Literature Review: Stress Management 1
Literature Review: Stress Management
Javier Rosado Fraguada
School of Business, Liberty University
Literature Review: Stress Management 2
Abstract - Done
In today's society, stress at work is increasingly recognized as a significant risk factor for chronic
illness, accidents, and poor quality of life among employees. Throughout the past two decades,
there have been more research on worksite stress intervention, and there is growing evidence of
its effectiveness (Kobayashi, 2019). In terms of the quantitative results, they will produce for you
and your business, the Stress Reduction as in Office training program delivers proprietary stress
management strategies that are unmatched. For stress management at work, more than simple
counsel is required. The shifting economic landscape is pulling us in a lot of different directions.
Both the stresses and obligations of one's work and personal lives overlap. As a result, stress's
negative effects at work are a direct result of both personal and professional events that affect
every one of us. Through highly interactive learning, participants use these stress management
training tools to accomplish more of what is important to them in less time. More items don't fall
between the cracks when things are properly organized.
Literature Review: Stress Management 3
Review of Literature
The published evidence on whether workplace health and well-being interventions are as
effective in maledominated industries compared with mixed-gender environments has not been
synthesised. We performed a systematic review of workplace interventions aimed at improving
employee health and well-being in maledominated industries. We searched Web of Knowledge,
PubMed, Medline, Cochrane Database and Web of Science for articles describing workplace
interventions in male-dominated industries that address employee health and well-being. The primary
outcome was to determine the effectiveness of the intervention and the process evaluation
(intervention delivery and adherence). To assess the quality of evidence, Cochrane Collaboration’s Risk
of Bias Tool was used. Due to the heterogeneity of reported outcomes, meta-analysis was performed for
only some outcomes and a narrative synthesis with albatross plots was presented.
After full-text screening, 35 studies met the eligibility criteria. Thirty-two studies delivered the
intervention face-to-face, while two were delivered via internet and one using postal mail. Intervention
adherence ranged from 50% to 97%, dependent on mode of delivery and industry. 17 studies were
considered low risk of bias. Albatross plots indicated some evidence of positive associations, particularly
for interventions focusing on musculoskeletal disorders. There was little evidence of intervention effect
on body mass index and systolic or diastolic blood pressure. Limited to moderate evidence of beneficial
effects was found for workplace health and well-being interventions conducted within male-dominated
industries. Such interventions in the workplace can be effective, despite a different culture in male-
dominated compared with mixed industries, but are dependent on delivery, industry and outcome
There is evidence that excessive stress can have a harmful impact on physical and mental
health, even as some degrees of stress may lead to improved functioning. Numerous health
problems that influence people's quality of life, including autoimmune illness, migraines,
Literature Review: Stress Management 4
obesity, muscle tension and backaches, high cholesterol, coronary heart disease, hypertension,
stroke, and others, have been linked to stress. Our thorough review of the research revealed that
mindfulness instruction appears to have a significant impact on the workplace as well. Because
mindfulness-related training has a strong correlation with employee productivity and
performance, mindfulness qualities can be employed as a useful tool in the recruitment,
selection, and hiring processes. Additional research can demonstrate the connections between
link between organizational effectiveness, leadership, job, group, and results due to the
interconnected nature of these elements within an organizational setting, mindfulness training.
Our analysis revealed that workplace culture and results of mindfulness-related training
can be significantly impacted by culture and climate. As they become advocates for The physical
environment and organizational structure of each company should be carefully considered by
training, senior management, and human resource specialists. This is related to the issue
expressed by many organizational experts who believe that contemporary workplaces may
discourage the attentive state by encouraging uninterrupted thinking. Therefore, to encourage
mindfulness, corporations should think about incorporating design cues from monasteries and
retreat centers.
The inflammatory response triggered by persistent psychological stress has been implicated in
virtually all chronic physical conditions (Cohen et al. 2007; Yusuf et al. 2004), and many mental health
conditions (Garcia-Bueno et al. 2008). Enduring work-related stress is a major contributor to overall
stress and meta-analyses of prospective studies indicate it is associated with a 1.4-fold increased risk of
coronary heart disease (Steptoe and Kivimäki 2012). Workplace stress is also predictive of metabolic
syndrome (Chandola et al. 2006) and major depressive disorder (Netterstrøm et al. 2008), and is
associated with overeating, smoking, alcohol misuse, low levels of activity, poor sleep quality and social
Literature Review: Stress Management 5
isolation (Chandola et al. 2008; Steptoe and Kivimäki 2012). The reduction of workrelated stress is
important for tackling stress-related health risks (Milczarek et al. 2009). Interest in the effectiveness of
mindfulness-based approaches in the workplace has been growing given their potential to reduce
current stress and protect against the effects of future stress (Wolever et al. 2012). Mindfulness can be
defined as a form of metacognitive monitoring of present moment experience without fixation or
judgement (Kabat-Zinn 2009; Lutz et al. 2008). One’s ability to be mindful can be improved through
training, and usually via an eight-week, structured group programme in which formal meditation
practices are taught to foster accepting awareness of thoughts, emotions and body sensations.
