. Quick & Nelson, 1997).

Job Stress In addition to the terms within the domain of stress defined earlier in the chapter, there is one other term that should be defined: job stress. Job stress is the mind–body arousal resulting from physical and/or psychological demands associated with a job (J. C. Quick & Nelson, 1997). Job stress may lead to enhanced job performance up to an optimum level of stress (eustress); conversely, job stress may place an employee at risk of distress if the job stress is too intense, frequent, or chronic (Selye, 1976a, 1976b). Understanding job stress is important in reducing the

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Stress management programs are strategies for preventing job strain and channeling job stress into healthy and productive outcomes (J. C. Quick & Quick, in press-b).

job strain (job distress) all too often associated with stress in organizations. This is often achieved through stress management programs, which are strategies for preventing job strain and channeling job stress into healthy and productive outcomes (J. C. Quick & Quick, in press-b). Job stress is triggered by a wide variety of job demands, which include taskspecific demands, role demands, interpersonal demands, and physical demands (J. C. Quick & Quick, 1984). These demands may or may not be inherently or necessarily harmful. In line with Lazarus’s perspective, the degree of stress they elicit in a person depends in part on the individual’s cognitive appraisal of that demand. Lack of control over and uncertainty about aspects of the psychosocial and physical work environments in industrialized nations are major sources of job stress (Sutton & Kahn, 1987). Extreme working environments, such as those of military fighter pilots or oil field service personnel in Arctic climates, create unique physical and/or peak demands (Gillingham, 1988). Consistent with our positive-based approach, Wright (2010b) suggested that individuals in extreme contexts are best served with a signature profile in character that includes the strengths of valor, honesty, perseverance, critical thinking, and selfregulation. However, and irrespective of the work context, whether the job stress level is healthy or unhealthy is determined in part by the prevalence of job strain within a given work population. High-strain jobs, characterized by high job demands and low employee control, have significantly higher incidence rates of distress, such as myocardial infarction (Theorell & Karasek, 1996).

Work: Benefits and Risks Work is an important feature of a full and healthy life. Individuals realize at least three benefits from their work. First, work for economic gain provides for the necessities of life by affording individuals income and benefits. Income and benefits are enabling factors for a person to meet a range of human needs, including basic needs for food and shelter as well as higher level needs for esteem and discretionary or leisure time activities. Income is one of three components determining an individual’s socioeconomic status (SES), and SES is a strong and consistent predictor of morbidity and premature mortality (Adler, Boyce, Chesney, Folkman, & Syme, 1993). This predictive power is found also for each of the key components of SES: income, education, and occupational status. Hence, income and occupational status positively benefit the individual in terms of health. Second, work is a defining feature of a life that affords individuals a basis for identity and human connection. Therefore, one’s work and occupation are vehicles that bring meaning into a person’s life and give

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one’s life value. Work is not the only basis for meaning, identification, and value in life, but it is one basis. Third, in accordance with Freud’s comment, work is one of two key elements that contribute to a person’s psychological health and wellbeing. Whereas work contributes to psychological health and well-being, the absence of work through displacement and/or unemployment can lead to significant adverse health consequences (Hargrove et al., 2012). Hence, people psychologically benefit from their work involvement. In addition to the benefits of work, there are also health risks associated with work in organizations. The health risks vary by occupational category, organization, and specific work setting. The two major categories of health risks are physical and psychological. First, there is physical health risk associated with various forms of work. Although the nature of the physical risks of work changed with the industrial revolution, there continues to be health risk associated with agrarian work. For example, farm equipment accidents are among the leading causes of death for the young in the agricultural sector of the United States. In industrial work settings, equipment accidents and injuries are among the most serious and life-threatening risks associated with work. In Germany during the 1860s, Chancellor Bismarck proposed that employees were entitled to medical care and some form of wage supplement to assist them in dealing with on-the-job injuries (Adams, 1987). Hence, physical injury was to become a work-related risk with costs for employers as well as employees. There are psychological health risks to which employees are subject. These health risks emerge from the psychological, social, and interpersonal dimensions of a person’s work environment. Dysfunctional conflicts, psychological or interpersonal abuse, confusion and uncertainty, and other psychosocial risks may take a toll on a person at work.

Occupational Stress: A Leadership Challenge Occupational stress has become a leadership challenge primarily because of the direct and indirect organizational costs associated with these risks and distress associated with work (Adkins, 1995; Cascio, 2011). The challenge for leaders is to create organizational cultures and work environments in which people may produce, serve, grow, and be valued. This challenge is not, however, exclusively a leadership challenge. It is a challenge for each and every member of a work organization; it is a challenge for management and labor, men and women, leaders and followers, and employers and employees alike. Leaders must take the lead in setting the tenor for healthy work environments, and followers must accept their responsibility to enhance the health of the work environment. One of the increasingly important direct costs concerns the legal liability to which a company may be exposed unless it learns to moni-

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tor, diagnose, and treat a distressful situation before it goes to court (e.g., Frank Deus vs. Allstate Insurance Company, 1990–1992). Ivancevich, Matteson, and Richards (1985) argued for a five-point program consisting of (a) formulation of a preventive law strategy, (b) development of a stress diagnostic system, (c) involvement of top-level management, (d) evaluation of current programs, and (e) documentation of what has been done. Responsible action cannot prevent all job distress or all litigation; however, it is an important first step in implementing a program of preventive stress management in organizations.

The Power of Prevention It would be nice . . . if there were not risks associated with work . . . if people did not get injured on the job . . . if there were no dysfunctional conflicts among people at work . . . if cooperation, productivity, service, and health were the hallmarks of all working environments! Yes, all of that would be nice; unfortunately, that is not the current organizational reality. Therefore, there is a need for prevention and therapy in dealing with the health risks in work organizations. We believe that the platform for action in this regard is the preventive medicine model used in public health for dealing with health risks and disease epidemics in human populations (Wallace & Doebbeling, 1998). There is great power found in the public health notions of prevention in ameliorating the burden of suffering that individuals and human communities experience. We begin to set forth our prevention framework by focusing first on life expectancy as the acid test in stress management.

The Acid Test: Are You Dead or Alive? Vaillant (1977) did not believe that stress killed people. Rather, he argued that it was the capacity of the individual to adapt to the demands and stressors of life that enabled people to live. Hence, the acid test of one’s stress management skills might well be the question, Are you dead or alive? Danner, Snowdon, and Friesen (2001) provided solid testimony to the benefits of adopting a positive approach to the demands and stressors of life. In a novel design, Danner et al. (2001) coded the handwritten autobiographies for 180 Catholic nun novitiates. The autobiographies were composed before the nuns took their final vows and were coded for both positive and emotional content. Providing strong evidence of the value of a positive approach, positive emotional content was significantly associated with life span measured 6 decades later. Those nuns in the top quartile of reported positive emotion sentences lived both

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healthier and longer—on average 6.9 years longer—than those nuns in the lowest quartile. The moral of this research is: Being positive in one’s outlook on work and life is highly consistent with the core tenets of public health and preventive medicine approaches.

Public Health and Preventive Medicine Public health and preventive medicine are highly relevant to work organizations because they are composed of large human communities. Health risk assessment, public education, psychological intervention, and medical treatment are all elements of preventive medicine. Sauter, Murphy, and Hurrell (1990) set forth a national strategy for the prevention of work-related psychological distress that is based on public health concepts and preventive medicine. The four major components of their strategy are (a) work and job redesign, (b) surveillance of stressors and distress in the workplace, (c) education and training programs, and (d) mental health service delivery for distressed employees. The core intent of this national strategy is to encourage the development of psychologically healthy occupational work environments. The strategy is comprehensive because it addresses aspects of the organization as well as the individual as points of intervention for change, accommodation, and development.

Occupational Health Psychology Occupational health psychology (OHP) is a specialty at the crossroads of public health and health psychology (J.C. Quick & Tetrick, 2011). OHP is distinguished by its focus on occupational settings, work environments, and organizations. Highly consistent with positive-based psychology and positive organizational behavior and scholarship (Wright, 2010b), OHP is about healthy people in healthy work environments and about healthy interactions between work and home environments. OHP incorporates the preventive and treatment interventions designed to bring about psychologically healthy workplaces. OHP has a threefold focus on the work environment, the individual, and the work–home interface.

Preventive Stress Management in Organizations Preventive stress management takes the public health notions of preventive medicine and translates them for application to a stress process framework in work organizations (Hargrove, Quick, Nelson, & Quick, 2011; J. D. Quick, Quick, & Nelson, 1998). The preventive stress management model

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F i g u r e 1 . 2  Organizational Demands and Stressors Task demands Role demands Physical demands Interpersonal demands

Modifiers of the stress response

Stress Responses Individual responses Organizational responses

Primary prevention: stressor-directed

Secondary prevention: response-directed

Distress Individual Behavioral problems Psychological problems Medical problems

Tertiary prevention: symptom-directed

Organizational Direct costs Indirect costs

The preventive stress management model.

Preventive stress management is an organizational philosophy and set of principles that uses specific methods for promoting individual and organizational health while preventing individual and organizational distress.

is shown in Figure 1.2. Preventive stress management is an organizational philosophy and set of principles that uses specific methods for promoting individual and organizational health while preventing individual and organizational distress. The major foci in preventive medicine are health risks, asymptomatic disease, and symptomatic disease. Health risks predispose one to develop disease, either without (asymptomatic) or with (symptomatic) symptoms such as pain, discomfort, or recognizable signs. The power of preventive medicine is found in the development of prevention strategies to address health risks (primary prevention), asymptomatic disease (secondary prevention), and/or symptomatic disease (tertiary prevention). When translated into a stress process framework, the major foci in preventive stress management are (a) demands or stressors, (b) stress responses, and (c) the various forms of distress. The translation of the notions of prevention again leads to one of three foci, which are the primary, secondary, and tertiary stages of prevention. Primary prevention aims to modify the demands or stressors to which people are subject in the work environment. Secondary prevention aims to change how individuals and organizations respond to the necessary and inevitable

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demands of work and organizational life. Tertiary prevention, which is therapeutic, aims to treat the psychological, behavioral, or medical distress that individuals, groups, and organizations may encounter. In this edition of the book, we introduce quaternary prevention and the concept of organizational protection in Chapter 2. Positive-based preventive stress management is the framework we propose as the platform for designing, organizing, implementing, and evaluating stress management interventions in organizations. Building on the emerging framework of the positive organizational movements and our eustress approach, the stress process model in the figure and the three stages of prevention are the organizing schema for the whole book.

Stress: Challenge, Threat, or Hindrance? Work and organizational life are undergoing dramatic change, and we expect that to continue and increase as we move deeper into the 21st century. Change is a major source of stress for people in organizations. Is change-induced stress simply a challenge, or a threat, or perhaps just a hindrance? Although our mind–body system may say it is a threat, maybe we need to change our minds and see the challenge and opportunity that stress may offer. Staw, Sandelands, and Dutton (1981) found a general tendency for individuals, groups, and organizations to experience environmental change as a threat. The experience of threat leads to a response of rigidity, which results from two processes. First, feeling threatened results in the restriction of information flow. Second, feeling threatened results in constriction of control. The two processes combine to cause rigidity, which is manifest in a reliance on well-learned or dominant responses. Unfortunately, well-learned or dominant responses may be the least functional in new situations, especially radically changed situations. So, look for the challenge in change, not the threat. Cavanaugh, Boswell, Roehling, and Boudreau (2000) and LePine, Podsakoff, and LePine (2005) contrasted the positive experience of challenge stress and the negative experience of hindrance stress. The experience of challenge stress is good and healthy. Perhaps the best example of how ingrained our responses are to stress from a threatening, often negative, lens can be found in Fredrickson’s (2009) work on the positivity ratio. According to Fredrickson, the ratio of experienced positive to negative feelings can greatly influence our success in work and personal life. Her work indicates that a ratio of 3 positive feelings to 1 negative feeling is considered a tipping point,

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distinguishing those individuals who are just getting by from those who are actually flourishing in both work and play. It is very easy to find out your positivity ratio. Simply take the free, 2-minute test on Fredrickson’s website, http://www.positivityratio.com. Fredrickson’s finding indicates that more than 80% of U.S. adults who took the test fall short of the 3-to-1 ratio. Whatever you currently scored on the test, we are confident that the information in this book will be useful in helping you to proactively develop the necessary personal strengths to effectively manage stress in your organization.

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O

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ccupational stress is a dynamic process associated with the transaction between the environment and the individual. It is considered a transaction rather than an interaction because each variable changes and is changed by the other in a bidirectional exchange or interplay. The observers cannot be separated from what they observe (Dewey & Bentley, 1949). Because individuals are embedded in an organizational environment, they are considered an interdependent occupational system. However, the system is often overlooked. Stress is most often conceptualized solely at the individual level. It is considered a personal problem and an individual’s responsibility to find a way to creatively manage stress or to remediate the potentially negative consequences. However, much of occupational stress originates from, and its effects are seen in, the organization itself, creating a need to identify demands as well as to intervene at the systems level. Certainly, the individual is important, but the individual is not the only target for intervention. If we want to be truly successful, DOI: 10.1037/13942-002 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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F i g u r e 2 . 1  Individual Preventive Stress Management = Prevention Build Capabilities Reduce Vulnerabilities Prevent Disease

Organizational Preventive Stress Management = Protection Build Protective Factors Eliminate/Reduce Risk Factors Preserve Function

Organization Healthy, High Functioning

Individual Fit and Hardy

Organizational Demands and Stressors Buffer Moderate Modify

Primary Prevention

Individual Strain/Fatigue

Acute and Chronic Stress Response

Organization Strain/Impairment

Secondary Prevention

Counter Mitigate Individual Distress/Disease/ Exhaustion

Organization Dysfunction/Disorder/ Collapse Remediate Restructure Abate

Tertiary Prevention

Individual Restore/Rehabilitate/ Reintegrate

Organization Restore/Recover/ Reconstitute

Preserve Maintain

Preserve Maintain Resilience, Sustainments, Growth

Individual prevention and organizational protection.

we must look also at the organization as an entity for assessment and intervention. Preventive stress management encompasses this complete occupational system, including the individual within the organizational context, as shown in Figure 2.1. This figure complements Figure 1.2 and makes the important distinction between individual prevention and organizational protection. Ideally, each component begins with a strong, healthy state. In reality, the ideal is not often achieved. The preventive methods for organizations are referred to as protection. Organizations generate both risk factors for stress exposure as well as protective factors that safeguard individual employees from the negative effects of stress. Organizations are responsible for proactively building positive protective factors and identifying and removing nonproductive stressors from the environment whenever possible. Of course, it is not always possible, and demands and pressures will exist. The process then follows a dual but overlapping,

Organizational Demands, Risks, and Protective Factors

Organizations create demands and pressures for people that carry risk but also offer protective factors that safeguard the health and well-being of people at work.

interdependent individual–organizational track for prevention, protection, and intervention, with the ultimate goal of achieving a system that is resilient in the face of organizational demands and stressors and that grows in strength and functions in a way that can be sustained or maintained through regular preventive maintenance. This chapter describes the environmental side of the system, and including organizational risk factors, demands, pressures, and stressors along with some of the protective factors that are presented in the occupational context. This description is clearly not exhaustive in detailing organizational factors, but it presents concepts most likely to be worthy of practice or to spur further exploration. Although each organization and occupational career field is different in certain ways, some primary categories of stress exposures can be identified and applied. Those broad categories include the following: ❙❙ the physical environment, which speaks to the tangible space and other objects associated with work; ❙❙ the functional environment, which includes the nature of the work or what employees do, such as their tasks, roles, and functions; and ❙❙ the contextual environment, which describes the psychological and social organizational context in which work is conducted, such as culture, climate, and interpersonal relationships, and demands associated with the organization or occupation. Two overarching factors are especially relevant: control and support. These are critical factors to consider as sources of stress when absent or out of balance as well as potential solutions or buffers to stress in the workplace. They are briefly mentioned here and more fully examined in Chapters 8 and 9, which discuss organizational prevention and protection, including these important protective factors.

Physical Environment The physical environment affects everyone in some way. It has traditionally been considered more relevant to blue-collar, industrial, or hazardous work environments; however, all types of work take place in an environmental setting that poses threats or benefits to the individuals and to the actual conduct of work. Physical environment factors are often ubiquitous and include environmental conditions such as climate and atmospheric conditions, toxins, pollutants, and noxious substances as well as safety and injury prevention; personal and collective space design and layout; and equipment, tools, and ergonomics along with technology and telework.

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Environmental Conditions

Occupational health and safety standards are designed to safeguard people from toxic substances, risks, and threats that exist in the physical environment.

Factors associated with the physical environment can precipitate a stressful experience for individuals, such as temperature variations, sound, light, vibrations, location in space, electricity, and crowding (Sapolsky, 2004; Selye, 1976a). Indoor air quality and noise have also been identified as potential physical environment stressors, both of which interact with psychosocial stressors to generate distress, discomfort, or eventually disease. Through the development of an all-encompassing safety culture and climate (Zohar & Luria, 2005), workplace safety along with accident and injury prevention have made significant advances over the past 2 decades in improving occupational health and safety across all occupational categories. Although many occupational settings are specifically buffered against physical environment stressors, with varying occupational health and safety standards established by various government agencies in virtually every country around the globe, some settings are particularly hard to control. Military environments are especially prone to uncontrolled temperature, dust, noise, vibration, and unsafe conditions, especially in a deployed environment (Adkins & Davidson, 2012). Construction, public safety and utilities, mining, shipping and transportation, and similar work that takes place in open, unplanned, or temporary locations cannot always be effectively controlled. In these cases, it is important to consider person–job fit and psychological contracts. A psychological contract includes an explicit statement by the employer about the potential work conditions. When people agree to take a job that involves the explicitly described work environment, they walk into the situation with full awareness of the hazards and at least tacit agreement to work under these conditions. People vary in their adaptability and personal preference for working in uncomfortable conditions. Clearly conveying the working conditions to employees in advance can reduce unanticipated exposure, giving more control to the individual who chooses to take the job despite the knowledge of physical discomfort in working conditions. A growing concern in terms of toxic substances in the workplace is secondhand smoke. The U.S. Surgeon General has declared the workplace as the major source of secondhand smoke exposure for adults, which has been linked to an increase in heart disease and lung cancer among adult nonsmokers and identified as one of the major lethal occupational health risks. The only effective way to eliminate secondhand smoke exposure in the workplace is through smoke-free policies; separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposure (U.S. Department of Health and Human Services, 2007). As a result, more occupational settings, including government work settings, are becoming tobacco free. As of 2006,

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14 states had enacted laws that make private workplaces smoke free, and numerous organizations have voluntarily implemented smokefree policies. Although blue-collar, service employees, and restaurants were far less likely to be protected, less than a third of all workplaces are left without a smoke-free policy.

Space, Design, and Aesthetics Increasing attention is being given to the effects of the potential healing features of space and space design features and the built environment on behavior, mood and attitudes, and productivity. Lessons learned from other social contexts, such as community development, socially aware architecture and interior design, crowding, order and organization, clutter management, and confined spaces can be well applied to the workplace to build protective factors and to reduce stress on workers. For example, as president and CEO of Manchester Bidwell Corporation and its subsidiaries, Bill Strickland founded his training center on the basis of the belief that people are a product of their environment and the physical and emotional environment has a profound impact on a person’s ability to grow, learn, and thrive. He envisioned details of light, space, color, art, fountains, and live plants to be included in a functionally state-of-the-art and aesthetically beautiful training center filled with positive and enthusiastic staff. In 4 decades of this center being in the middle of a high-crime, low-income neighborhood, it has never had an incidence of crime or vandalism. For his vision, he was awarded a MacArthur Genius Award, and his vision is being replicated across the nation (Strickland, 2011).

Technology—Crosscutting Effects Looking within the organizational environment, ergonomics and human factors applications have been applied to man–machine interfaces and technological systems. The primary goal of ergonomic design is to create a high-functioning physical work environment that minimizes the stress and strain on the operator, and ergonomic issues have been found to interact with other more psychosocial forms of stress to produce negative consequences in terms of health and safety. These principles also translate well into modern office design (May, Reed, Schwoerer, & Potter, 2004). Working at a computer keyboard and staring for hours into a computer display is just as restrictive and repetitive as working on a production line.

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Technology in the workplace can be labor saving and stress relieving while at the same time disrupting individual behavior and interpersonal relationships.

Although ergonomics has historically been considered the primary issue associated with technology in the workplace, the change in work processes, the cognitive changes required to adapt to new hardware and software, and the ever-changing occupation-specific processes involved with changing technology also generate stress. Learning and relearning skills associated with new technology can decrease perceptions of control, personal beliefs of mastery or accomplishment, and personal satisfaction with career progression. Technology can also change interpersonal interactions associated with work, flow of information, and communication methods. For example, the use of the electronic health record was intended to make it easier to maintain legible records of health care. However, health care providers are now challenged with talking face-to-face with the patient while also entering information about the conversation into the electronic record on the computer. Patients generally do not appreciate having the provider focused on the computer screen rather than on them. Providers do not appreciate the extra time it takes to document the complete encounter after the exam is over. Navigating through this change in process created by new technology will have an impact on the perceived quality of care for the patient. In non–health-care settings, communication methods can be changed by the use of e-mail and texting. It is not uncommon for coworkers to e-mail or text their colleagues sitting at the next cubicle rather than speak with them directly. Telework programs further change the flow of information, especially in supervisory relationships between two people separated by miles or in meetings that are conducted through telephone or video-teleconferencing. Electronic communication is seldom exactly the same as in-person meetings and discussions. The new methods of electronic communication and generational differences in comport with electronic communication can also create conflict in supervision and management styles. Designing and implementing technology changes within the organization in accordance with preventive stress management practices are important management responsibilities and will grow in their impact with time. The trend toward virtual offices, telecommuting, and home-based businesses includes offices at home used by entrepreneurs and telecommuting workers, as well as the off-site offices that some firms use to accommodate workers. Initially, telecommuting arrangements were initiated by employees who wanted more flexible work hours to accommodate their family concerns. Now private and public organizations are attempting to reduce real property costs and respond to environmental mandates by offering telecommuting. With the growing use of the Internet and social media to conduct business, traditional work environments separate from the home become less necessary, reducing the cost of doing business for several small businesses and changing the nature of stress in the workplace.

Organizational Demands, Risks, and Protective Factors

However, the trend toward working at home rather than working in a separate, controlled work environment brings new challenges. Separating the demands of family and work in the home can result in role ambiguity, as well as increased conflict in the family system. Although originally intended to rectify work–family balance, working at home can present problems such as maintaining good boundaries between work and family. In addition, traditional office atmospheres provide discipline, structure, and social interaction with a broader range of people, along with the opportunity to learn from others. The virtual office or homebased business can curtail this expanded social support system, leading to social isolation (Cascio, 2011; Lynch, 2000) and a new need to find collegial support and interaction from methods such as joining professional or trade associations or even connecting with like-minded workers online. In addition, the employer may find it difficult to meet occupational health and safety requirements, and the supervisory responsibilities may become increasingly complex. Although work-athome individuals have some greater element of autonomy and control, they may also lack opportunities to learn better methods from coworkers, to receive mentoring and timely feedback from supervisors, and to participate in the communication and information flow that is essential in team-based and group-managed products and processes. Navigating through the maze of telework and assisting small business development through new organizational structures will be important processes in the decades to come.

Functional Environment— The Content of Work The tasks associated with their work are typically what people think of when they consider their job. All jobs comprise a specific set of tasks and activities that are assigned to the employee who occupies the job. The task component of work includes such concepts as the nature of work, occupation, or career field; exposure to emotional work and perpetually unfinished work; the volume and pace of work to include work overload, work complexity, and time demands; and concepts of training, competency, and control over work demands.

Occupation, Careers, and Transitions Occupational category affects the type of stress an individual experiences primarily because it defines exposures and risk factors, but it also provides protective factors. Work gives purpose to living, shapes identity

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Mastering the functional environment can be a source of challenge stress yet is essential to high levels of individual functioning and job performance.

(Ibarro, 2003), and satisfies a variety of human needs (Baruch, 2004). A good fit between personal attributes and details of the occupation and occupational setting is more likely to lead to job satisfaction for the individual and effective job performance for the organization (Holland, 1959). However, the current work environment finds individuals much more mobile in their career progression. Individual employees are less likely to continue through an entire working career with a single organization or company, or even continue in the same occupation or career field. These personal changes can occur because of a mismatch in the person–job fit; because of a change in individual development, values, and priorities over stages in the individual’s life and career; or because of changes in the psychological contract, as the conditions or workload associated with the job changes. This changing reality creates an even stronger need for effective, life-long career development programs. Organizations need to have the right fit for employees from the outset to avoid the cost of training and turnover. Orienting, developing, and encouraging personal growth and being flexible to stages of development over time can assist in attracting and maintaining employees who will contribute to the growth and success of the organization. However, individuals also need to increasingly consider their own career development, which will likely span several different organizations. Coaches, mentors, and career counselors during times of indecision and transition can help to ease the stress associated with changing directions in life for both the individual and the organization. Organizations must also necessarily consider transition and succession planning as a routine task of maintaining operations, which may mean releasing employees with minimal negative emotions on both sides when it is in the best interest of both the individual and the company to do so. Individuals released early or midcareer may find their way back later in their career and can be a significant addition to continued organizational success.

Emotional Work The rapid growth of the service sector of the economy means that increasingly greater numbers of personnel are now required to interface with internal and external customers, clients, or patients. Emotional work is often used to denote tasks that involve confronting a variety of emotions from the customer or client as well as those tasks that evoke or make use of an emotional response from the employee. In such fields as customer service or account management, employees are often confronted with disgruntled customers who are looking for a sympathetic response and related action. The customers rarely consider the human nature of the employee, depersonalizing the employee as

Organizational Demands, Risks, and Protective Factors

a representative of a company with whom they have found disfavor or an obstacle to getting what they seek. Although customer service representatives may be trained (sometime minimally) to not take this behavior personally, it can be very difficult for them to constantly listen to angry or hostile comments without feeling emotional effects. For service providers in health care, counseling, coaching, or similar fields, the effects can be similar. Clients and patients want something from service providers, and that is often empathy. Through active listening and processing of negative or unhealthy emotional content and demonstrating empathy and compassion on a continual basis, the service provider can be drained by the emotionally demanding situation. In response, the concept of compassion fatigue has arisen. Giving constantly of your own emotions without balance or replenishment, along with giving to your job more than you get in return (Schaufeli & Buunk, 2003), can quickly result in job burnout (Maslach, 2006) and deleterious health and behavioral consequences. Burnout in the health care field has been especially concerning (J. C. Quick et al., 2006).

Unfinished Work Along with service and administrative work comes an increasing focus on unfinished work. In a production-related occupation, there is always the hope of a completed product—a house that is built, a car that rolls off the assembly line, a perfectly decorated cake. However, in service, administrative, and managerial work, the product seems never completed. To reach the bottom of the to-do list or to clear out all the e-mails from the in-box seems a task too far from reach, and this problem has resulted in an onslaught of time-management tools and recommendations. Without a source of completion, the ability to gain satisfaction from a job well done can be difficult. As a focus on performance-based management increases, finding a way to mark, celebrate, and reward completion of tasks will be a critical factor in reducing the stress of unfinished work. In addition, setting up work functions that allow for routine and frequent completion of concretely specified or operationally defined endpoints can help to improve job satisfaction and increase feelings of control, mastery, and self-efficacy.

Volume and Pace of Work The category of workload and time demands overlaps boundaries between task and role demands of the job. Work overload is quantitative and occurs when the employee is assigned too many tasks or given insufficient time to accomplish the assigned tasks. Role overload is qualitative in nature and occurs when too many behaviors are expected of

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an individual or when the behavior expected is too complicated or too difficult for the individual to execute. Work overload is based on sheer quantity of tasks, whereas role overload is based on expected behaviors. Employees who experience work and role overload typically report that the workload is unreasonable and/or unsupported by resources such as additional personnel or the necessary time to fulfill job requirements to the quality standards expected. They may also report that they have not had the proper training or do not feel equipped with the right capabilities to perform the tasks competently. An important component of workload in the information age is information overload. The amount and complexity of information that employees are expected to manage have increased exponentially with the advent of electronic information. In addition, the information is often presented in a fragmented, fast-paced, rapidly changing, multisensory fashion and without quality control in terms of accuracy. The process of consuming, interpreting, synthesizing, and applying that information holds potential for creating high levels of stress. With the change in focus to service delivery and high expectations of available service, timing of work periods has changed. To be competitive in a global environment, organizations feel compelled to provide services 24 hours a day, 7 days a week. Those hours entail personnel working shifts and increasing overtime to meet consumer demands. In addition, lean business practices put emphasis on efficiency to reduce any and all potential waste in a resource-constrained fiscal environment, increasing the demands and time pressures on every employee. These circumstances add up to a long workday and an even longer workweek. The tendency to work oneself to death is encapsulated in the Japanese term karoshi (Kawakami & Haratani, 1999). However, death is not the typical result in the Western workplace. More likely, there will be negative health and behavioral problems with individual employees and loss of effective productivity, unplanned absences (Nicholson et al., 2006), decreased morale, and increased turnover, ultimately leading to increased costs of doing business. American workforce estimates have suggested that workers with fatigue cost employers $136.4 billion each year in health-related lost productive time (Ricci, Chee, Lorandeau, & Berger, 2007). As the length of the workday grows, effective performance, attention, and concentration of employees can decline. Jobs that require these capabilities from their workers will suffer as the time grows longer. The amount of respite between workdays as well as the number of planned days away from work per year may vary on the basis of the demands of the job or occupation as well as cultural norms. Those jobs with high potential for burnout, emotional work, or unfinished work or jobs that require high levels of cognitive complexity are more likely to

Organizational Demands, Risks, and Protective Factors

require shorter work periods and longer respite periods. Unfortunately, those are also most likely positions of managerial responsibility and frequently have fewer respite hours. Certainly work-time policies will not take the place of successful stress management throughout the work period or achieve work–life balance every day of the year.

Roles at Work A role is typically defined in terms of expectations in the work environment. Whereas task demands are concerned with specific work activities that must be accomplished, role factors are related to the behaviors others expect of us as we fulfill our organizational responsibilities. Defining and understanding roles is not stress inducing. It is the dysfunctional aspects of this role-making and role-taking process that generate stress. The relevant role factors include role overload (discussed previously), role conflict, role ambiguity, and role insufficiency. Role conflict occurs for an individual when one expectation of behavior or performance makes it difficult or impossible to fulfill another behavioral expectation or set of expectations. Therefore, stress is caused by the inability or difficulty in meeting the various competing expectations. Role ambiguity results whenever there is inadequate information about what role behavior is expected, unclear or confusing information about expected role behaviors, unclear or confusing information about what behaviors may enable the incumbent to fulfill the role expectations, or uncertainty about the consequences of certain role behaviors (Kahn et al., 1964). Situations in which expectations are unclear or conflicting lead to stress for individuals as well as poor quality of work and low productivity as individuals strive to understand and accomplish what they believe is expected from them or what will be ultimately rewarded. Less ambiguity reduces stress (C. L. Cooper, 2002) and enables executives to feel less stressed (Baruch & Woodward, 1998). Most employees want to do a good job and to obtain satisfaction from their work. Lack of clarity or mutually competing objectives are obstacles that can often be removed by management. Some jobs are inherently more ambiguous, which would warrant employees who are more comfortable with uncertainly, creating an imperative for job–person fit to create a more optimized work situation. Role insufficiency results when there is an element of routine or boredom (Game, 2007) in the job that fails to meet the skill set or expectations of the employee (Schabracq & Smit, 2007). If the employee possesses skills, training, or capabilities that are not adequately recognized or used in the job or if there is a mismatch between employee talents and job requirements, then the employee may feel unrecognized, unfulfilled, and dissatisfied with the progression of his or her career or occupational

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standing, elevating levels of experienced stress. High levels of unemployment can create obstacles to the individual’s choice to change jobs, causing the individual to feel stuck in a job that does not fit his or her need for meaning or identity and resulting in increased stress and strain on both the individual and the organization. Job enrichment, rotation, and career development can make better use of each employee’s talents and mitigate some stress associated with role insufficiency.

Contextual Environment— Organizational Culture and Relationships at Work Paying attention to the unwritten rules of the workplace, the organizational culture, and personal relationships at work is important for health and well-being.

The organizational culture is the foundation on which all preventive stress management strategies rest. The culture reflects norms; values; benefits; communication; quality of life; and the ways in which people are developed, nurtured, and rewarded. Qualities of a strong, health-engendering culture represent some of the most potent protective factors associated with the occupational context. Leadership and supervision are critical parts of the culture and cannot be fully separated from the context created by the values established and implemented by people leading people. Essential components of a healthy organizational culture include unity, communication, justice, learning, flexibility, and support. A particular organizational culture variable recognized as critical to stress management is the concept of justice. Justice relates to the perception of equity in terms of rewards and consequences of behavior in the workplace (see Lavelle, Rupp, & Brockner, 2007). Justice is the foundation of trust, and trust drives loyalty, mutual respect, and supportive relationships at work. Four types of justice in organizations include procedural justice, or fairness of organizational process; distributive justice, or fairness of outcomes received by individuals; interpersonal justice, or fairness of how people are treated by others in the organizations, primarily supervisors; and informational justice, or the fair sharing of information (Graham, 2011). Favorable evaluations of organizational justice as a whole are generally related to lower job strain (Elovainio, Kivimäki, & Helkama, 2001).

Leadership and Supervision Leadership and supervision are not the same. Effective leaders set the culture and tone of the organization. They establish a clear mission,

Organizational Demands, Risks, and Protective Factors

Good leadership and supervision are some of the best protection factors for people at work, safeguarding their well-being.

communicate to employees how their roles fit into the overall mission, and influence employees to work with them to achieve mutually agreed-on goals. When employees do not have a clear understanding of their role in the organization, job ambiguity and misplaced energy increase strain for both individuals and the organization. Creating unity of mission, clarifying the vision of success, and personalizing that down to each individual employee reduce ambiguity, build loyalty and trust, and generate meaning and purpose. Employees seek meaning in their work now as much as ever. That meaning comes from leadership. Managers and supervisors are in a critical position to either generate stress or serve as a protective factor within the organization. Critical functions of managers and supervisors include communication and support. Supervisors are on the front line of operations and link leaders’ vision with employee work to carry out that vision. They are the conduit for most communication from top to bottom and back. They are also in the best position to understand the particular skills and stress management capabilities of each individual employee. They control training, clarify job responsibilities and lines of authority, and provide for resources employees need to accomplish their tasks and roles. Unfortunately, many workers report having experienced a toxic supervisor—that is, a supervisor who generates substantial stress in the working environment. Toxic supervisors are those who are poor communicators, who are abrasive and inflexible in their approach with employees, and who look after their self-interest before the interest of the job or the employees they supervise. Toxic supervisors can destroy an organization, regardless of the level at which they work. The culture of the organization can assist in either eliminating toxic supervisors or disciplining their behavior, but only if the organization places value on supportive supervision practices.

Interpersonal Relationships Interpersonal stressors at work are concerned with the demands placed on us in the normal course of social, personal, and working relationships in the organization. As individuals, we have various distinctive personality and behavioral characteristics that are a source of stimulation for some people and a source of aggravation for others. In addition, there are counterproductive behaviors that occur in the work setting, just as there are in other settings. Inappropriate, uncivil, and at times criminal behaviors hold great potential for stress. The specific interpersonal stressors addressed here include cooperation, competition, and teamwork; hostility and aggression; and diversity.

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Cooperation and Teamwork Teamwork is the method through which much is accomplished in organizations. Teams can be a protective factor or a risk factor, depending on the method of implementation and use and the general context of the culture of the organization. Team-based organizational cultures rely on concepts of cooperation rather than competition among individuals within the organization. If teams are not established in a way that rewards the group rather than individuals in the group, then teams can deteriorate into counterproductive competition and conflict rather than focusing on cooperative action toward a common goal. Teams place demands on workers for a certain level of interpersonal skills. Working in teams is not comfortable for some individuals who prefer more autonomy or personal control over the work or products. In addition, if the skill set is mismatched in the team, conflict rather than cooperation can occur, defeating the purpose of team establishment. If not defined or developed properly, the team concept can result in role ambiguity when self-directed teams take on tasks that were once the domain of managers and in role conflict when members are temporarily assigned to teams outside their traditional work boundaries or to cross-functional teams that cut across traditional organizational product lines.

Hostility and Aggression Violence and aggression perpetrated in the workplace has been a growing concern for the past 2 decades. Violence takes many forms and comes from different sources. It includes, but is not limited to, verbal and emotional abuse, bullying, harassment, and physical assault. Aggression and violence are almost always about attempts to gain a perception of power by controlling or denigrating someone else. These are not behaviors to be tolerated at any level and can easily escalate or spread if not curtailed immediately, with deleterious effects on individuals, teams, and the organization as a whole leading to zero-tolerance policies recommended by government occupational health and safety agencies and legal consultants. Workplace violence, including bullying and harassment, has been identified as among the top psychosocial risk factors in workplaces in general across 20 countries (Dollard, Skinner, Tuckey, & Bailey, 2007) and is particularly prominent among human service professionals (Rugulies et al., 2007). The perpetrator can be a coworker, an authority figure, a customer, or a family member who perpetrates domestic violence in the work setting. Customer-perpetrated violence is more likely to occur in environments in which anonymity is expected, such as convenience stores, or in situations in which customers are already experiencing distress, such as

Organizational Demands, Risks, and Protective Factors

Regardless of provocation or circumstances, there is no justification for bullying, disagreeableness, or lack of civility in the workplace.

health care facilities. Even telework can involve harassment. Female callcenter employees who report phone-based sexual harassment also report lower job satisfaction, decline in job performance, and increased strain (Sczesny & Stahlberg, 2000). Bullying is a more persistent form of verbal and emotional abuse (Einarsen, Hoel, Zapf, & Cooper, 2003). It is more prevalent when the organizational culture allows it or when supervisors avoid dealing with stressful conditions, such as poorly resolved conflict and poor communication (Hauge, Skogstad, & Einarsen, 2007). Similarly, gossip can degenerate into indirect verbal aggression and is equally divisive and demeaning. Good communication and accurate information flow, along with a culture of respect and clear expectations about interpersonal behavior, can assist in curtailing malicious gossip. Exposure to violence at work has been shown to lead to absenteeism (Rugulies et al., 2007), psychological strain, and fatigue (Agervold & Mikkelsen, 2004), along with individual and organizational distress (Shaffer, Joplin, Bell, Lau, & Oguz, 2000), while also negatively impacting productivity (Farrell, 2002) and increasing health care use and unplanned absences. Even low levels of harassment have led to negative psychological and job-related outcomes (Schneider, Swan, & Fitzgerald, 1997); isolated incidents, if severe and unexpected, can take a similar emotional and behavioral toll on workers. However, most detrimental effects result from persistent, repeated incidents or from an overall hostile environment created within organizations that fail to promptly and effectively address improper conduct. The problems associated with harassment are so pervasive that it has been labeled a chronic workplace problem to be treated with similar strategies as all other chronic health problems (Bell, Quick, & Cycyota, 2002).

Diversity and Discrimination Diversity encompasses all forms of differences among individuals, including culture, gender, age, ability, religious affiliation, personality, economic class, social status, military attachment, and sexual orientation. The global workforce is growing increasingly diverse (Sparks, Faragher, & Cooper, 2001); the U.S. workforce is aging as the baby-boomers age as a group (Bovbjerg, 2001), and women are increasing their presence across all levels of organizations, making globalization and diversity issues a growing area of interest (Macik-Frey, Quick, & Nelson, 2007). Diversity is a positive factor for organizational success, allowing organizations to benefit from a wider range of skills, knowledge, and problem-solving abilities among their employees. Nevertheless, diversity can generate nonproductive conflict. Minorities face challenges at work if the workplace is not a harmonious environment for individuals

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The appreciation of individual differences and diversity throughout a workplace is a powerful protective factor

with diverse backgrounds and beliefs. The prevalence of ethnocentric attitudes in the workplace can contribute to this stress (Marsella, l994). Surprisingly, even racial stereotypes that are perceived as positive can have negative effects in the workplace (Cocchiara & Quick, 2004). Discrimination and harassment issues are critical to address and must be incorporated into all workplace violence and standards of conduct policies and programs and reviewed frequently. Human relations training, along with effective policies and consistent and timely reinforcement or discipline for compliance with or deviation from policies, can create the environment in which diversity benefits the workforce as a whole.

that ensures individuals feel secure.

Extraorganizational Stressors Stressful life events of a personal nature, or extraorganizational stressors, also have an effect on an individual’s performance effectiveness and adjustment at work. For example, individuals working in sprawling urban areas such as New York City, Los Angeles, or Washington, DC, may experience extraorganizational stress from commuting through hours of traffic. In addition, personal and family relationships have an impact on work, whether they enter through a physical presence, through an electronic presence, or through a strictly mental presence. Work–life balance is a growing concern, and problems from one domain clearly can spill over into the other. The extraorganizational stresses, especially related to relationships, can be a benefit or protective factor or a significant source of distress, which is more likely to affect work as well as health. It is an organizational responsibility to identify and remove risk factors when practicable and to build protective factors into the system. If eliminating nonproductive stressors from the organizational environment is not possible, then buffering, mitigating, or remediating the effects is required to ensure that optimal performance is sustained. When organizational risk factors are not removed or cannot be buffered, negative effects can result through the individual response to stress, discussed in the Chapter 3.

Individual Differences in the Stress Response

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he diverse organizational risk factors described in Chapter 2 lead to a common result: the triggering of a psychophysiological reaction known as the stress response. Each individual exhibits the same basic response to similarly perceived acute stress exposure, although the immediate and long-term consequences of the stress response vary greatly among individuals. This variance is influenced by factors related to the individual and the other components of the stress process. This chapter focuses on individual-level strengths and vulnerabilities, which are considered modifiers of stress appraisal, modulators of the stress response, and moderators of its consequences. Although no absolute statements can be made about whether a specific individual will experience negative effects of stress exposure, some basic premises can be explored to better understand the relationship of individual responses to the experience of stress. The stress response, described in detail in Chapter 1, is a complex process that has been articulated and researched

DOI: 10.1037/13942-003 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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across decades by multiple disciplines. Within the stress process, organizational risk and protective factors transact with individual characteristics to produce a stress response. The transaction is mediated, or flows through, a process of cognitive appraisal that includes perception and interpretation. The process is affected by individual-level characteristics, such as demographics; relatively internal capabilities and characteristics, such as states, traits, attitudes, and behaviors; and relatively external capabilities or resources that influence internal psychophysiological states, such as social networks. The individual stress response may be seen in a variety of outcomes. Although the consequences of the stress response are often considered negative, resulting in distress, it is possible that individuals presented with occupational risk factors may increase their capacity for coping, develop new strengths or skill sets, and grow in their ability to reframe and re­­ interpret events in the environment in a way that modulates the negative effect. This increase in capacity to manage stress is generally referred to as eustress and results in the effect of resilience and growth. High levels of risk factors can overwhelm even relatively high levels of individual capacity to result in negative consequences. On the other hand, low levels of risk factors can be met successfully by individual strengths, resulting in no lasting negative effects or even in growth and resilience. Additionally, intervention into the process can lead to changes in interpretation and appraisal of the process, negating negative effects or even producing positive ones.

Cognitive Appraisal

Cognitive appraisal is the lens through which the individual sees events and people as opportunities that excite and inspire or as threats that frighten and intimidate.

The process by which the physiological response is triggered comes through perception or interpretation of events or thoughts of events by the individual. This process of perception and appraisal is key in understanding both the response and prevention strategies. R. S. Lazarus is credited with being among the first to draw attention to the importance of an individual’s cognitive appraisal in influencing the degree to which that individual experienced a stressor as subjectively stressful or threatening (Lazarus & Folkman, 1984). The cognitiveappraisal process is the platform on which subsequent emotion-focused and problem-focused coping may occur. Lazarus (1991) proposed that cognitions and emotions are linked in an ongoing evaluation of stressors as well as reaction to these stressors, forming a transactional definition of the stress process. A cognitive–affective approach to understanding individual differences in stress propensity and strain response was formulated by Wofford and Daly (1997) within the domain of cognitions and emotions. Wofford and Daly’s conceptualization views the cognitive– affective conceptualization as a mediating process in the stressor–strain

Individual Differences in the Stress Response

linkage. From a psychological perspective, cognitive appraisal influences an individual’s judgment and reactivity to stressors. However, as Wofford and Daly implied, there is not a clean separation of the psychological and physiological in the cognitive domain. On the physiological side, Schnall, Landsbergis, Schwartz, Warren, and Pickering (1998) postulated that physiological susceptibility is a key variable moderating the perceived linkage of stress and blood pressure response.

Types and Levels of Stress Traditionally the discussion of the stress response ends with a review of the psychophysiology of response to acute stress. However, that is only the beginning. The response to acute stress itself is quite adaptive. It positions the individual to manage a threat or emergent situation physically and psychologically. However, most stress experienced in the modern workplace is not associated with acute, short-term, emergent situations. There are other levels or categorizations of stress that influence distress, dysfunction, and disease.

Anticipatory Stress Humans are able to trigger the stress response simply by thinking about or anticipating a potentially stress-provoking event or situation (Sapolsky, 2004). Anticipating, imagining, or even ruminating about a future event can trigger a similar response as the actual experience of it. Individuals vary in their tendency to anticipate negative events or negative outcomes as well as in the length of time spent in this cognitive–affective activity, leading to differential effects.

Cumulative and Chronic Stress Chronic stress describes a situation in which the experience persists at a fairly stable level without interruption. In the acute stress situation, individuals respond and then recover or return to a relative state of psychophysiological balance. If the stress-producing situation continues for a prolonged period of time, the recovery phase may be delayed. When confronted with chronic, unremitting stressful conditions, even lowintensity demands, the same responses that assist in an acute emergent situation now become maladaptive. Cumulative stress results in situations in which there are multiple, frequent threat situations or fewer, shorter, or otherwise curtailed periods of recovery. As a caveat, when presented with the same stress-provoking situation, individuals can habituate to the situation, reducing the stress response with subsequent presentations.

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Chronic stress has a long-term debilitating impact on individuals and organizations that simply wears them down over the course of time.

However, in general terms, fatigue, degraded performance, counter­ productive behavior, and ill health can result from the overall stress burden. The effects of chronic and cumulative stress build up over time and require different strategies to manage than acute stress. The accumulated effect is referred to as allostatic load and results in wear-andtear injuries to individuals who cannot repair and recover adequately. Although there are methods by which individuals can increase their capacity to withstand a state of constant threat, most people will eventually wear out or experience some type of distress, which will degrade performance and negatively impact health. The management strategies for situations of chronic and cumulative stress involve first modifying the situation whenever possible to reduce the intensity, duration, or frequency of exposure. At the same time, increasing the capabilities of individuals to withstand the threat situation or to change their appraisal of the situation, to manage their physiological reaction, or to find cognitive methods to facilitate relief from the situation can reduce the effects on health and well-being while also preserving performance integrity.

Residual Stress Residual stress refers to the unresolved internal demands that each individual experiences, commonly referred to as “emotional baggage” (Adkins & Davidson, 2012). These thoughts and emotions most often remain below the state of overt conscious thought, but they still consume individual resources for management. Residual stress has traditionally been associated with situations in childhood and/or early adulthood; however, significant emotional events can add to the residual stress at any point in life. It is possible to reduce this stress burden through resolving the issues through purposeful effort, but the process is frequently uncomfortable and incompletely understood, leaving individuals often reluctant to take that action alone. Psychotherapy, psychological counseling, spiritual counseling, or even social support groups and self-help strategies such as journaling are techniques that can reduce residual stress.

Individual Differences in the Stress Process Because organizational demands and stressors may lead to a range of physiological, psychological, behavioral, or social consequences by way of the individual stress response, why do some individuals in high-

Individual Differences in the Stress Response

stress, demanding jobs survive and thrive and others experience a variety of disorders and distress? Important individual and interpersonal differences can help account for some of the variance in these diverse results. The resources and capabilities to manage stress vary among individuals and across time. These stress management capabilities are not fixed but dynamic; they can be increased through training and practice or can deteriorate with time and lack of use. The capabilities of an individual can also be overwhelmed with chronic or cumulative stress exposure, so that an event that would not routinely have a negative effect can differentially affect the individual if presented in the context of multiple demands that exceed his or her resources.

Complexities Associated With Individual Differences and Stress The conceptualization of individual differences related to stress is fraught with complexities and apparent contradictions. The reasons for the inconsistent findings can be at least partially explained by the various theories and methodologies associated with the study of individual differences combined with the multiple perspectives on the stress process itself. Intersecting these diverse fields of knowledge and inquiry brings with it added layers of complications.

Diverse Nature of Individual Differences The field of stress is not alone in complexities. The conceptualization and categorizations used in the broad field of individual differences can lead to inconsistent applications. There are divergent theories and lack of agreement about how individual differences are best explained and explored, along with even greater differences in consistency of descriptions and applications across disciplines and across studies within the same discipline. The theories of personality alone fail to find agreement or consistency in models or measurement (Williams, Smith, Gunn, & Uchino, 2011). The models are not fully integrated, which can lead to piecemeal, nuanced, or seemingly unrelated conceptualizations that may not be fully understood by those outside the individual differences professional community. When conceptualizations are inconsistently applied in the nexus between the two areas of study, inconsistencies can result. These discrepancies are compounded by divergent methods and measures that can also lead to different results. In addition, people are not unidimensional; they have varying levels of strengths and vulnerabilities that may have differential effects on their response to and management of stressful situations. The totality of the individual, with all his or her states, traits, attitudes, and behaviors,

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may produce different results from one of those characteristics considered in isolation during one period in time in a cross-sectional study.

Nonlinear Relationships Many of the relationships associated with stress, the stress response, and individual differences do not fall along the lines of traditional linear relationships. A nonlinear or curvilinear relationship may not produce consistent results in a traditional study. For example, the concept of control is frequently discussed in both stress and individual differences literature. However, too much or too little can have negative consequences. Where is the optimal balancing point?

Ambiguity and Preferential Labeling There is a human tendency to resolve ambiguity and to label characteristics and situations according to attitudes and beliefs that may not be helpful in discerning the true nature of relationships. There may not be inherently “good” or inherently “bad” characteristics in association with stress, as stress is not inherently good or bad. Just as there are two sides to every coin, there are positive and negative aspects to individual characteristics in general and in relationship to stress. Is heads or tails better? Is internal or external locus of control more desirable? Is a higher level of socioeconomic status (SES) better than a lower level of SES in terms of stress exposure or stress response? Is different good or bad? It depends on the situation. Attempts to make absolute statements or judgments about particular traits, states, or characteristics will likely fail to achieve consistency in all situations for all groups of people.

Reciprocal Nature of Stress Individual responses to stress are not cleanly separate from the environmental factors or context surrounding the individual’s experience. Because individuals are interdependent and they both change and are changed by the environment in which they live and work, measurement and explanation of responses are often influenced by situational factors and may not be easily explained by individual variables alone, leading to conditional statements about individual differences.

Multicomponent, Dynamic Nature of Stress There are different levels of response to different types and degrees of stress exposures; not all stressors necessarily produce the same kind or same level of stress response. Furthermore, because stress is a process, individual differences can be examined at each level in the process, and

Individual Differences in the Stress Response

these individual characteristics can be differentially associated with the various phases of the stress process. They can be seen to influence the exposures each individual experiences as well as the appraisal of the situation that can modulate or exacerbate the stress response. Individuals vary in terms of their psychophysiological reactivity and their coping strategies used in response to stress. Finally, individuals vary in terms of their recovery and restoration process, including how long it takes to begin recovery following exposure to acute and or chronic stress conditions. Individual differences are studied and applied in relationship to each of these components of stress. Therefore, the focus of the researcher or practitioner creates variations in the findings as well as applicability of the findings. The same characteristic can look very different when viewed at a different level or from a different perspective within the process. Furthermore, in thinking about the dynamics of the stress response, the distinction between modifiers of the stress response and management strategies or prevention techniques is not clear-cut. Modifiers, or individual capabilities or characteristics that influence the way in which a person responds in stressful conditions, are modifiable themselves. For example, although an individual may not be predisposed to hardiness or self-reliance, these attributes may be enhanced though effortful skill development. In this way, some of these capabilities can be learned, developed, or enhanced by the individual. In addition, coping strategies and resources vary over time and in conjunction with stages of adult development, just as exposures also vary across time and situation.

Categorizing Individual Differences The complexities of issues associated with individual modifiers to the stress response are important to understand, but they should not prevent exploration of this important area. Keeping in mind the complexities and caveats associated with individual differences, some general conceptualizations can be postulated. Expanding from Selye’s work (1976b), individual variables can be categorized into (a) general capabilities or characteristics, such as demographics or variables in common to groups or subgroups; (b) internal capabilities or characteristics, such as individual vulnerabilities, states, traits, attitudes, and behaviors; and (c) external factors, such as resources for social support and social networks. Exhibit 3.1 shows the individual differences included in the chapter.

Individual Vulnerabilities: The Achilles Heel Phenomenon The different patterns of distress can be partially explained by the concept of individual response specificity and vulnerability. The “Achilles heel” or “organ inferiority” hypothesis suggests that each individual

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Exhibit 3.1 Individual Difference Modifiers of the Stress Response

Everyone is vulnerable and at risk; the important question is where in a particular individual is that vulnerability or weakness that stress may exploit.

