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Stress and Well-Being at Work

Mark A. Griffin University of Sheffield

Sharon Clarke University of Manchester

To appear in S. Zedeck (Ed.). Handbook of Industrial/Organizational Psychology (Volume 3). Washington DC: American Psychological Association

August 2009

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STRESS AND WELL-BEING AT WORK INTRODUCTION Stress is the single most common reason given for absence from work in the UK, and one in six Americans report they are extremely stressed (HSE, 2008). However, the general notion of stress at work can be contentious, and the possibility that work causes illness has been received with varying degrees of skepticism, indifference, and alarm across sectors of modern society. Regulators, employers, unions, insurers, and health professionals continue to struggle with the meaning and management of stress in the workplace. Although there is much diversity across concepts of work stress, a considerable body of stress-related theory and practice has developed over the past 40 years. Researchers from psychology, economics, sociology, public health, engineering and medicine represent just some of the major disciplines that have addressed the nature and consequences of work stress (Ganster & Schaubroeck, 1991). Within the field of psychology, Beehr and Franz (1987) identified medical, clinical psychology, engineering psychology, and organizational psychology approaches. This chapter focuses on research from the field of organizational psychology but draws from multiple areas where appropriate. Work stress is not a single event or a specific psychological state. Rather, work stress describes a general process in which individuals respond to and manage demands to meet multiple goals over time. A basic distinction between stressors (e.g., excessive workloads) as the primary drivers of this process, and strains (e.g., anxiety and depression) as its primary outcomes, has proved useful building a more complete picture of the stress process (e.g., Caplan, Cobb, French, Harrison, & Pinneau, 1980; Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964; Lazarus, 1966; McGrath, 1976). Stressors describe the demands experienced by individuals and strains capture a

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range of negative outcomes for health and well-being. Nevertheless, most popular writing and many research studies refer to stress as if it was a single outcome, typically as a shorthand for the strain experience of feeling stressed. All theories of stress must grapple with the common observation that although some events are intrinsically stressful (e.g., experiencing a violent event at work), individuals respond to stressful events in different ways. At the extreme, the same work environment can be debilitating and negative for one individual while at the same time it is exciting and challenging for another. The distinction between stressors and strains has proved useful for addressing this core problem (Kahn & Byosiere, 1992). A stressor is the perceived demand from the environment and therefore comprises both external stimuli and the perceptual processes of the individual. Strains are the psychological, behavioral, and physiological outcomes of this process and include such diverse responses as anxiety, absenteeism, and illness. Overall, the stressor-strain distinction captures the elements of a negative transaction between the individual and the environment. The stressor-strain distinction has proved less useful for articulating how positive and negative experiences interact in the stress process or for elaborating the way the stress process unfolds over time. Recent approaches to work stress draw on more fully developed theories of affect (e.g., Watson, Wiese, Vaidya, & Tellegen, 1999) and give greater attention to systems of positive psychology (e.g., Seligman & Csikszentmihalyi, 2000) to build better elaborated models of well-being and the stress process (Folkman, 2008). Time spans have always been important considerations in models of stress, but most empirical studies have used cross-sectional designs (Zapf, Dormann, & Frese, 1996). Recently more attention has been paid to research designs that capture the unfolding transaction between individuals and their work context. For example, models of recovery incorporate a cyclical process of resource depletion and repair that unfolds from day to

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day and week to week (e.g., Sonnentag & Zijlstra, 2006). Importantly, just as work can have negative consequences for the health and well-being of individuals, so too can being out of work. Whilst unemployment may be viewed as a challenge by some people, depending on their personal agency, it can also be experienced as an extremely stressful experience for others, especially in the long-term (Fryer, 1986). The stress process associated with unemployment will not be considered further in this chapter, which focuses on stress related to work (for a review see Fryer, 1998). The remainder of this chapter is divided into four sections. First, we review seven different approaches to the stress process, highlighting influential research and theory over the past forty years. Second, we introduce an integrative framework as a basis for discussing similarities and differences across the major approaches. The integrated framework also provides a basis for reviewing the role of time in the stress process and considering implications for different methodological approaches and research paradigms. Third, we review organizational interventions to reduce stress and fourth, we conclude with a summary and review some future directions for the study of the stress process. Excluded from this review are specific sources of work-related stress, such as international assignments and home-work balance, which are covered elsewhere in this Handbook (see also Vol. 3, Chapter 23, by Leung and Peterson, on "Managing a Globally Distributed Workforce: Social and Interpersonal Issues" and Vol. 3, Chapter 14, by Hammer and Zimmerman, on "Quality of Work Life.") MAJOR APPROACHES TO THE STRESS PROCESS Below we review seven different theoretical approaches that have been influential in shaping understanding of the stress process at work. This coverage is not exhaustive but the approaches provide an overview of the different issues addressed in the study of stress and illustrate the different elements of the stress process at work that have been articulated to date.

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The socio-cognitive model The socio-cognitive or transactional model of stress (Lazarus & Folkman, 1984) emphasizes the ongoing interaction between the person and the environment. As such, stress is not located in the person or the environment, but in the relationship between the environment, individuals appraisals of the environment, and ongoing attempts to cope with issues that arise (Cooper, Dewe, & O'Driscoll, 2001). The model describes two stages of cognitive appraisal. First, primary

appraisal involves appraisal of potential stressors as threatening and posing some kind of threat to the individual. Then, secondary appraisal involves the evaluation of coping resources and

alternative responses. If an individual perceives that a situation is threatening, but that he or she has the ability to cope with it, then strain is not experienced. Indeed, the situation may be perceived as challenging. Coping has been defined as the thoughts and behaviors used to manage the external and internal demands of situations that are appraised as stressful and also shapes emotional responses (Folkman & Moskowitz, 2004, p. 745). A distinction is commonly made between problem focused coping, which seeks to solve the demands of a stressor, and emotion focused coping, which helps the individual to feel better about the stressor (Cooper et al., 2001). Strain arises when an individual appraises the demands of a particular situation as about to exceed available resources and, therefore, to threaten their well-being, necessitating a change in individual functioning to restore the imbalance (Lazarus, 1966). The model suggests that the relationship between the environment and person is ongoing and reciprocal, as it is the interactions between the two that determine strain. Interactive effects have been researched extensively and these are

discussed in more detail below in the section titled Longer-term dynamics of the stress process. Stable individual differences, such as personality, and within-person fluctuations in mood can affect both the appraisal of stressors as threatening and the appraisal of the individuals ability

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to cope. For example, moods have been shown to mediate the link between daily stressors and same-day job performance (Stewart & Barling, 1996), where subjective perceptions of stress influence mood which in turn impacts on job performance. This study found that the indirect influence of subjective stress on job performance (mediated by negative mood, B = -.38) was considerably stronger than the direct effect of subjective stress on job performance (B = -.21). Relatively stable personal factors, such as self-esteem, can also influence individuals appraisals. Individuals with high self-esteem will be less likely to view a potential stressor as threatening and more likely to view themselves as able to cope (Rector & Roger, 1996). The demands-control model The demands-control (DC) model (Karasek, 1979, 1989; Karasek & Theorell, 1990) proposes that job demands and job control play the key role in the stressor-strain relationship. Job demands refer to aspects of the job which require additional or sustained physical, psychological, or emotional effort (de Jonge & Dormann, 2003); job control, or decision latitude, refers to the degree of control over decisions concerning the job (Karasek & Theorell, 1990). The model predicts that excessive job demands increase strain, while high job control mitigates these adverse effects. Together, these effects constitute the strain hypothesis. Those in active jobs with high demands and high control should be able to minimize strain by actively managing job demands. The isostrain model (Johnson, Hall, & Theorell, 1989) added the role of support, proposing that social support also buffers the effects of job demands on strain. Iso-strain occurs in jobs characterized by high demands, low control and low support. Job control and social support are viewed as resources because both are aspects of the job which can lead to buffering job demands and related efforts (Schaufeli & Bakker, 2004). Both the strain and the iso-strain hypotheses have received substantial

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support in the literature (van der Doef & Maes, 1999; de Lange, Taris, Kompier, Houtman, & Bongers, 2003). The DC model assumes that those in active jobs will take advantage of the high level of control to actively manage high demands. However, there is research evidence to suggest that there are individual differences in the way that people react in these situations, such that personal characteristics moderate the demands-control relationship. Salanova, Peir, and Schaufeli (2002) found that for those with high self-efficacy, job control buffered the effect of job demands on strain, but for low self-efficacy individuals, job control acted as an additional stressor, leading to increased strain (R2 = .02) Thus, for some individuals high job control can exacerbate, rather than buffer, job stress in demanding jobs. Parker and Sprigg (1999) found that for those with a highly proactive personality in a high-control job, as demands increased, job strain decreased (R2 = .02). However, for passive employees, there was no demands-control interaction, indicating that strain increased with demands, regardless of the level of control. Meier, Semmer, Elfering, and Jacobshagen (2008) found for those with an internal locus of control, the predictions of the DC model were supported (R2 = .07). However, for those with an external locus of control, high demands had a more negative effect on strain under conditions of high control (rather than low control). Given the difficulty of finding a substantial three-way interaction in field studies, an additional contribution of up 3% can be considered of practical significance. Thus, relatively stable personality characteristics have a significant influence on the impact of job demands and job control on strain, particularly locus of control. The role stress model Roles describe the behavioral patterns and expectations of individuals in complex systems (Ilgen & Hollenbeck, 1991), and the process through which work roles create the experience of

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stress was one of the earliest and most fruitful approaches to work stress (Kahn & Byosiere, 1992). Kahn et al. (1964) reported the first of a series of studies based at the Institute of Social Research (ISR) and exploring the nature of role conflict and role ambiguity in the stress process. Role conflict describes two or more sets of incompatible work demands, whereas role ambiguity describes a lack of specificity or predictability in role functions and responsibilities (Beehr & Newman, 1978; Kahn et al., 1964; Katz & Kahn, 1978). Role overload is the third most common form of role stress and is sometimes viewed as a particular form of role conflict. Role overload is a function of too much work, time pressures, and a lack of resources to meet commitments and responsibilities (Beehr & Glazer, 2005). Role conflict and role ambiguity are probably the two most frequently studied stressors in organizational life (Kahn & Byosiere, 1992). There is substantial support for the role stress model, with large effect sizes (.43 < r < .48) reported for the effect of role stressors on measures of affective strain (Jackson & Schuler, 1985; Ortqvist & Wincent, 2006; Sauter, Murphy, & Hurrell, 1990). The cybernetic model Cybernetic models define goals and feedback loops as the central feature of the stress process (Cummings & Cooper, 1979). Through a feedback cycle, individuals monitor the discrepancy between a preferred or reference state and the actual work conditions as they are perceived. The perceived discrepancy is a source of strain for the individual and motivates action to reduce the discrepancy by changing or adapting to the environment in some way. For example, a discrepancy between perceived and preferred levels of workload leads to an attempt to reduce the level of workload or to adapt to this level of load. This coping action is then followed by a new comparison of the discrepancy between preferred and actual states (Edwards, 1992).

