The Benefits of Intervention for Work-Related Stress

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The Benefits of Interventions for Work-Related Stress

Objectives. This quantitative metaanalysis sought to determine the effectiveness of occupational stress–reducing interventions and the populations for which such interventions are most beneficial. Methods. Forty-eight experimental studies (n = 3736) were included in the analysis. Four intervention types were distinguished: cognitive–behavioral interventions, relaxation techniques, multimodal programs, and organizationfocused interventions. Results. A small but significant overall effect was found. A moderate effect was found for cognitive–behavioral interventions and multimodal interventions, and a small effect was found for relaxation techniques. The effect size for organization-focused interventions was nonsignificant. Effects were most pronounced on the following outcome categories: complaints, psychologic resources and responses, and perceived quality of work life. Conclusions. Stress management interventions are effective. Cognitive– behavioral interventions are more effective than the other intervention types. (Am J Public Health. 2001;91:270–276)

Jac J. L. van der Klink, MD, MSc, Roland W. B. Blonk, PhD, Aart H. Schene, PhD, MD, and Frank J. H. van Dijk, PhD, MD The efficacy and cost-effectiveness of interventions designed for patients with emotional difficulties is a relevant topic in general practice.1 Such considerations also apply in occupational health care. With the increases in workloads of the past decades, the number of employees experiencing psychologic problems related to occupational stress has increased rapidly in Western countries.2 At the societal level, costs are considerable in terms of absenteeism, loss of productivity, and health care consumption. In Britain, it is estimated that 40 million workdays are lost to the nation’s economy owing to mental and emotional problems.3 At the individual level, there are costs in terms of high rates of tension, anger, anxiety, depressed mood, mental fatigue, and sleep disturbances. These problems, usually referred to in aggregate as distress, are often classified as neurasthenia, adjustment disorders, or burnout. Incidence rates in the Netherlands vary from 14 to 50 cases per year per 1000 patients.4 Interventions designed to reduce occupational stress can be categorized according to focus, content, method, and duration. In regard to focus, interventions can be categorized as (1) aiming to increase individual psychologic resources and responses (e.g., coping) or (2) aiming to change the occupational context. The first category of intervention is usually referred to as stress management training. However, stress management is the common denominator of an assortment of interventions ranging from relaxation methods5 to cognitive– behavioral interventions6,7 and client-centered therapy.8 The second category refers to interventions such as organizational development9,10 and job redesign.11 We distinguished 4 intervention types according to categorizations used in previous reviews12–14: cognitive–behavioral approaches, relaxation techniques, multimodal interventions, and organization-focused interventions. Cognitive–behavioral approaches aim at changing cognitions and subsequently reinforcing active coping skills.6,7 Relaxation techniques focus on physical or mental relaxation as a method to cope with the consequences of stress. Multimodal interventions emphasize the acquisition of both passive and active coping skills. The fourth intervention type involves a focus on the organization as a whole. Several reviews have been conducted of interventions designed to reduce occupational stress.2,5,12,14–16 The general finding of these reviews is that such interventions are effective. However, the reviews have been qualitative in nature and thus provide limited information on which type of intervention is most effective and for whom. Recently, Bamberg and Busch conducted the first meta-analysis on...
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