Demographics ❚❚  Socioeconomic status ❚❚  Gender

Control ❚❚  Perceived ❚❚  Locus of control

Internal modifiers ❚❚  Type A behavior ❚❚  Negative affectivity ❚❚  Optimism/pessimism ❚❚  Hardiness

Lifestyle behaviors ❚❚  Diet ❚❚  Physical activity External modifier ❚❚  Social support

reacts to stress with a particular preferred pattern of psychophysiological response. In other words, stress hits you in your weakest or most vulnerable part. Studies have shown that individuals with stomach ulcers tend to respond to stress with gastric secretion, that individuals with diabetes respond to stress with greater changes in blood glucose than do normal individuals, and that individuals with cardiovascular disease show greater variability in heart rate and respiration. There also appear to be generalized “high reactors” or individuals who respond more extremely in the face of a perceived threat (Sapolsky, 2004). The study of family history can help to identify a possible Achilles heel, but the weakness does not necessarily predestine a person to heart disease or cancer; the results can be changed or influenced on the basis of presentation of stressors in the environment and management or change strategies on the part of the individual. The presence of these health problems merely establishes a risk factor to be monitored and managed.

General Group and Subgroup Modifiers: Demographics Demographic variables are the most common factors used to describe groups and subgroups. The group or subgroup to which a person belongs can impart a shared culture or shared appraisal tendencies that are more similar than different within the group (Semmer & Meier, 2009). In the general field of occupational stress, much of the information that we have come to rely on was developed using samples of fairly well-educated, middle-class White males in a Western culture. How much of that information transfers to other demographic groups as the work force becomes increasingly female, culturally diverse, and older? Demographic variables, including gender, diversity (ethnicity, race, or

Individual Differences in the Stress Response

Women and men have different risk factors and vulnerabilities, as well as different strength factors, simply because of their gender.

cultural background), SES, age, and education levels, are relevant to the examination of individual differences at levels of exposure, reactivity and appraisal, and effective coping. Demographic variables, such as age and education, are often examined in terms of their impact of increasing or decreasing exposure as well as the resources, practice opportunities, and problem-solving experiences that the particular characteristic brings to the stress management process. Culture is often associated with stress exposure, with minorities in the workplace often experiencing relatively higher rates of discrimination and negative social attitudes and hostility. Minorities are also more likely to be socially isolated, which would remove this particular source of buffering for the negative effects of stress. SES has long been associated with health outcomes, and some of those health affects have been attributed to stress. Individuals with lower SES tend to have higher levels of total life stress exposure in general and fewer outlets for frustration along with access to fewer available resources for maintaining and improving health. Nevertheless, studies using self-report questionnaires have upheld the notion that more highly educated and higher salaried employees report higher levels of perceived stress (Smith, Brice, Collins, Matthews, & McNamara, 2000) and that lower paid, unskilled workers report the least amount of stress (Chandola & Marmot, 2011). However, biological markers of stress reaction and allostatic load tend to demonstrate that lower SES groups experience higher stress response (Chandola & Marmot, 2011) and more negative health outcomes (Sapolsky, 2004). Generally, SES must be examined within the context of the total environment along with other individual characteristics to determine its effect on stress response and consequences. Gender is perhaps the most frequently examined demographic variable associated with occupational stress (e.g., M. C. Davis, Burleson, & Kruszewski, 2011; Nelson & Burke, 2000). Much attention has focused on stress exposure for women in organizations, with women facing a different set of stressors than men (Nelson & Quick, 1985). Like other minority groups in the workplace, women face discrimination and potential social isolation (Nelson & Burke, 2000). Studies of experienced stress at work have had mixed results. Some studies have reported that women experience or report higher levels of stress at work; however, when variables such as age, education, marital status, and salary are held constant, the results show no differences in reported stress levels (Galanakis, Stalikas, Kallia, Karagianni, & Karela, 2009). Gender has also been found to moderate the stress–strain relationship (Cocchiara & Bell, 2009). Although women may face the same levels of stress, they tend to respond differently (Swanson, 2000). It is most interesting that the psychophysiologic response by females to perceived threats tends to be different, with a stronger drive toward

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affiliation in response to stress (Sapolsky, 2004). This finding has led to a modification of the fight-or-flight model to the tend-and-befriend model (Taylor et al., 2000), pointing to the importance of social support and socially related activities representing more potent stress management strategies for women at work.

Internal Modifiers: States, TrAits, Attitudes, and Behaviors Your personality, temperament, and behaviors impact how you perceive the world (appraise situations), how you react to the presence of threats or demands, and how you respond to and cope with stressful situations. If you view the world as threatening, you are more likely to experience repeated and prolonged stress-response outcomes. If you view the world with curiosity and interest, then your physiological and psychological responses are likely to be very different. If you are unable to accurately determine if a situation is threatening or neutral, then physiological arousal is likely to result. Characteristics that impact both stress appraisal and stress response are related to perception of control, tendency to use active coping strategies (also an element of taking control of the situation), perception of predictability (i.e., ability to determine in advance if a situation is threatening and if the outcome is likely to be positive), and effective perception of and use of outlets for frustration (Sapolsky, 2004). Negativity, as described by such terms as neuroticism, pessimism, or hostility, tends to have negative outcomes in terms of both appraisal and response to stress. For example, Type A behavior is a term that has long had popular appeal. Two cardiologists, Milton Friedman and Ray Rosenman, began to recognize a pattern in the behavior of the coronary patients whom they were treating in the late 1950s to include competitive overdrive, excessive devotion to work, time urgency, anger, and hostility. Although the Type A behavior pattern was originally taken as a whole in constituting an important cardiac risk factor, the hostility factor has been shown to be the most potent in explaining cardiovascular disease in interaction with environmental risk factors. Similarly, negative affectivity is implicated as a moderator explaining high correlations in stressor and distress cross-section studies. More specifically, high negative affectivity appears to inflate relationships between work-stress measures and psychological symptoms (Brief, Burke, George, Robinson, & Webster, 1988). Negative affectivity is a broad, pervasive personality variable that appears to significantly influence the psychological and emotional reactions individuals have to stress (Watson & Slack, 1993). Although this variable has not been empirically demonstrated to relate to pessimism, people high in negative affectivity may be more pessimistic because they tend to focus on

Individual Differences in the Stress Response

Good events and bad events happen to everyone, but the important individual difference is found in how each individual interprets these events and then responds.

the negative aspects of the world and are predisposed to experience more distress and dissatisfaction. Optimism and pessimism are two alternative explanatory styles people use to explain the good and bad events in their lives to themselves (Seligman, 1990). These explanatory styles are most often described as habits of thinking learned over time, not innate attributes. Pessimism has been related to depression, poor health, and low levels of achievement (Burns & Seligman, 1989). Optimism is an alternative explanatory style that enhances physical health and achievement and averts susceptibility to depression. Optimistic people moderate distress by understanding the bad events and difficult times in their lives as temporary, limited, and caused by something other than themselves. Optimistic people face difficult times and adversity with hope. Whereas optimistic people take more credit for the good events in their lives, pessimistic people unfortunately take credit for the bad events in their lives. Optimists see these good events as more pervasive and generalized. Learned optimism, as contrasted with learned helplessness, is an approach to nonnegative thinking that is discussed in Chapter 11. Hardiness is a compilation of traits that has been conceptualized with three components (Maddi, 2002): commitment (vs. alienation), control (vs. powerlessness), and challenge (vs. threat). Commitment denotes a curiosity and engagement with one’s environment that leads to the experience of activities as interesting and enjoyable. Control is an ability to influence the process and outcomes of events, with an emphasis on one’s own responsibility and personal choices. Challenge is the viewing of change as the normative mode of life and as a stimulus to personal development, which leads to the experience of activities with openness. The hardy personality appears to use these three components actively to engage in transformational coping when faced with stressful events. People who are characterized as hardy tend to resist strain reactions when subjected to stressful events more effectively than do people who are not hardy. Hardiness has also been shown to have a positive effect on physical and psychological health (Beehr & Bowling, 2005) and to mediate the stress–strain relationship through appraisal and coping strategies (Florian, Mikulincer & Taubman, 1995), whereas moderator effects on health outcomes have been mixed (Beehr & Bowling, 2005). Because hardiness is a profile construct or a compilation of traits, it is common to have confounding effects from the interaction of the components. However, even controlling for confounds, a positive impact on health has been found (Semmer, 2006; Semmer & Meier, 2009). Looking from the reverse perspective, stress can also have a negative effect on hardiness (Vogt et al., 2008), decreasing those traits in individuals considered to exhibit high levels of hardiness. Hardiness is not the same as repression of affective and cognitive responses to stressful events. Those with repressive personality styles

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tend to report that everything is fine. They do not seem to be outwardly affected by the stressors of work and life. However, the effort required to maintain an outward appearance and psychological perspective of complete routine normalcy takes a toll in terms of stress-related physiological results. Transformational coping is a healthy preventive stress management skill discussed in Chapter 11, whereas regressive coping is an unhealthy strategy that may lead to short-term stress reduction at the cost of long-term healthy life adjustment.

Control

Although an internal LOC can lead to personal responsibility, extreme need for control may contribute to rigidity and difficulty in learning or adapting.

Perhaps no individual characteristic has received more attention than the concept of control. Control is a complex construct in its own right. It has been variously examined through at least three different theoretical lenses: (a) locus of control of reinforcement, (b) perceived control over work and work processes, and (c) social control or control of others as a means to control internal states or affective responses to stress or as an outlet to frustration. Each of these constructs has a different meaning and has been related to stress in a variety of ways. Unfortunately, the term control is often not explicitly defined in study descriptions and can be inconsistently construed and measured in study methodologies, leading to misunderstandings about control constructs and the effects. Perceived control is frequently examined in the area of occupational stress. It relates to process control or beliefs that the individual has control over relevant aspects of work (Spector, 2009). Self-efficacy (Bandura, 1997), a construct somewhat aligned with control, relates to the belief or confidence in one’s ability to effectively accomplish a task. The concepts of perceived control and self-efficacy have demonstrated a modulating effect on stress appraisal, the related stress response, as well as health and well-being (Spector, 2009). Locus of control (LOC) is a construct that has received a wealth of attention in terms of individual differences and health. It is a term promulgated by Rotter (1966) relating to how individuals perceive important outcomes or reinforcements to occur in their lives. Internal LOC refers to the belief that outcomes and reinforcements are individually controlled through personal effort. External LOC refers to individuals who believe that outcomes or reinforcements (positive or negative) in their lives occur as a result of chance or because of powerful others in their environment. It is believed that control orientation arises from social experiences, but it is mostly considered an enduring or dispositional trait (Ng et al., 2006). LOC is also considered one of four components of a personality profile referred to as core self-evaluation, which also includes self-esteem, self-efficacy, and emotional stability. Internal LOC has been linked to positive work outcomes, job satisfaction, and job performance (Bono & Judge, 2003;

Individual Differences in the Stress Response

Judge & Bono, 2001) and to overall health and well-being along with a widespread impact on an employee’s organizational life (Ng, Sorensen, & Eby, 2006; Spector, 2009). However, LOC is not a dichotomous variable; it is a continuum. Extreme perception of internal LOC can lead to increased levels of perceived stress as well as increased stress response and negative health outcomes, especially when someone with a strongly internal LOC is put in a situation that is uncontrollable or when confronted with repeated negative outcomes that could not be individually controlled (Sapolsky, 2004). As with other individual characteristics, LOC must be considered with other traits and states, such as cognitive flexibility that enables an individual to shift between perspectives depending on the nature of the experience rather than rigidly adhering to a specific perceptual lens.

Lifestyle Behaviors Stress is a disorder of lifestyle, so it is expected that other lifestyle behaviors are related. Behaviors and habits to include diet, physical activity, and unhealthy habits such as smoking and excessive alcohol consumption are stressors to the body and create vulnerabilities to stress while also interacting with the physiology of the stress response to modulate or exacerbate the effects of stress. Diet can be a moderator of the response to stress, with balance in the diet playing a buffering role in stressors becoming distress and imbalance in the diet setting an individual at risk of stressors being converted into distress more easily. Diet has an impact on blood chemistry, weight, and energy level and reserves. High sugar content in the diet can stimulate the stress response, and foods high in cholesterol can adversely affect blood chemistry. Good dietary practices contribute to a person’s overall health, making the person less vulnerable to distress. Other examples of how the impact of stress on illness may be modified by dietary factors include diabetes (stress plus overeating or high consumption of sweets), immune system functioning, and certain heartbeat irregularities (arrhythmia caused by caffeinated drinks). Physical activity is a powerful coping strategy as well as a preventive measure for ill effects of stress. Individuals who have high levels of health and fitness are less likely to experience negative health effects of stress (LeardMann, Smith, Smith, Wells, & Ryan, 2009). In addition, physical activity in the face of a fight-or-flight response naturally would be beneficial in managing the burst of energy generated from the stress response. Physical activity combined with mental-quieting activities, such as yoga, have demonstrated efficacy in modulating the health consequences of the stress response.

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Supportive and loving relationships may be one of the most power­ful therapeutic agents for any individual in the midst of the stress of trials and tribulations.

External Modifiers: Supporting Resources Social support, affiliation tendencies, and social isolation have all been related to stress appraisal, stress response, and coping strategies. Social isolation is as a major risk factor for morbidity and mortality, and social support is the ameliorating moderator of this process (House, Landis, & Umberson, 1988). Immunological alterations resulting from social isolation may provide one possible physiological pathway to explain these results, and the link between personal relationships and immune function is one of the most robust findings in psychoneuroimmunology (Kiecolt-Glaser, Malarkey, Cacioppo, & Glaser, 1994). Social support is more important as a moderator now as traditional societal structures such as the extended family and the township are being attenuated and individual mobility continues to increase and as telework options displace workers from traditional work settings. House (1981) pointed out that social support may come in one of four forms: emotional, instrumental, informational, or appraisal. To these, J. C. Quick, Nelson,

Ta b l e 3 . 1 Individual Stress Response: Physiological, Emotional, Cognitive, Behavioral, Social, Spiritual, and Existential Change

Acute effect

Chronic effect

Cardiovascular changes

Increase pulse, respiration, blood to muscles, organs, brain; blood thickens to control potential bleeding Ready to run or fight Increase energy, alertness

Dizziness, cold hands and feet, chronic high blood pressure, cardiovascular disease

Muscle tension Endocrine changes, stress hormones released

Insulin changes

Increase energy

Digestive system changes

Channel energy to muscles and brain Hyperalert to environment, scan for threats; focused productive application of skills

Sharpened vision, focused attention

Chronic pain, back pain, headaches Restless, fatigue, sleep disturbance, irritability, anger, edgy, productivity decline, decreased immunity, increased inflammation, increased risk taking Fatigue, irritability, eating changes, moodiness Indigestion, stomachache, change in eating habits Channelized attention, distraction, preoccupation, loss of situational awareness, poor concentration, memory, abstract problem solving, and decision making; increased error and mishaps; counterproductive behavior; disillusionment and loss of meaning

Individual Differences in the Stress Response

and Quick (1990) added protection from psychological, interpersonal, and physical stressors. Social support derives from a variety of social relationships at work, at home, and in the community. For example, although one’s spouse may be the key source of emotional support, it is the supervisor who provides much informational and appraisal support at work. Social support has also been associated with a buffering effect in relationship with stress (House, 1981) with somewhat mixed results depending on construct definition and measurement (Uchino, Smith, Birmingham, & Carlisle, 2011). The individual’s existing support system at work and at home may then be viewed as a wealth of resources that he or she may draw on in managing various stressful situations. Informational or instrumental resources help the individual meet the demands causing the stress, thereby reducing the level and intensity of the stress. Social support is a key moderator of the stress–distress relationship, further contributing to the understanding of individual variations in the response to organizational stressors. Unlike some of the other moderators that influence individual responses to stress, additional social support may be engendered by management and, to the extent that this is possible, can serve as an important preventive intervention. Because of its important role, social support as an organizational method of preventive stress management is discussed throughout the book. The individual stress response is one of our best assets for dealing with acute threats or emergencies and in achieving peak performances in a wide variety of tasks and activities (see Table 3.1). When elicited too frequently, too intensely, or for too long a period of time, the stress response may lead to distress, which is a main concern of the next two chapters.

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Individual Consequences of Stress

W Stress can contribute to the burden of human suffer­ ing through behavioral dis­ tress, psycho­ logical distress, or medical

4

hen stress is too intense, frequent, prolonged, chronic, or mismanaged, distress often results and manifests in negative well-being. On the other hand, eustress contributes to positive well-being and performance (Nelson & Simmons, 2011). This chapter examines both distress and eustress as individual consequences of stress. The negative consequences may be behavioral, psychological, and/or medical distress, as shown in Exhibit 4.1. From a health standpoint, stress contributes to the burden of suffering in any organization or population (Ganster & Perrewé, 2011; Macik-Frey, Quick, & Nelson, 2007). The burden of suffering refers to death (mortality) and disease (morbidity). Stress plays a direct or indirect role in seven of the 10 leading causes of death in developed countries (Contrada & Baum, 2011; J. C. Quick & Cooper, 2003): heart disease, cancer, stroke, injuries, suicide/homicide, chronic liver disease, and emphysema/chronic bronchitis. In addition, stress plays an important role in nonfatal health conditions from anxiety to sleep disturbances.

distress, but prevention is always ­available.

DOI: 10.1037/13942-004 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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exhibit 4.1 Individual Distress: Behavioral, Psychological, and Medical Consequences Behavioral distress ❚❚  Tobacco abuse ❚❚  Alcohol abuse ❚❚  Drug abuse ❚❚  Accidents ❚❚  Aggression ❚❚  Dietary extremes

Psychological distress

❚❚  Anxiety

❚❚  Burnout ❚❚  Depression ❚❚  Sleep

disturbances problems ❚❚  Sexual dysfunction ❚❚  Family

Medical distress heart disease and stroke ❚❚  Cancer ❚❚  Chronic pain and musculoskeletal injuries ❚❚  Headache ❚❚  Diabetes mellitus ❚❚  Additional medical distress ❚❚  Coronary

Although death and sickness are negative individual consequences of stress, early warning signs and symptoms precede serious disease. Thirteen leading early warning signs and symptoms are listed in Exhibit 4.2. These early warning indicators serve as wake-up calls and form the basis for personal action before more serious consequences manifest. In addition, there are important gender differences to recognize in stress and strain. Women have reported more stress and pressure from their jobs than men, especially in male-dominated industries, and that can translate to strain and distress (Gardiner & Tiggemann, 1999). The news is not all bad. Eustress is essential to healthy human functioning, contributes to a positive state of well-being, enables individuals to achieve great performance, and brings great joy to life. So, again, is

Exhibit 4.2 13 Early Warning Signs and Symptoms of Stress 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Irritability or anger Fatigue Lack of interest, motivation, or energy Feeling nervous or anxious Headache Feeling depressed or sad Feeling as though you could cry Upset stomach or indigestion Muscular tension Change in appetite Extreme change in sex drive Tightness in the chest Feeling faint or dizzy

Note.  Data from Clay (2011).

Individual Consequences of Stress

stress the kiss of death or the spice of life? The answer is both. Stress creates vulnerability for distress, whereas eustress can serve an important role in human health and optimum functioning.

Behavioral Distress

The abuse of tobacco, alco­ hol, and drugs leads to a host

Behavioral distress can include tobacco abuse, alcohol abuse, drug abuse, accidental injuries, aggression, and dietary extremes. Behavioral distress contributes to the burden of suffering for the individual who abuses substances and for secondary victims who may suffer collateral distress, such as from secondhand smoke or violent behavior.

of individual illnesses and

Tobacco Abuse

social prob­

Cigarette smoking and the use of other tobacco products constitute the single most devastating preventable cause of death in the United States. One quarter to one third of all deaths from coronary heart disease and cancer are attributable to smoking. In the United States, the excess mortality from cigarette smoking is estimated to be 443,000, including 128,922 excess deaths attributable to lung cancer, 128,922 excess deaths from ischemic heart disease, and 126,005 deaths from chronic obstructive pulmonary disease (National Center for Health Statistics, 2009). Smoking also causes immeasurable suffering and disability from chronic bronchitis and emphysema, angina pectoris, nonfatal strokes, and other tobacco-induced diseases. Concerns about “passive smoking” or secondhand smoke led to major workplace campaigns banning smoking and creating smoke-free work environments. The total annual direct cost of smoking was estimated to be $96 billion from 2001 to 2004; the indirect cost of lost productivity and increased health care expenditures was estimated to be $97 billion (Adhikari, Kahende, Malarcher, Pechacek, & Tong, 2009).

lems that incur financial and human costs for more than just the abuser.

Alcohol Abuse Excessive alcohol consumption is a major personal and societal hazard. About 18 million Americans and up to 8.5% of the workforce are alcohol dependent (Grant et al., 2004). T. Schwartz (2010) categorized alcohol and drug abuse along with overeating and excessive television as numbing behaviors in response to stress. Alcohol consumption is a major factor in one half of this country’s motor vehicle fatalities and homicides, one third of the reported suicides, the majority of the nation’s annual deaths from liver cirrhosis, and a substantial number of

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serious birth defects. The problem of alcohol abuse is also costly in economic terms. The cost of alcohol-related problems in the United States was estimated to be nearly $184.6 billion in 1998, including about $87.6 billion in lost productivity and employment (Harwood, 2000). The effects of alcohol abuse vary. For the assembly-line worker or night guard, stressed by the boredom of his or her job, alcohol abuse may become part of a daily work routine, beginning before the workday starts. This can lead to accidents and decreased productivity. For the white-collar employee, the effects of alcohol may be more insidious, affecting work performance and judgment. These subtler effects contribute to a downward spiral of stress, alcohol consumption, declining performance, increasing stress, increasing alcohol consumption, and so on. This self-destructive negative spiral is likely to continue in the absence of a compassionate confrontation from a supervisor, coworker, or family member. Alcohol abuse can also lead to medical distress. Cirrhosis of the liver, largely caused by excessive alcohol consumption, is a leading cause of death and disability. Excessive alcohol consumption also contributes to medical distress associated with heart disease and diabetes.

Drug Abuse Although alcohol abuse continues to be the most devastating form of drug abuse, abuse of illegal “recreational drugs” (cocaine, marijuana, and a variety of other nature and synthetic drugs) and prescription drugs also takes a major toll. At any one time, 1% to 2% of the U.S. population has a drug abuse problem that interferes with daily living, and about 6% of the population will have a significant drug abuse or drug dependency problem during their lifetime. The annual cost of drug abuse in the United States was estimated at $180.9 billion in 2002. This includes costs due to lost productivity from disability, death, and withdrawal from the workforce (Harwood & Bouchery, 2004). When drug abuse begins to affect work performance and individual relationships, it becomes part of the same downward spiral that characterizes alcohol abuse. Cocaine use increases with stress, despite the fact that the drug causes many of the same body stimulants that stress causes (Grunberg, Berger, & Hamilton, 2011).

Accidents and Aggression The annual cost of work-related motor vehicle accidents has been estimated at $60 billion (National Center for Health Statistics, 2009). In addition to the financial costs, there are human costs in suffering and lives lost, with industrial accidents being the leading cause of death for men at work.

Individual Consequences of Stress

Although stress is often the trig­ ger for work­ place violence, the good news is that 85% to 90% of work­ place violence is preventable,

The Federal Bureau of Investigation (FBI) has suggested that stress also contributes to workplace violence. Occupational stressors can be triggering events that lead to individual violence, whether that is self-directed as in suicide or other-directed as in homicide. Workplace violence is responsible for 14% of all deaths in the workplace (Harwood, 2000). Sadly, the leading cause of death for women at work is homicide, and women have 4 times the risk of violence that men do (de Becker, 2004). Fortunately, according to one FBI estimate, 85% to 90% of workplace violence is preventable (Mack, Shannon, Quick, & Quick, 1998). On a less severe note, bullying, a less intense form of workplace violence, is a stressor on the rise and entails adverse consequences (Pandey, Quick, Rossi, Nelson, & Martin, 2011).

according to one FBI

Dietary Extremes

estimate.

Stress can affect the quantity and the kinds of foods people consume (O’Connor & Connor, 2011). Individuals may respond to stress with either markedly increased or markedly decreased appetite. People under stress may also respond by overeating or by consuming high-fat diets such as those commonly found at fast-food chains. Obesity (defined as body weight over 20% above that in standard height–weight tables) is associated with higher rates of heart disease, diabetes, back and other musculoskeletal complaints, respiratory problems, and accidents. One third of all Americans are obese (Baskin, Ard, Franklin, & Allison, 2005). The Centers for Disease Control and Prevention’s 2007–2008 National Health and Nutrition Examination Survey found the prevalence of obesity among women (35.5%) and children ages 2 to 19 years (16.9%) to be stable since 1997 but the prevalence among men (32.2%) to be stable only since 2003 (Yanovski & Yanovski, 2011). Although First Lady Michelle Obama’s Let’s Move campaign may well help to improve the health of Americans through its multilevel, comprehensive approach, pregnant women, infants, and preschool-age children could benefit from more explicit incorporation into the campaign (Wojcicki & Heyman, 2010).

Obesity is a growing prob­ lem through­ out the United States and is preventable through dis­ ciplined regi­ mens of diet and exercise.

Psychological Distress Closely related to the behavioral distress is psychological distress. The leading burden of psychological distress comes from anxiety, burnout, and depression.

Anxiety The term anxiety is sometimes used to describe the stress reaction and other times to describe a general state of uneasiness, apprehension, and

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Although anxi­ ety is useful when facing real danger, it is one of the most common pre­ senting com­ plaints related to stress and affects one in six Americans.

worry. In contrast, anxiety disorders have specific definitions that are meant to guide diagnosis and treatment. Anxiety levels among Americans rose substantially between 1952 and 1993. Anxiety disorders affect one in every six people in the United States and one in every five people in the United Kingdom (J. C. Quick & Cooper, 2003). They include acute stress disorder, posttraumatic stress disorder (PTSD), panic disorder, agoraphobia, social phobia, obsessive–compulsive disorder, and generalized anxiety disorder. We focus on acute stress disorder, PTSD, and panic disorder. Acute stress disorder (ASD) is a diagnosis detailed by the American Psychiatric Association (2000). ASD refers to a pattern of anxiety, dissociative, and other symptoms that occur immediately after a traumatic event, last for at least 2 days, and resolve within 1 month. ASD can resolve with or without treatment, or it can evolve into depression, PTSD, or one of several other more chronic conditions. PTSD, in contrast, refers to a reaction that lasts longer than 1 month and occurs after an overwhelming traumatic event involving a threat to life or limb. Work on PTSD is often seen with combat veterans, victims of torture or other abuse, and survivors of natural disasters. Occupations at greater risk for workplace trauma include law enforcement, fire fighting, emergency rescue, retail banking (because of the risk of armed robbery), high-risk manufacturing operations, and rail transportation (because of the risk of accidents). Although women are often considered to be at lower exposure to traumatic events compared with men, women experience roughly twice the risk of developing PTSD following traumatic events than do men (M. C. Davis, Burleson, & Kruszewski, 2011). Panic disorder is characterized by periodic panic attacks that include palpitations, sweating, trembling, shortness of breath, or any of a number of other acute symptoms. Panic attacks may be situational, spontaneous (no identifiable stimulus), or one of several other forms. Situational attacks may result from specific, usually predictable triggers such as public speaking, flying, or similar events. Anxiety disorders can result in lost time from work and lost productivity while at work. Improved diagnosis in both primary and specialty care settings along with effective, evidence-based treatment have helped reduce the impairment in the workplace associated with anxiety disorders. Early recognition, diagnosis, and treatment are crucial.

Burnout Burnout is a pattern of negative affective responses that can result in reduced job satisfaction, reduced productivity, increased absenteeism, and increased turnover and can negatively impact workers’ physical health (Melamed et al., 2006). Burnout tends to occur in

Individual Consequences of Stress

The risk of burnout is especially great for caregivers, those in the helping profes­ sions, and those who are con­ stantly striving to achieve more and more.

individuals and professions characterized by a high degree of personal investment in work, high performance expectations, and emotionally demanding interpersonal situations (Maslach, 1982). Individuals with a strong commitment to work often derive much of their self-image and sense of worth from their occupation. This limits the amount of investment in recreational and family activities. When difficulties arise at work or there are limited rewards for increasing labor, burnout-prone individuals begin a negative spiral of work investment and home withdrawal. Maslach (1982) described burnout as a process that typically proceeds through three phases: emotional exhaustion, depersonalization or cynicism, and reduced personal accomplishment. Emotional exhaustion reflects a depletion of emotional resources and an inability to give psychologically. This is the individual stress component of burnout (Maslach, Schaufeli, & Leiter, 2001). Depersonalization, perhaps an attempt at coping, includes negative, cynical attitudes about the recipients of one’s services. Finally, reduced personal accomplishment refers to decreased job satisfaction and a reduced sense of competence. Job-related burnout is prevalent in advanced market economies and represents a pressing social problem in addition to the burden of individual suffering (Shirom, 2011). On the basis of the available evidence, Shirom (2011) strongly recommended a multidisciplinary approach composed of organizational, behavioral, psychological, physiological, and pharmacological interventions. Theoretically, burnout is a precursor of depressive symptoms.

Depression

Depression is one of the most treatable and prevent­ able forms of psychological distress, with the unfortu­ nate risk of suicide if severe and untreated.

Depression is one of the most common significant psychological conditions seen by both family physicians and mental health professionals. It ranks among the largest contributors to morbidity and lost productivity (Gutman & Nemeroff, 2011) and is predicted to be the main contributor to the burden of disease by 2030 (World Health Organization, 2004). Depression may also be accompanied by extreme anxiety and may be mild and self-limited or severe enough to lead to suicidal thoughts. Depression will affect approximately 16% of adults during their lifetime (M. C. Davis et al., 2011). Roughly one third of the gender rate differences for adult depression may be attributable to the higher incidence of women’s exposure to sexual assault and abuse, particularly in childhood and adolescence (M. C. Davis et al., 2011). Women have also reported more role burdens, such as work–home role overload, and relationship strain, which are stressors that may mediate the gender link to depression risk.

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Sleep depriva­ tion may be one of the most under­ recognized health risks in the United States that is easily prevent­ able through disciplined sleep hygiene.

Sleep Disturbances Inability to fall asleep the night before a stressful event, such as a key briefing of the company’s senior officers or a difficult performance review session, is a common experience. However, occupational stress can lead to chronic and sometimes debilitating sleep disturbances. Sleep disturbances and deprivation is a major, underrecognized health risk for adults. Insomnia, the inability to fall asleep or to stay asleep, affects one fourth of adults in the United States (Reite, Ruddy, & Nagel, 2002). Insomnia that is due to stress, including the stress of acute illness, accounts for an estimated 35% of sleep disorders. Worries over promotion, conflict at work, or project deadlines frequently cause difficulty in falling asleep. Excessive use or evening use of caffeinated liquids, such as coffee, tea, cola drinks, chocolate drinks, and many noncola drinks, can amplify the problem of stress-induced insomnia. Excess nicotine consumption from stress-induced cigarette smoking can also lead to difficulty falling asleep. Sleep disturbances may be aggravated by a common home remedy for insomnia: the use of alcohol. The depressant effect of beer, wine, or liquor often helps a person to fall asleep, but alcohol disrupts sleep cycles and leads to a rebound increase in adrenaline in the middle of the night. This may awaken the person, making it difficult to get back to sleep. The person is left fatigued in the morning, setting up a self-replicating cycle of stress–alcohol–awakening–fatigue– stress. Chronic insomnia currently occurs in 10% of Americans (Reite, Ruddy, & Nagel, 2002). Because sleep deprivation has a negative impact on mood and performance, it can exacerbate the work circumstances that first triggered the sleep disturbance. Therefore, it is important to recognize insomnia as a possible consequence of stress at work and to confront the problem as soon as it is recognized.

Family Problems Demographic trends of dual-earner partners, single parents, and families in the workforce facing the demands of elder care have led to substantial increases in work–family interface research (Greenhaus & Allen, 2011). Although much of this research focuses on understanding the interdependencies between work and family roles, the concept of balance is also important (J. D. Quick, Henley, & Quick, 2004). Greenhaus and Allen (2011) noted that there are negative and positive sides to the work–family interface. On the negative side is work–family conflict. Both internal and external accelerants such

Individual Consequences of Stress

as alcohol, sleep disturbances, travel, 24/7 communication devices, and toxic corporate cultures can amplify these conflicts (J. D. Quick et al., 2004). There is a growing recognition of positive spillover from home-to-work and work-to-home. Enrichment experiences in either role or the creation of positive energy and the facilitation of positive involvement in one domain can provide gains in the other domain. The notion of balance is also important. Strategies for a more balanced approach to the work–family interface include boundary management or integration of work–home roles in mutually complementary ways. Gender asymmetry also exists in work–family dynamics. Executive and professional women experience greater work–family conflict than do men, with women experiencing greater multiple-role conflict, less support at home, and greater intrusion of family into work (Hewlett, 2002). These issues are especially true for women with children and, in particular, with small children at home. Family businesses provide a unique setting for interactions between family pressures and work demands. Conflicts between parents and children or among siblings can be painful and disruptive for professional business practice (Levinson, 2006). So, work and family life can interact significantly. Work stress may impinge on family life and personal relationships and family stress can spillover, affecting work performance.

Sexual Dysfunction

Stress at work can have adverse spill­ over effects within the home and may interfere with a healthy, satisfy­ ing sexual life.

Another form of distress is the inability to function sexually and to fully enjoy sexual relations. Stress and stress-related anxiety are common causes of inhibited sexual desire. Alcohol and drug abuse, sometimes stress related, can also lead to inhibited sexual desire, impotence, or other forms of sexual dysfunctions. Stress can also reduce sex hormones in both men and women, which in turn may reduce sexual functioning (Laumann, Paik, & Rosen, 1999). In practice, it is unclear what portion of stress-related sexual dysfunction is attributable to physiological as opposed to psychological mechanisms. In women, disruption of menses and temporary infertility have also been attributed to hormonal changes associated with the stress response. Deterioration in sexual relations is undoubtedly one of the factors contributing to marital difficulties among executives and other individuals experiencing significant stress at work. Because satisfying sexual relations are an important part of one’s mental health and well-being, preventing or resolving sexual dysfunction is a necessary element of stress management.

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Medical Distress Although the costs of behavioral and psychological distress are significant, they may also have potentially irreversible effects on physiological well-being. We noted this in the case of alcohol abuse, for example, which can lead to cirrhosis of the liver or contribute to heart disease and diabetes. Empirical research and skilled clinical observations confirm the association between a wide range of stressors and disease. Table 4.1 lists major health problems in descending order of disability-adjusted life years (DALYs) lost to each health problem. The DALY is a method for factoring into the assessment of health impact not simply the number of deaths but also the number of years of life lost (accidental death at an early age weighs more heavily than death late in life) and the number of years lived with a disability (Mathers, Alan, & Murray, 2010). Using the DALY measure, such problems as mental disorders, traffic accidents, and alcohol dependence weigh more heavily than they would simply on the basis of numbers of deaths.

Coronary Heart Disease and Stroke Coronary heart disease (CHD) is the leading cause of death for both men and women. Each year, over 600,000 Americans die from CHD, and over 130,000 more die from stroke (Xu, Kochanek, Murphy, & TejadaTa b l e 4 . 1 Leading Causes of Death, United States and High-Income Countries

United States (2007) Rank

Cause of death

1 2 3 4

Heart disease Cancer Stroke Chronic lower respiratory diseases Accidents (unintentional injuries) Alzheimer’s disease Diabetes Influenza and pneumonia Nephritis, nephrotic syndrome, and nephrosis Septicemia Total for top 10 causes

5 6 7 8 9 10

No. of deaths

% of deaths

High-income countries worldwide (2004) No. of deaths

% of deaths

616,067 562,875 135,952

25.4 23.2 5.6

1,330,000 1,050,000 760,000

16.3 13 9.3

127,924 123,706 74,632 71,382 52,717

5.3 5.1 3.1 2.9 2.2

310,000 — 280,000 220,000 —

3.8 — 3.4 2.8 —

46,448 34,828 1,846,531

1.9 1.4 76.2

— — 42,349,735

— — 74.26

Note.  Data from Kochanek, Xu, Murphy, Miniño, and Kung (2011) and World Health Organization (2004).

Individual Consequences of Stress

Heart disease is the lead­ ing cause of death, and stroke is the third leading cause of death in developed nations for both women and men.

Vera, 2007). Men are at roughly twice the risk of women for CHD, even after adjusting for conventional CHD risk factors such as smoking, obesity, and cholesterol (M. C. Davis et al., 2011). The American Heart Association has identified stress as a contributing factor in CHD risk. Contributing factors are distinct from major risk factors. Three major risk factors are age, sex, and heredity, including racial heritage, and are not modifiable. However, the Centers for Disease Control and Prevention has suggested that differences in CHD death rates among Blacks and Whites may also reflect different distributions of more modifiable risk factors, such as cigarette smoking, body weight, diabetes, hyper­ tension, and socioeconomic differences. Stress has implications for several of the modifiable major risk factors, which include tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and overweight, and diabetes mellitus. Stress can certainly be implicated in tobacco smoking, high blood pressure, physical inactivity, and obesity. Stressful life events, behavior patterns, or personality factors, therefore, may contribute to CHD and strokes, either through a direct effect or indirectly through other CHD risk factors. Bekkouche, Holmes, Whittaker, and Krantz (2011) found a considerable amount of epidemiological evidence that supports the notion that acute stress can trigger cardiac events. They estimated the prevalence of individuals experiencing work stress to be between 10% and 40%, with approximately 30% of those individuals suffering from severe chronic psychosocial stress. This places from 3% to 12% of the population at high risk on the basis of work stress alone. Workplace trends and job stressors also contribute significantly to cardiovascular disease and hypertension (Landsbergis et al., 2011). In a review of job strain and cardiovascular disease, Swedish and U.S. researchers reported that 16 of 22 studies found a significant association between job strain and cardiovascular morbidity and/or mortality (Theorell & Karasek, 1996). In some cases, job strain was associated with increases in serum cholesterol, smoking, or blood pressure. In other studies, a direct relationship between job strain and CHD was found. Eller et al. (2009) found high psychological demands, lack of social support, and iso-strain (i.e., high job strain and low social support, or high isolated strain work) to be risk factors for ischemic heart disease. Poor managerial leadership and covert coping with unfair treatment at work are additional risk factors for ischemic heart disease. The impact of organizational stress on heart disease has been studied much more extensively than has its impact on strokes. The risk factors that lead to stroke are quite similar to those for heart attacks and include smoking, hypertension, poor diet, and diabetes. The extent to which organizational stress affects these risk factors influences death and disability from strokes.

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Cancer The relationship between stress and cancer is not as well- or easily characterized (Baum, Trevino, & Dougall, 2011). Baum et al. (2011) drew few definitive conclusions from the research because of variability in study methods. The direct effects of stress on cancer are, therefore, difficult to demonstrate. However, there is a story to be told as cancer is the second leading cause of death and therefore significant in terms of the overall disease burden. The leading cause of cancer deaths is lung cancer, a rapidly fatal form of cancer for which early detection has proven difficult and current treatments offer little survival benefit. The major risk factor is cigarette smoking, which accounts for three quarters of lung cancers. To the extent that organizational stress increases tobacco consumption, it in turn contributes in this indirect pathway to lung cancer. The relative increase in cigarette smoking among women is beginning to be reflected in rising rates of lung cancer among women. In addition, cigarette smoking contributes to the development of bladder cancer; stomach cancer; and cancer of the mouth, throat, and larynx. Again, these are indirect pathways. Another indirect pathway is through the immune system. Stress is known to suppress immune functions and increase susceptibility to infections and cancer (Dhabhar, 2011). Paradoxically, stress exacerbates asthma and allergic, autoimmune, and inflammatory diseases that should be ameliorated by immuosuppression. Finally, stressful life events and coping strategies may have an interactive effect on the development of cancer.

Pain and Musculoskeletal Injuries

Chronic back pain and musculosketal injuries are significant occupational health risks for a variety of professions and contribute to lost workdays.

Chronic back pain contributes to an estimated 96 million workdays lost each year in the United States, with annual direct and indirect costs totalling more than $61.2 billion (Stewart et al., 2003). The costs and prevalence of work-related musculoskeletal pain disability in industrialized countries are extremely high (Gatchel, Howard, & Haggard, 2011; Gatchel & Kishino, 2011). Back injury is more common in occupations such as materials movers, truck drivers, and those who work in environments with poor ergonomic designs. Back pain and injuries, musculoskeletal injuries, and related disability are less common among the physically fit, residents of rural areas, women, nonsmokers, and people in areas with less disability compensation. Chronic back pain may result in part from muscle spasm induced by stress and the lack of strength and flexibility, which is caused by a sedentary occupational and recreational life. Stress-induced muscle spasm can also lead to chronic neck pain, jaw pain, and other musculoskeletal complaints.

Individual Consequences of Stress

Work stress may contribute both directly or indirectly to pain and musculoskeletal injuries. Occupational stress, job dissatisfaction preceding injury, and poor work evaluations may lead to delayed recovery and return to work as well as a greater likelihood of chronic disability. Gatchel and Kishino (2011) offered a primary, secondary, and tertiary care continuum that is based on their biopsychosocial model of musculoskeletal pain, demonstrating that there is significant overlap in skills required for pain management and preventive stress management.

Headache Headaches are one of the most common symptoms of stress and are listed fifth on the early warning signs list (see Exhibit 4.2). Stressful occupations and stressful life events typically lead to common tension headaches, precipitate migraine headaches, cluster headaches, and other less common types of headache. Though most headaches last only a few hours and are readily treated with simple analgesics, more severe headaches can last several days and result in lost time at work. The annual direct cost of migraine headaches alone is estimated at $12.7 billion. Indirect costs are another $12 billion annually (Weiss, Bernards, & Price, 2008). Stressful job demands, shift work, excessive noise, unpleasant odors, and other physical stressors are all associated with a higher incidence of work-related headaches. Performance appraisals may be adversely affected for employees with recurring headaches.

Diabetes Mellitus Diabetes is a metabolic disorder characterized by abnormally high blood glucose and a wide range of adverse effects on the vital organs. It is the seventh leading cause of death in the United States and a major contributing factor to cardiovascular, kidney, and eye disease. Individual risk factors include family history, obesity, and physical inactivity. One of the predominant effects of the stress response and stress-related hormonal changes is an increase in the availability of blood glucose for fast energy, providing a link between stress and glucose regulation issues. Although it is unlikely that stress can cause diabetes in a nonsusceptible individual, in someone predisposed to diabetes, stress-induced obesity and stressrelated stimulation of blood sugar increases may tip the balance.

Additional Medical Distress Beyond the major contributors to medical distress that constitute the majority of the burden of suffering and disease, there is a range of additional forms of medical distress that manifest in specific individuals. Infertility, metabolic syndrome (belly fat), and skin diseases are among the

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forms of medical distress that are linked to chronic stress at work and cause significant individual suffering even though their contribution to the collective burden of suffering may not be as great (see Chandola, Brunner, & Marmot, 2006; Vitaliano et al., 2002; Wallace & Doebbeling, 1998).

Eustress, Hope, and Optimism

Challenge stress has positive outcomes and is an important contributor to human growth and the devel­ opment of com­ petence and self-mastery.

The chapter opened with a line about the good news of eustress. The individual consequences of stress are neither all bad nor all distressing. Much of the focus in individual preventive stress management is on the attitudes, actions, and activities that are positive, healthful, and life giving. We examine the positive aspects in Chapters 10 and 11, which address primary and secondary prevention. Although no one should ignore the warning signs of individual distress, dwelling on the negative alone can become a life-draining downward spiral. Nelson and Simmons (2011) drew attention to the positive side of individual stress in the form of optimism as an individual difference as well as the many forms of eustress. These include hope, positive affect, vigor, satisfaction, commitment, ability to find meaning in unexpected events, and ability to manage multiple or unusual demands. The whole realm of positive psychology has brought attention to the importance of human strengths, abilities, and positive passions, all of which are influenced by an individual’s attitude and point of view. T. Schwartz (2010) suggested that the way we have been working simply is not working because we too often engage in numbing behaviors like using alcohol and drugs, overeating, and excessive television viewing. Alternative healthy habits can respond to our deepest needs for sustainability, security, self-expression, and significance, thus reducing our distress and creating challenge stress. Physical, emotional, mental, and spiritual challenges may be considered stressful yet can lead to healthy habits, improved health, and greater longevity. The stress response is an integral psychobiological pattern of sympathetic nervous system and endocrinal reactions and can be our best asset for achieving peak performance and successfully managing legitimate emergencies. Although stress can turn to behavioral, psychological, and medical distress when chronic and/or mismanaged, it can also lead to eustress and positive well-being when channeled in constructive, productive ways. The pathways through which stress-induced energy flows are influenced by an individual’s preventive stress management skills, which are more fully addressed in Chapters 10, 11, and 12. In addition, they are influenced by the organizational culture and leadership, home, job, and work system within which a person lives and works. Chapter 5 addresses the organizational consequences of stress, which can be both positive and negative—just as they are for the individual.

Organizational Consequences of Stress

O Heart disease alone, independent of other causes of death, presents a significant amount of organizational

5

rganizations and individuals benefit from eustress and pay a price for distress and strain. For organizations, eustress manifests in high performance and vitality. Individual distress and strain roll up into organizational distress. This chapter addresses the benefits of organizational health and eustress along with the direct and indirect costs of distress. It concludes by presenting a positive pathway to psychologically healthy organizations. Heart disease exemplifies how individual distress can become organizational distress, financially and in other ways. As the leading cause of death for men and women, heart disease causes significant organizational distress in economic costs alone. The American Heart Association developed a simple way to calculate the number of employees lost to heart disease as well as the direct hiring and training costs associated with replacing them. The American Heart Association estimated that the cost of cardiovascular disease in 2009 was $475.3 billion (Lloyd-Jones et al., 2009). Figure 5.1 shows both the total

distress in terms of direct and indirect costs.

DOI: 10.1037/13942-005 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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F i g u r e 5 . 1  500 450 400

Cost (billions of dollars)

74

350 Lost Productivity/Mortality

300

Lost Productivity/Morbidity

250

Drugs/Others

200

Physicians/Other Professionals

150

Nursing Home Hospital

100 50 0 Heart Diseases

Coronary Heart Disease

Stroke

Hypertensive Disease

Heart Failure

Total Cardiovascular Disease

The direct and indirect costs of cardiovascular disease. Data from Lloyd-Jones et al. (2009).

cost of cardiovascular disease as well as the direct and indirect costs of heart disease, coronary heart disease, stroke, hypertensive disease, and heart failure. The direct costs include hospitals, nursing homes, physicians and other professionals, drugs, and other expenses. The indirect costs include lost productivity from morbidity and lost productivity from mortality.

Organizational Health The concept of organizational health is central to preventive stress management, occupational health psychology, and positive psychology. It is inherently systemic and requires jointly pursuing individual well-being and organizational effectiveness. Because organizations are dynamic, multidimensional systems, disease and dysfunction disrupt balance in the system. Therefore, there can be contagion effects throughout an organization when problems, failures, or dysfunctions break out in one location. Organizational health, like individual health, requires continuous management. Organizations operate in a state of continuous change and flux. Only organizations that are able to flex with short-term change

Organizational Consequences of Stress

and adapt to long-term cycles of growth and transformation are able to achieve, maintain, and enhance levels of organizational health (Adkins, Quick, & Moe, 2000). Three characteristics distinguish healthy organizations from unhealthy ones: adaptiveness, flexibility, and productivity. These characteristics relate to the effectiveness of the organization. Adaptiveness refers to the ability of an organization to change and to resist becoming rigid in its functioning and operating procedures, especially vis-à-vis its task environment (i.e., the part of the organization’s environment related to its goal-attainment efforts). Flexibility differs from adaptiveness in terms of response time. Adaptiveness is concerned with longterm adjustment, whereas flexibility is concerned with adjusting to internal and external emergencies. Productivity is concerned with the amount of product or service provided by the organization. Productivity, in the context of organizational health, concerns the degree to which the amount of product or service provided varies during times of organizational change. Healthy organizations perform various internal adjustment activities aimed at having the people, structure, technology, and task of the organization work in harmony. A misfit between two or more of these dimensions may cause internal health problems for the organization. Such a problem would be illustrated in the case of a manager placed in a job for which he or she was not fully qualified. In this example, the organization may change the manager through a training and development effort. Or the organization may change the job, reassigning those job functions for which the manager is not qualified to another job. In either case, the improved fit of a manager with a job improves organizational health. Healthy organizations also adjust to the demands of the task environment. Important agents in the task environment include customers, suppliers, competitors, regulators, and the community. This external adjustment is essential primarily because of the organization’s dependence on these environmental agents in achieving its objectives. Good external adjustment is essential to organizational health and vitality and is best achieved through the mutual, reciprocal exchange of knowledge, products, and other resources between the organization and the agents in its task environment. A good example would be the growth of General Electric’s jet engine business with the rise in air travel, adding to the company’s previous strength in building railroad locomotives. Assessing psychosocial strengths and weaknesses associated with both the organizational environment and the individuals within that environment can help leaders to target resources at high-risk, highleverage variables. In addition, leaders who promote organizational health can also attain public recognition for their organization. Annually, the

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To learn more about psycho­ logically healthy workplaces and how your organization can be recognized, visit http://www. phwa.org/.

American Psychological Association honors healthy organizations by awarding Psychologically Healthy Workplace recognitions nationwide. Although the American workforce is stressed and many are struggling, some employers have crafted psychologically healthy workplaces in the private and public sectors, in for-profit and not-for-profit organizations, as well as in military and educational institutions (American Psychological Association, 2011). Kaiser Permanente Center for Health Research (CHR) Northwest is one award-winning psychologically healthy workplace. CHR-Northwest is a professionally independent, nonprofit research institute dedicated to improving individual health and informing health policy. The Kaiser Permanente affiliation creates access to 8.6 million member medical records, presenting a wealth of research opportunities. A roster of scientists, along with strong academic and community partnerships, promotes diverse research in a setting that fosters collegiality and scientific inquiry. From an employee involvement perspective, CHR-Northwest is distinguished by a culture of transparency, staff involvement, and centerwide information sharing. First Horizon, another award-winning psychologically healthy workplace, is a premier financial services company dating back to 1864 in Tennessee. One of the top 50 bank holding companies in the United States, First Horizon is known for exceptional customer service and a deep commitment to its people. The strong, positive relationship culture makes it a sought-out employer of choice. Employee involvement comes through employee-led councils and committees. The Firstpower Council makes recommendations on key initiatives to foster candor, inclusion, and teamwork. The Diversity Council works for inclusion through employee resource groups, which work to engage and attract a diverse workforce, with groups developed around themes such as women’s initiatives, administrative assistants, and African American mentoring.

Costs of Organizational Distress All organizations are not as psychologically healthy as First Horizon or CHR-Northwest. Organizational distress is divided into two major cost categories: direct and indirect, as summarized in Exhibit 5.1. Direct costs include the high cost of turnover, the often hidden costs of absenteeism, and poor performance on the job. Human resource accounting estimates these costs, and people’s positive value, using behavioral and economic approaches (Cascio, 2011; Flamholtz, Bullen, & Hua, 2002). Worker compensation, health care costs, investigation, and litigation are additional direct costs. Indirect costs include broken and disrupted communication, poor morale, faulty decisions, aggression, and/or workplace violence.

Organizational Consequences of Stress

Exhibit 5.1 Costs of Organizational Distress Direct costs Indirect costs Participation and membership Loss of vitality z  Turnover z  Low morale z  Absenteeism z  Low motivation z  Sick leave z  Low dissatisfaction z  Strikes, lockouts, and work stoppages Communication breakdowns z  Decline in frequency of contact Performance on the job z  Performance decrements z  Distortions of messages z  Grievances Errors in decision making z  Accidents Quality of work relations z  Unscheduled downtime z  Distrust z  Material and supply overuse z  Disrespect z  Inventory shrinkages z  Animosity Investigation and litigation Aggression and violence Opportunity costs

Direct costs of distress to organizations include medical care, lost production, loss of managerial skills, and employee retraining.

Direct Costs of Organizational Distress The diseases of maladaptation and individual distress discussed in Chapter 4 have an organizational cost correlate. As pointed out at the beginning of this chapter, cardiovascular diseases cost the United States a total of $475.3 billion in 2009. Of this amount, $20.2 billion is attributable to lost production (Lloyd-Jones et al., 2009). Most of the remaining direct costs are attributable to medical care, loss of managerial skills, and retraining (see Figure 5.1). Cascio & Boudreau (2011) presented a systematic approach to costing employee attitudes and behaviors. He applied standard cost accounting procedures to employee behavior. Direct costs include participation and membership (e.g., high cost of turnover), performance on the job (e.g., poor-quality work), and costs of investigation and litigation (e.g., sexual harassment complaints). In addition to the direct economic costs associated with specific employee behaviors, organizations are now being held compensatorily responsible by some courts for on-the-job distress encountered by employees. Let’s have a closer look at each of these categories of direct costs.

Participation and Membership There are numerous reasons why an individual may not be available to work, some permanent and some temporary. There is a high cost for turnover as well as for absenteeism, sick leave, strikes, lockouts, and other forms of work stoppage.

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Organizational policies can encourage a healthy amount of voluntary turnover and save money in job advertising, preemployment administrative functions, entrance interviews, testing, and other areas.

