Stress Interventions Management
There is nothing novel or striking in the observation that work organizations and other institutions introduce polices and practices in the absence of evidence for their effectiveness.
What are the main types of stress interventions used by organizations? Critically evaluate the evidence for their effectiveness? How can stress interventions be made more effective?
Stress management interventions (henceforth SMIs) has been defined as an activity, program or opportunity which aims to decrease the presence of work related stressors or to support individuals in coping more effectively with the adverse impacts of stress (Ivancevich, Matteson, Freeman and Philips, 1990). From an organizational perspective, stress interventions would aim to improve the effectiveness of employees by reducing the levels of those phenomena (e.g. turnover, absenteeism and loss in motivation) which are believed to be caused by stress (Briner, 1997).
Stress interventions have been categorized by different researchers in a number of manners. These approaches, amongst other criteria, differentiate stress interventions according to the level of intervention (Icancevich et al, 1990, Reynolds and Briner, 1994); its focus and expected outcomes (Ivancevich et all 1990; De Frank and Copper, 1987 as cited in Dewe, 1994). For instance, Murphy (1988) categorized stress interventions into primary, secondary and tertiary. Primary interventions focus on minimizing the causes of organizational stress. Secondary interventions aim to focus on equipping people with skills that help them cope successfully with job conditions and stressors, whereas tertiary interventions focus on treating individuals who are experiencing distress. Stress interventions have also been classified as individual interventions, individual/organizational interface and organizational interventions (De Frank and Cooper, 1987). The former interventions attempt to develop actions and strategies that can be used by individual employees, which in turn may help them to deal more effectively with difficult work conditions and demands. Organizational interventions, on the other hand involve techno- structural interventions, which aim to minimize stress by modifying certain features of the work environment (Matteson et al. 1990). Individual/organizational interface are less technical in nature and aim to focus on certain aspects which may be problematic such as person- environment fit and problems at work (Cooper and Cartwright, 2007).
Individual based interventions together with secondary and tertiary interventions are conceptually similar because they reflect the subjective concept of stress. They typically aim to equip individuals with skills that enable them to cope with stressors and include interventions such as Stress Management Training (henceforth SMT) and Employee Assistance Programmes (henceforth EAPs). Organizational focused interventions on the other hand are similar to primary interventions because they focus on changing the objective work environment and aim to reduce specific job stressors. They mainly include, what is termed as, technostructural interventions within the organizational development literature, such as increasing role clarity, reducing job demands and increasing employee autonomy (Freidlander and Brown 1974).
Identifying the “main” types of stress intervention techniques used in organizations, is not an easy task especially because there is not much evidence about what sort of stress management interventions are implemented within organizations (Briner, 1997). I will thus focus on those interventions that are mostly researched within the literature of organizational psychology i.e. SMIs, EAPs and organizational interventions mainly (name). I will be discussing organizational based interventions from a broader perspective because research and designed evaluations of these interventions are limited (Bunce and West, 1996; Ivancevich and Matteson, 1987; Reynolds and Briner, 1994). Throughout this essay, I will argue that stress management interventions are not as effective, as organizations and the mainstream literature perceives them to be, mainly because of theoretical misconceptions of the concept of “stress”, methodological weaknesses in stress related studies and lack of effective evaluations of stress interventions.
To which extent are stress management interventions effective?
Before discussing the extent to which specific stress management interventions are effective, I will argue in this section, that one of the major shortcomings of SMIs is that although they are assumed to reduce stress, the definition and conceptualization of stress is ambiguous and conflicting. Furthermore, within the stress literature, few empirical researches have studied the effectiveness on SMIs despite the fact that within most organizations SMIs are being popularized.
What is stress?
The meaning of “stress” has until now not been clearly defined and there is no single agreed definition of what stress is (Cox, 1985). Researchers, within different fields conceptualize stress differently, ranging from early models of stress as an adaptive response to strains (Seyle, 1957) to interactional and transactional approaches of stress as a process between the individual's responses to external stressors (Cox, 1978; Fisher, as cited in Reynolds and Sapiro 1986, Lazarus). The lack of clarity and the broad conceptualization of “stress” contributed to a scientific fragmentation of the concept, inadequate theories, and confusion in research (Dewe 1989; Newton 1988 as cited in Reynolds and Sapiro; Pratt and Barlin, 1988 page 38 research guide; Briner, 1997). Yet, ironically a “stress” industry had been popularized and integrated in various life sectors including the workplace, creating an increasing demand for stress-management services within organizations (Palmer and Dryden,; Reynolds and Sapiro, 1991; Briner and Reynolds, ).
