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“The difficulty in science is often not so much how to make the discovery but rather to know that one has made it.”

– J.D. Bernal

Causes & Sources of Stress

Living conditions, the political climate, financial insecurity, and work issues are some stressors US adults cite as the cause of their stress. Ineffective communications increase work stress to the point of frustration that workers want to quit. These stressors, unfortunately, are not something people can just ignore. Quitting a job would result in debt and financial instability which, in turn, would be added stressors.

35% of workers say their boss is a cause of their workplace stress.
80% of US workers experience work stress because of ineffective company communications.
39% of North American employees report their workload the main source of the work stress.
49% of 18 – 24 year olds who report high levels of stress felt comparing themselves to others is a stressor.
71% of US adults with private health insurance say the cost of healthcare causes them stress while 53% with public insurance say the same.
54% of Americans want to stay informed about the news but following the news causes them stress.
42% of US adults cite personal debt as a source of significant stress.
1 in 4 American adults say discrimination is a significant source of stress.
Mass shootings are a significant source of stress across all races; 84% of Hispanic report this, the highest among the races.

Stress Statistics

Two years after the World Health Organization declared COVID-19 a global pandemic, inflation, money issues and the war in Ukraine have pushed U.S. stress to alarming levels, according to polls conducted for the American Psychological Association.

A late-breaking poll, fielded March 1-3 by The Harris Poll on behalf of APA, revealed striking findings, with more adults rating inflation and issues related to the invasion of Ukraine as stressors than any other issue asked about in the 15-year history of the Stress in AmericaTM poll. This comes on top of money stress at the highest recorded level since 2015, according to a broader Stress in America poll fielded last month.

Top sources of stress were the rise in prices of everyday items due to inflation (e.g., gas prices, energy bills, grocery costs, etc.) (cited by 87%), followed by supply chain issues (81%), global uncertainty (81%), Russia’s invasion of Ukraine (80%) and potential retaliation from Russia (e.g., in the form of cyberattacks or nuclear threats) (80%).

Adults also reported separation and conflict as causes for straining and/or ending of relationships. Half of adults (51%, particularly essential workers at 61%) said they have loved ones they have not been able to see in person in the past two years as a result of the COVID-19 pandemic. Strikingly, more than half of all U.S. adults (58%) reported experiencing a relationship strain or end as a result of conflicts related to the COVID-19 pandemic, including canceling events or gatherings due to COVID-19 concerns (29%); difference of opinion over some aspect of vaccines (25%); different views of the pandemic overall (25%); and difference of opinion over mask-wearing (24%).

30% of Us adults eat comfort food “more than the usual” when faced with a challenging or stressful event.
51% of US adults engage in prayer—a routine activity—when faced with a challenge or stressful situation.
Coping mechanisms of Gen Z and Millenials experiencing stress in the US 44% of Gen Z and 40% of Millenials sleep in while exercising counts for 14% and 20% respectively.
49% of US adults report enduring stressful situations as a coping behavior to handle stress.
Less than 25% of those with depression worldwide have access to mental health treatments.

Sources: CompareCamp, American Psychological Association

Stress Management Statistics

A look at the stress management techniques employed by US adults to deal with their stress, an overwhelming majority are self-care practices. Though very helpful, it does not address the stressor at the root of the problem. Stress management programs would be beneficial not only for employees but for the company in the long run.

Stress Research from the National Library of Medicine

Stress and Cardiovascular Disease
Stress and Cancer
Stress and Diabetes
Post Traumatic Stress Disorder
Stress and Aging
Stress in Adolenscents
Stress and Meditation
Stress and Yoga
Workplace Stress

Cardiac Coherence and Post-traumatic Stress Disorder in Combat Veterans

Jay P. Ginsberg, Ph.D.; Melanie E. Berry, M.S.; Donald A Powell, Ph.D.

Alternative Therapies in Health and Medicine, A Peer-Reviewed Journal, 2010;16 (4):52-60. PDF version of the complete paper: Cardiac Coherence and PTSD in Combat Veterans

The Effect of a Biofeedback-based Stress Management Tool on Physician Stress: A Randomized Controlled Clinical Trial

Jane B. Lemaire, Jean E. Wallace, Adriane M. Lewin, Jill de Grood, Jeffrey P. Schaefer

Open Medicine 2011; 5(4)E154. PDF version of the complete paper

Coherence Training In Children With Attention-Deficit Hyperactivity Disorder: Cognitive Functions and Behavioral Changes

Anthony Lloyd, Ph.D.; Davide Brett, B.Sc.; Ketith Wesnes, Ph.D.