Sustained rehearsal of these practices appears to engender a disposition to be mindful in daily living
(Chambers et al. 2009). Mindfulness training produces significantly different cardiovascular and
autonomic effects than relaxation training (Ditto et al. 2006; Jain et al. 2007) and is thought to generate
positive effects through distinct psychological mechanisms. The core proposed change is in the nature
and function of attention (Bishop et al. 2004; Carmody 2009; Lutz et al. 2008), particularly the directing
of attention and the monitoring of distracting thoughts, emotions or sensations (Jha et al. 2007; van den
Hurk et al. 2010). Improved attentional control, when combined with awareness (Reb et al. 2013), is
thought to be the building block for other changes pertinent to stress reduction including enhanced
body awareness, emotion regulation, tolerance of negative states and de-centering (i.e. perceiving the
self as an observer rather than casualty of stress experiences) (Carmody and Baer 2008; Hölzel et al.
2011). When sustained, these changes are collectively conceived of as enhanced mindfulness. Meta-
analyses of the effectiveness of mindfulness interventions on mental health and psychological distress in
nonclinical populations report post-treatment summary effect sizes in the medium to large range
(Chiesa and Serretti 2009; de Vibe et al. 2012; Grossman et al. 2004; Khoury et al. 2015). Variants of
mindfulness interventions have been developed for implementation in organisations (e.g. Good et al.
2015; Klatt et al. 2009), and their effectiveness in reducing stress been indicated (Allen et al. 2015;
Literature Review: Stress Management 6
Hyland et al. 2015) among working adults exposed to high occupational stress, including doctors, nurses
and other healthcare professionals (e.g. Bazarko et al. 2013; Irving et al. 2009; MartínAsuero and García-
Banda 2010); teachers (Emerson et al. 2017); those working in occupations with high emotional labour
(Hülsheger et al. 2013); and with indices of poor mental health (Huang et al. 2015). However, whilst
several studies have reported associations between increased dispositional mindfulness and positive
outcomes (e.g. Baer et al. 2012), others have shown that not all currently measurable facets of
mindfulness explain the effects of interventions on well-being (e.g. Eberth and Sedlmeier 2012; Nyklicek
and Kuijpers 2008). We have little understanding of what these others factors are, and for workplace
interventions in particular, as most studies have focused on outcomes rather than process. Where
studies of mechanisms of change exist, they have tended to focus on clinical populations, where the
application of mindfulness training (e.g. to coping with pain or cancer) is likely to shape process and
outcomes (e.g. Dobkin 2008; Mackenzie et al. 2007; Malpass et al. 2012). Only a handful of qualitative
studies have explored the experience of mindfulness interventions for non-clinical populations, and
these have relied on feedback forms (e.g. Morone et al. 2012) or have reported experiential themes
rather than mechanisms (e.g. Beckman et al. 2012; Cohen-Katz et al. 2005). Mechanisms of change have
been explored for healthcare professionals but these have focused on the ways mindfulness can
promote patient care or prevent compassion fatigue (Irving et al. 2014; Morgan et al. 2015). Experiences
of change in a non-clinical, nonhealthcare workforce have not been examined; many have argued that
examining such experiences could offer theoretical developments about how mindfulness-based
interventions are working within a normative, stressed workforce and how the nature and form of such
interventions could be enhanced (Good et al. 2015; Hyland et al. 2015; Jamieson and Tuckey 2016).
There is a difference between pressure and stress.Pressure can be positive and a
motivating factor,and is often essential in a job. It can help us achieveour goals and perform
better. Stress occurs whenthis pressure becomes excessive. Stress is a naturalreaction to too
Literature Review: Stress Management 7
much pressure.[11]Workplace stress arises when pressures related to workoutweigh an
individual’s capacity to cope with them. Itcan adversely affect an individual’s well-being (both
phys-ical and psychological), their relationship to their job andorganisation (e.g. job satisfaction,
motivation, organizational ommitment) and life outside work (e.g. family relation-ships). It is
also known to have an adverse effect on theorganisation and is the leading cause of long-term
absencefrom work in the UK (as well as a common cause ofshort-term absence).[12]Workplace
stress can contributeto reduced productivity, increased staff turnover, acci-dents and errors,
industrial disputes and reputationaldamage.It has been estimated that psychological ill health
costsUK employers£28.3 billion per year (at 2009 paylevels),[13]equivalent to an annual cost
of approximately£1000 per employee, through sickness absence, presen-teeism and staff
turnover. In the USA, it has been esti-mated that the annual healthcare costs associated
withworkplace stress amount to up to $190 billion.[14]It hasbeen reported that rates of
psychological ill health in theUK have stayed at similar levels for the past decade sug-gesting
similar costs are still likely being incurred, with anaverage 23 working days lost per case of
psychological illhealth.[15]Employers in the UK also have a legal ‘duty ofcare’ which includes
minimising the risk of stress-relatedillness or injury, taking measures to alleviate
monotonoustasks, adapting work to the individual and tackling thecauses of work-related stress.
