Chapter 16. Stress, Health, and Coping
- Appreciate the costs associated with stress-related illness in the workplace.
- Understand the unique role that organizational change plays in the growing levels of workplace stress.
- Gain a general understanding of prevalent stress management and workplace wellness strategies.
The Costs of Stress in the Workplace
Stress in the workplace is increasing along with the pace of global change. Bacharach & Bamberger (2007) found that stress is associated with work overload, role conflicts, and job insecurity. Some of the common health outcomes resulting from stress overload are depression, memory loss, poor attention, and anger. Sustained stress leads to cynicism, inefficiency, and exhaustion (Maslach, Schaufelo, & Leiter, 2001; Snyder, 2001). Mental health concerns resulting from stress overload can result in lost workdays, lower employee productivity, and high job turnover rates. These conditions can increase the costs of organizational staffing and health benefits. The inability to cope or adapt to stressful conditions results in poor leadership performance and has repercussions for the stability of organizations (Maki, Moore, Grunberg, & Greenberg, 2005).
Recent studies have confirmed that workplace stressors are associated with physical health impacts such as a greater coronary heart disease risk (Chandola, Heraclides, & Kumari, 2009). Physiological measures that are considered indicators of stress-related disorders such as coronary disease and peptic ulcers include higher levels of serum cholesterol, triglyceride serum, uric acid, blood pressure, and post-morning cortisol levels (Steffy & Jones, 1988). Psychological and social consequences of workplace stress are given a wide exposure in the literature (Barling, Dupre, & Kelloway, 2009; Henning, Hawken, & Hill, 2009, Kumar, Fischer, Robinson, Hatcher, & Bhagat, 2007; Srivastava et al., 2007). Some of the obvious psycho-social indicators of workplace stress include problems with personal and professional relationships, insomnia, headaches, anxiety, panic attacks, and depression (Deckard, Meterko, & Field, 1994; Srivastava et al., 2007). Owens (2001) also explored the prevalence of sleep loss and fatigue among medical personnel and noted links with stress, the incidence of medical errors, and quality of patient care. At one extreme of the continuum, there is also evidence to suggest that job stress is linked to workplace aggression and violence (Barling, Dupre, & Kelloway, 2009). In particular, health professions were shown to have higher rates of workplace stress and the negative outcomes associated with it. Dellasega (2009) found in her survey of over 1,000 health workers that 44% of nurses in the United Kingdom had experienced “peer bullying.”
Common Stress-Coping Strategies in the Workplace
Typically, techniques for coping with workplace stress involve working harder, pushing through, or toughing it out. Such strategies can prove unsustainable over the long term. In fact, some short-term coping strategies, such as presenteeism, which involves working while ill or injured (Aronsson, Gustafsson, & Dallner, 2000), or working harder by putting in longer hours (Worrall & Cooper, 2004) actually exacerbate the costs of stress (Caverley, Cunningham, & MacGregor, 2007; Goetzel et al., 2004; Kivimäki et al., 2005). Researchers have identified three primary domains of human adaptation in stressful situations:
- Emotional management strategies
- Cognitive strategies
- Social support strategies
In a review of literature on organizational factors mediating work stress, key practices found to contribute to improved performance in a stressful workplace included:
- Clarity of roles and tasks
- Opportunity for control and empowerment in relation to work processes
- Open communication and transparency
- Supervisory support in terms of providing constructive feedback and learning opportunities
- Congruency with the organizational vision and values (McAllister & McKinnon, 2009; Schneider, Alexander, Salerno, Rainforth, & Nidich, 2005).
Emotional management strategies can be central to the initial stress response and include how individuals appraise the situation and its degree of threat, how they control the emotional response of fight-or-flight, and what actions they take to reach emotional equilibrium. Critical emotive skills include self-awareness and skills in controlling emotional responses (Barsade & Gibson, 2007; Ciarocchi & Scott, 2006; Mayer & Salovey, 1997; Rosete & Ciarrochi, 2004).
Cognitive action strategies reflect the mental approaches that can be taken to confront and resolve stressors and include the following:
- Analyzing the problem to understand what is happening.
- Establishing who is accountable and for what.
- Analyzing evidence to separate facts from assumptions.
- Acting to establish control over events.
- Reducing confusion and conflict by improving lines of communication.
- Setting goals and engaging in learning strategies that support change and growth.
- Asking questions, observing what works, and adjusting strategies (Siebert, 2005; Stolz, 2000).
Social supports and strong social networks enhance some individuals’ capacity to adapt to stressful work environments. Individuals demonstrate greater ability to achieve effective control over their emotions and behaviours when they access external resources such as friends, social service helping systems, or colleagues and superiors in their organizations (Glicken, 2006; Siebert 2005; Stoltz, 2000). Additionally, organizational supports play a significant role in fostering the ability of the individual to adapt to stressful work conditions (Bacharach & Bamberger, 2007; Bell, 2002; Coutu, 2002; Luthans, Avolio, Avey, & Norman, 2007; Norman, Luthans, & Luthans, 2005; Sutcliffe & Vogus, 2003). Gretchen Spreitzer and colleagues (2005) provide evidence that employees engage in more task focus, exploration, and relating with others when working in an environment that features discretion, information sharing, and a climate of trust and respect.