Turnover has functional as well as dysfunctional consequences for the organization. When poorly performing or overpaid employees leave, this can be a real benefit for the organization in the long run even though there are short-term financial costs associated with functional turnover. Dysfunctional turnover is painful and costly because the organization loses its best and brightest talent. Functional turnover, in contrast, enables the organization to remain healthy by improving the quality of its human resources. Thus, if overpriced employees or unproductive employees leave and make room for new, vital personnel, then turnover is healthy. Or, if individuals leave because of a change in organizational tasks and goals, then such turnover can be good. Unfortunately, the functional aspects of turnover are often overlooked. In either case, functional or dysfunctional, turnover has a high price. Turnover causes organizations to incur both separation costs and replacement costs (Cascio & Boudreau, 2011). Separation costs are those accrued during the process of termination of an employee. Separation costs to consider are the exit interview and administrative functions related to termination, separation pay, and unemployment tax. Cascio (2011) provided detailed formulas and examples for understanding and calculating these costs. Although total separation costs are substantial, total replacement costs may well be greater. Replacement costs include communication of job availability, preemployment administrative functions, entrance interviews, testing, staff meetings, travel and moving expenses, postemployment acquisition and dissemination of information, and employment medical examinations. In addition, there may be training costs for either formal or informal training aimed at ensuring performance competence on the part of the new employee. Finally, there may be a cost associated with the difference in performance between the new and the replaced employee. Cascio & Boudreau (2011) suggested monitoring and managing turnover by focusing primarily on voluntary turnover, which contrasts with involuntary turnover. Organizations should consider both the performance requirements associated with a position as well as the replaceability of the incumbent in the position. Organizational policies may be helpful in enhancing a healthy amount of turnover, such as the up-or-out policies of the United States military services. By setting tenure limits in each enlisted and officer grade, the military services stimulate growth, development, performance enhancement, and increased responsibility among the enlisted and officer corps. This set of policies encourages mostly healthy turnover throughout the services. The policy is coupled with the recognition that not all turnovers are desirable and allows for exceptions to hold especially valuable enlisted and/or officer personnel in a given grade beyond the established tenure limits. During times of war, managing turnover can be more challenging.

Organizational Consequences of Stress

The hidden costs of absenteeism and sick leave may well overshadow the costs of turnover, depending on industry and a range of other factors.

Absenteeism and sick leave are two behaviors associated with nonparticipation and may well carry hidden costs. Cascio and Boudreau (2011) estimated that 16% of absenteeism can be directly attributable to stress and 26% to family-related issues. The remaining 60% is attributable to personal illness, personal needs, and entitlement mentality in that order. They found that estimating absenteeism costs is more complicated than calculating turnover costs, and many of the costs may be hidden, such as the total compensation lost to absent employees. This latter number alone can be very significant. Hence, the hidden costs of absenteeism and sick leave may well overshadow the costs of turnover, depending on a range of factors such as industry. Cascio and Boudreau (2011) cited Honda as an example of a company that manages absenteeism and sick-leave abuse with a no-work, no-pay policy. Honda’s policy is not strictly punitive and provides for progressively larger bonuses for employees who report on time and do not punch out early. Health care costs may well be considered along with the issue of sick leave. As indicated in the chapter’s opening example of cardiovascular disease, $150.1 billion (or 85%) of the costs of cardiovascular diseases fall under the rubric of health care hospital costs (Lloyd Jones et al., 2009). If the proportion of variance from stress, especially job stress as a contributing factor to cardiovascular disease, were known, then the proportion of the health care costs attributable to stress and job stress could be estimated. Although they improve health care, technology advances are a major factor in increasing health care costs and seem to have little containment (Bodenheimer, 2005). Strikes, lockouts, and work stoppages are other forms of nonparticipation that may be initiated by employees or employers and carry costs for both parties in the organization. There are not only the direct costs associated with loss of production and/or replacement of personnel but also the indirect costs of lost opportunities and/or disruption of relations with suppliers, clients, and others in the task environment. The 2011 decertification of the NFL football players union followed by a lockout by the NFL owners is an example of a work stoppage with significant financial considerations at stake as well as reputational considerations. The latter are among indirect costs and are discussed in more detail later in the chapter. As management and labor engage in conflict dynamics, as in the NFL example, there is an ongoing balancing act that considers costs incurred and potential future benefits accrued.

Performance on the Job Stress influences not only participation and membership or the lack thereof, but also performance on the job. For example, although one individual may choose to be absent because of distress, another

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individual may display presenteeism (Pandey, Quick, Rossi, Nelson, & Martin, 2011). Or distress might manifest itself in aggression or conflicts that disrupt team performance. Production quantity and quality, grievances, accidents, unscheduled machine downtime and repair, material and supply overuse, and inventory shrinkages are among the costs associated with job performance. Performance decrements attributable to excessive levels of stress or to boredom have been known for a century. When stress becomes distress, then the quality and/or the quantity of the employee’s work suffers. This may occur routinely in repetitive work situations in which the employee starts losing concentration after approximately 30 minutes. When the employee’s attention starts drifting because of the repetitiveness of the work, then quality and quantity of performance can suffer. Fatigue that is due to work overload or role overload can also contribute to poor quality and/or quantity of work. Executive burnout is a form of distress at work that results in individuals losing enthusiasm and vitality for their work (Levinson, 2006). Burnout is often accompanied by declining job performance because of emotional exhaustion and low energy. Burnout is a form of emotional and psychological fatigue, akin to depression. The absence of work respites and energy recovery periods as well as work and role overload are important contributing factors. This condition appears to influence both the quality and quantity of work that an individual produces. People who work directly with employee problems as well as those in very-high-demand jobs are particularly prone to this form of distress. Grievances and accidents take away from an employee’s performance on the job. Informal complaints or suggestions that get acted on by managers or supervisors and thus never reach the formal grievance action stage are not included here. Such informal action may well be very beneficial to improved organizational health and cost the organization little beyond supervisory and employee time to resolve the issue. Included here are the formal actions such as those that result from work overload during periods of economic difficulty or downsizing (C. L. Cooper, Pandey, & Quick, 2012). Some organizations respond to economic stress and industrial competition by seeking cost savings through reductions in their labor force. In cases in which commensurate reductions in work activities do not accompany the human resource reductions, the results may be work overload, grievance actions, and accidents. Unscheduled downtime, material and supply overuse, and inventory shrinkages are additional direct costs of organizational distress that can be incurred in manufacturing, industrial, and production organizations. Although not all incidents of these employee behaviors are attributable to employee distress, some are. Fatigue, poor judgment, anger, inattention, and other outcomes of distress at work are factors

Organizational Consequences of Stress

Many organizations do not legitimize the formal verbal­ ization or expression of feelings such as anger, hostility, and anxiety or do not offer avenues to express employee appreciation.

contributing to occurrence of these dysfunctional behaviors. In addition to the direct costs of performance decrements attributable to the abovementioned behaviors, poor job performance may be attributable to the sublimation of negative feelings on the part of the employee. Feelings of anger, hostility, and anxiety are normal responses to stressful situations at work, such as conflict with one’s boss or other superior, role ambiguity about expected work performance, work overload, and other related experiences. However, many organizations do not legitimize the formal verbalization or expression of these normal feelings. Although the repression of these feelings may lead to conversion reactions and psychosomatic disorders, as discussed in Chapter 4, it can alternatively lead to action, such as in subversive behaviors, intentional machine malfunctions, or poor-quality work. Some of these poor performance behaviors are consciously or unconsciously designed to get the individual attention at work, for there is interpersonal stress associated with being ignored at work. Among thousands of workers in six occupational groups, the Academy of Family Physicians found that employees change jobs to seek greater selffulfillment and because they experience a lack of appreciation in their present organizational circumstances. Therefore, employees may seek dysfunctional ways of gaining attention if they do not feel appreciated.

Investigation and Litigation Mismanaging people can be very expensive (Cascio, 2011). Whether through sexual assault, wrongful termination, wrongful death, or malicious job strain, the mistreatment of customers, employees, or supervisors can lead to significant costs (J.B. and B.O. vs. Harris Methodist H-E-B Hospital, 2009; Dolese vs. Office Depot, Inc., 2000). Cascio (2011) detailed the costs for single-plaintiff cases as well as complex class-action cases. These costs include filing a complaint, conducting discovery with opposing counsel, pretrial order with the judge, written discovery, depositions, pretrial dispositive motions, and all the costs associated with a trial. Many of the trial preparation costs are incurred even if the case results in settlement negotiations and ultimately a settlement before formal court proceedings. The direct economic costs do not give weight to the anxiety, suffering, and strain for both the plaintiff and the defendant in these formal proceedings. Even threat of litigation is a severe job stressor, as in the case of metropolitan general practice physicians in Australia (Schattner & Coman, 1998). On the positive side, the better management of human resources can help to avert these costs and even lead to potential savings and benefits. For example, the better management of the workers compensation system allowed a 54% decrease in workers compensation

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as a percentage of payroll from the years 1992–2002 (Bernacki & Tsai, 2003). Organizations can follow both state and federal court rulings to determine what the trends are for such direct costs.

Indirect Costs of Organizational Distress In addition to the various direct economic costs of organizational distress, there are a number of indirect costs associated with organizational distress. These indirect costs were well charted in the seminal research on organizational stress conducted by Robert Kahn and his associates (Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964) at the University of Michigan’s Institute for Social Research. Although these indirect costs can be significant and with clear impacts, the same cost calculations that Cascio and Boudreau (2011) so systematically worked out for the employee attitudes and behaviors in the direct cost categories are not available. The absence of such indirect costing procedures does not make the indirect costs any less painful or damaging or the suffering any less.

Loss of Vitality Superficial adaptive energy enables individuals to cope with immediate emergency or stressful situations. Individuals who are constantly experiencing too high a level of stress for their particular abilities and energy resources may not have sufficient recuperative time to replenish the superficial adaptive energy supply that gets consumed on a daily basis. Employees who are so expended on a regular basis in this way may end up accruing some direct performance costs for the organization in the form of lowered work quality. Even in the absence of such direct costs, there may be indirect costs associated with the inability to effectively cope with changes and adjustments at work. Long-term work overload would reasonably create such a condition with its associated problems. Therefore, individuals who are chronically distressed lose their responsiveness and resiliency because they do not have the necessary super­ ficial adaptive energy to cope with stress. Employees who are expended in this way are not able to contribute constructively and consistently to organizational health and functioning. This loss of vitality may well manifest itself in varying degrees of low morale, low motivation, and dissatisfaction in the work force. These indirect costs have been shown to contribute to some of the direct costs previously discussed, such as those associated with low morale and high turnover or dissatisfaction and low productivity. However, these manifestations of loss of vitality have implications other than their contribution to the direct costs. They are also evidence of poor-quality work life, which has humanitarian implications over and above the

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Organizations that are actively involved with employee

economic considerations discussed. The work environment need not be a dissatisfying place. On the contrary, there are long-term benefits available to organizations that are concerned with humanitarian and morale considerations, such as the goodwill that leads individuals to seek employment with the organization. See, for example, the case of First Horizon mentioned earlier.

morale and humanitarian action can cultivate goodwill, which leads individuals to seek employment there.

When communication becomes less frequent, the resulting disruption and misunder­ standing can seriously hamper accomplishment of interdependent tasks and activities.

Communication Breakdowns Distress at work also has adverse effects on communication patterns of employees. Kahn et al. (1964) found that as role conflicts and role ambiguity intensify, there is a decline in the frequency of communication between the individual and others in the working environment. The decline in communication frequency was much more notable in the case of role conflict, in which the individual experiencing the conflict attempts to reduce it by withdrawing from conflicted relationships. This reduction in the frequency of communication interactions may lead to disruption and to misunderstanding in the accomplishment of interdependent tasks and activities. Especially at the managerial level, much of the work in an organization gets accomplished through verbal and written instructions, directions, information sharing, and clarification of objectives and activities. For example, a miscommunication occurred at a large photochemical company one summer when the crew was told to paint the windows in one of the company’s buildings. The crew never asked for clarification and simply painted the windowpanes in the entire building, rather than the frames as had been intended! In addition to the reduced frequency of communication that may occur because of stress, there is a clear potential for distortions to occur in communication linkages. One of the associated events of a stressful situation is the arousal of defense mechanisms. Although the psychological defense mechanisms that individuals use to protect ego integrity have some functional value, they may also distort both the messages that one sends and the interpretation of messages that one receives. Either is dysfunctional for effective working relationships.

Errors in Decision Making Effective decision making requires information about the decision situation and goal judgmental processes on the part of the decision maker (Nelson & Quick, 2011). The communication breakdowns discussed previously are an organizational cost of distress and may contribute to errors in decision making. That is, as communication flows and patterns are disrupted, information may be lost or not transmitted within

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the organization. This can have a detrimental effect on any decisions to which the information is relevant and can be especially problematic in decision contexts in which hierarchical decision making is not open to input from junior colleagues, such as decision making by pilots in cockpits and surgeons in the operating room. A second way distress at work can lead to errors in decision making is by impairing a person’s judgment. When a manager is distressed, physiological and psychological processes may be adversely affected. Specifically, a manager who is bored because of too little stress may be inattentive and lack alertness in making a decision, whereas a manager who is overloaded with demands may not carefully weigh and evaluate the decision alternatives and the information relevant to them. Both poor judgment and lost information that are due to communication breakdowns can contribute to costly bad decisions for the organization. In the health care system, and especially among surgeons, errors in decision making can be very costly. Common problems that occur in orthopaedic surgery are most often related to oversight errors in decision making rather than errors of commission; that is, the errors are unintentional rather than intentional (J. C. Quick et al., 2006). Such errors include prescription errors, oversights of surgical infections, and wrong-site surgery decisions. Many of these errors in decision making and poor judgment proceed from the stress of overwork and/or burnout.

Quality of Work Relationships The communication problems that result from distress are one aspect of the overall quality of working relationships in an organization. In addition to the reduced communications, Kahn et al. (1964) found a marked increase in distrust, disrespect, and animosity occurring under conditions of stress. That is, individuals who are experiencing role distress tend to have markedly less trust in, less respect for, and less liking for those with whom they are working. Deterioration in the quality of work relations in the organization can have at least two dysfunctional side effects. First, distrust and dislike may both contribute to destructive conflict and animosity in the relationship. The more energy that is consumed in this manner, the less constructive energy is available for people to use in work performance. This form of conflict is different from constructive conflict, which when managed in a forthright manner can lead to change and growth.

Aggression and Violence Workplace aggression and violence is a form of organizational distress of concern to employees and employers (de Becker, 2004; Mack et al., 1998). Organizationally motivated aggression is instigated by some

Organizational Consequences of Stress

factor in the organizational context and may lead to organizationally motivated violence. There are examples of aggression and violence in American industry back through its history, such as the conflict and violence that periodically erupted in the U.S. steel industry in and around Pittsburgh during the 1920s (e.g., Cotter, 1921; Dickson, 1938). Aggression and violence need not be physical, however. Verbal, interpersonal, and psychological abuse can be nearly as destructive as physical aggression and violence. In particular, medical and health care professionals are frequently exposed to, or are victims of, workplace violence. Further, violence from home can spill into the workplace when family members attack each other at work, which occasionally happens.

Opportunity Costs Healthy organizations respond and adapt to their task environments, as do healthy individuals, to minimize the impact of threats while working to take advantage of opportunities. The threat-rigidity thesis highlights the difficulty in maintaining flexibility and adaptability during changing, stressful, and/or challenging times (Staw, Sandelands, & Dutton, 1981). Distressed employees and organizations are at a disadvantage in this regard because they may develop tunnel vision and may devote more energy to defensive, maintenance responses than to adaptive, positive responses. Distressed individuals and organizations may use most of their available energy for coping or survival. Under such extended conditions, the longer time perspective needed for examining future opportunities gets lost, and the real possibilities in an environment or task environment are simply not seen.

Positive Paths to Psychological Health and Eustress in Organizations Although organizational distress is costly and painful, there are alternatives. Psychological health and eustress can be achieved in organizations by capitalizing on employee and organizational strengths so that both thrive. Stress, challenge, and eustress can provide positive pathway to psychologically healthy organizational outcomes. Adkins et al.’s (2000) four guiding principles of organizational health are as follows: 1. Health exists on a continuum from mortality to vibrant wellbeing.

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2. Organizational health is a continuous process, not an obtainable state. 3. Health is systemic in nature and results from interconnections of multiple factors. 4. Organizational health relies on fulfilling relationships achieved through communication, collaboration, and relationship-building actions. From these guiding principles, Grawitch, Gottschalk, and Munz (2006) set forth a PATH (practices for achievement of total health) model. According to them, the five categories of healthy workplace practices are (a) work–life balance, (b) employee growth and development, (c) health and safety, (d) recognition, and (e) employee involvement. These five workplace practices are positive pathways to employee well-being and organizational improvements that, taken together, result in healthy organizations. For Grawitch and his colleagues, employee well-being includes physical, mental, and emotional aspects of employee health on the basis of indicators such as physical health, mental health, stress, motivation, commitment, job satisfaction, morale, and climate. Organizational improvements are indicated by competitive advantage, performance and productivity, reduced absenteeism and turnover, reduced accident and injury rates, increased cost savings, hiring selectivity, improved service and product quality, and better customer service and satisfaction. In Chapters 8 and 9, we demonstrate a range of organizational preventive interventions that address the above sets of principles. However, interventions are predicated on a diagnostic understanding of the organization and its people. In Chapter 6, we discuss how to conduct stress assessment and surveillance.

Stress Measurement, Assessment, and Surveillance

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ssessment forms the foundation of preventive stress management, just as it represents a key component of the various sub­disciplines that compose the practice of stress management in organizations. For example, public health practitioners measure and track threats to health and disease burden over time to protect and promote health in a population. Within the field of health care, regular medical exams, mental health evaluations, and health-risk appraisals for preventive medicine and workplace wellness provide important data supporting both individual and organizational level decision making. Within organizational and management disciplines, metrics and monitoring of processes, products, and funding flow are essential to both beginning and sustaining operations. The same critical influence of identification, measurement, and tracking across multiple dimensions forms the basis for stress-related prevention and intervention practices, policies, and programs. Similarly, program evaluation strategies inform leaders, managers, and practitioners of the level of effectiveness of interventions. In this DOI: 10.1037/13942-006 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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F i g u r e 6 . 1  Factors – Individual and Organizational

System Factors – Cross-functional and Process

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Indicators – Individual and Organizational

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PRIMARY PREVENTION

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Multidimensional model of assessment.

chapter, we examine the process of analysis, measurement, assessment, and monitoring of stress within the organizational context. There are various purposes for engaging in formal stress assessment, which include (a) determining the causal and contributing factors associated with organizational stress; (b) assessing strengths, vulnerabilities, and coping strategies for individuals and groups at risk; (c) recommending and evaluating preventive managerial interventions; and (d) providing a basis for research regarding organizational stress. Figure 6.1 adapts the dimensions of organizational stress (discussed in Chapter 2 and summarized in Figure 2.1) to depict the complexity and potential targets for assessment. Symptoms of distress are the target areas for primary, secondary, and tertiary prevention practices. The presumed causative and contributing factors associated with the individual, the organization, and the system entail assessing the presence of individual strengths and organizational protective factors along with individual vulnerabilities and organizational risk factors. Once interventions are implemented, effectiveness measures are needed to determine the results. The levels of effectiveness dimension associated with program evaluation determine whether the process is being implemented with fidelity and whether the

Stress Measurement, Assessment, and Surveillance

If it is worthy of time and attention, it is worth measuring. Assessing the health of your organization requires dedicated planning, both for the overall strategy and specific tactics.

desired outcomes (or direct, proximal effects) and impacts (or indirect, distal effects) are realized. And the remaining dimension, although not depicted in the figure, is that of time. The assessment process is not a onetime activity. Rather, it is an ongoing component of effective preventive maintenance to ensure sustained optimal functioning across time. In addition to being essential to preventive stress management, an organization may engage in routine assessment for many other reasons. Measuring a process requires carefully identifying and clarifying that process and calls attention to its importance. If it is worthy of time and attention, it is worth measuring. The act of measuring and assessing alone has the potential to change that process. However, to achieve the optimal positive benefit of assessment requires dedicated planning. Although every individual and every organization is different, there are some similarities that can assist in designing an assessment and intervention strategy, enabling each organization to learn from the experience of others. Nevertheless, individual and organizational prevention activities should be tailored to the specific individual or organization on the basis of the assessment findings, taking into consideration the individual differences discussed in Chapter 3 (see Adkins, Kelley, Bickman, & Weiss, 2010). If preventive stress management is worth doing, it is definitely important to get it right. Incomplete or ineffective applications of generalized principles will most probably meet with ineffective outcomes, creating disincentives and resistance for the leaders and employees to embark on the journey again in the future. Effective programs begin with planning for assessment and intervention that follows the basic structure for any corporate planning process for initiating a successful process or product line—that is, strategic planning.

Clearly Articulate a Vision Dedicated planning establishes the road map for the future and determines how you believe the actions taken will get you to the end result you seek.

Strategic planning helps executives and their multidisciplinary teams of experts to analyze their current situation, to develop clear goals for the preventive stress management process within their enterprise, and to identify pathways for reaching those goals. Dedicated planning establishes the road map for the future and determines how you believe the actions taken will get you to the end result you seek. That road map starts with a vision or clear articulation of the desired end state. In looking at the various domains for action, what does fit and healthy look like for your organization or for individuals within your organization? How will you know if you have achieved the goal of fostering and sustaining a fit and healthy system? What deviations or signs of strain are you willing to accept as the cost of doing business? What are the values that you place on individual health? What state of normal is acceptable to you for organizational health? If you use transient day labor, effective communication,

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rapid assimilation to teamwork, and decreased workplace violence may be very important. If your organization requires a long training period for employees, you may be more interested in their long-term quality of life. Retention, reduced turnover, and lower health care costs are very relevant goals for you. Do not overlook this vital part of the process. It will help you to sort through the proliferation of measures and practices that are available to you in terms of assessment and analysis. The values, norms, and goals of the organization are key ingredients to a successful preventive stress measurement plan.

Select an Assessment Strategy, Measures, and Techniques There are numerous types of assessment measures and a variety of techniques for collecting information about stress factors, consequences, and interventions. To design a strategy, the assessment professional or team must choose among the measures and techniques available for a particular organization and purpose. Decision points in designing a strategy include determining the overall purpose of the assessment strategy (e.g., whether it is a comprehensive or a targeted assessment process), deciding on a good measure, and selecting a data collection method. Once techniques have been decided on, evaluation measures are then warranted to track the effectiveness of the program or the policies put into place.

Comprehensive Measures and Strategies The comprehensiveness of the procedure may be very relevant when there are few apparent specific indicators or symptoms. Because distress may be manifested in such a variety of ways, it is important to ask whether the assessment procedure considers all the possible symptoms and causes, as well as possible strengths and protective factors. Greater comprehensiveness in the assessment process can be achieved by using multiple types of procedures, as previously discussed. The limiting consideration here is whether the use of multiple procedures becomes so complex as to be unworkable. Related to the comprehensiveness criterion is depth. Although comprehensiveness is concerned with how well the procedure identifies all forms of stress, depth is concerned with how well the procedure details the relative importance or magnitude of any particular stressor. For example, a questionnaire procedure may identify one’s marriage relationship as a source of stress without providing detailed information on the nature of that stress. In this case, an interview procedure

Stress Measurement, Assessment, and Surveillance

Because distress may be manifested in such a variety of ways, it is important to ask whether the assessment procedure considers all the possible symptoms and causes, as well as possible strengths and protective factors.

would afford the opportunity for exploring the nature of the stress in more detail. Open-ended questionnaires rather than structured questionnaires would provide a similar opportunity. Another criterion to consider is the degree of instrumentation in the procedure. That is, to what degree is the procedure quantitative versus qualitative? If it is a highly quantified procedure, then it allows for greater cross-subject (either individual or organization) comparison. This is of some concern when considering concurrent and predictive validity. The alternative to a highly quantified procedure is a highly qualitative one, which may leave more discretion and judgment in the hands of the administrator but provide for richer detail in the assessment process. Use of a comprehensive assessment strategy can provide actionable and useable information that cannot be otherwise obtained. For example, an assessment instrument and procedure that collects a full scope of information from the same individuals at the same time will undoubtedly provide the best quality of data. If you obtain information about perceived stress factors in the workplace, the reported signs and symptoms of distress, and the types of coping strategies and resources available to that same set of people at the same time, more definitive statements can be made regarding the association and the intervention strategies. If these pieces of information are collected from different people, or from the same people but at different points in time, the same level of certainty about the relationship of the different components cannot be ensured. In all assessment strategies, it is recommended that at least one source of comprehensive, quantitative data be used, supplemented by more qualitative or targeted data collection strategies to maximize the utility of the information.

Selecting a Measure An understanding of some of the fundamental principles of measurement and assessment can minimize wasted time and effort in building an assessment program. Although the risk factors and effects of stress may vary, measurement principles are fairly standardized. Organizations or individuals may assume that they can best design questions or data collection methods to meet their particular needs, without understanding that the information collected may not be useful. Several criteria should be considered in determining the relative merit or value of any stress-assessment procedure. An effective assessment instrument or method should meet certain minimum standards or selected criteria.

Validity Validity is probably the most important characteristic of a good instrument, and it is probably the most difficult criterion to meet. Validity is

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concerned with whether the methods and procedures that are used to measure organization stress are in fact measuring what they are designed to measure. Although there are psychometrically different procedures that may be used in evaluating the various forms of validity, each comes down to a point of judgmental evaluation by some investigator. Of the various forms of validity, several are relevant to our purposes. Construct validity is concerned with the extent to which the assessment procedure measures the theoretical construct stress. A primary issue that makes addressing construct validity very difficult is the current theoretical difficulties in definition. There is no one unified, agreed-on construct called stress, which then leaves the construct validity issue problematic. The measures you select should correlate with your conceptualization of the term stress and remain consistent in all measurements to maximize validity. Also relevance is the issue of discriminant validity. This form of validity is concerned with the distinction of organizational stress from such related constructs as anxiety, frustration, anger, joy, and other such phenomena. A good assessment procedure should be able to separate organizational stress symptoms from other experiences. Although it may be reasonable to see some relationships or similarities with one or more of the related experiences, they are not the same; a good procedure or instrument should be able to separate the difference. A final form of validity is concurrent and/or predictive validity. That is, if the procedure used yields a stress assessment, then it would also be expected to show various consequences of stress either concurrently or at some point in the future. These consequences would most commonly take the form of individual and organizational dysfunction. If the assessment procedure cannot predict these consequences of the stress, then it has little value in preventive or therapeutic intervention.

Reliability The second criterion for a good assessment procedure is reliability. Here the concern is with the accuracy of the assessment measures. This criterion is sometimes determined by taking measures at two time points (test–retest reliability) and examining their degree of relationship. Reliability is particularly important as a criterion for an assessment procedure because it limits the validity criterion. Thus, regardless of how valid the measurement is, its usefulness is limited by the reliability of the measure. That is why the interrater reliability and the internal consistency of the assessment procedure should be good. The first of these suggests that the procedure should yield the same result regardless of the professional who uses it, or that different assessment professionals should get the same result when using a particular interview or ques-

Stress Measurement, Assessment, and Surveillance

tionnaire procedure. In addition to getting the same results from different assessors or different times of administration, a procedure should be internally consistent. That is, the questions related to a particular source of stress should elicit a common response from the same individual. An unreliable procedure, in either regard, can yield one of two errors. Either the diagnosis identifies stress where none really exists or it fails to identify stress where it does exist. The latter error is potentially harmful, whereas the former may simply lead to wasted time and energy in preventive or remedial treatment. Failing to identify stress that is actually operating has the potential for allowing serious disease to evolve beyond the point of preventive action, leaving remedial or therapeutic action as the only alternatives. For these reasons, the reliability of the assessment procedure is particularly important.

Feasibility The third criterion for an assessment procedure is feasibility. It must not be too complex for the administrator or employee to use. Unless it is a feasible procedure for a variety of organizational settings, it will not yield the needed results even if it meets the validity and reliability criteria. The procedure must be valid and reliable, but it must also be sufficiently simple and economical to use.

Actionable Information or Utility The fourth key criterion is actionable information or utility. Gathering information may be very interesting for the stress management professional or for leaders and managers, but if no action can be taken in response, then the effort is less useful. If information is solicited from employees without any action coming in response, trust can be lost. Before embarking on an assessment and intervention strategy, clear goals and actions available should be delineated so that the data you collect are operationally defined and actionable for future fostering of protective factors, remediation of distress, or tracking of progress.

Select and Design Assessment Techniques and Procedures A wide variety of procedures may be used in conducting assessments of individual and organizational functioning. Because of the nature of stress and the dual levels of assessment, it is appropriate to draw on more than one type of assessment procedure in conducting a thorough assessment at either the organizational or individual level.

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Discussions and Interviews Simply talking with employees about their work life and concerns about their jobs and work tasks can elicit invaluable information and facilitate the assessment process. This is especially true for small organizations or for those with little experience in assessment. This is also a good technique to use in the beginning or exploratory phase of assessment in that it can yield valuable information for use in designing more definitive assessment strategies. It is also a valuable technique to use in conjunction with more objective and standardized instruments to expand on some of the individualized aspects for a particular organization or unit. Opening a channel of communication with employees produces a rich source of information regarding stress and its perceived sources and often generates useful ideas concerning organizational stress reduction. Perhaps more important, it also “legitimizes” stress as an appropriate topic of discussion at the workplace. Focus groups represent a slightly more formal level of measurement than informal discussions with employees about work. Focus groups provide an opportunity to achieve consensus regarding the most important sources of organizational stress. In addition, group discussions provide a useful vehicle for brainstorming stress interventions with the employees who, in reality, are most closely affected by the stressors and most intimately involved in any intervention efforts. Individual interviews may be used to assess either organizational or individual stress, depending on the structure and focus of the interview. Interviews can be open-ended, semistructured, or more formally structured in terms of predetermined questions or flexibility in probing or asking follow-up questions by the interviewer. In general, interviews give the interviewee an opportunity to depict in more detail both perceptions and feelings about stressful events. As such, the interview may be used without constraining the subject too narrowly. The difficulty with this procedure is in its user and not in its nature. That is, the success of using interviews hinges on the skills and characteristics of the interviewer as much as on the structure and design of the interview protocol. Although the protocol should have some structure, it is important that it be sufficiently open-ended to allow for unsolicited inputs from the interviewee. A key advantage of the interview is the detail and depth of perspective that it can provide over and above the level of detail obtained by using other procedures. The interview combines a procedure for selfreport data collection with some observation on the part of the interviewer. The limitation of the interview is its time-consuming nature and the potential difficulties in summarizing a number of interview results. There is much room for both faulty interpretation and unconscious bias being introduced in the analysis of interview data. Feeding

Stress Measurement, Assessment, and Surveillance

back the results of interviews to management becomes more complicated and cumbersome if the open-ended interviews are used.

Questionnaires Standardized instruments are those that have been developed and tested on large groups of people to establish an estimate of what is considered normal, referred to as norms. Using standardized instruments has many advantages. They can give you a benchmark against which you can compare your organization. How high is a high level of stress, on average? How much strain do your employees have compared with others in your occupational category? Many well-established standardized instruments are available, and these instruments are continually being developed and revised (see http://pubs.apa.org/books/supp/ quick/ for a listing and description). It can be risky for an organization with little knowledge of psychometric properties of questionnaires to develop something new only for their own use. The ability to collect reliable, valid, and actionable data can be compromised if questions are not composed correctly. Questionnaires, either standardized or individualized, are suitable for either individual or organizational use. In addition, they enable the collection of data from large groups of people much more easily than would be possible through interviews. Because of the quantifiable responses that result from most social or behavioral science questionnaires, this type of assessment procedure allows for more measurable intersubject comparisons. Even with semistructured interview protocols, it is often difficult to do more than make qualitative comparisons regarding the data. Questionnaire results are often more easily communicated to management. Such results do not require as much interpretation as needed when reviewing interview data, although there is some need for explanation and clarification. Although questionnaire results may look more objective because of their quantitative nature, they are still self-report data, and as such they still represent subjective responses of the individuals completing the instrument. Some of the individual biases that distort interview results still operate, but there can be compensations if larger samples are included when questionnaires are used. There are several other limitations to cross-sectional surveys. One involves response bias. Response bias can take many forms, reflecting misrepresentation of work factors (intentional and unintentional), poor memory recall, and nonresponse bias. This last form of bias can be particularly troublesome because some workers may be unable to read or understand the questionnaire items, and others may be highly motivated to complete and return the survey (or parts of the survey) for reasons unrelated to the nature of the questionnaire. It is not uncommon in job

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stress surveys to achieve less than a 50% response rate, and the obvious question becomes whether the nonrespondents differ from respondents along sociodemographic and/or stress variables. The extent to which these groups differ determines the representativeness of the respondent sample or the work population of interest and, therefore, the generalizability of results. Self-administered questionnaires can lack flexibility. With no interviewer present, variation in questions posed to the worker and probing for greater insight are not possible. Finally, single domain cross-sectional questionnaires provide only a snapshot view of stress, representing only one point in time. To remedy some of these shortcomings, questionnaires are often supplemented by focus group or structured interview techniques. In addition, proactive, longitudinal survey procedures can be put into place, which would involve administering the same questions in advance of presenting stress consequences and then administering them again to the same group of individuals over time to more fully examine changes that take place in individual and organizational stress coincident with changes in the workplace. Longitudinal tracking is certainly more complex than cross-sectional data collection, but if implemented correctly, it can provide the organization with a rich data set that can be used to both design and evaluate stress management programs and policies. The increasing use of electronic information and handheld electronic devices such as smartphones can enable time-sensitive collection of data in real time as situations evolve. These electronic data collection methods hold potential for more accurate measurement across time for both individual stress profiles and organizational context variables.

Observational Techniques There are two categories of observational techniques that lend themselves to use in stress diagnosis: behavioral observation and medical observation. Both techniques should be used by a trained observer who is skilled at selecting and evaluating which aspects of the field to observe. Qualitative and quantitative observations are both important and may be used to complement and supplement each other. Behavioral observations can be useful in individual stress assessment. They are difficult to use alone without alternative types of assessment procedures but can be very helpful as supplemental sources of data. Relevant behavioral observations associated with organizational health include absenteeism and tardiness rates; turnover rates; lost time resulting from injury, illness, or health care use; and strikes and other forms of work stoppages. Some occurrences of these behaviors should be anticipated in any organization. Judgment is required in the assessment process to determine if the occurrence rates of these behaviors are healthy or suggest organizational distress.

Stress Measurement, Assessment, and Surveillance

Behavioral observations may also be made at the organizational level. Observations at this level are frequently, but not always, collected in the form of institutional records or archival data. Every organization regularly collects information regarding personnel and operations. This information is typically used for business purposes, but it is very relevant for the assessment of stress and stress consequences. In designing a measurement, an assessment, and especially a tracking strategy, these data should be collected and reported in as consistent a format as possible. Use of existing data to supplement formal measurement strategies can provide a much more complete picture of the organization and the individuals within it. Medical observations are the second category of observational data. These consist of a set of possible observations made by a clinician using laboratory or clinical assessment instruments. These observations are used in individual stress assessment and may supplement organizational stress measures. There are several key medical observations that may include, among others, heart rate, blood pressure, HDL and LDL cholesterol levels, and stress hormone levels. There are established normal ranges for all of these observations. Observations outside of the normal ranges would suggest that the individual may well be experiencing distress. Health-risk appraisal, individual stress profiles, and self-report questionnaires focused on behaviors and lifestyle factors, supplemented with medical observations such as those previously listed, have been long used for worksite wellness programs. They can be helpful in identifying lifestyle behaviors that warrant change and in examining potential targets for individual strength building or vulnerability modification.

Establish a Baseline Now that you have your ideal state in mind, have analyzed the situation within your organization, and have selected measurements and techniques, it is time to take stock of where you are. All effective program development and measurement processes begin with a baseline. Whether you are just starting out in your organizational endeavor or whether you have been in business for years, getting a baseline of where you stand today will determine what practices or programs are needed to advance you toward your ideal vision. Because stress is individualized, it can be difficult to have a gold standard for measurement. The ability to identify deviations or improvements from your corporate ideal state will depend on baseline measures. Designing intervention strategies will also depend on your organizational risk and protective factors at the outset as well as individual strengths and vulnerabilities of

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your employees, regardless of the size or structure of your organization. What effects are you currently seeing in terms of stress, strain, dysfunction, or disease within your organization? The measures used for your baseline will depend on your vision of fit and healthy. The measures will need to be repeated again on a regular basis to determine the level of effectiveness of your interventions.

Design and Evaluate Your Prevention and Intervention Strategy Every program, policy, or practice is deserving of an evaluation strategy. Evaluation strategies should be built into the program from the beginning for maximal utility. There are three primary types or purposes of evaluation. Process evaluations consider whether the process is being implemented with fidelity. This type of evaluation looks at how the intervention, policy, or practice is being administrated. If the practice has not been implemented with fidelity, then any result or lack of result may not be attributable to the program. If it has been implemented correctly, the result may be very different. Process evaluations are critical and require measures that can be obtained easily and quickly to determine if changes or revisions in implementation are needed if the program or practice veers off-track. Outcome evaluations look at the products or outcomes of the program or practice as implemented correctly. Outcomes represent direct results or consequences of a practice. Impact evaluations look at more distal or indirect results or consequences presumed to be related to the policy, program, or practice that is implemented. Both outcome and impact evaluations rely on a program theory or program logic model that is developed along with the practice or intervention. The program logic model or program theory is the key to an effective program evaluation (Bickman, 1990). The logic model is just what it states. It is a diagram or theoretical set of connections that the program designer or evaluator proposes as being the method by which results are obtained or expected to be obtained in a program. The logic model also will be invaluable in selecting measures for the process, outcomes, and impact from a program. For example, suppose that prolonged stress exposure is leading to lost time in the workplace. You decide to implement a relaxation program that enables employees to take 20 minutes a day to practice relaxation or meditation in a dedicated relaxation room, which costs the organization time and money. Is it worth it? The process evaluation would mean monitoring how many employees actually take a full 20 minutes and are trained and subsequently practice an effective relaxation or meditation routine for the recommended time period to achieve a result. The out-

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come would be reported levels of feeling more relaxed at work. The impact would be reduced sickness and reduced absenteeism. How do you postulate that relaxation actually reduces absenteeism? One would assume that increased relaxation reduces stress hormones, improves immune response, improves sleep quality, and decreases fatigue, making individuals less susceptible to disease and less likely to take an unplanned absence with or without a doctor’s visit. All of these interim presumed steps could be measured to determine if your theory or logic model is correct. If, in fact, the outcome is reduced stress hormones, improved reported sleep quality, and reduced fatigue, but you still have the same level of absenteeism, then your theory or model may be faulty. It could be that the time frame needs to be longer to see an impact, or it could be that there are other factors at play. In any event, you will never know if you do not take the time to actually postulate your model and then measure each interim step to determine the level of effectiveness of your program. Program evaluation is the most ignored and least well-understood aspect of measurement and assessment in stress management programs, much to the detriment of program development and to the science of preventive stress management in organizations. Only through quality examination of what works, why it works, and what does not work will science and practice be advanced.

Track and Monitor Routine Indicators Once there is a vision and a baseline, identify existing data to track, select measures and techniques, and design an intervention and evaluation strategy. Then an additional decision is warranted. That decision is to select routine measures, indicators, or metrics to watch regularly to determine if your preventive stress management program is working as expected. The indicators should be simple, easily collected, and regularly reported across the organization as a means of preventive maintenance. Indicators may need to change as the organization grows, expands, contracts, or transforms, leading to stress and health measures.

Individualized Assessment General assessment provides an overlay for preventive stress management and for promoting individual and organizational health. Never­ theless, there are situations that arise in the organization that are specific to a particular unit of operation or to particular individuals or a particular point or phase in time. General techniques may not illuminate the situation clearly enough to provide actionable information for intervention and remediation. In those cases, it can be easy to look on the

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F i g u r e 6 . 2  ASSESSMENT OF ORGANIZATIONAL FUNCTIONING

ORGANIZATIONAL PREVENTION NONE APPARENT THERAPEUTIC INTERVENTION

ASSESSMENT OF INDIVIDUAL FUNCTIONING

NONE APPARENT

DETERMINATION OF UNDERLYING CAUSES

INDIVIDUAL PREVENTION

IDENTIFICATION OF DYSFUNCTIONS: ORGANIZATIONAL INDIVIDUAL

The process of organizational stress diagnosis.

surface or to apply a generalized principle rather than getting to the heart of the matter. A better strategy is a root-cause analysis, to provide a more in-depth look at the causative and contributing factors and to provide a more effective program logic model to guide targeted intervention and tracking of progress toward getting back to optimal health. The overall process of assessment for units within an organization or specific situations is presented in Figure 6.2. This model presents a strategy for assessment of health and functioning at both the organizational and individual levels. Using this model, the assessor must (a) propose individual and organizational prevention activities to be used to preclude distress as well as (b) list the points of dysfunction at the organizational and individual levels. The points of dysfunction are identified by the

Stress Measurement, Assessment, and Surveillance

Individual and organizational prevention activities can be tailored to the specific individual or organization on the basis of assessment findings. Even if no distress is revealed, it is still a good idea to continue the organizational and individual assessment activities at periodic intervals.

Actual instruments and procedures for assessment are reviewed on http://pubs. apa.org/books/ supp/quick/.

problems and/or inconsistencies in the individual’s or organization’s functioning (Levinson, 2002). To identify these dysfunctions requires both skill and sensitivity on the part of the assessor. As Levinson (1975, p. 7) put it, “Any fool can tell that a river flows. Only he who understands its cross-currents, its eddies, the variations in the speed, the hidden rocks, its action in drought and flood, is the master of its functioning.” So it is with individuals and organizations. Until the diagnostician has fully familiarized himself with the subject of the assessment, it is not possible to delineate the points of dysfunction. Individual and organizational prevention activities can be tailored to the specific individual or organization on the basis of the assessment findings, taking into consideration the individual differences previously discussed. A diagnosis may reveal no notable, current dysfunctions. Even if no distress is revealed, it is still advisable to continue the organizational and individual assessment activities at periodic intervals. Failure to do so invites the potential problem of dealing with a distressing crisis in a fullblown form. Periodic assessments, say on an annual basis, provide a more fertile ground for effective implementation of preventive management. Therapeutic interventions are also a part of preventive management (see Figure 6.2). Any therapeutic interventions must be based on a determination of the underlying causes of stress, not the surface symptoms. The therapeutic activities must also be tailored to the specific individual, organization, or unit within the organization. The purpose of the therapeutic interventions is to prevent further deterioration in functioning or to rectify problems that were not precluded by other preventive activities introduced on the basis of the assessment activities. Individually tailored assessment strategies are often useful in divisions within the organization that experience high levels of individual or organizational signs of distress, such as high absenteeism or lost time, injuries, low productivity, or high conflict. When multiple individuals seem to experience the same problems, it may be an organizational problem and not an individual problem. This situation provides a great opportunity for preventive stress management to improve the organizational environment for all employees and for the good of the organization as a whole. Leaders can facilitate this assessment process by asking key individuals in their organization nonaccusatory yet inquisitive questions, such as, “Can you explain to me what is going on?” By listening nonjudgmentally, leaders are well positioned to be informed and educated by their followers. The process of organizational stress assessment forms the foundation of the philosophy of preventive management. In Chapter 7, we lay out our philosophy and guiding principles that form the basis for the practice of preventive stress management. We elaborate on our thesis that stress is inevitable, but distress is not.

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Preventive Stress Management Principles, Theory, and Practice

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he first six chapters of this volume discussed the sources of stress in organizations, the stress response and its modifiers, individual and organizational consequences, and stress assessment. This chapter lays out the principles, theory, and practice of preventive stress management. Chapters 8 through 12 follow up by describing specific organizational protection and individual prevention practices.

Guiding Principles of Preventive Stress Management Preventive stress management is a framework for organizing effective organizational and individual stress management methods and reflects the way in which an organization

DOI: 10.1037/13942-007 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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should operate. This philosophy is based on five fundamental principles that can serve as guidelines for leaders and executives who practice preventive stress management as well as researchers who test and evaluate stress management methods.

Principle 1: Individual Health and Organizational Health Are Interdependent

Healthy, engaged

The major conclusions that can be drawn from Chapters 2 through 5 are that organizational stressors put employees at risk of distress and that distressed employees create considerable organizational dysfunction. This overlooked interdependency is the essence of Principle 1. In addition to its financial assets, an organization has human assets that can be liquidated as surely as its capital assets can be. The wellbeing or ill health of human assets may not have an immediate effect on organizational health. It takes time—sometimes as much as a year or 2 years or even 5 years—for the benefits of human resource development to have an effect on the health of the organization. It may take an equivalent time period for the detrimental effects of the liquidation of human assets to be felt in the declining health of the organization. Organizations cannot achieve a high level of productivity, adaptability, and flexibility without vital, healthy individuals. By the same token, individuals may have a great deal of difficulty maintaining their psychological and physical health in unproductive, rigid, and toxic organizations. This interdependency is expressed more formally in the concept of the person–organization fit. First, there is the degree to which individual resources meet organizational goals and requirements where individual resources contribute to organizational goals. Individual health and vitality contribute to organizational health where organizational resources contribute to individual needs. Then organizational health and vitality contribute to organizational health.

employees are powerful assets for organizations, making positive and impactful contributions to organizational growth and advancement.

Principle 2: Leaders Have a Responsibility for Individual and Organizational Health The responsibility for the active pursuit of the development of an organization lies with its leadership. Apathetic or passive leadership on the part of management is an irresponsible posture that leads to organizational decay and decline. The corollary to the interdependency described in Principle 1 is that leaders also have a responsibility for individual health and wellbeing. Although this interest can be based partly on altruism, it is rooted in enlightened self-interest: Individuals who are highly distressed are

Principles, Theory, and Practice

not as effective as those who are not. Leaders’ responsibilities include monitoring and diagnosing organizational stress, selecting appropriate organizational and individual methods of preventive stress management, and implementing programs tailored to the organization’s unique needs. Although leaders have a key role in pursuing individual and organizational well-being, they do not have exclusive responsibility for either individual or organizational health. Employees are also responsible for their health as individuals and for the health of the organization. This too is a corollary of the person–organization interdependency contained in Principle 1. An individual who accepts employment has a responsibility to contribute to the organization and to participate in efforts to combat organizational distress. Although leaders have a responsibility for individual health, it is important to recognize that the ultimate responsibility for an individual’s health lies with that individual. We believe that each person must take responsibility for his or her own life, health, and well-being and that to surrender that responsibility is both immature and hazardous. Principle 2 does not in any way attempt to relieve individuals of responsibility for their own health and well-being.

Principle 3: Individual Distress and Organizational Distress Are Not Inevitable To accept distress as inevitable is a hopeless attitude, whereas recognizing that distress is not inevitable provides the impetus for positive, responsible prevention.

Task, role, physical, and interpersonal demands are an inescapable part of organization life and work. Unfortunately, too many of these demands and too much of the resulting distress are accepted as “the price of success,” “part of the global knowledge revolution,” or “a necessary evil of work.” These narratives are used to rationalize inaction and neglect by managers and employees alike. In fact, many stressors can be reduced or eliminated, the impact of other stressors can be softened, and the resulting distress can be greatly reduced. Although the stress and demands of work life are inevitable, distress resulting from stress and demands is not inevitable. Eustress should be promoted, whereas distress should be minimized or eliminated altogether. From the assertion that leaders have a responsibility for individual and organizational health (Principle 2), it follows that leaders have the responsibility to identify and modify preventable sources of organizational and individual distress. The organizational and individual tools for this endeavor are the subjects of Chapters 8 through 12. Distress is averted through preventive managerial action using these methods. Principle 3 is based on a proactive model of organizational change. It is difficult to avert distress when its consequences are already being

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experienced at the individual or organizational level. Therefore, it is necessary to anticipate and influence those demands that are the source of stressful events as well as to use methods for shielding the individual or organization from their harmful effects. Leaders may be able to prevent distress through a proactive posture.

Principle 4: Each Individual and Organization Reacts Uniquely to Stress There are considerable individual differences in the demands that are perceived as stressful, in the response to these demands, in the recognition and toleration of distress, in the capacity for recognizing and generating eustress, and in response to stress management interventions. These differences have important implications for diagnosing organizational stress and for designing effective preventive stress management programs. For example, routine, monotonous work may be quite distressing for one person but reassuring and secure for another; social isolation at the job may be quite upsetting for one person but a virtual employment requirement for another. An effective preventive stress management program must address the stressors that are relevant to the individuals concerned. This observation highlights the importance of the diagnostic process described in Chapter 6. There are also variations in the response to stress, as we noted in Chapter 3. For example, some individuals might respond to a surprise short deadline with increased cigarette consumption, others with a headache, and still others with nothing but quiet and efficient productivity. Signs of distress may also be perceived differently by different organizations. For instance, a company dependent on large numbers of unskilled laborers who require minimal training may have little interest in reducing a stress-related high turnover rate. In contrast, a firm that uses internally trained specialized technicians might be alarmed by stressors that cause even a modest increase in turnover. Finally, the feasibility, acceptability, and effectiveness of preventive stress management interventions vary among organizations and individuals. A small firm often cannot afford on-site counselors, fitness trainers, or special health facilities. An effective system for identifying and referring individuals having particular difficulties might suffice. At the individual level, techniques that are attractive to one individual may be entirely unacceptable to another individual. It is important to recognize from the outset that the discussion of preventive stress management methods in Chapters 8 through 12 is not meant to provide a “cookbook” for organizational stress management. Distress prevention methods are presented, and guidelines for designing stress management programs are considered. Nevertheless, the uniqueness of individuals and organizations requires that inter­ventions be

Principles, Theory, and Practice

chosen and implemented in light of the particular characteristics and needs of the individual or organization being served.

Principle 5: Organizations Are Ever-Changing, Dynamic Entities Healthy organizations, like healthy individuals, are open systems that often have a life cycle of growth, maturation, and decline, even death, but with many options for revitalization. K. H. Cooper and Cooper (2007) showed how this natural life cycle can be “squared off” and the pinnacle of vitality can be extended out over time with healthy practices and disciplines. In the case of organizations, the pinnacle of vitality can be extended by decades. At the heart of Principle 5 is the effort to maximize health and vitality while minimizing decay and disease. This can only be accomplished by attending to the ever-changing, dynamic nature of the organization. It requires the active involvement and participation of all organizational members in the process of organizational growth and change.

The Theory of Preventive Stress Management

Strong protective mechanisms provide an individual with shields and weapons to defend against health risk factors and environmental threats that cause distress.

The theory of preventive stress management arises from the translation of the public health notions of prevention overlaid onto an organizational stress process model (J. D. Quick, Quick, & Nelson, 1998). There were six hypotheses and one corollary that formed the theory, to which we added a second corollary in this edition on the basis of a systemic review and evaluation (Hargrove, Quick, Nelson, & Quick, 2011). The first three hypotheses and first corollary address the organizational stress process, from demands through the stress response to distress and eustress. Hypothesis 1: Intense, frequent, prolonged organizational demands increase the stress response in people at work. Hypothesis 2: Intense, frequent, prolonged elicitation of the stress response increases the risk and incidence rates of distressful health consequences. Hypothesis 3: Individuals high in vulnerability modifiers are at greater risk of distress than individuals low in vulnerability modifiers. Corollary 1: Individuals high in protective mechanisms and defenses are more immunized against the risk of distress than individuals low in these factors.

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Hypotheses 4 through 6 and Corollary 2 address the application of the public health notions of prevention. Primary, secondary, and tertiary prevention are elaborated in the following section of the chapter, which sets forth the practice of preventive stress management. Hypothesis 4: Primary prevention interventions to reduce, modify, or manage the intensity, frequency, and/or duration of organizational demands reduce the stress response in people at work. Hypothesis 5: Secondary prevention interventions to moderate individuals’ stress responses reduce the intensity, frequency, and/or duration of the individuals’ experience of the stress response. Corollary 2: Eustress generation efforts in organizations help individuals by creating working environments that encourage the positive stress response at work, capitalizing on its healthenhancing properties. Hypothesis 6: Tertiary prevention interventions to minimize distress and provide therapy shorten and improve the healing process from stressful or traumatic events in organizations.

The Practice of Preventive Stress Management The five principles frame the philosophy of preventive stress management, whereas the six hypotheses and two corollaries form the theory that can be implemented in practice and tested. The three stages of prevention set forth in Hypotheses 4, 5, and 6 and Corollary 2 are the basis for the methods of individual and organizational preventive stress management. Here we elaborate on the public health notions of primary, secondary, and tertiary prevention. We conclude the chapter with an overview of the preventive stress management methods in Chapters 8 through 12.