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The feedback cycle assumes that individual behavior is directed toward a steady state of balance between the individual and the environment. This drive towards homeostasis creates strain when homeostasis is disrupted, and it motivates the need for engaging in coping activities (Miller, 1965). Edwards (1992) noted that feedback cycles are part of most theories of stress including transactional and role stress models. However, he argued that the underlying cybernetic principles had been given insufficient attention in these models of the stress process. The proposed benefits of the cybernetic approach include a more systematic definition of the components of the feedback cycle that can be used to identify and explain a wide range of stressors, strains, and coping responses. The cybernetic feedback cycle is hierarchically organized so short-term cycles (e.g., a disruption to work load) are embedded within longer-term cycles (e.g., achieving life goals). For each cycle, perceived and actual standards provide a comparison point for determining action (Carver & Scheier, 1990). The source of preferred states or reference criterion derives from individual factors such as values and personality (Cummings & Cooper, 1998). Both positive and negative affect can be elicited by the feedback cycle. The cybernetic model often reflects a highly dynamic situation as individuals are faced with allocating limited resources in terms of time and attention to managing multiple goals over time. Schmidt and DeShon (2007) found that resource allocation is affected by both progress towards goals and the consequences of failing to reach goals, with avoidance goals (avoiding losses) attracting greater resources in the short term. However, in the longer term, this may be damaging to health and well-being. Carver and Scheier (1990) conceptualized a second feedback system that played a meta-monitoring function in the evaluation of goal progress. Affect is proposed to arise as a function of the speed of progress toward goals. From this perspective, homeostasis is maintained by the hierarchically nested negative feedback

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loop while affect arises from the meta-monitoring of the speed of progress through feedback loops toward goal attainment. Although not as well-researched as the previous stress models, the major tenets of the cybernetic model have received support. The primary prediction of the cybernetic model is that the discrepancy between a preferred or desired state and actual work conditions will affect strain; as the discrepancy increases, so too will the adverse effects on well-being. Elsass and Veiga (1997) operationalized this process by examining the effect of desired goals (in this case, desired control) over and above the effect of job characteristics (in this case, actual control); they found that desired control accounted for significant additional variance in job strain, controlling for both job autonomy (R2 = .04) and desired participation (R2 = .03). Stronger support was demonstrated where desired states were operationalized as personal goals (ter Doest, Maes, Gebhardt, & Koelewijn, 2006); with personal goal facilitation accounting for significant additional variance in four measures of job strain (job satisfaction, personal accomplishment, emotional exhaustion and psychological symptoms), controlling for demographics and job characteristics (.05 < R2 < .07). The challenge-hindrance model LePine, Podsakoff, and LePine (2005) proposed the challenge-hindrance framework, based on Lazarus socio-cognitive model, to account for the inconsistent evidence of the relationship between stressors and performance. Within this framework, stressors may be appraised as either challenges or hindrances. When stressors are appraised as challenging, positive emotions are evoked and active coping strategies, such as problem-solving, are engaged. Challenge stressors include job and role demands, pressure, time urgency, and workload. Drawing on expectancy theory, LePine et al. (2005) suggest that challenge stressors are associated with high motivation and, therefore, lead to better performance because individuals are likely to believe that there is a

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positive relationship between effort and expectancy. When stressors are appraised as threatening, negative emotions ensue and a passive or emotion-focused style of coping is used. These are described as hindrance stressors and include constraints, hassles, role ambiguity, role and interpersonal conflict, role overload, supervisor-related stress, and organizational politics. These stressors are not motivating because effort expended to cope with them is unlikely to be successful or bring valued rewards. The model predicts that hindrance and challenge stressors are both subject to the same psychological process (primary appraisal) and both will result in strain. Indeed, LePine et al. (2005) found that there is some degree of overlap between these types of stressor (r = .33), perhaps due to the similarity in some of the stressors, e.g., role overload (hindrance) and role demands (challenge). However, whilst both types of stressor are significantly related to strain (hindrance, = .50; challenge, = .23), other outcomes will differ, as challenge stressors are associated with positive emotions and attitudes (LePine et al, 2005). Research has supported the distinction between these two types of stressors, and their differential relationship with job satisfaction (Cavanaugh, Boswell, Roehling, & Boudreau, 2000). Podsakoff, LePine, and LePine (2007) showed strong support for the differential relationships between hindrance stressors and job satisfaction ( = -.57) compared to challenge stressors and job satisfaction ( = -.02). A similar differential relationship has also been demonstrated with role-based performance (Wallace, Edwards, Arnold, Frazier, & Finch, 2009). This framework de-emphasizes the need for individual difference explanations as it assumes a degree of consistency in the perception of stressors, i.e., some will be consistently appraised as challenging, whilst others will be consistently appraised as hindrances. However, despite some supporting evidence (LePine et al, 2005; Podsakoff et al, 2007; Wallace et al, 2009), this model is inconsistent with a substantial body of research that has emphasized the moderating

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effect of personality, and other individual difference variables, on how individuals appraise stressors (see section titled Individual differences below). The conservation of resources model The Conservation of Resources (COR) approach to stress proposes that people fundamentally seek to obtain, retain, protect, and restore resources. Resources describe a wide range of objects (e.g., shelter), personal characteristics (e.g., self-esteem), conditions (e.g., status), or energies (e.g., knowledge) that are important for adaptive functioning (Hobfoll, 1989). Resources are valued in their own right or because they lead to other valued resources. Strain results from the threat of resource loss, the actual loss of resources, or failure to gain sufficient resources. Individuals also strive to develop surplus resources, which are the source of higher levels of wellbeing. Stressors are generally perceived to be negative because they deplete resources. This was supported by Lee & Ashforth's (1996) meta-analysis which found that five of eight work demands were strongly related to affective strain (r >.50). COR proposes that the main motivational process in stress is preventing the loss of resources. Losing resources creates strains, and coping responses are enacted with the goal of protecting and restoring resources. COR has most frequently been studied in relation to burnout (see next section), and Lee and Ashforth (1996) found support for the basic propositions of COR theory in their meta-analysis of burnout correlates. The burnout model The term burnout has received substantial attention as a distinct dysfunctional outcome of the stress process for individuals. Burnout research focuses on strain outcomes of the stress process, in particular the more extreme forms of strain with long term negative consequences for individuals. Maslach and Jackson (1981) defined three dimensions of burnout: emotional exhaustion,

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depersonalization, and diminished personal accomplishment. Emotional exhaustion describes feelings of being emotionally overextended, depersonalization refers to cynical and detached responses to others, and reduced personal accomplishment refers to a decline in efficacy and feelings of competence and productivity (Maslach, 1998). Burnout research initially focused on employees working in caregiving and people oriented roles where high demands arose from working with clients although the approach is widely adopted in other settings (Cooper et al., 2001). Lee and Ashforth (1996) argued that service providers suffer strain when their emotional resources are depleted to such an extent that they are no longer able to meet the demands of interpersonal stressors. Their results supported the link between burnout and a wide range of individual, job, and organizational stressors. The three dimensions of burnout are part of a theoretical process whereby exhaustion leads to actions that distance the individuals from elements of their work that are stressful, resulting in cynicism and depersonalization. Over time, these actions and withdrawal result in decreased

experiences of efficacy. The causal sequence among dimensions has been controversial and alternative sequences have been proposed (Golembiewski, Munzenrider, & Carter, 1983), with some suggesting that personal accomplishment develops somewhat independently of the other two dimensions (Leiter, 1993). This is supported by meta-analytic findings (Lee & Ashforth, 1996) that exhaustion and depersonalization are more closely related ( = .64) than personal accomplishment with exhaustion ( = -.33) or with depersonalization ( = -.36). Exhaustion is the most widely reported and studied dimension of burnout (Maslach & Leiter, 2008). Lee and Ashforth's (1996) meta-analysis supports the proposition that exhaustion (mean = .44) and depersonalization (mean = .33) are more strongly related to job stressors than diminished personal accomplishment (mean = .10). However, Halbesleben (2006) did not find that social support was a stronger predictor of

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exhaustion as proposed in burnout models, although it acted as a moderator. Evidence linking burnout to individual difference variables is inconsistent, with the exception of an association between neuroticism and burnout. Personality traits were found to account for significant

additional variance over and above job stressors (R2 = .12), but only neuroticism was a significant predictor of burnout ( = .32) with those who are high in neuroticism more likely to develop the symptoms of burnout in response to stressors (Zellars, Perrewe, & Hochwarter, 2000). INTEGRATING FRAMEWORK There is much overlap in the issues and constructs addressed by different approaches to stress, and all of the models presented above have some features in common. Overall, there are few examples where different theoretical approaches result in different predictions (although see Edwards, 1992 for examples). Rather, the complexity of the stress process means that different approaches tend to emphasize some features of the process and place less emphasis on others. For example, role theories of stress emphasize the demands imposed by the environment, transactional theories emphasize the appraisal of demands, and burnout theories emphasize the responses and consequences of demands. Although there is substantial support for components of these stress models, there is also evidence that focusing on a limited number of stressors (such as job demands and job control) fails to adequately reflect the complexity of the stress-strain relationship (van Veldhoven, Taris, de Jonge, & Broersen, 2005). To provide a comprehensive comparison and review of stress models we present an integrating framework in Figure 1 that summarizes the ongoing transaction between the person and the situation. The goal of the overall framework is to provide a broad picture of the relationships between more complex sub-components or facets. For example, overall models such as Beehr

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(2000) and Cox and MacKay (1981) build on specific facet models of stress (Beehr & Newman, 1978; Newman & Beehr, 1979). Insert Figure 1 about here

The framework highlights two key processes of work stress: a transactional process linking the person and environment, and a dynamic process that unfolds over time. First, transactional approaches describe how the individual evaluates and responds to environmental conditions. This transaction is a feature of many stress models particularly the socio-cognitive model (Lazarus & Folkman, 1984) and the challenge-hindrance model (LePine et al., 2005) that specify how environmental features are appraised by individuals; and cybernetic approaches (Edwards & Cooper, 1990) where the discrepancy between the individuals preferred state and the perceived environment is the main motivational process. Other approaches emphasize the role of the environment more directly. Role theory (Kahn & Byosiere, 1992) describes how specific task conditions can have an impact on strain outcomes, the demands-control model (Karasek, 1989) focuses on interaction of specific work characteristics, and the conservation of resources approach (Hobfoll, 1989) emphasizes the way the environment helps build or deplete resources. Despite the large role played by the environment in models of stress, Daniels (2006) notes that external features such as job characteristics are typically assessed by individual self-reports that make it difficult to disentangle environmental conditions from psychological processes such as bias, mood, and social interaction. Second, the stress process is dynamic because the transaction between the person and environment unfolds over time through a process of mutual influence. The figure incorporates this dynamic by specifying a short term time cycle of ongoing appraisal, goals, and action within a

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longer term cycle of interaction between the individual and the environment. This nesting of processes recognizes the hierarchical structure of feedback loops in the stress process (Carver & Scheier, 1990). Stress theories typically incorporate propositions about the temporal ordering of events, and each major theory described above identifies a primary causal sequence through which stressors are translated into strains. There is also some attention to stressors that might have long or short term consequences (Beehr & Franz, 1987). However, the dynamics of mutual influence over time have proved difficult to specify (Beehr, 2000). In the following section, we provide a more detailed review of elements that constitute the longer-term and the shorter-term dynamics of the stress process. We then explore the role of time for linking short-term and long-term dynamics and conclude this section with a discussion of methodological implications for studying the stress process. Longer-term dynamics of the stress process The interaction between the individual and the environment We begin reviewing the specific content of Figure 1 by identifying the relatively longerterm elements of the person and the environment interaction. We first review studies that inform main effects of the environment and individual on strain outcomes, then review issues associated with understanding person-environment interactions. The environment The environment creates demands and provides supports in the stress process. The potential range of environmental factors is vast: almost any event or situation that a person encounters could be viewed as a source of stress. Most stress models propose that relatively stable job characteristics such as job demands and control have an impact on workers health and well-being. Generic role stressors and demands have been found to differ significantly across occupations (Sparks & Cooper,

