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Stress in the workplace: sources, strategies and interventions

The workplace is constantly changing with time. Historical perspectives suggest that major changes in the structure of the workplace, such as the Industrial Revolution and the electronic revolution, have led to a major shift in the fundamental balance between mental and physical components of a typical job.

The general trend of industrial progress has tended to be accompanied by a general reduction in the amount of heavy physical work that needs to be done by humans.

According to von Onciul (1996):
Mental and emotional strain have increased in new working environments that are characterised by lack of time, more uncontrollable factors, background distractions, lack of space, general uncertainty, and more administrative work.

There are a huge number of potential stressors that can generate stress in an individual worker and indeed, the same stressor may well generate different levels of stress in different workers. (Lynch et al 1997). They can be generally categorised as either physical, mental or emotional stressors. In this regard we consider physical stressors in the workplace to be conditions such as noise or heat (or lack of it) and occasionally chemical considerations. Emotional stressors can range from examples such as bullying, sexual harassment or a change of job.

In general terms, stressors tend to be additive in their effect and that effect is usually magnified by chronicity. For example, the stress of going to an important business meeting can be exaggerated considerably if the car breaks down on the way. Equally a job done in a noisy atmosphere will typically produce higher stress levels if the noise is prolonged or constant. (Peter et al 1998)

In terms of our specific considerations of stress in the workplace, we should note that different people, with different values, experiences and differing abilities to adapt to situations, will react to stress in different ways (Vrijkotte et al 2000)

It will become clear, as we examine the evidence, that the stress response is a successful evolutionary adaptation of an organism. In human terms, it is often necessary in order to keep a person both motivated, adaptable and interested in a particular task. As we shall discuss in the context of this dissertation, it is when a person actually becomes over-stressed, when demands made on either mind or body are too high, made over too long a period of time, or are actually more than can be met by an appropriate adaptive response, then the person can exhibit signs of becoming distressed. This may manifest itself in a number of ways which we shall explore. (Macleod et al. 2001)

We shall also discuss the problems encountered by the huge number of variants of both cause and presentation of stress-related symptoms. The causes can be as varied as interpersonal problems with new working colleagues or new managers, or on the other extreme, impending redundancy (or the perceived threat of it), is an equally potent cause of stress-related symptoms. (Morris et al 1994). Something as nebulous as distracting noise in the environment can cause a totally disproportionate stress reaction in a susceptible person. (Marmot et al 1997).

Part of the problem relating to stress in the workplace, is that suffering from stress (particularly the somatic manifestations of stress), is often perceived by some workers as a form of weakness, a lack of stamina or character, or even abject failure, with an associated stigma that goes with failure or an inability to achieve a goal. The realisation that stress in the workplace is often treatable, can be a revelation to some sufferers. They may well have been labouring under the delusion that they had to just get on with it which in its turn may well have lead to more stress and further failure.

The pathophysiology of stress

To the man in the street, stress is a sensation that he thinks that he can both recognise and deal with. On a colloquial level, this may, of course be true. If we consider a deeper and more analytical look at the situation we quickly discover that stress is difficult to define, (Brown 2002), has a multitude of different psychological and somatic sequelae, and is coped with and responded to by different people in a multitude of different ways. (Reed et al 1999)

In this dissertation we are primarily concerned with occupational stress, or stress in the workplace. We shall consider its aetiology, its detection, its management, its treatment and the legislation that is designed to both prevent, reduce or control it.

We shall consider the differences between psychological and biological ( physical) stress. These two entities are obviously related, but are clearly different. The reason that stress is difficult to define is that it is manifest by a multitude of different responses to a large number of possible causes. (Crampton et al. 1995)

Crampton's article is a particularly useful starting point for our considerations. It is an impressive tour de force of the current status of stress research. In it, she discusses the evolution of the various definitions of stress. Selye is a name that is frequently seen in matters relating to stress research. Crampton refers to him as the Father of the field). He defines stress as “the non-specific response of the body to any demands made upon it” (Selye 1956).

Anshel, (et al 2001) take this definition and modifies it to include the fact that stress can be considered to be an internal state or a reaction to anything that we perceive as a threat, consciously or unconsciously, whether it is real or imagined.

Barlow (2000) Tells us that stress has the ability to evoke a number of emotions and feelings including fear, pressure, anger, inadequacy, loneliness, frustration, conflict, hurt, sadness, guilt or even confusion.

