LITERATURE REVIEW 1
Literature Review: Stress Management
Rachel S. Brazell
Overton Graduate School of Business, Liberty University
Human Resources Development BUSI 644-D01
Dr. Daniel Gilbert
April 30, 2021
LITERATURE REVIEW 2
Abstract
Employment related stress is an ongoing and increasing issue around the world.
Unmanaged stress is detrimental to the health of employees and the overall functionality of
organizations. There are multiple stress management interventions, strategies, and training
programs that can be used to counteract the negative effects of stress. To fully understand how
employers can effectively support employee stress management, this literature review will
analyze nine studies and Biblical concepts that explore the causes of stress, the effects of stress
on the health and job performance of employees, how unmanaged employee stress negatively
effects organizations, stress management interventions that are proven effective, and the
responsibilities of human resources development to insure that employees have available stress
management resources and are aware of the resources available to them. The findings will help
employers, employees, and scholars understand employee stress and how it can be effectively
managed.
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Introduction
Stress is a growing epidemic within the workforce that contributes to health and
behavioral problems for millions of people every year (Ajayi et al., 2019). Individuals under
stress have an increased risk of cardiovascular disease, diabetes, arthritis, respiratory disease, and
sleep disorders (Mutambudzi & Henkens, 2020). Organizations loose time, money, and
productivity as a direct result their employee’s unmanaged stress. Compared to stress free
employees, workers who experience stress are found to take more repeated breaks at work which
disrupt their workflow and production, are more likely to have increased absenteeism and
tardiness, and have a higher probability of making errors during work production (Brough &
Boase, 2019).
Stress can be effectively managed through employee education and workplace
interventions. Stress managements tools and resources are widely available, easy to use, and are
often little to no cost to employers (Castillo et al., 2019). Increasing occupational stress
experienced by employees and the abundance of low cost, easy to implement interventions
(Tement et al., 2020), is phenomenon that warrants research. This Literature Review will
analyze nine present-day scholarly articles on the causes and effects of stress, stress
management, and Biblical concepts will be explored which relate to the ethical responsibility of
Human Resources Development to protect the wellbeing of employees through stress
management interventions.
The Literature Review will start by discussing the causes of stress among employees,
how stress can affect the wellbeing of employees, and how unmanaged stress negatively impacts
the organization. Then, the Literature Review will explore various studies that focus on stress
management tools and interventions and how said measures effectively reduced occupational
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stress when correctly implemented and followed. Further, the Literature Review will discuss
stress management as it relates to Human Resource Development. Effective stress management
is essential to the field of Human Resources Development. Human Resource Development has
the ethical responsibility of molding values, ingraining knowledge, and influencing attitudes of
employees to support the overall sustainability and performance of an organization (Castillo et
al., 2019). Thus, Human Resource Development is obligated to promote stress management in
order to foster the wellbeing of employees and the organization as a whole.
Content
Causes and Effects of Stress
Stress is equivalent to any other deadly disease that humans suffer from. Individuals
often identify similar themes related to the causes of stress and similar negative health effects.
Additionally, industries experience similar negative effects directly related to unmanaged
employee stress. In a study by Ajayi et al., (2019), the cause of stress among construction
workers in the United Kingdom was explored in addition to the negative impact that unmanaged
stress had on the construction industry. Common themes related to the cause of stress among
construction workers included workload, hours worked, demanding work environment and
deadlines, pressure to perform, lack of organizational support, and lack of mental health and
stress management education (Ajayi et al., 2019). The study revealed that stress experienced by
construction workers cost employers £33bn and £42bn per year as a direct result of loss of
productivity and absenteeism (Ajayi et al., 2019).
Ajayi et al., (2019), utilized an exploratory sequential mixed method research design
which included two data collection stages. The first stage consisted of interviews and the second
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stage included questionnaires. Both stages were used to gauge the stress level and reasons for
stress among construction workers (Ajayi et al., 2019). Cronbach’s alpha test was completed to
measure the reliability of the quantitative data collected by questionnaires, which revealed
extremely high levels of reliability of the data (Ajayi et al., 2019). Extensive literature, which
focused on the causes and effects of stress and preventative strategies, was incorporated into the
research methodology. The study conducted by Ajayi et al., (2019), utilized descriptive mean
testing to determine common patterns related to the causes of stress and the lack of stress
management education among employees, which has led to significant negative impact on the
overall health and wellbeing of construction workers (Ajayi et al., 2019). This study finished
with a discussion of the research approach, data analysis, and findings (Ajayi et al., 2019).
