The physiotherapist's role in the management of stress-related work absence in vocational rehabilitation

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Introduction

The intention of this wiki is to provide an online self-directed learning tool on the topic of vocational rehabilitation for final year physiotherapy students and newly qualified physiotherapists. As this is such a wide topic, we have chosen to focus on the issue of stress-related work absence in vocational rehabilitation. There is a strong link between stress and sickness absence. Mental health conditions are increasingly prevalent and stress in the workplace is becoming more common. Work-related stress is estimated to be the biggest occupational health problem in the UK, after musculoskeletal conditions such as back pain (The Mental Health Foundation 2000).

Learning Outcomes

Aims

The aims of this wiki are:

1)To present a learning resource for Scottish final year physiotherapy students and newly qualified graduates which aims to develop their evidence-informed knowledge and understanding of vocational rehabilitation.

2)To present a learning resource for Scottish final year physiotherapy students and newly qualified graduates which aims to develop evidence-informed knowledge and understanding of vocational rehabilitation for stress-related work absence and promote in-depth exploration of the physiotherapist’s role in this area.

Learning Outcomes

Through completion of this wiki you will be able to:

1)Synthesise the main principles of vocational rehabilitation and critically analyse its role in achieving an optimum vocational outcome.

2)Explain the impact of stress and stress-related work absence on the individual.

3)Critically evaluate the role of the physiotherapist in the management of stress-related sickness absence/work loss in stress and how this relates to vocational rehabilitation settings.
4)Critically reflect on the challenges facing the physiotherapist in vocational rehabilitation.

Stress

Definition

There are numerous definitions of stress but no generally established medical definition, (Waddell & Burton 2006). However, according to the Health and Safety Executive (2012) stress is the negative response an individual exhibits when excessive pressure or demands are placed on them. Additionally, MIND (2015) define stress as a response to being put under pressure or situations that put an individual under pressure.

Stress can be divided into two categories: Distress and Eustress. Distress is the negative response to stressors whereas eustress is the positive response to stressors. When an individual is distressed they experience negative psychological states such as frustration, low satisfaction and alienation that eventually result in work and social loss as well as negatively effects on their physical and mental well-being. Conversely, not all stress is bad for you. For instance when an individual experiences eustress they have positive psychological states such as meaningfulness, motivation, enthusiasm and participation that result in positive implications for both the individual's' well-being and performance.In additon to this, stress can have also have a positive effect on individuals when experienced in short intervals. Short-term exposure to stress has been found to boost the immune system, however, it is still important to be aware that long-term or chronic stress has an adverse effect on the immune system that eventually results in illness. Therefore, the important feature linked to stress is its chronic effect over time (Gardner and Fletcher 2006; Salleh 2008).

Predisposition to stress varies among individuals. An event that causes illness in one individual may not cause illness in another. Events are influenced by a number of background factors that lead to the manifestation of illness. Genetic vulnerability, coping style, type of personality and social support may all influence an individual’s susceptibility to stress. When faced with a problem, an individual assesses how serious the problem is and determines whether they have the necessary resources required to deal with the problem. If the seriousness of the problem outweighs the present resources, an individual may perceive themselves as being under stress. However, if the resources match or outweigh the problem an individual copes much better with the problem. It is this response system to situations that results in the differences in individual’s susceptibility to illness and overall well-being, (Salleh 2008).

Stress can be caused through various things happening in your life. It can result by either external factors in the environment or internal factors to the individual. Stress can also result as a consequence of real or perceived psychosocial pressures. Being under pressure, having too much or too little control over something or even worrying can trigger stress. Stressors are things that cause stress. Chronic stressors encountered in everyday life include work overload, financial difficulties or family problems. There are many other things that can cause stress but the aforementioned stressors are the ones most commonly encountered in everyday life. Although these stressors may occur independent from one another, most times they are interrelate. For instance, financial problems may have negative implications for both the individual and family. Additionally, research on the relationship between family problems and work have found that problems at home such as marital issues affect an individual's ability to perform adequately at work, conversely, pressure at work can affect an individual’s ability to function socially at home. Hence, even though a problem may root from work, family or finances, they may still have an overall impact in other areas of life and vice versa. With saying this it has been reported by employees that the single most stressful factor in their lives above finances and relationships was work, (MIND 2015; Salleh 2008; Bagwell 2000)

Task:

Take a moment now and reflect on where stress is coming from in your life. What impact is it having on you and those around you? Are you coping with it? If so, how? If not, what's stopping you from coping with it?