Alternative Therapies in Health and Medicine, A Peer-Reviewed Journal, 2010; 16 (4):34-42. PDF version of the complete paper

Coherence and Health Care Cost – RCA Actuarial Study: A Cost-Effectiveness Cohort Study

Woody Bedell; Mariette Kaszkin-Bettag, Ph.D.

Alternative Therapies in Health and Medicine, A Peer-Reviewed Journal, 2010;16 (4):26-31. PDF version of the complete paper

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Research: Why Breathing Is So Effective at Reducing Stress

Emma Seppälä,
Christina Bradley,
Michael R. Goldstein

Studies found it outperformed other techniques over both the short and long term.

Anxiety in the workplace is a serious problem. What can you do to stay calm, rational, and productive when dealing with a stressful situation? In several recently published studies, the authors explored the effectiveness of different techniques and found that one method — SKY Breath Meditation — offered the best results for both immediate and long-term stress reduction. This comprehensive series of breathing and meditation exercises engages the parasympathetic nervous system, which is responsible for the body’s “rest and digest” activities, helping you to calm down and think rationally in the face of stress. These simple techniques can help you sustain greater emotional wellbeing and lower your stress levels at work and beyond.

When U.S. Marine Corp Officer Jake D.’s vehicle drove over an explosive device in Afghanistan, he looked down to see his legs almost completely severed below the knee. At that moment, he remembered a breathing exercise he had learned in a book for young officers. Thanks to that exercise, he was able to stay calm enough to check on his men, give orders to call for help, tourniquet his own legs, and remember to prop them up before falling unconscious. Later, he was told that had he not done so, he would have bled to death.

Emma Seppälä , PhD, is a faculty member at the Yale School of Management, faculty director of the Yale School of Management’s Women’s Leadership Program and bestselling author of SOVEREIGN (2024) and The Happiness Track (2017). She is also science director of Stanford University’s Center for Compassion and Altruism Research and Education . Follow her work at emmaseppala.com , http://www.iamsov.com or on Instagram . emmaseppala
Christina Bradley is a doctoral student in the Management & Organizations department at the University of Michigan’s Ross School of Business. Her research focuses on how to talk about emotions at work.
Michael R. Goldstein , Ph.D., is a Postdoctoral Research Fellow at Beth Israel Deaconess Medical Center and Harvard Medical School. He is a Licensed Clinical Psychologist and his research examines the physiological mechanisms of mind-body interventions for insomnia.

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January 2021

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Feeling Stressed?

Ways to Improve Your Well-Being

Illustration of a man and woman laying on the floor with one hand on their chest and the other on their belly

Have you been feeling more stressed than usual? Many people are during these challenging times. The COVID-19 pandemic has many people feeling overwhelmed.

Everyone feels stress sometimes. It’s a natural response to a challenge or demand. Stress can come from the day-to-day pressures of work and family.

But stress is much more than just being busy, explains Dr. Janice Kiecolt-Glaser of The Ohio State University, who studies the effects of stress on the body.

“It’s the feeling that you’re overloaded, out of control, and unable to cope,” she says.

Stress can also come from a sudden negative change in your life like a divorce or losing a job. Traumatic events like a major accident, assault, or natural disaster can cause severe stress .

It’s important for your health and well-being to learn how to cope with stress. Researchers are working to understand how stress affects health. They’re also studying ways to relieve stress. These techniques may help you to feel calmer and more relaxed.

Stress and the Body

Stress isn’t always bad. It’s actually a survival response. It helps you leap into action in the face of a threat. Your heart rate speeds up, and you breathe faster as you prepare to fight or run to safety.

Short-term stress can even help you perform—you’re more able to ace an interview or meet a project deadline. But when stress lasts a long time, it may also harm your health. Your body is constantly acting as if it were in immediate danger.

“There’s a really big body of research now that says that chronic stress promotes inflammation Heat, swelling, and redness caused by the body’s protective response to injury or infection. ,” says Kiecolt-Glaser.

Inflammation is associated with many diseases, including heart disease, cancer, arthritis, and some mental health conditions.

Stress may also affect your metabolism—the chemical changes in the body that release energy and produce the substances you need to grow, move, and stay healthy.

Kiecolt-Glaser’s research shows that stressful events can cause the body to burn fewer calories at rest. Stress can also cause changes in mood and increase irritability with those around us.