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1999). In addition, job characteristics specific to particular occupations can be important predictors of stress outcomes. For example, Cooper, Clarke, and Rowbottom (1999) identified occupational characteristics within medical specialties that were specifically relevant for anaesthetists. Alfredsson and Theorell (1983) developed an assessment of the risks posed by objective job characteristics for myocardial infarction in 118 occupational groups. In a review of 63 studies, van der Doef and Maes (1999) reported that two-thirds supported a relationship between job characteristics and psychological well-being and this conclusion has been supported in reviews of longitudinal studies (de Lange et al., 2003). Overall, the design of jobs can have a significant impact on a wide range of positive and negative health outcomes associated with the stress process (Parker, Turner, & Griffin, 2003). In addition to job characteristics, organization design factors, such as the structure and climate of the organization, management style, communication, level of consultation and politics, influence individuals health and well-being. Indeed, a number of studies have found a more negative effect associated with organizational stressors than stressors more intrinsically related to the job in occupations including police (Hart, Wearing, & Headey, 1995; Thompson, Kirk-Brown, & Brown, 2001), ambulance staff (Glendon & Coles, 2001), and teachers (Hart, 1994). For

example, Hart et al (1995) reported that police officers reported higher levels of psychological distress in relation to organizational hassles (such as administration and paperwork) compared to operational hassles (such as dealing with victims of crime or facing physical danger). Sparks, Faragher, and Cooper (2001) identified four sources of stress that have become increasingly important as employment conditions change: job security; long work hours; control at work; and, managerial style. In particular, a lack of job security has been found to have detrimental effects on health and well-being in European (Borg, Kristensen, & Burr, 2000; Domenighetti,

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DAvanzo, & Bisig, 2000) and North American workers (McDonough, 2000; Probst & Brubaker, 2001). Job security can be objective, reflecting the actual likelihood of redundancy, or subjective, reflecting perceptions of job security. The social environment at work can constitute a demand or a resource, and can also act as a moderator of the stressor-strain relationship. Social support has been one of the most prominent resources investigated in the stress process and was included as an integral part of the extended demand-control model (Johnson, Hall, & Theorell, 1989; Karasek, 1979). Kahn and Byosiere (1992) reviewed 22 studies that investigated the link between social support and strain. All but two reported main effects of social support on strain and, in most cases, the effect was observed for support from both coworkers and supervisors. Viswesvaran, Sanchez, and Fisher's (1999) metaanalysis found a medium effect size ( = -.21) for the direct relationship between social support and strain. This negative effect indicates that social support has a reducing effect on strain (independent of stressors) across most situations. Evidence that social support moderates stressor-strain relationships is more mixed despite a large number of studies as well as narrative and meta-analytic reviews assessing the proposed effect. Partial evidence for the moderating effect of social support was reported by (Viswesvaran et al., 1999), who found an accumulated R2 of 3% across studies in their meta-analysis. The interaction between support and stressors might be observed more reliably if assessed at the appropriate level of analysis (Bliese & Castro, 2000) and where the type of support matches the type of stressor (de Jonge & Dormann, 2006). For example, stressors associated with the organizational level of analysis might show more consistent effects by taking account of systematic differences between organizations rather than individuals perceptions within organizations.

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The home-work interface is a distinct topic in the stress literature and a chapter in this Handbook reviews home-work issues in more detail (see also Vol. 3, Chapter 14, by Hammer and Zimmerman, on "Quality of Work Life"). Meta-analyses have explored the antecedents and consequences of work-family conflict, generally supporting the proposition that work stressors have an impact on the extent to which work interferes with family (e.g., Byron, 2005). Stressors at work can also have an impact on the health of the employees family members (Bakker, Demerouti, & Dollard, 2008). Physical demands (such as exposure to heat, noise, and toxic substances) have received less attention than psychological stressors. These demands are sometimes used as a control variable to estimate the effects of psychological stressors or excluded from consideration as psychological stressors (e.g., Ganster, 2008). The impact of shift work and work schedules, in contrast, has received a great deal of attention. Totterdell (2005) provides an extensive review of the impact of scheduling on factors such as fatigue, disease, and absence. There is widespread agreement that shift work and long work hours significantly increase the risk of sleep disturbance and fatigue and also increase the likelihood of some cancers, particularly breast cancer, gastrointestinal disorders and cardiovascular disease. The increased risk is quite substantial for both breast cancer (50-60%) and cardiovascular disease (40%) (see Totterdell, 2005, for further discussion). The role of individual differences Stable dispositional factors, such as personality, influence the stress-strain process in a number of different ways, including: exposure to stressors; appraisal and reactivity to stressful events; consistent use of coping strategies and development of coping style; and, susceptibility to stress outcomes (Bolger & Zuckerman, 1995; Grant & Langan-Fox, 2006). For example, exposure to stressors appears to occur more frequently for individuals high in neuroticism because they are

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more likely to view a situation as threatening and to use maladaptive coping techniques (Hemenover, 2003; McCrae & Costa, 1986). In contrast, those high in extraversion and conscientiousness are more likely to view potential stressors as a challenge and to adopt problemsolving coping strategies (Watson & Hubbard, 1996). Research on the interactive effects of personality traits (Grant & Langan-Fox, 2006) highlighted the role of combinations of neuroticism, extraversion and conscientiousness specifically that combinations of high neuroticism-high conscientiousness predicted higher stressor exposure and low neuroticism-high extraversion and/or high conscientiousness predicted lower stressor exposure. In relation to coping, high extraversionhigh conscientiousness generally predicted higher problem-focused coping and high neuroticismlow conscientiousness generally predicted lower problem-focused coping. Overall, personality type explained approximately 8% of the variance in stressor exposure and 11% of the variance in coping. Low strain was consistently associated with low neuroticism-high extraversion-high conscientiousness; however, high strain was differentially related to personality type, depending on the outcome variable (Grant & Langan-Fox, 2006). Physical ill-health was most associated with impulsive personality types (high extraversion-high neuroticism-low conscientiousness), whereas job dissatisfaction was most associated with individuals low on all three personality dimensions. Low agreeableness in combination with high neuroticism was related to job dissatisfaction, but not physical ill-health; this finding suggests an affective, rather than a physiological, response is typical for such individuals. Kahn and Byosiere (1992) argued that locus of control influences how individuals cope with stress; those with an internal locus of control will engage more actively to cope with stress, and so display better health outcomes. An internal locus of control is associated with the belief that outcomes can be controlled and so individuals are more likely to adopt a proactive approach to

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dealing with a negative work environment. Individuals with an internal locus of control are more likely to prevent the development of stressful conditions and to actively seek out ways of managing negative situations when they occur. Overall, internals are more likely to perceive work stressors as manageable and less threatening. For example, Daniels and Guppy (1994) found that job control moderated the stress-strain relationship, but only for individuals with internal locus of control. Ng, Sorensen, and Eby (2006) found that internal locus of control was strongly associated with wellbeing, including mental well-being ( = .36), physical health ( = .31) and burnout ( = -.27), predominately through cognitive processes, self-evaluation, motivation, and coping strategies. Extending locus of control, the concept of core self-evaluation (CSE) reflects an individuals overall perception of self-worth and is comprised of: locus of control, plus generalized self-efficacy, and neuroticism (Judge, Erez, Bono, & Thoresen, 2002; Judge, Locke, & Durham, 1997). CSE can influence the type of jobs that individuals select, the work environments that they experience and their perceptions of the environment (Dormann, Fay, Zapf, & Frese, 2006). Feeling able to control ones job situation is a central part of CSE and an important aspect of well-being; feeling in control will lead to satisfaction regardless of whether that control is actually exercised. Therefore, an internal locus of control can be more important for job satisfaction than available control. In some situations, an internal locus of control might lead to less engagement with the external environment to protect mental resources that otherwise would be depleted (Schnpflug, 1983). There are circumstances, however, where an internal locus of control may have adverse effects, for example, an internal locus of control might lead one to expend effort to manage a situation that cannot be controlled, thus depleting resources (Muraven & Baumeister, 2000). A wide variety of additional factors have been studied as individual antecedents in the stress process, or as moderators of the stress process, including negative affectivity, hardiness, Type A

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personality, and optimism (Cooper et al., 2001). We consider individual factors as moderators in more detail in the next section. Interactions between the individual and the environment A defining feature of the stress process is the way individual characteristics interact with features of the environment. In this section we review various approaches to describing and analyzing this interaction from the perspective of more stable person and environment features. The socio-cognitive approach (Lazarus & Folkman, 1984) and the demands-control model of stress (Karasek & Theorell, 1990) include person-environment interactions as a central part of each theory. Other approaches incorporate this interaction as an implicit link between core constructs such as person-environment fit (Edwards & Cooper, 1990) and homeostasis (Hobfoll, 1989). One complexity associated with assessing an interaction between individuals and environments is the sheer number of interactions that can be considered. All environmental demands and resources can potentially interact with all individual differences. A further methodological complexity is the form of the interaction. In its simplest form, an interaction can be represented by a multiplicative relationship between two variables so that the effect of one variable depends on the level of the second variable. Extensive research has assessed this interaction using concepts of moderation, contingency, and buffering. We reviewed some of these issues in the discussion of social support above. The DC model incorporates interaction as part of its central propositions and we review this model next in more detail together with other features of the person-environment interaction. Many different forms of interaction between demands and control have been tested empirically (Van Vegchel, De Jonge, & Landsbergis, 2005). Karasek (1989) proposed that the interaction could simply reflect the joint effect of demands and control on strain via an additive

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effect, given that multiplicative terms are difficult to detect in practical situations. Van Vegchel et al. (2005) found that both multiplicative and ratio interaction terms were significant predictors of strain; both supported the combination of high demands, low control as high strain, but differed on other conditions. The results were consistent with Warr's (1994) suggestion that relationships between environmental characteristics, such as job demands, and well-being are non-linear. The existence of non-linear relationships is problematic for testing interactional effects. Inconsistencies in the reporting of interaction effects may also be partially explained by the matching hypothesis (de Jonge & Dormann, 2006), whereby interaction effects are more likely to be demonstrated when there is a match between the type of stressor, resource and strain. de Jonge and Dormann (2006) found that interactions were more likely to be supported when there was a triple match between the stressor, resource and strain. For example, physical resources and physical stressors were more likely to interact in the prediction of physical outcomes compared to other outcomes. A review conducted by de Lange et al. (2003) included only longitudinal studies that met a high quality standard. They found that of 19 studies reviewed, 8 reported support for the joint effects of job demands, job control or social support on health outcomes over time. The basic interaction between demands and control has been extended in a variety of ways. Three-way interactions have been supported for self-efficacy (Salanova et al., 2002; Schaubroeck & Merritt, 1997), active coping (de Rijk, Le Blanc, Schaufeli, & De Jonge, 1998), proactive personality (Cunningham & De La Rosa, 2008; Parker & Sprigg, 1999), information (Jimmieson & Terry, 1999), and locus of control (Meier et al., 2008). Although the theoretical basis for individual moderators is elaborated in these studies, an overall framework for selecting substantively different types of moderators has not been established. It is possible failures to demonstrate interactions

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between demands and control result from a lack of methodological and theoretical sophistication (Parker et al., 2003). For example, significant interactions have been found when the level of analysis at which constructs are theorized is matched to the measurement strategies and analyses (Bliese & Castro, 2000; Morrison, Payne, & Wall, 2003). In addition to the DC model, other approaches to the stress process either test an interaction between the person and the environment directly or describe some form of mutual and interdependent relationship. The concepts of fit and discrepancy are particularly important for conveying this interdependence in conservation of resources, P-E fit and cybernetic models of stress. Cummings and Cooper (1979) provide a comprehensive portrayal of the personenvironment interaction in terms of time, information, and feedback. An underlying feature of interaction arguments is a drive toward homeostasis, where the individual and environment achieve a state of equilibrium (Hobfoll, 1989). From this perspective, a stressor is a force disrupting a system beyond its range of stability, and the stress process involves the actions that achieve a new state of equilibrium. It is difficult to assess the unique importance of interactions in the stress process independent of main effects. Interactions are often reported in relation to multiple main effects, null effects are often observed, and the proportion of variance explained by interactions is frequently small. Design, measurement, and statistical artifacts can also bias the size of interaction effects downwards (Aguinis, Beaty, Boik, & Pierce, 2005). Overall, effect sizes for interactions explaining between 2% and 5% of strain outcomes appear to have a significant and meaningful impact in the stress process.