Prevalence

Among the leading contributors to disease and disability burden globally are mental health problems, making 10.5% of the worldwide disease burden. In the United Kingdom, mental health problems are the single largest source of disability, accounting for 23% of total disease burdens (Kings Fund 2012).

About 1/4 of the general population will experience some kind of mental health problem in the course of a year. That is 1 in 4 British adults experiencing at least one mental disorder in any one year (John Cruddas 2014).

Women are more likely to be treated for mental health conditions than men, with 29% of women affected compared with 17% men.

Common mental health problems peak in middle age with 20-25% of people in the age group 45-54 years having a neurotic disorder. The figures fall as people grow older, with only 9.4% of people aged 70-74 years having a neurotic disorder compared with 16.4% of the general population.

Neurotic disorders: Prevalence by age per 100

About a third of the working population will have some mental symptoms at any one time in their lives. 1 in 3 British adults in the working age population will experience some kind of mental health problem. Of this, 1 in 6 people in the working age population will experience depression, anxiety or problems related to stress.

(UNISON 2015)

In 2013 the Labour Force Survey found that 131 million days were lost due to absence either as a result of sickness or injury. Mental health problems such as stress, anxiety and depression, musculoskeletal disorders and minor illnesses contributed to this number with 15 million, 31 million and 27 million, respectively.

Days off work by reason in 2013

According to the Chartered Institute of Personnel and Development (CIPD 2015) annual absent report:
- The main causes of short term absence (≤ 4 weeks) were minor illness, musculoskeletal disorders and stress. Musculoskeletal disorders are more prevalent in manual workers and stress is more prevalent in non-manual works.

Common causes of short term absences

- The main causes of long term absence (≥ 4 weeks) were acute medical conditions, stress, mental ill health and musculoskeletal disorders.

Common causes of long term sickness

- The median annual absence cost per employee across all organizations was £554. This cost varied in the different individual organizations, ranging from between £400 - £914, with the highest costs being in the public services.

[INSERT BAR CHART 2 HERE]

According to the Labour Force Survey in 2013/14:

- The total number of cases of work-related stress, depression or anxiety was 487000 cases (39%) out of a total of 1241000 cases for all work-related illnesses.

- There was an estimated prevalence of 221000 male and 266000 female cases of work-related stress and an estimated incidence of 115000 male and 128000 female cases.

- The total number of working days lost due to work-related stress, depression or anxiety was 11.3 million, an average of 23 days per case of stress, depression or anxiety.

- Of the 11.3 million lost days, male workers accounted for approximately 5.4 million of those days while female worker accounted for approximately 5.9 million days

- The age 45-54 years had the highest incidence rate for all genders

Summary of findings from both mental health and stress statistics:

- The age group most affected is 45-54 years old.

- Women are more affected than men.

- The prevalence of stress higher in non-manual workers than in manual workers.

Although not a medical condition in itself, stress that is left unmanaged has been associated with stress-related mental and physical health problems such as anxiety, depression, cardiovascular disease and musculoskeletal pain, (CIPD 2011).

Quiz on prevalence

https://www.qzzr.com/c/quiz/149020/facts-and-figures-3cbec696-e555-4b4f-b0ef-6d1ab90fdf42

Impact

Although there is a collective opinion that mental health problems are caused by work, the relationship between the two is complex. While there is strong evidence that work is good for both mental and physical health, there is also evidence that mental well-being can be adversely affected by work.

Work-related stress may occur when individuals are faced with work demands or pressures they cannot cope with or have very little control over. The Health and Safety Executive (2015) defines stress as the negative response an individual exhibits when excessive pressure or demands are placed on them. Job stress is one of the top 10 work-related health problems and has increasingly been associated with the occurrence of mental health problems, cardiovascular disease and musculoskeletal disorder, (Waddell and Burton 2006; Habibi, Dehghan and Hassanzadeh 2014).

It is believed that the pathogenesis of physical disease is influenced by stress. Stress results in the production of adverse affective states which have a direct impact on the biological processes and behavioural patterns that predispose an individual to the risk of disease.

Stress can elicit the same responses that the body would produce if it were in physical danger. The body goes into ‘flight or fight’ mode, triggering the stress hormones adrenaline, noradrenaline and cortisol which in turn cause accelerated breathing, increased heart rate and dilation of blood vessels leading to increased blood pressure. In small amounts these responses are not harmful however when exposed to them for prolonged periods degenerative changes can occur within the body. Prolonged exposure to increased heart rate, blood pressure and stress hormones consequently lead to hypertension, arrhythmias, myocardial infarctions, or stroke (Torpy et al 2007). Furthermore, adrenaline can cause muscles to automatically contract and tense up in a biological response to stress as a means to protect the body from further harm. Prolonged exposure to muscle tension and muscle overuse causes the muscles to fatigue, tighten or degenerate, consequently increasing the risks of developing musculoskeletal disorders, (Lundberg 2002).

Stress can cause psychological changes that result in numerous adverse effects on an individual such as reduced competency, diminished initiative, reduced through flexibility, loss of accountability and reduced concern for both work colleagues and the organization as a whole. Additionally stress alters an individual’s physical state. The changes that occur in muscular structures can cause pain and discomfort resulting in an individual finding it difficult to sit at an office desk for the whole day or concentrate on work tasks due to lack of comfort. If stress is not managed immediately the physical and psychological effects of it that consequently lead to mental and physical changes can stop an individual from working at optimum capacity (Ongori and Agolla 2008).

The conservation of an individual’s physical and mental health depends on their ability to adequately satisfy the demands they are confronted with. The greater an individual’s ability and control are over the exposed demands, the more effective the response produced will be. Conversely, when an individual is exposed to demands found to predominate their current knowledge and abilities they exhibit reduced capacity to work and perform their job adequately causing them to produce responses that are not effective (Negeliskii and Lautert 2011).

A major contributor to an organisation's profit and its existence is the amount of productivity delivered by employees. It is well established that excessive stress is detrimental to both an individual’s mental and physical well-being as well as productivity. With knowledge of this it can be recognised that stress is therefore a serious concern for organizations. Mental and physical changes can significantly influence an individual’s ability to work effectively which as a consequence can lead to increased absentee rates, increased turnover, sickness absence and work-related accidents. All of which negatively impact on an organization by decreasing its probability of success in competitive markets through reductions in overall productivity and service quality as well as increased expenditure on recruitment and selection costs as a result of turnover effects, (Ongori and Agolla 2008; Ekundayo 2014). Additionally, these factors cost the national economy an astounding amount of money annually through sickness absence which results in sick pay, staff turnover and loss of productivity. Furthermore, social welfare systems endure the costs of medical care and potential compensations in salary (Park 2007; Hauke et al 2011).

Tasks for Impact

1. Define stress and work related stress.

2. We are aware that stress can result in musculoskeletal and cardiovascular problems. Name the physiological changes that occur to result in these problems.

3. What are the negative effects of stress on an individual's cognitive ability?

4. Why should stress be a serious concern for organizations?
Reflection for impact: Knowing that stress has adverse effects on both physical and mental wellbeing it is important that it is addressed. Have you ever encountered a patient who was suffering from work related stress? Did you address this? What did you do? What do you think you could have done/done differently?

Vocational Rehabilitation

The government policy ‘What Works, For Whom and When’ (2008) describes vocational rehabilitation as helping people with health problems stay at, return to and remain in work and this is unanimously the widespread definition. The Vocational Rehabilitation Association (2013) describes vocational rehab as any process which supports people with functional, physical, psychological, developmental, cognitive or emotional impairments to overcome obstacles to accessing, maintaining, or returning to work or another useful occupation. Vocational rehabilitation can be described as an idea or an approach, as much as it can an intervention (Connolly, 2011).