Ways to De-Stress

The first step is to recognize the signs that you’re stressed beyond a normal level. Trouble sleeping can be one. Some people get headaches or stomachaches. Stress can also cause changes in appetite that lead you to gain or lose weight.

Once you know you need to reduce stress, there are practical steps you can try. Getting regular exercise can be helpful. Doing an activity you enjoy can also help with stress. This can be anything—from dancing to making art or getting out into nature or having fun with friends.

Making sure to get enough sleep is important, too. “People are more sensitive to stress when they don’t have enough sleep,” says Kiecolt-Glaser.

Staying socially connected is important, too. Close personal relationships are key to reducing stress. Reaching out to friends and family by phone, video chat, and email can help you stay in touch even when you’re not able to see them in person.

“Make a conscious effort to reach out and to maintain contact,” says Kiecolt-Glaser. “Loneliness is really destructive.”

Eating regular, well-balanced meals and avoiding alcohol and other drugs also help reduce stress.

Mindfulness Approaches

Using mindfulness helps some people cope with stress. It teaches you to focus on being present in the moment. Research shows that simply being aware of what you’re doing can improve well-being.

One study showed that people spent nearly half of their waking life not paying attention to what they were doing, says Dr. Richard Davidson of the University of Wisconsin-Madison, an expert on mindfulness. “And when they were not paying attention to what they’re doing, they were significantly less happy.”

Davidson’s research is shedding light on how mindfulness affects the brain to improve mood. “Regular mindfulness practices can have an impact on specific circuitry in the brain that we know to be important in emotion regulation,” he explains.

For those starting to practice mindfulness: One size is not likely to fit all. Davidson recommends starting modestly with three to five minutes, a few times a day. That way you don’t get overwhelmed and stop. There are many mindfulness apps available that teach different techniques.

Just Breathe

The simple act of controlled breathing can bring stress relief.

“It’s well known that slow breathing techniques have a positive effect on emotional state,” says Dr. Jack Feldman of UCLA, an expert on the neuroscience of breathing.

His research has identified the brain circuits responsible for breathing and sighing. Now he’s working to understand how breathing techniques affect the brain to improve mood.

Breathing techniques can be used to help people who are depressed or anxious. Controlled breathing may disrupt the brain circuits involved in depression, he explains.

There are many different breathing techniques you can try. Practicing a few minutes a day can help you get started.

“People who start up a breathing practice may find that it reduces their stress and anxiety considerably,” he says.

If you want to try controlled breathing, “belly breathing” is a simple form. Sit or lie down in a comfortable position. Place one hand on your upper chest and the other on your belly. Take a slow, deep breath in through your nose, taking air into your lower belly. The hand on your stomach should rise, while the hand on your chest remains still. Slowly exhale through your mouth.

For more tips on relieving stress, see the Wise Choices box.

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1 University of Louisville
2 Univ of Louisville School of Medicine
PMID: 30020672
Bookshelf ID: NBK513300

Effective techniques for stress management are varied. They typically include behaviors that improve physical health, such as nutrition and exercise, but may also incorporate strategies that improve cognitive and emotional functioning. The stress-reduction approach based on mindfulness practices has recently enjoyed an explosion of interest from a variety of healthcare and epidemiological researchers. The concept of mindfulness, which originates from practices of Buddhism, is defined as a focused awareness of one’s experience, and purposeful and nonjudgmental focus on the present moment. Structured interventions, such as the Mindfulness-Based Stress Reduction (MBSR) program, provide participants with the opportunity to learn breathing meditation, body scanning techniques, and gentle, yoga-inspired physical exercises. With practice, individuals learn to process emotions, thoughts, and sensations as they arise. Individuals learn to modify their reflexive conditioning from automatically reacting or worrying about the future to a more adaptive, measured response with greater awareness of the present moment. The literature is replete with evidence suggesting that, with practice, individuals can become more mindful, increasing their capacity to fully process emotions, thoughts, and sensations as they arise. MBSR interventions have been adapted to a wide variety of individuals, from those suffering from chronic or debilitating health conditions to healthy undergraduate or medical students. Randomized controlled trials of MBSR interventions have demonstrated improvements to psychological and physiological processes with relevance to health outcomes and improved stress management.

