Stress prevention can be achieved with different sorts of programs (ivancevich & Matteson, 1988; Murphy, 1988; Murphy, 1996; Theorell, 1993). In the United States, stress interventions are often only directed at the individual in the sense of stress management programs. In Europe, there has been a bit more emphasis on job-oriented stress interventions such as job restructuring (which increases the resources control and skills; Cooper & Payne, 1992). Table 18.4 displays
organizational and personal approaches to stressors, strains, and resources. Although the differentiation in various approaches is convenient, in many cases multiple approaches are combined—for example, institutional resource enhancement and individual stress-management programs (cf. Kompier, Aust, Van den Berg, & Siegrist, 2000; Kompier, Cooper, & Geurts, 2000).
Stressor Reduction
Stressors can be reduced by individuals or by institutions (or some combination). Examples for the latter are reduction of noise, change of assembly line speed in accordance with the circadian rhythm, reduction of interruptions at work. Individual stressor reduction is often an outgrowth of stress management programs that alert people to the fact that they can ^hange certain parts of their work environment. However, individual stressor reduction often presupposes a certain amount of control over work (or in general, a certain amount of resources). Certainly, people have an impact on what the job looks like—including the stressors and the resources (Ilgen & Hollenbeck, 1991). As discussed previously, we do not know of any studies, however, that have examined how resources affect stressors or vice versa. These studies are necessary to understand how people as individuals change stressors.
Institutional stressor reduction approaches may take many different forms. A general stressor reduction approach (or better exposure time reduction) is to decrease the number of working hours, which seems to have positive effects, as reported in some company reports (Kompier, Aust, et al., 2000) and in a meta-analysis (Sparks. Cooper, Fried, & Shirom, 1997). Other institutional approaches reduce specific stressors that are suspected to be problematic. For example, an organization may reduce noise and may ensure a better flow of material, thereby reducing organizational problems—or there may be a reduction of time pressure, task ambiguity, or task difficulty. Such institutional stressor reduction approaches are useful, although problems may arise if such an approach is used singly and not in combination with other approaches: nrst, reducing stressors may sometimes lead to a reduction of challenges. If there is high qualitative overload, one may be tempted to reduce overload by decreasing the cognitive demands of a job. This can, however, reduce not only overload ma*so challenges and resources. A case in point was the ef-°rt to reduce external disturbances in secretaries by intro-ucing central typing pools. In this case, interruptions and 'sturbances—stressors about which secretaries frequently mplain—were reduced, but this also reduced control over w and when to do a job and reduced a clear and reliable
Stress Interventions 475
relationship between a secretary and his or her boss. Second, because technological and organizational changes are quite frequent and increasingly rapid, research is too slow to tell us which stressors are particularly problematic and need to be taken care of. Therefore, reduction of stressors should be accompanied by an increase in resources.
Increase in Resources
Two important resources at work are control at work and competencies or skills. Resources in the sense of control or participation in decision making help individuals to have an influence on how to do their work and to increase or reduce stressors appropriately. Stressors that come about through new technology can best be addressed when resources are given to influence one's work. Thus, restructuring work by increasing job content and responsibilities often has a stress-preventive function as well. At least two careful studies on the effects of institutionally increasing control have been done (Jackson, 1983; Wall & Clegg, 1981). Jackson (1983) used a four-group Solomon control group design to study the effects of enhanced participation (increase of group meetings) in decision making that she hypothesized to increase power, information, and social support. An increase of participation in decision making decreased emotional stress, absence frequency, and turnover intention. Wall and Clegg (1981) showed that increase in autonomy and control by introducing semi autonomous work groups led to short- and long-term (12 months after the study was ended) increases in mental health. Unfortunately, this effect could not be replicated in another study (Wall, Kemp, Jackson, & Clegg, 1986).