An effective vocational rehabilitation service should adopt a multi disciplinary approach, involving both healthcare professionals and employers. Vocational rehabilitation can also be practiced in a variety of settings. Primary healthcare settings can have a positive effect on occupational outcomes, either helping people with mild to moderate conditions return to work promptly or continue to offer treatment, education and help devise a return to work plan for a person who requires further assistance. Workplace interventions can also be highly beneficial. Many organisations have developed sickness absence and disability management programmes which efficiently cuts costs and enables return to work or the possibility of adapted working. More structured vocational rehabilitation programmes can also be followed for those with more severe cases. Vocational rehabilitation programmes can help to improve work outcomes for those in the early stages of claiming incapacity benefits. Incapacity benefit comes after a period of statutory sick pay and generally does not start until week 29 of sickness absence. However, many people are not employed at the time they start receiving benefits and they can often be faced with many barriers when trying to return to work. A person is likely to remain on benefits long term once they have been claiming for 1-2 years, meaning it is vital for vocational rehabilitation to play a part early on (Waddell et al 2008).

For many people these days, work is their key determinant of self worth, family income and esteem, as well as identity within the community and social fulfilment (Black 2008). Carol Black’s ‘Working for a healthier tomorrow’ review looking at the health of our working population suggests that the average UK employee is absent from work due to sickness for six days each year. Although these figures vary between workplaces, it is thought that these absences equate to an annual cost of around £598 per employer. Therefore, the estimated cost to the UK economy as a result of employee absence is around £100 billion annually- which is greater than the NHS annual budget (NICE 2009).

Healthcare understandably plays a vital role in Vocational rehabilitation, but ultimately, it is not effective without working closely alongside employers (Waddell et al 2008). There is strong supporting evidence that a proactive workplace approach to sickness and modified working is not only most effective but is also an effective cost saving method for the company, especially in larger enterprises.

Employers can have a key role in facilitating an employee’s early return to work following a sickness absence by having early, regular and sensitive contact during their leave, although around 40% or organisations have no sick leave management policy at all (Black 2008). This report also discusses the stigmas associated with absence from work due to disability and ill health, and states how this can also be a contributing factor in delaying a persons return to work. This is especially apparent in employees suffering from mental health conditions as organisations often fail to recognise their capabilities. There is significant evidence to suggest that the longer a person is absent from work due to ill health, the harder it is for them to make an effective return.

Although employment rates for those suffering from a disability or long term health condition are increasing, with employment rates in Britain being high when compared to most countries, 7% of the working population are still seeking incapacity benefits, while another 3% are off work sick at one given time (Black 2008).

Physiotherapists Role in Vocational Rehabilitation

Which settings are they involved in

What conditions/problems do they help deal with What interventions do they use to help these problems

Look specifically into stress management

Link into PT and stress: managment and return to work

Physiotherapists play an important role in rehabilitation. As reported by the Chartered Society of Physiotherapist (CSP 2015) physiotherapists aim to get patients back to their best possible level of function and well being. Physiotherapist’s main goals for patients is to get them back to their regular lifestyle which may include activities in the home, activities for leisure or work. This expands beyond patients that suffer from MSK (musculoskeletal) conditions and it is shown that physiotherapists are increasingly aiding in the recovery of patients who suffer from mental health conditions. (www.sept.nhs.uk) A physiotherapist role in the recovery and rehabilitation of patients suffering from a mental illness merge the treatment of psychological and physical conditions into one. As WHO (The World Health organization) defines health as ‘Physical, mental, and social well-being, not merely the absence of disease and infirmity’. Thus highlighting the importance of a combined treatment approach within Physiotherapy.

Challenges to Vocational Rehabilitation

- barriors

- communication

- teamwork

early intervention

gap between reserch and practice- we can all add to

managment oposition

lack of resources, policy support, networks like other organisations

work hand in hand with employers and pts

Internal barriors

Managers beliefs

Barriors to returning to work in stress

Specific to PT_________________________________________________________

- barriors to PT in stress; pts communication style changing when stressed

Physiotherapist Role in Managing stress through VR

- Consolodate all evidence
- OUTCOME MEASURES HEADING  
http://www.mdpi.com/1660-4601/12/2/1928/htm

http://www.mdpi.com/1660-4601/12/2/1928/htm

== With this wiki the aim is to look more in depth at the treatment and intervention provided by physiotherapists to manage stress, primarily in patients who are out of work due to a multitude of ailments whether that be physical, mental or psychosocial.
What is stress in the work place?
MedNet.com (2015) defines stress as a physical, mental or external factor that causes physical or physiological strain on the individual. Another definition, looking more specifically at work stress, states that it is a hostile reaction individuals have to too much pressure or strain on them in the work place. As stress is becoming a worldwide issue it is important to acknowledging the effects of stress on individuals in and out of the workplace. It is suggested that a considerable percentage of people out of work will develop a mental disorder due to the stress of unemployment, likewise, patients can equally develop a mental disorder and be subject to mental distress within the workplace. (Audhoe. 2009) this it is important as developing physiotherapists that we are aware of the effect Benefits of exercise for the treatment of stress within the work place.
There is significant evidence to show the benefits of exercise in general and there has been recent increases in the application of prescribed exercise. A systematic review (Lawlor 2001) highlights the benefits of exercise on improving the symptoms of those suffering from depression such as self-worth, self-image and self-efficacy. With the increase of prescribed exercise there is also an increased awareness of stress affecting employees in the work place (B, Long 2007). therefore there is an emphasis on creating effective work based exercise programmes aimed at helping people suffering from stress manage their symptoms more effectively.

Physiotherapist’s management of stress.
With stress management there are key stages that implemented to ensure effective treatment. The initial stage should be highly focused on the education of the individual ( Meichenbaum 1985) it is suggested that a heavily structured programme is created and agreed on between employer and employee.
There is limited evidence to suggest a precise physiotherapy management for patients suffering from stress. (Waddel, 2008) this can be contributed to the increase in stress cases yet the still unclarified definition of stress and its manifestations. However there is still great evidence to support the need for an MDT approach when implementing vocational rehabilitation, especially within the work place and out in the community. ( C. Gobelet et al 2009)

==

(Alexanders et al. 2015) 2002 – 2013 studies

Physiotherapists must take a holistic approach to health and well-being recognising the importance of how diverse symptoms such as anger, depression and low-self-esteem have effects of patients and so  their potential treatment outcomes. 

Documents to help PT with this, include: 

NHS KSF Outlines in HWB6 and HWB7;  require the consideration of both physiological and psychological factors throughout assessment, treatment planning and implementation. 

HCPC; standard 13.9; 

University physiotherapy degree programmes consider many topic areas which fall under the word 'psychology'; communication skills, personality theories, effective team working and the impact of terminal illness on mental health. 

Within clinical practice there are many different interventions used by physiotherapists. Some of these highlighting in _________________ (refs 2 and 10 of Alexs)  study include; relaxation, imagery, positive self talk and goal setting. Cognitive behavioural therapy (CBT), neuro-linguistic programming (NLP) and 'mindfulness based stress reduction' are also being used. (14, 15,18 resp) 

(Specific disciplines of physiotherapy practice are also beginning to include such interventions ,mostly chronic pain (11), anterior cruciate ligament rehabilitation (10), neurology (12,13) and sport (2).

Systematic Review - Exploration of MSK PT perceptions regarding use of psychological interventions in clinical practice:
Studies investigated “common psychological symptoms that PT encounter within clinical practice.”

RESULTS:

“Stress and anxiety were the most frequently encountered psychological symptoms amongst individuals undergoing rehabilitation”

Interventions; “In particular goal setting, positive self talk, effective communication and variation in rehabilitation exercises all appear to be relatively widely used.”

PT would like to improve their ability to improve their ability to implement realistic goal setting (24, 25)

4/6 studies say they received insufficient psychological training during Bsc studies (22,23,26,27)

PT working in MSK environment commonly encounter psychological symptoms. 

Pt suffering from psychological symptoms following injury are more likely to develop non-specific MSK complaints  eg increased muscular tension, development of trigger points and reduced function. 

Occurrence of psychological symptoms following injury are frequent and significant issues

A vaulable approach in tackling this issue is to integrae psychological interventions within physiotherapy practice. 

Psychological interventions are used widely by MSK PT, using; goal setting, positive self talk and effective communication, with goal setting being identified as the most common psychological intervention.