Interventions to Promote Workplace Health
Ironically, productive workplaces and healthy cultures are often described as being associated with high complexity, rapid change, and risk-taking innovation. Challenge and stress can also support growth. The current literature describes employees who survive in high-demand environments as “resilient” (Maddi, 2006). Likewise, “thriving” denotes sustainable growth in the face of adversity (Carver, 1998; O’Leary, 1998; Spreitzer, Sutcliffe, Dutton, Sonenshein, & Grant, 2005).
In order to facilitate a capacity for greater resilience or thriving in the workplace, many workplaces have adopted a variety of wellness programs, supported to various degrees by the health benefit supplier. Offering gyms, exercise programs, health leaders, health promotion specialists, and vouchers for external programs in or near the workplace are common initiatives.
Walinga and Rowe (2013) found a variety of strategies facilitated a thriving response to workplace stress in a work environment. Most important was offering training in the use of coping strategies to address the underlying issues rather than simply fixing the problem in an effort to make it go away quickly. Other workplace initiatives that can foster a thriving resilience to stress include:
- Cognitive appraisal training to help individuals recognize and see beyond what they cannot control in order to frame the problem more systemically and inclusively.
- Social and organizational initiatives that support a culture of open communication, psychological safety, and the capacity to identify the main problem and reveal sources of personal power and control, which are needed to support the problem solving, communication, and reflection necessary to thrive amid stress.
- Communication and problem-solving strategies being developed and enhanced through training in communication planning and in the design of communication systems that facilitate problem solving and implementing solutions.
The organizational culture of a workplace can likely have more impact in fostering an environment that helps employees be more resilient to stress within a fast-paced, quickly changing, complex environment. Organizational culture is the values, beliefs, and assumptions of an organization enacted through its various structural, political, and communication channels and artifacts (e.g., organizational chart, power structures, roles and responsibilities, types and timing of communications, layout of office space, access and availability of resources all communicate various beliefs, values and assumptions) (Schein, 2004). Fostering a climate and culture that values health, offers psychological safety, and promotes learning from errors or failure is critical to developing a stress-resilient, thriving, or coping capacity within employees.
Research Focus: Coping with Workplace Stress
The notion of adaptation and resilience resonates within the health profession literature. Sisley and colleagues (2010) developed a model and intervention based on the cognitive appraisal theory of stress and coping (Lazarus & Folkman, 1984) designed to address chronic workplace stress and the resulting state and consequences of over-arousal. In a review of resilience in relation to health professions and their adaptation to the health workplace, McAllister and McKinnon (2009) found that resilience has personal and cultural aspects that are required when faced with demanding work environments. For example, every day nurses and paramedics are placed in traumatic or crisis situations that are extremely adverse. The researchers point to the accumulation of stress over time as the biggest threat to the health and well-being of health professionals. People tend to have a reasonably constant normal state of arousal when awake until some event or activity changes their state of arousal significantly. Sleep is one such change; the fight-or-flight response to an acute stressor is another.
Ideally, individuals would have an opportunity to recover fully from the physiological changes produced by the stress response, and their arousal profile would return in due course to its normal levels. However, in many workplace environments, and especially in the health professions, the frequency of stressors is high enough to prevent recovery. In these cases, individuals begin to recover from one acute stress response but have not yet completed the process when another stressor occurs, producing an overlapping stress response. In a high-stress environment, the frequency of stressful events can prevent individuals from fully recovering from or ameliorating the stressor and consequently returning to the original state of arousal until they have finished work for the day. Recovery at this stage is likely to take longer than it would from a single stressful event — a product of accumulative stress. If the workplace is chronically stressful, the result can be an enduring change in arousal state, with that a higher level becoming the new “normal” state, interrupted only by sleep.
The researchers suggest that practising effective relaxation can reverse this cumulative process and actually lower a person’s “normal” arousal state, making the individual more resilient overall. The concept is that after a session of, say, tai chi, progressive muscle relaxation, or transcendental meditation, the person’s arousal index will have fallen significantly, and when that person returns to usual activities he or she will retain a slightly more relaxed state than normal. Over time, typically several months, this change can become lasting, resulting in a new lower “normal” state of arousal — almost a mirror image of the higher arousal produced by long-term stress.
- Stress in the workplace has many physical, psychological, and social costs to the individual with associated social, cultural, and financial costs to the organization.
- Common coping strategies typically include working harder. Presenteeism is the concept of attending work despite illness or injury and has been shown to have negative effects on productivity and health of the organization.
- Other coping strategies include emotional management, cognitive strategies, and social support networks.
- Interventions to stress resilience or thriving in the workplace include building wellness programs, a healthy organizational culture, access to social support networks, system-wide communication strategies, and a process for reframing the core issue or stressor as an opportunity for growth.
- A unique approach to building stress resilience in the workplace is to monitor acute stress events and arousal state and offer regular opportunities to recover or relax fully from these events in order to return an individual’s arousal state to a normal.
Exercises and Critical Thinking
- In your group, conduct a stress audit of one of your workplaces. That is, in general how stressful would you rate this workplace on a scale of 1 to 10? What are some of the stressors inherent in the nature of the work or in the nature of the work environment? What stressors might lead to chronic stress? What stressors might be perceived by some individuals as negative and by others as positive?
- What workplace stress management strategies are you most familiar with? What alternative stress management strategy might you be comfortable using? What would make this strategy effective in your opinion?
- Think of a particularly stressful incident you have experienced in your workplace that you believe you handled well. Reflect on what stress management strategies may have come into play in facilitating a positive outcome: emotional management, cognitive management, and/or social support.
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