Stages of Prevention Chronic diseases develop gradually through a progression of disease stages, a “natural life history.” The natural history of most chronic diseases is one of evolution from a stage of susceptibility, to a stage of early disease, to a stage of advanced or disabling disease. At the stage of susceptibility, the individual is healthy but exposed to risk factors or disease precursors. For example, individuals who choose a sedentary life or who choose to overconsume food are at the stage of susceptibility for coronary artery disease and several other diseases. When these and other risk factors lead to the development of arteriosclerotic plaques or hardening of the arteries to the heart, the individual is at the

Principles, Theory, and Practice

stage of early disease or preclinical disease. At this point the person’s body has responded to the disease precursors, but there are few, if any, symptoms. As the disease advances further, it becomes symptomatic or clinical disease. Angina pectoris (chest pains) and heart attacks are advanced manifestations of coronary artery disease. Preventive stress management is rooted in the public health notions first used in preventive medicine. The dominant diagnostic model in public health involves the interaction between a host (the person), an agent (health-damaging organism or substance), and the environment. One fundamental concept of preventive medicine is that there is an opportunity for preventive intervention at each stage in the life history of a disease. These interventions aim to preclude, slow, stop, or in advanced cases reverse the progression of disease. Primary prevention is the protection of health at the stage of susceptibility and aims to eliminate or reduce the impact of risk factors (Winett, l995). Primary prevention is always preferable from a public health standpoint. Secondary prevention aims at the early detection of disease and early intervention to correct departures from health (Last, 1988). Tertiary prevention is prevention in name and therapeutic by nature, treats symptomatic or advanced disease, alleviates discomfort, and restores function. Organizational stress progresses through several stages, much like a chronic disease. Therefore, there are several opportunities for preventive stress management intervention. Figure 7.1 presents the three stages of prevention in a preventive medicine context, along with the stages in an organizational context. Primary prevention aims to modify organizational demands and stressors that may eventually lead to distress. Secondary prevention aims to identify, arrest, and/or reverse individual and organizational strain and distress. Tertiary prevention attempts to minimize or alleviate individual and organizational suffer­ing that results when organizational stressors and resulting stress responses have not been adequately controlled. For example, conflicted reporting relationships (stressor) can cause chronic anxiety (stress response) and in turn absenteeism (organizational consequence of distress). Primary prevention would attempt to resolve the conflicts that exist in the reporting relationships. Secondary prevention might address the problem by providing a program of relaxation training to help alleviate signs of tension among affected employees. Tertiary prevention might include an employee-counseling program designed to help employees cope with conflicting expectations. What is preventable really is dependent on the nature of the demand(s), the characteristics of the individual, and the resources available in the situation. The appropriate stage of prevention for precluding or arresting distress is, therefore, often contextually determined. Sometimes it is not possible to change a demand or reduce one’s vulnerability to the demand, which then indicates that tertiary prevention is

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F i g u r e 7 . 1  Preventive medicine context

Organizational context Organizational demands and stressors Task demands Role demands Physical demands Interpersonal demands

Stress responses Individual responses Organizational responses

Primary prevention: stressor-directed

Health risk factors

Secondary prevention: response-directed

Asymptomatic disorders, behavioral problems, and disease

Tertiary prevention: symptom-directed

Symptomatic disorders and disease

Distress Individual Behavioral problems Psychological problems Medical problems Organizational Direct costs Indirect costs

The stages of preventive stress management.

most appropriate. Thus, what is realistically preventable at each stage may be as much a function of circumstances as rational choice. There are available at each stage of prevention individual and organizational interventions. At the organizational level, primary prevention aims to manage the number and intensity of work demands. At the individual level, primary prevention helps individuals manage frequency and intensity of the stressors to which they are subject. The goal is not to eliminate stressors but to optimize their frequency and intensity. When the stress response is elicited too frequently or too strongly at work, organizational and individual strain and disease become inevitable. This leads to exhaustion. When the stress response is not elicited frequently enough, lethargy, lack of growth, and failure to adapt follow. Either extreme is to be avoided, and an optimum level is to be sought. This optimum level varies among individuals and groups. Secondary prevention is directed at managing the stress response itself and includes efforts to optimize the intensity of each stress response

Principles, Theory, and Practice

Regardless of how much good comes from primary and secondary prevention, tertiary prevention is always needed for the wounded and those in pain and suffering.

an individual experiences. Although low-intensity stress responses may provide insufficient impetus for adaptability and growth, high-intensity responses may lead to sudden death or other serious individual distress. Because of individual differences, the optimum intensity for one individual may not be optimum for another. The importance of optimizing both the frequency and the intensity of the stress response is reflected in the expanded Yerkes–Dodson curve shown in Figure 7.2. Tertiary prevention is concerned with minimizing the organizational costs and individual suffering resulting from frank manifestations of too much stress. For organizations, this usually takes the form of crisis intervention. For individuals, this usually is done through psychological and/or medical interventions. Problem-focused and emotion-focused coping strategies have been found to alleviate distress and parallel primary and secondary prevention discussed here. Coping is a cognitive and behavioral process of mastering, tolerating, or reducing internal and external demands (Lazarus & Folkman, 1984). Problem-focused coping is concerned with managing or altering the source of stress in the person–environment relationship and parallels preliminary prevention. Emotion-focused coping is concerned with regulating stressful emotions and parallels secondary prevention. This coping scheme does not incorporate a notion that parallels tertiary prevention. Eustress generation means creating work environments in which individuals can experience the positive stress response. One of the primary indicators of the eustress response is engagement, so efforts to enhance individuals’ engagement at work may be vehicles through which eustress may be generated (Simmons & Nelson, 2001). Challenge stressors directly and positively affect performance (LePine, Podsakoff, & LePine, 2005). Eustress is related to health (Little, Simmons, & Nelson, 2007) and wellbeing (Simmons, Nelson, & Quick, 2003). Even in extremely stressful jobs, eustress can be experienced. Given the emergence and growth of positive psychology and positive organizational behavior, eustress is a dimension of the model that warrants considerable research attention. Our knowledge of eustress must catch up with our progress in understanding distress.

Preventive Interventions The three stages of prevention provide a useful means to understand the process of preventive stress management. The preventive interventions may be more usefully discussed according to target, that is, the organization or the individual. Organizational prevention aims to protect people through structural and environmental interventions as well as through nurturing relationships to strengthen the human fabric of the organization. Organizational

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F i g u r e 7 . 2 

Overstimulation of the stress response

Very demanding workload

Understimulation and low arousal

Insufficient frequency of intensity of stress response

High

Health and Performance

112

Low Low (Distress)

Optimum (Eustress) Stress Level

Optimum stress load Perceived as stressful Distress

An expanded Yerkes–Dodson curve.

High (Distress)

Principles, Theory, and Practice

protection may change the organization’s structure, its processes, and/or its working relationships. Chapters 8 and 9 address organizational protection and protection as shown on the right side of Figure 2.1. Individual prevention aims to strengthen individuals to manage the necessary, inevitable demands of working and provide an effective complement to organizational prevention. Organizational prevention is essential, yet it can never be sufficient because of individual differences. Individual prevention is categorized as primary, secondary, and tertiary. Each of these is addressed in a separate chapter. Chapters 10, 11, and 12 address individual prevention as shown on the left side of Figure 2.1.

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Organizational Prevention Protecting People

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his is the first of two chapters dealing with organizational preventive stress management, or protection. Figure 2.1 set forth a model for protecting people at the organizational level that involves building protective factors, eliminating and/or reducing risk factors, and preserving function. Organizational prevention aims to modify and shape the organization to protect people from physical, psychological, emotional, and social harm or injury. The intention is not to eliminate all the stress for people at work. Rather, the intent is to reduce distress, increase eustress, and optimize stress to enhance health and functioning. To achieve this, organizational protection buffers the negative impact of organizational stressors on people. Protection is an organizational responsibility that is most effective when complemented with individual preventive stress management. This chapter presents examples for preventive interventions designed to protect people at work, summarized in Exhibit 8.1. They include an Organizational Health Center

DOI: 10.1037/13942-008 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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Exhibit 8.1 Organizational Prevention: Protecting People Organizational Health Center This comprehensive, multidisciplinary, multicomponent system is designed to implement key elements of public health, preventive medicine, and health protection into the very core of an organization. The three distinguishing characteristics are the reliance on collaboration among all organizational functions concerned with people’s well-being, on surveillance systems for early warning, and on the full continuum of protection and preventive intervention. Job redesign This is a set of methods for changing the job demands placed on people at work. This is accomplished by restructuring one or more job dimensions. The result of job redesign is to improve person–job fit and to increase the job incumbent’s passion, positive motivation, and challenge stress while reducing hindrance stress or distress on the job. Career development Through the structuring of career paths, this method encourages individual growth and development. This is achieved through self-assessment, feedback, and opportunity analysis. Talent management is an organizational aspect of career development. The result is to increase challenge stress, reduce hindrance stress and frustration, while retaining high potential people. Ergonomic office design This approach to physical office environments is important to the fulfillment of employee needs and the way physical office design influences employee effectiveness. The design approach gives consideration to the objective nature of jobs and to job perceptions. The result is a more human-centered approach to the design of the physical office environment. Work–life programs This method relies heavily on enhanced flexibility coupled with employee- and familysupportive programs. Through greater flexibility, employees are better able to reduce frustration and stress while increasing work–life balance. Work–life programs also include child- and dependent-care benefits, leave options, information services and HR policies, and organizational culture issues.

(OHC), which represents a comprehensive, multifaceted preventive stress management program as well as more targeted interventions directed at interdependent factors associated with functional and contextual environment modification programs, including job redesign, career development and talent management, physical ergonomic office design, and work–life programs. Organizational protection is concerned with implementing Principle 2 of preventive stress management, which posits the following:

Protecting People

Leaders can improve individual and organizational health through organizational protection that creates positive environmental change while bolstering support programs for people.

Leaders have a responsibility for individual and organizational health. The methods of preventive stress management discussed in this chapter are designed to maintain organizational health by protecting people against organizational conditions such as insufficient job control and discretion that may lead to individual and organizational distress. Organizational protection improves organization health through environmental change to optimize the stress experience and bolster support programs to buffer stress in the workplace. These methods focus primarily on adjustments or changes that are internal to the organization. Organizational changes that create internal adjustment also have the potential to create uncertainty and stress, especially if the intervention or change is poorly implemented or mismanaged. The risk of problems with any organizational intervention, regardless of scope, is greatly reduced through careful planning and active collaboration with people affected by the change. We recommend thoughtful use of prevention and protective interventions.

Organizational Health Center

An Organizational Health Center helps keep employees healthy, happy, and on the job while at the same time supporting the organization’s mission achievement, efficiency, and productivity.

The concept of an OHC was conceived within the United States Air Force Colonel Joyce Adkins (Adkins, 1999; Adkins, Quick, & Moe, 2000; J. C. Quick, Tetrick, Adkins, & Klunder, 2003). The OHC represents a comprehensive, integrated, cross-functional organizational health approach that addresses the full scope of protection and prevention in the occupational setting. The OHC mission is to keep people happy, healthy, and on the job while also advancing the mission of the organization to achieve high levels of efficiency and productivity. These goals are reached by focusing on workplace stressors, organizational and individual forms of distress, and managerial as well as individual strategies for preventive stress management. As such, the OHC seeks to bring together concepts of organizational protection along with individual-level prevention in a single organizational function reporting to the senior executive of the organization. This reporting chain provides the executive team with a single point of entry into the health of the organization and its employees. Ideally, an OHC within an organization is led by a chief psychological officer who embodies organizational and clinical expertise; thus, an occupational health psychologist is ideally suited for this position. The OHC rests on active early warning or surveillance systems that seek equally to identify organizational risk factors and to identify employees at risk for physical, psychological, emotional, or behavioral distress. Because of the scope and complexity of the operations, implementation of an OHC necessarily requires collaboration among a range of organizational

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functions concerned with human resources and relies on public health notions of surveillance that offer early warnings before disasters strike and a full range of preventive interventions to strengthen individuals and the organization.

Collaboration to Protect People Although a chief psychological officer in an organization is ideal to lead an OHC, a fully functioning OHC requires a team approach, with professional expertise from human resources professionals, workers compensation and health care staff, occupational safety personnel, security staff, legal advisors, payroll and financial services staff, health and fitness staff, and chaplains in partnership with representatives from labor and management (D. F. Schwartz & Adkins, 1997). The team approach also brings a synergy to the work, reduces conflict among the various subgroups in the organization, and provides a ready source of social support to fellow team members, thus reducing the stress often associated with the emotional work of service provision. This full range of experts is also critical to establishing a monitoring system for people within the organization. A cross-functional team approach reduces gaps and redundancies in services, enables better targeting of risk factors, and leverages resources to address those risk factors. A clear composite picture of who is healthy and who is at risk emerges only when the entire spectrum of experts who have specific responsibility for people and their well-being pool information. The collaboration is central to the protection of people in any organization.

Surveillance and Early Warnings One of the key functions of public health is the establishment of surveillance systems to monitor people’s health and the risk factors to which they are or may be exposed. Tetrick and Quick’s (2011; Tetrick, Quick, & Quick, 2005) surveillance model is one that primarily identifies people in three categories: people who are not now at risk, people who are at risk, and people with health decrements. The core function of surveillance is to help ensure that people’s health status, stress, and wellbeing are accurately identified along this continuum. Surveillance data are the key to targeting and then delivering preventive interventions. Klunder (2008; J. C. Quick & Klunder, 2000) used a 3%-at-high-risk guideline in a very large industrial closure process over a 6-year period (1995–2001) to then identify the pool of several hundred high-risk employees who needed the most preventive attention. The success of his approach underpinned the power of prevention in protecting people because no lives were lost and over $33 million in costs was avoided through disasters that never happened.

Protecting People

Preventive Interventions The range of preventive interventions that are possible through an OHC goes beyond the preventive stress management interventions discussed in this book. In the context of the OHC, preventive interventions may come from any of the professional experts within the collaboration. By having a centralized data repository and systemic view of measures, it is possible to target particular work units that may be experiencing distress and to design interventions best capable of meeting those particular needs. Intervening at the systems level can have a bigger impact on the people in the unit than one-by-one, individual-level interventions. By including all stakeholders, including key members from labor and management, buy-in can be achieved early in the process, making organizational intervention less conflicted and more effective. On the individual side, the preventive interventions target the three categories of people identified in the surveillance process that offers early warnings before individuals experience disaster. Primary prevention is for people not now at risk and helps to build and enhance capabilities and reduce vulnerabilities. Secondary prevention represents early intervention for people at risk and offers protection before problems become serious. Those who are at high risk are a prime group for services and support. Tertiary prevention is for people with health or functional decrements resulting from unavoidable or unabated stress.

Job Redesign Job redesign activities aim to modify the job demands, employee control, and

Job redesign is a form of functional and contextual environment modification. The purposes for undertaking job redesign for organizational protection are (a) to enhance challenge, motivation, and eutstress within the job; (b) to increase control within the job so as to reduce unresolved strain and distress; and (c) to reduce levels of uncertainty within the job. The two dominant job redesign models over the past 2 decades are the demand–control model advanced by Theorell and Karasek (1996) and the effort–reward model advanced by Siegrist (1996).

organizational rewards so that the job fits and maximizes employees’ knowledge, skills, and abilities.

Demand–Control Model The demand–control model developed by Theorell and Karasek (1996) offers a powerful and robust approach to job redesign. Alternatively identified as the job strain model and the psychological demand–decision latitude model, the model has two core dimensions (psychological demands and decision latitude, or control) that frame it and two axii (active learning and residual strain) that run through it. The two core dimensions of demands and control lead to four job categories: high strain, active, low

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strain, and passive. High-strain jobs are characterized by high demands coupled with low control, whereas active jobs are characterized by high demands coupled with high control. Low-strain jobs are characterized by low demands coupled with high control, whereas passive jobs are characterized by low demands coupled with low control. Figure 8.1 shows the costs of high-strain jobs and how these jobs are different from low-strain jobs, passive jobs, and, most important, active jobs.

High-Strain Job Risks Because high-strain jobs are at the upper end of the residual (unresolved) strain axis, they are the most distressful and risky jobs for employees. Jobs characterized by heavy responsibilities without commensurate authority and autonomy are high-strain jobs, with the accompanying symptoms of exhaustion, depression, job and life dissatisfaction, elevated consumption of tranquilizers and sleeping pills, and illness days (Karasek, 1979). Subsequent research has shown that high-strain jobs increase the cardiovascular risk for incumbents as well (Landsbergis

F i g u r e 8 . 1  Psychological Demands Low

Passive

High

High-strain

Risk of Psychological Strain and Physical Illness

Low Decision Latitude (control)

4

1

3

2

High Low-strain

Active

Learning Motivation to Develop New Behavior Patterns

The psychological demand-decision latitude model. Reprinted from “Current Issues Relating to Psychosocial Job Strain and Cardiovascular Disease Research,” by T. Theorell and R. A. Karasek, 1996, Journal of Occupational Health Psychology, 1, p. 11. Copyright 1996 by the American Psychological Association.

Protecting People

et al., 2011). Reducing these risks associated with high-strain jobs involves redesign efforts targeted at increasing employee control, reducing psychological demands, or a combination of the two.

Redesigning High-Strain Jobs: Increasing Control on the Job The most common redesign strategy for high-strain jobs is to redesign them through increasing control for employees. There are at least three ways in which this might be accomplished. First, employees might be given the opportunity to control various aspects of their work and the workplace. This includes work pace, task assignments, methods of payment, task content, and goal selection. The caveat associated with this first redesign strategy is that employees are interdependent, not independent, participants in the organization, and their redesign efforts need to be undertaken within the constraints of their larger work area. The process for implementing increased control then becomes an iterative, participative decision-making process in which employees and leaders talk about the degrees of freedom and flexibility achievable within a particular work environment. Second, control can be increased by designing systems with optimal response times or optimal response ranges. Information, mechanical, financial, performance, or other organizational systems whose response time is too fast or too slow pose problems for employees. Where the response times are too fast, employees may well feel pushed by the system without sufficient recovery and/or response time of their own. This is akin to being on a fast-moving treadmill that accelerates the employee’s activity level above that which is effective and/or comfortable for that employee. Where the response times are too slow, employees may likely experience frustration and inefficiency, having to wait on the machine or system to take further action. In both cases, the response times may be measured in terms of seconds for information or computerized systems, in terms of hours or days for financial status systems, or in terms of weeks or months for performance systems. Third, performance monitoring could be appropriately introduced and implemented as a source of relevant feedback to individuals for improving the quality and quantity of performance. Performance monitoring and feedback systems, whether mechanized or interpersonal in nature, are a critical dimension of an employee’s task environment. Performance monitoring and feedback constitute a key system through which employees are influenced at work. By introducing and implementing these systems to allow for employee input and accommodation, employees can enhance their experience of control with these systems. One key aspect of the implementation is being clear and explicit about the use and consequences of the monitoring and feedback information. It is one thing to use the information for performance

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adjustment or improvement, and it is quite another to use it strictly for evaluation or employee payments.

Contextual Considerations Two contextual considerations should be considered in executing job redesign. The organizational culture is a key context variable to address in this regard. The norms, values, leadership styles, and power dynamics are among the cultural variables that one might consider. In addition to the organizational culture, technology might be considered. Although technological advances, such as in computers and information systems, may be sources of job insecurity for some when viewed pessimistically, they are a great lever for increasing employee skill acquisition when viewed optimistically. Therefore, as job redesign is undertaken to enhance employee control, it cannot and should not be done without consideration of organizational culture, technology, and other key context variables.

Effort–Reward Model Siegrist’s (1996) effort–reward model offers useful considerations in undertaking job redesign efforts in organizations. As a balancing model for job design, the core argument is that distress arises from the imbalance of effort and reward, especially high effort–low reward. The key effort and reward variables of concern to Siegrist (1996) are shown in Figure 8.2. Siegrist (1996) suggested that occupational groups who experience the lower levels of status control are more likely to have high incidence of high effort–low reward imbalance. This idea is very consistent with the well-known socioeconomic status (SES) data showing that those at the bottom of the SES ladder have the highest incidence of morbidity and mortality. Hence, in this context of medical sociology, the approach F i g u r e 8 . 2  High Effort

Extrinsic

Intrinsic

(demands, obligations)

(critical coping e.g., need for control)

Low Reward

Money Esteem Status control

The effort-reward model. Reprinted from “Adverse Health Effects of High-Effort/Low-Strain Reward Conditions,” by J. Siegrist, 1996, Journal of Occupational Health Psychology, 1, p. 30. Copyright 1996 by the American Psychological Association.

Protecting People

to job redesign is not as specifically targeted at the individual job as is the case with the job characteristics model. However, organizations and individuals may still use the components of Figure 8.2 for job redesign.

Implementing Effort–Reward Rebalancing Job redesign in the context of the effort–reward model requires primary consideration of the three key reward variables in Figure 8.2. What is neither clear nor specified is how the three variables interplay and/or counterbalance each other. For example, in some organizational contexts, given the financial constraints of the organization and industry, the option of enhancing money via salary increases and/or bonuses may come quickly into conflict with the availability of money. Although not a fixed-reward resource, money is more constrained than esteem or status control as resources. If either or both of those are able to be enhanced substantially, then changes in money may be a less critical consideration.

Positive Influence of Job Flexibility Flextime, job sharing, teleworking, part-time work, and compressed workweeks are all ways of creating job flexibility, a hallmark of the IBM response to employee stress and burnout. We explore these in more details in the Work–Life Programs section of the chapter. Hill, Hawkins, Ferris, and Weitzman (2001) examined the relationship between job flexibility and work–family balance in a study of 6,451 IBM employees. They found a clear and positive influence from perceived job flexibility after controlling for paid work hours, unpaid domestic labor hours, gender, marital status, and occupational level. This was a systematic approach to the stress of work-to-family and family-to-work spillover. Their approach to flexibility captured both job flexibility in terms of timing (flextime) and location of work (flexplace). Formal flextime and flexplace corporate programs aim to increase work–family balance. However, there is more. Hill and his colleagues found that job flexibility had positive personal and family outcomes as well as positive business outcomes. Specifically, job flexibility had the net effect of employees’ finding an extra day in the week because they could work longer hours before impacting work– family balance. Rigid work environments do not offer this benefit.

Career Development Career development, along with talent management, is important to the individual and the organization to maximize a person’s potential while ensuring organizational vitality. Career stress and career development

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Career development and talent management are collaborations between employees and the organiza-

require a broad view of one’s life in context. Changing work realities, as we see later in the IBM case that spans 20 years, are revising the psychological contracts between individuals and organizations. Individuals should think more in terms of portfolios of skills, abilities, and competencies. Career planning is directly linked to career success (Abele & Wiese, 2008). Career planning and counseling are powerful tools for career development, benefiting both the individual and the organization. Nelson and Quick (2013) explored the many aspects of career management in their Chapter 17.

tion aimed at helping

Self-Assessment

individuals to

Career planning, decision making, and development depend on good self-assessment and good opportunity analysis. A thorough assessment of individual needs, interests, skills, abilities, and knowledge is one basis for effective career planning and decision making. Students who participate in self-assessed career planning are found to have increased motivation to study and increased study skills (Abdullah & Salleh, 2010). The MyersBriggs Type Indicator (MBTI) is a widely used personality instrument that is useful to professionals in counseling with the goal of discovering psychological preferences, optimal career families, and potential employment opportunities (Kennedy & Kennedy, 2004). The best resource for selecting an aptitude test is Buros’s Eighteenth Mental Measurement Yearbook (Spies, Carlson, & Geisinger, 2010).

develop their full potential while meeting organizational talent needs.

Individual Interests Individuals differ in their preferences and interests. There may be varying degrees of distress associated with engaging in activities that the individual does not like. Some such activities are present in any job or occupation but can be isolated and managed through effective self-assessment. Two of the most widely used and best-researched measures of individual interests are the Strong Interest Inventory and the Kuder Occupational Interest Survey; the Buros’s Eighteenth Mental Measurement Yearbook (Spies, Carlson, & Geisinger, 2010) lists additional interest inventories to consider. Regardless of the assessment used, it is essential to successful self-assessment that individuals understand their interests and preferences.

Individual Abilities Although interests are an important part of the self-assessment process, it is essential for individuals to have a realistic and objective understanding of their abilities. This aspect of the self-assessment process concerns the special knowledge, intellectual capability, and emotional competencies that the individual has (Deary, Penke, & Johnson, 2010), as well as the unique physical skills and talents (Anderson, 2007). Each

Protecting People

ability area can be developed with the proper drive and interest, but there may be limits to the development that may occur.

Opportunity Analysis Opportunity analysis is the process of environmental scanning, career paths, and professions available for an individual. This personal analysis of the environment can help associates prepare for new positions inside and outside their current company. As organizations and societies change, opportunities change. A person must identify each opportunity and the requirements essential to take advantage of it. These include educational and physical requirements.

Employee Orientation and Socialization Orientation and socialization processes add control to the experience of employees as soon as they enter the organization. This perception of control and familiarity with the organization reduces the stress of change and starting a new job. Newcomer socialization is a key entry point to a career or profession that is a uniquely stressful process. The process has three phases: anticipatory socialization, encounter, and (followed by) change and acquisition. Newcomers experience different stressors, demands, and challenges as they work through each of the three phases of socialization to become established insiders within their career and organization. Reality shock in the encounter phase may be a spike point for a newcomer’s stress level. However, the intensity and duration of reality shock are shaped by the extent and degree of information gathering undertaken in the anticipatory socialization phase of the process. Organizations can benefit significantly in the satisfaction, performance, and longevity of their employees by facilitating newcomer socialization, defining career paths, and creating advancement opportunities.

Defining Career Paths Some organizations and occupations still have defined career paths for employees, whereas other organizations in extremely dynamic and growing industries may not have, or may not be able to effectively formulate, well-defined career paths. There are various ways to create career paths that enhance the individual’s growth and development. The blockage of such growth and development in and of itself may have detrimental effects on organizational health. Organizations and professions differ in what may constitute individual growth and development. Some organizations, such as private-sector corporations and military services, lend themselves to upward mobility as a characteristic of career development. Professional organizations and universities, on the other hand, lend themselves to the horizontal career development.

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Creating Opportunities Although organizations and professions may limit the opportunities available, individuals can create their own opportunities. This is exactly what Bill Gates did in creating Microsoft and much of the information software industry, what Reed Hastings did in creating Netflix, and what Ebby Halliday did in creating Ebby Halliday Realtors. Organizations protect their people by careful talent management and advancement, ensuring that best performers are well led and managed. Those whose performance is not the best may be coached to seek opportunities that may better fit their skills, abilities, and interests. Poor performance is not necessarily a personal problem, although it could be. Poor performance can result from a lack of person–job, person–environment fit too. The best leaders actively engage in coaching and counseling all of their people in the best interests of the organization and the individual.

Coaching and Talent Management We address the coaching aspect of a leader’s responsibility in Chapter 9 in the section Resonant Leadership. Talent management in human resource management practices currently lacks clear definition and scientifically supported practices. However, Lewis and Heckman (2006) suggested that there is a real opportunity to ground talent management in the organization’s strategic decision framework, thus clearly guiding talent decisions; developing systems-level models that illustrate the multipool impacts of talent choices; and developing reliable, valid, and theoretically meaningful measures for researchers and practitioners alike. In summary, career development and talent management can be challenging yet eustressful to the extent that they enable the individual to learn new skills, acquire new knowledge, and overcome previous limitations while enabling leaders to manage their best talent for retention and advancement. The lack of advancement opportunities may lead to frustration, distress, and other negative outcomes. Organizational prevention through career development is one more way of protecting people at work.

Ergonomic Office Design Ergonomic office design aims to modify a person’s physical workspace in such a way as to optimize the person–environment interface. A prime target for intervention lies in the area of human factors and ergonomics. Workplace ergonomic design characteristics are not as explicitly specified as are the traditional job redesign characteristics models. However,

Protecting People

An employee’s physical workspace can be ergonomically engineered to fit the person’s individual physical characteristics, thus minimizing strain and maximizing performance.

ergonomics can draw on job or task redesign theories and characteristics. Alternatively, focusing on equipment design places the focus of the change interventions on the equipment itself. Finally, interventions aimed at changing the environment in which people work, in contrast to the equipment itself, is a third way of applying ergonomics. These three ergonomic approaches to design are not mutually exclusive and in fact can work in concert or complementary fashion.

Prevention Targets The two goals of ergonomics are health and productivity. Specifically related to the health goal, ergonomics often targets risks for repetitive motion injuries, persistent pain, and eyestrain. This is especially applicable to computer workstations where operators perform work for extended periods of time (May, Reed, Schwoerer, & Potter, 2004). Preventing repetitive motion injuries, persistent pain, and eyestrain, ergonomic office design interventions contribute to employee health and well-being. These health risks may be a growing concern as the workforce ages and experiences physiological decrements that affect hand and arm strength, eyesight, and musculoskeletal flexibility. On the basis of an individual’s perceptions, a wide range of preventive interventions is possible. These include new chairs, back supports, chair modifications, chair cushions, wrist rests or pads, keyboard trays, computer relocations or repositioning, and workstation rearrangements. All of these modifications aim to improve the alignment and fit between the individual and the immediate physical work setting.

Prevention Versus Repair Ergonomics can be applied along the continuum of preventive stress management, from primary prevention to secondary prevention as well as tertiary prevention. Tertiary prevention is of course appropriate where problems or symptoms exist. Reactive ergonomics is appropriate here because it aims to fix or repair what is broken and to take corrective action to solve a problem. From a public health standpoint, primary prevention is always preferable and secondary prevention the next preferred. Proactive ergonomics aligns well with primary and secondary prevention because it seeks areas for improvement to make things better (primary) and to fix things before they become big problems (secondary). Ergonomics works at the interface of engineering and psychology yet has clear public health impact in relieving human suffering. Although often applied to a work station, ergonomics may be more broadly applied in office and organizational contexts. This might be especially true of industrial ergonomics.

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Work–Life Programs Work–life programs create the workplace flexibility that can enable employees to meet organizational demands and personal, family responsibilities in a discretionary way.

Cascio (2011) made the case for work–life programs in human resource management, reporting that organizations with work–life programs report half the levels of burnout and stress of those reported by organizations without work–life programs. Work–life programs are any employersponsored benefit or working condition that helps an employee to balance work and nonwork demands. Work–life programs span broad areas that include child- and dependent-care benefits, flexible working conditions, leave options, information services and human resources policies, organizational culture issues, worksite wellness programs, and employee assistance programs. Work–life programs have grown into this array of programs that constitute a business imperative to attract, motivate, and retain key talent needed to drive the success of the business. This is achieved by lowering stress, tension, and conflict into the zone where it is healthy and productive. Whereas work–life programs and workplace flexibility have grown over the past several decades, stress levels for employees have declined for two fundamental reasons. First, work–life programs expand the discretion and control that employees have over work and life. Second, work–life programs offer employees support to meet work and life demands, such as life-skill educational programs in parenting, health, financial management, and retirement.

Work and Family at IBM IBM was one of the pioneers in work–life programs starting in 1985 (Hill, Jackson, & Martinengo, 2006). When Lew Platt’s wife, Susan, died at a young age in 1981 while he was a young Hewlett-Packard manager, Mr. Platt developed empathy for working mothers that helped him later, as chairman, transform HP into a more family-friendly culture (J. C. Quick & Quick, in press-a). Similarly at IBM, the corporate work and family program was aimed at accommodating the needs of working mothers. The assumption during this era was that an employee who excelled at work and had a successful family life was one with a stay-at-home spouse. This was not the case for most IBM employees with spouses. The company initiated a work-at-home pilot program and implemented the first extensive national elder care referral service between 1987 and 1990. IBM recognized in the early 1990s that employees wanted more flexibility in working arrangements and experienced greater dependent care demands. The company expanded flextime to include midday flex while piloting a work from home during regular business hours. Throughout the 1990s, employees experienced growing dependent care and family responsibilities but did not feel a need for additional

Protecting People

IBM programs. Rather, they wanted the programs already on the books to be used without prejudice and to be extended throughout the company. In 1998, IBM established a corporate flexibility project office with the mission of implementing flexibility initiatives worldwide. By 2001, elder care responsibilities had skyrocketed for IBM employees, making flexible working arrangements an imperative. The hallmarks of IBM’s response to the stress and demands on their employees over a 20-year period were flexibility and dependent care. By promoting flexibility and support, the company was actively engaging organizational prevention for the protection of its employees as well as its business. The origins of work–life conflict may come from work demands, home demands, or self-imposed demands (J. D. Quick, Henley, & Quick, 2004). What can get overlooked are the accelerants that amplify the conflict, which include alcohol and other substances, sleep disturbances, travel, toxic corporate cultures, and the range of electronic communication devices that operate 24/7. The IBM and HP experiences clearly suggest that organizational prevention to protect people through corporate policies and practices is positive and powerful. Those are balancing strategies within the workplace. Employees can supplement these with balancing strategies within the family and with personal self-management practices (Benson & Casey, 2008; J. D. Quick, Henley, & Quick, 2004).

The Influence of Leadership Whereas leadership is central to nurturing relationships, as we see in Chapter 9, positive leadership can play an important protective function in organizational prevention related to work–life conflict and stress. Specifically, family-supportive supervisor behaviors can be positive and powerful as interventions (Hammer, Kossek, Anger, Bodner, & Zimmerman, 2011). Hammer et al. (2011) executed an intervention study in which a group of supervisors were trained in family-supportive supervisor behaviors. Their findings were positive for employees who had high levels of family-to-work conflict. This was not the case for employees who had low levels of family-to-work conflict. This suggests that there are benefits in leadership that is individually and personally responsive because not all employees have the same stress, needs, and pressures.

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Organizational Prevention Nurturing Relationships

T Strong, healthy relationships are in themselves powerful protective factors for collective and

9

he organizational prevention methods discussed in Chapter 8 focused on protecting people through organizational interventions at the system and job levels. Our focus in this chapter is on interventions to build and nurture relationships throughout an organization. Strong, healthy relationships are in themselves powerful protective factors for collective and individual well-being. In addition, healthy relationships can help alert teams and individuals to risk factors in an organization while preserving the functioning of the organization, its teams, and its people. Healthy relationships have a powerful buffering effect against the adverse effects of stress in organizations and have a remedial and therapeutic effect when people are hurting. The five interventions considered in this chapter are resonant leadership, goal setting, social support, teamwork, and appreciation of diverse individual differences. The five methods are briefly discussed in Exhibit 9.1.

individual wellbeing through which help and healing can come too.

DOI: 10.1037/13942-009 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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Exhibit 9.1 Organizational Prevention: Nurturing Relationships Resonant leadership This model of leadership rests on the skills of emotional and social intelligence competencies. At the heart of resonant leadership is self-awareness, especially emotional self-awareness. From self-awareness proceed empathy, adaptability, emotional self-control, and ultimately the skills of relationship management, including coaching, teamwork, and conflict management. Goal setting This method focuses on the primary relationship between an employee and immediate supervisor. The aim is to clarify the person’s work role by specifying major areas of responsibility and performance goals in each responsibility area. The result is reduced role stress and confusion accompanied by increased eustress and motivation. Social support This is a method for ameliorating many of the effects of work stress on a person. This may occur through a buffering effect of stressors on a person physically and psychologically through emotional, informational, appraisal, instrumental, or protective support. There may be direct effects as well in the form of caregiving, empathy, and compassion. Teamwork This is an intervention for building bonds, relationships, and functional support for intact work groups. The aim is to fulfill task and maintenance functions throughout the relationships within the group for eustress while confronting, working through, and resolving any interpersonal conflicts causing distress within the group. Diversity programs This intervention ensures that the variance in talents and perspectives within an organization are valued and maximized. These programs aim to debunk stereotypes, emphasize the value of individual differences, and maximize the experience of working together in complementary and collaborative ways through open and mutually supportive cultures.

Resonant Leadership It is our opinion that many organizations are overmanaged and underled. Leadership, however, is a double-edged sword that can either hinder people in their work or positively challenge them to achieve much in healthy ways. To be a positive force in organizations, leaders should look first at their own character and strengths. Character-based leadership suggests that a leader inventory his or her character strengths (Wright &

Nurturing Relationships

Quick, 2011). Great leaders are known for their character strengths. For examples, Dallas Cowboy NFL Hall of Fame quarterback Roger Staubach and Texas Capital Bank Chairman Emeritus Joseph M. Grant are two leaders whose positive character strengths have inspired generations of young men and women (Goolsby, Mack, & Quick, 2010). Strength of character is one pathway to positive well-being, especially for executives (J. C. Quick & Quick, in press-a). Beyond positive strengths of character, healthy leaders need the emotional competencies that enable them to resonate with their followers. Resonant leadership is a pathway to sustainable leadership that is compassionate while achieving great performance results (Boyatzis, Smith, & Blaize, 2006). In the long run, the concern for people and the concern for profits converge. People are the pathway to profits in any organization because they are the most powerful resource. Building a strong network of positive relationships throughout an organization begins with leaders and the second principle of preventive stress management. From Principle 2—leaders have a responsibility for individual and organizational health—it follows that leaders should take care of themselves, take care of their followers, and take care of business. There is a synergy among these three that begins with the leader.

Myths and Truths About Leadership

Resonant leaders are empathetic and compassionate, possessing the emotional competencies that enable them to build and maintain positive, healthy relationships with people.

McKee, Boyatzis, and Johnston (2008) identified three myths about leadership. Myth 1 is that smart is good enough. Myth 2 is that a leader’s mood does not matter. Myth 3 is that great leaders thrive on constant pressure, that they are stress addicts. The truth is quite different. Intellect and technical knowledge are necessary for leadership, but they are not sufficient. Adam Smith (1759) drew attention to the importance of the social passions that balance the selfish passions. World-class leaders build relationships throughout organizations by balancing their self-interest with the interest of others. They deliver top-quartile business results along with high morale because they work well with others (Burnham, 2002). Emotions are contagious, and leaders’ moods do matter. Positive, energized leaders infuse their followers with the same positive energy and enthusiasm that they themselves experience. Another truth about great leaders is that they practice the preventive stress management skills that lead to personal renewal and rejuvenation (T. Schwartz, Gomes, & McCarthy, 2010). McKee et al. (2008) suggested that this process of renewal is attained through practices centered on mindfulness, hope, and compassion that lead to sustained, effective, resonant leadership. These same personal practices can then

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be modeled by followers and peers throughout an organization to build relationships. How do resonant leaders develop?

The Leadership Battery® Developing resonant leadership and strong, positive relationships throughout an organization is an effortful process and a good investment. The Leadership Battery® provides a framework for developing self-awareness. Self-awareness is a foundational skill for resonant leadership and relationship development. The Leadership Battery® is a set of assessment instruments custom-compiled into a battery for clients by Debra Nelson and James Campbell Quick. A given battery includes a range of assessments, such as the Myers-Briggs Type Indicator that was discussed in Chapter 8. In addition, the Fundamental Interpersonal Relations Orientation–Behavior to assess interpersonal needs can be used especially in the context of team building. The Self-Reliance Inventory provides information about attachment styles in forming and maintaining relationships (Joplin, Nelson, & Quick, 1999). The Emotional Competence Inventory assesses emotional and social competencies in a 360-degree format (Boyatzis, Goleman, & Rhee, 2000). Avolio’s Multifactor Leadership Questionnaire assesses the full range of leadership skills in a 360-degree format, from transformational leadership through transactional leadership to coercive leadership. The assessment and feedback process provides a leader with information for use in raising self-awareness, leading to intentional change and purposeful development.

The Healing Power of Compassion and Forgiveness Most organizational prevention is either primary or secondary prevention aimed at protecting people. However, there is an important role for tertiary prevention in resonant leadership to heal the wounds and harm that inevitably occur in organizations. Accidents and wrong­ doing lead to negative, stressful outcomes that cannot and should not be ignored. Toxic effects of emotions do harm, hence the need for compassion and forgiveness (Frost, 2003). Compassion is the emotional competence of experiencing empathy and sympathy for another person in the midst of their hurt and suffering. Resonant leaders are ones who coach followers and colleagues with compassion (Boyatzis, Smith, & Blaize, 2006). Interestingly, compassion is good for the leader experiencing and expressing it as well as for those who receive it. There may be a need for action beyond compassion to address the hurt and harm done by a particular stressful event or circumstance. However, the process of healing begins with compassion.

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Forgiveness is a second emotional competence essential to the healthy response to hurt and harm. Forgiveness has healing power to resolve or abandon negative feelings, bitterness, resentment, desire for revenge, or retaliatory behavior in favor of positive emotions, affirmative motivation, and prosocial behavior in the ideal or a neutralized position at the minimum (Cameron, 2007). Compassion, forgiveness, and the host of emotional and social intelligence competencies that infuse an organization with positive, healthy energy often begin with leaders. In Chapter 10, we explore the positive power of expressing gratitude. Followers can join leaders in demonstrating greater emotional self-mastery skills and modeling emotional health for their peers and others throughout an organization. For followers to await the arrival of resonant leadership is an abdication of their own power and potential as positive forces in nurturing healthy relationships.

Goal Setting Challenging goals lead to challenge stress, raise people’s aspirations, and help direct and focus their

Goal setting is a method of establishing specific objectives for an individual’s job. Goals, mission, and purpose provide positive pathways for stress-induced energy and challenge stress. Goals create challenge stress for people along with providing direction for the release of energy. Goal setting is best done in collaboration between leaders and followers, leading to clear understanding of one’s job and work environment. Goal setting improves communication while reducing conflicts, ambiguity, and confusion. It helps eliminate anticipatory stressors by focusing attention on goal accomplishment instead of an uncertain future.

energy so that they can achieve great performance.

Characteristics of Effective Goals Five commonly accepted characteristics of effective goals are specific, measurable, attainable, realistic, and timely. Specific, challenging goals lead to the best performance. Measurable goals form the basis for feedback about goal progress. Feedback helps alleviate uncertainty and increases an individual’s self-efficacy, which can in turn reduce distress. Attainable and realistic goals provide a person with a line of sight to the goal, which can be a stretch but within one’s grasp. Timely goals enhance measurability and provide good targets for goal accomplishment. Prioritizing goals helps direct the individual’s efforts and behavior. All of these characteristics help to increase motivation and performance, but these are not the only functions of goal setting.

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Goal setting plays a major role in reducing stress that is associated with conflicting or confusing expectations. This is done by communicating task–role expectations to employees. Supervisors, coworkers, and employees are all important sources of task-related information. The improved role clarity from goal setting is due to improved communication between managers and employees. Organizations like Ford Motor Company and Federal Express include communication-related targets in their goal-setting processes.

Organizational Goal-Setting Programs Goal-setting programs have been used for decades in many organizations and have gone by a variety of names. Management by objectives (MBO) programs couple goal setting and performance evaluation on the basis of a negotiated agreement between employees and managers. The central stress-related aspects of goal setting and MBO programs are to build collaboration and relationship between a leader and a follower, hence strengthening the relationship. In addition, when leader and follower come to agreement about work-related goals, there is significant reduction in conflict, confusion, and ambiguity about the work. The planning component consists of both organizational and individual goal setting. Organizational goal setting is a prerequisite to individual goal setting, and the two must be closely linked for MBO to be successful. Discretionary control is given to individuals and departments to develop goals that support organizational objectives. This control helps to reduce stress. The emphasis is on formulating not only the goal (what) but also the pathways to achieving that goal (how). The evaluation component consists of periodic reviews by managers and employees on goal progress, along with formal performance evaluations. Although this may raise performance anxiety stress, the evaluation component provides information that can be used to modify and alter performance. Goal setting and evaluation thus remove some of the anxiety and ambiguity from the appraisal process. A depiction of this goal-setting process is shown in Figure 9.1. The first step in the process is to establish a goal (Whetten & Cameron, 2011). The second step is to identify specific behaviors that lead toward accomplishment of the goal. The more difficult the goal, the more rigorous and specific these behaviors should be. The third step involves establishing accountability. The final step is to identify the criteria for goal accomplishment and to link rewards to success. The whole point of the goal-setting model is to eliminate distress by providing focus and direction. The anxiety associated with uncertainty can be dissipated when mental and physical efforts are focused on goal-directed activity.

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F i g u re 9 . 1 

1. Establish a goal

4. Specify success with rewards

2. Specify actions and behaviors

3. Specify accountability requirements

A model for goal setting. From Developing Management Skills (8th ed., p. 133), by D. A. Whetten and K. S. Cameron, 2011, Upper Saddle River, NJ: Prentice Hall. Copyright 2011 by Prentice Hall. Adapted with permission.

Increase Challenge Stress, Motivation, and Performance While Reducing Distress Three important behavior aspects of goal setting create challenge stress, facilitate motivation and performance, and facilitate reduction of distress. These aspects are employee participation, management commitment, and performance feedback. Employee participation leads to goal commitment and goal accomplishment. Management commitment reflects the organization’s commitment to the goal-setting program. Feedback on goal progress that is timely and useful provides knowledge of results that can help employees redirect efforts and provides needed encouragement for further efforts. The stress-reducing properties of goal-setting programs revolve around task goals and manager–employee interactions. Goal setting facilitates open, supportive communication in the relationship. Because goal setting reduces ambiguity, provides support, and provides a sense of control, it is reasonable to expect an overall reduction in an employee’s distress at work.

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Social Support Social support is a means of augmenting the natural physiological and psychological resources that each individual has to manage the demands at work that cause stress. Many definitions of social support have been advanced, and these concepts are complementary. They vary from social support as the individual perception that one is cared for and loved, is esteemed and valued, and belongs to a network of communication and mutual obligation to something more transactional that involves an exchange of resources. We define social support as the assistance one receives through his or her interpersonal relationships.

Social Support and Health

Social support may help an individual

The general relationship between social support and health is rooted in a broad array of studies indicating that the absence of social support, specifically, social isolation, has dire consequences (Lynch, 2000). Social isolation is a risk factor for both mortality and morbidity. There is a strong connection between social relationships and health. What is less clear, however, is the exact mechanism whereby social relationships and social support affect health. Social support may impact health through one of three mechanisms. First, social support may have a direct effect on work stress by altering a work demand or modifying one’s response to the demand. Second, social support may have a direct effect on health by improving one’s physical or psychological well-being. Third, social support may buffer the adverse effects that work stress may have on one’s health. In the stress-buffering model, support may influence the stressor–strain connection by altering the cognitive appraisal of the stressor or by dampening health-damaging psychological processes.

more effectively meet workplace demands, lead to improved physical or psychological well-being, or provide a buffer against distress.

Forms of Social Support Social support comes in one or more of five forms: emotional, appraisal, informational, instrumental, and protective support (see Table 9.1). Emotional support involves providing empathy, emotional caring, and love, such as quietly listening to the lament of an individual who has just lost a job. Appraisal support involves transmitting information to an individual about role performance and behavior. An example would be the performance appraisal interview. Informational support involves providing information needed to manage demands or problems—for example, receiving specifications for a new computer software system from a user. Instrumental support involves behaviors that directly assist

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Ta b l e 9 . 1 Five Functions of Social Support Type of social support

Function

Protection from stress predators

Direct assistance in terms of resources, time,   labor, or environmental modification Provision of information necessary for managing  demands Feedback on both personal and professional role  performance Evidence of behavioral standards provided   through modeled behavior Empathy, esteem, caring, love

Informational Evaluative Modeling Emotional

Note. From Stress and Challenge at the Top: The Paradox of the Successful Executive (p. 171), by J. C. Quick, D. L. Nelson, & J. D. Quick, 1990, Chichester, England: Wiley. Copyright 1990 by Wiley. Reprinted with permission.

another individual in need, such as taking on part of a colleague’s work after your own has been completed. Protective support comes from those in the organization who shield a person from stress of a threatening nature. Supportive relationships at work can serve as a form of protection or as a shield from stressors. Employees often perform this defender function for their supervisors by forming an impermeable boundary around the leader. Protective support may take on the simple form of having someone to turn to for resources (e.g., lunch money). Informational support is critical in work settings. Given the emphasis on organizational restructuring, information is needed to help eliminate the ambiguity and hence the anxiety that exists in the workplace. This may come from either the formal or the informal organization. Evaluative support is of critical importance. Employees need consistent and timely feedback on performance. It should be noted that those at the upper levels of the organization need this evaluative support as well. Upward feedback should be solicited, and providers should be able to provide the feedback without fear of rejection or reprisals. Modeling support is the way individuals learn appropriate behavior. People in organizations look to leaders as models they can emulate. Finally, emotional support at work is essential for effective functioning. An empathetic listener may not be able to resolve an issue, but the concern and time spent processing the issue constitutes an outlet that helps the individual manage the response to stress.

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Sources of Social Support Every individual has a social support network that varies in both size and composition. For many people, family and work are the primary domains in which they have and maintain relationships. However, these may be supplemented with relationships in fraternal and religious organizations, relationships with health care professionals, and relationships in community networks and alumni associations. The wide range of relationships in a support network helps an individual manage demands, solve problems, metabolize stress, and engage in recovery and renewal. Familial support systems can be especially important as a source of guidance, renewal, and emotional support. In the childhood years, the family plays a vital role in an individual’s socialization and adjustment to the broader society. In the adult years, the family is an important source of identification and strength. The family’s value as a support system depends in part on its acceptance of an individual’s whole personality, including the flaws and inconsistencies in that personality. It also depends on the recognition and meeting of the individual’s more fundamental needs. In addition, families evaluate and regulate the behavior of their members. Therefore, the family is a vital social support system that combats loneliness and alienation and that provides a source of identity and guidance. Effective support systems are also needed within work organizations. There are several reasons for this. First, the demands of work require a response using various resources available to the individual. Appraisal and informational forms of social support enhance our knowledge and skill utilization in meeting these diverse demands. Without the supplemental outside resources to assist us in managing demands at work, the stress response caused by specific demands may be more intense and sustained than would otherwise be the case. Second, the instrumental form of social support provides us with the additional resources and assistance that we need to manage specific demands. Third, when our emotional needs are not met, we become preoccupied with the particular need deprivation that we are experiencing. If we are getting the emotional support we need at work, then such need deprivation may not be a driving force for our behavior.

Building Support Systems Building effective social support systems starts at the top. Executives, especially, need diverse professional supports to ensure their own wellbeing (J. C. Quick & Quick, in press-a). From the top, management should provide people in an organization with positive support, both of a formal and a more personal nature. For example, managerial titles

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and office settings provide some emotional support by way of esteem and status gratification. Evaluative support may be provided through the performance evaluation and reward allocation processes. Informational support may be provided through policy directives and written procedures. Protective support may be provided by way of the capital, material, and human resources available to the manager. These formal forms of support can be supplemented with more personal forms of support. These complement and supplement the systems that provide support and protection. Coaching and mentoring encourage and reward interdependence and social support. Some companies have formal mentoring programs, but in many organizations mentoring relationships develop informally. Mentors can provide many valuable sources of support, including information on the political climate of the organization and modeling of appropriate behavior. Mentoring should be rewarded by the organization, and experienced employees should be encouraged to serve as mentors. Newcomer socialization efforts provide another way for organizations to encourage social support. Newcomers should be introduced to reliable support figures early in their socialization, and they should be encouraged to develop mutually supportive relationships with other newcomers. Providing opportunities for newcomers to socialize informally with other organization members provides valuable networking opportunities. Organizations can and should strive to encourage self-reliance among individuals. Employees can be trained to assess work situations, rely on their own resources when appropriate, and ask for support from others when it is needed. Some organizations emphasize independence to the extent that individuals are reluctant to seek support. To counter this, leaders can send a message that seeking assistance and developing supportive relationships at work are valued activities. Employees should also be educated about the health risks of social isolation and the health benefits of social support.

Teamwork Teamwork is a prevention method aimed at improving performance effectiveness through cooperative, supportive relationships in a work team. The outcome of effective team building should be a cohesive, well-integrated team in which individuals give and receive needed support while delivering great performance. A team is much more than a collection of individuals.

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Teamwork enables individuals to share the workload effectively, to achieve psychological intimacy, and to become

Teams, by their very nature, provide two important social benefits for members, the first being relationship oriented and the second task oriented. Psychological intimacy is emotional and psychological closeness to other team members. It results in feelings of unconditional positive regard and the opportunity for emotional expression and support. The other social benefit, integrated involvement, is closeness achieved through tasks and activities. It results in enjoyable and involving work, social identity, and being valued for one’s skills and abilities. Both psychological intimacy and integrated involvement contribute to health and well-being.

integrally involved in work activities.

Basic Conditions for Great Teams Hackman (2002) identified five basic conditions that leaders and organizations must fulfill in order to create and maintain effective teams. The following basic conditions set the stage for great performance, an essential element in organizational functioning: 1. Teams must be real. The leader must make clear who is on the team and who is not on the team. This message must get to everyone affected by the function and operation of the team; hence, it is essential to the organization’s operational knowledge. 2. Teams need a compelling direction. This is related to the team’s goal, purpose, and mission. Team members must know and agree on what it is that they are doing together. The leader is in the best position to articulate this clear direction, and without it there is the real risk of different agendas among the team members. Competing agendas can cause a real fracture in the cohesion of a team and break down teamwork. 3. Teams require enabling structures. There are at least three enabling structures that underpin great teamwork. The first structure is a well-designed, clear task. Poorly designed or inadequately articulated tasks set the stage for confusion. A second structure concerns the number and composition of the team. Starting with the task, it is essential to identify the right number and expertise of team members to be assembled. A third structure is clear, well-understood, and agreed-on norms. Fuzzy, unenforced norms or ones not agreed on invariably get a team in trouble. 4. Teams need a supportive organization. The organizational context must be supportive of teams for them to be effective. Here again, there are structural elements within the organization that lead to support. The human resources system, the reward system, and the information systems of the organization may either facilitate teamwork or serve to hinder and frustrate teamwork.

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5. Teams need expert coaching. In a similar way to how leaders can benefit from coaching, so too can teams benefit from coaching. However, these may not involve the same type of coach. Many executive coaches focus on individual performance and leadership development. These coaches do not necessarily improve teamwork, which is what a team coach must be focused on improving. Coaching in team processes can be especially vital at the beginning, midpoint, and end of a team project.

Cautionary Notes The effective use of team building requires an organizational culture and emphasizes trust. Three other necessary conditions are (a) participation in decision making relative to the work being performed, (b) excellent communications, and (c) commitment to collaboration. To reap the benefits of team building, employees must be actively involved in all aspects of the process. Team building may require a redistribution of power, taking it out of the hands of the manager and placing it in the hands of team members. The threat to some managers is obvious. In addition, employees who are not accustomed to making decisions may balk at the opportunity to do so. Existing reward structures in the organization are probably directed at individual performance. Rethinking the organizational reward system and incorporating rewards on the basis of team performance may be a precondition for team-building efforts, as noted previously. Because team building involves change, it is essential that resistance is anticipated and that employees are involved in the process. Team building can be seen as a reframing of what is happening in the organization. When managed properly, team building can diminish the frequency and intensity of work-related stressors and pave the way for increased productivity.

Emotional Intelligence and Teamwork One of the enabling structures for great teamwork is well-understood and enforceable norms of conduct among team members. This becomes especially important when it comes to emotions and emotional regulation within team. Druskat and Wolff (2001) discussed two important categories of norms in this regard. One concerns norms that create awareness of emotions and the other concern norms that help regulate emotions. Emotional awareness and regulation are keys to the experience and expression of stress by individuals and within teams. Teams and their members can develop positive norms that facilitate interpersonal understanding, constructive confronting, and caring while creating an affirmative environment of proactive problem solving and

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self-evaluation. The healthy identification, experiencing, and processing of emotions within teams is essential to individual, team, and organizational vitality.