In conclusion, Ajayi et al., (2019), suggested that organizations benefited more from
preventing stress by addressing the fundamental causes of stress, rather have financially
supporting the treatment needed for mental health conditions cause by unmanaged stress among
employees (Ajayi et al., 2019). Stress prevention interventions included setting realistic work
goals and deadlines, improving organizational communication, providing high-quality stress
management education to employees, and emphasizing teamwork (Ajayi et al., 2019).
A study conducted by Mutambudzi & Henkens (2020), explored the increase of chronic
health conditions associated with work related stress among workers in various industries located
in European countries. The methodology used in this study included analyzing data gathered in a
2015 study related to Dutch pension funds. Using this data, questionnaires were mailed to
potential respondents throughout European countries (Mutambudzi & Henkens, 2020). The
questionnaire focused on gaging participant’s emotional demands, physical demands, and stress
related to their employment, and determining whether the participant suffered from or were at
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risk for chronic health conditions (Mutambudzi & Henkens, 2020). Chronic health conditions
included were cardiovascular disease, arthritis, sleep disorders and respiratory disorders. The
sample of participants included 6793 individuals, with an average age of 62, working an average
of 31.8 hours per week, and 49% began work as a young adult (Mutambudzi & Henkens, 2020).
The data gathered in the study completed by Mutambudzi & Henkens (2020), was
analyzed using three models: baseline characteristics, logistic regression for independent
association with chronic health conditions and work stress, and logistic regression for all
association with chronic health conditions and work stress. The individual analyses revealed
slightly differing associations between chronic health conditions and work stress, depending on
the varying factors such as industry of work, age of participant, and other demographic
information (Mutambudzi & Henkens, 2020). Overall, the results of this study indicated that the
chronic health conditions included in this study were all associated with work related emotional
demands, physical demands, and stress (Mutambudzi & Henkens, 2020).
The study concluded by Mutambudzi & Henkens (2020), demonstrating that stress
experienced by employees is associated with chronic health conditions (Mutambudzi & Henkens,
2020). The study suggested that additional research is needed to understand the exact
relationship between occupational stress and chronic health problems, as further research can be
used to identify stress management interventions and help employees remain healthy, both
physically and mentally (Mutambudzi & Henkens, 2020).
Stress Management Training and Intervention
In a quasi-experimental study by Shariatkhah et al., (2017), the relationship between
employee stress and stress management training was explored. 40 Birjandian nurses participated
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in this study and completed a survey related to job stress. Following completion of the survey,
the nurses were divided into two groups. During an eight-week period, one group completed a
two-hour training session each week related to cognitive behavioral stress management
(Shariatkhah et al., 2017). The controlled group did not participate in any training related to
stress management. Then, approximately eight weeks after the stress management training was
complete, the questionnaire was readministered to both groups of nurses (Shariatkhah et al.,
2017).
The quasi-experimental research conducted by Shariatkhah et al., (2017), involved the
manipulation of an independent variable consisting of a group of nurses who completed stress
management training and a dependent variable consisting of nurses who had no stress
management training. This study utilized a pretest-posttest design in which a questionnaire was
used to measure the stress level of nurses before training was implemented and then again after
training was completed. Shariatkhah et al., (2017), found that the group who completed
cognitive behavioral stress management training experienced a significant decrease is stress,
compared to the controlled group who received no stress management training. Thus, it was
suggested that the cognitive behavioral stress management training be administered to nurses
within the hospital as an effective means to decrease stress and optimize job performance
(Shariatkhah et al., 2017).
Stress management interventions are available in abundance, are oven low cost or free,
and are easy to implement in the workplace. In a study by Hedman et al., (2016), the
effectiveness of internet based cognitive behavior therapy (ICBT) used to treat and manage
health related stress and anxiety was explored and compared to internet delivered behavioral
stress management (IBSM). ICBT treatment consisted exposure to stress and anxiety related
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situations combined with stress and anxiety prevention techniques (Hedman et al., 2016).