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Longer-term outcomes of the stress process We now look at the final element of the longer-term time cycle in the Figure, the outcomes of the stress process. Individuals can vary greatly in their response to stressors. For example, a heavy workload might cause psychological effects in one person, making them anxious, whilst another might experience physiological symptoms, such as headaches. There are also differences of the impact of some stressors on health for men and women. For example, long work hours have a negative effect on health (Sparks et al., 2001) but the risk is greater for women (Starrin, Larsson, Brenner, Levi, & Petterson, 1990). Various categorizations of longer-term stress outcomes have been proposed but are generally grouped as psychological, physiological, or behavioral outcomes (Kahn & Byosiere, 1992). Most research has focused on the psychological outcomes of the stress process and the strongest empirical effects of stressors have been observed in relation to psychological outcomes. This stronger effect might be inflated because of common method bias resulting from similar measurement for stressors and strains (Podsakoff, MacKenzie, Lee, & Podsakoff, 2003). It is possible that experience of one strain can increase vulnerability to other types of strain. For example, the long-term effects of job dissatisfaction associated with role ambiguity might be physical ill-health. This causal process would lead to a weaker relationship between stressors and physical outcomes compared to psychological outcomes. We now explore the negative outcomes of the stress process and integrate some more positive features of health and well-being. We review the different categories of outcome in terms of psychological strain and well-being, physical health, and behavioral outcomes.

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Psychological strain and well-being Kahn and Byosiere (1992) identified over 40 different measures of psychological strain, although they noted considerable conceptual overlap among categories. Job dissatisfaction was the most commonly used measure of strain, and other common measures were anxiety, depression, and generalized strain. Most research reviews indicate that psychological strains, such as anxiety and depression, are strong correlates of work-related stressors (Jackson & Schuler, 1985; Jex & Beehr, 1991; Kahn & Byosiere, 1992). Viswesvaran et al (1999) estimated a correlation of .43 between the general construct of work stressors and the general construct of strain. In the DC model, the benefits of control and support in buffering against the negative health effects of high demands, via coping, accumulate over time. Control and support have their buffering effect by facilitating problem-solving. Over time, consistent use of coping mechanisms leads to a coping style, a cross-situational consistency in coping. Daniels, Beesley, Cheyne, and Wimalasiri (2008) found that consistent use of problem-solving coping, enacted through support and control, led to fewer risky decisions, but could have detrimental effects in the short term. These findings would support the adjustment model, where strain increases proportionately with increases in the intensity of the stressor until the individual adjusts to the stressor (Frese and Zapf, 1988). Although it is clear that the stress process is associated with a wide range of psychological strains, there has often been limited theoretical justification for the specific strains included in a particular study (Cooper et al., 2001). The study of burnout is an exception, with the three dimensions of exhaustion, depersonalization, and lower efficacy derived from theoretical propositions about the aetiology of symptoms. Further progress toward a more theoretical description of stress outcomes has been made by integrating the broader construct of well-being. The typical conceptualization of stress covers only a

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part of the broader domain of well-being (Warr, 2005). Mental health should not be considered merely as the absence of stress symptoms, but in terms of the presence of active mental health (Parker et al., 2003). Such a state would have positive indicators, such as competence, mastery, aspiration and desire for autonomy (Warr, 1994). These indicators encompass the motivational and behavioral dimensions of well-being as well as its affective nature. Ryff & Keyes, (1995) developed a six-factor model of wellness: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. These aspects of well-being are defined as: a sense of self-determination and the ability to resist social pressures to think and act in certain ways (autonomy); the capacity to effectively manage ones life and the surrounding world (environmental mastery); the sense of continued growth and development as a person as well as openness to new experiences (personal growth); positive regard for other people, such as a genuine concern about the welfare of others (positive relations with others); the belief that ones life is purposeful and meaningful and that one has something to live for (purpose in life); and a positive evaluation of oneself and ones past life (self-acceptance). Warr (1994) emphasizes the importance not only of these separate dimensions, but also of integrated functioning that represents the person as a whole. The importance of achieving such a balance is reflected in the definition of happiness as the balance between positive and negative affect (Bradburn, 1969). Models of burnout have also been extended to include engagement dimensions that represent positive poles of the burnout dimension (Maslach & Leiter, 2008). Positive mental wellbeing has been related to work engagement, where engaged workers are defined as those who have a sense of energetic and effective connection with their work activities and [they] see themselves as able to deal well with the demands of their job (Schaufeli, Taris, & van Rhenen,

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2008, p. 176). It comprises three aspects: high levels of energy and mental resilience (vigor); a sense of significance, enthusiasm, inspiration, pride and challenge (dedication); and, being fully engrossed in work (absorption). The latter element of absorption has also been associated with workaholism; however, workaholism has been linked with poor well-being (Schaufeli et al., 2008; Taris, Schaufeli, & Verhoeven, 2005). There is moderate support for a positive relationship

between work engagement and good mental health: Schaufeli & Bakker (2004) found that emotional exhaustion was negatively correlated with vigor (r = -.40) and dedication (r = -.28), but had little relationship with absorption (r = -.07). The association with well-being may be explained by engaged individuals response to highly demanding, but highly resourced jobs. Engaged

workers become engrossed in their work, but perceive work as fun. In contrast, workaholics tend to work excessively hard in poorly resourced jobs, i.e., those that are highly demanding, but have poor support (Demerouti, Bakker, de Jonge, Janssen, & Schaufeli, 2001). Thus, motivational aspects differ: workaholics are driven to work hard, whilst engaged workers are more intrinsically motivated. However, managing highly demanding jobs over time, even for engaged workers, may eventually lead to burnout (Schaufeli et al., 2008). Physical health Physiological outcomes are studied less often than other outcomes in stress research. However, there is a substantial body of evidence that the stress process, over time, can have a significant negative effect on workers physical health and immunity (van der Doef & Maes, 1999; Segerstrom & Miller, 2004). Whilst acute and time-limited stressors lead to an adaptive response, chronic stressors result in decreased potential adaptiveness of the immune system over time (Segerstrom & Miller, 2004). Chandola et al. (2006) assessed data from over 4000 individuals on four occasions to link work stressors to health outcomes, including a metabolic syndrome

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associated with increased risk of heart disease and Type 2 diabetes. The study found that chronic work stress substantially increased the likelihood of developing the metabolic syndrome: men were nearly twice as likely and women over five times more likely to have the metabolic syndrome, compared to those with no exposure to work stress. Heart rate, blood pressure and catecholamines have been assessed most often as indicators of physiological functioning. Jones et al. (2007) argue that one mechanism linking job strain to health is through a range of health behaviors. Those most studied are alcohol and smoking (e.g., Kouvonen, Kivimaki, Cox, Cox, & Vahtera, 2005). Other studies have shown that job strain is associated with decreased healthy eating or increased body mass index (Hellerstedt & Jeffery, 1997; Kouvonen et al., 2005; Lallukka et al., 2004; Tsutsumi et al., 2003). Studies investigating health outcomes have not reported consistent findings, although Zapf et al. (1996) argue that the effect size of the stressor-strain relationship is limited, due to the large number of potential causative factors influencing health and well-being (including environment, leisure and family stressors, social class, personality, and health behaviors). Segerstrom (2007) noted that the most psychologically healthy individuals sometimes have the least robust immune system, further complicating a straightforward link between long-term stressors and health; for example, unnecessary energy allocated to the immune system makes less energy available for other systems. When resources are threatened, it could be adaptive for organisms to direct energy away from the immune system and toward protecting or restoring resources (Segerstrom, 2007). Work stress has been associated with a range of musculoskeletal diseases and complaints (Bongers, de Winter, Kompier, & Hildebrandt, 1993; Carayon, Smith, & Haims, 1999). Biomechanical processes explain some of the reasons that stressors such as workload might lead to musculoskeletal complaints. However, psychological processes also play a part in shaping the

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experience of these factors. Authors have proposed that psychological affective strains might mediate the link between stressors and musculoskeletal complaints (e.g., Kjellberg & Wadman, 2007). The prevalence of office based work and increasing computer use mean that these problems are likely to increase. Sprigg, Stride, Wall, Holman, and Smith (2007) found that the impact of workload on musculoskeletal disorders for call centre employees was partially mediated by the psychological experiences of anxiety and depression. Behavioral outcomes Indirectly, a broad domain of behavioral responses has been linked to the stress process. Jex and Beehr (1991) divide behaviors into those with significance for the organization, including job performance, turnover and absenteeism; and those with significance to the individual, including use of alcohol, smoking, substance use and destructive behaviors. Behaviors can be associated with stressors via a direct relationship (e.g., work overload causes absence from work) or mediated by an affective state (e.g., work overload causes anxiety, which in turn causes absenteeism). The experience of transient positive moods has also been linked to enhanced outcomes (Erez & Isen, 2002; Totterdell, 2000). Tsai, Chen, and Liu (2007) found that positive mood states predicted task performance. Furthermore, the study showed that positive moods have a lasting effect on task performance measured three weeks later. This effect may be facilitated through interpersonal processes, such as helping coworkers whereby an employees positive mood results in greater engagement in helping coworkers motivated by desire to maintain his or her positive mood. Positive moods can be contagious as individuals helping behavior encourages positive moods in coworkers. Walter and Bruch (2008) argue that although most research has considered positive moods and emotion at the individual level, they may be viewed as collective constructs

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operating at a group level. George (1990) showed that positive group affect is related to absenteeism and individual well-being. Proactive work behavior has also been linked to enhanced well-being (Crant, 2000); this behavior is defined as taking initiative in improving current circumstances; it involves challenging the status quo rather than passively adapting present conditions (p.436). Examples of proactive behavior include generating and implementing new ideas and taking the initiative in problemsolving. Such behavior involves a conscious decision-making process and is affected by the

individuals level of self-efficacy (need to feel in control of a situation) and felt responsibility for change (motivated to approach initiative and willing to accept responsibility). Parker, Williams, and Turner (2006) showed that self-efficacy played a significant role in proactive behavior, highlighting the importance of building employees perceptions of their own capability as a means of enhancing employee proactivity, and subsequently their well-being. Response to stressors can include a range of work withdrawal behaviors (R. L. Kahn & Byosiere, 1992). Darr and Johns (2008) reviewed 153 studies and found positive but small connections among work strain, illness, and absenteeism, challenging the popular workplace estimates that introduced this chapter. They estimated that work strain accounts for between six and 29% of the variance in absenteeism. In comparing whether absence was primarily a response to a noxious workplace or a function of illness, they concluded with tentative support for a partial illness explanation. Workplace safety is another potentially important outcome of the stress process. Stress is considered to be responsible for 60-80% of all workplace accidents (Cooper, Liukkonen, & Cartwright, 1996), yet there is a lack of research examining accidents as an outcome of occupational stress. Occupational stress is related to increased accident risk in a variety of working

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environments.

