Stressed Out About Stress Management Program
Evaluation?
Ernesto A. Randolfi, Ph.D.
Presented at the
Outcomes of Preventive Health Programs Conference
December 12-13, 1996
Atlanta, Georgia
Presentation Outline
- Review of Stress Related Outcomes
- Research on Clinical Effectiveness of Stress Management
- Research on Stress Management in the Workplace
- Application of Research to Program Planing and Evaluation
- Comprehensive Stress Management Interventions
- Comprehensive Evaluations
Northwestern Life Insurance Survey (1992)
- Seven in ten American workers indicated that job stress is causing
frequent health problems and has made them less productive
- 46 percent reported that their job was very stressful
- 34 percent thought about quitting their jobs because of workplace
stress
- 14 percent left their job because of stress
- Workers who report high stress are three times more likely than workers
reporting low stress to suffer from frequent illness
Research on Stress Related Outcomes
- Psychological Consequences
- Physical Consequences
- Behavioral Consequences
- Organizational Consequences
Psychological Consequences
- Anxiety
- Boredom
- Low Self-Esteem
- Forgetfulness
- Depression
- Anger
- Apathy
- Worry
Physical Consequences (85% of all physical illness is stress related)
- Headache
- Diabetes
- Fatigue
- Hypertension
- Chest and Back Pain
- Ulcers
- Infectious Disease
Behavioral Consequences
- Overeating - Loss of Appetite
- Smoking
- Alcohol Abuse
- Sleeping Disorders
- Emotional Outbursts
- Violence and Aggression
American Academy of Family Physicians
Job stress found to be the greatest cause of poor health habits
Organizational Consequences
- Absenteeism
- Accidents
- Job Turnover
- Low Morale
- Poor Work Relations
- Poor Organizational Climate
- Reduced Productivity
Metropolitan Life Insurance Company (1984)
Average of one million workers are absent on any given day largely due to
stress disorders
Cost to Employers
- Stress on the job estimated to cost businesses over 150 billion dollars
per year (Donatelle and Hawkins, 1989)
- Stress related disability cases have doubled in the last ten years.
- The average cost of each claim in California is $73,270 (Scott and
Jaffe, 1994)
Clinical Effectiveness of Stress Management Modalities
Many interventions have a positive impact on many of the psychological and
physical variables we have identified
Research on Stress Management in the Workplace
- American Journal of Health Promotion Review (1996)
- Cognitive/Behavioral skills impact on psychological outcomes
- Relaxation skills impact on physiological outcomes
- Combination techniques effective across outcome measures
Implications of the Research
Interventions and evaluations should be specific to the institution and
the individual
Worker Stress
- Task/Organizational Stressors
- Personal Stressors
Task/Organizational Stressors
- Task Demands
- Role Demands
- Participation
- Control
- Organizational
- Structure
- Policies
- Values
Personal Stressors
- Personal Problems
- Relationships
- Life Changes
- Lifestyle
- Personality
- Gender
- Age
Target Interventions Through Assessments
Causes of Stress are Multifacited, Assessment Instruments Should be Comprehensive
in Nature
- Job Content Questionnaire (Karasek, 1985)
- NIOSH Occupational Stress Questionnaire (Hurrell & McLancy, 1988)
- Computer Stress Inventory, (Preventive
Measures, Inc..)
Comprehensive Stress Management Interventions
Interventions are interrelated, if changes occur in one area, positive effects
carryover to other areas
- Organizational Interventions
- Individual/Organizational Interface
- Individual Client Interventions
Organizational Interventions
- Policies and procedures
- Workload/Work Pace
- Training and Development
- Employee Assistance/Counseling Programs
- Ergonomics
Individual/Organizational Interface
- Job Demands-Person Style Fit
- Participation Preferences Practices
- Autonomy Preferences Practices
- Co-Worker Relationships
Individual Client Interventions
- Life Situation Interventions
- Perception/Appraisal Interventions
- Emotional Arousal Interventions
- Physical Arousal Interventions
Life Situational Interventions
Involve social engineering and a reduction in the number of stressors one
experiences)
- Time management
- Social Support
- Assertiveness/Communication Skills
- Job Demands
Perception/Appraisal Interventions
Cognitive Restructuring Techniques: Work by changing how one thinks of stressors
- Strategies to Improve Locus of Control
- Strategies to Enhance Self Efficacy -- Self Esteem
- Humor
- Ellis's Rational Emotive Therapy
Emotional Arousal Interventions
Relaxation techniques that reduce the physical response to stress
- Progressive Relaxation
- Meditation
- Visual Imagery
- Autogenic Training - Self Hypnosis
- Biofeedback
- Flotation REST (Restricted Environmental Stimulation Technique)
- Massage
- Freeze Frame
- Yoga
- Tai Chi
- Quieting Reflex
Physical Arousal Interventions
Involve what one must do to relieve the physical effects of stress, or make
one's body stronger and more resistant to stress
- Good health habits in general
- Exercise
- Nutrition
Key Points for Stress Management Programming
- Interventions should be targeted to the individual
- Interventions should target behaviors and be behaviorally based
- Interventions require practice and reinforcement
Evaluation Methodology
- Pre and post Intervention Assessments
- Comparison to a cohort group
- Assessments should test to see how compliant clients are
- Assessment should utilize valid and reliable instruments
Effective Evaluations Assess Measurable and Relavent Variables
- Health care utilization
- Accidents
- Productivity
- Absenteeism
- Turnover
- Worker's Compensation
- Pharmaceutical Data
Psychometric Assessments
- Anxiety
- Job Satisfaction/Stress
- Depression
- Hostility/Anger
- Quality of Life
- Self Efficacy/Self Esteem
- Coping Ability
Physiological Assessments
- Blood Pressure
- Cholesterol
- Sleep Habits
- Muscle Tension
- Cortisol
- Symptomatic Checklists
Cost-Benefit Cost-Effective Analysis
- Many benefits are time sensitive
- Break even point may be delayed
- What is the cost of doing nothing?
Qualitative Assessments
- Cultural Transformations
- Self Efficacy Assessment
- Job Satisfaction
- Employee Morale
References
Hurrell, J. J. & Murphy, L. R. (1996). Occupational stress intervention.
American Journal of Industrial Medicine. 29, 338-341.
(1996) American Journal of Health Promotion. 11: