What kinds of interventions are typically used to manage 'stress' at work? How effective are they?

  Murphy (1996) concludes his review of studies of SMT effectiveness as follows: “Stress management interventions have been generic in nature, not targeting specific work stressors or stress symptoms, and studies comparing the relative effectiveness of different training techniques have produced equivocal results” (p.437).  Additional problems include the absence of appropriate follow-up.  In fact, “Where such follow-up has been done, the changes are typically not sustained and there is a regression to the baseline” (Newell, 2002/p.88).  Interestingly, clear evidence of any long-term impact on employee performance is almost totally nonexistent (Heron, McKeown, Tomenson and Teasdale, 1999; Jones and Bright, 2001; Reynolds, 2000; Reynolds and Briner, 1996).  As Reynolds and Briner (1996) note: It is…extremely unlikely that the uniformly beneficial results which are promised implicitly and explicitly by occupational stress practitioners and researchers will ever occur in practice” (pp.153-4).  But even for the shorter-term individual effects demonstrated the evidence is incomplete as it does not reveal the mechanisms that bring them about (Bond and Bunce, 2000).   Finally, as many have commented most of the research has been and remains methodologically very weak (Murphy, 1988, Newell, 2002).

Other limitations of SMT practice and research would include the lack of any systematic research on the role of individual differences in SMT or the absence of any serious concern with a proper needs assessment before SMT interventions are attempted (Murphy, 1996; Kompier and Kristensen, 2001; Briner and Reynolds, 1996).  In fact, rather than reflecting the nature and intensity of the problems they are supposed to be targeting SMT is offered in a packaged and pre-programmed format.  As Kahn and Byosiere (1992) write: “The programs in stress management that are sold to companies show a suspicious pattern of variance; they differ more by practitioner than by company” (p.623).

Attention should also be drawn to another issue: It is not immediately apparent that the skills employees are requested to learn can indeed be learned in the appropriate manner.  In the few studies in the literature that report relevant data, a rather disheartening 30% of participants seem to fail to learn any of the techniques on offer (Murphy, 1984, 1996; see also Kompier and Kristensen, 2001).

It is not immediately apparent how the problems identified above with respect to SMT could be resolved.  Common proposals on how to proceed with a needs analysis or undertake a risk assessment, for instance, are not without their problems.  Many would suggest a stress audit  (Cooper, Dewe and O’Driscoll, 2001).  The problem here is that the instruments commonly used in stress audits do not usually reach acceptable levels of demonstrable predictive validity (Rick, Briner, Daniels, Perryman and Guppy, 2001).  Stress-audits based on more qualitative methodologies (e.g., focus groups, interviews), potentially more sensitive to the local context, suffer from problems of their own, especially relating to construct validity and reliability.      

2.2. Tertiary Interventions

As noted earlier, tertiary stress management intervention is concerned with the rehabilitation of individuals whose health or other aspects of well-being have suffered in ways that affect their performance in the workplace.  They aim to minimize the negative consequences of stressors by helping employees cope more effectively with them.  Relevant typical interventions include employee assistance programmes (EAPs) and counselling.

EAPs seem to be very popular indeed.  As Arthur (2000) puts it, “they are now employed as one of the main occupational stress interventions”.  The UK Employee Assistance Professionals Association has defined EAPs as “…worksite focused programmes to assist in the identification and resolution of employee concerns such as personal or work related matters, which affect, or may affect performance” (UK EAPA, 1998).  Although there is no standardized model of EAP practice (Arthur, 2000; Davis and Gibson, 1994), most such programmes seem to almost invariably include confidential assessment, counselling, and therapeutic services for employees (and sometimes their dependants).  It is also common for telephone helplines for advice on domestic, legal, medical and financial matters to be provided within the context of the same (contracted out) service.

 

EAPs have a long history in the USA (some going as back as the 1920s) with most of the early schemes dealing primarily with alcohol and substance abuse.  Many such programmes were subsequently extended to cover more general social and psychological employee problems and it is in this latter form they are becoming increasingly popular in the UK.  Interestingly, the UK may be unique in its enthusiasm for EAPs among major European countries (Kompier and Cooper, 1999).

Despite the popularity of workplace counselling services very little research has been carried out on them and whatever research has been conducted seems to be methodologically inadequate ( Arthur, 2000; Berridge, 1999; Blaze-Temple and Howat, 1997; Csiernik, 1995).   Arthur (2000) comments on the current state of affairs regarding EAPs as follows: “These services are unregulated, of variable quality and have not been subjected to proper evaluation and scrutiny by researchers and critics” (p.500).