It is assumed that stress has negative consequences for both the individual and the organization, often represented as illness amongst employees and economic loss to organizations due to absenteeism, loss of motivation and reduced performance. (Reynolds and Sapiro; Briner 1994; Briner 1997). Stress management interventions are thus introduced within organizations, to reduce stress and consequently enhance increase employee effectiveness. However, over and above the fact that the evidence to support the relationship between stress and ill health is conflicting and inconclusive (O'Leary 1990; Cohen and Williamson 1991 and Weisse 1992), it is somewhat naïve to assume that the relationships amongst human behaviors operate in such a simple cause and effect fashion. Furthermore, the assumption that reducing stress will lead to increased performance and effectiveness, has lead researchers, mainly from a positivist paradigm, to consecutively study stress and its outcomes, at the expense of ignoring why or how the relationship between stress and its outcomes may function (Briner and Reynolds, 1999).
The Effectiveness of Individual based interventions
Individual based interventions aim to equip employees with the requisite skills in an attempt to diminish the adverse impacts caused by occupational stress (Burke, 1993). Briner (1997) identifies Stress Management Training (henceforth SMT) and Employee Assistance Programs (henceforth EAPs) as the most common types of individual based interventions. However, despite the fact that both interventions function within the same unit of analysis, SMT has been categorized as a secondary level intervention whereas EAPs as a tertiary level intervention. This is because whereas SMT aim to give people skills to cope with stress, EAPs offer assistance to individuals who are already experiencing distress (Briner, 1997).
But how effective are these stress management interventions in helping employees coping with occupational stress? If I had to answer the question by simply acknowledging the face validity of such interventions, I would confidently conclude that most individual based interventions have been successful. But a more critical analysis of the situation seems to suggest that most individual based interventions are simply selected using anecdotal information and not on evidence based approach scientific evaluations (Reynolds and Briner, 1994).
Throughout this section I will critically discuss the effectiveness of the above mentioned stress interventions i.e. SMT and EAPs as encountered in the literature.
Effectiveness of SMT
SMT aims to equip employees with certain skills which are believed to help individuals to cope with stress. These take the form of a short training course, typically based on a cognitive behavioral approach. It includes different forms of training such as relaxation techniques, time management skills, cognitive techniques, biofeedback and assertiveness skills.
SMT studies have reported moderate improvements in self reported perceptions of stress (e.g. Ganster et al. 1982; Murphy, 1988, Cecil, 1990; Grossman, 1993; Hyman, 1993). Yet there has been weak or no significant evidence, which suggests that that SMT can have an impact on desirable employee behaviors such as job satisfaction, organizational commitment; motivation and reduction in sickness absence leave (Whatmore et al; 1994; Reynolds et al 1993; Murphy and Soreson, 1988; Sallis et al 1987; Bond and Bunce 2000).
Studies also show that self reported perceptions of stress post SMT seem to be only effective for a short period (Ivancevich et al 1990; Giga Cooper and Faragher, 2003). For instance, a study in a UK government department found that most beneficial outcomes of stress management techniques (personal stress awareness, exercise and cognitive restructuring) on the participants' mental health were only evident at three months post training period but were not evident after six months (Whatmore et al. 1999). Briner (1997) posits that these brief effects may be simply attributed to the “good feeling factor” stemming from the mere participation in the training; rather than from its' contents.
Indeed the “equivalence paradox” (Stiles, Shapiro and Elliot, 1987) which occurs when conceptually different interventions obtain similar outcomes (e.g. Bond and Bunce, 2000; Sallis et al 1987) may support Briner's argument that non- specific factors such as positive feelings elicited from participating in the training, may be more beneficial than the technical content of the SMT itself.
Another explanation for the “equivalence paradox” may stem from methodological weaknesses and deficiencies in research designs, resulting in studies which may not be sensitive enough to discriminate between the outcomes of different stress management interventions (Bunce, 1997). Furthermore, most studies utilized a small sample and thus were unable to statistically analyze inter-group differences in order to delineate results achieved from different training methods (Murphy, 1984; McLeroy at al. 1984 as cited in Bunce 1997).
