Article summary with Workplace Stress Management Interventions and Health Promotion by Tetrick & Winslow - 2015

In 2014, 31% of working adults felt tension or stress, and 61% reported that they had enough resources to deal with this stress. A low salary and a lack of opportunities for growth were the most common sources of stress. Job insecurity is also in the top 5. Furthermore, uncertain job expectations and long working days were also in the top 5. With regard to interventions against work stress, the emphasis has probably been too much on 'red cape interventions' with the intention of stopping negative experiences, instead of on the 'green cape interventions', interventions with the aim of growing positive experiences. An example for the focus in this is increasing the employee resources. In this article, literature about stress management interventions is summarized, with an emphasis on green cape interventions.  

Theoretical framework

The authors use the job demands-resources (JD-R) model, a dual process model. This model reflects two mechanisms through which job demands and resources can lead to tension or motivation that subsequently influences organizational and individual outcomes. The first process is a health limiting process in which poorly designed jobs and chronic demands lead to poorer outcomes for employees and companies by exhausting the mental and physical resources of the employee. The second process, a motivational process, assumes that sources (for example, control, autonomy and feedback) can be motivators because they can help to achieve work goals or stimulate growth and development. This motivational process is especially important for health promotion and positive interventions. In particular, the mediating effect of burnout and work engagement between job demands and resources on the one hand, and well-being on the other, is supported by literature.      

Stress management interventions

Stress management interventions in 2008

The authors have categorized the different interventions into three categories: primary interventions are proactive and aimed at prevention and focuses on all employees, secondary interventions focus on employees at risk, and tertiary interventions focus on employees who need stress experienced guidance to to recover from this. Primary interventions are seen as the most effective, followed by secondary interventions and finally the tertiary interventions. Three meta-analyzes showed that stress management interventions are effective, but this seems to depend on the outcome being measured. Relaxation interventions are less effective than cognitive behavioral interventions. This is perhaps because relaxation is not aimed at changing cognitions but at letting go. CBT interventions are proactive. Moreover, a multimodal approach combining different types of interventions is no more effective than a unimodal approach, because it requires much more from the participant's resources. A system approach, in which both individual and organizational interventions are combined, is more effective because it does not necessarily exhaust the resources of the individual. The organization-oriented interventions are primary interventions and are the least researched. Whether these interventions are effective on their own is not yet clear.          

Recent developments

Mindfulness based interventions

In recent years there has been an increase in the number of interventions that use mindfulness techniques. The definition of mindfulness is "a state of giving attention to and awareness of what is taking place in the present." It could reduce employee stress by accepting an event and not judging it. The mindfulness-based interventions that are now being discussed are primary: aimed at all employees. According to a study by Wolver and colleagues, workers in the mindfulness and yoga condition experienced significantly a reduction of stress and improvement of sleep quality. There were also differences in heart rate variability and breathing, but no differences in blood pressure and work productivity. The intervention was just as effective when it was offered online as when it was done in real life. Research by Hülsheger and colleagues focused on the Mindfulness-Based Stress Reduction Program and Mindfulness-Based Cognitive Therapy. There was a significant decrease in emotional exhaustion and an increase in job satisfaction. Michel and colleagues (2014) found that participants who took a mindfulness intervention could psychologically detach themselves better from their work and experience less work-family conflict and were more satisfied with their work. Loving-kindness meditation also led to more positive affect, self-efficacy and job satisfaction and less psychological stress.           

Recovery interventions

Another intervention type focuses on facilitating experiences and improving processes that can reduce the negative effects of work stress. Hahn and colleagues (2011) studied the effectiveness of a recovery program consisting of four modules: psychological detachment from work, mastery, relaxation, and a check during leisure time. It consisted of two sessions of 4 to 5 hours. Improvement in all four areas was observed, as well as a decrease in stress and negative affect and a significant increase in self-efficacy. Siu and colleagues (2014) also showed positive results: higher scores on positive emotions and mastery and lower on emotional exhaustion and physical and psychological symptoms. However, the results were not statistically significant. Finally, there was an intervention that was tertiary and lasted 12 months. However, there was no standardization and no control group, so this means that no conclusions can be drawn.     