[16–19]In the USA, whereemployee health insurance is covered by some organisa-tions, there
are additional financial implications linked tothe healthcare costs associated with workplace
stress.There are therefore clear organisational imperatives in theUK and elsewhere for
implementing workplace stressmanagement and prevention strategies and a need tounderstand
the usefulness and likely success of differentinterventions.
Literature Review: Stress Management 8
Organisational stress management and prevention inter-ventions have been categorised in
a number of ways inthe literature, including according to theirlevelof preven-tion (i.e. primary,
secondary or tertiary), theirfocus(i.e.on the individual employee or on the organisation)
ortheirtargetor the aspect of the work environment beingmodified (i.e. socio-technical or
psychosocial). For thisreview, the framework proposed by DeFrank andCooper[20]was
adopted to guide the selection and synthe-sis of published evidence. These authors expand upon
thegeneral distinction between individual and organisationalinterventions and propose three
categories of intervention,those with a focus on theindividual, those focusing onthe interface
between the individual and organisationandthose focused on theorganisation.Historically,
stressmanagementinterventions havefocused predominantly on the individual (e.g. counselling
stress management training), usually providing support tothose already suffering from the effects
of work stress orgiving them the tools or resilience to cope with workstress when it arises (i.e.
secondary prevention). Individ-ual-level approaches also include interventions to assistthose
whose health has already been damaged by chronicstress (tertiary prevention; e.g. employee
assistance pro-grammes, return-to-work schemes). A number of system-atic reviews already
exist looking at the effectiveness ofsuch individually focused interventions.[20–23]Over
recentyears, however, efforts have increasingly been focused oninterventions designed to reduce
the organisational causesof stress (primaryprevention), either targeting thoseaspects of work
at the individual–organisational interface(e.g. role clarity, co-worker support, autonomy) or
inrelation to the organisational context (e.g. ergonomics,management style, work schedules). De
Frank and Cooperpostulated that employers needed to move away fromfocusing solely on
modifying an individual’s reactions tostressful situations (a ‘band aid’ approach to stress man-
Literature Review: Stress Management 9
agement) and instead consider addressing the organisa-tional causes of stress (stress prevention)
to fulfil theirlegal duty of care in relation to workplace stress.
Stress is cited in the UK as the biggest single factor influencing the decision of staff to leave,
which has resulted in an increasing call for stress management interventions within the public sector
(Audit Commission, 2002), together with an increasing demand for evaluation of work funded by public
agencies to become more focused on demonstrating effectiveness (Wimbush and Watson, 2000). Public
sector absence averages 9.1 days per employee per annum, compared to 6.4 days per private sector
employee (Confederation of British Industry, 2005). A reduction in the absence rate in the public sector
to that of the private sector would result in a saving of £1.2 billion to UK taxpayer (Confederation of
British Industry, 2005). Throughout the research staff reported that the most difficult aspects of their job
were: too much work to do in too little time; challenging behaviour from service users and a lack of staff.
Specific issues that were raised relating to the context of the programme were: the number of changes
that the organisation was undergoing; the fact that change can cause distress to both staff and service
users; the lack of trust and blame culture within the organisation and a call from staff for more support
at times of change.
From the studies reviewed above, the tendency to attribute illness to stress appears to have
become commonplace: the implications of these attributions for health and disease are considerable.
Some studies suggest highlighting similarities and differences between lay and professional discourses
on stress (e.g. Clark, 2003). It is acknowledged, however, that to some extent these theories are
mutually reinforcing (Pollock, 1988). There is some evidence that the lack of consensus amongst stress
researchers as to the precise meaning of the stress concept is also found in lay representations of the
phenomenon. An analysis of data obtained from three interview studies that explored lay
conceptualisations of life stress and illness reveals considerable variation in how the concept is
Literature Review: Stress Management 10
understood. Participants utilised a number of varied and creative metaphors when describing stress:
such as, a heavy weight pressing down on the individual; a state of tension such as a wire that is taut
and could suddenly snap; a ‘‘speeding up’’ of physiological processes that leads to physical breakdown; a
malfunctioning of the body as a machine; the body being ‘‘under siege’’; a gradual wearing out of the
body’s defence systems; the depletion of essential internal resources or ‘‘reserves’’; and the build up of
pressure that needs to be released in some manner (Helman, 1985; Hodgetts & Chamberlain, 2000;
Pollock, 1988). Interviewees tended to highlight the stressful nature of contemporary life as an
explanation for ill health. More specifically, Pollock’s interviewees generally believed that stress had
increased (and would continue to do so) in response to a pathogenic society, a faster pace of life,
greater pressure to achieve, more materialism and the erosion of social support networks. The majority
maintained that stress was unavoidable and, consequently, little could be done to reduce or manage it.
Work was considered to be a significant source of stress, but certain sectors were thought to be
particularly at risk from stress-related illness: most notably, ‘‘the paradigm heart-attack case’’ was the
‘‘pressurised executive’’ (p. 382). The pervasiveness of this belief, and its implications for health, is
illustrated in a more recent study conducted by Clark (2003). Interviews conducted with patients who
had recently experienced mycardial infarction revealed that stress (especially work stress) was
considered as having a more influential causal role than other factors such as smoking, poor diet and
lack of exercise.
Literature Review: Stress Management 11
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