Increasing individual competence and skills is also an aspect of resources, although it has not been typically discussed as a stress prevention technique. Without the necessary skills it is not possible to use control (Frese, 1989). Three arguments speak for the importance of competence as a resource in the stress process. First, working smarter, not harder is a good description of what superworkers—that is, excellent performers—do (Frese & Zapf, 1994; Sonnentag, 2000); because working smart implies using efficient rather than inefficient action strategies, this means that employees experience less stress when working smart. Second, it follows from the P-E fit model (cf. our discussion of this model earlier in this chapter) that people can increase the fit by developing their competence to deal with environmental demands. When a person is supposed to produce a certain number of products, development of skills helps him or her to actually do that—the P-E fit will be high and strain low. Third, self-efficacy is intimately related to competence. Bandura (1997) has argued for the strain-reducing function of self-efficacy in
and—finally—there was also a positive performance effect (r=. 296; Saunders eta]., 1996).
One meta-analysis of 16 work-related stress management studies found an average effect size of 0.41 (Bamberg & Busch, 1996). A second, more recent meta-analysis (Van der Klink et al., 2001) found somewhat different effect sizes for 18 cognitive-behavioral studies (d = .68), 17 relaxation studies (d = .35), and 8 so-called multimodel approaches (acquisition of passive and active coping skills; d = .51). Thus, stress management programs increase health by about a half of a standard deviation. The study by Murphy (1996) corroborates these results by showing that published reports on 64 stress management interventions show on average between 59% (for job and organizational outcome measures) and 68% (for physiological and biochemical outcome variables) positive and significant results. Furthermore, those interventions that used a combination of approaches (e.g., relaxation and I cognitive-behavioral techniques) tended to lead to the best results. Murphy (1996) and Van der Klink et al. (2001) also reported results for more disturbed individuals and for remedial interventions to be better than results for normal employees or preventive approaches; this implies that clinical studies show better results than does stress management training for unselected working populations. An additional constraint of most stress management programs is that they presuppose that the employees can actually do something about their stress levels (i.e., have at least some measure of control at work). Employees with a high degree of control at work and with higher status jobs showed better success in stress management interventions than did low-control or low-status job employees (Van der Klink et al., 2001). For this reason, stress management programs are probably less useful for blue-collar workers than for white-collar workers and managers. Thus, in general, a positive picture on stress management programs appears. However, a number of caveats are in order: First, it is quite plausible that negative or zero effects do not find their way into the journals (Murphy, 1996). Second, the tetter studies with randomized control groups showed a lower degree of success than did the studies without a control group (Murphy, 1996). Finally, reviews find clear nonspecific enects; this points to the importance of using control groups n stress intervention studies. For these reasons, a certain de-2ree of skepticism has to prevail. On the positive side, stress
^agernent programs are often effective in increasing life «*pectancy-fbr example, if given to heart disease patients ■ * reduction in cardiac mortality; Dusseldorp, Van
lderen- Maes, Meulman, & Kraaij, 1999).
"gressing somewhat from the general theme of strain re-
Uc,1°n, it is useful to look at Van der Klink et al.'s (2001)
Stress Interventions 477
comparison of individual stress management approaches to organizational changes with the aim to reduce stress and increase resources. Organizational changes had a nonsignificant effect size that was significantly lower than was the effect size for individually oriented approaches. Unfortunately, they could only include five samples from four organizational intervention studies; these studies showed widely differing effect sizes, from a negative effect size of - .20 (Landsbergis & Vivona-Vaughan, 1995) to a positive effect size of .50 (Jones et al.. 1988). Moreover, one study had 1,375 participants (Heaney, Price. & Rafferty, 1995), whereas the other studies included only very small groups of participants. Thus, the field of organizational intervention does not provide sufficient data yet to make a meta-analysis feasible. Moreover, it is necessary to study moderators of the effect; for example, Landsbergis and Vivona-Vaughan (1995) explained their negative effects with lack of management commitment to stress management and with obstacles in the implementation of the intervention strategies.