Virtual Teams One of the stressors associated with the advent of technology is that of virtual teams. Virtual teams are ones composed of members working from different geographical locations and even different time zones, often simultaneously and interactively by a common set of communication media. This may be done by voice or on the Internet. An example project might be finalizing a procurement contract in a virtual team of subject matter, legal, client, and human resources experts. Virtual teams create challenges for teams, team members, and their organizations (Nydegger & Nydegger, 2010). Organizations are increasingly taking advantage of the opportunities that new technologies offer for purposes of efficiency and effectiveness. However, virtual teams pose challenges to meeting Hackman’s (2002) basic conditions for great team performance and for establishing healthy norms for emotional regulation and expression. People are prone to be less inhibited and possibly less honest when technology provides a hurdle between them and others. For example, some individuals send inflammatory e-mails or vent over a phone in a way they would not do in face-to-face teamwork. In addition, some team members withhold information in a virtual environment that they might not withhold in a face-to-face confrontation with team members.

Diversity Programs Increasing diversity within the workforce, including gender, sexual orientation, race, ethnicity, religion, age, and ability, makes the provision of diversity programs a critical issue from a stress perspective. Organizations face economic gains and losses associated with the effective and ineffective management of diversity (Cascio, 2011). Effective diversity programs offer the benefit of effective management that reduces financial and human costs while increasing appreciation of differences. Valuing differences leads to moving beyond the problem of stereotyping, which damages relationships and causes painful divisions among people (Cocchiara, Gavin, Gavin, & Quick, 2011). Bell (2007) provided possibly the best framework for understanding diversity in organizations. Her in-depth examination of differences among people in race, ethnicity, sex, age, physical and mental ability,

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Valuing differences and appreciating all forms of diversity leads to overcoming stereotypic thinking about groups and to more withingroup thinking about individuals.

sexual orientation, religion, work and family status, weight and appearance, and other attributes covered the gamut of individual differences. She then put diversity in a global context by examining international diversity. Diversity encompasses all forms of differences among individuals (Bell, 2007). Organizations are concerned about managing diversity for several reasons. First, there is a concern that managers lack the knowledge of how to motivate diverse groups. Second, there is a concern that managers are unsure of how to effectively communicate with those who have different values and language skills. Working with others who are different from oneself can be a source of stress for some individuals. Although diversity programs do not focus directly on work stress, it is reasonable to expect a reduction in interpersonal stressors from these interventions. Many diversity programs are intended to improve interpersonal relations among different groups. Workshop activities (e.g., frank and open discussions) are used to pinpoint issues, present different points of view, and devise solutions to diversity-related problems. Such activities may involve uncovering hidden assumptions or biases that employees hold so that differences are seen as assets and all people are valued. Younger workers, for example, often hold false impressions of older workers, seeing them as resistant to change, unable to learn, less physically capable, and less creative than younger employees. They may fail to recognize that older employees can make valuable contributions because of their experience and are often more motivated and more committed to the organization than their younger coworkers are. Diversity programs that debunk stereotypes can help employees overcome interpersonal obstacles to working together productively. Diversity programs take on a number of forms. Microsoft and Hilton Hotels are among the leading companies that strive to create positive and supportive work environments for minorities, women, older workers, and other diverse groups within the workforce. Even positive stereotypes carry the potential for harm because of racism and discrimination caused by ethnic stress (Cocchiara & Quick, 2004). The preventive management of performance stereotypes of all types through effective coping can improve organizational health and function.

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Primary Prevention for Individuals Managing and Coping With Stressors

T

10

he concept of person–environment fit in organizational stress suggests that the least stressful circumstances are ones in which a good fit exists between the person and the organizational environment (Edwards, 1996). In this chapter and the subsequent two, we address strategies for changing and modifying individual perceptions, attitudes, and behaviors to enhance individual health and well-being. This set of three chapters is about individual preventive stress management and concerns the question, What can I do as an individual to responsibly manage my own stress? Building on the positive organizational movements (Wright, 2003) and our eustress approach, we expand on our introductory comments in Chapter 1 and further specify the valuable role of signature character strength development and implementation in successful stress management prevention. The role of character is receiving increased attention in the organizational sciences (Wright & Goodstein, 2007). Peterson and Seligman (2004) identified the following six

DOI: 10.1037/13942-010 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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Good character provides an individual with the inner strength and personal security to withstand the stress and pressure of uncertainty and adversity.

core virtues (with the strengths of character common to each virtue listed in parentheses): wisdom and knowledge (creativity, curiosity, critical thinking, love of learning, perspective), courage (bravery, integrity, persistence, zest), humanity (kindness, love, social intelligence), justice (fairness, leadership, citizenship), temperance (forgiveness, modesty, prudence, self-regulation), and transcendence (appreciation of beauty, gratitude, hope, humor, spirituality). As the reader will see, this classification framework provides an excellent starting point for a discussion of character strength in preventive stress management. Exhibit 10.1 presents an overview of the individual preventive stress management strategies discussed. Our overarching goal is for the reader to be able to successfully develop a plan for preventive stress management. This chapter discusses primary prevention for individuals and considers the use of stressor-directed strategies aimed at preventing individual distress and managing the stress response in everyday work life. As noted in Exhibit 10.1, the primary prevention strategies considered fall into three groups: (a) managing personal perceptions of stress, (b) managing the personal work environment, and (c) managing lifestyle. The strategies discussed are ones for which there is a conceptual and/or evaluation research basis for their use and effectiveness.

Managing Personal Perceptions of Stress A key to the definition of stressor is the notion that a condition (i.e., person or event) must be perceived as demanding or stressful by the person experiencing it if the condition is to be a source of stress. For example, selecting a $5,000,000 piece of hospital equipment may be quite stressful to a new health care administrator whose largest past purchase was the $30,000 family car. Alternatively, for a health care administrator of a large chain of hospitals who has occasionally bought equipment costing over $10,000,000 and often contracts for several million dollars worth of new equipment, a decision about $500,000 may be made with relative equanimity. Hence, personal perceptions of people and events become central to a person’s propensity for experiencing the stress response. Efforts to alter personal perceptions of stress are directed at changing one’s cognitive–psychological evaluation of potential stressors and/ or reducing one’s affective–emotional arousal or stress response. The essence of managing personal perceptions of stress is embodied in the 2,000-year-old words of Epictetus: “Men are disturbed not by things but by the views they take of them.” Managing personal perceptions of stress requires changing how one thinks and how one behaves. We use

Primary Prevention for Individuals

Exhibit 10.1 Preventive Stress Management for Individuals Primary prevention: Stressor-directed Managing personal perceptions of stress ❙❙ The positivity ratio ❙❙ Gratitude expression ❙❙ Learned optimism ❙❙ Constructive self-talk ❙❙ Selective ignoring

Managing lifestyle ❙❙ Maintaining a balance ❙❙ Leisure time

Managing the personal work environment ❙❙ Planning and time management ❙❙ Overload avoidance ❙❙ Social support Secondary prevention: Response-directed Relaxation training ❙❙ The relaxation response ❙❙ Meditation ❙❙ Biofeedback training

Emotional outlets ❙❙ Talking it out ❙❙ Writing it out ❙❙ Acting it out

Spirituality and faith

Physical fitness ❙❙ Aerobic fitness ❙❙ Muscular flexibility ❙❙ Muscle strength training Nutrition Tertiary prevention: Symptom-directed

Emotional health in the workplace Psychological interventions ❙❙ Symptom-specific programs ❙❙ Individual counseling ❙❙ Group approaches to tertiary prevention Career counseling

the positivity ratio (Fredrickson, 2009) discussed in Chapter 1 to develop ways not only to increase positivity but also to decrease negativity through the expression of character strength, gratitude, the incorporation of a hopeful cognitive style of learned optimism, constructive selftalk, and a transformational style of coping with demands and stressors.

The Positivity Ratio According to Fredrickson and her colleagues (Fredrickson, 2009; Fredrickson & Losada, 2005), the ratio of experienced positive to negative feelings can greatly influence our success in work and personal life. Her work demonstrated that a positivity ratio of 3 positive feelings to

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1 negative feeling can be considered as a necessary “tipping point” for individuals to develop the skills to flourish, thrive, and grow. Fredrickson (2009) noted that this ability to flourish is consistent across levels of analysis, with research on married couples and business teams providing support for this 3-to-1 tipping-point ratio. Interestingly, there appears to be a second tipping point or law of diminishing returns. That is, when positivity ratios become very high, in excess of 11 to 1, the ability to engage in honest dialogue and attempts at conflict resolution may be compromised. However, because more than 80% of U.S. adults fall short of the 3-to-1 ratio, we focus on strategies to help achieve this realistic positivity goal. Our first strategy to enhance positivity can be found in the literature on the expression of gratitude.

Gratitude Expression

The expression of gratitude and optimistic thinking are sources of energy and renewal that draw attention to the positive without denying the existence of the negative.

Peterson and Seligman (2004) defined gratitude in terms of being cognizant of and thankful for the many good things that happen to us. In other words, gratitude involves the ability to take the time necessary to “smell the roses.” Lyubomirsky (2007) called the ability to genuinely express gratitude a metastrategy in the successful pursuit of well-being and stress reduction. Research has indicated that grateful individuals are relatively happier, more helpful, empathic, forgiving, energetic, hopeful, display more positive emotions, and assist people in more effectively coping with stress and trauma (Emmons, 2007; Lyubomirsky, 2007). A number of gratitude intervention strategies have been developed, such as the gratitude journal and the direct expression of gratitude to another. In the former, an individual notes in a journal the three to five things that he or she has to be grateful for each day. A more direct approach is to express gratitude to another individual by calling the person on the phone; sending a letter, an Internet message, or a text message; or setting up a face-to-face conversation (Lyubomirsky, 2007). The most effective strategy for many individuals may involve varying how gratitude is expressed as well as varying the aspects of life for which they express gratitude. For example, one day an individual can express gratitude to close friends and relatives, and another day the individual can focus on his or her physical health, and so on. The goal is to not get bored by the procedure. For those interested in initiating a gratitude expression program, it may be beneficial to briefly express three to five things for which they are grateful immediately after waking up.

Learned Optimism Individuals differ in how they explain the events of life—the good, the bad and the stressful—to themselves. Individuals who have an optimistic cognitive style are more hopeful and less distressed than those who

Primary Prevention for Individuals

have a pessimistic cognitive style (Seligman, 1990). Although optimism alters the view one has of life’s stressful events, the denial of legitimate risks or real threats would be hazardous, even dangerous, to one’s wellbeing. Hence, optimism must be tempered by the reality of life’s challenges and problems. Seligman (1990) described optimism as a style of nonnegative thinking that enhances well-being and enables people to live with hope and without depression. The alternative to optimism is pessimism, which is a style of negative thinking. These are two alternative styles for explaining the good and bad events that occur in life. As such, they are cognitive lenses through which a person views life’s events. Although an optimistic style helps people avoid distress through a view of stressful events as temporary occurrences with limited effects for which they do not have personal responsibility, a pessimistic style leads people toward distress and depression through a view of stressful events as permanent problems with pervasive effects for which they have some personal responsibility. Therefore, individuals whose cognitive style is optimistic face stressful and adverse events with hope; they perceive that the good events in life outnumber the bad events. In addition, an optimistic style enables a person to view success in both the personal and career realms of life as due to his or her own efforts and abilities. This leads optimists to persevere (Segerstrom, 2001), set more difficult goals (Snyder et al., 1991), be willing to take the initiative (Lyubomirsky, 2007), and maintain their well-being level during stressful situations (Scheier & Carver, 1993). Although the benefits of optimism are obvious, we must emphasize that there is a place for cautious, even pessimistic, thinking when it comes to stressful events with high-risk, adverse consequences. For example, undue optimism on the part of a pilot attempting to land an airliner in the midst of an ice storm may lead to unreasonable risks given the circumstances. A dose of pessimism in such stressful circumstances may be healthier for both pilot and passengers, leading to a request that the control tower divert the flight to an alternate destination within fuel range. Now that we have extolled the benefits of being optimistic, let’s look at how an optimistic outlook can be developed. King (2001) developed an intervention strategy to help individuals visualize their “best possible future selves.” This exercise asked participants to actively visualize their best possible future selves across a range of work and life situations for 20 minutes per session for 4 days. For example, a struggling college freshman might visualize how in just 3 more years she will have successfully completed her degree program, be engaged to her high school sweetheart, and work in a high-paying production management position for a Fortune 500 company. This intervention

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has proven to be successful, and many participants have experienced significant increases in positive moods. Other researchers have adopted the best possible selves exercise with similarly positive results (Lyubomirsky, 2007).

Cognitive Distortion Cognitive distortion, or what Nolen-Hoeksema (2003) called self-focused rumination, is a self-defeating, high-anxiety, frequently irrational pattern of negative thinking. Cognitive distortion may stress a person through a self-perpetuating series of negative beliefs, much like the pessimistic style of thinking. Cognitive distortion or overthinking has a number of negative consequences, such as heightening sadness, reducing one’s motivation, and hampering one’s ability to problem solve (Lyubomirsky, 2007). Unfortunately, cognitive distortions may manifest themselves as conscious, persistent beliefs. Ellis (1955) proposed a systematic approach to modifying cognitive distortion through rational emotive therapy (RET). RET is a form of cognitive restructuring through a process of logical questioning aimed at disputing and modifying irrational beliefs. According to RET, the disruption of cognitive distortions can be attempted by detecting the irrationalities, debating against the irrationalities, discriminating between rational and irrational thinking, defining circumstances to prevent cognitive distortion, and maintaining closer contact with reality. Another approach to cognitive restructuring involves stopping a thought and substituting a key thought that cycles into a more positive and healthy way of thinking. Table 10.1 illustrates several typical cognitive distortions and the key cognitive restructuring phrases that can be used to combat the distortion (J. C. Quick, Nelson, & Quick, 1990). One common cognitive distortion, for example, is mind reading. Individuals often think they can read another person’s mind by their facial expressions, imagining the worst. Suppose that when giving an important speech, an individual is confronted with puzzled expressions in the audience. He or she may react by thinking, “Oh no, they think I’m an idiot.” The key phrase to use with this distortion is “Check it out.” The individual, rather than guess at the source of the problem, would be better off by simply saying, “Am I confusing you?” or “Tell me what you think.” This beats imagining the worst.

Constructive Self-Talk Constructive self-talk is a conscious effort to replace negative, self-defeating, self-effacing, often irrational narrative with positive, reinforcing, and more rational self-talk. During their daily activities, most people conduct an intermittent mental monologue or narrative about the events they

Primary Prevention for Individuals

Ta b l e 1 0 . 1 Cognitive Restructuring: Ten Styles of Distorted Thinking Distortion

Mental key

  1. Filtering: You take the negative details and magnify them while filtering out all the positive aspects of a situation.   2. Polarized thinking: Things are black or white, good or bad. You have to be perfect or you’re a failure. There is no middle ground.   3. Mind reading: Without them saying so, you think you know what people are feeling and why they act the way they do. In particular, you are able to divine how people are feeling toward you.   4. Catastrophizing: You expect disaster. You notice or hear about a problem and start what ifs: What if tragedy strikes? What if it happens to me?   5. Control fallacies: If you feel externally controlled, you see yourself as helpless and a victim of fate. The fallacy of internal control has you responsible for the pain and happiness of everyone around you.   6. Fallacy of fairness: You feel resentful because you think you know what’s fair, but other people don’t agree with you.   7. Shoulds: You have a list of ironclad rules about how you and other people should act. People who break the rules anger you.   8. Fallacy of change: You expect that other people will change to suit you if you pressure or cajole them enough. You need to change people because your hopes for happiness seem to depend entirely on them.   9. Being right: You are continually on trial to prove that your opinions and actions are correct. Being wrong is unthinkable and you will go to any length to demonstrate your rightness. You don’t listen well. 10. Heaven’s reward fallacy: You expect all your sacrifice and self-denial to pay off, as if there were someone keeping score. You feel bitter when the reward doesn’t come.

Don’t magnify.

Think in percentages.

Check it out.

Calculate the realistic odds.

Discriminate between I make it happen and they make it happen.

Think of preference, not fairness.

Develop flexible rules.

Assert, my happiness depends on me.

Use active listening.

Recognize that the reward is now.

Note.  From Stress Management for Wellness (pp. 225–227), W. Schafer, 1987, New York, NY: Holt, Rinehart & Winston. Copyright 1987 by Cengage. Adapted with permission.

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How one talks to oneself has significant effects on one’s feelings, one’s physiology, one’s stress level, and therefore one’s health and well-being.

are experiencing and their reactions to the events. This monologue, or self-talk, can be positive in tone: “Gee that really was a witty remark.” Or the content of the self-talk can be negative or self-effacing: “Boy, are you dumb, why not just keep your mouth shut?” Self-talk may be conscious or unconscious, although it is often conscious and may even be said out loud. Negative self-talk can waste emotional energy by setting up a tension-sustaining mental short circuit. Table 10.2 lists examples of several common situations, the typical mental monologues that a person might go through, and constructive self-talk alternatives. The potential benefit of constructive self-talk can be appreciated by imagining oneself in any of the situations listed in Table 10.2 and noting how one would feel after 5 or 10 minutes of the typical monologue. An important part of constructive self-talk is rethinking—that is, recognizing when one has latched onto dead-end or downhill thoughts and consciously beginning to substitute constructive, forward-looking thinking. There are several other related concepts. Quick recovery, for example, refers to the ability to rebound in a short period of time from strong emotions. One person might ruminate for several days over a missed promotion or bad grade, whereas another person may brood about it for a few hours and then bounce back determined to work even harder to earn the promotion or a better grade. Another concept is that of thought stopping. This also involves recognizing dead-end or downhill thoughts, but instead of staying on the same subject and changing the tenor of the thinking, one mentally—or verbally—says “stop” and changes the subject. The technique of mental diversion is also useful in reducing the extent to which one experiences anxiety or distress over daily events. For example, the morning before a test or presentation for which a student has studied thoroughly or for which a manager has prepared completely, the student or manager may allow her- or himself to worry obsessively. This can continue until the test or presentation begins and may prove to be a significant mental drain. Alternatively, having completed preparations the night before, these individuals can choose to occupy their minds with other mental activities of a positive or pleasing nature. Mental diversion requires that one have a few positive topics on hand to substitute. Constructive self-talk is a primary prevention strategy that enables a person to alter his or her view of the stressful events in life, thus reducing the adverse impact of a stressor. Learning the cognitive skills of learned optimism and constructive self-talk enables one to take full advantage of the power of positive thinking (Peale, 1952), and as with any new behavior, practice and repetition are essential if these cognitive psychological strategies for changing the way one thinks are to become useful, integrated skills. For those whose predisposition is pessimistic and negative, patience is another essential ingredient to realizing the benefits of these cognitive skills.

Primary Prevention for Individuals

Ta b l e 1 0 . 2 Constructive Self-Talk Alternatives to Typical Mental Monologues Situation

Typical mental monologue

Constructive self-talk alternative

Driving to work on a day that will be full of appointments and potentially stressful meetings

Oh brother, what a day this will be! It’s gonna be hell. I’ll never get it all done. It’ll be exhausting. What if I blow it? Nobody will laugh at that opening joke. What if they ask about . . .? I hate talking to groups.

This looks like a busy day. The day should be very productive. I’ll get a lot accomplished today. This ought to be a challenge. I’ll take a deep breath and relax. They’ll enjoy it.

Anticipation of a seminar presentation or public address Recovering from a heart attack

I almost died. I’ll die soon. I’ll never be able to play sports again.

Difficulty with a superior at work

I hate that person. He makes me feel stupid. We’ll never get along.

Flat tire on a business trip

Damn this old car (pacing around the car, looking at the flat tire). I’ll miss all my meetings. It’s hopeless.

Each presentation goes a bit better. I didn’t die. I made it through. The doctor says I’ll be able to get back to work soon. I can keep active and gradually get back to most of my old sports. I don’t feel comfortable with him. I let myself get on edge when he’s around. It will take some effort to get along. These things happen to every  one. I can fix it. Bad time for a flat (beginning to get tools out and start working). I’ll call and cancel Jenkins. I should make the rest of the appointments.

Transformational Coping One key component of workplace hardiness is transformational coping (Maddi, 1995). Transformational coping involves actively changing a stressful event by viewing it in a broader life perspective, thus reducing the emotional power and impact of the event. Transformational coping also involves achieving a greater understanding of the process of the event, which enables one to alter the course and the outcome of the event through appropriate action. The hardy personality uses commitment, challenge, and control to engage in transformational coping. Hardy individuals are committed to their work, families, and beliefs; interpret change as a challenge; and feel in control of events and their

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responses to those events. Hence, hardy people use transformational coping to manage stress and frustration in productive, healthy ways. Although some relationships and events are legitimately stressful due to their threatening nature, other stressors may be unrealistically interpreted as threatening and therefore cause one to experience unnecessary distress. Individuals who engage in transformational coping are more likely to interpret stressors as challenges rather than threats and to perceive themselves as able to control stressful situations. Taking an exam, for example, is stressful for many people. A student engaged in transformational coping might approach the exam by interpreting the test as an opportunity to show his or her knowledge, thus exerting control through preparation and study. The benefits from adopting a transformational coping perspective were accurately identified in the title of R. Carlson’s (1997) best-selling book, Don’t Sweat the Small Stuff.

Selective Ignoring Selective ignoring is a variation of psychological withdrawal, a process by which a person looks for the positive aspects of a troublesome situation and anchors his or her attention to these, to the exclusion of the noxious aspects of the situation (Pearlin & Schooler, 1978). This process is facilitated by magnifying the importance of the positive aspects and viewing that which is noxious as trivial. Selective ignoring may be counterproductive to transformational coping if used too frequently, too pervasively, or for extended periods of time. Further, although the feeling of control is central to the process of transformation coping, there are limits to a person’s capacity for control. An old prayer petitions that when things are amiss, “Give me the strength to change what I can, the patience to accept what I cannot change, and the wisdom to know the difference.” In any organization there are circumstances, persons, and events that one may not be able to alter. Learning to accept that which is inevitable helps avert some of the stress and distress one might otherwise feel. However, accepting too much as inevitable risks greater distress in the future if one develops a sense of helplessness or impotency in the organization (Seligman, 1975). Active passivity is different from learned helplessness.

Managing the Personal Work Environment At any level in an organization, there are aspects of the daily work routine that are in the individual’s control and there are aspects that are totally out of the individual’s control. Managers and supervisors are

Primary Prevention for Individuals

sometimes surprised to discover that they can control their working life to a greater extent than they had thought. Several techniques are available to managers, supervisors, and employees for reducing work stressors by better management of their personal work environment. Obviously, some techniques are more applicable at certain levels in the organization than at others. Similarly, some techniques are more applicable in certain types of organizations than in others. As with the techniques for managing personal-response patterns, the techniques for managing the work environment are reported largely on the basis of the experience of management consultants and the other individuals who have described the techniques.

Planning and Time Management

Planning and time manage­ ment are central skills to focusing, directing, and managing one’s energy and stress in constructive, productive, and healthy ways.

Planning and time management are central skills for managing the stress of one’s personal work environment (Whetton & Cameron, 2011). Good planning and time management go together for someone who is a good “macro time manager,” which may be contrasted with the distressed “crisis time manager” (Brooks & Mullins, 1989). Macro time managers live with a sense of purpose and know the activities that contribute the most to their long-term life development. Therefore, a macro time manager begins by setting life goals and works to achieve these goals through a systematic process of (a) prioritizing the goals, (b) planning goal attainment through scheduling and delegation, and (c) praising oneself for small and notable achievements along the way (Brooks & Mullins, 1989; Weick, 1984). In the work setting, personal planning involves looking into the future, identifying goals and possible job stressors, and developing a strategy to achieve goals while avoiding the negative impact of anticipated stressors. The process of personal planning parallels that of organizational planning. In a study of healthy executives, planning was one of the key preventive stress-management strategies used (J. C. Quick, Nelson, & Quick, 1990). Planning allows executives to minimize or eliminate surprises and focus their energies, thereby helping them manage stress. One of the central issues in the planning process is time management. Deadlines, productivity objectives, and project timetables bring the manager and employee face to face with time and in doing so create significant distress. Time management represents a set of skills and attitudes that can be highly effective in reducing time stress and improving effectiveness. Increased job satisfaction and peace of mind are important consequences of wise time management. Davis, Eshelman, and McKay (2008) identified symptoms of poor time management, such as rushing, constantly missed deadlines, insufficient time for rest or personal relationships, and the sense of being overwhelmed by demands and details.

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Alan Lakein (1973) was a pioneer in time management who outlined a systematic approach to the effective use of time. Three concepts that are fundamental to his method are (a) the goals statement, (b) the to-do list with priorities, and (c) a schedule. One study of 353 employees in a variety of jobs found that some time management behaviors may have beneficial effects on job tension, stress, and satisfaction while apparently not having a beneficial effect on job performance as evaluated by their supervisors (Macan, 1994). One major reason for poor time use is the lack of a clear sense of purpose. For the individual it is necessary to consider carefully what he or she wants out of life, to formulate a lifetime goals statement, to review it regularly, and to revise it periodically (Lakein, 1973, suggested revising the list each birthday). A major stumbling block to effective time use in organizations is lack of awareness or agreement about the duties, authority, and responsibilities associated with each individual job. The central concept in time management is that of the written to-do list. The list should include all significant time demands and things that need to be accomplished. Some people try to keep their to-do list in their head. This is less reliable, and it makes setting priorities more difficult. The list should be expanded each time new items arise, and tasks should be deleted as soon as they are completed. A stack or pocketful of slips of paper with various undone tasks scribbled on them does not constitute a to-do list. Whenever a list is made, each item should be given a priority. Lakein (1973) suggested an A-B-C priority system, with A corresponding to high-priority items and B and C corresponding to medium- and low-priority items, respectively. The A items can be further classified as A-1, A-2, A-3, and so on. However, making the list overly detailed and specific can be self-defeating. All A items should be completed before going on to B and C items. This is difficult at times, because the B and C items are more numerous and often easier to finish. This reflects a phenomenon referred to as the 80/20 rule: “If all items are arranged in order of value, 80% of the value would come from only 20% of the items, while the remaining 20% of value would come from 80% of the items” (Lakein, 1973, p. 71). This means that in a list of 10 items, two of them will account for 80% of the productivity or value. These two items should be identified, labeled A, and completed as soon as possible. The purpose of setting priorities is simply to ensure that the important items are identified and receive enough time. Most B and C items can wait. Completing the A items requires a schedule or time plan. In preparing the plan, one should take advantage of internal prime time and external prime time by scheduling quiet time and availability time. Internal prime time is the time when you concentrate the best and work the most productively; for some people this is before sunrise, whereas

Primary Prevention for Individuals

for others it is late afternoon. External prime time represents the best opportunity to deal with other people, including coworkers, business associates, and social contacts. To accomplish the most within limited time, it is useful to set aside portions of one’s internal prime time as quiet time. To do this, it is necessary to use whatever measures are available to minimize interruptions. Limiting phone calls, educating fellow workers about your time preferences, and closing an otherwise open office door can help to reduce interruptions. A macro time manager is not a machine, and planning and time management should not become a source of distress. To the contrary, putting important items first should ensure that the high-value items are completed; this contributes to a greater sense of accomplishment. In addition, an important aspect of time management is putting time aside to relax. Effective use of time also permits one to “slow down” final decisions and reduces some of the pressure inherent in making major decisions at the last minute. The best time managers are not necessarily the ones who get the most things done.

Overload Avoidance Time management may reduce some of the stress from a demanding job, but there is a limit to what it can achieve if the demands on an individual are excessive. If preventive efforts at the organizational level have been effective, then overload should be minimized. Nevertheless, several avenues are open to the individual who is faced with excessive work obligations. Research has found that total workload varies by gender, age, occupational level, and number of children (Lundberg, Mardberg, & Frankenhaeuser, 1994). Specifically, women were found to have heavier total workloads than men, work stress peaked at ages 35 to 39, upper level managers had more control over their total workload, and total workload increased with an increase in number of children. Because work overload triggers neuroendocrine and cardiovascular reactions that may have adverse health effects, managing one’s total workload to avoid overload is desirable. This may be accomplished in a variety of specific ways, such as identifying and eliminating busy work to reduce total workload and learning to delegate when possible. Eliot (l995) proposed the following checklist for reducing or eliminating frustrating tasks: 1. Is it necessary to do this at all? 2. Is it necessary to do this task so frequently? 3. What would happen if this task was simply not done? 4. Is there an alternative? 5. Could someone else do it?

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Overload avoid­ ance is an appropriate defensive strategy for keeping one’s time and energy focused on the most important, joyful activities in life and work.

The checklist could also be applied to household chores. Balancing work and home demands can be a challenge, and using the checklist both at work and at home can help in avoiding overload. Equally important is learning how to avoid excessive obligations in the first place. All too often employees are unwilling to negotiate a reasonable deadline or to redefine the scope of a task assigned to them by the boss. Management frequently has only a vague idea of the resources required to complete a specific project and a limited knowledge of the employee’s actual workload. If the individual to whom the job is assigned does not negotiate a reasonable timetable at the outset or renegotiate the timetable when it appears unrealistic, then the individual falls victim to his or her own obligations. Thus, overload avoidance involves learning to decline, whenever possible, those requests that are unreasonable or overwhelming and renegotiating those obligations that are no longer feasible. Although these sound like easy steps to take, experience has demonstrated that considerable skill may be required to control one’s obligations in a demanding or insensitive environment.

Social Support Good, loving personal and professional relationships are among the most effective defenses against distress and offer deep sources of renewal and joy.

Work overload and high work demands are common characteristics of many organizational environments. Social support may be especially beneficial in the context of demanding and stressful jobs (Parkes, Mendham, & von Rabenau, 1994). Active social support may help a person in managing the personal work environment in at least two different ways. First, colleagues and coworkers may help a person develop perspective and understanding of persons or events that are experienced as stressful. Hence, through the dialogue in social support, the person is able to reframe how the stressor is experienced. Second, colleagues and coworkers may help provide the instrumental support of sharing demands that helps ease the stress load on the person. Although social support may be thought of as a personal matter, it is also influenced in the work setting by organizational factors. Fortunately, there are a number of strategies for encouraging social support with friends and coworkers. Psychologists have suggested that we should have at least three friends or companions that we can count on when the going gets tough. Lyubomirsky (2007) provided several suggestions for those interested in creating positive friendships. First, show a genuine interest in other people and, where appropriate, provide encouragement. This can be best accomplished by creating recurring rituals. Get together with the person and share an activity that you both enjoy, such as having a meal, going on a hike, taking a drive, attending a religious service, or taking a

Primary Prevention for Individuals

class together. In the words of Sallust (86–34 B.C.), “To like and dislike the same things, that is indeed true friendship.” Second, engage in the rules of good communication: Make eye contact, listen, and acknowledge your friend’s statement without feeling compelled to offer unsolicited advice (Lyubomirsky, 2007). It is about them, not you! Finally, be loyal and supportive in times of stress and adversity. Be willing to stick up for your friend, if appropriate, even if there can be a cost to you. Saki Hector Hugh Munro said this best when he noted, “The sacrifices of friendship were beautiful in her eyes as long as she was not asked to make them.” In addition, social support from family and friends may incrementally aid one in managing workplace demands, and this may relate to the process of managing one’s overall lifestyle.

Managing Lifestyle Even when work demands do not take time away from family activities, work stress frequently spills over into the home as the working spouse brings the day’s tensions into family interactions. Conversely, marital and other forms of family discord can readily lead to distraction or a quick temper at work (J. D. Quick, Henley, & Quick, 2004). At the same time, the family can serve an important role in countering and attenuating the amount of distress that organizational stressors induce. Thus, the family may be a help or a hindrance in confronting stress at work, depending on the nature of the marriage, the underlying personal priorities of the individuals, and the demands of the job. The emphasis throughout this book has been on preventive stress management in the workplace. Yet, there is an undeniably large interaction between work life and home life. The manner in which this interaction is handled may have an important bearing on an individual’s overall well-being, influencing both health and work performance. There are two important aspects of the work–life and home–life interaction over which management may have some influence: the ongoing balance between work and home and the use of leisure time.

Maintaining a Balance Some organizations reward employees for losing themselves in their work, which explains why it is not hard for some executives to lose their balance (Kofodimos, 1990). People who work long hours, put in extra time on weekends, and take work home may advance rapidly and appear to be succeeding marvelously. However, workaholic behavior eventually takes its toll. The workaholic remains chronically in a state

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Work and play are both essential ingredients of healthy, happy living, and balancing the two is an artful activity and not a mathematical calculation.

of distress. Often the person is unaware of his or her own signs of distress and may manifest the distress only through increased cigarette or alcohol consumption. This excessive involvement in work is really a form of addiction with potentially quite serious consequences. One approach to establishing a healthy balance between one’s career and personal life involves moderating the drive for mastery while encouraging an executive’s capacity for intimacy (Kofodimos, 1990). Workaholics perceive more control over their lives when they are working (Eliot, 1995). Spending long hours at work may actually be an escape from responsibilities in the personal arena and from relationships. The danger in this strategy is that if one’s life is dependent on the career, when the career is in trouble there are no other resources for satisfaction. In contrast to the distress of the workaholic lifestyle is the eustress, which is usually achieved by maintaining balance between work life and home life. Overinvestment in work activities frequently reflects an effort to gain rewards and a sense of value from work that are not coming from outside activities. Rather than working to make the outside activities more satisfying, the workaholic submerges himself or herself in his or her job, creating extreme imbalance in family life. Fredrickson’s (2009) positivity ratio provides insights into how we can provide a proper work–family balance. John Gottman is a widely read marriage counselor whose evidencebased research provides testimony to the power of the positive. Gottman’s approach is to videotape married couples and observe how they interact. He then tracks them over time and evaluates their relationship, predicting with 91% accuracy that couples will stay together (Gottman & Silver, 1999). Consistent with the positivity ratio, happy relationships consistently have positive to negative affectivity ratios of 5 to 1. The positivity ratio appears to be relevant in business settings as well. Losada (Fredrickson & Losada, 2005) found that high-performance work teams had positivity ratios in the 6-to-1 range, whereas low-performance teams had ratios well below a 1-to-1 ratio. Individuals can adopt strategies that focus on increasing the number of positive feelings and behaviors, decreasing the number of negative feelings and behaviors, or a combination of increasing positive while decreasing negative feelings and behaviors. We conclude with a discussion of leisure time.

Leisure Time One can assume and easily defend the notion that one virtue of leisure is stress reduction. A study of 1,929 informal caregivers found that reducing leisure led to emotional and physical stress and less life satisfaction (White-Means & Chang, 1994). Yet, little attention has been paid to the wise and creative use of leisure time as a stress management

Primary Prevention for Individuals

tool. Vacations as one form of leisure are accepted as one of the rewards for working, and people often may express the need for a vacation. Although vacations may be stress reducing for some people in the right circumstances, for other people vacations may be stress provoking. Although 1- or 2-week block vacations are one use of paid-time off, 3-day weekends and scattered “mental health” days are an alternative use of vacation and leisure time. For example, 3-day weekends can be great stress busters, although a 3-day weekend may have a different meaning for those who are on 4-day work weeks of 10-hour days. In any event, a well-planned 3-day weekend can be extremely refreshing, particularly during or following a period of extreme stress. There is evidence that individuals have a greater tolerance for adversity and a decreased nervous system responsiveness following vacations. There is also some evidence that creative use of leisure time and attention to lifestyle can be as important as diet and exercise in preventing heart attacks (K. H. Cooper & Cooper, 2007). Thus, vacation planning should be considered as part of any personal stress management plan. However, it is important to recognize that vacations are not necessarily relaxing. The workaholic who tries to squeeze as much sightseeing or golf as possible into a week’s vacation may return as stressed and as tired as before he or she left. Vacations may be physically tiring, but they should be planned in a way that makes them mentally relaxing. The use of leisure time is important. Leisure means freedom from work and the demands and control of others. It is not the particular activity that is important, but the individual’s attitude toward that activity. True leisure means doing something fulfilling without having to reach a goal. Some of us know how to work, but not how to play. One woman, when asked what she did in her leisure time, said she cleaned house. When asked if housework was really fulfilling and relaxing, she reflected and said that it really added to her stress. Some people spend leisure time with pets. The companionship of pets has been shown to contribute to health by lowering blood pressure and heart rate, providing a sense of optimism and a feeling of control (Lynch, 2000). Human–animal bonds have been shown to alleviate a variety of illnesses and increase life expectancy. Playing frisbee with a dog or simply watching a cat relax may provide a different perspective on life. The unconditional positive regard provided by pets can serve as social support.

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Secondary Prevention for Individuals Modifying Responses to Inevitable Demands

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11

hapter 10 described three categories of primary prevention methods aimed at helping individuals reduce, modify, and manage the demands on their work lives, including restructuring their perceptions of these demands as stressors. Chapter 11 considers secondary (i.e., response-directed) prevention methods aimed at dissipating the physical and psychological energy of the stress response once it has been evoked. The methods described in this chapter are widely used and well researched. Several of these strategies (relaxation training, emotional outlets, and exercise), along with the cognitive–behavioral interventions discussed in Chapter 10, have produced positive changes in immune function (see Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002), suggesting their preventive role in inoculating individuals against distress and strain. The chapter is organized around the five categories of secondary prevention (see Exhibit 10.1): relaxation training, spirituality and faith, emotional outlets, physical outlets, and nutrition.

DOI: 10.1037/13942-011 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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Relaxation Training Relaxation training refers to a variety of methods for achieving muscular and psychological relaxation and/or deactivation. Selection of a specific method is largely an individual matter that is based on personal motivations and beliefs, the need for a mental versus a physical emphasis, the availability of instructors, and price. Selection is also partly a matter of trial and error; if a method does not seem to work well, one should remain open to trying another approach. In fact, we suggest that there are benefits from sampling a number of different techniques, and some individuals obtain optimal results from combining multiple techniques (Benson & Casey, 2008). Relaxation methods can also differ in the extent to which they emphasize mental or physical relaxation. Transcendental Meditation (TM), for example, focuses primarily on mental relaxation. In practice, most methods that have been studied achieve both mental and physical relaxation, even if one is emphasized over the other. Finally, some relaxation methods are rooted in religious or spiritual beliefs. The generalized relaxation response is virtually the reverse of the stress response. A comparison of the actions of the fight-or-flight (stress) response and the relaxation response is presented in Table 11.1 (Benson & Stark, 1996, p. 131). Herbert Benson and his associates at the Harvard Medical School were the first to recognize that a wide variety of religious and secular practices all appear to achieve relaxation through a common physiological mechanism (Benson & Casey, 2008) that they termed the relaxation response. The relaxation response is the patterned response

Ta b l e 1 1 . 1 Comparison of the Fight-or-Flight Response and the Relaxation Response Physiologic state

Fight-or-flight response

Relaxation response

Metabolism Blood pressure Heart rate Rate of breathing Blood flowing to the muscles   of the arms and legs Muscle tension Slow brain waves

Increases Increases Increases Increases

Decreases Decreases Decreases Decreases

Increases Increases Decrease

Stable Decreases Increase

Note. From Timeless Healing: The Power and Biology of Belief (p. 131), by H. Benson, 1997, New York, NY: Fireside. Copyright 1996 by Herbert Benson, MD. Reprinted with permission.

Secondary Prevention for Individuals

leading to a generalized decrease in sympathetic nervous system activity accompanied by a possible increase in parasympathetic activity.

The Relaxation Response Benson and Stark (1996) stated that there are only two basic steps needed to elicit the relaxation response. First, repeat a word, sound, prayer, phrase, or muscular activity. The choice of a focused repetition is up to the individual. It may be a word such as one or peace, or a prayer, or any sound that seems appropriate for remembered wellness. Second, passively disregard everyday thoughts that come to mind and return to the word repetition. Thoughts might be dismissed with a phrase such as “Oh, well.” Although there is no single common method for eliciting the relaxation response, it works best when an individual uses a disciplined routine that best meets his or her needs. One example of such a discipline is as follows: 1. Pick a focus word that is rooted in your belief system. 2. Sit quietly in a comfortable position. 3. Close your eyes. 4. Relax your muscles. 5. Breathe slowly and naturally, and repeat your focus word silently as you exhale. 6. Assume a passive attitude, dismissing random thoughts that may come to your mind. 7. Continue for 10 to 20 minutes. 8. Do not stand immediately. Open your eyes and sit for another minute before rising. 9. Practice this technique once or twice daily.

The relaxation response is the flip side of the stress response and leads to energy recovery and renewal when practiced with regularity and moderation.

The relaxation response can be elicited using alternative methods or disciplines provided the basic two steps noted previously are observed. One primary benefit of the relaxation response is to clinically treat disorders of arousal (Benson & Casey, 2008). Another benefit is its ability to combat “monkey mind,” the mind that leaps from thought to thought just as monkeys leap from tree limb to tree limb. Monkey mind, from the Buddhist term papanca, prevents the individual from concentrating, learning, or falling asleep. Excessive brain activity that overloads the system can be calmed with the relaxation response. Considerable evidence exists regarding the efficacy of the relaxation response in terms of physiological and psychological benefits. For example, individuals who frequently visited health maintenance organizations with psychosomatic complaints reduced their number of visits by 50% by using the relaxation response (Hellman, Budd, Borysenko, McClelland, & Benson, 1990). Workers experienced lower levels of

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depression, anxiety, and hostility; fewer sick days; improved performance; and lower blood pressure by using the relaxation response (Carrington et al., l980). Individuals with hypertension showed significant decreases in blood pressure and needed fewer or no medications after practicing the response over a 3-year period (Benson & Stark, l996). There are several caveats to note with regard to the relaxation response. First, its beneficial effects may not be immediately apparent. That is, one should expect to practice the relaxation response on a daily basis for several weeks to over a month before experiencing notable change. Second, one should limit the practice to once or twice a day for about 15 or 20 minutes. Extended periods of relaxation or highly frequent periods of relaxation may have unintended side effects, such as lethargy and even some reality disorientation. For many workers in today’s highly turbulent society, just finding the necessary daily time to practice can be a major source of stress, adding further stress to the equation. In situations of severe time limitation, we suggest the following to our clients: Just before going to the doctor for a stress-producing procedure or when stuck in heavy, seemingly endless traffic, try what Benson and Casey (2008) called minirelaxation. According to Benson and Casey, even if a person has only a minute or two, he or she can practice highly beneficial techniques— for example, finding a comfortable place to sit, taking a few deep and slow breaths, and quietly repeating “I am” on inhaling and “at peace” on exhaling. Correctly repeating this technique two or three times should provide a measure of desired total body relief. The following minirelaxation technique can take only 2 minutes: First, start at the number 10 and slowly count down to zero. Take one complete breath with each number, deeply exhaling and inhaling. By the time you get to zero, you should feel more relaxed. If you feel lightheaded, try to increase the time between counts, spacing your breaths further apart (Benson & Casey, 2008). If not immediately successful and you have the time, repeat the exercise. Benson and Casey listed several other techniques that take less than 10 minutes. Given the possible benefits, we suggest that everyone has 1 or 2 minutes available for a minirelaxation session.

Meditation To a certain extent the relaxation response is a distillation of a variety of practices that induce relaxation. Benson’s (1974) study of TM popularized the concept of the relaxation response. However, many other forms of meditation, including clinically standardized meditation, Zen, and yoga can achieve similar relaxation effects. One study of the efficacy of meditation and relaxation training using university students found significant benefits from mantra meditation and yogic relaxation,

Secondary Prevention for Individuals

although larger gains were realized by those practicing meditation (Janowiak & Hackman, 1994). TM is a well-known meditation method of Eastern origin. Based primarily on Hindu practices, the method was introduced into the Western world in the late 1950s by Maharishi Mahesh Yogi. Meditators are taught to spend two daily 20-minute periods in a quiet place in a comfortable position while silently repeating their mantra, the sound or word given to the trainee by the instructor. The aim is to develop a passive attitude and a peaceful worldview. TM seemed revolutionary when it was introduced into the United States, and its aura of mysticism added to its appeal for many people. Promoters of TM have emphasized its beneficial effects in increasing practitioners’ ability to cope with stress reactions and in improving physiological measures of stress, such as high blood pressure. In a retrospective study of business professionals who practiced TM, Frew (1974) concluded that regular meditators showed more job satisfaction, more stability in their jobs, better interpersonal relationships with supervisors and coworkers, less anxiety about promotion combined with a record of moving ahead quickly, and improved job performance. Furthermore, the greater the authority and responsibility the meditator had in the organization, the greater the gain in productivity, satisfaction, and work relations seemed to be. In considering such studies, it is difficult to determine which effects are due to meditation itself and which effects are due to differences in the individuals who choose to meditate. In addition to secular forms of meditation, such as the relaxation response and clinically standardized meditation and the popularized Eastern method of TM, there are numerous other meditation practices of Eastern origin, including Chakra yoga, Rinzai Zen, Soto Zen, Zazen, Ananda Marga yoga, Mudra yoga, Tantra yoga, Sufism, Kundalini yoga, and Shavasana. Descriptions and comparisons can be found in Pelletier (1977) and Benson and Casey (2008).

Meditation and biofeedback are disciplines that lead to relaxation and positive psychophysiological responses when practiced on a recurring basis.

Biofeedback Training We previously defined the stress response as a well-organized pattern of autonomic nervous system and endocrine system responses. Because physiologic responses such as changes in blood pressure, heart rate, and sweating occur without conscious effort, they were originally thought to be involuntary responses. However, some striking examples of voluntary control of autonomic function stimulated medical researchers to explore the extent to which control of visceral functions could be learned. The tool, as well as the product, of this exploration has been biofeedback (see Contrada & Baum, 2011, for current research and practice). Biofeedback may be more suitable to the control of individual reactivity and/or responses to specific stressors. For example, biofeedback

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may be a very appropriate prevention method for irritable bowel syndrome (M. S. Schwartz, 1995). Lehrer, Carr, Sargunaraj, and Woolfolk (1994) reviewed the variety of specific methods of biofeedback, such as electromyography (EMG) biofeedback and thermal biofeedback, which may be used independently or in conjunction with one or another cognitive method of primary prevention discussed in Chapter 10. Phillips (1991) outlined the principles of biofeedback training in the context of health psychology, considered some of the more popular applications, and assessed the clinical effectiveness of biofeedback. The Equitable Life Assurance Society’s Emotional Health Program found that significant net savings can be achieved in the workplace through the control of work-related stress symptoms, even factoring in the cost of equipment. These savings are calculated by comparing the cost of biofeedback training with the savings in employee and physician time from reduced illnessrelated visits to the medical department (Manuso, 1982). The term feedback was coined around the beginning of the 20th century by the pioneers in radio. Mayer (1970) quoted Norbert Wiener, a mathematician instrumental in feedback research, who described feedback quite simply as a method of controlling a system by reinserting into it the results of its past performance. Biofeedback is possible whenever a physiological function can be recorded and amplified by electronic instruments and reported back to a person through any of the five senses. The equipment reflects the individual’s response much the way a mirror would reflect his appearance. Although any of the five usual senses could be used, feedback is generally auditory (using tones of varying pitch or rhythm) or visual (using blinking lights, colors, and graphs). In clinical biofeedback, the focus is usually on one physiologic measurement—skin temperature, for example. A temperature-sensitive electrode is attached to the skin, and an amplifier converts the skin temperature reading to a stream of soft tones; the colder the skin, the faster the tones. The subject is not instructed to make his skin warmer, but to slow the tones. By imagining warm thoughts like a beach, the desert, or the sun, individuals can increase blood flow and the warmth of the hands or other parts of the body (G. E. Schwartz, 1984). Although medical researchers have demonstrated many of the anatomical and functional nervous system connections that are involved in the feedback loop, the exact way in which an individual “learns” from the feedback remains somewhat of a mystery. Biofeedback can be applied to any physiological function that can be easily measured. For example, sweating is measured by sensors of galvanic skin response, muscle tension by EMG, brain waves by electroencephalography (EEG), heart rate and heart rhythm by the electrocardiogram, blood flow by plethysmography, blood pressure by an electric sphygmomanometer, intestinal movement by amplification of the stethoscope sounds, stomach acid by a pH meter, and so on.

Secondary Prevention for Individuals

Although any of these measurements can be used, the three most commonly used for relaxation therapy are muscle tension, brain waves, and sweating. To achieve relaxation through control of muscle tension, the EMG sensors are connected to either the forehead (frontalis muscle) or the back of the neck (trapezius muscle). By learning to relax these muscles, many people experience a generalized sense of relaxation. Alternatively, brain waves can be monitored with sensors attached to the scalp and hooked to an EEG machine. One particular type of brain wave, the slow alpha wave, is associated with feelings of relaxation and well-being. The biofeedback EEG machine is programmed to recognize this wave form and to provide visual or auditory information to the subject. Using an “alpha trainer,” as some of the specialized EEG devices are called, can result in greater relaxation by teaching the subject how to increase alpha brain waves and reduce other brain waves. Biofeedback has a distinct advantage over other methods in that it provides the individual with precise data about his or her state of relaxation. However, cost and convenience are significant limiting factors in the use of biofeedback. Successful clinical applications of biofeedback include beneficial effects on such conditions as tension headaches, potentially serious heartbeat irregularities, and chronic pain (Fuller, 1978; Gentry, 1975; N. E. Miller & Dworkin, 1977). Repeated blood pressure monitoring has a modest hypotensive effect on the hypertensive patient. Monitoring is thus a form of high blood pressure biofeedback. In a study of patients with chronic low back pain, electromyographic biofeedback was associated with lower pain intensity, lower perceived levels of disability, and lower levels of depression (Newton-John, Spence, & Schotte, 1995). NASA has used biofeedback to help astronauts control motion sickness, with approximately 85% of those trained learning to control motion sickness within 6 hours (Bartholomew, l994). Biofeedback has received acceptance for many uses.

Spirituality and Faith A number of relaxation practices are rooted in the spiritual disciplines of religious and faith traditions, such as the spiritually based Eastern meditation practice of TM previously mentioned or the Judeo-Christian tradition of prayer noted by Benson and Stark (1996). Hence, relaxation practices may intertwine and overlap with one’s spiritual and faith practices. Organ (1970, p. 303) described the long history of systematic efforts to achieve mental and physical relaxation dating at least to the 6th century BC, when the Hindu scripture, the Upanishads, suggested that

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Spiritual, faith, and religious traditions include ancient disciplines of peaceful prayer that are pathways to the relaxation response and renewal.

individuals could reach a state of spiritual unity “by means of restraint of breath, withdrawal of sense, meditation, concentration, contemplation, and absorption.” Since that time, various means for achieving mental or physical relaxation have been described largely within religious contexts. Chinese Taoism, Japanese Shintoism, Zen Buddhism, Judaism, and various Christian leaders and sects have described practices for achieving individual relaxation. Long taboo in the behavioral sciences (Emmons, 2003), the power of spirituality and faith in maintaining and restoring health has moved more into the mainstream of medical, social science, and organizational research over the past 3 decades. A central element in Ornish’s (1990, Chapter 9) plan for reducing heart disease is “opening your heart to a higher power.” Because mind, body, and spirit are all interconnected, practices that focus only on the heart itself are insufficient and lead to recurrent disease. By addressing the spiritual and emotional dimensions, comprehensive healing may begin. Empirical evidence has emerged that supports what many individuals have intuited to be true: that spirituality and faith are important in health and well-being (Emmons, 2003). People who attend church regularly have less cardiovascular disease, emphysema, and cirrhosis of the liver and lower blood pressure (Comstock & Partridge, 1972). In the classic Alameda County study, researchers asked whether individuals regularly attended a church or synagogue. A follow-up showed that individuals with weak attendance had a mortality rate 2 to 3 times higher than those with strong attendance (Berkman & Syme, 1979). Open-heart surgery patients over age 55 who received comfort from their religious beliefs had a survival rate 3 times higher than those who did not have such beliefs (Oxman, Freeman, & Manheimer, 1995). A review of research on the connection between spirituality and physical health found a positive relationship (Matthews, Larson, & Barry, 1994). Among patients with cancer and heart disease, religious involvements were related to increased survival and quality of life and to decreased anxiety, depression, anger, and substance abuse. In a review of epidemiological studies, Levin (1994) concluded that a belief in God lowered mortality rates and increased positive health and well-being. The reasons for the connection between belief and health are not fully understood (Emmons, 2003). Levin (1994) suggested that religious involvements produce a sense of belonging and fellowship that buffers the negative effects of stress by triggering biological processes that lead to improved health. He suggested that religious support offers a sense of optimism about the future, and that the character strengths of forgiveness and hope provided by religious involvements are powerful stress reducers. Benson and Stark (1996) argued for a biological predisposition to believe in a higher power and to practice those beliefs. They suggested

Secondary Prevention for Individuals

that the health benefits of belief are rooted in the ability to shortcircuit the nonproductive worries and doubts that elicit the flight-orfight response. These nonproductive thoughts lead to stress-related illnesses and hinder our own healing capacities. Strong faith enables a person to experience a sense of inner control, which in turn can reduce the risk of disorders and enhance psychological well-being. Spirituality and faith constitute powerful ways of managing one’s response to stress; there is a power to prayer. As a method of preventive stress management, they provide optimism, inner control, and a secure attachment that transcends human relationships.