^This is particularly encouraging finding given that goal setting during rehabilitation appears to improve patients' self confidence, self esteem and self efficacy (32)

Goal setting highlighted as an intervention PT want to learn more about ;

(33 Schoeb) detailed insight into use of goal setting in clinical setting – GS is frequently employed by PT however the approaches used for goal setting are rarely standardised. 
Effectiveness of GS varies significantly between difference PT's. 

Study with difference HCP indicated GS has many difficulties; poor patient involvement throughout the goal setting process. (34) 

Goal setting has been proven to have minimal consideration being given to psychological implications. 

^ significant as “ patient participation appears to be of paramount importance – due to many beneficial effects associated with patient participation” 

- Increasing patient participation during rehabilitation

- empowering patients to take responsibility for their recovery
- making rehabilitation process more meaningful to patients.

Key points from systematic review:

Disparity between PT's reported use of goal setting and the training [rovided in this area in Bsc degree
- some degrees do not provide sufficient level of formal training in the use of psychological interventions.
- Pts repor feeling inadequatly trained in psychological interventions and welcome further training.

PT's ability to effectively incorporate psychological interventions would maximise potential of individual patients eg ensuring when goals are set they are both patient led and not just therapist led
- so there is a need to review curricula of PT degrees to ensure training of psychological interventions is standarised!!

Future research using observational methods to investigate PT's implementation of goal setting in clinical setting would provide further insight into this area and be of value in identifying PT's training needs. 

PT perceptions and practical use of psychological interventions are limited
Clearly warranted due to large occurrence and impact on treatment outcomes
Required to compare sporting private vs hospital NHS

(Romano and Peters 2015) Mechanisms of change in motivational interviewing: Meta analysis

Key points:

Motivational Interviewing (MI) is a patient centred directive method
of facilitating change that aims to enhance motivation through the
exploration and resolution of ambivalence (Miller & Rollnick, 1991).
MI was originally developed to treat substance use disorders, however,
the application of MI has extended to a growing list of psychological and
physical health issues. Meta-analytic research provides support for the
efficacy of MI in the treatment of physical activity, dietary change, and
diabetes (Martins & McNeil, 2009), and gambling and general health
promoting behaviours (Lundahl, Kunz, Brownell, Tollefson, & Burke,
2010). There is also a growing evidence base to suggest that MI is useful
as an adjunctive treatment to enhance treatment outcomes for patients
presenting with anxiety disorders (Aviram & Westra, 2011; Westra,
Arkowitz, & Dozois, 2009; Westra & Dozois, 2006),

However, in the treatment
of psychological disorders such as anxiety and eating disorders, MI is primarily
used as an adjunctive treatmentwith an aim to enhance treatment
gains as a result of another treatment. In these areas, employing MI is
thought to facilitate patient motivation and engagement in other treatment
(e.g., cognitive behavioural treatment; CBT), thereby potentially
yielding more positive outcomes (Westra, Aviram, & Doell, 2011).
H I G H L I G H T S

• Motivational interviewing (MI) is useful in the treatment of a variety of mental health problems. • Previous meta-analyses of MI mechanisms of change are limited to substance using populations. • This review examined change mechanisms in patients diagnosed with anxiety, mood, eating, psychotic, and comorbid conditions. • Research should further examine MI mechanisms of change in diverse populations.

This review is a first attempt to investigate and meta-analyse MI mechanisms of change research conducted with participants who
suffer mood, anxiety, psychotic, eating disorders, and comorbid conditions.

Results indicated that while MI did not increase patient motivation more so than
did comparison conditions, MI showed a favourable effect on patient engagement variables

Overall, there were few MI mechanisms of change available for review, though the results suggest that patient engagement with treatment may be a potential mechanism of change in populations diagnosed with anxiety, mood, and psychotic disorders.

Anxious participants who receivedMI prior to CBT showed less resistance during CBT than thosewho did not receive a pre-treatment. When compared to CBT, MI also achieved a positive effect on resistance

Also, anecdotal evidence from therapists suggested
that participants who attendedMI groups were more willing to engage
in discussions about change (Dean et al., 2008),which supports the role
ofMI in facilitating the change process.Moreover, quantitative findings
demonstrated that participants who completed MI were more willing
to partake in CBT and were more open to therapist contact (Buckner &
Schmidt, 2009).While these datawere not included in effect size calculation,
the findings further support the positive effect ofMI on engaging
patients in active treatment.