An institutional approach to reducing strain is to provide rest periods. Whereas stress management is a modern topic and full of new research, the study of rest periods is an older topic, with only a few studies appearing each year (Graf, Rutenfranz, & Ulich, 1970). It is well-known that the recovery is fastest after short periods of work and that the first few minutes of a rest period are most important for recovery. Graf et al. (1970) suggests, therefore, that 5% of the work time should be taken as rest periods. Because rest periods are anticipated, performance is higher if there are rest periods (Graf et al., 1970). Therefore, there is usually no decrement in overall performance in spite of the time needed for rest periods (Galinsky, Swanson, Sauter, Hurrell, & Schleifer, 2000; Graf et al., 1970). At the same time, stress effects are smaller when rest periods are interspersed in work (Galinsky et al., 2000). Evidence in the literature suggests that rest periods should be organizationally prescribed and supervised but should not be self-taken (concealed breaks) because people tend to take less frequent and too short rest periods when left to their own decisions (Graf et al., 1970; Henning, Sauter, Salvendy, & Krieg, 1989). Employees also want to cluster rest periods and add them at the end or at the beginning of the workday rather than interspersing them into their workday at regular intervals. We think that the issue of rest periods should be taken more seriously again in the literature on stress interventions than it is at the moment.
Additionally, to strain reduction programs individuals may initiate strain reduction by themselves during vacation and other leisure time periods (for a recent review on respites from work, cf. Eden, 2001). Research has shown that during
478 Stress in Organizations
vacations, burnout decreases—particularly when an individual is satisfied with his or her vacations (Westman & Eden, 1997). Researchers even reported that military reserve service results in a decline in burnout and that psychological detachment from work increased this effect (Etzion, Eden, & Lapidot, 1998). Similarly, leisure time activities pursued during evenings of normal workdays can reduce strain. For example, a diary study revealed that specific activities such as low-effort activities, physical activities, and social activities had a positive impact on a person's well-being, whereas work-related activities performed during leisure time had a negative impact (Sonnentag, 2001). These studies suggest that psychological detachment from work during vacation or leisure time periods is crucial for strain reduction to occur.
i
Lifestyle Changes
Individually oriented lifestyle change programs attempt to improve diet, to support healthy living (e.g., reducing alcohol and tobacco consumption), and to increase physical exercise. Employee assistance programs (EAP) are a case in point: They often target alcoholism or other addictions, but they can also be broad-based and include exercise and stress management programs; they experienced a tremendous growth in companies during the 1970s and 1980s (Matteson & Ivancevich, 1987). Breslow and Enstrom (1980) have shown that men who used seven positive habits (sleeping 7-8 hours, eating breakfast almost every day, never or rarely eating between meals, being near height-adjusted weight, never smoking, moderate or no use of alcohol, and regular physical activity) had a lower mortality rate across 10 years than did those who followed zero to three practices. Exercise- and health-promoting programs at work have been quite successful in decreasing anxiety (Long & Van Stavel, 1995), in reducing cardiovascular mortality after myocardial infarction (O'Connor et al., 1989), and in enhancing general well-being (Ivancevich & Matteson, 1988). A dramatic example of the success of a wellness program for cardiovascular fitness is the one used by the New York Telephone Company that saved the organization $2.7 million in reduced absenteeism and treatments costs in 1 year alone (Cartwright, Cooper, & Murphy, 1995). More specific psychological programs— for example, toward the coronary-prone Type A behavior pattern—also proved to be effective in reducing coronary recurrences (Nunes & Kornfeld, 1987).
Surprisingly, institutional approaches such as building architecture have not been studied to our knowledge as potential stress interventions. Office buildings may make it easier or harder to use the stairs, for example, by making either the staircase or the lift salient. It is surprising that a
relatively small amount of daily physical activities, such walking stairs, walking to work, doing small errands on foot or bicycling to work have an enormously positive effect on mortality ratios. An example is the study by Pfaffenberger Hyde, Wing, and Hsieh (1986) who showed that people usine up 500 to 2,000 kcal per week had a reduced mortality rate within the 16 years of study in comparison to men who did not do any physical exercises. The reduced mortality rate was even more pronounced for those using 2,000 kcal per week Burning 2,000 kcal per week is equivalent to walking, for example, 35 km per week or climbing three flights of stairs 70 times per week; this speaks for the importance of encouraging light sports in the office building by building adequate, aesthetically pleasing, and salient staircases and by encouraging employees to use the stairs.