Emotional Outlets Emotional outlets are excellent methods for ventilating the effects of stressful events, such as job loss (Spera, Buhrfeind, & Pennebaker, 1994) and accelerating the coping process with such events (Pennebaker, Colder, & Sharp, 1990). Unfortunately, there are often social barriers to emotional outlets. We learn to keep our feelings to ourselves. Some individuals learn not to cry and wish not to appear weak. However, there is a price to be paid for inhibition, and emotional outlets are one important means of dissipating stress-induced energy that may otherwise become counterproductive to a person (Pennebaker, 1990). Therefore, talking with coworkers, friends, and other people; writing out one’s feelings in one form or another; and acting out the feelings in a controlled way are all viable means to release tension arising from organizational demands. Emotional outlets are essential to maintaining health and well-being. In a review of the evidence on the cancer-prone personality, Eysenck (l996) noted that cancer is substantially correlated with the suppression and inhibition of emotion. Cancer-prone individuals tend to suppress emotions like fear and anger and appear to operate on an even keel to other people. How we cope has also been shown to play a significant role in cardiovascular health (American Heart Association, 2010a; Wright, 2010b). This is important, as over 80 million Americans and countless millions of others worldwide are afflicted with one or more types of coronary heart disease (CHD). The majority suffer from high blood pressure. Although high blood pressure has a number of sources, Wright (2010a) proposed that employees involved in stressful work situations have a higher incidence of high blood pressure. Whether we consider the individual or organization, the costs associated with CHD are catastrophic. In particular, the American Heart Association (2010b) estimated the yearly cost of cardiovascular diseases and strokes in the United States

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at over $500 billion, with approximately 60% of this cost related to direct medical costs and the remaining 40% attributable to lost productivity. Of course, the problem is global in nature and not specific to the United States. For example, strokes are the second leading cause of death worldwide, with an estimated 90% of the CHD burden originating in developing countries (Hecht & Hecht, 2005; Wright, 2010a). Using a sample of correctional workers employed in a highly stressful work environment, Wright and Sweeney (1990) found that those employees experiencing higher diastolic blood pressure were more likely to cope through reliance on negative-based strategies characterized by wishful thinking, avoidance, and minimization of threat. Incorporating a committed-to-participant research perspective (Wright & Wright, 1999), Wright and Sweeney followed up with those participants deemed to be at cardiovascular health risk and provided them with several positive-based coping intervention strategies. Incorporating Fredrickson’s 3-to-1 positivity ratio as an evidence-based framework, the participants were provided with intervention strategies to help reduce their reliance on these denial and avoidance-based coping strategies and substitute positive-based coping strategies, such as “talking it out” and actively problem solving. Wright and Quick (2009b) reported an uplifting example of the benefits of incorporating positivebased coping strategies.

Talking It Out Talking, writing, and acting are all ways of expressing deep emotions around stressful events that can lead to catharsis and healthy responses in mind and body.

The simple, age-old method of talking it over is an effective means of emotional expression. Social support from others, whether they are colleagues at work or trusted friends, provides the catharsis and emotional ventilation that may be the primary mechanism through which social support affects health (Gottlieb, 1996). Groups can provide this catharsis if they are safe, supportive environments in which individuals feel secure enough to be themselves. Catharsis can function like a reset button that initiates the recovery of the autonomic nervous system after stress arousal. Sometimes managers are uncomfortable with the expression of emotion at work. They fear that stirring things up may disrupt productivity. However, allowing employees to discuss feelings in a controlled atmosphere can relieve tension and let them return to work and be productive. By discussing stressful situations, employees work through their emotions and feelings in order to be freed of the unwanted intrusion they have on concentration. The value of talking it out is not only the expression of feelings but also the opportunity to reconstruct and integrate the experience through verbal expression. For some individuals, talking about a stressful expe-

Secondary Prevention for Individuals

rience allows them to put the experience behind them and move on. The value of talking it out is its association with reduced stress, reduced strain on the restorative mechanisms of the body, a reduced tendency to ruminate and obsess about events, and an increased likelihood of making sense of the stressful experience (Everly & Mitchell, 1995).

Writing It Out Even before the popularity derived from the positive organizational movements, writing letters and keeping journals or diaries were socially accepted methods for expressing emotions that do not find adequate expression elsewhere. For example, Abigail Adams used letter writing as a method of coping with the stressful 10-year period surrounding the Revolutionary War (Gelles, 1994). The use of writing as a means of emotional release at the workplace is most visible in office or interdepartmental memoranda. Corporate executives, secretaries of state, and managers have all been embarrassed, demoted, or expelled as a result of angry and candid memos. At the same time, however, a welltempered and carefully composed letter or memorandum can be an effective tool for ventilating tension as well as communicating information that may be useful in moderating future demands. For a written communication to be emotionally cathartic without jeopardizing one’s good standing, it may be useful to write the first draft while the frustration or anger is fresh and then save it for a day or two to be revised under calmer circumstances. Often the process of writing the draft is an end in itself; many hostile memos and letters of resignation have landed in the wastebasket, with the writer much relieved and no one the wiser. Written expressions of emotion, whether kept to oneself or shared with others, should be viewed as a legitimate form of stress control and not, as sometimes happens, a childish self-indulgence. Provided that the writing process actually serves to ventilate the feelings, it is useful. Writing about emotional trauma can be good for the immune system. Pennebaker and his colleagues demonstrated this by asking a group of undergraduate students to write for 20 minutes on 4 consecutive days (Pennebaker, Kiecolt-Glaser, & Glaser, 1988). Half of the students were asked to write about a trauma in their lives, and the other half were asked to write about trivial events. Blood samples were taken before, after, and throughout the exercise, and visits to the health center were also monitored for 4 weeks prior and 6 weeks after. The students who wrote about their traumas showed an increase in immune system activity, whereas those who wrote about trivial events showed no change. The study was conducted during midterm exams and peak cold-and-flu season. The self-disclosing group made fewer visits to the health clinic, whereas the visits of the group writing about trivial events

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increased. Writing about emotional trauma can improve immune system function and reduce the need to seek health care.

Acting It Out Finally, there are many ways of releasing tension by acting it out. Crying, shouting, screaming, and especially laughing are all potentially legitimate forms of expression. They need not happen in public to be effective. Anger can be talked out, cried out, or yelled out. Other, more creative avenues can also be explored. The manager of a small retail shop, for example, found that beating a pillow with a plastic baseball bat for 15 or 20 minutes after particularly stressful days during their peak season gave him his appetite back and made his evening at home much more enjoyable. Other ways of acting it out include throwing darts at a dart board or using a punching bag. The two guidelines for acting out emotions are (a) that no one is harmed, including the person who is expressing his or her feelings, and (b) that the action is truly effective in releasing tension. Within these guidelines, pillow fights, punching bags, dart boards, pulling weeds, and a variety of other creative solutions are all permissible.

Physical Fitness Physical fitness is a central element of many employee wellness and corporate fitness programs for the workplace that have proliferated over the past 50 years, making physical exercise much more widely available to employees (Kirkcaldy, Furnham, & Shephard, 2009). The concept and practice of physical fitness has a long history. The first printed work recommending exercise as a health-promoting and disease-preventing activity was published in Seville in 1553 by Christobal Mendez (Kilgour, 1960). The first company-supported recreation and fitness program in the United States may have been that started by the National Cash Register Company in 1904 (Duggar & Swengios, 1969). The United States military services have long and distinguished histories of physical fitness regulations and standards for their personnel (Nelson, Quick, & Quick, 1989). There are three core elements of physical fitness, as reflected in Exhibit 10.1: aerobic fitness, muscle flexibility, and muscle strength training. These aspects of physical fitness may be achieved in various ways other than employee wellness programs. For example, recreational sports and activities such as bowling, softball, horseback riding, racket games, gardening, and chopping wood may all contribute to physical

Secondary Prevention for Individuals

Cardiovascular fitness along

fitness and may also serve as physical outlets for stress-induced energy, frustration, and aggression. There are specific benefits in these various forms of physical activity and benefit trade-offs of various alternatives.

with muscle flexibility and strength are powerful protective factors that inoculate an individual against health risks and distress.

Aerobic Fitness Aerobic fitness refers primarily to the cardiovascular fitness achieved through aerobic exercise. Aerobic exercise is any form of repetitive physical activity that produces a sustained heart rate, respirations, and metabolic rate for a period of at least 20 to 30 minutes. Jogging, swimming, aerobic dance, brisk walking, rowing, continuous bicycling, vigorous tennis or other racket games, and cross-country skiing are examples of such exercise. The key is that the exercise must involve the large muscle groups, be rhythmic, and be continuous. Aerobic exercise is the only form of exercise that can predictably achieve cardiovascular fitness. An 8-week aerobic training program experiment with college students found that enhanced parasympathetic nervous system activity and decreased central nervous system laterality were mechanisms underlying certain aerobic training effects (Kubitz & Landers, 1993). In sum, various forms of physical exercise have been shown to lead to a variety of emotional, psychological, and physiological benefits (Bean & Frontera, 2008; Kirkcaldy et al., 2009; Salmon, 1993).

Muscle Flexibility There are milder forms of physical fitness training that may also be very important to individual preventive stress management. Because of the redirection of blood flow to the brain and large muscle groups in stressful circumstances, there is a need for a countereffect aimed at achieving flexibility and muscular relaxation through regular, rhythmic routines that are not necessarily intense enough to produce cardiovascular conditioning. Examples include simple calisthenics and muscletoning exercises, modern dance, the popular traditional Chinese system of symbolic movements known as Tai Chi Chuan, and other systems of Eastern origin such as Hatha yoga and Aikido. Muscle stretching and flexibility training may be used in the context of relaxation training because the practice lowers subjective and objective states of arousal (C. R. Carlson, Collins, Nitz, Sturgis, & Rogers, 1990). Tai Chi, a moving meditation, is characterized as a moderate physical exercise activity that may have superior effects in recovery from stressful events (Jin, 1992). During a 6-week study in an electronics assembly plant, modest improvements in mood and flexibility were found as the result of a daily 10-minute strength and flexibility program (Pronk, Pronk, Sisco, Ingalls, & Ochoa, 1995). Muscle flexibility and

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strength are related in that it is difficult to develop full strength in tense muscles that lack flexibility.

Muscle Strength Training Muscle strength training is a third component of overall physical fitness and may be central to the successful management of certain specific demands or stressors. U.S. Air Force pilots put on a weight-training program for increasing muscle strength were able to tolerate higher G-forces caused by high linear accelerations in fighter aircraft, such as the F-15 Strike Eagle, than pilots in an aerobic training program or control group. Hence, some occupations and work tasks require muscle strength for successful performance. However, only 22% of adult males and 18% of adult female currently engage in weight training twice a week (Bean & Frontera, 2008). These figures are well below the government’s Healthy People initiative of having 30% of American adults incorporate strength training in their health program. Strength training strengthens muscles and bones, improves balance, helps control blood sugar, boosts metabolism, relieves arthritic pain and expands range of motion, provides benefits to the heart, and increases confidence and reduces depression (Bean & Frontera, 2008).

Physical Fitness: Overall Evidence The physiological and psychological benefits that have been claimed for regular physical exercise are numerous. Simply stated, almost any of the myriad forms of exercise offer a host of health-enhancing benefits when performed regularly (a minimum of three times a week appears to be a good rule of thumb) at moderate intensity (Benson & Casey, 2008). Benefits attributed to exercise include increased muscle tension, heightened mental energy, improved feelings of self-worth, greater sense of well-being, improved memory, greater self-awareness, and realization of “peak experiences.” In the workplace, benefits include decreased absenteeism, improved performance, and lower attrition. Although some of the evidence is anecdotal, the consistency and fervor of these reports are striking. Well-designed, controlled studies have confirmed many of these results. The psychological benefits of exercise have been demonstrated among the mentally well and those with psychological and psychiatric disorders (Baun, Bernacki, & Herd, l987). Aerobic exercise has been associated with an increased sense of control, lower levels of depression and anxiety, fewer sick days, and increased work satisfaction (e.g., K. H. Cooper & Cooper, 2007). There is even greater support for some of the physiological benefits of exercise. Regular programs of vigorous conditioning have fairly consistently been found to increase bone density, lower resting heart

Secondary Prevention for Individuals

rate and blood pressure, decrease the formation of blood clots, improve oxygen utilization, and create a more favorable cholesterol and triglyceride profile (Ornish, 1990). Clinical studies have demonstrated a salutary effect on such stress-related problems as high blood pressure, back and other muscle aches, chronic lung disease, diabetes, and mobility difficulties in older people (Fentem & Bassey, 1979; Yarvote, McDonagh, Goldman, & Zuckerman, 1974). Epidemiological studies have confirmed that a sedentary lifestyle increases the likelihood of heart attack in comparison with a lifelong pattern of regular physical activity (Leon, Connett, Jacobs, & Rauramaa, 1987; Paffenbarger & Hyde, 1980). Aerobically fit individuals have a lower level of catecholamines in their bloodstreams and demonstrate a better interplay between their activating, stress response sympathetic nervous system and their relaxing, restorative parasympathetic nervous system. This suggests that fit individuals may be less physiologically reactive in stressful situations. Exercise can flush out the body through the cleansing action of the lymphatic system. In addition, exercise allows an individual to divert attention from a stressor and receive various forms of emotional relief. Most intriguing is the evidence that vigorous exercise leads to a transient quadrupling of the blood levels of endorphins, naturally occurring morphine-like hormones associated with pain relief and feelings of well-being (Gambert, Hagen, Garthwaite, Duthie, & McCarty 1981). Thus, the mood-elevating effect of exercise may in fact be a naturally produced biochemical high. Whatever the mechanism, there is general agreement that regular physical exercise is an effective stress reduction technique for many individuals. A few words of caution are appropriate here. For those who aren’t currently physically active or who have a serious health problem, seek the counsel of your personal physician before undertaking any exercise program. If you join a gym and seek the advice of a personal trainer, be sure that the trainer has received an appropriate level of certification. There are an abundance of personal trainers from which to choose, so make sure that you select one with whom you feel comfortable and with whom you want to interact on a regular basis. When you exercise, always listen to your body. Perform only those body movements that are comfortable for you (Benson & Casey, 2008). Be sure to coordinate efforts to expand your range of motion and resistance training as you grow stronger and more flexible. Integrate other stress management techniques into your exercise routine. For example, Benson and Casey (2008) strongly recommended that one integrate deep, calm breathing into one’s exercise routines. Proper breathing is especially important for those who incorporate resistance training into their exercise program.

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Nutrition

The foods an individual eats can either be accelerants for the stress response or lean fuels for ensuring a healthy, metered energy supply throughout the days and years.

An effective program of self-care that helps individuals manage their response to stress must include nutrition. Too often, stressed individuals eat too much, eat too little, or eat the wrong foods. When overwhelmed with life’s responsibilities, it seems much easier to drop by a fast food restaurant than to plan a more nutritious meal. A long-term junk food diet, high in fat, can impair the immune system (see Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002). Because butter adds to flavor, many restaurants encourage their kitchen staff to add butter in food preparation (Sacks, 2008). Another consideration when eating out is portion size. To enhance perceived competitive value, many restaurants, especially those in the fast food industry, provide very large portions with lots of calories (Sacks, 2008). These are two facts to keep in mind when dining out. What you eat is even more important when you are under stress. The production of cortisol is enhanced during stressful times, which causes the body to both retain salt and to crave more salt. Stress also alters the body’s ability to metabolize carbohydrates, and catecholamines can cause an increased appetite for sweets (K. H. Cooper & Cooper, 2007). What you eat can have an impact on attention span, memory, and mood, similar to the effect of many drugs. Studies have shown that a highcarbohydrate, low-protein meal induces a relaxed mood and reduces mental acuity, whereas a low-carbohydrate, high-protein meal does the opposite (Spring, Maller, Wurtman, Digman, & Cozolino, l982–l983). When you eat is also of importance. A stable flow of blood sugar is essential for responding to stressors effectively. The brain needs a steady flow of glucose to function properly. The body uses nutrients more efficiently with four or five small meals a day. Individuals who ingest the bulk of their caloric intake in one large evening meal risk weight gain and increased cholesterol levels. Summarizing the extant body of knowledge, the following 12-step program comprises a comprehensive, but simple prescription for a healthy diet that enhances the ability to cope with stress (Benson & Casey, 2008; Davis, Eshelman, & McKay, 2008; Sacks, 2008). 1. Eat a variety of foods. 2. Eat from smaller plates; larger plates equal larger servings. 3. Avoid seconds; if you are still hungry, substitute a piece of fruit or glass of water. 4. Maintain an ideal weight. 5. Avoid fats. 6. Avoid unnecessary processed sugar intake.

Secondary Prevention for Individuals

7. Eat more fibrous, whole foods, such as fruits, grains, and raw and steamed vegetables. 8. Use salt in moderation. 9. Use alcohol in moderation. 10. Limit caffeine use. 11. Consider the use of vitamin and mineral supplements. 12. Start your meal with a hot beverage, such as tea. Hot drinks are more filling than cold ones.

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n the best of all organizations, health promotion, primary prevention, and secondary prevention would be enough to manage stress at work through organizational change and individual adaptation to achieve good health and high performance (Mensah et al., 2005). Yet despite the best efforts of individuals and organizations, distress does occur; people suffer pain, organizations break down, and healing the resulting wounds becomes necessary (Cameron, 2007). Tertiary prevention is directed toward healing. It is designed to remediate distress and disease, return and reintegrate employees into the work environment, and prevent the recurrence of distress. Tertiary prevention may rely on both self-help and professional help. Our philosophy is that healing is a natural process within individuals, groups, and organizations. Leaders in organizations have an important responsibility to recognize those who need additional assistance or professional services

DOI: 10.1037/13942-012 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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and ensure that appropriate resources are made available. We have compiled many referral resources and other supports for leaders on our book’s companion website (http://pubs.apa.org/books/supp/quick/). However, it is important to keep in mind that these resources are not intended as individual treatment recommendations. Readers are encouraged to seek appropriate health care resources for treatment of individual health conditions and concerns. The chapter is organized around the three categories of tertiary prevention (see Exhibit 10.1). Although the chapter discusses psychological interventions and health care in separate sections, we do not separate physical health and mental health. Rather, health is a whole, and the interactions between mind and body are far too complex to be bifurcated. In addition, there is an important distinction between stress-related symptoms or conditions and major mental health dis­­orders. Stress-related illness is not necessarily or even primarily mental health related. Physical illness and lifestyle diseases such as cardio­ vascular disease, gastrointestinal disorders, and even cancer have been related to stress either directly or indirectly. It would be misleading to necessarily imply that stress and mental health represent the same experience. Some stress hazards are psychosocial, and some effects are related to mental health, but they are not one and the same. Nevertheless, there are mental health implications associated with stress, and mental health effects are much more insidious and often seem less acceptable to individual identification and treatment. In fact, mental health conditions, especially those associated with stress, are treatable and are more effectively addressed when identified early and directly. Mental health is also interdependent with physical health, such that good health and vitality—to include physical, mental, and organizational—comprise the mutually supportive key goals of preventive stress management programs. Consistent with our overall positive-based eustress approach, the final section presents an example for a preventive stress management plan that integrates primary, secondary, and tertiary prevention approaches appropriate for individual, group, and organization-level applications. Our positive-based approach also emphasizes the potential for cross-level (i.e., individual, group, and organization) application. To that end, and adopting the positive-based approach of Fredrickson’s positivity ratio and the broaden-and-build theory of positive emotions (Fredrickson, 1998, 2001, 2009), we propose a self-directed preventive stress management approach designed to enhance both individual betterment and organizational health. Before providing selected individual strategies for tertiary prevention, we present the necessary theoretical background information for our eustress, growth-oriented stress management plan.

Tertiary Prevention for Individuals

Emotional Health in the Workplace Emotionally healthy workplaces are ones in which individuals feel safe and secure and can use their knowledge, skills, and abilities to achieve their full potential.

Historically, the prevailing theoretical approach to the study of feelings and emotions focused on the negative ones, such as anger and fear. A key to this traditional negative focus was the belief that feelings and emotions are best considered in the context of specific action tendencies (Wright, Cropanzano, & Bonett 2007). According to Fredrickson (2003), a specific action tendency is “the outcome of a psychological process that narrows a person’s momentary thought-action repertoire by calling to mind an urge to act in a particular way (e.g., escape, attack, expel)” (p. 166). Thus, a specific action tendency is something that gets our attention and is predicated on evolutionary, survival-based actions. A prime example of this approach can be found in the stress literature and the fight-or-flight approach. We offer our positive-based approach as a complement to the more traditional, negative, and survival-based stress management perspective. According to Fredrickson’s approach, a number of positive feelings and emotions, including employee well-being, all share the capacity to “broaden” an individual’s momentary thought-action repertories through expanding the array of potential thoughts and actions that come to mind (Fredrickson & Branigan, 2001; Wright, 2005). For example, psychologically well employees tend to be more outgoing and extroverted, remember favorable events accurately, and are less likely to encode an ambiguous event as threatening compared with their less psychologically well coworkers (Wright et al., 2007). These broadened mind-sets provide long-term adaptive value as well and assist in “building” an individual’s physical, psychological, intellectual, and social resources (Wright, 2005). Research has demonstrated that this increased capacity to experience the positive is seen as being crucial to one’s capacity to thrive, mentally flourish, and psychologically grow (Fredrickson, 2001; Wright et al., 2007). Experiencing the positive can also provide benefits at the organizational level of analysis. In work settings, employee well-being has been related to a number of work outcomes, including job performance, employee retention, workplace accidents, sick days, absenteeism, customer engagement, quality defects, and profitability (Harter, Schmidt, Killham, & Agrawal, 2009; Rath & Harter, 2010a, 2010b; Wright & Bonett, 2007; Wright & Staw, 1999). In keeping with Fredrickson’s broaden-and-build model, psychological well-being has been shown to moderate the relation between job satisfaction and job performance (Wright et al., 2007) and between job satisfaction and job turnover (Wright & Bonett, 2007). That is, the positive evaluative feelings associated with high levels of job satisfaction

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(a positive-feeling state) can be further “broadened” and “built on” when the employee feels psychologically well. Besides the previously stated wide range of benefits at the employee level of being psychologically well, there are significant benefits at the organization level as well. Wright et al. (2007) found strong empirical support that those employees high in well-being benefited more from a satisfying job than did those low in well-being. Consistent with the broaden-and-build thesis, employee well-being moderated or influenced the job satisfaction to job performance relation—in particular, the more positive the employee’s well-being, the stronger the observed relation between job satisfaction and job performance. Using a cost-benefit analysis approach, Wright and Cropanzano (2004) reported findings demonstrating that employee well-being, job satisfaction, and the well-being by job satisfaction interaction (the broaden-and-build moderator effect) accounted for approximately 25% of the variance in employee job performance. In their reported research, this finding translated to approximately $125 per week/per person in potentially lost productivity. In a study of management personnel from a large customer service-oriented organization, Wright (2010b) reported similar benefits for employee well-being as predictive of both job performance and employee retention, with the organization losing a disproportionate share of its better workers. Cascio (2013) suggested that turnover costs can run between 1.5 and 2.5 times the job incumbent’s annual salary. Wright (2010b) reported that employees exhibiting high levels of well-being were not only better performers but also more likely to remain on the job. Consistent with the broaden-and-build perspective, the findings indicated that high-performing employees were also more likely to remain on the job as the level of well-being increased. Using Cascio’s framework, retaining the highest performing, psychologically well employees resulted in potential savings to the organization of up to $250,000 per employee. With this backdrop, and following our approach to primary and secondary prevention, we offer the following individual-based strategies for tertiary prevention and treatment.

Psychological Interventions Psychological interventions include tertiary prevention appropriate for individuals, groups, and organizations. This section of the chapter reviews five categories of psychological interventions: problem- or symptom-specific programs; individually based treatment programs; group approaches for education, support, or treatment; and career or vocational counseling programs.

Tertiary Prevention for Individuals

Regardless of the good done through organizational protection and individual prevention, psychological help must be available for those who need help.

Employee assistance programs have become well recognized for improving health and productivity in organizations and are fairly standard programs provided by most employers in the public and private sectors. Employee assistance programs are variously included under primary, secondary, or tertiary prevention. They are considered secondary prevention efforts in that they strive to identify problems early and address them before they become clinically significant. They can also be primary prevention efforts when they provide worksite wellness programs or supervisor training that improves the overall culture and climate of the organization. They are tertiary when they provide early intervention and referral for conditions that require treatment from a health care professional and in that way represent a primary gateway for identification and treatment of more serious illness or disease. In general, however, these programs are considered multicomponent or broad-scope programs that address a variety of issues and concerns related to work and work stress. With the exception of some of the symptom-specific programs, such as substance-abuse counseling, most employee assistance programs aim to provide general short-term, problem-focused, and supportive counseling. Individuals who require long-term or intensive treatment are typically referred to internal or external health care plans or professionals. Some employee assistance programs are maintained in human resources departments, whereas others have been incorporated into occupational health clinics, providing a seamless continuum of care from counseling to health care when needed. However, much of the need in preventive stress management is seen in the areas of short-term and supportive interventions. There are a wide variety of psychological counseling programs available within the umbrella of employee assistance programs, with various outcome measures reported. For example, in a study of 250 United Kingdom Post Office employees and 100 controls, stress-related counseling led to significant declines in sickness absence days and events, clinical anxiety, somatic anxiety, and depression, although job satisfaction and commitment were unaffected (C. L. Cooper & Sadri, 1991).

Symptom-Specific Programs Diseases of lifestyle, including substance abuse, tobacco use, and obesity, are commonly associated with stress. Although substance abuse is an important issue for organizations, its treatment is an important issue for professionals. Many of the earliest ventures of business and industry into the field of employee assistance counseling were in the area of substance abuse and dependence. Eastman Kodak, Dupont, Equitable Life, and Consolidated Edison of New York are among the companies that, decades ago, pioneered the development of employee substance abuse

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programs. The extent of substance abuse and the need for corporate involvement were recognized over 30 years ago by Warshaw (1979), who stated the following: In my view, any organization that does not have an alcoholism program, or which has not recently examined an established program to make sure that it is up to date and working well, is needlessly dissipating its human and financial resources and failing its responsibilities as a corporate citizen. (pp. 104–105)

Of the various reasons for workplace substance abuse programs, the two most compelling are that they are capable of achieving measurable success and they are cost-effective. Historically, the National Council on Alcoholism has cited recovery rates ranging to 80% for occupational programs. An important element in successful programs is a “job jeopardy” or “performance approach” in which specific penalties, including dismissal, are part of a therapeutic contract with the employee (Warshaw, 1979). The loss of productive time and the additional expense from alcoholassociated accidents, absenteeism, and interpersonal troubles are considerable, and it should not be surprising that a review of occupational substance abuse programs concluded that these programs are generally cost-effective when well managed (Frone, 2011). Smoking cessation and weight management programs are taking on an increasingly important role in preventive management programs. For example, over the years, the U.S. military has been concerned with weight and fitness as well as smoking and use of other tobacco products, such as smokeless tobacco. Programs aimed at smoking cessation have now gained wider support with the increase in smoke-free environments. Consistent with our positive-based approach, the U.S. Army is currently focusing on developing comprehensive soldier fitness (Casey, 2011; Cornum, Matthews, & Seligman, 2011) by providing a comprehensive, integrated program that includes the interdependent components of fitness such as physical, emotional, social, family, and spiritual. Expanding on the more traditional forms of fitness, the Comprehensive Soldier Fitness program emphasizes resilience training designed to enhance soldier ability to handle a wide variety of forms of adversity (Peterson, Park, & Castro, 2011; Reivich, Seligman, & McBride, 2011). The emphasis on conceptualizing fitness as not solely restricted to physical fitness has found popularity across the other Armed Services with varying levels of maturation of these programs. Outcome studies are underway and should provide a rich source of information for corporate programs in the future.

Individual Counseling In the context of stress management, much counseling is aimed at reducing or managing the stress response by providing information and

Tertiary Prevention for Individuals

insights about the stressor or environmental conditions, the individual’s perception of a certain condition as a stressor, changing cognitions related to or contributing to the perception of stress or pressure, and increasing awareness and management of individual physiologic arousal. Psychological counseling may be helpful to an individual in achieving a better fit with aspects of the organization. Programs vary considerably in their emphasis. Some are concerned primarily with providing psychological first aid or support for individuals during a time of crisis. Other programs provide short-term individual or family counseling to help resolve a specific problem or to evaluate the need for more intensive treatment. Counseling can also be directed at developing specific personal skills, such as greater comfort with common stressful situations like public speaking or meeting new clients. We have included the discussion of counseling under tertiary prevention, but like other tertiary techniques it also can have an important impact as a primary or secondary prevention measure. For example, good psychological counseling may be tertiary prevention for a senior executive, whereas his or her psychological counseling becomes primary prevention for the executive’s employees. For some, a stigma continues to be associated with all concepts of counseling or psychotherapy. Another fear that sometimes inhibits the development of an effective counseling program is concern about the maintenance of confidentiality. The issue of confidentiality may be significant enough to necessitate outsourcing this service to an external agency. Internal and external programs both have advantages and disadvantages, but the decision warrants deliberate consideration by the executive team of the organization, which can be better informed through collaboration with program design consultants. The professional credentials of the counseling team are also an important consideration. For example, Seligman (1995) suggested that psychologists, psychiatrists, and social workers seem to achieve positive results, whereas results by other counseling professionals do not appear as efficacious.

Group Approaches for Tertiary Prevention Individual counseling offers many potential benefits to employees, whereas group approaches may complement these with some distinct advantages of their own. Group-based interventions make efficient use of the provider, disease manager, or health educator’s time and skills, allowing limited resources to benefit more people. Group therapy may provide and strengthen social support in the organization while taking advantage of the influence of peer feedback and shared perceptions or experiences. Group appointments and support groups are often used in conjunction with medical management, disease management, and rehabilitation programs for cardiovascular conditions and cancer (see Siegel, 1990).

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As with individual intervention and treatment models, there are many types of group interventions. Group therapy may be used for adapting to the stress of loss or for chronic health conditions, either on a short-term or long-term basis (McKay & Paleg, 1992; Piper, McCallum, & Azim, 1992; Stone, 1996). Self-help or support groups may be formed with individuals sharing common stressful experiences and may be quite helpful. For example, basic trainees adjusting to the stress and rigors of military life were formed into support groups through which the majority of trainees developed adequate self-reliance to successfully complete the training program (J. C. Quick, Joplin, Nelson, Mangelsdorff, & Fiedler, 1996). The common stressors for such a group may be organizational ones, which affect both home and work life, or global ones, which are relevant to the workplace. Examples of issues considered by existing groups of managers (and in some cases spouses) are the problems of living abroad, the problems of managers who are parents without partners, the problems of two-career couples, and the problems of a heavy travel schedule.

Career Counseling Counseling for career development may be a proactive strategy of primary prevention or a therapeutic strategy of tertiary prevention for those who have experienced organizational restructuring, job loss, or organizational dead-ending (Spera, Buhrfiend, & Pennebaker, 1994). In other words, systematic attention to career development should help individuals progress along career paths in which the demands are best suited to their skills and interests. If the demands are optimal, then there should be little stress and even less distress. Unfortunately, this is not always the situation. Sometimes individuals find themselves in jobs to which they are not suited. The person–job mismatch may result from the individual’s personality, temperament, ability, or training; from the nature of the work environment and peer group; from having been promoted too rapidly or too slowly; from being required to report to a toxic boss; or from a transitional crisis such as that which frequently occurs during midlife. Once any of these circumstances has originated, then career counseling of a remedial nature is warranted. Some best practices identified at universities and professional organizations provide a wide variety of resources for sound career counseling (Nelson & Quick, 2013). One promising, positive-based approach to career counseling across career stages involves the selection, training, and development of employees who exhibit strengths of character (Wright, 2010b). Another approach involves the selection of potential employees who exhibit

Tertiary Prevention for Individuals

“profiles in character” consistent with the demands and requirements of their chosen occupation (Wright & Quick, 2011). Building on Peterson and Seligman’s (2004) 24 strengths of character framework (e.g., valor, kindness, forgiveness, self-regulation, honesty, hope, persistence), Wright and his colleagues (J. C. Quick & Wright, 2011; Wright, 2010b; Wright & Quick, 2011) have identified signature strength profiles for a number of occupations. Signature strengths are the top five strengths deemed most appropriate to individual betterment and career success in a given occupation. For example, through the use of a focus-group approach, the top-five signature strength profile for those interested in a career in sales/marketing consists of the following five strengths: zest, social intelligence, creativity, and curiosity. For nurses, the top-five profile is composed of honesty, kindness, prudence, fairness, and forgiveness. Finally, accountant profiles include honesty, critical thinking, prudence, perseverance, and valor. Wright (2010b) noted a twofold contribution to stress management in having employees and leaders who demonstrate strong ethical character. First, these individuals will demonstrate both physical and psychological health (Gavin, Quick, Cooper, & Quick, 2003). Second, the health of the organization may also benefit through increased performance, adaptability, and flexibility. For example, a growing body of evidence has indicated possible linkages between employee well-being and such strengths of character as spirituality, forgiveness, humility, gratitude, zest, hope, and kindness (e.g., Avey, Luthans, Smith, & Palmer, 2010; Peterson & Seligman, 2004; Wright & Quick, 2011).

Health Care Standard health care is another form of tertiary prevention for suffering, discomfort, distress, disability, and potentially fatal stress-related conditions. When organizational change and individual adaptation have been pushed to the limit, individuals may present themselves to health care providers with a whole range of stress-related conditions. Until recently, primary care providers usually responded to stressrelated illness with some nonspecific advice and, in many cases, medication. Through advances in behavioral medicine and occupational health, family-practice physicians are recommending exercise, relaxation breaks, and other forms of primary and secondary prevention for individuals in need of additional stress management skills. Growing public awareness of preventive medicine and health promotion leads people to seek care earlier, giving physicians the opportunity

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Health care must be available for employees who may simply suffer from the wear and tear of unavoidable or necessary stress and risks at work.

to use more preventive approaches. Nevertheless, much of the care provided by physicians is still aimed at treating major manifestations of stress-related illness and disease with medications, surgery, and sometimes physical therapy. We would prefer to see primary and secondary preventive measures used more frequently and more effectively; nevertheless, it is useful to briefly review the range of benefits that can be derived from standard health-care. Depression should not be considered a one-size-fits-all condition. Just like heart disease, depression can take many forms. The Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) lists three main depressive conditions: major depressive dis­ order, dysthymic disorder (a chronic or recurrent low-level depression), and bipolar disorder (also popularly referred to as manic-depressive disorder). The roots of depression are complex, with many contributing etiological factors, including mood regulation irregularities emanating from neurological structures and functions, genetic susceptibility, medication use, chronic health conditions, and stressful life events (M. C. Miller, 2008). Regarding faulty mood regulation, M. C. Miller (2008) reported the intriguing finding that the hippocampus is smaller in those who experience major depression. Stress is proposed to be a principal reason for this reduced size because it may suppress the production of new nerve cells in the hippocampus. Similarly, increases in hippocampus volume have been noted following the practice of deep relaxation techniques such as mindful meditation and yoga, lending credence to the increased use of mind–body modalities in health care services. Treatment options for depression include medications and psychotherapy. Choosing the right regimen should involve an individualized treatment plan resulting from a collaborative partnership between the provider and the patient. Doctors typically consider many factors, including the actual diagnosis, patient age and overall health, any medications currently taken, average daily consumption of alcohol and other substances, and the patient’s overall mental health and medication history (M. C. Miller, 2008). Antidepressant medications are commonly used and may be clinically effective pharmacotherapy for alleviation of depressive symptoms, providing enough of an improvement in a person’s mental outlook to allow the person to make the necessary changes in cognition and behavior to facilitate long-term recovery and remediation of symptoms (Ravindran, Griffiths, Waddell & Anisman, 1995). Evidence-based psychotherapy methods, notably cognitive therapies, have proven to be equally effective as medication in the treatment of depression. Combined use of medication and psychotherapy is often recommended for moderate to severe cases. Depression is increasingly identified and treated in primary care settings and often arises in the midst of presentation of other health-

Tertiary Prevention for Individuals

related complaints, leaving little time for thorough exploration, counseling, individually tailored treatment compliant with evidence-based clinical practice guidelines, or routine follow-up. The integration of behavioral health providers into primary care settings has significantly aided primary care providers in both identification and effective treatment of depression and other mental health conditions that commonly present to primary care. The collaborative team approach to comprehensive, patient-centered care promises to improve early intervention and delivery of more efficacious treatment or appropriate referral to specialty care for mental health conditions as well collaborative treatment of stress-related physical health conditions that have a significant behavioral component, such as obesity and smoking cessation.

Traumatic Workplace Events Traumatic events may occur through unanticipated accidents or through malicious, motivated human behavior, but organizations must be pre-

Traumatic events such as job loss, aggression, harassment, discrimination, and violence may create levels of extreme stress for individuals in organizations. Although trauma in the workplace clearly creates stress, the whole domain of traumatic stress treatment is a specialty in its own right and somewhat beyond our scope here. What is clearly within our scope is to sensitize leaders to rely on corporate health professionals and specialists when traumatic workplace events emerge. Bernstein’s (2011) guide to crisis management may be among the most comprehensive resources for extreme stress, from industrial accidents in an oil refinery, to suicide within a finance department, to accidental death in a railcar overhaul facility, to sexual assault in a community hospital.

pared for either.

Creating a Personal Preventive Stress Management Plan Whether stress management is handled by the medical, psychology, social work, human resources, personnel, or occupational health departments or is left as an individual matter, each employee should be encouraged to develop his or her own preventive stress management

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The best protection for individuals and prevention of distress can come through careful observation, planning, and disciplined practice of healthy habits.

plan. Initially, a good plan should be simple, brief, and actionable; later plan iterations may benefit from greater complexity and elaboration. The planning process itself may be as important and valuable as the final product. Many early stress management programs took a narrow approach to stress management: “Exercise your stress away!” “Relaxation for low stress living!” We recommend use of a wide range of methods and a combination of methods of preventive stress management for individuals that vary in focus, complexity, cost, accessibility, and effectiveness. Consistent with our overall positive-based approach, we present a plan that highlights the integration of primary, secondary, and tertiary prevention approaches. To that end, we recommend a systematic approach to creating a preventive stress management plan that consists of the following five steps: (a) identify demands and stressors, (b) identify stress responses, (c) identify action options, (d) make a plan, (e) assess process and outcomes, and (f) revise or modify the plan as needed and when needed. With this backdrop, we turn now to our hypothetical stress management plan.

Identify Demands and Stressors Self-observation is the first step in preventive stress management. An individual may identify demands and stressors through an informal process of personal reflection or a more structured approach. Our book’s companion website (http://pubs.apa.org/books/supp/quick/) includes download links and reviews of various self-assessment instruments. There are many tools available, and they are being continuously developed and revised as the science of stress management advances. Because of the ever-changing selection of tools, they are maintained on the website so that they can be updated frequently. One current example is the military-focused Global Assessment Tool (Peterson et al., 2011). Another emotionally based assessment tool that can be useful for tracking over time is Fredrickson’s (2009) free, 2-minute positivity ratio test available at http://www.positivityratio.com. The positivity ratio test can be supplemented with various behavioral measures, a daily log of stress-related symptoms, the Maslach Burnout Inventory, the Cornell Medical Index, and other procedures or instruments deemed useful for structuring the identification of responses. In using any standardized assessment method, it is important for the individual to bear in mind that it is merely a tool, not an end in itself. The individual should come away from the self-assessment process not only with a score or checklist pattern, but also with specific knowledge of what stressors exist in his or her life and what is their relative impact.

Tertiary Prevention for Individuals

Identify Stress Responses The signs of the stress response and resulting distress were listed and described earlier. Individuals can learn to monitor their own stress responses. Becoming aware of individual-level stress and distress is the first step. Responses can manifest themselves as subtle physiological changes such as a rise in heart rate, as behavioral changes such as increased smoking, as emotional changes such as depression, or as psychophysiological symptoms such as headaches. It is important for individuals to develop an internal barometer that monitors these responses and tells them when stress responses and distress are increasing. With some individual signs and symptoms, it is not always easy to decide whether they are related to stress. Self-assessment is not a substitute for professional assistance or health care services.

Identify Action Options Most people develop unique patterns or habits of coping on the basis of their own individual experiences and skills. Identifying these habits, deciding which ones seem to work best, and learning to apply effective methods when tension begins to develop is an important first step. Fortunately, there is a broad set of action options for individual preventive stress management. An effective stress management plan depends on narrowing the action options to those that seem to be acceptable, feasible, and appropriate to the individual’s particular demands, stressors, stress responses, and strain. First, acceptability of a specific method is a prerequisite for including it in a stress management plan. For example, a traditional method such as knitting or a mystic relaxation technique such as Zen meditation may be wholly unacceptable to a bank president whose life might be greatly improved by daily exercise, involvement in a men’s prayer group, or progressive relaxation. Second, feasibility is important to identifying action options. Although most individual methods of preventive stress management require little in the way of equipment, a number may require trained instructors, psychologists, physicians, or other professionals. If these individuals are unavailable or their cost is prohibitive, then the action options are limited to those that involve minimal expense. However, the cost of prevention should always be balanced with the cost of inaction. Finally, the action options should be appropriate to the person’s particular demands, stressors, stress responses, and symptoms of distress. One reason for classifying preventive stress management methods as stressor directed, response directed, and symptom directed is the help it provides in selecting specific methods for individual use. For example, the manager who deals with all aspects of his job except public presentations may benefit from using a stressor-directed technique.

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Make a Plan After an individual has identified the range of action options available, he or she should select those action options that seem most acceptable, feasible, and appropriate to formulate into a preventive stress management plan. Figure 12.1 provides a template with an example of one individual’s plan. Although many people deal with daily stress without a written plan, a plan makes the stress and the action more concrete and more actionable. A plan also serves as a self-affirming contract and a reminder of action option decisions for managing stress. Jon is a senior facilities executive overseeing major construction projects for his company that demand a high level of cognitive engagement in his work, a high level of interpersonal exchange with a wide range of people within and outside the company, and a high level of physical energy for site visits to the various construction locations where projects are being completed. Jon’s plan in Figure 12.1 addresses the uncertainties involved in his work; the requirement for physical fitness for the job; the need for emotional fitness, relaxation, and leisure time with family and business associates; and the need to be organized and positive. Jon has no requirement for professional help at this time beyond his annual physician visits and routine health screenings.

Assess Results and Revise the Plan Preventive stress management is as much art as science, and it is impossible to know in advance what methods will work best for a particular individual. Therefore, the personal stress management plan should always be viewed as tentative, and the process of developing a plan should be seen as one of trial and success. The bottom line is whether the individual feels a sense of relief and achieves the feeling we described earlier as eustress. The basic question is: “When you use the action options outlined, how do you feel at the end of the day? At the end of the week? At the end of the year?” There are a number of interventions with proven success to increase a sense of subjective well-being along with reduced strain on the body. Individuals can be trained to proactively self-monitor or manage their personal perceptions to both enhance positive and discourage negative displays of emotion. Constructive self-talk is a learned technique that replaces negative self-talk with more positive and reinforcing selftalk (Wright et al., 2007). Another potential avenue of change involves incorporating signature strengths of character into one’s daily routine, both at home and at work. As previously discussed, a growing body of evidence has indicated possible connections between positive feelings and well-being and such character strengths as spirituality, forgiveness,

Tertiary Prevention for Individuals

F i g u r e 1 2 . 1 

Personal preventive stress management plan Name: Jon Dickinson

Date: 2-14-2013

Personal Perceptions of Stress

1) Practice constructive self-talk 2) Learn to recognize the inevitable 3)

Personal Work Environment

1) Learn to say No! (nicely) 2) Each day make a to-do list and daily plan 3)

Lifestyle Choices Leisure time use: Other:

1) Take an out-of-town 3-day weekend every 2 months 2) Don’t forget vacations

Relaxation Method(s)

1) Practice progressive relaxation each evening 2) Use momentary relaxation at work 3)

Physical Fitness

1) Jog 30 minutes every other day 2) Tennis or fold each weekend 3)

Emotional Fitness

1) Take time to talk-out work frustrations with the wife 2) Practice controlled expression of anger at supervisors

Professional Help

1) None now 2)

Personal preventive stress management plan.

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humility, gratitude, zest, hope, and kindness (Peterson & Seligman, 2004; Wright & Quick, 2011). One caveat is appropriate here. As with any change attempt, the audience must perceive the change as authentic and genuine. Change attempts that are perceived as insincere and phony will eventually be found out, and all goodwill will be lost. The content and context of the intervention are both very important. Being intentionally hurtful and negative on a subject that speaks to another’s actual or perceived core strength will never be counterbalanced by telling that person several times that his or her new hat is attractive. In the words of Dale Carnegie (1982, p. 112), “Become genuinely interested in other people”(Principle 1) and “Make the other person feel important, and do it sincerely” (Principle 6).

Preventive Stress Management Challenge and Opportunity

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e stand at the century mark from the first identification of the Yerkes–Dodson law (circa 1908) by American Psychological Association (APA) Past-President Robert Yerkes and of the stress response by APA member Walter B. Cannon (1915). Stress in organizations is alive and well today, but research from the past few decades leads us to believe that stress is not all bad. Eustress is good; distress is bad. Preventive stress management helps one convert stress from a threat into the experience of challenge and opportunity with positive outcomes of health and achievement. Our hope for this book is that it will challenge organizational leaders and managers, and indeed all individuals involved in organizations, to reframe the way we think about stress so as to see the opportunity it offers as a source of energy.

DOI: 10.1037/13942-013 Preventive Stress Management in Organizations, Second Edition, J. C. Quick, T. A. Wright, J. A. Adkins, D. L. Nelson, and J. D. Quick Copyright © 2013 by the American Psychological Association. All rights reserved.

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A Proactive Agenda for Preventive Stress Management The field of stress, although nearly a century old, is still a very active and fertile one, and the concerns centered on stress in organizations are also still very active. We believe there is an active agenda for at least seven constituencies concerned with stress in organizations: scientists and researchers, executives and leaders, educators and trainers, physicians, psychologists, employees, and public health officials.

Scientists and Researchers A key arena for further research concerns effectiveness and efficacy evaluation research. Much core medical and psychological knowledge has been established through the decades of basic research. The next frontier is for applied research in organizational settings, aimed at specifying the physical and psychosocial attributes of healthy work environments and healthy personalities for specific work environments. A dual emphasis on the work environment and on the person is essential because of the differential impact that stress has on individuals. Organizational designers may come up with great concepts for healthy organizations (see the American Psychological Association’s, 2011, Psychologically Healthy Workplace Awards), and those design concepts must be rigorously evaluated. Therefore, efficacy and effectiveness research is able to tell us what works, what is useful, and under what conditions. Scientists and researchers play a critical, pivotal role in establishing essential evidence for preventive action.

Executives and Leaders Executives and leaders have a professional and ethical duty to act as stewards for organizational resources and for the people whom they lead. This entails an obligation to take all those actions that make their organizations better; promoting eustress and preventing distress are necessarily two of those actions. In addition, executives and leaders have a unique opportunity to leverage their actions, especially in a crisis. Strength of character sets the stage for inspiring and positive leadership in those situations. The actions of top leaders can affect many thousands of lives and save many millions of dollars (Goolsby, Mack, & Quick, 2010). Occupational stress and organizational health are leadership challenges. Good stress management skills are important for executives and leaders for at least two reasons. First, management skills are critical to

Challenge and Opportunity

Most organizations are led by healthy men and women with good intentions, so it is unfortunate that the few unhealthy leaders can trigger negative images for all.

business success in the face of contemporary economic and competitive challenges (Whetten & Cameron, 2011). Second, the mismanagement of stress contributes to the direct and indirect organizational costs of distress. There is reason for optimism and hope in meeting these challenges because good people management is more important than all other factors in predicting profitability, and stress management is good management. Interviews with 402 highly effective managers, as identified by peers and superiors in a sample of business, health care, education, and state government organizations, identified 10 key skills of effective managers (Whetten & Cameron, 2011). Managing time and stress was second on the list of key skills. Mastering the skills of time and stress management benefits the executive or leader personally, and it benefits the organization and its employees. First, the organization benefits from an executive’s health, right along with the personal benefit to the executive, because of the reduced health care costs for that executive. Second, the organization benefits from the function executives and leaders serve as role models for employees, thus advancing organizational health and preventive stress management at work. The famous physician and educator, William Osler, responded to a medical student commenting on a “typical neurotic” during grand rounds one day with “Funny, isn’t it, how they run the world?” In the framework of preventive stress management, healthy executives, not neurotics, are sought as the role models of healthy stress management for others in the organization.

Educators and Trainers Educators and trainers have available to them sufficient objective and cognitive skill knowledge to design courses and educational modules in preventive stress management. University courses in stress management, preventive stress management, and combat stress in colleges of business administration, departments of psychology, schools of public health, and departments of behavioral sciences and leadership in a military service academy continue to grow. Whetten and Cameron’s (2011) educational module on managing stress is a sufficiently substantive core around which to build a university course. Organizational courses in hardiness training, preventive stress management, humor, and general speaking skills for people under pressure can be offered to executives and employees under the rubric of executive education and human resources management. In addition to curriculum development and delivery, educators and trainers may help through the identification of high-risk populations or high-risk worksites for which information can make a difference. Although it would be ideal to begin this educational process very early in the life cycle, even in kindergarten and elementary school, reality

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suggests that it is more likely to occur later in the life cycle. Hence, concentrating educational resources to high-risk populations and worksites may yield the highest returns.

Physicians Physicians, especially in occupational medicine, can advance the practice of preventive stress management by overcoming specialty boundaries and developing a deeper appreciation for the person as a whole. The development of specialties throughout Westernized medicine has led to a reductionistic focus on specialized knowledge. Although valuable at one level, the risk of overspecialization is the loss of the general practitioner’s perspective. This is especially problematic in the domain of stress because it is a generalized response. If the physician does not have an appreciation for the whole person and the systemic interrelationships, he or she may only respond to a specific symptom and miss a much bigger problem. Further, the contribution of stress to various disorders calls for the generalist perspective. This requires consideration of the work and life contextual factors that may play contributory roles to specific disorders.

Psychologists help improve life for millions of people, and what better venue than the workplace to make significant new, positive advances?

Psychologists A key emerging specialty within psychology that is very compatible with preventive stress management is occupational health psychology. Occupational health psychology is moving forward from the crossroads of health psychology and public health; it is concerned with healthy people in healthy work environments and with healthy interactions between work and family–home environments. Occupational health psychologists should strive to enhance eustress and eliminate distress from the workplace. Rather, their focus should be on how to take the distress out of work in the face of inevitable risks, challenges, and difficulties.

Employees As in the case of executives, employees have a responsibility to learn the skills of preventive stress management. Self-reliance is a key tenet of our work, and self-reliance calls for taking responsibility to learn the skills and knowledge necessary for successful work achievement. This applies no less to time and stress management skills than it does to job content skills. Hence, the acceptance of responsibility for one’s work and one’s work environment demands learning the necessary cognitive and behavioral skills to successfully manage the demands that accompany the work environment. This entails a proactive posture in learning about the demands of a job and organization before accepting a position

Challenge and Opportunity

and then being assertive about acquiring the additional knowledge and skills to be successful once there.

Public Health Officials A key role for public health officials in preventive stress management concerns surveillance of physical and psychosocial health risks in organizations and work environments. This entails a process of environmental monitoring, surveillance of disorders, and examination of hazard–disorder linkages. At present, effective environmental monitoring and surveillance systems for psychosocial work-related disorders and psychological distress do not exist. The development of epidemiological systems in organizations helps identify environmental risk factors and executive and employee populations who may be especially vulnerable or at risk.

Looking Within: Be the Leader We took a look forward, so now let’s take a look within. The positive and powerful effects of self-awareness and personal responsibility are especially central and relevant to the domain of stress. Is stress a challenge, a threat, or a hindrance? The answer is: Yes! Stress is all of these, but how it unfolds for each individual and each organization calls for a leader who takes personal responsibility for acting in positive and constructive ways in response to the opportunities before him or her. Stress is an opportunity when it challenges a leader to be all that he or she can be. Stress is an opportunity when it enables a person to display the talents, skills, knowledge, and gifts with which he or she is endowed. Stress is an opportunity when one grows, learns, changes, and develops through the experience. Stress is an opportunity when it leads us to transform ourselves, adapt to changing circumstances, and live well.

In the Eye of the Beholder What makes the difference in whether stress is a challenge, a threat, a hindrance, or an opportunity lies in the eye of the beholder. Where some see threat, others see opportunity. The theory, methods, and practice of preventive stress management are simply tools for leaders and all organizational members to use as they experience, process, metabolize, and ride the wave of stress as it flows through the workplace. Preventive stress management is a flexible framework that enables leaders and all organizational members to develop the necessary skills, tools, and information for transforming a threat into an opportunity. Stress is

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not our enemy; it is our ally in dealing with the demands of work and organizational life. When a person becomes divided within himself or herself and enters the stage of resistance with its inevitable conflict and struggle, it is then that stress becomes a threat and one begins to lose. When a person becomes unified and focused through the experience of stress, acts with decisiveness, chooses the high road, and pursues options for using the stress-induced energy, it is then that challenge stress becomes an opportunity for success and achievement.

A Leap of Faith The wide array of medical, psychological, and behavioral stress skills set out in the chapters of this book are useful weapons in the war against distress, strain, and suffering. They may not, however, be quite enough. Each of us has limitations of time, energy, money, and other resources. So, the final question we are left with is this: What happens when these methods are not quite adequate, when we have done everything that is humanly possible and it is still not enough to manage the stress or relieve the distress? At those times, one may take a leap of faith. We have found that the most self-reliant individuals have a secure attachment to a higher power and turn to that power, to God, or to the place of his or her ultimate faith when all that is humanly possible has been done (Ornish, 1990; J. D. Quick, Nelson, Matuszek, Whittington, & Quick, 1996). In the final analysis, that is the source of grace, peace, and salvation. “Amazing Grace” is perhaps the best-known hymn to American Christians. The lyrics of this sacred song communicate powerfully to many Christians about the stressful and distressing times in life, as reflected in the third stanza: “Through many dangers, toils, and snares, I have already come / ‘Tis grace has brought me safe thus far, and grace will lead me home.” Those of other faiths may well have other sources that lead them to the same place. Hence, a spiritually secure attachment to the source of life is one answer to the question about what to do when everything humanly possible is not enough for stress and distress at work. Each of us is powerful, blessed with talents and strengths, yet at the same time limited in power. Knowing that, we may be a source of strength and power for others in their time of distress, strain, and suffering. In that way, we may become a miracle for someone else. Therefore, this book is other-centered as opposed to self-centered. Although the book discusses ways of managing stress, that is not the end in itself. Rather, the purpose of self-care through preventive stress management is to become more competent in managing stress; to become healthier; and as a result of that competence and health, to be a stronger asset for the groups and organizations in which we participate.