Prevention techniques included mindfulness training and techniques which focused on
identifying stress triggers and acceptance of triggers and stressful situations (Hedman et al.,
2016). IBSM treatment included relaxation techniques, problem solving techniques, stress
reduction techniques, and application of these techniques in stressful situations (Hedman et al.,
2016).
The study by Hedman et al., (2016), consisted of 158 adult who volunteered for the study.
79 adults participated in ICBT treatment and 79 adults participated in IBSM treatment.
Participants in both groups suffered from stress and anxiety for an average period of 13 years and
had previously undergone treatment for these conditions (Hedman et al., 2016). Both groups
completed stress and anxiety treatment that consisted of 12 modules and homework exercises
over a 12-week period. Data and participant feedback were gathered throughout the 12-week
study. The study by Hedman et al., (2016) also reviewed two previous studies previously
conducted which analyzed the cost effectiveness and treatment effectiveness of ICBT compared
to more traditional treatment methods. A comprehensive review of both studies reveals that the
cost difference in ICBT and traditional stress and anxiety treatment methods were insignificant
and ICBT was more effective in treating stress and anxiety (Hedman et al., 2016).
The study by Hedman et al., (2016), concluded that participants in both ICBT and IBSM
treatment had a reduction in costs related to healthcare visits. Individuals who received IBSM
treatment reduced their medication costs. Overall, ICBT treatment proved more cost effective
compared to IBSM (Hedman et al., 2016). ICBT treatment is also highly accessible and readily
available, which allowed individuals to receive treatment in a short time frame. The study found
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that both ICBT and IBSM treatments effectively treated and controlled stress and anxiety among
study participants (Hedman et al., 2016).
Many employees experience stress due to their inability to disengage from work related
pressures and lack of knowledge related to stress management. A study by Tement et al., (2020),
analyzes the effectiveness of two stress management interventions on the overall wellbeing of
employees. The two stress management interventions explored in this study are cognitive
behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) (Tement et al., 2020).
Prior to the study completed by Tement et al., (2020), a preliminary study was completed
in order to identify effective stress management techniques that could be taught online. The
preliminary study resulted in the selection of twenty stress reduction exercised that would be
taught during the training sessions (Tement et al., 2020). MBSR activities included yoga, mental
scanning, deep thought techniques, and other activities. CBT exercises included exercises such
as addressing core beliefs, negative thoughts, and other cognitive training (Tement et al., 2020).
The research methodology utilized in this study completed by Tement et al., (2020), was
internet based and consisted of a randomized control trail including one CBT intervention group,
one MBSR intervention group, and one waitlist control group. All participants were employees
from various industries who all reported some form of stress related to employment (Tement et
al., 2020). The intervention groups completed twelve training sessions during a six-week period.
Training session for both the CBT and MBSR groups included a 30-minute audio guided session
and one hour activity assignments (Tement et al., 2020).
In the study completed by Tement et al., (2020), questionnaires were completed by
participants each week of the training program to measure work-specific and general wellbeing
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outcomes such as burnout, work engagement, workaholism, depression, anxiety, stress, and life
satisfaction (Tement et al., 2020). This study utilized a pretest-posttest design which measured
causes of stress, symptom of stress, and moderators before and after stress prevention training
was completed (Tement et al., 2020). The posttest was completed three months after training
was finalized. The waitlist group only completed the questionaries and did not received any
stress management training or educational material (Tement et al., 2020).
The study completed by Tement et al., (2020), concluded that CBT based intervention is
more effective in helping employees mentally disconnect from the stressors of work when they
are outside of work, which reduced burnout. MBSR intervention is effective in improving the
overall wellbeing of employees and general satisfaction with life (Tement et al., 2020). Although
CBT and MBSR interventions did not produce results that reflect equal benefits for every
employee, the results of the study suggested that both intervention methods are effective
depending on the specific causes of stress (Tement et al., 2020).
A study by Brough & Boase (2019), analyzed how the use of work stress management
techniques used by lawyers impacted their level of job satisfaction, work engagement, and
psychological strain. Two stress management techniques were included in this study, relaxation
and cognitive restructuring (Brough & Boase, 2019). The methodology of this study included an
anonymous survey administered to lawyers that assessed the impact of relaxation and cognitive
restructuring on psychological outcomes and common job characteristics (Brough & Boase,
2019). The survey gathered data on job characteristics, stress management, and dependance
variables using a five-point scale The sample included 114 lawyers employed in Australia, 79
of whom were female, and participants age ranged between 22 to 77 years of age (Brough &
Boase, 2019). Most participants were employed full time in their profession and years in the
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profession ranged from four months to fifty-two years. Legal expertise varied and most
participants were employed in private practice (Brough & Boase, 2019).