Hsieh et al 2012 – DASS scale (depression, Anxiety, Stress Scale)

Coping with Work-Related Stress through Guided Imagery and Music (GIM): Randomized Controlled Trial
(Bolette Daniels Beck, PhD, Åse Marie Hansen, PhD and Christian Gold, PhD,2015)

Background: Long-term stress-related sick leave constitutes a serious health threat and an economic burden on both the single worker and the society. Effective interventions for the rehabilitation and facilitation of return to work are needed.

Objective: The aim of the study was to examine the effects of Guided Imagery and Music (GIM), a psychotherapy intervention including relaxation, music listening, and imagery, on biopsychosocial measures of work-related stress.

Results: Significant beneficial effects of GIM compared to wait-list after nine weeks with large effect sizes were found in well-being, mood disturbance, and physical distress, and in cortisol concentrations with a medium effect size. A comparison between early and late intervention as related to the onset of sick leave showed faster job return and significantly improved perceived stress, well-being, mood disturbance, depression, anxiety, and physical distress symptoms in favor of early intervention. In the whole sample, 83% of the participants had returned to work at nine weeks’ follow-up.

Conclusions: The results indicate that GIM is a promising treatment for work-related chronic stress, and further studies are recommended.

http://www.bbc.co.uk/news/uk-scotland-highlands-islands-34572044

^Bycycle inititive

Taehan Kanho Hakhoe Chi. 2007 Jun;37(4):529-39.
[A meta-analysis of effects of job stress management interventions (SMIs)].
[Article in Korean]
Kim JH1.
Author information
Abstract
PURPOSE:
This quantitative meta analysis sought to determine the effectiveness of SMIs.
METHOD:
Forty-six experimental studies with a randomized or nonequivalent control group pre-post test design were included in the analysis. The selected studies were classified according to the sample characteristics, the types and methods of the interventions, and the types of outcome variables. Six intervention types were distinguished: cognitive-behavioral intervention(CBT), relaxation techniques(RT), exercise(EX), multimodal programs 1 and 2(MT1, 2), and organization focused interventions(OTs). Effect sizes were calculated for the 4 outcome categories across intervention types: psycho-social outcome, behavioral-personal resources, physiologic, and organizational outcome.
RESULTS:
Individual worker-focused interventions(ITs) were more effective than OTs. A small but significant overall effect was found. A moderate effect was found for RT, and small effects were found for other ITs. The effect size for OTs was the smallest. The interventions involving CBT and RT appeared to be the preferred means of reducing worker's psycho-social and organizational outcomes. With regard to physiologic outcomes, RT appeared to be most effective. CBT appeared to be most effective in reducing psycho-social outcomes. The effects of OT were non-significant, except for the psycho-social outcomes.
CONCLUSIONS:
SMIs are effective. Interventions involving RT and CBT are more effective than other types.

Med Pr. 2010;61(2):191-204.
[Stress prevention programs--strategies, techniques, effectiveness. Part II. Organizational activities to prevent stress at work].
[Article in Polish]
Małgorzata W1, Merecz D, Drabek M.
Author information
Abstract
This is the second part of the publication on approaches to occupational stress prevention and a state of the art in different European countries. In this part, stress prevention within an organization is described and discussed. Although there is no one way of tackling stress at work, some recommendations can be formulated to increase the effectiveness of such interventions. The effective stress reducing programs should be aimed both at changes in the organization itself and empowerment of employees' coping with stress resources. It is also important to take the advantage of wide spectrum of methods and techniques (e.g., work redesign, participation, team work, cognitive behavioral methods, relaxation, etc.) remembering that one size does not fit all. The intervention should be carefully planned and adopted to the various branches, an individual organization or department and should be preceded by the identification of stress risks and risk groups. To have the stress prevention program successfully introduced one should also consider factors which may influence (positively or negatively) the process of program implementation.

Conclusion

- - Linking diagram; consolodating eveything

References

References will automatically be added here, see adding references tutorial.