Estimates of the effectiveness of EAPs are often extrapolated from a broad range of studies of counselling and psychotherapy.  However, as Reynolds (2000) notes, the extent to which the positive results of formal psychotherapy and the more equivocal ones of counselling in primary care setting “can be generalized to informal counselling services for workers with less severe problems is unknown” (p.316).  

Moreover, what are often considered to be encouraging findings for EAPs may not be very relevant in a UK context as they are based on American studies in the 1970s and 1980s on large alcohol and drug abuse programmes involving mandatory referral (Arthur, 2000; Macdonald, Lothian and Wells, 1997).  Only a few such studies relate to more broadly based EAPs in large American organizations as, for example, the McDonnell Douglas study (Alexander Consulting Group, 1989) which is usually quoted as having delivered an estimate of an overall savings to be 4 dollars returned for each dollar spent on EAPs (Berridge, Cooper and Highley-Marchington, 1997, 1997).  But, as Masi (1997) points out, while establishing the usefulness of the EAP for the treatment of alcohol abuse this study fail to provide conclusive evidence of the cost-effectiveness of more broadly based EAPs.  A review of seven major American broad-based EAP evaluation studies found that despite some encouraging any discussion about whether the benefits spring from the EAPs involved “…could be written off as self-interest by internal providers and as anecdotal writings with a research methodology utilized that has conspicuous limitations” (Cserniak, 1995/p.34).

One of the very few UK evaluations of an internal counselling programme was carried out in the Post Office (Cooper , Sadri, Allison and Reynolds, 1990).  Findings from 250 employees who had received counselling were compared with a matched control group.  Significant declines in sickness absence, clinical anxiety levels, somatic anxiety and depression, and increases in self-esteem were reported.  Importantly, however, there were no changes in job satisfaction or in organizational commitment.  

The Health and Safety Executive in the UK commissioned the Manchester School of Management to carry out the first nationwide, independent study of British EAPs and workplace counselling in nine separate companies (Berridge, Cooper and Highley-Marchington, 1997).  After receiving counselling and at follow-up clients reported significantly improved general and work-related mental and physical well-being, compared to before counselling and an unmatched control group.  With the exception of sickness absence no organizational relevant benefits were obtained.  Marchington-Yeoman and Cooper (2002) comment on these findings, which were similar to those obtained in the Post Office study, as follows: “the company-wide data do not suggest that an EAP has any effect on the organization, other than reducing absence in those who use the service” (p.219).

The evaluation research that has been carried out appears to suffer from many methodological problems.  Not that we are short on proposals on how best to conduct such research.  Rather, as Arthur (2000) notes, “the literature contains considerably more articles on how to conduct such research than has actually been carried out” (p.553).   Proposals for methodologically sound research in this area include the following: Uniform and standardized data that would allow comparison between studies, a true experimental research design involving proper control groups, collection of data at least 3 years prior to and 3 years following the EAP intervention, use of valid performance indicators and a cost-benefit analysis (Arthur, 2000; Blaze-Temple and Howat, 1997; Macdonald, Lothian and Wells, 1997).  Given the nature of this list, Arthur’s conclusion is rather unsurprising: “To date there is no single study that can satisfy all these criteria” (Arthur, 2000/p.553).   Additional suggestions on how to improve our understanding the effectiveness of EAPs and related interventions include paying more attention to the variety of the employers’ motives for setting up counselling (Berridge, 1999) and the moderating effects of organizational culture (Carroll, 1996).  Although such proposals are potentially very interesting it should be noted that they remain at present mostly speculative.

 

Suggestions for improved counselling provision or research on EAPs should not distract us from the realization that  “the growth of EAPs in North America and the UK is not matched by firm and substantial research to provide evidence of their effectiveness (Arthur, 2000/552).  In fact so little seems to be known about EAPs in particular that Briner (2000) is capable of issuing perfectly reasonable reversals of what could be expected following the introduction of EAPs.  He turns, almost entirely effortlessly, what are usually taken to be expectations for invariably positive outcomes (e.g., the employee feels better as the result of an EAPs therefore shows more commitment to the organization) into distinct disadvantages for organizations or employees alike (and vice versa). In our example, the employee decides that his job is not worth carrying out well!  