As part of the study completed by Brough & Boase (2019), data gathered from
anonymous surveys was analyzed using a variety of methods. IBM SPSS Statistics software was
used to determine if the psychometric properties of the work stress management techniques were
accurately assessed (Brough & Boase, 2019). Harman's single‐factor test was used to determine
if a general theme is identified by the data (Brough & Boase, 2019). Finally, three hierarchical
moderated multiple regression analyses were used to analyze how job characteristics and work
stress management techniques were associated with job satisfaction, work engagement, and
psychological strain (Brough & Boase, 2019).
The study completed by Brough & Boase (2019), concluded that stress management
techniques used by lawyers are extremely effective. Cognitive restructuring was found have a
high association with work engagement and satisfaction, even when work demands were
stressful (Brough & Boase, 2019). Relaxation techniques were found to have a small, but
positive, association with psychological strain. However, associations with other variables did
not align with other analysis, and it was suggested that further investigation is needed to clarify
the influence of relaxation techniques on job satisfaction, work engagement, and psychological
strain (Brough & Boase, 2019).
Stress Management and Human Resources Development
Stress management interventions and employee training are simple and cost-effective
ways to increase the overall wellbeing of an origination (Castillo et al., 2019). As discussed in
this literature review, multiple studies have shown that employees that have been provided stress
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management skills are overall healthier and better employees. Therefore, stress management is a
necessary priority for human resource development. A study by Tonkin et al., (2018),
investigated the effectiveness of employment wellbeing interventions on employees’ stress
coping ability and resilient workplace behaviors. The study was completed online and included a
total of 211 employees from two separate organizations divided into an intervention group and a
control group (Tonkin et al., 2018).
The study by Tonkin et al., (2018), started by administering a survey which focused on
employee behaviors at work and their ability to manage stress. After all participants completed
the initial survey, the intervention group completed a one-month workplace wellbeing
intervention program which included various wellbeing intervention activities offered by The
Wellbeing Game, an online tool developed by the Mental Health Foundation of New Zealand
(Tonkin et al., 2018). Following completion of all activities, both groups were readministered
the survey.
The results of this study by Tonkin et al., (2018), revealed that, following completion of
the workplace wellbeing intervention training, participants employee resilience and wellbeing
increased. Participants of the intervention group reported improvements in their sleep quality,
ability to concentrate, and strengthening in relationships (Tonkin et al., 2018). Employers of the
intervention group reported decreased absenteeism and improved work performance (Tonkin et
al., 2018). The study concluded by offering evidence-based findings that interventions that
support employee resilience and wellbeing are effective and lead to organizational resilience
(Tonkin et al., 2018). Thus, proving stress management interventions and training is an
organizational benefit that should be prioritized by human resource development.
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As discussed, Human Resources Development can use stress management intervention
and training to benefit the organization and employees. Aside from benefiting the organization,
Human Resources Development is ethically obligated to foster the wellbeing of employees. The
Bible explains this moral obligation, Matthew 7:12, “Therefore all things whatsoever ye would
that men should do to you, do ye even so to them: for this is the law and the prophets.” (King
James Bible, 1769/2017). The Bible explains the obligations we have to others and protecting
their interest. Romans 15:1-2, “We who are strong have an obligation to bear with the failings of
the weak, and not to please ourselves. Let each of us please his neighbor for his good, to build
him up.” (King James Bible, 1769/2017).
The Bible emphasizes the importance of being a good teacher (King James Bible,
1769/2017). Organizations must ensure that employees receive the training and interventions
needed to be effective employees and promote their wellbeing. Proverbs 9:9, “Give instruction
to a wise man, and he will be still wiser; teach a righteous man, and he will increase in learning”
(King James Bible, 1769/2017). The Bible also provides guidance on how to support the
wellbeing of others, 2 Timothy 3:16-17 “All Scripture is breathed out by God and profitable for
teaching, for reproof, for correction, and for training in righteousness, that the man of God may
be competent, equipped for every good work.” (King James Bible, 1769/2017). Treating others
well and protecting the interests of other is reiterated multiple times throughout the Bible (King
James Bible, 1769/2017).