SMT evaluative studies suffer from other methodological problems such as the omission of follow up studies and control groups (Higgins, 1986; Ganster et al. 1982; Cecil, 1990; Grossman, 1993; Hyman, 1993). Briner (1997) further argues that another major flaw rests in SMT evaluation designs. He posits that evaluative researchers usually study SMT as if it was a treatment and not a preventative measure. Consequently, researchers implement study designs with the aim of measuring the impact of SMT on well being, whereas a preventative measure, in itself, will not necessarily lead to instant benefits.
Thus despite the apparent positive outcomes of SMT towards individual participants such results cannot be confidently generalized due to methodological shortcomings. In practice, however the above mentioned problems may be difficult to eliminate especially because SMT tend to vary in content, duration and number of participants (Van der Hek and Plomp, 1997).
Another problem in SMT studies may stem from the principle of SMT itself. Briner (1997) posits that SMT revolves around the assumption that if individuals learn how to use stress management skills, they should be able to minimize the adverse impact of stressors. However, such reasoning rests on the assumption that skills, despite their complexity, are being effectively transmitted to participants without addressing the competency of the trainer or any individual differences (Briner, 1997; Palmer Dryden, 2007; Icancevish et al 1990). This lack or recognition of individual differences and their needs is reflected in how SMT has been offered as a pre-programmed packaged format (Kahn and Byosieri, 1992 as cited in Reynolds and Briner), at the exclusion of a thorough assessment of what is actually required both at the individual and at the organizational level (Ivancevich and Matteson, 1987 as cited in Reynolds and Briner, 1994).
Moreover, SMT are based on the presumption that certain factors are more important than others in diminishing the negative effects of stress. For instance, it may be assumed that coping skills may be more useful that personality in dealing with stress. Indeed research has suggested that certain personality traits such as negative affectivity, external locus of control and Type A personality can amplify one's perceptions and predisposition to stress (Spector and O'Connel, 1994, Cassar and Tattersall, 1998; Rees and Cooper, Ganster, 1987).
Effectiveness of EAPs
EAPs are broad programs aiming to assist employees by providing various services including counseling, health, legal and financial advice. Despite the growth of EAPs across different organizations within several sectors, rigorous scientific studies, accounting for their effectiveness continue to be minimal in the literature (Caroll, 1996; Berridge, 1999, Blaze- Temple and Howat 1997, Loo 1994. Mc Donald et al 1997; Murphy 1998 as cited in Arthur, 2000).
A number of authors (e.g.) have portrayed EAPs in a positive light, citing research suggesting that EAPs are a sustainable investment for organizations. Studies, especially in the US have supported (e.g. Shneider, Casey and Kohn, 2000; McClelland, 1989, Alexander and Alexander, 1989; Holder and Blose, 1992) this argument by suggesting that EAPs have improved the mental health, stress levels and effectiveness in employee performance. Despite the insistence of EAPs advocates that such programs are beneficial for the employee and the employer, sound empirical evidence, accounting for EAPs effectiveness seems to suggest otherwise (Arthur, 2000). The appraisal of EAPs has also been put in question because of conceptual and methodological weaknesses.
One of the few evaluative studies of the outcome of stress counseling took place in a UK Post Office (Cooper and Sadri, 1991). This study involved a sample of 250 employees working across all the hierarchical levels, from shop floor to management, and who received counseling over a period of one year. Compared with a control group, those employees who received counseling services took less sickness absence leave, reported an increase in their self esteem and also claimed lower levels of anxiety and depression. This study also showed that there was no significant improvement in employees' job satisfaction and organizational commitment, even after they received counseling. Thus it seems that although counseling has some positive impact on individuals, it proved to be less effective for the organization. This trend has also been found in a study commissioned by the UK Health and Safety Executive on the effectiveness of counseling as part of an EAP (Berridge et al. 1997). This study within nine companies concluded that although counseling may have psychological benefits for the individuals it has fewer benefits for the organization. Indeed, this study suggested that apart from a reduction in sickness absence leave, there were no changes in turnover, morale, productivity and stress levels, which would have been of benefit to the organization.