2.3. The Effectiveness of Typical SMIs and Primary SMIs Compared

Insofar as typicality has been defined in terms of established frequency of use, primary interventions are not at all ‘typically’ used to manage stress at work and, therefore, need not be considered in any detail.  However, a better idea of non-primary SMI effectiveness would certainly emerge from a comparison of such SMIs with their primary counterparts.  Moreover, a rather telling dialectic, evident in most accounts of SMIs, renders aspects of the character of non-primary interventions somehow dependent on the notion of primary interventions.  A sense that non-primary SMIs have a distinctly quasi character, one moreover of rather doubtful ethical credentials, pervades many of the relevant discussions.  It is as if primary SMIs somehow exemplify what is more proper, more genuine and more resolute not only within the domain of their own applicability but, importantly, SMIs in general.

Although rather positive statements about the effectiveness of primary interventions are still being made in the academic literature (e.g. Cooper, Dewe and O’Driscoll, 2001), and they are virtually endemic in practitioner circles, a number of influential recent reviews seem to have contributed to an emerging view of such interventions as relatively ineffective.  According to Parkes and Sparkes (1998) review for the HSE, “Taken as a whole, the cases studied…do not present a convincing picture of the value of organizational interventions designed to reduce work stress” (p.43; for additional reviews see Briner and Reynolds,1999; Rick et al., 2002) .

There is no compelling evidence, therefore, to suggest that employees would, in general, be better off with any of the more ‘princely’ primary interventions.  A general impression of relative ineffectuality is rather unavoidable with respect to all types of SMIs.  Moreover, the gist of this conclusion is little threatened by repeatedly made calls for relevant studies to incorporate in the future substantial methodological improvements.  Although some problems may be solvable many are destined to remain intractable for possibly a very long period as they relate to serious theoretical problems in the area.  It is to a discussion of such problems that we now turn.

PART 3

Stress, “Stress”, Stress Theory and SMIs:

There are indeed serious difficulties relating to the lack of substantial and adequately explanatory stress theories.  As Dewe and O’Driscoll (2002) note, “ Future research should consider whether it is possible to design effective intervention programs without first trying to resolve some of the confusion surrounding the term ‘stress’” (p.145).  Not an easy task as “The job-related stress literature is massive…, populated by a diversity of theoretical orientations…, and too often methodologically muddled” (Brief and Weiss, 2002/ p.287).  Briner (1997b) is even more emphatic about the possible consequences of problems with stress theory: “Perhaps the central problem in the area of SMIs is the failure to assess the extent of whatever problems may exist as a result of making largely false assumptions about what stress is, what it does, and how it can be reduced” (p.69; emphasis added).

With substantial reviews failing to support many of the earlier claims about the possible links between stress and health (e.g., Rick, Thomson, Briner, O’Regan and Daniels 2002), routinely assumed links between employee psychological well-being and performance being shown to have been grossly simplistic if not entirely mistaken (Briner, 1997b; Reynolds, 2000), and research, of the type reviewed here, indicating that typically used SMIs are mostly ineffective, one wonders whether more radical moves may be required than has been the case in recent decades.

The radicalism of Briner and the position taken by Carver and Scheier (1998) has already been noted.  Such views are consequential for the issues discussed here insofar as it is becoming increasingly clear that, at the very least, stress refers to a more distributed set of more or less related (and possibly several unrelated) phenomena.  In what follows a brief statement of the present authors theoretical preferences is attempted in a way that brings together some of the major issues addressed by this study.

It has already been noted that the present author’s preferred approach to stress is a transactional one (Lazarus and Folkman, 1984) according to which stress arises “from the appraisal that particular demands are about to tax individual resources for dealing with them, thus threatening well-being” (Dewe, 2000/p.4)).   Although far from serving as a fully explanatory theory of either, the transactional approach is potentially capable of providing a rationalizing platform for several SMIs (Cooper, Dewe and O’Driscoll, 2001).  In fact, the transactional approach with its emphasis on such cognitive processes like appraisal is well placed to both guide, as well as further explain, whatever modest successes may be associated with CBT as applied in stress management training and counselling.

However, it must be admitted that even the transactional model, better perhaps in this respect than most, is only modestly geared towards addressing genuine explanatory issues.   Moreover, if its full implications are taken seriously, whatever explanatory power it may have it can only dispense in ways that render substantial experimental research virtually impossible.  The problem of drawing clear distinctions between independent variables and dependent variables has already being mentioned (see Briner, 1997, 1999c; Goldenhar and Schulte, 1994; Kasl, 1998).  The difficulties Kasl, for example, is complaining about, however, may have more to do with the fact that some linear unidirectional causality is presupposed by his essentially epidemiological perspective (see Wainwright and Calman, 2002), rather than registering any genuine problems with the notion of stress itself.