Some individuals have a greater innate, or trait, capacity for mindfulness. These individuals, who have not participated in mindfulness-training interventions, tend to experience better physical health, report fewer physiological symptoms such as pain, and utilize fewer healthcare resources. Trait mindfulness has been associated with lower ratings of anxiety and depression in a variety of medical and non-medical populations. Trait mindfulness may emerge from a genetic predisposition. A recent epidemiological study of adolescent twins revealed that trait mindfulness was 32% heritable. The same study also revealed that 66% of the variance in trait mindfulness was due to environmental factors, suggesting that is also a skill that can be learned. In fact, an MBSR study in university undergraduates revealed that, while increases in mindfulness and psychological outcomes can be observed in participants as a whole, effects may be more pronounced among individuals higher in trait mindfulness at study entry. These data substantiate the utility of mindfulness training, even for high-trait individuals.

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Disclosure: Mary Worthen declares no relevant financial relationships with ineligible companies.

Disclosure: Elizabeth Cash declares no relevant financial relationships with ineligible companies.

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Mindfulness meditation: A research-proven way to reduce stress

Mindfulness meditation can improve both mental and physical health.

Mindfulness
Mental Health

People have been meditating for thousands of years, often as part of a spiritual practice. But in more recent years, mindfulness has become a popular way to help people manage their stress and improve their overall well-being — and a wealth of research shows it’s effective. Psychologists have found that mindfulness meditation changes our brain and biology in positive ways, improving mental and physical health.

What is mindfulness meditation?

Meditation can be defined in many ways. But a simple way to think of it is training your attention to achieve a mental state of calm concentration and positive emotions.

Mindfulness is one of the most popular meditation techniques. It has two main parts: attention and acceptance.

The attention piece is about tuning into your experiences to focus on what's happening in the present moment. It typically involves directing your awareness to your breath, your thoughts, the physical sensations in your body and the feelings you are experiencing. The acceptance piece involves observing those feelings and sensations without judgment. Instead of responding or reacting to those thoughts or feelings, you aim to note them and let them go.

Mindfulness classes and mindfulness-based therapies provide the tools to put those concepts into practice. Such programs might include breathing exercises, yoga and guided lessons to help you become aware of your body sensations, thoughts and feelings.

Much of the research on mindfulness has focused on two types of interventions:

Mindfulness-based stress reduction (MBSR) is a therapeutic intervention that involves weekly group classes and daily mindfulness exercises to practice at home, over an 8-week period. MBSR teaches people how to increase mindfulness through yoga and meditation.
Mindfulness-based cognitive therapy (MBCT) is a therapeutic intervention that combines elements of MBSR and cognitive behavioral therapy (CBT) to treat people with depression.

Researchers reviewed more than 200 studies of mindfulness among healthy people and found mindfulness-based therapy was especially effective for reducing stress, anxiety and depression . Mindfulness can also help treat people with specific problems including depression, pain, smoking and addiction . Some of the most promising research has looked at people with depression. Several studies have found, for example, that MBCT can significantly reduce relapse in people who have had previous episodes of major depression . What's more, mindfulness-based interventions can improve physical health , too. For example, mindfulness may reduce pain, fatigue and stress in people with chronic pain . Other studies have found preliminary evidence that mindfulness might boost the immune system and help people recover more quickly from cold or flu.

How mindfulness works

How could simply tuning into your thoughts and feelings lead to so many positive outcomes throughout the body? Researchers believe the benefits of mindfulness are related to its ability to dial down the body's response to stress.

Chronic stress can impair the body's immune system and make many other health problems worse. By lowering the stress response, mindfulness may have downstream effects throughout the body.

Psychological scientists have found that mindfulness influences two different stress pathways in the brain , changing brain structures and activity in regions associated with attention and emotion regulation . Scientists are also beginning to understand which elements of mindfulness are responsible for its beneficial effects. In a review of meditation studies, psychology researchers found strong evidence that people who received MBCT were less likely to react with negative thoughts or unhelpful emotional reactions in times of stress . They also found moderate evidence that people who participated in MBCT or MBSR were better able to focus on the present and less likely to worry and to think about a negative thought or experience over and over.

[ Related: 6 mental health tips psychologists use]

How to get started

Ready to give it a try? Learning mindfulness is easier than ever. Mindfulness classes and interventions are widely available in settings including yoga centers, athletic clubs, hospitals and clinics, though the classes can vary in their approach. Find a therapist trained in MBSR or MBCT — interventions that have the most evidence of benefits.