References

Abdullah, S. M. S., & Salleh, A. (2010). Developing the potential of under-achieved students using careerplanning module. European Journal of Social Sciences, 16, 645–652. Abele, A. E., & Wiese, B. S. (2008). The nomological network of self-management strategies and career success. Journal of Occupational and Organizational Psychology, 81, 733–749. doi:10.1348/096317907X256726 Adams, G. T. (1987). Preventive law trends and compensation payments for stress-disabled workers. In J. C. Quick, R. S. Bhagat, J. E. Dalton, & J. D. Quick (Eds.), Workstress: Health care systems in the workplace (pp. 235–245). New York, NY: Praeger. Adhikari, B., Kahende, J., Malarcher, A., Pechacek, T., & Tong, V. (2009). Smoking-attributable mortality, years of potential life lost, and productivity losses. Oncology Times, 31(2), 40, 42–43. Adkins, J. A. (1995, February). Occupational stress: A leadership challenge. Paper presented at the Air Force Material Command Horizons conference, Albuquerque, NM. Adkins, J. A. (1999). Promoting organizational health: The evolving practice of occupational health psychology. Professional Psychology: Research and Practice, 30, 129–137. doi:10.1037/0735-7028.30.2.129 205

206

references

Adkins, J. A., & Davidson, B. M. (2012). Large scale trauma: Institutionalizing pre- and post-trauma prevention, intervention and treatment. In R. Hughes, A. Kinder, & C. Cooper (Eds.), International handbook of workplace trauma support. New York, NY: Wiley. Adkins, J. A., Kelley, S. D., Bickman, L., & Weiss, H. M. (2010). Program evaluation: The bottom line in organizational health. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology (2nd ed., pp. 339–416). Washington, DC: American Psychological Association. Adkins, J. A., Quick, J., & Moe, K. (2000). Building world-class performance in changing times. In L. Murphy & C. Cooper (Eds.), Healthy and productive work: An international perspective (pp. 107–131). London, England: Taylor & Francis. Adler, N. E., Boyce, W. T., Chesney, M. A., Folkman, S., & Syme, S. L. (1993). Socioeconomic inequalities in health: No easy solution. JAMA, 269, 3140–3145. doi:10.1001/jama.1993.03500240084031 Agervold, M., & Mikkelsen, E. G. (2004). Relationships between bullying, psychosocial work environment and individual stress reactions. Work & Stress, 18, 336–351. American Heart Association. (2010a). Cardiovascular diseases. Retrieved from http://www.americanheart.org/downloadable/heart/126566 515297ODS-3241%20heartstrokeupdate_2010 American Heart Association. (2010b). Healthcare costs risk as risk factors remain widespread. Retrieved from http://www.newsroom.heart.org/ index.php?s=43&item=909 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. American Psychological Association. (2011). Psychologically healthy workplace awards and bests practice honors. Washington, DC: Author. Anderson, K. M. (2007). Tips for teaching. Preventing School Failure, 51(3), 49–54. Avey, J. B., Luthans, F., Smith, R. M., & Palmer, N. F. (2010). Impact on positive psychological capital on employee well-being over time. Journal of Occupational Health Psychology, 15, 17–28. doi:10.1037/ a0016998 Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: W.H. Freeman. Bartholomew, A. (1994). Biofeedback is back. Omni, 17, 16. Baruch, Y. (2004). Transforming careers: From linear to multidirectional career paths: Organizational and individual perspectives. Career Development International, 9, 58–73. doi:10.1108/13620430410518147 Baruch, Y., & Woodward, S. (1998). Stressful situations? The case of management burnout/buyins. Management Decision, 36, 641–648. doi:10.1108/00251749810245282

References

Baskin, M. L., Ard, J., Franklin, F., & Allison, D. B. (2005). Prevalence of obesity in the United States. Obesity Reviews, 6, 5–7. doi:10.1111/ j.1467-789X.2005.00165.x Baum, A., Trevino, L. A., & Dougall, A. L. (2011). Stress and the cancers. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 411–424). New York, NY: Springer. Baun, W. B., Bernacki, E. J., & Herd, J. A. (1987). Corporate health and fitness programs and the prevention of work stress. In J. C. Quick, R. S. Bhagat, J. E. Dalton, & J. D. Quick (Eds.), Workstress: Health care systems in the workplace (pp. 217–234). New York, NY: Praeger. Bean, J., & Frontera, W. (2008). Strength and power training: A guide for adults of all ages. Boston, MA: Harvard Health. Beehr, T. A., & Bowling, N. A. (2005). Hardy personality, stress, and health. In C. L. Cooper (Ed.), Handbook of stress and health (2nd ed., pp. 193–211). New York, NY: CRC Press. Bekkouche, N. S., Holmes, S., Whittaker, K. S., & Krantz, D. S. (2011). Stress and the heart: Psychosocial stress and coronary heart disease. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 385–398). New York, NY: Springer. Bell, M. P. (2007). Diversity in organizations. Mason, OH: South-Western. Bell, M. P., Quick, J., & Cycyota, C. S. (2002). Assessment and prevention of sexual harassment of employees: An applied guide to creating healthy organizations. International Journal of Selection and Assessment, 10, 160. doi:10.1111/1468-2389.00203 Benson, H. (1974). Your innate asset for combating stress. Harvard Business Review, 4, 49–60. Benson, H., & Casey, A. (2008). Harvard Medical School stress management: Approaches for preventing and reducing stress. Cambridge, MA: Harvard Medical School. Benson, H., & Stark, M. (1996). Timeless healing: The power of biology of belief. New York, NY: Scribner. Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and morality: A nine-year follow-up study of Alameda County residents. American Journal of Epidemiology, 109, 186–204. Bernacki, E. J., & Tsai, S. P. (2003). Ten years’ experience using an integrated workers’ compensation management system to control workers’ compensation costs. Journal of Occupational and Environmental Medicine, 45, 508–516. doi:10.1097/01.jom.0000063629.37065.0c Bernstein, J. (2011). Manager’s guide to crisis management. New York, NY: McGraw-Hill. Bickman, L. (Ed.). (1990). Advances in program theory [Special issue]. New Directions for Program Evaluation, 1990(47). Bodenheimer, T. (2005). High and rising health care costs. Part 2: Technologic innovation. Annals of Internal Medicine, 142, 932–937.

207

208

references

Bono, J. E., & Judge, T. A. (2003). Core self-evaluations: A review of the trait and its role in job satisfaction and job performance. European Journal of Personality, 17(S1), S5–S18. doi:10.1002/per.481 Bovbjerg, B. D. (2001). Older workers—Demographic trends pose challenges for employers and workers. Washington, DC: Government Printing Office. Boyatzis, R. E., Goleman, D., & Rhee, K. S. (2000). Clustering competence in emotional intelligence. In R. Bar-On & J. D. A. Parker (Eds.), The handbook of emotional intelligence (pp. 343–362). San Francisco, CA: Jossey-Bass. Boyatzis, R. E., Smith, M., & Blaize, N. (2006). Developing sustainable leaders through coaching and compassion. Academy of Management Learning and Education, 5, 8–24. doi:10.5465/AMLE.2006.20388381 Brief, A. P., Burke, M. J., George, J. M., Robinson, B. S., & Webster, J. (1988). Should negative affectivity remain an unmeasured variable in the study of job stress? Journal of Applied Psychology, 73, 193–198. doi:10.1037/0021-9010.73.2.193 Brooks, W. T., & Mullins, T. W. (1989). High-impact time management. Englewood Cliffs, NJ: Prentice-Hall. Brown, S. P., & Siegel, L. B. (2005, August). Mass layoff data indicate outsourcing and offshoring work. Monthly Labor Review, 128(8), 3–10. Bureau of Labor Statistics. (2011, May 20). Mass layoffs—April 2011 (News Release). Retrieved from http://www.bls.gov/news.release/ archives/mmls_05202011.pdf Burnham, D. H. (2002). Inside the mind of the world-class leader. Boston, MA: Burnham Rosen Group. Burns, M. O., & Seligman, M. E. (1989). Explanatory style across the life span: Evidence for stability over 52 years. Journal of Personality and Social Psychology, 56, 471–477. doi:10.1037/0022-3514.56.3.471 Cameron, K. (2007). Forgiveness in organizations. In D. L. Nelson & C. L. Cooper (Eds.), Positive organizational behavior (pp. 129–142). London, England: Sage. Cannon, W. B. (1915). Bodily changes in pain, hunger, fear and rage: An account of recent researches into the function of emotional excitement. New York, NY: Appleton-Century-Crofts. doi:10.1037/ 10013-000 Carlson, C. R., Collins, F. L., Jr., Nitz, A. J., Sturgis, E. T., & Rogers, J. L. (1990). Muscle stretching as an alternative relaxation training procedure. Journal of Behavior Therapy and Experimental Psychiatry, 21, 29–38. doi:10.1016/0005-7916(90)90046-N Carlson, R. (1997). Don’t sweat the small stuff . . . and it’s all small stuff: Simple ways to keep the little things from taking over your life. New York, NY: Hyperion. Carnegie, D. (1982). How to win friends and influence people (rev. ed.). New York, NY: Pocket Books.

References

Carrington, P., Collins, G. H., Benson, H., Robinson, H., Wood, L. W., Lehrer, P. M., . . . Cole, J. W. (1980). The use of meditationrelaxation techniques for the management of stress in a working population. Journal of Occupational and Environmental Medicine, 22, 221–231. Cascio, W. F. (2013). Managing human resources: Productivity, quality of life, profits (9th ed.). New York, NY: McGraw-Hill. Cascio, W. F., & Boudreau, J. W. (2011). Investing in people: Financial impact of human resource initiatives (2nd ed.). Upper Saddle Ridge, NJ: Pearson Education/FT Press. Casey, G. W., Jr. (2011). Comprehensive soldier fitness: A vision for psychological resilience in the U.S. Army. American Psychologist, 66, 1–3. doi:10.1037/a0021930 Cavanaugh, M. A., Boswell, W. R., Roehling, M. V., & Boudreau, J. W. (2000). An empirical examination of self-reported work stress among U.S. managers. Journal of Applied Psychology, 85, 65–74. doi:10.1037/0021-9010.85.1.65 Chandola, T., Brunner, E., & Marmot, M. (2006). Chronic stress at work and the metabolic syndrome: Prospective study. British Medical Journal, 332, 521–525. doi:10.1136/bmj.38693.435301.80 Chandola, T., & Marmot, M. G. (2011). Socioeconomic status and stress. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (185–193). New York, NY: Springer. Clay, R. A. (2011). Stressed in America. Monitor on Psychology, 42, 60. Cocchiara, F., Gavin, D. J., Gavin, J. H., & Quick, J. C. (2011). Valuing the differences: Stress response lessons from the opposite sex. Working paper. Cocchiara, F. K., & Bell, M. P. (2009). Gender and work stress: Unique stressors, unique responses. In C. L. Cooper, J. C. Quick, & M. J. Schabracq (Eds.), International handbook of work and health psychology (3rd ed., pp. 123–145). Oxford, England: Wiley-Blackwell. doi:10.1002/9780470682357.ch7 Cocchiara, F. K., & Quick, J. (2004). The negative effects of positive stereotypes: Ethnicity-related stressors and implications on organizational health. Journal of Organizational Behavior, 25, 781–785. doi:10.1002/job.263 Comstock, G. W., & Partridge, K. B. (1972). Church attendance and health. Journal of Chronic Diseases, 25, 665–672. doi:10.1016/ 0021-9681(72)90002-1 Contrada, R. J., & Baum, A. (Eds.). (2011). The handbook of stress science: Biology, psychology, and health. New York, NY: Springer. Cooper, C. L. (2002). The changing psychological contract at work. Occupational and Environmental Medicine, 59, 355. doi:10.1136/ oem.59.6.355

209

210

references

Cooper, C. L., Dewe, P. J., & O’Driscoll, M. P. (2001). Organizational stress: A review and critique of theory, research, and applications. Thousand Oaks, CA: Sage. Cooper, C. L., Pandey, A., & Quick, J. C. (2012). Downsizing: Is less more? Cambridge, England: Cambridge University Press. Cooper, C. L., & Sadri, G. (1991). The impact of stress counseling at work [Special issue: Handbook on job stress]. Journal of Social Behavior & Personality, 6, 411–423. Cooper, K. H., & Cooper, T. C. (2007). Start strong, finish strong: Prescriptions for a lifetime of health. New York, NY: Avery. Cornum, R., Matthews, M. D., & Seligman, M. E. P. (2011). Comprehensive soldier fitness: Building resilience in a challenging institutional context. American Psychologist, 66, 4–9. doi:10.1037/a0021420 Cotter, A. (1921). United States Steel: A corporation with a soul. Garden City, NY: Doubleday, Page, and Company. Danner, D. D., Snowdon, D. A., & Friesen, W. V. (2001). Positive emotions in early life and longevity: Findings from the nun study. Journal of Personality and Social Psychology, 80, 804–813. doi:10.1037/ 0022-3514.80.5.804 Davis, M., Eshelman, E. R., & McKay, M. (2008). The relaxation and stress reduction workbook (6th ed.). Oakland, CA: New Harbinger. Davis, M. C., Burleson, M. H., & Kruszewksi, D. M. (2011). Gender: Its relationship to stressor exposure, cognitive appraisal/coping processes, stress responses, and health outcomes. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 247–262). New York, NY: Springer. Deary, I. J., Penke, L., & Johnson, W. (2010). The neuroscience of human intelligence differences. Nature Reviews Neuroscience, 11, 201–211. de Becker, G. (2004). The gift of fear. New York, NY: Dell. Dewey, J., & Bentley, A. (1949). Knowing and the known. Boston, MA: Beacon Press. Dhabhar, F. S. (2011). Effects of stress on immune function: Implications for immunoprotection and immunopathology. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 47–64). New York, NY: Springer. Dickson, W. B. (1938). History of Carnegie Veteran Association. Montclair, NJ: Mountain Press. Dolese vs. Office Depot, Inc., 1999–2000 Civil Action No. A-99-CA479-SS, U.S. District Court, Western District of Texas. Dollard, M., Skinner, N., Tuckey, M. R., & Bailey, T. (2007). National surveillance of psychosocial risk factors in the workplace: An international overview. Work & Stress, 21, 1–29. doi:10.1080/02678370701254082 Druskat, V. U., & Wolff, S. B. (2001). Building the emotional intelligence of groups. Harvard Business Review, 79, 80–90.

References

Duggar, B. C., & Swengios, G. V. (1969). The design of physical activity programs for the industry. Journal of Occupational and Environmental Medicine, 11, 322–329. Edwards, J. R. (1996). An examination of competing versions of the person-environment fit approach to stress. Academy of Management Journal, 39, 292–339. doi:10.2307/256782 Einarsen, S., Hoel, H., Zapf, D., & Cooper, C. L. (2003). Bullying and emotional abuse in the workplace. New York, NY: Taylor & Francis. Eliot, R. S. (1995). From stress to strength: How to lighten your load and save your life. New York, NY: Bantam Books. Eller, N. H., Netterstrøm, B., Gyntelberg, F., Kristensen, T. S., Nielsen, F., Steptoe, A., & Theorell, T. (2009). Work-related psychosocial factors and the development of ischemic heart disease: A systematic review. Cardiology in Review, 17(2), 83–97. doi:10.1097/CRD.0b013e318198c8e9 Ellis, A. (1955). How to live with a neurotic. New York, NY: Crown. Elovainio, M., Kivimäki, M., & Helkama, K. (2001). Organizational justice evaluations, job control, and occupational strain. Journal of Applied Psychology, 86, 418–424. doi:10.1037/0021-9010.86.3.418 Emmons, R. A. (2003). Personal goals, life meaning, and virtue: Wellsprings of a positive life. In C. L. Keyes & J. Haidt (Eds.), Flourishing: Positive psychology and the life well lived (pp. 105–128). Washington, DC: American Psychological Association. doi:10.1037/10594-005 Emmons, R. A. (2007). Thanks! How the new science of gratitude can make you happier. New York, NY: Houghton Mifflin. Everly, G. S., & Mitchell, J. T. (1995). Prevention of work-related posttraumatic stress: The critical incident stress debriefing process. In L. R. Murphy, J. J. Hurrall, S. L. Sauter, & G. P. Keita (Eds.), Job stress interventions (pp. 173–184). Washington, DC: American Psychological Association. Eysenck, H. J. (1996). Personality and cancer. In C. L. Cooper (Ed.), Handbook of stress, medicine, and health (pp. 193–215). Boca Raton, FL: CRC Press. Farrell, L. U. (2002, March 18). Workplace bullying’s high cost: $180M in lost time, productivity. Orlando Business Journal. Retrieved from http:// www.bizjournals.com/orlando/stories/2002/03/18/focus1.html Fentem, P. H., & Bassey, E. J. (1979). The case for exercise (Sports Council Research working papers No. 8). London, England: Sports Council. Flamholtz, E. G., Bullen, M. L., & Hua, W. (2002). Human resource accounting: A historical perspective and future implications. Management Decision, 40, 947–954. doi:10.1108/00251740210452818 Florian, V., Mikulincer, M., & Taubman, O. (1995). Does hardiness contribute to mental health during a stressful real-life situation? The roles of appraisal and coping. Journal of Personality and Social Psychology, 68, 687–695. doi:10.1037/0022-3514.68.4.687

211

212

references

Frank Deus vs. Allstate Insurance Company, 1990–1992 Civil Action Case Number 88-2099, U.S. District Court, Western District of Louisiana. Fredrickson, B. L. (1998). What good are positive emotions? Review of General Psychology, 2, 300–319. doi:10.1037/1089-2680.2.3.300 Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist, 56, 218–226. doi:10.1037/0003-066X.56.3.218 Fredrickson, B. L. (2003). Positive emotions and upward spirals in organizations. In K. S. Cameron, J. E. Dutton, & R. E. Quinn (Eds.), Positive organizational scholarship: Foundations of a new discipline (pp. 163–175). San Francisco, CA: Berrett-Koehler. Fredrickson, B. L. (2009). Positivity: Groundbreaking research reveals how to embrace the hidden strength of positive emotions, overcome negativity, and thrive. New York, NY: Crown. Fredrickson, B. L., & Branigan, C. A. (2001). Positive emotions. In T. J. Mayne & G. A. Bonnano (Eds.), Emotion: Current issues and future directions (pp. 123–151). New York, NY: Guilford Press. Fredrickson, B. L., & Levenson, R. W. (1998). Positive emotions speed recovery from the cardiovascular sequalae of negative emotions. Cognition and Emotion, 12, 191–220. doi:10.1080/026999398379718 Fredrickson, B. L., & Losada, M. F. (2005). Positive affect and the complex dynamics of human flourishing. American Psychologist, 60, 678– 686. doi:10.1037/0003-066X.60.7.678 Fredrickson, B. L., Maynard, K. E., Helms, M. J., Haney, T. L., Seigler, I. C., & Barefoot, J. C. (2000). Hostility predicts magnitude and duration of blood pressure response to anger. Journal of Behavioral Medicine, 23, 229–243. doi:10.1023/A:1005596208324 Frew, D. R. (1974). Transcendental meditation and productivity. Academy of Management Journal, 17, 362–368. doi:10.2307/254990 Frone, M. R. (2011). Alcohol and illicit drug use in the workplace. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology (2nd ed., pp. 277–296). Washington, DC: American Psychological Association. Frost, P. J. (2003). Toxic emotions at work. Cambridge, MA: Harvard Business School Press. Fuller, G. D. (1978). Current status of biofeedback in clinical practice. American Psychologist, 33, 39–48. doi:10.1037/0003-066X.33.1.39 Galanakis, M., Stalikas, A., Kallia, H., Karagianni, C., & Karela, C. (2009). Gender differences in experiencing occupational stress: The role of age, education and marital status. Stress and Health, 25, 397– 404. doi:10.1002/smi.1248 Gambert, S. R., Hagen, T. C., Garthwaite, T. L., Duthie, E. D., Jr., & McCarty, D. J. (1981). Exercise and the endogenous opioids. The New England Journal of Medicine, 305, 1590–1592. doi:10.1056/ NEJM198112243052619

References

Game, A. (2007). Workplace boredom coping: Health, safety and HR implications. Personnel Review, 36, 701–721. doi:10.1108/ 00483480710774007 Ganster, D. C., & Perrewé, P. L. (2011). Theories of occupational stress. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology (2nd ed., pp. 37–53). Washington, DC: American Psychological Association. Gardiner, M., & Tiggemann, M. (1999). Gender differences in leadership style, job stress and mental health in male–and female–dominated industries. Journal of Occupational and Organizational Psychology, 72, 301–315. doi:10.1348/096317999166699 Gatchel, R. J., Howard, K., & Haggard, R. (2011). Pain: The biopsychosocial perspective. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (461–474). New York, NY: Springer. Gatchel, R. J., & Kishino, N. (2011). Pain, musculoskeletal injuries, and return to work. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology (2nd ed., pp. 265–275). Washington, DC: American Psychological Association. Gavin, J. H., Quick, J. C., Cooper, C. L., & Quick, J. D. (2003). A spirit of personal integrity: The role of character in executive health. Organizational Dynamics, 32, 165–179. doi:10.1016/S0090-2616(03)00016-0 Gelles, E. B. (1994). Letter writing as a coping strategy: The case of Abigail Adams. Psychohistory Review, 22, 193–209. Gentry, W. D. (1975). Behavioral treatment of somatic disorders. In W. D. Gentry (Ed.), Applied behavior modification. St. Louis, MO: Mosby. Gillingham, K. K. (1988). High G-stress and orientational stress: Physiologic effects of aerial maneuvering. Aviation, Space, and Environmental Medicine, 59, A10–A20. Goolsby, J. L., Mack, D. A., & Quick, J. C. (2010). Winning by staying in bounds: Good outcomes from positive ethics. Organizational Dynamics, 39, 248–257. doi:10.1016/j.orgdyn.2010.03.007 Gottlieb, B. H. (1996). Theories and practices of mobilizing support in stressful circumstances. In C. L. Cooper (Ed.), Handbook of stress, medicine, and health (pp. 339–356). Boca Raton, FL: CRC Press. Gottman, J. M., & Silver, N. (1999). The seven principles for making marriage work. New York, NY: Three Rivers Press. Graham, H. (2011). Organizational justice and perceived stress: A novel approach to preventive stress management. Unpublished major area paper, University of Texas at Arlington. Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Dufour, M. C., Compton, W., . . . Kaplan, K. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the national epidemiologic survey on alcohol

213

214

references

and related conditions. Archives of General Psychiatry, 61, 807–816. doi:10.1001/archpsyc.61.8.807 Grawitch, M. J., Gottschalk, M., & Munz, D. C. (2006). The path to a healthy workplace: A critical review linking healthy workplace practices, employee well-being, and organizational improvements. Consulting Psychology Journal: Practice and Research, 58(3), 129–147. doi:10.1037/1065-9293.58.3.129 Greenhaus, J. H., & Allen, T. D. (2011). Work-family balance: A review and extension of the literature. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology (2nd ed., pp. 165–183). Washington, DC: American Psychological Association. Griffin, R. W., O’Leary-Kelly, A. M., & Collins, J. M. (1998). Dysfunctional behavior in organizations: Violent and deviant behavior. Stamford, CT: JAI Press. Grunberg, N. E., Berger, S. S., & Hamilton, K. R. (2011). Stress and drug use. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 287–300). New York, NY: Springer. Gutman, D. A., & Nemeroff, C. B. (2011). Stress and depression. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 345–358). New York, NY: Springer. Hackman, J. R. (2002). Leading teams. Boston, MA: Harvard Business School Press. Hammer, L. B., Kossek, E. E., Anger, W. K., Bodner, T., & Zimmerman, K. L. (2011). Clarifying work-family intervention processes: The roles of work-family conflict and family-supportive supervisor behaviors. Journal of Applied Psychology, 96, 134–150. doi:10.1037/a0020927 Hargrove, M. B., Cooper, C., & Quick, J. C. (2012). Individual outcomes resulting from downsizing related stress. In C. Cooper, A. Pandey, & Quick (Eds.), Downsizing: Is less still more? (pp. 293–325). Cambridge, England: Cambridge University Press. Hargrove, M. B., Quick, J. C., Nelson, D. L., & Quick, J. D. (2011). The theory of preventive stress management: A 33-year review and evaluation. Stress and Health, 27, 182–193. Harter, J. K., Schmidt, F. L., Killham, E. A., & Agrawal, S. (2009). Gallup Q12 meta-analysis: The relationship between engagement at work and organizational outcomes. Omaha, NE: Gallup. Harwood, H. J. (2000). Updating estimates of the economic costs of alcohol abuse in the United States: Estimates, update methods, and data. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Retrieved from http://pubs.niaaa. nih.gov/publications/economic-2000/ Harwood, H. J., & Bouchery, E. (2004). The economic costs of drug abuse in the United States, 1992–2002. Washington, DC: Executive Office of the President, Office of National Drug Control Policy.

References

Hauge, L. J., Skogstad, A., & Einarsen, S. (2007). Relationships between stressful work environments and bullying: Results of a large representative study. Work & Stress, 21, 220–242. doi:10.1080/02678370701705810 Hecht, B. K., & Hecht, F. (2005). Heart attack risks around the world. Retrieved from http://www.medicinenet.com/scriptmain/art.asp? articlekey=38774 Hellman, C. J., Budd, M., Borysenko, J., McClelland, D. C., & Benson, H. (1990). A study of the effectiveness of two group behavioral medicine interventions for patients with psychosomatic complaints. Behavioral Medicine, 16, 165–173. doi:10.1080/08964289.1990.9934605 Hewlett, S. A. (2002). Executive women and the myth of having it all. Harvard Business Review, 80(4), 66–73. Hill, E. J., Hawkins, A. J., Ferris, M., & Weitzman, M. (2001). Finding an extra day a week: The positive influence of perceived job flexibility on work and family life balance. Family Relations, 50, 49–58. doi:10.1111/j.1741-3729.2001.00049.x Hill, E. J., Jackson, A. D., & Martinengo, G. (2006). Twenty years of work and family at International Business Machines Corporation. American Behavioral Scientist, 49, 1165–1183. doi:10.1177/ 0002764206286384 Hobfoll, S. E. (1998). Stress, culture, and community: The psychology and philosophy of stress. New York, NY: Plenum Press. Holland, J. L. (1959). A theory of vocational choice. Journal of Counseling Psychology, 6, 35–45. doi:10.1037/h0040767 House, J. S. (1981). Workstress and social support. Reading, MA: AddisonWesley. House, J. S., Landis, K. R., & Umberson, D. (1988, July 29). Social relationships and health. Science, 241, 540–545. doi:10.1126/science. 3399889 Ibarro, H. (2003). Working identity: Unconventional strategies for re­­inventing your career. Boston, MA: Harvard Business School Press. Ivancevich, J. M., Matteson, M. T., & Richards, E. P., III. (1985). Who’s liable for stress on the job? Harvard Business Review, 63(2), 60–72. J.B. and B.O. vs. Harris Methodist H-E-B Hospital, 2009 Case No. 342235724 09, District Count of Tarrant County. Janowiak, J. J., & Hackman, R. (1994). Mediation and college students’ self-actualization and rated stress. Psychological Reports, 75, 1007–1010. doi:10.2466/pr0.1994.75.2.1007 Jin, P. (1992). Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress. Journal of Psychosomatic Research, 36, 361–370. doi:10.1016/0022-3999(92)90072-A Joplin, J. W., Nelson, D. L., & Quick, J. (1999). Attachment behavior and health: Relationships at work and home. Journal of Organi­za­tional Behavior, 20, 783–796. doi:10.1002/(SICI)1099-1379(199911)20: 63.0.CO;2-P

215

216

references

Judge, T. A., & Bono, J. E. (2001). Relationship of core self-evaluations traits—self-esteem, generalized self-efficacy, locus of control, and emotional stability—with job satisfaction and job performance: A meta-analysis. Journal of Applied Psychology, 86, 80–92. doi:10. 1037/0021-9010.86.1.80 Kahn, R. L. (1987). Work stress in the 1980s: Research and practice. In J. C. Quick, R. S. Bhagat, J. E. Dalton, & J. D. Quick (Eds.), Work stress: Health care systems in the workplace (pp. 311–320). New York, NY: Praeger. Kahn, R. L., Wolfe, D. M., Quinn, R. P., Snoek, J. D., & Rosenthal, R. A. (1964). Organizational stress: Studies in role conflict and ambiguity. New York, NY: Wiley. Karasek, R. A. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly, 24, 285–308. doi:10.2307/2392498 Kawakami, N., & Haratani, T. (1999). Epidemiology of job stress and health in Japan: Review of current evidence and future direction. Industrial Health, 37, 174–186. doi:10.2486/indhealth.37.174 Kennedy, R. B., & Kennedy, D. A. (2004). Using the Myers-Briggs type indicator in career counseling. Journal of Employment Counseling, 41, 38–43. doi:10.1002/j.2161-1920.2004.tb00876.x Kiecolt-Glaser, J. K., Malarkey, W. B., Cacioppo, J. T., & Glaser, R. (1994). Stressful personal relationships: Immune and endocrine factors. In R. Glaser & J. K. Kiecolt-Glaser (Eds.), Handbook of human stress and immunity (pp. 321–340). San Diego, CA: Academic. Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002). Psychoneuroimmunology: Psychological influences on immune function and health. Journal of Consulting and Clinical Psychology, 70, 537–547. doi:10.1037/0022-006X.70.3.537 Kilgour, F. G. (Ed.). (1960). Christobal Mendez book of bodily exercise. New Haven, CT: Elisabeth Licht. King, L. A. (2001). The health benefits of writing about life goals. Personality and Social Psychology Bulletin, 27, 798–807. doi:10.1177/ 0146167201277003 Kirkcaldy, B., Furnham, A., & Shephard, R. (2009). The impact of working hours and working patterns on physical and psychological health. In S. Cartwright & C. L. Cooper (Eds.), The Oxford handbook of organizational well-being (pp. 303–330). Oxford, England: Oxford University Press. Klunder, C. S. (2008, February). Preventive stress management at work: The Case of the San Antonio Air Logistics Center, Air Force Materiel Command (AFMC). Paper presented at the Managing and Leading: SPIM Conference and Institutes, San Antonio, TX. Kochanek, K. D., Xu, J., Murphy, S. L., Miniño, A. M., & Kung, H.-C. (2011). Deaths: Preliminary data for 2009. National Vital Statistics Reports, 59(4), 1–50.

References

Kofodimos, J. R. (1990). Why executives lose their balance. Organizational Dynamics, 19, 58–73. doi:10.1016/0090-2616(90)90048-T Kubitz, K. A., & Landers, D. M. (1993). The effects of aerobic training on cardiovascular responses to mental stress: An examination of under­ lying mechanisms. Journal of Sport & Exercise Psychology, 15, 326–337. Lakein, A. (1973). How to get control of your time and your life. New York, NY: Wyden. Landsbergis, P. A., Schnall, P. L., Belkic, K. L., Baker, D., Schwartz, J. E., & Pickering, T. G. (2011). Workplace and cardiovascular disease: Relevance and potential role for occupational health psychology. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology (2nd ed., pp. 37–54). Washington, DC: American Psychological Association. Last, J. M. (1988). A dictionary of epidemiology (2nd ed.). New York, NY: International Epidemiological Association. Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States. JAMA, 281, 537–544. doi:10.1001/jama.281.6.537 Lavelle, J. J., Rupp, D. E., & Brockner, J. (2007). Taking a multifoci approach to the study of justice, social exchange, and citizenship behavior: The target similarity model. Journal of Management, 33, 841–866. doi:10.1177/0149206307307635 Lazarus, R. S. (1967). Psychological stress and the coping process. New York, NY: McGraw-Hill. Lazarus, R. S. (1991). Emotion and adaptation. In L. A. Pervin (Ed.), Handbook of personality: Theory and research (pp. 609–637). New York, NY: Guilford. Lazarus, R. S., DeLongis, A., Folkman, S., & Gruen, R. (1985). Stress and adaptational outcomes: The problem of confounded measures. American Psychologist, 40, 770–779. doi:10.1037/0003-066X.40.7.770 Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York, NY: Springer. LeardMann, C. A., Smith, T. C., Smith, B., Wells, T. S., & Ryan, M. A. K. (2009). Baseline self-reported functional health predicts vulnerability to posttraumatic stress disorder following combat deployment: Prospective US military cohort study. British Medical Journal, 338, 1273. doi:10.1136/bmj.b1273 Lehrer, P. M., Carr, R., Sargunaraj, D., & Woolfolk, R. L. (1994). Stress management techniques: Are they all equivalent, or do they have specific effects? Biofeedback and Self-Regulation, 19, 353–401. doi:10.1007/ BF01776735 Leon, A. S., Connett, J., Jacobs, D. R., & Rauramaa, R. (1987). Leisure time physical activity levels and risk of coronary heart disease and death. JAMA, 258, 2388–2395. doi:10.1001/jama.1987.03400170074026 LePine, J. A., Podsakoff, N. P., & LePine, M. A. (2005). A meta-analytic test of the challenge stressor-hindrance stressor framework: An explanation for inconsistent relationships among stressors and

217

218

references

performance. Academy of Management Journal, 48, 764–775. doi:10.5465/ AMJ.2005.18803921 Levin, J. S. (1994). Religion and health: Is there an association, and is it casual? Social Science & Medicine, 38, 1475–1482. doi:10. 1016/0277-9536(94)90109-0 Levinson, H. (1975). Executive stress. New York, NY: New American Library. Levinson, H. (1978). A psychoanalytic view of occupational stress. Occupational Mental Health, 3(2), 2–13. Levinson, H. (2002). Organizational assessment: A step-by-step guide to effective consulting. Washington, DC: American Psychological Association. doi:10.1037/10453-000 Levinson, H. (2006). Harry Levinson on the psychology of leadership. Boston, MA: Harvard Business School Press. Lewis, R. E., & Heckman, R. J. (2006). Talent management: A critical review. Human Resource Management Review, 16, 139–154. doi:10.1016/j. hrmr.2006.03.001 Little, L. M., Simmons, B. L., & Nelson, D. L. (2007). Health among leaders: Positive and negative affect, engagement and burnout, forgiveness and revenge. Journal of Management Studies, 44, 243–260. doi:10.1111/j.1467-6486.2007.00687.x Lloyd-Jones, D., Adams, R., Carnethon, M., De Simone, G., Ferguson, T. B., Flegal, K., . . . Hong, Y. (2009). Heart disease and stroke statistics— 2009 update: A report from the American Heart Association statistics committee and stroke statistics subcommittee. Circulation, 119, 480–486. doi:10.1161/CIRCULATIONAHA.108.191259 Lundberg, U., Mardberg, B., & Frankenhaeuser, M. (1994). The total workload of male and female white collar workers as related to age, occupational level, and number of children. Scandinavian Journal of Psychology, 35, 315–327. doi:10.1111/j.1467-9450.1994.tb00956.x Luthans, F. (2002). The need for and meaning of positive organizational behavior. Journal of Organizational Behavior, 23, 695–706. doi:10.1002/ job.165 Lynch, J. J. (2000). A cry unheard: The medical consequences of loneliness. Baltimore, MD: Bancroft. Lyubomirsky, S. (2007). The how of happiness. New York, NY: Penguin Books. Macan, T. H. (1994). Time management: Test of a process model. Journal of Applied Psychology, 79, 381–391. doi:10.1037/0021-9010.79.3.381 Macik-Frey, M., Quick, J. C., & Nelson, D. L. (2007). Advances in occupational health: From a stressful beginning to a positive future. Journal of Management, 33, 809–840. doi:10.1177/0149206307307634 Mack, D. A., Shannon, C., Quick, J. D., & Quick, J. C. (1998). Stress, prevention, and workplace violence. In R. W. Griffin, A. O’LearyKelly, & J. M. Collins (Eds.), Dysfunctional behavior in organizations: Violent and deviant behavior (pp. 119–141). Stamford, CT: JAI.

References

Maddi, S. R. (1995, August). Workplace hardiness for these turbulent times. Paper presented at the annual meeting of the Academy of Management, Vancouver, Canada. Maddi, S. R. (2002). The story of hardiness: Twenty years of theorizing, research, and practice. Consulting Psychology Journal: Practice and Research, 54, 173–185. doi:10.1037/1061-4087.54.3.173 Manuso, J. S. J. (1982). Stress management and behavioral medicine: A corporate model. In M. O’Donnel & T. Ainsworth (Eds.), Health promotion in the work place. New York, NY: Wiley. Marsella, A. J. (1994). Work and well-being in an ethnoculturally pluralistic society: Conceptual and methodological issues. In G. B. Keita & J. J. Hurrell, Jr., (Eds.), Job stress in a changing workforce (pp. 147–160). Washington, DC: American Psychological Association. doi:10.1037/10165-009 Maslach, C. (1982). Burnout: The cost of caring. Englewood Cliffs, NJ: Prentice-Hall. Maslach, C. (2006). Understanding job burnout. In A. M. Rossi, P. L. Perrewe, & S. L. Sauter (Eds.), Stress and quality of working life: Current perspectives in occupational work (pp. 37–51). Greenwich, CT: Information Age. Maslach, C., Schaufeli, W. B., & Leiter, M. (2001). Job burnout. Annual Review of Psychology, 52, 397–422. doi:10.1146/annurev. psych.52.1.397 Mathers, C. D., Alan, D. L., & Murray, C. J. L. (2010). The burden of disease and mortality by condition: Data, methods, and results for 2001. In A. D. Lopez, C. D. Mathers, M. Ezzati, D. T. Jamison, & C. J. L. Murray (Eds.), Global burden of disease and risk factors (45–234). Washington DC: Oxford University Press and The World Bank. Matthews, D. A., Larson, D. B., & Barry, C. P. (1994). The faith factor: An annotated bibliography of clinical research on spiritual subjects. Rockville, MD: John Templeton Foundation, National Institute for Healthcare Research. May, D. R., Reed, K., Schwoerer, C. E., & Potter, P. (2004). Ergonomic office design and aging: A quasi-experimental field study of employee reactions to an ergonomics intervention program. Journal of Occupational Health Psychology, 9(2), 123–135. doi:10.1037/10768998.9.2.123 Mayer, O. (1970, October). The origins of feedback control. Scientific American, 223(4), 110–118. McKay, M., & Paleg, K. (1992). Focal group psychotherapy. Oakland, CA: New Harbinger Publications. McKee, A., Boyatzis, R. E., & Johnston, F. (2008). Becoming a resonant leader: Develop your emotional intelligence, renew your relationships, sustain your effectiveness. Boston, MA: Harvard Business School Press. Mensah, G. A., Dietz, W. H., Harris, V. B., Henson, R., Labarthe, D. R., Vinicor, F., & Wechsler, H. (2005). Prevention and control of coronary

219

220

references

heart disease and stroke—nomenclature for prevention approaches in public health: A statement for public health practice from the Centers for Disease Control and Prevention. American Journal of Preventive Medicine, 29(5, Suppl. 1), 152–157. Melamed, S., Shirom, A., Toker, S., Berliner, S., & Shapira, I. (2006). Burnout and risk of cardiovascular disease: Evidence, possible causal paths, and promising research directions. Psychological Bulletin, 132, 327–353. doi:10.1037/0033-2909.132.3.327 Miller, M. C. (2008). Understanding depression. Boston, MA: Harvard Health Publications. Miller, N. E., & Dworkin, B. R. (1977). Effects of learning on visceral functions: Biofeedback. The New England Journal of Medicine, 296, 1274–1278. doi:10.1056/NEJM197706022962210 National Center for Health Statistics. (2009). Health, United States, 2009: With special feature on medical technology. Retrieved from http://www. cdc.gov/nchs/data/hus/hus09.pdf Nelson, D. L., & Burke, R. J. (2000). Women executives: Health, stress, and success. The Academy of Management Executive, 14, 107–121. doi:10.5465/AME.2000.3819310 Nelson, D. L., & Quick, J. C. (1985). Professional women: Are distress and disease inevitable? Academy of Management Review, 10, 206–218. Nelson, D. L., & Quick, J. C. (2011). Organizational behavior (7th ed.). Mason, OH: Cengage Learning. Nelson, D. L., & Quick, J. C. (2013). Organizational behavior: Science, the real world, and you (8th ed.). Mason, OH: Cengage Learning. Nelson, D. L., Quick, J. C., & Quick, J. D. (1989). Corporate warfare: Preventing combat stress and battle fatigue. Organizational Dynamics, 18, 65–79. doi:10.1016/0090-2616(89)90032-6 Nelson, D. L., & Simmons, B. L. (2011). Savoring eustress whole coping with distress: The holistic model of stress. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology (2nd ed., pp. 37–54). Washington, DC: American Psychological Association. Newton-John, T. R. O., Spence, S. H., & Schotte, D. (1995). Cognitivebehavior therapy versus EMF biofeedback in the treatment of lower back pain. Behaviour Research and Therapy, 33, 691–697. doi:10.1016/ 0005-7967(95)00008-L Ng, T. W. H., Sorensen, K. L., & Eby, L. T. (2006). Locus of control at work: A meta-analysis. Journal of Organizational Behavior, 27, 1057– 1087. doi:10.1002/job.416 Nicholson, S., Pauly, M. V., Polsky, D., Sharda, C., Szrek, H., & Berger, M. L. (2006). Measuring the effects of work loss on productivity with team production. Health Economics, 15, 111–123. doi:10.1002/ hec.1052 Nolen-Hoeksema, S. (2003). Women who think too much. New York, NY: Henry Holt.

References

Nydegger, R., & Nydegger, L. (2010). Challenges in managing virtual teams. Journal of Business & Economics Research, 8(3), 69–82. O’Connor, D. B., & Conner, M. (2011). Effects of stress on eating behavior. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 275–286). New York, NY: Springer. Organ, T. W. (1970). The Hindu quest for the perfection of man. Athens, OH: Ohio University Press. Ornish, D. (1990). Dr. Dean Ornish’s program for reversing heart disease. New York, NY: Ivy Books. Oxman, T. E., Freeman, D. H., & Manheimer, E. D. (1995). Lack of social participation or religious strength and comfort as risk factors for death after cardiac surgery in the elderly. Psychosomatic Medicine, 57, 5–15. Paffenbarger, R. S., & Hyde, R. T. (1980). Exercise as a protection against heart attack. The New England Journal of Medicine, 302, 1026–1027. doi:10.1056/NEJM198005013021810 Pandey, A., Quick, J. C., Rossi, A. M., Nelson, D. N., & Martin, W. (2011). Stress and the workplace. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 137–150). New York, NY: Springer. Parkes, K. R., Mendham, C. A., & von Rabenau, C. (1994). Social support and the demand-discretion model of job stress: Tests of additive and interactive effects in two samples. Journal of Vocational Behavior, 44, 91–113. doi:10.1006/jvbe.1994.1006 Peale, N. V. (1952). The power of positive thinking. New York, NY: Prentice Hall. Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2–21. doi:10.2307/2136319 Pelletier, K. R. (1977). Mind as healer, mind as slayer. New York, NY: Dell. Pennebaker, J. W. (1990). Opening up: The healing power of confiding in others. New York, NY: Avon Books. Pennebaker, J. W., Colder, M., & Sharp, L. K. (1990). Accelerating the coping process. Journal of Personality and Social Psychology, 58, 528– 537. doi:10.1037/0022-3514.58.3.528 Pennebaker, J. W., Kiecolt-Glaser, J. K., & Glaser, R. (1988). Disclosures of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56, 239–245. doi:10.1037/0022-006X.56.2.239 Peterson, C., Park, N., & Castro, C. A. (2011). Assessment for the U.S. Army Comprehensive Fitness program: The global assessment tool. American Psychologist, 66, 10–18. doi:10.1037/a0021658 Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues: A handbook and classification. Washington, DC: American Psychological Association.

221

222

references

Phillips, K. (1991). Biofeedback. In M. Pitts & K. Phillips (Eds.), The psychology of health: An introduction (pp. 106–120). London, England: Routledge. Piper, W. E., McCallum, M., & Azim, H. F. A. (1992). Adaption to loss through short-term group psychotherapy. New York, NY: Guilford Press. Pronk, S. J., Pronk, N. P., Sisco, A., Ingalls, D. S., & Ochoa, C. (1995). Impact of a daily 10-minute strength and flexibility program in a manufacturing plant. American Journal of Health Promotion, 9, 175– 178. doi:10.4278/0890-1171-9.3.175 Quick, J. C., & Cooper, C. L. (2003). Stress and strain (2nd ed.). Oxford, England: Health Press. Quick, J. C., Joplin, J. R., Nelson, D. L., Mangelsdorff, A. D., & Fiedler, E. (1996). Self-reliance and military service training outcomes. Military Psychology, 8, 279–293. doi:10.1207/s15327876mp0804_2 Quick, J. C., & Klunder, C. (2000). Preventive stress management at work: The case of the San Antonio Air Logistics Center (AFMC). Paper presented at the Eleventh International Congress on Stress, sponsored by the American Institute of Stress, Mauna Lani Bay, Hawaii. In Proceedings of the Eleventh International Congress on Stress. Quick, J. C., Murphy, L.R., & Hurrell, J. J. (1992). Stress and well-being at work. Washington, DC: American Psychological Association. Quick, J. C., & Nelson, D. L. (1997). Job stress. In L. H. Peters, S. A. Youngblood, & C. R. Greer (Eds.), The Blackwell dictionary of human resource management (pp. 193–194). Oxford, England: Basil Blackwell. Quick, J. C., Nelson, D. L., & Quick, J. D. (1990). Stress challenge at the top: The paradox of the successful executive. Chichester, England: Wiley. Quick, J. C., & Quick, J. D. (1984). How good working relationships can help relieve pressures on the job. Management Review, 73(5), 43–45. Quick, J. C., & Quick, J. D. (in press-a). Executive well-being. In K. Cameron & A. Caza (Eds.), Part VII—Happiness and organizations, handbook of happiness. New York, NY: Oxford University Press. Quick, J. C., & Quick, J. D. (in press-b). Stress and stress management. In D. Guest & D. Needle (Eds.), Wiley encyclopedia of human resource management. London, England: Wiley-Blackwell. Quick, J. C., Saleh, K. J., Sime, W. E., Martin, W., Cooper, C. L., Quick, J. D., & Mont, M. A. (2006). Stress management skills for strong leadership: Is it worth dying for? Journal of Bone and Joint Surgery, 88, 217–225. doi:10.2106/JBJS.E.0092 Quick, J. C., & Tetrick, L. E. (2011). Handbook of occupational health psycho­ logy (2nd ed.). Washington, DC: American Psychological Association. Quick, J. C., Tetrick, L. E., Adkins, J. A., & Klunder, C. (2003). Occupational health psychology. In I. Weiner (Ed.), Comprehensive handbook of psychology (pp. 569–589). New York, NY: Wiley. Quick, J. C., & Wright, T. A. (2011). Character-based leadership, context, and consequences. The Leadership Quarterly, 22, 984–988.

References

Quick, J. D., Henley, A. B., & Quick, J. C. (2004). The balancing act: At work and at home. Organizational Dynamics, 33(4), 426–438. doi:10.1016/j.orgdyn.2004.09.008 Quick, J. D., Nelson, D. L., Matuszek, P. A., Whittington, J. L., & Quick, J. C. (1996). Social support, secure attachments, and health. In C. L. Cooper (Ed.), Handbook of stress, medicine, and health (pp. 269–287). Boca Raton, FL: CRC Press. Quick, J. D., Quick, J. C., & Nelson, D. L. (1998). The theory of preventive stress management in organizations. In C. L. Cooper (Ed.), Theories of organizational stress (pp. 246–268). New York, NY: Oxford University Press. Rath, T., & Harter, J. (2010a). Wellbeing: The five essential elements. New York, NY: Gallop Press. Rath, T., & Harter, J. (2010b). The economics of wellbeing. New York, NY: Gallop Press. Ravindran, A. V., Griffiths, J., Waddell, C., & Anisman, H. (1995). Stressful life events and coping styles in relation to dysthymia and major depressive disorder: Variations associated with alleviation of symptoms following pharmacotherapy. Progress in NeuroPsychopharmacology & Biological Psychiatry, 19, 637–653. doi:10.1016/ 0278-5846(95)00108-8 Reite, M., Ruddy, J., & Nagel, K. (2002). Concise guide to evaluation and management of sleep disorders. Washington, DC: American Psychiatric Publishing. Reivich, K. J., Seligman, M. E. P., & McBride, S. (2011). Master resiliency training in the U.S. Army. American Psychologist, 66, 25–34. doi:10.1037/a0021897 Ricci, J. A., Chee, E., Lorandeau, A. L., & Berger, J. (2007). Fatigue in the US workforce: Prevalence and implications for lost productive work time. Journal of Occupational and Environmental Medicine, 49, 1–10. doi:10.1097/01.jom.0000249782.60321.2a Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs: General and Applied, 80, 1–28. doi:10.1037/h0092976 Rugulies, R., Christensen, K. B., Borritz, M., Villadsen, E., Bültmann, U., & Kristensen, T. S. (2007). The contribution of the psychosocial work environment to sickness absence in human service workers: Results from a 3-year follow-up study. Work & Stress, 21, 293–311. doi:10.1080/02678370701747549 Sacks, F. M. (2008). Healthy eating: A guide to the new nutrition. Boston, MA: Harvard Health. Salmon, P. (1993). Emotional effects of physical exercise. In S. C. Standford & P. Salmon (Eds.), Stress: From synapse to syndrome (pp. 395–419). London, England: Academic Press.

223

224

references

Sapolsky, R. M. (2004). Why zebras don’t get ulcers. New York, NY: Holt. Sauter, S. L., Murphy, L. R., & Hurrell, J. J. (1990). Prevention of work related psychological disorders: A national strategy proposed by the National Institute of Occupational Safety and Health (NIOSH). American Psychologist, 45, 1146–1158. doi:10.1037/0003-066X.45.10.1146 Schabracq, M., & Smit, I. (2007). Stress and effectiveness: An approach for changing organizational culture. In C. L. Cooper, J. C. Quick, & M. J. Schabracq (Eds.), The international handbook of work and health psychology (3rd ed., 445–470). Chichester, England: Wiley. Schattner, P. L., & Coman, G. J. (1998). The stress of metropolitan general practice. The Medical Journal of Australia, 169, 133–137. Schaufeli, W. B., & Buunk, B. P. (2003). Burnout: An overview of 25 years of research and theorizing. In M. J. Schabracq, J. A. M. Winnubst, & C. L. Cooper (Eds.), The handbook of work and health psychology (pp. 383–425). Chichester, England: Wiley. Scheier, M. F., & Carver, C. S. (1993). On the power of positive thinking: The benefits of being optimistic. Current Directions in Psychological Science, 2, 26–30. doi:10.1111/1467-8721.ep10770572 Schnall, P. L., Landsbergis, P. A., Schwartz, J. E., Warren, K., & Pickering, T. G. (1998). A longitudinal study of job strain and ambulatory blood pressure: Results from a 3-year follow-up. Psychosomatic Medicine, 60, 697–706. Schneider, K. T., Swan, S., & Fitzgerald, L. F. (1997). Job-related and psychological effects of sexual harassment in the workplace: Empirical evidence from two organizations. Journal of Applied Psychology, 82, 401–415. doi:10.1037/0021-9010.82.3.401 Schwartz, D. F., & Adkins, J. A. (1997). In pursuit of partnership. In M. A. Rahim, R. T. Golembiewski, & C. C. Lundberg (Eds.), Current topics in management (Vol. 2, pp. 243–252). Greenwich, CT: JAI Press. Schwartz, G. E. (1984). Psychophysiology of imagery and healing: A systems perspective. In A. A. Sheikh (Ed.), Imagination and healing (pp. 35–50). Farmingdale, NY: Baywood. Schwartz, M. S. (1995). Irritable bowel syndrome. In M. S. Schwartz (Ed.), Biofeedback: A practitioner’s guide (2nd ed.). New York, NY: Guilford Press. Schwartz, T. (2010). The way we’re working isn’t working: The four forgotten needs that energize great performance. New York, NY: Free Press. Schwartz, T., Gomes, J., & McCarthy, C. (2009). The way we’re working isn’t working: The four forgotten needs that energize great performance. New York, NY: Free Press. Schwartz, T., Gomes, J., & McCarthy, C. (2010). Be excellent at anything: The four keys to transforming the way we work and live. New York, NY: Free Press.