For example, job stress was found to be a small but significant predictor of work

accidents ( = .13, p <.01) in a study of 778 veterinarians (Trimpop, Kirkcaldy, Athanasou, and Cooper, 2000) and also in a sample of 2500 doctors ( = .09, p <.05; Kirkcaldy, Trimpop, and Cooper, 1997). Experience of workplace stressors may have direct effects on performance, increasing accident liability, or the effects may be indirect, mediated by employee health and wellbeing. Exposure to long-term stressors that result in psychological and physical symptoms of illhealth can also lead to increased accident risk. For example, Houston and Allt (1997), in a study of junior house officers, found that psychological distress was linked to significant medical errors, as well as everyday errors. Cooper and Cartwright (1994) elaborated on multiple processes through which individual symptoms can ultimately influence organizational outcomes such as accident rates. For example, high absenteeism might lead to staff shortages increasing workload on remaining personnel, and making errors more likely. Short-term dynamics of the stress processes We next view the stress process in terms of psychological systems that dynamically interact with each other over shorter periods of time. This dynamic process is embedded in the longer term process described above and is consistent with the notion that feedback cycles at lower levels of analysis are likely to occur more rapidly than those at higher levels (Campion & Lord, 1982). In contrast to the longer term cycle, the cognitive, affective, and behavioral processes in this cycle are more fluid and difficult to differentiate. This cycle is also likely to involve automatic processing that occurs without conscious responding (Aarts & Dijksterhuis, 2000; Bargh, 1990). Nevertheless, the theoretical approaches we have introduced to date are relevant to various parts of this process and we describe them next.

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Appraisal Processes First, the appraisal process involves the perception of environmental stimuli. Different approaches to stress propose categorization processes that describe how features of the environment are encoded by individuals. In the appraisal process, the environment becomes salient due to events that occur in relation to histories and propensities of the individual. Many approaches to stress emphasize appraisal although the conceptualization and measurement of ongoing appraisals is problematic (Troup & Dewe, 2002). The socio-cognitive approach places particular emphasis on appraisal of the environment (e.g., Lazarus & Folkman, 1984). Primary appraisal involves the recognition of a potential stressor and initial evaluation of whether the stressor presents a loss, threat, or challenge. Although a wide range of factors can be appraised as stressors, the categorization of a situation as threatening and uncertain is particularly important. The socio-cognitive approach to appraisal has been further refined through hindrancechallenge models of stress (Podsakoff, LePine, & LePine, 2007). The central appraisal process in this approach is whether a potential stressor is categorized as a challenge or a hindrance. The nature of the stressor is an important determinant of the categorization. As noted above, many individual and situational characteristics combine to determine how the environment is categorized, although the hindrance-challenge approach allows for intrinsic features of environmental demand. The DC model involves initial appraisal of demands and resources to meet the demands and implies strain related outcomes are derived when demands exceed resources. Cybernetic models incorporate appraisal directly with perceptions of discrepancy. Individuals appraise the environment with reference to internal standards and it is these appraisals that motivate subsequent responses.

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Surprisingly little research has elaborated the appraisal process by integrating development in social cognition and cognitive psychology. An exception is provided by Daniels, Harris, and Briner (2004) who identify automatic and controlled information processing pathways through which the perception of an event is encoded. Recent biological research investigates the relationship between the appraisal process and cortical activity. For example, appraisal of a stressor with low controllability is associated with higher cerebral blood flow in the orbitofrontal and prefrontral cortices, which in turn were related to peripheral autonomic and immune activities (Ohira et al., 2008). In summary, most major approaches to stress incorporate some form of cognitive appraisal involving an evaluation and categorization of environmental features. Central to this evaluation is the categorization and comparison of resources and demands. Goal processes Next, we consider how appraisal of the environment engages the individuals goal systems. Goals are cognitive representations of desired or undesired states (Austin & Vancouver, 1996). Goals are distinct from the evaluation of referents and discrepancies described in the appraisal process because they guide the selection and persistence of further action. Goal processes are generally considered controlled and intentional, though once established they can be activated quickly and automatically (Bargh & Ferguson, 2000). Cybernetic models of stress include goals as a central mechanism (Cummings & Cooper, 1979; Edwards, 1992; Miller, 1965). The goal system comprises a negative feedback loop which acts to minimize discrepancies between environmental characteristics and relevant reference criteria (Cummings & Cooper, 1979; Edwards, 1992). The cybernetic approach has been criticized for failing to capture important features of human goal systems such as forethought and the deliberate

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creation of discrepancies to motivate action (Locke, 1991, 1994). In response, Edwards (1998) argued that the hierarchical arrangement of feedback loops explains how effort to resolve discrepancies at lower levels also helps to resolve discrepancies at higher levels. This system explains the link between short term discrepancies and the striving to longer term value-based goals. In effect the discrepancy perceived in the appraisal processes, is incorporated into the goals system of the hierarchical set of discrepancies. Setting standards might also be considered here, as this activity involves forethought (Edwards, 1998). Both cybernetic and socio-cognitive theories of stress describe how perceptions of threat and discrepancy engage goal systems that motivate further action. The socio-cognitive theory of stress incorporates aspects of this goal process in terms of secondary appraisal. The evaluation of response options and resources for coping occurs as part of this appraisal. Daniels et al. (2004) described a cognitive process through which a mental model of work events is built dynamically to identify and evaluate progress toward goals. A further elaboration of the goal process is contained in the distinction between approach and avoidance goals (Elliot, 2006). Based on the dichotomy between pleasure-pain, the approach and avoidance distinction has been part of human philosophy for hundreds of years, and theories of stress incorporate the distinction in various ways. For example, primary appraisal in the sociocognitive model includes categorization of an event as harmful, beneficial, or neutral (Lazarus & Folkman, 1984). In recent years, a more fine-grained development of approach and avoidance motivations has been developed and integrated with the study of affect, cognition, and behavior (Carver, 2006; Elliot & Thrash, 2002; Higgins, 1997). Approach motivation is the direction of behavior toward positive stimuli whereas avoidance motivation is behavior directed away from negative stimuli (Elliot, 2006). Goals provide cognitive representation of an outcome that guides the

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individual toward or away from that outcome (Elliot & Fryer, 2007). This work is important for extending the study of goals in the stress process in a number of ways. First, stress research through its focus on negative outcomes is intrinsically concerned with avoidance goals. However, most stress models incorporate negative feedback or discrepancy reducing loops (Edwards, 1998). In contrast, the motivational process underlying avoidance involves discrepancy enlarging loops. Discrepancy enlarging loops differ from discrepancy reducing loops because the distancing process has no specific direction. That is, a discrepancy reducing loop helps individuals to home in on a specific goal whereas a discrepancy enlarging loop simply leads away from the anti-goal. The discrepancy enlarging goal is therefore less directive (Carver, 2006). In most systems, the enlarging process eventually leads to a positive incentive that then engages approach motivation. For example, actively avoiding participation in a group with a negative work climate might bring an individual in contact with a group where the work climate is positive. Approach goals for the second work group might then guide behavior according to a discrepancy reduction loop. Stable individual differences can influence whether approach or avoidance goals are adopted. For example, Elliot and Thrash (2002, p. 806) described stable temperaments to adopt either approach or avoidance goals based on networks of biological sensitivities that are responsible for immediate affective, cognitive, and behavioral propensities in response to encountered or imagined stimuli. Carver and White (1994) identified differential sensitivity among individuals to the experience of punishment and rewards. Using Gray's (1994) distinction between behavioral activation system (BAS) and behavioral inhibition systems (BIS) they found that some individuals were more sensitive.

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In general, the BIS system serves to protect the individuals by inhibiting behavior that could result in aversive consequences (Watson et al., 1999). As yet, few studies have applied this distinction to stress and the work environment. One example is provided by van der Linden, Taris, Beckers, & Kindt (2007) who found that punishment sensitivity interacted with job characteristics to predict fatigue at work, where high BIS-individuals with low job control experienced higher levels of fatigue ( = -.13, p <.05). In summary, if an environmental transaction is appraised in positive terms then approach goals are activated and pursued through a negative feedback loop. On the other hand, a transaction appraised as threatening can lead to avoidance or approach goals. Avoidance goals are based on a positive feedback loop that is conceptually distinct and based on different physiological and neurological processes. The implications of this difference have not been fully explored in the stress literature and we examine this issue further in the next section of the dynamics process. Responses in the shorter term Once a particular goal is activated, individuals are motivated to strive toward achieving the goal. Cognitive, affective, behavioral, and physiological responses are distinct components of goal striving and achievement. However, disentangling these components is difficult because they are interdependent and closely related in any given moment. For example, Grandey (2000) suggested that keeping a diary of emotional events is a potential strategy for regulating the cognitive and physical arousal associated with emotional labor at work. While recognizing that the components of response are interdependent, different perspectives emphasize the role of specific response systems. We review different approaches in terms of the degree to which they define response as an active agent in the short term dynamic process. First, we consider reactive responses where the outcome is viewed primarily as a consequence or epiphenomenon of the stress process. For

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example, physiological studies of stress often view increased heart rate as a response to threat with long term consequences for health, but not as part of the ongoing cycle of appraisal and goals. Reactive responses have a short life span and should be distinguished from outcomes which develop over a longer period of time. However, reactive responses may accumulate over time to lead to longer-term health outcomes. Second, we view more active responses such as coping behavior that involves directly changing the elements of the dynamic process in either a positive or negative way. Reactive response Affective and physiological outcomes are the most commonly studied reactive responses in the stress process. Negative affect is a fundamental response to discrepancy (Edwards, 1998), mismatch (French, Caplan, & Harrison, 1982), and imbalance (Siegrist, 1996). Although this negative affect provides the broad motivational basis for addressing this lack of fit, its role is nonspecific. The quality of affect is determined not only by the size of the gap between actual and desired states, but by the rate of progress towards goals (Carver & Scheier, 1990). Different affective responses have been proposed for the pursuit of approach or avoidance goals (Carver, 2006). Carver and White (1994) found differences in individual sensitivity to activation or inhibition systems were related differentially to the experience of emotion in situations of threat or reward. For example, people higher in BIS sensitivity showed higher levels of anxiety in response to threat. Short term physiological responses within the stress process encompass changes in the endocrine, immune, cardiovascular, and musculoskeletal system. In the work context, most interest in physiological systems has focused on how that activation or suppression of these systems leads to long term negative outcomes such as disease or injury (see next section). Sonnentag and Fritz

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(2006) conducted an extensive review of research linking acute and chronic stressors to catecholamines (adrenaline and noradrenaline) and cortisol. Acute stressors were most commonly studied in laboratory settings and were clearly related to an increase in adrenaline levels. Tasks that posed social-evaluative threat and low controllability elicited strongest cortisol response (Dickerson & Kemeny, 2004). Noradrenaline was more strongly associated with aversive experiences and demanding tasks. In field studies, workload and control were the most common factors investigated but results across studies were more variable. In general, more evidence was found for the impact of acute versus chronic stressors on endocrine responses (Sonnentag & Fritz, 2006). Physiological responses to work have most often been studied as a means to understand the negative consequences of stressors. However, Heaphy and Dutton (2008) recently called for the positive physiological consequences of work to receive more attention and be better integrated within this stream of research. Active response Active responses are viewed as actions that change the unfolding pattern of the dynamic stress process. Here, the concept of coping with stressors is most relevant. Coping is one of the most common and important responses studied in the stress process (Lazarus & Folkman, 1984). Coping serves four major functions: approach, avoidance, emotional regulation and reappraisal (Ferguson & Cox, 1997), although a widely accepted definition of the content and function of coping responses has proved elusive. However, a distinction between problem focused coping that seeks to solve the demands of a stressor, emotion focused coping that helps the individual to feel better about the stressor, and appraisal focused coping that attempts to redefine the stressor, has been used widely to capture different goals of coping (Cooper et al., 2001).