Similarly a study in a transportation company in Canada found that, compared to a control group, employees who were making use of an EAP were satisfied with its effectiveness because they perceived a positive impact on their well being as well as on their work performance. However, data collected from company records suggested that there were no improvements in absenteeism rates, lateness and sickness absence among EAP users. Surprisingly enough, absenteeism and sickness absence increased among EAP users during and after the treatment (MacDonalad, 1997 et al). Although, such results in themselves may seriously question the extent to which EAPs are effective especially for the organization, one cannot simply draw conclusions, especially because this study was not free from methodological flaws. In fact one of the major limitations of this study was that EAP users were not compared to other employees, within the same company and who were not EAP users, but were compared to a sample of the Canadian population.
The above mentioned studies suggest that the effectiveness of EAPs has only been perceived as effective from the subjective perceptions of EAP users and counselors. However, research does not support the assumption that EAPs are sustainable for organizations, especially because research suggests that there was no significant increase in employee's productivity, morale, performance and turnover amongst EAP users.
Such disappointing findings may be stemming from a conceptual limitation of EAPs in themselves, suggesting that by reducing employees' negative affectivity, performance will increase (Briner, 2000). However, research focusing on emotions at work does not support the notion that “a happy worker is a productive worker” (Briner and Reynolds, 1999 and see George and Brief). Indeed, research shows that positive affectivity may act as a distracter to performance (source). Moreover, Briner (2000) argues that employee performance is not simply restricted to how the employee is feeling, but is a hybrid of factors including the relationship at work, the task itself and the skills of the individual employee amongst other things. Thus, as Lazarus (1995) suggests EAPs may be only addressing employee problems superficially while ignoring contextual differences in the nature of the problems and how people may react differently to stress.
A number of methodological shortcomings further question the extent to which EAPs are effective for both the employee and the employer. One of the limitations rests in the fact that a number of so called “evaluative” studies, often conducted by stakeholders which are interested in demonstrating that EAPs are successful interventions, lead to bias and unreliable studies (Berridge et al 1997 as cited in Arthur). Such studies do not offer a comprehensive assessment of the situation because they tend to focus on alcohol and drug based EAPs. Consequently these findings cannot be generalized to other type of interventions used in EAPs both in the US and in other countries (Arthur, 2000; Mac Donald et al 1997).
Csiernik, 1995 (as cited in Arthur, 2000) further argues that due to a number of methodological weaknesses in studies, it would be difficult to make inferences as to determine whether the success claimed can be attributed directly to EAPs. Methodological weaknesses include assessing the program immediately after the person has undertaken counseling, omitting the use of longitudinal follow ups and control groups. Control groups and longitudinal studies are particularly important because they allow the researcher to be able to determine whether the desirable changes are attributable to the EAP itself. The difficulty in obtaining hard data about employees due to restriction in accessibility to employee records, has been acknowledged both as a methodological weakness which leads to biased studies (Csiernik, 1995) as well as a mere shortcoming in the nature of EAPs themselves (Highley and Cooper, 1994). The latter sustain their argument by claiming that issues of confidentiality and ethical considerations may hinder hard data collection, making it more difficult to evaluate EAPs effectiveness. It has also been acknowledged that EAPs are so diverse in the different kind of programs which they provide that it is difficult to assess and compare their effectiveness (Berridge and Cooper, 1993 as cited in Dewe, 1994).
However, other argue (Mc Donnel Douglas, Swanson and Murphy as cited in Highley and Cooper) that the lack of evaluative studies is attributable to the resistance made by providers of EAPs services, and who use the argument that the benefits and positive impact of EAPs cannot be quantified. However, McDonnel Douglas argues that this is just a myth and providers simply use this argument because they fear that studies may illustrate otherwise.
Perhaps Briner's less orthodox views may be insightful in establishing the criteria when assessing EAPs. Briner (2000) identifies a number of costs and indirect beneficial outcomes of EAPs for both the organization and the individual. He argues that although EAPs may be effective in solving individual problems related to the client's work environment and which may be common to a number of clients; this may remain unsettled at the organizational level. This may lead to a short lived effectiveness, despite the costs, and energy levels involved in dealing with the problem individually. The use of an external EAP may also have negative implications on the organization, suggesting that the organization is avoiding dealing with the employee problems, and instead is referring them to external services.
Briner (2000) also recognizes that EAPs may have indirect positive outcomes, for example through the process of emotional contagion (Parkisnon et al 1996 as cited in Briner, 2000) due to counseling interventions from one employee to the rest of the team.
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