References

Sczesny, S., & Stahlberg, D. (2000). Sexual harassment over the telephone: Occupational risk at call centres. Work & Stress, 14, 121–136. doi:10.1080/026783700750051649 Segerstrom, S. C. (2001). Optimism, goal conflict, and stressorrelated immune change. Journal of Behavioral Medicine, 24, 441–467. doi:10.1023/A:1012271410485 Seligman, M. E. P. (1975). Helplessness: On depression, development and death. San Francisco, CA: Freeman. Seligman, M. E. P. (1990). Learned optimism. New York, NY: Knopf. Seligman, M. E. P. (1995, December). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50, 965–974. doi:10.1037/0003-066X.50.12.965 Selye, H. (1973). Evolution of the stress concept. American Scientist, 61, 692–699. Selye, H. (1976a). Stress in health and disease. Boston, MA: Butterworth. Selye, H. (1976b). The stress of life (Rev. ed.). New York, NY: McGrawHill. Semmer, N. K. (2006). Stress, personality, and coping. In M. E. Vollrath (Ed.), Handbook of personality and health (pp. 73–113). Chichester, England: Wiley. doi:10.1002/9780470713860.ch4 Semmer, N. K., & Meier, L. L. (2009). Individual differences, work stress, and health. In C. Cooper, J. C. Quick, & M. Schabracq (Eds.), International handbook of work and health psychology (3rd ed., 99–101). Chichester, England: Wiley. doi:10.1002/9780470682357.ch6 Shaffer, M. A., Joplin, J. R. W., Bell, M. P., Lau, T., & Oguz, C. (2000). Gender discrimination and job-related outcomes: A cross-cultural comparison of working women in the United States and China. Journal of Vocational Behavior, 57, 395–427. doi:10.1006/jvbe.1999.1748 Shirom, A. (2011). Job-related burnout: A review of major research foci and challenges. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology (2nd ed., pp. 223–241). Washington, DC: American Psychological Association. Siegel, B. S. (1990). Love, medicine, and miracles: Lessons learned about selfhealing from a surgeon’s experience with exceptional patients. New York, NY: HarperPerennial. Siegrist, J. (1996). Adverse health effects of high-effort/low-strain reward conditions. Journal of Occupational Health Psychology, 1, 27–41. doi:10. 1037/1076-8998.1.1.27 Simmons, B. L., & Nelson, D. L. (2001). Eustress at work: The relationship between hope and health in hospital nurses. Health Care Management Review, 26(4), 7–18. Simmons, B. L., Nelson, D. L., & Quick, J. C. (2003). Health for the hopeful: A study of attachment behavior in home healthcare nurses. International Journal of Stress Management, 10, 361–375. doi:10.1037/ 1072-5245.10.4.361

225

226

references

Smith, A. (1759). The theory of the moral sentiments. Edinburgh, Scotland: A. Kincaid and J. Bell. Smith, A., Brice, C., Collins, A., Matthews, V., & McNamara, R. (2000). The scale of occupational stress: A further analysis of the impact of demographic factors and type of job (Health and Safety Executive Contract Research Report 311/2000). Cardiff, England: Cardiff University. Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigmon, S. T., . . . Harney, P. (1991). The will and the ways: Development and validation of an individual-difference measure of hope. Journal of Personality and Social Psychology, 60, 570–585. Sparks, K., Faragher, B., & Cooper, C. L. (2001). Well-being and occupational health in the 21st century workplace. Journal of Occupational and Organizational Psychology, 74, 489–509. doi:10.1348/096317901167497 Spector, P. (2009). The role of job control in employee health and wellbeing. In C. Cooper, J. C. Quick, & M. Schabracq (Eds.), International handbook of work and health psychology (3rd ed., 173–195). Chichester, England: Wiley. doi:10.1002/9780470682357.ch9 Spera, S. P., Buhrfeind, E. D., & Pennebaker, J. W. (1994). Expressive writing and coping with job loss. Academy of Management Journal, 37, 722–733. doi:10.2307/256708 Spies, R. A., Carlson, J. F., & Geisinger, K. F. (2010). The eighteenth mental measurements yearbook. Lincoln, NE: University of Nebraska Press. Spring, B., Maller, O., Wurtman, J., Digman, L., & Cozolino, L. (1982– 1983). Effects of protein and carbohydrate meals on moods and performance: Interactions with sex and age. Journal of Psychiatric Research, 17, 155–167. doi:10.1016/0022-3956(82)90017-6 Staw, B. M., Sandelands, L. E., & Dutton, J. E. (1981). Threat rigidity effects in organizational behavior: A multilevel analysis. Administrative Science Quarterly, 26, 501–524. doi:10.2307/2392337 Stewart, W. F., Ricca, J. A., Chee, D., Morganstein, D., & Lipton, R. (2003). Lost productive time and cost due to common pain conditions in the US workforce. JAMA, 290, 2443–2454. doi:10.1001/ jama.290.18.2443 Stone, W. N. (1996). Group psychotherapy for people with chronic mental illness. New York, NY: Guilford Press. Strickland, W. (2011, March). Making the impossible possible with artful leadership. Paper presented at the 21st annual Art and Science of Health Promotion Conference, Colorado Springs, CO. Sutton, R. I., & Kahn, R. L. (1987). Prediction, understanding, and control as antidotes to organizational stress. In J. W. Lorsch (Ed.), Handbook of organizational behavior (pp. 272–285). Englewood Cliffs, NJ: Prentice-Hall. Swanson, N. G. (2000). Working women and stress. Journal of the American Medical Women’s Association, 55(2), 76–79.

References

Taylor, S. E., Klein, L. C., Lewis, B. P., Grueewald, T. L., Gurung, R. A. R., & Updegraff, J. A. (2000). Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Psychological Review, 107, 411–429. doi:10.1037/0033-295X.107.3.411 Tetrick, L. E., & Quick, J. C. (2011). Overview of occupational health psychology: Public health in occupational settings. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology (2nd ed., pp. 3–20). Washington, DC: American Psychological Association. Tetrick, L. E., Quick, J. C., & Quick, J. D. (2005). Prevention perspectives in occupational health psychology. In A.-S. G. Antoniou & C. L. Cooper (Eds.), Research companion to occupational health psychology (pp. 209–217). Cheltenham, England: Edward Elgar. Theorell, T., & Karasek, R. A. (1996). Current issues relating to psycho­ social job strain and cardiovascular disease research. Journal of Occupational Health Psychology, 1, 9–26. doi:10.1037/1076-8998.1.1.9 Uchino, B. N., Smith, T. W., Birmingham, W., & Carlisle, M. C. (2011). Social neuroscientific pathways linking social support to health. In J. Decaty & J. Cacioppo (Eds.), Oxford handbook of social neuroscience (pp. 804–813). New York, NY: Oxford University Press. U.S. Department of Health and Human Services. (2007). The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Retrieved from http://www.surgeongeneral.gov/library/ secondhandsmoke/factsheets/factsheet5.html Vaillant, G. E. (1977). Adaption to life. Boston, MA: Little, Brown. Vitaliano, P. P., Scanlan, J. M., Zhang, J., Savage, M. V., Hirsch, I. B., & Siegler, I. C. (2002). A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosomatic Medicine, 64, 418–435. Vogt, D. S., Rizvi, S. L., Shipherd, J. C., & Resick, P. A. (2008). Longitudinal investigations of reciprocal relationship between stress reactions and hardiness. Personality and Social Psychology Bulletin, 34, 61–73. doi:10.1177/0146167207309197 Wallace, R. B., & Doebbeling, B. N. (1998). Maxcy-Rosenau-Last public health and preventive medicine (14th ed.). Stamford, CT: Appleton & Lange. Warshaw, L. J. (1979). Managing stress. Reading, MA: Addison-Wesley. Watson, D., & Slack, A. K. (1993). General factors of affective temperament and their relation to job satisfaction over time. Organizational Behavior and Human Decision Processes, 54, 181–202. doi:10.1006/ obhd.1993.1009 Weick, K. E. (1984). Small wins: Redefining the scale of social problems. American Psychologist, 39, 40–49. doi:10.1037/0003-066X.39.1.40 Weiss, M. D., Bernards, P., & Price, S. J. (2008). Working through a migraine: Addressing the hidden costs of workplace headaches. AAOHN Journal, 56, 495–500; quiz 501–502.

227

228

references

Whetten, D. A., & Cameron, K. S. (2011). Developing management skills (8th ed.). Upper Saddle River, NJ: Prentice-Hall. White-Means, S. I., & Chang, C. F. (1994). Informal caregivers’ leisure time and stress. Journal of Family and Economic Issues, 15, 117–136. doi:10.1007/BF02353636 Williams, P. G., Smith, T. W., Gunn, H. E., & Uchino, B. N. (2011). Personality and stress: Individual differences in exposure, reactivity, recovery and restoration. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 231–246). New York, NY: Springer. Winett, R. A. (1995). A framework for health promotion and disease prevention programs. American Psychologist, 50, 341–350. doi:10.1037/ 0003-066X.50.5.341 Wofford, J. C., & Daly, P. S. (1997). A cognitive-affective approach to understanding individual differences in stress responses propensity and resultant stress. Journal of Occupational Health Psychology, 2, 134– 147. doi:10.1037/1076-8998.2.2.134 Wojcicki, J. M., & Heyman, M. B. (2010). Let’s move—childhood obesity prevention from pregnancy and infancy onward. The New England Journal of Medicine, 362, 1457–1459. doi:10.1056/NEJMp1001857 World Health Organization. (2004). The world health report 2004. Annex Table 2: Deaths by cause, sex and mortality stratum in WHO regions, estimates for 2002. Retrieved from http://www.who.int/whr/2004/annex/ topic/en/annex_2_en.pdf Wright, T. A. (1989). The curvilinear relationship between demand level and performance in an organizational field setting. Perceptual and Motor Skills, 69, 835–840. doi:10.2466/pms.1989.69.3.835 Wright, T. A. (1991). The level of employee utilization and its effect on subsequent turnover. The Journal of Applied Business research, 7, 25–29. Wright, T. A. (2003). Positive organizational behavior: An idea whose time has truly come. Journal of Organizational Behavior, 24, 437–442. doi:10.1002/job.197 Wright, T. A. (2005). The role of “happiness” in organizational research: Past, present and future directions. In P. L. Perrewe & D. C. Ganster (Eds.), Research in occupational stress and well-being (Vol. 4, pp. 221– 264). Amsterdam, the Netherlands: JAI Press. Wright, T. A. (2010a). More than meets the eye: The role of employee well-being in organizational research. In P. A. Linley, S. Harrington, & N. Page (Eds.), Handbook of positive psychology and work (pp. 143–154). New York, NY: Oxford University Press. Wright, T. A. (2010b). Much more than meets the eye: The role of psychological well-being in job performance, employee reten-

References

tion and cardiovascular health. Organizational Dynamics, 39, 13–23. doi:10.1016/j.orgdyn.2009.10.009 Wright, T. A., & Bonett, D. G. (2007). Job satisfaction and psychological well-being as nonadditive predictors of workplace turnover. Journal of Management, 33, 141–160. doi:10.1177/0149206306297582 Wright, T. A., & Cropanzano, R. (2004). The role of psychological wellbeing in job performance. Organizational Dynamics, 33, 338–351. doi:10.1016/j.orgdyn.2004.09.002 Wright, T. A., Cropanzano, R., & Bonett, D. G. (2007). The moderating role of positive well-being on the relation between job satisfaction and job performance. Journal of Occupational Health Psychology, 12(2), 93–104. doi:10.1037/1076-8998.12.2.93 Wright, T. A., & Goodstein, J. (2007). Character is not “dead” in management research: A review of individual character and organizationlevel virtue. Journal of Management, 33, 928–958. doi:10.1177/ 0149206307307644 Wright, T. A., & Huang, C. C. (2008). Character in organizational research: Past directions and future prospects. Journal of Organizational Behavior, 29, 981–987. doi:10.1002/job.521 Wright, T. A., & Quick, J. C. (2009a). The emerging positive agenda in organizations: Greater than a trickle, but not yet a deluge. Journal of Organizational Behavior, 30, 147–159. doi:10.1002/job.582 Wright, T. A., & Quick, J. C. (2009b). The role of positive-based research in building the science of organizational behavior. Journal of Organizational Behavior, 30, 329–336. doi:10.1002/job.581 Wright, T. A., & Quick, J. C. (2011). The role of character in ethical leadership research. The Leadership Quarterly, 22, 975–978, Wright, T. A., & Staw, B. M. (1999). Affect and favorable work outcomes: Two longitudinal tests of the happy-productive worker thesis. Journal of Organizational Behavior, 20, 1–23. doi:10.1002/(SICI)10991379(199901)20:13.0.CO;2-W Wright, T. A., & Sweeney, D. A. (1990). Correctional institution workers’ coping strategies and their effect on diastolic blood pressure. Journal of Criminal Justice, 18, 161–169. doi:10.1016/0047-2352(90)90033-8 Wright, T. A., & Wright, V. P. (1999). Ethical responsibility and the organizational researcher: A committed-to-participant research perspective. Journal of Organizational Behavior, 20, 1107–1112. doi:10.1002/ (SICI)1099-1379(199912)20:73.0.CO;2-L Xu, J., Kochanek, K. D., Murphy, S. L., & Tejada-Vera, B. (2007). Deaths: Final data for 2007. National Vital Statistics Reports, 58, 19. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_01.pdf Yanovski, S. Z., & Yanovski, J. A. (2011). Obesity prevalence in the United States—Up, down, or sideways? The New England Journal of Medicine, 364, 987–989. doi:10.1056/NEJMp1009229

229

230

references

Yarvote, P. M., McDonagh, T. J., Goldman, M. J., & Zuckerman, J. (1974). Organization and evaluation of a fitness program in industry. Journal of Occupational Medicine, 16, 589–598. doi:10.1097/00043764197409000-00003 Yerkes, R. M., & Dodson, J. D. (1908). The relation of strength of stimulus to rapidity of habit-formation. Journal of Comparative Neurology and Psychology, 18, 459–482. doi:10.1002/cne.920180503 Zohar, D., & Luria, G. (2005). A multilevel model of safety climate: Cross-level relationships between organization and group-level climates. Journal of Applied Psychology, 90, 616–628. doi:10.1037/00219010.90.4.616

Index

A A-B-C priority system, 158–159 Abilities, 124–125 Absenteeism, 41, 79 Acceptability, 195 Acceptance, 156 Accidents, 62–63, 80 Accomplishment, 65 Achilles heel phenomenon, 49–50 Acting it out, 176 Action, 195 Actionable information, 93 Activity, physical, 55 Acute stress, 56 Acute stress disorder (ASD), 64 Adams, Abigail, 175 Adaptation, 16–17, 75 Adjustments, organizational, 75 Adkins, J. A., 117 Aerobic fitness, 177, 179 Aesthetics, 31 Affect, 52–53, 148 Age, 145 Aggression indirect costs of, 84–85 individual consequences of, 62–63 interpersonal, 40–41 Alcohol abuse individual consequences of, 61–62 programs for, 188 in sleep disturbances, 66

Allen, T. D., 66–67 “Amazing Grace” (hymn), 204 Ambiguity, 37, 48 American Psychological Association (APA), 76 Anticipatory stress, 45 Antidepressant medications, 192 Anxiety, 63–64 APA (American Psychological Association), 76 Appraisal. See also Cognitive appraisal shared, 50–51 support, 138, 140 Arousal disorders, 167 ASD (acute stress disorder), 64 Assault, physical, 40–41 Assessment. See also measurement and assessment of personal preventive stress plan, 196, 198 selection of method for, 93–97 of self, 124 Assistance programs, 187 Asymmetry, gender, 67 Asymptomatic disease, 24 Attitude, 42, 52–54 Attributes, personal, 34 Availability time, 158–159 Avoidance, 159–160 Avolio, B. J., 134 Awareness, 191–192 B Back pain, 70 Baggage, emotional, 46

231

232

i nde x

Balance in effort–reward model, 123 in organizational system, 74–75 programs for, 116 work–life, 42, 128–129, 161–163 Baseline, 97–99 Boudreau, J. W., 77, 78–79, 82 Behavioral distress, 60–63 Behavioral observations, 96–97 Behavioral stress responses, 56 Behaviors as internal modifier, 52–54 lifestyle, 55, 187–188 Type A, 52 workaholic, 162 Bekkouche, N. S., 69 Bell, M. P., 144–145 Benson, H., 11, 166–169, 171–173, 179 Bernstein, J., 193 “Best possible future selves” strategy, 151–152 Bias, response/nonresponse, 95–96 Biofeedback training, 169–171 Blood pressure, 45, 173–174 Blood sugar, 71, 180 Boredom, 37–38 Boswell, W. R., 25 Boudreau, J. W., 25 Boyatzis, R. E., 133 Breakdowns, communication, 83 Brown, S. P., 12 Buffering effects, 57 Bullying, 40–41 Burden of suffering, 59 Burnout, 64–65, 80 C Caffeinated liquids, 66 Cameron, K. S., 201 Cancer, 70 Cancer-prone personality, 173 Cannon, W. B., 16, 17, 199 Cardiovascular disease. See also Coronary heart disease and coping strategies, 173–174 direct and indirect costs of, 73–74, 77 Career counseling, 190–191 Career development in organizational prevention, 123–126 paths of, 125 programs for, 34 as protective factor, 116 Carlson, R., 156 Carnegie, Dale, 198 Carr, R., 170 Cascio, W. F., 77–79, 81, 82, 128, 186 Casey, A., 11, 168, 169, 179 Catastrophizing, 153

Categorization, 49 Catharsis, 174 Cavanaugh, M. A., 25 Center for Health Research (CHR), 76 Challenges and hardiness, 53 for leadership, 21–22 with stress process, 25–26 with virtual offices, 33 Challenge stress, 111, 137 Change fallacy of, 153 mind–body, 13–14 organizational, 25–26, 74–75 stages of, 110 Character core virtues of, 147–148 strengths of, 19, 132–133, 191 Characteristics. See also Personality of healthy organizations, 75 as internal modifier, 52–54 as interpersonal stressors, 39–42 and occupational setting, 34 in stress process, 44, 48–49 CHD (coronary heart disease), 68–69 CHR (Center for Health Research), 76 Chronic back pain, 70 Chronic diseases, 108–109 Chronic insomnia, 66 Chronic stress, 45–46, 56 Cigarette smoking cessation programs for, 188 deaths related to, 61 and lung cancer, 70 secondhand exposure to, 30–31 Clear direction, 142 Coaching in career development, 126 as social support, 141 of teams, 143 Cognitive appraisal and coping, 18 and stress response, 44–45, 148–149 Cognitive distortion, 152, 153 Cognitive restructuring, 152, 153 Cognitive stress responses, 56 Cognitive style, 151 Collaboration, 118 Commitment, 53 Communication breakdown of, 83 managers and supervisors in, 39 with technology, 32 Compassion, 35, 134–135 Competencies, emotional, 133 Competition, 12 Complaints, informal, 80 Complexities, 47–49

Index

Comprehensive measures, 90–91 Comprehensive Soldier Fitness program, 188 Conceptualizations, 47 Concurrent validity, 92 Confidentiality, 189 Conflict, role, 37 Connections, 20–21 Constructive self-talk, 152, 154–155 Construct validity, 92 Context in demand–control model, 122 of organizational life, 38–42 stages of change in, 110 Contract, psychological, 30 Control of daily work routines, 156–161 fallacies of, 153 and individual differences, 50, 54–55 lack of, 20 on-the-job, 121–122 in transformational coping, 155–156 in workaholic behavior, 162 Cooper, K. H., 107 Cooper, T. C., 107 Cooperation, 40 Coping strategies and cardiovascular disease, 173–174 and cognitive appraisal, 18 diet, 55 focus of, 111 physical activity, 55 transformational, 155–156 Core virtues, 147–148 Cornell Medical Index, 194 Coronary heart disease (CHD), 68–69. See also Cardiovascular disease Costs direct, 21–22, 73–74, 77–82 of drug abuse, 62 indirect, 73–74, 82–85 Counseling, 188–191 Courage, 148 Crisis management, 193 Cropanzano, R., 186 Cross-sectional surveys, 95–96 Culture, 38–42, 50–51 Cumulative stress, 45–46 Curvilinear relationships, 48 Customer-perpetrated violence, 40–41 D Daily work routine, 156–161 DALY (disability-adjusted life years), 68 Daly, P. S., 44–45 Danner, D. D., 22–23 Data, 96, 99 Davis, M. C., 157

Death. See also Mortality leading causes of, 11–12, 59, 68 from overwork, 36 stress as cause of, 22–23 Decision making, 83–84 Degree of instrumentation, 91 Demand–control model, 119–122 Demands definition of, 13 in demand—control model, 120 and distress inevitability, 105 excessive, 159–160 identification of, 194 of job, 35–36 and prevention, 109–110 Demographic variables, 50–52, 66–67 Dependency, drug, 62 Depersonalization, 65 Depression, 65, 192–193 Depth of measure, 90–91 Design of assessment methods, 93–97 of jobs, 119–123 office, 31–33, 116, 126–127 of physical work environment, 31 of prevention/intervention strategy, 98–99 Diabetes mellitus, 71 Diagnosis, 100, 109 The Diagnostic and Statistical Manual of Mental Disorders (DSM), 192 Diet extremes of, 63 healthy, 180–181 in stress response, 55 Differences, 144–145 Direct costs of cardiovascular disease, 73–74 legal liability as, 21–22 of organizational distress, 77–82 Disability-adjusted life years (DALY), 68 Discriminant validity, 92 Discrimination, 41–42 Diseases asymptomatic, 24 and coping strategies, 173–174 direct and indirect costs of, 73–74, 77 natural life history of, 108–109 related to lifestyle behaviors, 187–188 symptomatic, 24 Distortion, cognitive, 152, 153 Distress. See also specific headings behavioral, 60–63 eustress vs., 199 of individuals, 15–16 inevitability of, 3, 105–106 psychological, 63–67 Disturbances, sleep, 66

233

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i nde x

Diversity in individual differences, 47–48 in occupational stress research, 50–51 programs for, 132, 144–145 as risk or protective factor, 41–42 Don’t Sweat the Small Stuff (R. Carlson), 156 Downsizing, 12 Downtime, unscheduled, 80–81 Drug abuse, 62 Druskat, V. U., 143 DSM (The Diagnostic and Statistical Manual of Mental Disorders), 192 Dutton, J. E., 25 Dysfunction points of, 100–101 sexual, 67 E Early warnings, 118 Ebby Halliday Realtors, 126 Economic competition, 12 Educators, 201–202 EEG (electroencephalography), 170 Effectiveness, 88–89 Efficacy, 54, 167–168 Effort—reward model, 122–123 Ego ideal, 18 Eighteenth Mental Measurement Yearbook, 124 80/20 rule, 158 Electroencephalography (EEG), 170 Electromyography (EMG) biofeedback, 170 Electronic devices, 96 Eliot, R. S., 159–160 Eller, N. H., 69 Ellis, A., 152 E-mail, 32 Emergency reaction, 16, 17 EMG (electromyography) biofeedback, 170 Emotional abuse, 41 Emotional baggage, 46 Emotional Competence Inventory, 134 Emotional competencies, 133 Emotional exhaustion, 65 Emotional health, 185–186 Emotional intelligence, 143–144 Emotional stress responses, 56 Emotional support, 138 Emotional trauma, 174–176 Emotional work, 34–35 Emotion-focused coping, 111 Emotions arousal of, 148–149 in cognitive appraisal, 44–45 negative, 52–53 outlets for, 173–176 positive, 185–186 Empathy, 134

Employees assistance programs for, 187 challenges and opportunities for, 202–203 depersonalization of, 34–35 health responsibilities of, 105 job control by, 121–122 orientation of, 125 records on, 97 socialization of, 125 well-being of, 185–186 wellness programs for, 176–177 Enabling structures, 142 Environments. See also Work environment conditions of, 30–31 contextual, 38–42 extreme, 20 functional, 33–38 physical, 29–31 task, 75 Epictetus, 148 Ergonomic office design for organizational prevention, 126–127 as protective factor, 116 in stress prevention, 31–33 Errors, 83–84 Eshelman, E. R., 157 Ethnocentric attitudes, 42 Eustress definition of, 14 distress vs., 199 effects of, 60 generation of, 111 individual consequences of, 72 organizational benefits of, 73 as outcome, 44 in positive-based approach, 184 positive paths to, 85–86 in public health, 107–108 in Yerkes–Dodson law, 14–15 Evaluation, 98–99 Evaluative support, 139, 141 Excessive demands, 159–160 Executives, 80, 200–201 Exercise. See Physical fitness Exercise program, 179 Exhaustion, emotional, 65 Existential stress responses, 56 Expectations, 37 External LOC, 54–55 External modifiers, 56–57 External prime time, 158–159 Extraorganizational stressors, 42 Extreme work environments, 20 Eysenck, H. J., 173 F Fairness, 153 Faith, 171–173, 204

Index

Fallacies, 153 Family balance of work with, 128–129 leadership supportive of, 129 problems in, 66–67 as support system, 140 work stress spillover in, 123, 161–163 Fatigue, 35, 41 Feasibility, 93 Feedback, 121–122, 169–171 Ferris, M., 123 Fight-or-flight response, 16, 166 Filtering, 153 First Horizon, 76 Fitness, physical, 176–180 Flexibility in healthy organizations, 75 muscle, 177–178 in work–life programs, 128–129 Flextime, 123 Flourishing, 150 Focus groups, 94 Food, 180–181 Forgiveness, 135 Fredrickson, B. L., 25–26, 149–150, 162, 185, 194 Freud, S., 21 Frew, D. R., 169 Friedman, Milton, 52 Friesen, W. V., 22–23 Functional environment, 33–38 Fundamental Interpersonal Relations Orientation–Behavior, 134 Future selves, best possible, 151–152 G GAS (general adaptation syndrome), 16–17 Gatchel, R. J., 71 Gates, Bill, 126 Gender, 51–52, 67 General adaptation syndrome (GAS), 16–17 General assessment, 99–100 Generation, eustress, 111 Global economic competition, 12 Goals, 142 Goal setting, 132, 135–137 Gottman, J. M., 162 Gottschalk, M., 86 Grant, Joseph M., 133 Gratitude, 150 Grawitch, M. J., 86 Greenhaus, J. H., 66–67 Grievances, 80 Group-based interventions, 189–190 H Habits, 195 Hackman, J. R., 142–144 Halliday, Ebby, 126

Hammer, L. B., 129 Harassment, 40–41 Hardiness, 53–54 Hastings, Reed, 126 Hawkins, A. J., 123 Headache, 71 Healing, 134–135, 183 Health. See also specific headings ergonomics in, 127 individual, 104 mental, 184 organizational center for, 115–119 physical, 184 and physical fitness, 178–179 psychological, 85–86 risks to, 21, 24 and social support, 138 and socioeconomic status, 51 and spirituality, 172–173 in Yerkes–Dodson curve, 112 Health care costs of, 79 measurement and assessment in, 87 service providers in, 35 technology in, 32 as tertiary prevention, 191–193 Health psychology, 23 “Heaven’s reward” fallacy, 153 Heckman, R. J., 126 High blood pressure, 45, 173–174 High reactors, 50 High-risk populations, 201–202 High-strain jobs, 120–122 Hill, E. J., 123 Hindu scripture, 171–172 Historical perspective, 16–19 Holmes, S., 69 Home-based businesses, 32–33 Honda, 79 Hope, 72 Hormone system, 13–14 Hostility, 40–41, 52 House, J. S., 56 Humanity, 148 Hurrell, J. J., 23 I IBM, 128–129 Ideal, ego, 18 Identity, 20–21 Ignoring, selective, 156 Immune system and cancer, 70 and emotional trauma, 175–176 and nutrition, 180 Inaction, 195 Indirect costs, 73–74, 82–85

235

236

i nde x

Individual consequences, 59–72 behavioral distress as, 61–63 medical distress as, 68–72 psychological distress as, 63–67 of stress, 59–61 Individual counseling, 188–189 Individual differences, 46–57 categorization of, 49 complexities with, 47–49 and control, 54–55 demographic variables in, 50–52 external modifiers of, 56–57 internal modifiers of, 52–54 lifestyle behaviors in, 55 in organizations, 144–145 in stress responses, 106–107 in vulnerabilities, 49–50 Individualized measurement and assessment, 99–101 Individual prevention interventions for, 113 measurement and assessment for, 100–101 and organizational protection, 28–29 Individuals abilities of, 124–125 distress in, 3, 15–16, 105–106 health of, 104, 117 interdependence of, with organizations, 28–29 interests of, 124 interviews of, 94–95 in multidimensional model of assessment, 88 primary prevention for, 147–149 secondary prevention for, 165–166 tertiary prevention for, 183–184 Inevitability, 3, 105–106 Informal complaints, 80 Information, actionable, 93 Information overload, 36 Injuries, musculoskeletal, 70–71 Insomnia, 66 Instrumental support, 138–140 Instrumentation, 91 Instruments, standardized, 95 Insufficiency, role, 37–38 Integrated involvement, 142 Intellectual ability, 133 Intelligence, emotional, 143 Interactions, 27, 32 Interdependence, 28–29, 104–105 Interests, individuals, 124 Internal adjustments, 75 Internal LOC, 54–55 Internal modifiers, 52–54 Internal prime time, 158–159 Internet-based teams, 144 Interpersonal relationships, 39–42 Interventions for depression, 192–193 gratitude strategies in, 150

group-based, 189–190 preventive, 111, 113, 119 psychological, 186–191 Interview, assessment, 94–95 Investigation, 81–82 Involvement, integrated, 142 Irritable bowel syndrome, 170 Ivancevich, J. M., 22 J Job redesign, 116, 119–123 Job-related burnout, 65 Job stress, 19–20 Johnston, F., 133 Justice, 38, 148 K Kahn, R. L., 17, 82–84 Kaiser Permanente, 76 Karasek, R. A., 119–120 Karoshi, 36 King, L. A., 151 Kishino, N., 71 Klunder, C. S., 118 Knowledge, 148 Krantz, D. S., 69 L Labeling, preferential, 48 Labor unions, 79 Lakein, A., 158 Landsbergis, P. A., 45 Layoffs, 12 Lazarus, R. S., 17, 18, 20, 44 Leaders challenges and opportunities for, 200–201 in effective teams, 142 in preventive stress management, 105–106, 203–204 responsibilities of, 104–105, 117 Leadership challenges for, 21–22 family-supportive, 129 in organizational culture, 38–39 resonant, 132–135 Leadership Battery, The, 134 Learned optimism, 150–152 Legal liability, 21–22 Lehrer, P. M., 170 Leisure time, 162–163 Length, of workday, 36–37 LePine, J. A., 25 LePine, M. A., 18 Letter writing, 175 Levels of effectiveness, 88–89 Levinson, Harry, 17 Lewis, R. E., 126 Liability, legal, 21–22

Index

Lifestyle behaviors diseases related to, 187–188 in individual differences, 55 in primary prevention, 161–163 Limitations, 95–96 Litigation, 81–82 Lockouts, 79 Locus of control (LOC), 54–55 Logic model, 98–99 Loss of vitality, 82–83 Low-strain jobs, 120 Lung cancer, 70 Lyubomirsky, S., 150, 160 M Macro time managers, 157, 159 Management crisis, 193 talent, 126 time, 157–159, 201 turnover, 78 weight, 188 Management by objectives (MBO), 136 Managers, 39 Manchester Bidwell Corporation, 31 Married couples, 162 Maslach, C., 65 Maslach Burnout Inventory, 194 Mass layoffs, 12 Matteson, M. T., 22 Mayer, O., 170 MBO (management by objectives), 136 MBTI (Myers-Briggs Type Indicator), 124 McKay, M., 157 McKee, A., 133 Measurement and assessment, 87–101 in biofeedback, 170–171 establishing baseline for, 97–99 individualized, 99–101 measure selection for, 91–93 multidimensional model of, 87–89 planning of, 89–90 strategy for, 90–97 technique/procedure selection for, 93–97 Measures, 90–93, 97–99 Medical distress alcohol-related, 62 consequences for individuals, 60 as individual consequence, 68–72 and stress, 11–12 Medical observations, 97 Medical perspective, 16–17, 23 Medication, 192 Meditation, 168–169 Membership, 77–79 Mendez, Christobal, 176 Mental health, 184 “Mental health days,” 163

Mental monologues, 152–154 Mentoring, 141 Metastrategy, 150 Methods acceptability of, 195 qualitative/quantitative, 91 for relaxation, 167–168 selection of, 93–97, 106–107 Microsoft, 126 Migraine headaches, 71 Military environments, 30 Miller, M. C., 192 Mind–body changes, 13–14 Mind reading, 152, 153 Mini-relaxation, 168 Mismanagement, 81 Mission, 38–39 Modifiers demographics as, 50–52 external, 56–57 internal, 52–55 Monitoring in biofeedback training, 171 of data, 99 of performance, 121–122 of turnover, 78 Morale, 82–83 Morbidity, 20 Mortality with alcohol abuse, 61–62 with cigarette smoking, 61 and socioeconomic status, 20 Motivation, 137 Multidimensional model, 87–89 Multifactor Leadership Questionnaire, 134 Munro, Saki Hector Hugh, 161 Munz, D. C., 86 Murphy, L. R., 23 Muscle flexibility, 177–178 Musculoskeletal injuries, 70–71 Myers-Briggs Type Indicator (MBTI), 124 N National Football League (NFL), 79 Natural life history, 108–109 Negative self-talk, 154 Negativity in cognitive distortion, 152, 153 as internal modifier, 52–53 Nelson, D. L., 56–57, 72, 134 Netflix, 126 Neuroticism, 52 NFL (National Football League), 79 Nolen-Hoeksema, S., 152 Nonlinear relationships, 48 Nonresponse bias, 95–96 Norms, 95

237

238

i nde x

Nurturing relationships, 131–145 diversity programs in, 144–145 goal setting in, 135–137 with resonant leadership, 132–135 with social support, 138–141 with teamwork, 141–144 Nutrition, 180–181 O Obesity, 63 Observation behavioral, 96–97 medical, 97 and observers, 27 of self, 194 Occupational health psychology (OHP), 23 Occupational health risks, 18–19 Occupational medicine, 202 Occupational stress, 21–22, 27–29 Occupations, 33–34 Office design ergonomic, 16, 31, 126–127 stress prevention in, 31–33 OHC (Organizational Health Center), 115–119 OHP (occupational health psychology), 23 On-the-job control, 121–122 Open-heart surgery, 172 Opportunities analysis of, 125 costs of, 85 creation of, 126 for employees, 202–203 for leaders, 200–201 with stress process, 25–26 Optimal responses, 121 Optimism in individual stress management, 72 as internal modifier, 53 learned, 150–152 Organ, T. W., 171–172 Organ inferiority hypothesis, 49–50 Organizational change, 25–26, 74–75 Organizational consequences, 73–86 direct costs in, 77–82 indirect costs in, 82–85 for organizational health, 74–76 Organizational culture, 38–42 Organizational distress heart disease in, 73–74 and individual distress, 15–16 inevitability of, 105–106 Organizational factors, 88 Organizational health center for, 117–119 and individual health, 104 leaders in, 117 in organizational consequences, 74–76 Organizational Health Center (OHC), 115–119

Organizational life, 27–42 contextual environment of, 38–42 functional environment of, 33–38 physical environment of, 29–31 stress in, 27–29 technology–crosscutting effects in, 31–33 Organizational prevention, 115–129. See also Nurturing relationships assessment for, 100–101 career development in, 123–126 ergonomic office design for, 126–127 health center for, 117–119 interventions for, 111, 113 job redesign in, 119–123 measurement for, 100–101 work–life programs for, 128–129 Organizational protection as buffer, 115 in content of work, 34–38 and individual prevention, 28–29 interpersonal relationships in, 38–42 in physical environment, 31, 116 Organizational stress. See also Organizational distress and heart disease, 69 person–environment fit in, 147 stages of, 109–111 Organizational stress process model, 107–108 Organizations. See also specific headings adjustments made by, 75 diversity in, 144–145 as dynamic, 107 interdependence of, 28–29 justice in, 39 reward systems in, 143 role stress in, 17 stress process in, 19–22 stress response variations in, 106–107 Orientation, 125 Ornish, D., 172 Outcomes evaluations of, 98, 99 individual differences in, 44 Outlets, emotional, 173–176 Outsourcing, 12 Overload, 35–36, 159–160 P Pace, 35–37 Pain, 70–71 Panic disorder, 64 Papanca, 167 Participation, 77–79 PATH (practices for achievement of total health) model, 86 Paths, career, 125 Pelletier, K. R., 169 Pennebaker, J. W., 175 Perceived control, 54

Index

Perceptions of control, 54 of stress, 148–156, 203–204 Performance costs of distress for, 79–81 and goal setting, 137 monitoring of, 121–122 and opportunities, 126 in Yerkes–Dodson curve, 112 in Yerkes–Dodson law, 14–15 Personal accomplishment, 65 Personal attributes, 34 Personality cancer-prone, 173 repressive, 53–54 theories of, 47 Personal responsibility, 3 Personal stress management plan, 193–198 Person–environment fit, 147 Person–job fit, 34, 190 Pessimism, 52, 151 Peterson, C., 147–148, 150, 191 Phillips, K., 170 Physical activity, 55 Physical assault, 40–41 Physical environment, 29–31 Physical fitness, 176–180 Physical health, 184 Physicians, 202 Physiological stress responses, 56 Pickering, T. G., 45 Planning of measurement and assessment, 89–90 of personal preventive stress management, 196–198 as primary prevention, 157–159 of vacation, 163 Platt, Lew, 128 Platt, Susan, 128 Podsakoff, N. P., 172 Polarized thinking, 153 Poor performance, 79–81 Positive-based approach for career counseling, 190–191 eustress in, 184 integrated, 194 to preventive stress management, 25 to symptom-specific programs, 187 Positive emotions, 185–186 Positive paths, 85–86 Positive relationships, 160–161 Positivity ratio in married couples, 162 and perceptions of stress, 149–150 and stress response, 25–26 test for, 194 Posttraumatic stress disorder (PTSD), 64

Practices for achievement of total health (PATH) model, 86 Predictive validity, 92 Preferential labeling, 48 Prevention. See also specific headings constructive self-talk for, 154 repair vs., 127 stages of, 108–111 and stress process, 22–25 Preventive interventions, 111, 113 Preventive medicine awareness of, 191–192 and public health, 23 in stages of prevention, 109, 110 Preventive stress management, 199–204 definition of, 3–4 for individuals, 148 leaders in, 203–204 model of, 23–25 positive-based, 25 research agenda for, 200–203 Preventive stress management theory, 103–113 guiding principles of, 103–108 practical application of, 108–113 Primary care settings, 193 Primary prevention, 147–163 in ergonomic office design, 127 individual protections in, 119 for individuals, 147–149 lifestyle management in, 161–163 in multidimensional model of assessment, 88 at organizational level, 110 perceptions of stress in, 149–156 in preventive medicine, 109, 110 in preventive stress management model, 24 in public health, 107–108 social support as, 160–161 work environment in, 156–161 Priority system, 158–159 Problem-focused coping, 111 Process evaluations, 98 Process model, of organizational stress, 107–108 Productivity, 75, 127 Profiles in character, 191 Program evaluation, 98–99 Program theory, 98 Protection collaboration for, 118 definition of, 28 organizational, 115 Protective factors career development as, 116 and individual characteristics, 44 managers and supervisors as, 39 support as, 139 teamwork as, 40 of work–life programs, 116

239

240

i nde x

Psychoanalytic perspective, 18 Psychological contract, 30 Psychological demands, 120 Psychological distress, 60, 63–67 Psychological health, 85–86 Psychological interventions, 186–191 Psychological intimacy, 142 Psychological withdrawal, 156 Psychologists, 202 Psychology, 17–18, 23 Psychosocial strengths, 75–76 Psychosocial weaknesses, 75–76 Psychotherapy, 192 PTSD (posttraumatic stress disorder), 64 Public health challenges and opportunities for officials in, 203 measurement and assessment in, 87 and occupational health risks, 18–19 and organizational stress process model, 107–108 and preventive medicine, 23 preventive stress management in, 109 surveillance systems in, 118 Purpose, 142, 158 Q Qualitative methods, 91 Quantitative methods, 91 Questionnaires, 95–96 Quick, J. C., 56–57, 118, 134 Quick, J. D., 56–57 Quick recovery, 154 Quiet time, 158–159 R Racial stereotypes, 42 Ratio, positivity, 25–26 Rational emotive therapy (RET), 152 Reaction, emergency, 16, 17 Reciprocal effects, 48 Recovery, quick, 154 Redesign, job, 116 Reduced personal accomplishment, 65 Reinforcement, 54–55 Rejuvenation, 133–134 Relationships. See also Nurturing relationships interpersonal, 39–42 in organizational culture, 38–42 positive, 160–161 quality of, 84 strong and healthy, 131 Relaxation response, 166–168 Relaxation training, 166–171 Reliability, 92–93 Renewal, 133–134 Repair, 127 Replacement costs, 78

Repression, 53–54 Research, scientific, 200 Residual stress, 46 Resistance stage, 17 Resonant leadership, 132–135 Response relaxation, 166–167 stress. See Stress response Response bias, 95–96 Response-directed prevention, 149, 165 Responsibilities of employees, 105 of leaders, 104–105, 117 personal, 3 Restructuring, cognitive, 152, 153 RET (rational emotive therapy), 152 Rethinking, 154 Revision, 196, 198 Rewards, 122–123 Reward systems, 143 Richards, E. P., III, 22 Rightness, 153 Risk factors with high-strain jobs, 120–122 and individual characteristics, 44 for medical distress, 69 organization-generated, 28–29 teamwork as, 40 with work, 20–21 Roehling, M. V., 25 Role ambiguity, 37 Role conflict, 37 Role insufficiency, 37–38 Role overload, 35–36 Role stress, 17 Rosenman, Ray, 52 Routine, 37–38 Rumination, self-focused, 152 S Sandelands, L. E., 25 Sargunaraj, D., 170 Sauter, S. L., 23 Schnall, P. L., 45 Schwartz, J. E., 45 Schwartz, T., 61, 72 Scientific resesarch, 200 Secondary prevention, 165–181 emotional outlets for, 173–176 employee assistance programs as, 187 in ergonomic office design, 127 individual protections in, 119 for individuals, 149 in multidimensional model of assessment, 88 nutrition for, 180–181 at organizational level, 110–111 physical fitness as, 176–180

Index

in preventive medicine, 109 in preventive stress management model, 24–25 in public health, 107–108 relaxation training as, 166–171 spirituality and faith in, 171–173 Secondhand smoke exposure, 30–31 Selection of assessment techniques and procedures, 93–97 of measures, 91–93 of preventive stress method, 106–107 of relaxation method, 166 Selective ignoring, 156 Self-administered questionnaires, 96 Self-assessment, 124 Self-care, 180 Self-efficacy, 54 Self-focused rumination, 152 Self-help groups, 190 Self-image, 18 Self-observation, 194 Self-reliance, 141, 202 Self-Reliance Inventory, 134 Self-talk, 152, 154–155 Seligman, M. E. P., 147–148, 150, 151, 189, 191 Selye, H., 16–17, 49 Separation costs, 78 Service sector, 34–36 SES (socioeconomic status), 20, 51 Sexual abuse or assault, 65 Sexual dysfunction, 67 Shared culture, 50–51 Shirom, A., 65 “Shoulds,” 153 Sick leave, 79 Siegel, L. B., 12 Siegrist, J., 122–123 Signature strengths, 191 Simmons, B. L., 72 Sleep disturbances, 66 Smith, Adam, 133 Smoking cessation programs, 188 Snowdon, D. A., 22–23 Social barriers, 173 Socialization, 125, 141 Social psychological perspective, 17 Social stress responses, 56 Social support as emotional outlet, 174–175 as external modifier, 56–57 nurturing relationships with, 138–141 in organizational prevention, 132 as primary prevention, 160–161 for team, 142 with virtual offices, 33 Socioeconomic status (SES), 20, 51 Space, 31 Spirituality, 56, 171–173

Standardized instruments, 95 Stark, M., 167, 171–173 States, internal, 52–54 Staubach, Roger, 133 Staw, B. M., 25 Stereotypes, racial, 42 Stigma, 189 Stopping, of thought, 154 Strain from exposure to workplace violence, 41 and gender, 51–52 inevitability of, 3 job, 20 in stress process, 15–16 Strategies, comprehensive, 90–91 Strength of character, 19, 132–133, 191 muscle, 178 psychosocial, 75–76 Strength training (muscle), 178 Stress. See also specific headings anticipatory, 45 categories of exposure sites, 29 challenge, 111, 137 chronic or cumulative, 45–46 definition of, 12–16 and distress inevitability, 3, 105–106 as dynamic, 48–49 energy induced by, 3 individual consequences of, 59–61 job, 19–20 level of, 45–46, 112 mind–body changes with, 13–14 occupational, 21–22, 27–29 and organizational change, 25–26 in organizational life, 27–29 perceptions of, 148–156, 203–204 reciprocal nature of, 48 residual, 46 role, 17 type of, 45–46 Stress management for leaders, 201 organizational programs for, 20 personal plan for, 193–198 Stressors definition of, 13, 148 extraorganizational, 42 identification of, 194 interpersonal, 39–42 in physical environment, 29–31 prevention directed at, 149 in transformational coping, 156 in workplace, 69 Stress process, 11–26 challenges and opportunities with, 25–26 elements of, 12–16

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Stress process, continued in historical view, 16–19 in organizations, 19–22 and stress prevention, 22–25 Stress response, 43–57 and biofeedback training, 169–171 cognitive appraisal in, 44–45, 148–149 definition of, 13, 43 identification of, 195 individual differences in, 46–57 in medical perspective, 16–17 personal characteristics in, 44 and positivity ratio, 25–26 and relaxation response, 167–168 stress level and type in, 45–46 uniqueness of, 106–107 Strickland, W., 31 Strikes, 79 Stroke, 68–69, 74 Structures, enabling, 142 Substance abuse, 61–62, 188 Suffering, burden of, 59 Supervision, 38–39 Support. See also Social support appraisal, 138, 140 evaluative, 139, 141 groups for, 190 instrumental, 138–140 protective, 141 Surgery, open-heart, 172 Surveillance model, 118 Sweeney, D. A., 174 Sympathetic nervous system, 13–14 Symptomatic disease, 24 Symptoms prevention directed at, 149 programs specific to, 187–188 of stress, 60 System factors, 88 T Tai Chi, 177 Talent management, 126 Talking it out, 174–175 Task environments, 75 Teams, virtual, 144 Teamwork nurturing relationships with, 141–144 in Organizational Health Center, 118 in organizational prevention, 132 as protective or risk factor, 40 Technical knowledge, 133 Technologies, 31–33, 144 Telecommuting, 32–33 Temperance, 148 Tertiary prevention, 183–198 and emotional health, 185–186

in ergonomic office design, 127 health care as, 191–193 individual protections in, 119 for individuals, 149, 183–184 in multidimensional model of assessment, 88 at organizational level, 111, 113 personal stress management plan for, 193–198 in preventive medicine, 109 in preventive stress management model, 25 psychological interventions for, 186–191 in public health, 107–108 for traumatic workplace events, 193 Tetrick, L. E., 118 Theorell, T., 119–120 Theoretical perspective, 47 Therapeutic interventions, 101 Thermal biofeedback, 170 Thought stopping, 154 Threats, 25–26 Time management of, 157–159, 201 in multidimensional model of assessment, 89 for relaxation training, 168 Tipping point, 25–26 TM (Transcendental Meditation), 166, 168–169 Tobacco abuse, 61 To-do list, 158 Toxic substances, 30–31 Toxic supervisors, 39 Tracking, of data, 99 Trainers, 201–202 Training biofeedback, 169–171 in muscle flexibility, 177–178 for muscle strength, 178 relaxation, 166–171 and trainers, 201–202 Traits, 52–54 Transactions, 27 Transcendence, 148 Transcendental Meditation (TM), 166, 168–169 Transformational coping, 155–156 Transitions, 33–34 Trauma, emotional, 174–176 Traumatic events, 3, 193 Triggers, 45, 159–160 Trust, 143 Turnover, 77–78 Type A behavior, 52 U Uncertainty, 20 Unfinished work, 35 Unions, labor, 79 Unscheduled downtime, 80–81 U.S. Air Force, 117, 178 Utility of measure, 93

Index

V Vacations, 163 Vaillant, G. E., 22 Validity, 91–92 Variations, 106–107 Verbal abuse, 41 Violence, 84–85 Virtual offices, 32–33 Virtual teams, 144 Virtues, core, 147–148 Vitality, 82–83 Volume, 35–37 Vulnerabilities, 49–50 W Warnings, early, 118 Warren, K., 45 Warshaw, L. J., 188 Weakness, psychosocial, 75–76 Weight management programs, 188 Weitzman, M., 123 Well-being, 186 Whetten, D. A., 201 Whittaker, K. S., 69 Wiener, Norbert, 170 Wisdom, 148 Withdrawal, psychological, 156 Wofford, J. C., 44–45 Wolff, S. B., 143 Woolfolk, R. L., 170 Work benefits and risks of, 20–21 content of, 33–38 daily routines of, 156–161 health risks with, 21 home-based, 32–33 overinvestment in, 162 overload of, 159–160 pace of, 35–37 pain and injuries related to, 71 roles of, 37–38 stoppages of, 79 stress spillover of, 123, 161–163

unfinished, 35 volume of, 35–37 Workaholics, 161–162 Workday length, 36–37 Work environment and career development, 34 extreme, 20 health risks in, 21 morale in, 82–83 planning in, 157–159 in primary prevention, 156–161 uncertainty in, 20 Work–family interface, 66–67 Work–life balance maintenance of, 161–163 programs for, 116, 128–129 as stressor, 42 Work overload, 35–36 Workplace aggression in, 40–41, 62–63, 84–85 building support systems in, 140–141 emotional health in, 185–186 evaluative support in, 139, 141 expression of emotions in, 174 newcomer socialization in, 141 protective support in, 141 stressors in, 69 supportive relationships in, 139 toxic substances in, 30–31 traumatic events in, 3, 193 turnover in, 77–78 violence in, 63, 84–85 Wright, T. A., 19, 20, 174, 186, 191 Writing it out, 175–176 Y Yerkes, R. M., 199 Yerkes–Dodson law curvilinear relationships of, 111, 112 eustress in, 14–15 and medical perspective, 16 in preventive stress management, 199 Yoga, 169

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About the Authors

James Campbell Quick, MBA, PhD, is professor of organizational behavior and John and Judy Goolsby– Jacqualyn A. Fouse Endowed Chair in the Goolsby Leadership Academy at the University of Texas at Arlington and Honorary Professor, Lancaster University Management School, Lancaster, England. He and his brother, Jonathan D. Quick, developed their signature theory of preventive stress management as they launched their careers. Dr. Quick has over 130 publications in 10 languages. He is a fellow of the American Psychological Association, the Society of Industrial and Organizational Psychology, and the American Institute of Stress. He was honored with a Maroon Citation by Colgate University, the 2002 Harry and Miriam Levinson Award by the American Psychological Foundation, and the Legion of Merit by the U.S. Air Force. Dr. Quick is a partner in NelsonQuick Group, LLC. He is married to the former Sheri Grimes Schember, and both are Paul Harris Fellows of the Rotary Foundation and members of the Silver Society of the American Psychological Foundation. Thomas A. Wright, PhD, is the Felix E. Larkin Distinguished Professor in Management at Fordham University in New York and founder and CEO of TKW Consulting 245

246

a b out the authors

Corporation, specializing in finding innovative, positive solutions to employee stress management, health, well-being, and character development. His work has been published in such outlets as Academy of Management Review, Journal of Applied Psychology, Psychometrika, Academy of Management Executive, Leadership Quarterly, Organizational Dynamics, Journal of Supply Chain Management, Journal of Organizational Behavior, Journal of Occupational Health Psychology, Journal of Management, and Journal of Management Inquiry. In recognition of his career accomplishments, Dr. Wright has been awarded fellow status in the Association for Psychological Science, the American Psychological Association, the Western Psychological Association, and the Society for Industrial and Organizational Psychology. He received his PhD from the University of California, Berkeley. His favorite stress management techniques are spending time with his wife (Kay), family, and friends; hiking in the mountains; walking on a quiet beach; prayerful meditation; and competitively lifting weights with other gym fanatics. Joyce A. Adkins, PhD, MPH, is an occupational health psychologist with 28 years of military service in clinical, policy, human factors, and executive positions. She was instrumental in establishing landmark programs in clinical and technology-assisted practice, occupational health and safety, deployment health, suicide prevention, and health-risk communication. Within the U.S. Department of Defense, she directed combat stress and quality of life programs, served on White House working groups, and was lead consultant in the global transformation of psychological health services. Dr. Adkins received six scientific achievement awards for her work in organizational health as well as the 2011 National Public Service Award for contributions to the health and quality of life of the military community. Dr. Adkins received a PhD from Vanderbilt University and a master of public health from Harvard School of Public Health. She has published across broad areas, including occupational stress and health services. Debra L. Nelson, PhD, is the Spears School Associates’ Distinguished Professor of Management at Oklahoma State University. Dr. Nelson is the author of over 100 research articles focusing on work stress, gender issues in the workplace, and leadership. Among her books are Stress and Challenge at the Top: The Paradox of the Successful Executive; Gender, Work Stress, and Health; and Organizational Behavior: Science, the Real World, and You. Dr. Nelson has been honored with a host of teaching and research awards, including the Burlington Northern Faculty Achievement Award, Regents Distinguished

About the Authors

Research Award, Regents Distinguished Teaching Award, Oklahoma State University Outreach Excellence Award, Greiner Graduate Teaching Award, and Chandler-Frates & Reitz Graduate Teaching Award. She has served as a leadership consultant and executive coach for several organizations, including AT&T, Anadarko Petroleum, Conoco-Phillips, ONEOK, State Farm Insurance Companies, Southwestern Bell, and Williams Companies. She is a partner in NelsonQuick Group, specializing in executive development. Jonathan D. Quick, MD, MPH, is a family physician and health management specialist and the president and CEO of Management Sciences for Health (MSH), a nonprofit global health consultancy working to develop local health leadership and sustainable health systems in over 60 countries in Africa, Asia, Latin America, and the Middle East. He was director of essential drugs and medicines policy at the World Health Organization from 1996 to 2004. Prior to that, he served with MSH as founding director of the Center for Pharmaceutical Management, and health systems advisor with the Afghanistan Health Sector Support Project and the Kenya Health Care Financing Project. Dr. Quick has carried out assignments in over 50 countries in Africa, Asia, Latin America, and the Middle East. He is on the faculty of Harvard Medical School Department of Global Health and Boston University School of Public Health, a fellow of the Royal Society of Medicine, and an honors graduate of Harvard College and the University of Rochester Medical School.

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