A study by Gauche et al., (2017), explored the ethical responsibility of Human Resources
Development to empower organizations to develop work cultures and environments that promote
employee wellbeing. This study utilized a phenomenological methodology which included a
combination of convenience and purposive sampling (Gauche et al., 2017). Qualitative research
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was used to collect data, understand participant’s perspectives, and explore the impact of
resources on the wellbeing of employees who participated in the study. The study sample
included a total of 26 financial service employees located in South Africa who had previously
been identified through an employment survey as being as risk for burnout (Gauche et al., 2017).
Ages of participants ranged from 25 to 35 years of age; 54% of participants were female and
46% were male (Gauche et al., 2017). Data for the study was collected through face-to-face
interviews which consisted of nine questions asked to employees by interviewers. The collected
data was then evaluation using a six-step thematic analysis and used a four-step quality
evaluation strategy to insure trustworthiness of the data (Gauche et al., 2017).
The study completed by Gauche et al., (2017), concluded that employees who were at
risk for employment related stress and burnout lacked the receipt or understanding of stress
management and wellbeing resources provided by their employer. The study provides that
employees who understand employment resources offered by their employer would be more
likely to use them (Gauche et al., 2017). Thus, employers should create employee awareness of
available resources and engage employees in wellbeing interventions. The study suggested that
such a strategy leads to greater employee wellbeing and higher workplace engagement, which
benefits employees and the organization as a whole (Gauche et al., 2017).
A study by Tharikh et al., (2018), explored how an employer contributed to the overall
wellbeing of civil air traffic control employees through employment resources and interventions.
A quantitative approach was used in this study and included and extensive literature review and a
cross-sectional designed survey method (Tharikh et al., 2018). The sample included a total of 43
civil air traffic control employees located in Malaysia. Most participants in the study had more
than 20 years’ experience in their field of work. The survey was based on the Work Design
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Questionnaire and was completed by email (Tharikh et al., 2018). The questionnaire focused on
measuring the participants job performance, work conditions, work demands, and job resources.
(Tharikh et al., 2018).
The study completed by Tharikh et al., (2018), concluded that work conditions and
resources that are influenced or controlled by human resources directly impact the wellbeing of
employees. The study suggested that human resources within an organization should make effort
to better understand the wellbeing of employees, advocate for the wellbeing of employees
through wellbeing interventions and training programs (Tharikh et al., 2018).
Conclusion
There are many valuable lessons that were identified by this comprehensive Literature
Review. There are a wide variety of stress management techniques, interventions, and training
programs for employers to choose from (Hedman et al., 2016). Employers who couple in-depth
understanding of employee wellbeing with the implementation of employee stress management
strategies are shown to effectively improve the overall wellbeing of employees and the
organization as a whole (Shariatkhah et al., 2017). Further, all stress management interventions
explored in this review have indicated positive results as shown in concluding follow up data in
the various studies. The literature review determined that similar stress management
interventions effectively reduce stress in employees in a wide variety of industries around the
world, regardless of age, gender, or other demographics (Tement et al., 2020). This Literature
Review also shed light on the ethical obligations that human resources development has to
protect the wellbeing of employees.
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Implications of this Literature Review added to the scholarly understanding of stress.
Common themes were identified of factors that cause or contribute to employee stress. Specific
chronic health conditions that were related to ongoing stress were explored (Ajayi et al., 2019).
Additionally, the literature review identified how employee stress is responsible for negative
effects on the organization’s productivity and functionality. Stress management techniques
explored throughout this literature review enhanced the overall understanding of how employers
in a variety of industries can actively work to reduce stress and improved employee health. This
information can be utilized by Human Resource Development teams around the world to
improve employee health and organizational functionality.
With respect to the studies analyzed in this Literature Review, additional research should
be conducted related to which stress management interventions are proven most effective
(Brough & Boase, 2019). Additional, research related to the long-term mental health effects and
healthcare costs related to work related stress would be helpful in understanding the overall
benefit of stress management interventions from a healthcare administration perspective.
Further, long term studies would be beneficial in determining if chronic health conditions in
employees were reversed or improved following the implementation of stress management
interventions and training.
LITERATURE REVIEW 17
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