A number of mindfulness-based interventions are now available online or through smartphone apps as well, although more long-term research is needed to explore how they affect the body and the brain. Still, early studies have found that online mindfulness-based interventions can have a positive effect on mental health .

It can take a little while for mindfulness meditation to feel natural and to become a part of your regular routine. But with practice, you may discover a powerful tool for relieving stress and improving well-being.

Thanks to psychologists J. David Creswell, PhD, and Bassam Khoury, PhD, who assisted with this article.

The Meeting of Meditative Disciplines and Western Psychology: A Mutually Enriching Dialogue Walsh, et. al., American Psychologist 2006

Mindfulness-Based Therapy: A Comprehensive Meta-Analysis Khoury, B., et. al. Clinical Psychology Review, 2013

Mindfulness-Based Interventions for Psychiatric Disorders: A Systematic Review and Meta-Analysis Goldberg, S.B., et. al. Clinical Psychology Review, 2018

Mindfulness Interventions Creswell, J.D., Annual Review of Psychology, 2017

Mindfulness Training and Physical Health: Mechanisms and Outcomes Creswell, J.D., et. al., Psychosomatic Medicine, 2019

Mindfulness and Cognitive–Behavioral Interventions for Chronic Pain: Differential Effects on Daily Pain Reactivity and Stress Reactivity Davis, M.C., et. al., Journal of Consulting and Clinical Psychology, 2015

Mindfulness Meditation and The Immune System: A Systematic Review of Randomized Controlled Trials Black, D.S., et. al. Annals of the New York Academy of Sciences, 2016

Meditation or Exercise for Preventing Acute Respiratory Infection: A Randomized Controlled Trial Barrett, B., et. al., Annals of Family Medicine, 2012

The Neuroscience of Mindfulness Meditation Tan, Y.-Y., et. al., Nature Reviews Neuroscience, 2015

How Do Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction Improve Mental Health and Wellbeing? A Systematic Review and Meta-Analysis of Mediation Studies Gu, J., et. al. Clinical Psychology Review, 2015

Effectiveness of Online Mindfulness-Based Interventions in Improving Mental Health: A Review and Meta-Analysis of Randomised Controlled Trials Spijkerman, M.P.J., et. al., Clinical Psychology Review, 2016

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Mind and Body Approaches for Stress and Anxiety: What the Science Says

Clinical Guidelines, Scientific Literature, Info for Patients: Mind and Body Approaches for Stress and Anxiety

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} Relaxation Techniques

Relaxation techniques may be helpful in managing a variety of stress-related health conditions, including anxiety associated with ongoing health problems and in those who are having medical procedures. Evidence suggests that relaxation techniques may also provide some benefit for symptoms of post-traumatic stress disorder (PTSD) and may help reduce occupational stress in health care workers. For some of these conditions, relaxation techniques are used as an adjunct to other forms of treatment.

What Does the Research Show?

Biofeedback for anxiety and depression in children. A 2018 systematic review included 9 studies—278 participants total—on biofeedback for anxiety and depression in children and adolescents with long-term physical conditions such as chronic pain, asthma, cancer, and headache. The review found that, although biofeedback appears promising, at this point it can’t be recommended for clinical use in place of or in addition to current treatments.
Heart rate variability biofeedback. A 2017 meta-analysis looked at 24 studies—484 participants total—on heart rate variability (HRV) biofeedback and general stress and anxiety. The meta-analysis found that HRV biofeedback is helpful for reducing self-reported stress and anxiety, and the researchers saw it as a promising approach with further development of wearable devices such as a fitness tracker.
Progressive muscle relaxation. A 2015 systematic review , which included two studies on progressive muscle relaxation in adults older than 60 years of age, with a total of 275 participants, found that progressive muscle relaxation was promising for reducing anxiety and depression. The positive effects for depression were maintained 14 weeks after treatment.
PTSD. A 2018 meta-analysis of 50 studies involving 2,801 participants found that relaxation therapy seemed to be less effective than cognitive behavioral therapy for PTSD and obsessive-compulsive disorder. No difference was found between relaxation therapy and cognitive behavioral therapy for other anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias. The review noted, however, that most studies had a high risk of bias, and there was a small number of studies for some of the individual disorders.
Anxiety in people with cancer. In the 2023 joint guideline issued by the Society for Integrative Oncology and the American Society for Clinical Oncology on integrative oncology care of symptoms of anxiety and depression in adults with cancer, relaxation therapies may be offered to people with cancer to improve anxiety symptoms during active treatment (Type: Evidence based; Quality of evidence: Intermediate; benefits outweigh harms; Strength of recommendation: Moderate).
Relaxation techniques are generally considered safe for healthy people. In most research studies, there have been no reported negative side effects. However, occasionally, people report negative experiences such as increased anxiety, intrusive thoughts, or fear of losing control.
There have been rare reports that certain relaxation techniques might cause or worsen symptoms in people with epilepsy or certain psychiatric conditions, or with a history of abuse or trauma.