Yet, at the practical level that SMIs take place it may not be immediately clear how this approach could lead to the formulation of any well-structured effective SMIs.  In the complex interpretive game the transactional approach sets (or so it should set) the appraisal processes which are so crucial to an understanding of stress, one very possibly loses almost entirely the value of a causal approach and may be forced to opt for some form of hermeneutics (Ricoeur, 1981; Thompson, 1981).  Insofar as this is a valid point, the transactional model is integrated at least partly with recent interpretive approaches and may contribute to the understanding, among other things, of interpretive contagion phenomena (Barley and Knight, 1992; Wainwright and Calnan, 2002; see also Meyerson, 1998; Wessely and Hotopf, 2001).

It would be rather unwise to leave this essay without reflecting on the possibility that our analyses so far, valid perhaps within the constraints of their theoretical horizons, may be limited by their naiveté regarding the wider socio-political parameters of stress phenomena.  Work, Wainright and Calman (2002) write “may not be the pathogenic destroyer of health and well-being portrayed in the stress discourse, but for many people the experience of paid employment is one of boredom, unfulfilled potential, frustration, uncertainty, dissatisfaction or alienation” ( p.116).  Stress discourse is relevant here in that “the structural relationship between employer and employee is essentially antagonistic…In the past this antagonism presented itself to experience in the form of political or trade union struggle.  However, historical change has rendered this form of struggle ideologically and organizationally defunct…The work stress ‘epidemic’ has emerged in this political vacuum as the new phenomenal form of the antagonistic relationship between employer and employee” (pp.196-7).

CONCLUSIONS

The status of the Janus-faced primary interventions, ineffective and rarely used, but also desired-for and viewed as the real solution reflects, perhaps, the conflictual nature of paid employment.  Often viewed as second bests, secondary and tertiary SMIs were revealed to be essentially atheoretical attempts to provide support for workers either by reinforcing their ability to cope or by alleviating the consequences of not coping.  Neither really impressive as a type of SMI, they may still be relied upon to produce some largely temporary and modestly positive outcomes for at least some employees.  Evidence of their contribution to the attainment of more organization-level goals can only be described as virtually nonexistent.

Proper experimental studies involving valid and reliable measurements are the obvious data collection methods when causal inferences and precise quantitative statements are sought.  It also helps if the investigators are properly ‘disinterested’, the whole exercise is conducted in a theoretically rich environment and, to the extent that multiple evaluative frameworks are called for, it is desirable for the resulting multiplicity not cloud the judgement.

If this is the ideal one has to emulate then the outcome of our journey was destined to miss its target by the mile as mostly methodologically flawed research, often conducted by practitioners themselves, in environments either hostile or entirely inappropriate to host genuine experimental studies, put to the test, in front of diverse and differently motivated audiences, ideas derived from suspect theoretical formulations in an area where the central notion itself (that of stress), threatened both by natural death (as it could no longer deliver) and the suffocation that fan worship can induce, found it necessary to surround itself with quotation marks.

Yet, it was argued that the conclusion that typical SMIs are not really effective could be trusted despite the shortcomings of the relevant evaluation research.  It is more a case of ‘they were never really meant to be particularly effective’, rather than one of ‘serious doubts about whether they are effective remain’.  The main reason for this was the lack of properly explanatory theories in this domain.  In fact, to a very great extent we witnessed this domain exhibit almost terminal annihilation as claims of the yesteryear seemed largely unsustainable and greater theoretical acuity led to serious dissatisfaction with extant stress theories and, indeed, the notion of stress itself.

Are developments in this field imminent? Unless the more recent work on organizational well-being in terms of specific emotional and other affective states (space limitations did not allow any substantial discussion of these exciting developments; see Briner, 2002) is capable of forcing some nonlinearity soon, it is very unlikely that the current state of theoretical confusion would allow for any substantial further developments either in methodology or in application.

Thinking back of the closing paragraph of the last section…one does wonder whether muscle relaxation, the rearrangement of a few patterns of thinking about largely non-political issues or the search for some personalized solution in the context of a 5-session bout of counselling as offered by some EAP were ever destined to be enough to effectively handle the multitude of specific problems generated by the antagonistic elements of that most perennial and inevitably largely conflictual of couplings namely that between employers and employees.

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