Multimodal interventions

Multimodal interventions consist of elements from different types of interventions, and are primary: available for all employees. Eisen and colleagues (2008) studied an intervention consisting of general stress education, stress reduction techniques, and progressive relaxation. They compared a group intervention with a computer-based intervention. In both groups there was a decrease in stress after each intervention module. However, there was no global decrease in stress after the intervention or a month later. The authors blame this on the fact that employees have not applied the skills learned in their daily lives. There were also a lot of dropouts in the computer group. Bourbonnais et al. (2011) investigated an intervention aimed at improvement in various psychosocial work factors. Three years after the intervention there was a significant improvement in almost all factors that were part of the study. Moreover, there was a decrease in work-related stress and burnout. The effectiveness of this intervention is probably due to the risk assessment that led to the development of the intervention. Cifre et al. (2011) did an intervention focused on the JD-R model. First they mapped out the psychosocial risk factors: few resources in the job (e.g. autonomy), innovation climate and perceived quality of training. Based on this analysis, they did a team redesign consisting of job redesign and training. This was a secondary intervention. The intervention led to increased self-efficacy and competence, perception of innovation climate and work involvement. Another intervention, Workplace Triple P (WPTP) is specially designed for parents with a job with the aim of building personal resources and coping behavior. It reduces dysfunctional parenting which in turn reduces general stress levels. This in turn led to a reduction in work-related stress.              

Summary and future research

There have been a number of new interventions since the meta-analysis by Richardson and Rtohstein (2008), namely mindfulness focused interventions, recovery interventions and multimodal interventions. Some studies had poor methodology, and most were primary and focused on individual outcomes. In addition, the measurements mainly consisted of self-reports. It must become more clear a) which outcomes are influenced by which types of interventions / activities, b) for whom an intervention type or specific intervention is most effective, c) the specific causal mechanisms.    

Health promotion and workplace welfare programs   

Stress management programs are generally red cape programs. Health promotion and well-being programs, on the other hand, are usually green cape programs because they focus on improving and promoting health. Madsen (2003) reported that welfare programs increase the emotional, intellectual, physical, social and spiritual well-being of employees, where well-being is defined as functioning at the highest possible level of yourself. Well-being programs in the workplace can focus on communication and awareness, or screening and assessment. A third category focuses on lifestyle and education programs. The latter category focuses on behavioral change and support. Previous research has shown that these programs have positive results for organizations, but there is not yet a lot of research into changes in employee behavior. Parks and Steelman (2008) found that it reduces absence and increases satisfaction.        

System approaches

Byrne et al. (2011) investigated annual assessments over a period of 7 years. It was a primary intervention focused on health risk assessment and educational video to raise employee awareness. It also included a lifestyle management tool to encourage employees to set specific goals to reduce their health risk and maintain their health. They found that most risk factors improved over time, but the biggest difference was between the first and second year of the intervention. There was clear evidence of lasting improvements in terms of increased physical activity, improved nutrition, less smoking, and an increase in the use of a seat belt. The implementation of health promotion programs in the workplace started in 1970, and about 70% of large and more than 50% of medium-sized organizations have such a program. Lincoln Industries is a small company that has implemented such a program. The primary purpose of this welfare program is to improve physical fitness and nutrition and increase employee satisfaction. It consists of health screenings and three activities in which employees can participate. Merrill et al. (2011) observed significant improvements in body fat, blood pressure and employee flexibility, with the greatest results among older employees and those with the highest risk factors. There was also an overall improvement in physical and mental health. One of the factors that contributed to this success is the culture of health created by Lincoln Industries' senior staff. Most health promotion programs take a medical perspective and focus on behaviors that are risky to health. Little work is done with positive psychology.    

Positive psychology interventions

Positive psychology interventions focus on increasing positive aspects of well-being and therefore not only on negative outcomes. An advantage is that individuals can often do this themselves. Only a few studies have looked at positive psychology in the workplace. Writing down things that you are grateful for at work leads to an increase in gratitude and work-related well-being. Writing down three positive things per working day also leads to less stress, fewer mental and physical health problems and being able to distance yourself better from work. It also reduces the negative effects of work-family conflict.   

Directions for future research

This article has shown that there is evidence that stress management interventions and workplace health promotion and that well-being programs can be effective. The authors indicate that prior to further research better theoretical models have to be developed to provide an integrative structure to interventions that indicate the specific effects of an intervention on organizational and individual level to explore causal mechanisms of intervention. There must also be a more integrated system perspective to understand the experiences of employees inside and outside the working environment, as well as the effects of these experiences on employees, families and organizations. Ideally, longitudinal studies should be carried out to serve as a barometer for the health of their employees and the working environment. Research has also shown that there may be important moderators of the effects, so more research needs to be done on this. This can be, for example, national or organizational culture. There must be more cross-cultural investigations to clarify similarities and differences . The quality of intervention studies is slowly improving. There should also be more studies with a control group. Literature suggests that interventions with a system approach and both an individual and organizational component are the most effective. Based on this article, the JD-R model is a useful framework. Recognizing multiple domains and resources is a useful extension, especially for the understanding of employee well-being.