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Although many studies treat coping as a dispositional response, the concept also informs the more dynamic aspects of the link between the individual and the environment (Folkman & Lazarus, 1988). From a cybernetic perspective, coping behavior is a process of feedback control (Carver & Scheier, 1990) and discrepancies increase the intensity of coping efforts (Edwards, 1998). Coping is complex because it is conceived as both a cause and a consequence of the stress process (Kinicki & Latack, 1990). Coping behaviors are initiated as a result of primary and secondary appraisal (Lazarus & Folkman, 1984). Behavioral responses are important because they involve actions that can directly influence and change the environment. For example, seeking feedback aids problem solving. On the other hand, emotion focused responses, such as emotional discharge, have generally been considered escapist strategies that are not beneficial for the individual in the long term. Folkman and Moskowitz (2004) identified three types of coping strategy that evoked positive emotions: positive reappraisal; problem-focused coping; and imbuing ordinary events with positive meaning. Coping strategies that evoke positive emotions, such as humor, may be particularly effective in coping with stressful situations that generate negative emotions, such as anxiety and depression. Those individuals who are more aware of their own emotions may be better able to use such coping mechanisms. Affective response can actively influence the dynamic stress process by directly influencing the categorization process. Daniels et al.'s (2004) model of affect and well-being proposed that affect influences the cognitive processes by which events are categorized and the mental models that are constructed to create and pursue goals. Broaden-and-build theory (Fredrickson, 1998) accounts for the effects of positive emotions in broadening peoples momentary thought-action repertoires (in contrast to negative emotions which tend to have the opposite effect). The theory

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states that discrete positive emotionsshare the ability to broaden peoples momentary thoughtaction repertoires and build their enduring personal resources (Fredrickson, 2001, p.219). The theory is based on the adaptive role of emotions as triggers for a specific set of behaviors; for example, experiencing fear leads individuals to make their escape. Most specific actions, however, are linked to negative emotions; whereas positive emotions lead not to specific actions, but encourage a broader range of approach behaviors. It is argued that the experience of positive emotions broadens the scope of attention, cognition and action and leads to the development of physical, intellectual and social resources over time (Fredrickson, 2001). The building of personal resources helps individuals to develop psychological resilience when faced with potential stressors in the future. Furthermore, the enhancement of psychological resilience can lead to improved wellbeing over time creating the possibility for an ongoing upwards spiral. The role of time in the stress process To understand the dynamic features of psychological processes it is necessary to identify stability and change in constructs, allow for multiple patterns of change over time, and distinguish recurrent versus ongoing phenomena (Roe, 2008). Neufeld (1999) differentiated five types of timedependent systems that researchers have used to describe the stress process: transactional, dynamic, process like, adaptational, and recursive. Transactional systems are represented by a network of variables that are closely connected and interdependent, for example reciprocal determinism (Bandura, 1978); dynamic systems are characterized by variables that interact with each other over time (e.g., McGrath & Beehr, 1990; Roe, 2008); process like systems are those where the evolution of variables over time depends on prior continuous change and so remains in a state of flux (e.g., Edwards, 1992); adaptational systems are those in which variables respond and adapt to changes in each other (e.g., Lazarus & Folkman, 1984); finally, recursive systems reflect a dynamic state of

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interaction between variables that form a predictable pattern, for example, limit cycles which reflect a stable oscillation, within a given period and amplitude (Neufeld, 1999). Although time has always played a role in models of stress, few approaches provide such a detailed distinction between time frames (Beehr, 2000). Our framework incorporates time by differentiating a longer-time cycle within which is nested a shorter-term cycle. The longer-term processes involve changes in fairly stable individual differences (e.g., personality) and environmental factors (e.g., task structures). The short-term cycle denotes more variable fluctuations such as the effect of daily work patterns on mood changes (DeLongis, Folkman, & Lazarus, 1988). In reality, the time frame for the stress process ranges on a continuum from moment-to-moment appraisals of the environment and coping responses (e.g., Sonnentag & Fritz, 2007) to the long term effect of chronic stressors such as heart disease which might be expressed over periods of years (e.g., Chandola, Brunner, & Marmot, 2006). A review of 45 longitudinal studies identified time lags ranging between 28 days and 12 years with approximately two thirds providing a theoretical rationale for the particular time lag (de Lange et al., 2003). Our framework also indicates a cyclical process whereby strain outcomes have an influence on stressors over both the short term and longer term. For example, an anxiety response in the work place can lead to a subsequent experience of stressors by contributing to a more fearful environment. This form of reciprocal determinism is fundamental to social cognitive processes (Bandura, 1978) but difficult to establish empirically (Lance, Lautenschlager, Sloan, & Varca, 1989). Kohn and Schooler (1978) conducted a 10-year longitudinal study of the reciprocal effects of work complexity and intellectual flexibility and demonstrated a pattern of reciprocal relationship between work and personal characteristics. Frese, Garst, and Fay (2007) identified a reciprocal

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relationship between personal initiative and work characteristics as a positive feedback loop occurring over a four-year time lag. It seems likely that this reciprocal influence is weaker than the alternative path from stressors to strains (de Lange et al., 2003). There is fairly strong evidence from longitudinal studies that work characteristics can influence stress-related outcomes, and some high quality longitudinal studies investigating reciprocal relationships have failed to identify reverse causation (Carayon, 1992, 1993). The process through which short-term responses shape long term outcomes raises both theoretical and methodological hurdles. Stress theories are generally better suited to explaining how short-term dynamics are shaped and constrained by the more stable context of person and situation characteristics (Griffin, 1997). The mechanism through which short-term dynamics shape long-term dynamics is likely to involve not only the translation of short-term responses into long term health outcomes, but also result in change for the person and the situation. Frese and Zapf (1988) described five types of stress exposure models through which short-term dynamics might be expressed in terms of long term strain outcomes. First, a stress reaction model describes the case where strain increases proportionately with increases in the intensity of the stressors. This case describes the implicit, though largely untested assumption, of most stress models that higher appraisals of stress over time lead to greater strain outcomes. Second, an accumulation model proposes that accumulation of stressors might only appear as strains after a certain breaking point and might not disappear when stressors are removed. Jones, Conner, McMillan, and Ferguson (2007) found that daily fluctuations in job demands and mood were associated with health-related behaviors such as smoking and caffeine intake which might result in the later onset of illness.

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Third, a dynamic accumulation model where a person is weakened by exposure to stressors so that an inner dynamic continues to increase strain even after the stressors are removed. Brosschot, Pieper, and Thayer (2005) describe a process of perseverative cognition where negative thoughts and emotions initiated by environmental conditions but prolonged by short-term dynamics such as worry, rumination, and anticipatory stress. Fourth an adjustment model which begins as with the stress reaction model but only until the person adjusts to the stressor. An example of this process is provided by recent research on recovery, which has been described as the opposite to the strain process (Sonnentag & Fritz, 2007). The recovery process restores personal resources that have been depleted through the stress process (Meijman & Mulder, 1998). Research investigating the daily fluctuations in stress and recovery suggest an ongoing cyclical process where daily stressors create a need for recovery, and the quality of recovery from day to day influences the experience of subsequent stressors (Sonnentag, 2003; Sonnentag & Fritz, 2007). Finally, Frese and Zapf (1988) propose a sleeper effect in which the strain appears some time after the period of stress exposure as in post-traumatic stress disorder. More complex processes involving the environment are possible. For example, the support deterioration model proposes that individuals exposed to high levels of stressors will, over time, experience reduced social support because the providers of support are unable to maintain the high level of support required. Longitudinal studies have supported this process (Cieslak, Knoll, & Luszczynska, 2007). In combination, short-term and long-term approaches to stress suggest mechanisms by which the daily experience of demands and resources is translated via affect, behavior, and cognition into long term health outcomes.

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Implications for assessing the stress process The above review highlights a range of methodology issues for studying the stress process. We summarize these issues in relation to three key questions of what, when, and how of measurement. First what is the construct domain that is assessed in the stress process? Our review shows that domain is extremely broad, ranging from organizational characteristics, through individual differences, to long term physical health. The vast number of constructs requires researchers to be selective about what is measured in any particular study. At the same time, it is important to span dimensions that contribute to strain outcomes (van Veldhoven et al., 2005). The distinction between situational constructs, such as job characteristics, and individual constructs, such as personality, provides one basis on which to ensure broad coverage of constructs. Integration across these domains requires greater attention to multiple levels of analysis (Bliese & Jex, 2002). The distinction between psychological, behavioral and physiological constructs also identifies content dimensions that require greater integration. The when of measurement is particularly important in our review. Because the stress process unfolds over time, it is important to assess constructs with appropriate time lags. Longitudinal studies are increasingly reported in the literature, both for shorter-term and longerterm dynamics. However, integrating both time frames requires consideration of multiple time lags in longitudinal studies (Frese & Zapf, 1998). Evaluating the relative importance of different time frames is difficult because the constructs within each time frame are different. For example, measures of short-term stressors are often occupation specific (e.g., physical threat) while long-term stressors tend to be more general (e.g., work overload, Beehr, 2000). Finally, how the stress process is assessed is determined by the available assessment tools and sources of research data. By far, self-report surveys dominate the assessment of work-stress.