Poczwardowski (et al. 2002) divide stress into positive and negative types. They give examples of negative stress as the loss of a relative or family member whereas positive stress arises from a promotion at work or the organisation required to go on a holiday.

Theorell (et al 1996) points to the fact that many people subscribe to the popular belief that if they avoid stress they will live longer while in collaboration with Karasek (Karasek & Theorell 1990), he argues that stress is actually a vital and necessary ingredient of human life which is a trophic factor for both development and survival.

Consideration of these various definitions tells us that Selye is giving us a basic definition of biological stress while the others (Anshel and Barlow) are considering the fact that there are psychological factors that can generate various biological responses.(MacHale 2002)

Marmot (et al 1997), adds a clinical dimension by dividing the population into copers and non-copers by the way that they either cope, or fail to cope with the stresses that are incumbent on them at any one time.

The trophic effects of stress we shall discuss later in more detail, but in general terms there is little doubt that stress does have a direct and measurable effect on performance (both physical and cognitive). (Lynch et al 1997)

There is plenty of experimental evidence to show that individuals who are chronically overstressed may have their attention span reduced and their interpretative ability impaired, thereby performing less well than they might, (Cheng et al 2000), while those that are less than optimally stressed may not make maximal effort to achieve their own goals and targets. (Karasek 1989).

To either side of the norm is a zone of potential sub-optimal performance. In the context of the workplace, it is the skill of the experienced manager that ensures that the workforce is sufficiently stressed to perform well (motivation) but not so overstressed that their productivity is impaired. (Alterman et al 1994)

We cannot leave this area without at least passing comment on the much publicised area of Post-traumatic Stress Disorder. There is considerable controversy about the exact incidence, causation and in some quarters, even the legitimacy, of the diagnosis.

Post-traumatic Stress Disorder (Shalev et al 2001) is thought to be a specific variant on the more prevalent basic anxiety disorder syndrome. It tends to arise as a result of witnessing or dealing with a discrete stressor which is completely outside of normal experience. It tends to be characterised by the manifestation of any one of a number of symptoms, which can be either subacute or chronic. Typically it has elements of intrusion of unwelcome thoughts and experiences that can be associated with the original triggering event. (Ismail et al. 2002)

Classical treatment is to use debriefing techniques after the event, but there have not (to date) been any convincing studies that demonstrate the efficacy of this approach. (Hotopf 2000)

As we have implied above, there is a considerable range in the ability of individuals to actually manifest these various clinical conditions. This can be influenced by factors such as heredity (genetic factors), which can influence the nature of the acute response, and other factors such as the lifestyle of the individual concerned. (Dembe et al 2005). This, together with factors such as education and environmental considerations, will ultimately determine exactly what range of coping or adaptive strategies are available to any individual. (Liu et al 2002)

Some authors point to factors such as work style, attitude towards the unpredictable, and confidence in one's own abilities as being significant factors as well. (Tapia Granados 2003)

It would appear that stress in short bursts or infrequent episodes of high intensity stress are neither harmful nor necessarily associated with increased incidences of morbidity. Some authors suggest that this is actually a trophic situation rather than an inhibitory one. (Elisburg D 1995). It appears to be the chronicity of unresolved stressful situations that increases the incidence of stress-related illness.

The human body has evolved over the millennia to respond to acute and extreme situations of stress, but there appears to have been little evolutionary need to adapt to chronic stress situations. As a result, the persistence of the unresolved stressful situation keeps the body in a state of prolonged or constant activation, which (figuratively) increases the rate of wear and tear, or biological breakdown of the various biological systems. The cardiovascular system appears to be the system that shows the greatest and most significant changes.

In Selye's scheme, the exhaustion stage correlates with a build up of chronic fatigue and the body then fails to repair of maintain its defence systems. In the long term, damage results from this inability to sustain homeostasis and the risk and incidence of injury or disease starts to escalate. (Bond et al. 1998).

This is manifest by an American study, which is useful as the American system of healthcare is far more cost orientated than the NHS. As a result, it is easier to tract the exact costs incurred with each individual patient or class of illness. This particular study found that expenditure on health care was, on average nearly 50% higher for workers who self reported high levels of stress at work. (Goetzel et al. 1998)