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Because individual perceptions are so important within the psychology of the stress process, this emphasis is understandable. However, the self-report cross-sectional surveys that remain common in stress research are limited in the extent to which they answer what and when questions above. The dynamics of the stress process require multiple measurement approaches including observational and participative methods (e.g., Rutledge et al., 2009), discourse analysis (e.g., Harkness et al., 2005), archival data, and experiments. Within survey methods there is scope to extend self-report measurement to include ratings by people other than the focal individual such as co-workers and family members (e.g., Sonnentag & Kruel, 2006). The use of aggregated ratings also enables properties at the team and organizational level to be assessed (Daniels, 2006). The what, when, and how of assessment in the stress process is particularly relevant for understanding how organizations can manage the stress process and enhance the well-being of employees. To manage stress and well-being, organizations seek to influence the unfolding stress process for both long-term and short-term outcomes. In the next section, we review research relevant to various strategies for managing health and well-being. MANAGING STRESS AND WELL-BEING Organizations have adopted a variety of strategies to reduce strain and improve well-being. A distinction between primary, secondary, and tertiary strategies has proved useful for describing the different approaches to intervention. Stress management that focuses on prevention is referred to as primary intervention and is most often targeted at the work environment; for example, work redesign or organizational change and development. Primary interventions that involve preventive action may also be targeted at the individual; techniques include health promotion programs, training and education, selection and placement. In addition, many organizations engage tertiary interventions to deal with those employees who report physical or psychological ill-health as an

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outcome of stress. In this case, employees are already suffering stress outcomes and require treatment activities, such as stress counseling. Secondary interventions are required where employees report responses to stressors and experience feelings of being unable to cope. In this case, action is needed to prevent employees from developing stress-related outcomes; for example by increasing their capacity to cope with stressors. Secondary interventions include programs that encourage more healthy lifestyles, such as relaxation classes, or provide education on how to develop more effective stress management skills. Tertiary intervention Tertiary interventions act to mitigate individual stress outcomes, for example, helping individuals to cope with their anxiety through stress counseling. Organizations often provide workers with access to Employee Assistance Programs (EAPs) in order to help those who are experiencing stress outcomes. EAPs, which are often supplied by external providers, offer a number of services, including counseling, advice and referral to other sources of support and specialist treatment. Workplace counseling is usually offered as part of an EAP. This process is aimed at helping people to explore a problem and finding alternative ways of dealing with it so that something can be done about it. The overriding goal is to help clients to help themselves and to take responsibility for their own lives. Counseling can improve employees psychological wellbeing by increasing their confidence and self-esteem (Berridge & Cooper, 1997). Positive effects of improved self-esteem can feed back into the stress process by boosting individuals resilience in the face of stressors (forming a feedback loop between stress outcomes and the individual depicted in Figure 1). There have been reports that companies can benefit from good return rates on their investment in counseling services and EAPs; for example, US figures have demonstrated that companies made savings to investment returns of between 3:1 and 15:1, following the introduction

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of stress counseling (Cooper & Cartwright, 1994), based on subsequent reductions in absenteeism (Cooper and Sadri, 1995). However, there is a lack of systematic evaluation studies in the

published academic literature to support these findings (Reynolds, 2000). Indeed, reviews of existing evaluation studies have reported mixed results (Shapiro, Cheesman, & Wall, 1993). From a sample of 61 police officers, Doctor, Curtis, and Isaacs (1994) evaluated the effectiveness of an EAP in terms of absenteeism and health but found no significant effects over a 12-week evaluation period. However, Michie (1992, 1996) examined the effectiveness of an EAP in samples of nurses; in both cases, significantly reduced anxiety, depression and life satisfaction were observed after six months. In a sample of UK City Council workers, Reynolds, Taylor, and Shapiro (1993) also found that workers physical and psychological well-being improved as a result of stress counseling. Cotton and Hart (2003) suggest that EAPs may lead to improved morale amongst employees leading to participants reporting improved satisfaction, rather than impacting on psychological distress in terms of clinical outcomes. Other intervention programs have included an EAP as part of a package of measures, which also included organizational-level interventions (Adkins, Quick, & Moe, 2000; Peters & Carlson, 1999) however, these studies did not report on the effectiveness of individual elements of the package. Thus, there is a need for further research to establish the effectiveness of EAPs and stress counseling programs. Secondary intervention Secondary interventions operate by developing individuals skills in identifying and managing stressors, and by improving their coping strategies and/or by replacing maladaptive coping styles with more successful ones. As people in stressful situations may resort to

maladaptive behaviour (such as smoking or drinking alcohol to excess) or to inappropriate responses (such as working harder but making more mistakes or unrealistic promises), the aim of

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stress management programs is to educate employees to identify potential stressors (influencing appraisal processes in Figure 1) and learn to apply adaptive coping strategies (influencing active responses in Figure 1). Adaptive responses could include: planning, organizing, prioritizing

assignments and enlisting others support (Murphy, 1985). There is evidence that both meditation and relaxation techniques are successful in alleviating negative responses to stress (Toivanen, Helin, & Hnninen, 1993; Toivanen, Lnsimies, Jokela, & Hnninen, 1993; Wiholm, Arnetz, & Berg, 2000) and enhancing coping strategies (Alexander et al., 1993; Hyman, 1993), with some indication of long-term improvement (Sheppard, Staggers, & John, 1997). Another common

technique, cognitive behaviour therapy (CBT) has demonstrated significant improvements through increased coping abilities and awareness of stress (Firth-Cozens & Hardy, 1992; Freedy & Hobfoll, 1994; Grnningter, Hytten, Skauli, Christensen, & Ursin, 1992). In a meta-analytic review, Richardson and Rothstein (2008) found that CBT was the most effective intervention for reducing the negative psychological responses to stress, particularly anxiety (Cohens d = 1.16). There is also evidence that stress management programs are associated with reduced absenteeism and lower medical costs (Cooper, 1986; Giga, Faragher, & Cooper, 2003). Participation in stress management training should not only reduce stress symptoms during the course of the intervention program, but also provide skills to help manage stressors in the future. One explanation for the effectiveness of CBT is its proactive focus, as opposed to the more popular, but less effective (Cohens d = 0.51) techniques of relaxation and meditation, which are essentially passive (Richardson & Rothstein, 2008). While some studies have indicated long term improvements (Kushnir & Malkinson, 1993), including an impact on general life satisfaction, suggesting that skills may transfer to non-work domains (Reynolds et al., 1993), others have shown no long term effects (e.g., Whatmore,

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Cartwright, Cooper, Kompier, & Cooper, 1999). Techniques are often successfully combined within stress management programs (Peters & Carlson, 1999; Tsai & Crockett, 1993). Health promotion programs are broad in scope, ranging from purely educational schemes to more proactive interventions, such as learning to take ones own blood pressure, or altering ones lifestyle in terms of exercise or diet. These programs are based on research that has linked various lifestyle and health habits (e.g., physical fitness, sleeping) with a reduction in the impact of work stress (Steffy, Jones, & Noe, 1990). For example, exercise (aerobic) is generally regarded to be a valuable technique in combating stress, and it is interesting to note that many body movements imitate the bodys natural response to stress for example, action based on flight or fight. Exercise has also been found to help in improving self-esteem and mastery and thus can also contribute to problem-focused coping (Long & Flood, 1993). However, individual differences mean that regular exercise can help some, but not necessarily all, individuals. A causal link between physical activity and CHD risk has been suggested (Powell, Thompson, Caspersen, & Kendrick, 1987), with heart disease almost twice as prevalent in inactive compared with active individuals. In a review of 95 studies, van Doornen and De Geus (1993) reported that different methodological strategies make it difficult to differentiate the effects of physical activity and fitness on CHD risk. However, they found that 84% of studies concluded that physically active or fit subgroups were significantly better able to deal with the physiological consequences of stress compared to less active or less fit subgroups. They concluded that individuals do have control over a number of CHD risk factors, although exercise has to be combined with other beneficial actions (e.g., diet, attitude to life) to reduce CHD risk significantly. (Daubenmier et al., 2007) found that multicomponent programs, which included diet, exercise, and stress management, significantly reduced coronary risk for participants after three months. Health promotion programs may also act

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as an avenue for delivering social support, as they are often group-based rather than individualbased; thus, they can serve as social support interventions, as well as stress-reduction techniques. Primary intervention Primary interventions often focus on the reduction of stressors in the workplace and take place at an organizational level. For example, where the nature of the job is leading to stress, the task or the work environment might be subject to redesign; or, where the organizations structure or climate is the source of stress, a more participative management style might be encouraged. Hart and Cotton (2003) report that in occupations characterized by unique operational pressures (e.g., dealing with victims and danger for police), organizational stressors (such as leadership style and organizational climate) were the strongest determinants of levels of positive affect, accounting for approximately 70% of the variance in levels of morale. Such research would suggest that primary interventions in these cases should focus on workplace strategies (at group or organizational level) to maintain employee morale. Interventions are frequently aimed at changing the work environment, but this may not always be practicable or desirable. Some aspects of the work environment may not be amenable to change, particularly certain aspects of the job itself, the level of job security or job-related pay and benefits. In such cases, it may be more appropriate to develop selection and recruitment

procedures; first to ensure that appropriate individuals are attracted and selected for these posts, and second that appropriate support and training is offered to help post-holders. Training may be considered as primary prevention, rather than secondary, as it enhances task-related knowledge and skills. Training can also be useful in building employees perceptions of their own capability, in terms of self-efficacy (Parker et al., 2006). Richardson and Rothstein (2008) found that

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interventions that aimed to help participants to build personal resources and improve stress management skills were highly effective (Cohens d = 1.41). Work redesign There is a relatively limited literature on stress reduction at the primary level, as few studies have focused on work redesign or restructuring (Giga et al., 2003; Israel, Baker, Goldenhar, Heaney, & Schurman, 1996). However, evidence suggests that primary interventions have a

significant impact both on individuals health and well-being and on organizational outcomes, including productivity and absenteeism. Reviewing findings from 1500 projects funded by the Swedish Working Life Fund, Brulin and Nilsson (1994) found that productivity improved on average by 10%, including production errors and delivery times. Kawakami, Araki, Kawashima, Masumoto, and Hayashi (1997) demonstrated significant effects on stress symptoms and absence levels following a one-year intervention program involving changes to the work environment, job redesign and training. Another means to reduce employees stress levels focuses upon improving communication. Cartwright, Cooper, and Whatmore (2000) found that improvements in

communications within a UK Government department led to significant enhancements in job satisfaction and perceptions of control. Evans, Johansson, and Rydstedt (1999) also found However, neither of these studies examined

significant reductions in stress symptoms. performance. Participation and autonomy

Many jobs are characterized by high demands, where the nature of the demands cannot be changed. However, the negative effects of high job demand can be mitigated by enhancing

opportunities for control, according to the DC model of stress. This may be achieved through employee participation or increased autonomy, As noted earlier, job control can have positive

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effects as it leads to the feeling of being in control even where that control is not actually exercised. Job autonomy enhances self-efficacy (Axtell & Parker, 2003; Parker, 1998) which in turn mediates the link to personal initiative (Frese & Fay, 2001). Increasing job control also leads to enhanced mastery (Bandura, 2001) enabling individuals to cope more effectively with perceived stressors. Control can be introduced in a number of ways, such as developing autonomous work groups. Studies of such work groups have found positive effects on productivity and other work criteria, but a lack of improvement in well-being, motivation and absenteeism (Goodman, Devadas, & Hughson, 1988). Changes to the level of skill discretion and authority over decisions are also outcomes resulting from participation interventions (Theorell, Emdad, Arnetz, & Weingarten, 2001). To relieve job strain, it is suggested that workers should be given greater scope for decisionmaking and use of discretion at work but at the same time not to overreach individual capabilities in the quest to obtain more substantial job responsibilities. As noted earlier, there are individual differences in employees responses to enhanced control whereas one employee may view additional autonomy as a challenge, another may view it as a source of stress. Evaluation studies of interventions using participation and autonomy have had mixed results. For example, Reynolds et al. (1993) found no significant changes in well-being or absenteeism in UK public sector workers as the result of a participation intervention. Similarly, Heaney et al. (1993) found that worker well-being failed to improve, whilst Mikkelsen and Gundersen (2003) found a short-term improvement in subjective health, but this was not maintained in the longer term. Other studies have shown that work reorganisation interventions result in significant reductions in depression (Bond & Bunce, 2001) and improved attitudes towards innovation (Bunce & West, 1996). Bond and Bunce (2001) demonstrated that job control mediated the effect of the intervention on employees mental health. In a later study, Bond, Flaxman, and

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Bunce (2008) further showed that this effect is moderated by the individual difference variable, psychological flexibility, such that those who were high in psychological flexibility benefited most from the intervention in terms of mental health. Whilst interventions that focus on work design alone are relatively uncommon, interventions combining changes to the work environment with increased participation are increasingly employed by organizations (Giga et al., 2003). Evidence suggests that this combination is particularly

powerful in terms of improving absence and performance rates (e.g., Bond & Bunce, 2001; Matrajt, 1992). For example, Terra (1995) reported a 50% decrease in sickness absence and improved productivity following the introduction of job redesign and self-regulating teams. Increased job control may be not an appropriate means of reducing stress for all individuals. Although many will find that low control is a source of stress, there are individual differences in the degree of psychological strain experienced. The increased responsibility and decision latitude associated with greater autonomy can be perceived as an unwanted burden by some individuals, indicating that stress reduction measures targeted at increasing worker autonomy will not be suitable for all workers. Worker participation and careful monitoring of the effects of any changes is needed when implementing stress reduction measures. Sparks et al. (2001) recommended that relevant training support be provided; for example, where appropriate, problem-solving sessions could be held between supervisors and workers to identify job demands or stressors. Parker and Sprigg (1999) argue that increasing job control for passive employees will have little effect on strain; for such employees, the most successful strategy would be to reduce demands. Other options would include training passive employees to become more proactive (using more active coping strategies and building individuals ability to manage demands confidently). Strategies could seek to increase workers perceived control so that they can cope more effectively (Spector, 1998).

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Training that enhances workers control beliefs may help to protect health and well-being (Meier et al., 2008). In addition, there is evidence that cultural differences exist in the response of employees to interventions that increase job control, such as empowerment (Hui, Au, & Fock, 2004). Support networks Consistent with the iso-strain hypothesis, external support networks have been found to buffer individuals against psychological strain during times of crisis (Rodin & Salovey, 1989). Individuals with external support tend to rely more on active coping strategies than do those without such support (Billings & Moos, 1984). Establishing co-worker support groups has been found to improve psychological well-being (Bagnara, Baldasseroni, & Tartaglia, 1999). Grossman and Silverstein (1993) evaluated the effectiveness of support groups for healthcare professionals; the study found that workers reported reduced stress and improved performance at work. However, the groups experienced high dropout rates, perhaps caused by those workers who most needed help leaving the group. Greater success was associated with groups who had high autonomy and decision latitude; these groups perceived their work as more stimulating and received increased feedback from supervisors (Eriksson, Moser, Unden, & Orth-Gomer, 1992). Support groups have been successfully combined with individual-level techniques in stress interventions, such as CBT and relaxation; evaluation studies indicating that in addition to reducing stress symptoms, participants support seeking skills and adequacy of coping also improved (Elliott & Maples, 1991; Lees & Ellis, 1990; McCue & Sachs, 1991). However, as with individual-level interventions, there is some doubt concerning long-term effects. In combination with primary organizational interventions, such as work redesign, training and communication, long-term maintenance of low levels of stress has been reported (Griffin, Hart, & Wilson-Evered, 2000; Kalimo & Toppinen, 1999). For example, Kalimo and Toppinen (1999) examined work and health

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related factors over a 10-year period for 11,000 forestry industry workers who participated in a stress intervention program involving work redesign, training and co-worker support groups. The study found that a majority of staff rated their psychological working capacity as good and that stress remained low. Caution needs to be exercised in respect of alleged beneficial effects of social support, because there are occasions when social interaction (and even inappropriate counseling) can have a detrimental effect upon an individuals health, for example where conflict and strife is inherent in social relationships. Summary of intervention studies There is substantial evidence to suggest that many stress intervention programs are effective in mitigating stress symptoms (Berridge & Cooper, 1997; Highley-Marchington, Cooper, & Britain, 1998). However, much of the evidence is focused on secondary and tertiary measures, such as CBT, relaxation and stress counseling, which are aimed at individuals who feel stressed or display stress outcomes, such as ill-health. Although secondary and tertiary interventions are effective when targeted at high risk individuals or groups, there has been a tendency for organizations to employ such programs for the workforce as a whole. This has been described as the inoculation approach to stress, as it focuses on the consequences, rather than the sources of stress, reflecting an approach that stress is an inherent and enduring feature of the working environment. Isolated programs can have temporary effects in reducing stress (Murphy, 1985): although stress outcomes are improved as a result of treatment and job perceptions become more positive, these changes can decay over time if employees return to an unchanged work environment, with the same level of stressor exposure. There is also the danger that such programs tend to attract the worried well (Sutherland & Cooper, 1991), rather than those who most need help, particularly where programs are used across the workforce, rather than being targeted at high risk individuals. The integrative

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framework (Figure 1) emphasizes the importance of feedback loops in the stress process, suggesting that interventions which feed back to influence the work environment and the person (and the P-E relationship) will be most effective over time, e.g., CBT and skills training which help to build personal resources. Reviews of stress intervention programs (Burke, 1993; Cooper & Payne, 1988; Kahn & Byosiere, 1992; Karasek, 1992) have suggested that such programs often fail to emphasize prevention at source. However, although still comparatively rare, there are examples of multiperspective approaches to stress intervention, which include measures aimed at both prevention and remedial action (Giga et al., 2003). Figure 1 highlights the multiple facets and complex dynamics of the stress process, suggesting that interventions targeted at both short-term and longer-term processes are likely to be the most effective. Such approaches can have a powerful effect, not only in making long term improvements in mental and physical well-being (Elo, Leppanen, & Sillanpaa, 1998; Munz, Kohler, & Greenberg, 2001), but also in enhancing relationships, industrial relations, work climate and increasing awareness of stress as an organizational issue (Lourijsen et al, 1999; Nijhuis et al, 1996; Poelmans et al, 1999; Wynne & Rafferty, 1999). In addition, evaluation studies report significant reductions in sickness absenteeism (Lourijsen, Houtman, Kompier, & Grundemann, 1999; Munz et al., 2001; Poelmans, Compernolle, De Neve, Buelens, & Rombouts, 1999), mishaps and suicides (Adkins et al., 2000), and improved productivity (Munz et al., 2001). Cox et al (2000) recommend that a package of measures is more likely to succeed, particularly where measures are to be implemented at primary and secondary levels and involve preventive action in addition to tertiary action. The importance of developing an intervention strategy based on a risk assessment of the health and safety hazards has been emphasized by a number of researchers (Clarke & Cooper, 2004; T. Cox et al., 2000; Giga et al., 2003). Nevertheless, there is

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currently a lack of evaluation studies that are needed to support the effectiveness of such intervention strategies, particularly over the long term.
CONCLUSION AND FUTURE DIRECTIONS

Studies of the stress process ask a deceptively simple question: why does work sometimes have a negative impact on the health and well-being of individuals? We identified two major themes that highlight why a straightforward answer to this question has not been forthcoming: reciprocal time cycles, and the integration of positive well-being. We explored these themes in relation to some of the major theories of the stress process and developed an integrative framework for comparing time frames and integrating positive health outcomes. We now review each of these themes in terms of their implication for future research and practice. Time cycles First, stress involves an ongoing process of interaction between the individual and the environment that unfolds over both short-term and longer-term time scales. Short term dynamic processes, such as cognitive appraisal, are shaped by the long-term context and can also influence long-term outcomes. This system of embedded cycles means that even sophisticated research designs will not reflect the multiple time frames and causal sequences of the full stress process. This research challenge of complex time cycles is not unique to stress-related research, but does suggest the kinds of questions that are relevant. For example, what is the correct time lag for estimating the impact of work overload on depression? How do short term-recovery strategies map onto long term health outcomes such as heart disease? Researchers have made many inroads into answering these questions and the scope of stress research is daunting. Research designs that range from laboratory studies measuring endocrinal function in the workplace to national studies interviewing cohorts of employees over decades are

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commendable feats of researcher sweat and inspiration. Nevertheless, cross-sectional studies in stress are still very common (de Lange et al., 2003; Zapf et al., 1996), and likely to remain popular as more organizations seek to evaluate the risks associated with stressors and strains in their workplace. Unfortunately, the scope for these single-time and single-organization surveys to contribute new theoretical understandings about the stress process itself is diminishing. Promising developments for understanding more dynamic processes can be seen in the use of methods that capture unfolding dynamics such as time sampling methods. However, addressing issues of time is not only a matter of adopting a particular research design. It is also important to theorize about the role of time cycles in each study, speculate about their impact on the stress process, and integrate practical outcomes for the management of stress in organizations. We propose three questions that can be considered in: a) what is the time lag of effects, b) how does reciprocal causation operate, and, c) what is the link between short term and long term processes? These three questions can be addressed not only through specific research designs but as part of any study that incorporates the stress process. Even cross-sectional studies can articulate how constructs at a single time point reflect the effect of relationships over time. In this way, researchers can develop a more systematic dialog about time cycles in the stress process. Integrating positive features of well-being The second theme concerned integrating positive aspects of health and well-being within studies of the stress process. The negative outcomes of the transaction are clearly important but, if considered in isolation, provide a necessarily limited view of the link between work and well-being. At the extreme, a focus on negative outcomes might actually help to shape the stress process itself by influencing the scope of research that is conducted and influencing the attention of policymakers.

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Increasingly, research studies are integrating positive dimensions of affect, cognition, and behavior at various stages of the stress process. For example, both individual and environmental factors provide positive resources for coping, positive affect shapes the stress process as both an independent and dependent variable, and active mental health is an important long term outcome of dynamic processes. The integration of positive dimensions is sometimes the focus of research studies, such as those integrating engagement and burnout. More often, positive constructs can be incorporated with a range of constructs to provide a more fully developed model of the stress process in a particular context. A potential concern with integrating fully elaborated models of well-being into the stress process is that the topic of stress might become so broad as to be meaningless. In that case, would it be better to subsume stress into more general theoretical frameworks such as employee motivation, well-being, or work design? In part, the answer to this question is yes. The theoretical frameworks for these topics continue to develop and draw on broader fields of psychology and other disciplines. A better understanding of the dynamic processes of which stress is a part might be achieved by more concerted efforts toward building general motivational frameworks. In part, the answer is also no because there are negative outcomes of the stress process that are important for different stakeholders to identify and to differentiate from positive outcomes no matter how desirable the latter might be. In particular, organizations and public bodies with responsibility for managing risk and harm have a particular interest in the negative consequences of the stress process. The above issues denote some ambivalence about the direction of future stress research in relation to other topics in work motivation. However, the study of stress is a multidisciplinary and energetic field that will continue to develop in multiple directions. As with our first theme, we

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recommend some questions that can be addressed in most studies of the stress process across a broad domain of research studies: a) can positive and negative processes be differentiated at each stage of the process, b) how do positive and negative constructs combine and interact with each other throughout the stress process? Again, these are considerations that can be addressed directly in research designs or as an intrinsic part of the theoretical development and practical application in individual studies. Conclusion The stress process engages fundamental experiences of work for individuals and has important management and strategic consequences for organizations. Diverse studies over the past 40 years show the variety of mechanisms through which work can influence employee well being. The field continues to develop a better understanding of the ongoing transaction between the individual and their environment. Future directions include greater emphasis on the time cycles in the stress process and greater integration of positive constructs to understand the sometimes negative consequences of work.

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Longer-term dynamics
Environment Task Role Social Physical

Short-term dynamics
Approach Avoid

Goal processes

Appraisal Processes

Response processes

Outcomes Health Well-being Performance

Resources

Demands

Active

Reactive

Person Personality Values Skills Abilities

Figure 1. Integrating framework for different time cycles