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} Yoga, Tai Chi, and Qigong

A range of research has examined the relationship between exercise and depression. Results from a much smaller body of research suggest that exercise may also affect stress and anxiety symptoms. Even less certain is the role of yoga, tai chi, and qigong—for these and other psychological factors. But there is some limited evidence that yoga, as an adjunctive therapy, may be helpful for people with anxiety symptoms.

Yoga for children and adolescents. Findings from a 2021 meta-analysis and systematic review of 10 trials involving a total of 1,244 adolescents suggest a potential beneficial effect of tai chi and qigong on reducing anxiety and depression symptoms, and reducing cortisol level in adolescents. However, nonsignificant effects were found for stress, mood, and self-esteem. A 2020 systematic review of 27 studies involving the effects of yoga on children and adolescents with varying health statuses, and with varying intervention characteristics, found that in studies assessing anxiety and depression, 58 percent showed reductions in both symptoms, while 25 percent showed reductions in anxiety only. Additionally, 70 percent of studies included in the review that assessed anxiety alone showed improvements. However, the reviewers noted that the studies included in the review were of weak-to-moderate methodological quality.
Yoga, tai chi, and qigong for anxiety. A 2019 review concluded that yoga as an adjunctive therapy facilitates treatment of anxiety disorders, particularly panic disorder. The review also found that tai chi and qigong may be helpful as adjunctive therapies for depression, but effects are inconsistent.
Yoga for anxiety. A 2021 randomized controlled trial examined whether Kundalini yoga and cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) were each more effective than a control condition (stress education) and whether yoga was inferior to CBT for the treatment GAD. The trial found that Kundalini yoga was more efficacious for generalized anxiety disorder than the control, but the results support CBT remaining first-line treatment. A 2018 systematic review and meta-analysis of 8 studies of yoga for anxiety (involving 319 participants with anxiety disorders or elevated levels of anxiety) found evidence that yoga might have short-term benefits in reducing the intensity of anxiety. However, when only people with diagnosed anxiety disorders were included in the analysis, there was no benefit.
Yoga is generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor. However, as with other forms of physical activity, injuries can occur. The most common injuries are sprains and strains. Serious injuries are rare. The risk of injury associated with yoga is lower than that for higher impact physical activities.
Older people may need to be particularly cautious when practicing yoga. The rate of yoga-related injuries treated in emergency departments is higher in people age 65 and older than in younger adults.

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} Meditation and Mindfulness-Based Stress Reduction

Some research suggests that practicing meditation may reduce blood pressure, anxiety and depression, and insomnia.

Mindfulness-based stress reduction. A 2023 randomized controlled trial involving 208 participants found that mindfulness-based stress reduction (MBSR) is noninferior to escitalopram, a commonly used first-line psychopharmacologic treatment for anxiety disorders. A 2021 randomized controlled trial of 108 adults with generalized social anxiety disorder found that cognitive behavioral group therapy and MBSR may be effective treatments with long-term benefits for patients with social anxiety networks that recruit cognitive and attention-regulation brain networks. The researchers noted that cognitive behavioral therapy and MBSR may both enhance reappraisal and acceptance emotion regulation strategies.
Mindfulness-based meditation. A 2019 review concluded that as monotherapy or an adjunctive therapy, mindfulness-based meditation has positive effects on depression, and its effects can last for 6 months or more. Although positive findings are less common in people with anxiety disorders, the evidence supports adjunctive use. A 2019 analysis of 29 studies (3,274 total participants) showed that use of mindfulness-based practices among people with cancer significantly reduced psychological distress, fatigue, sleep disturbance, pain, and symptoms of anxiety and depression. However, most of the participants were women with breast cancer, so the effects may not be similar for other populations or other types of cancer. A 2014 meta-analysis of 47 trials in 3,515 participants suggests that mindfulness meditation programs show moderate evidence of improving anxiety and depression. But the researchers found no evidence that meditation changed health-related behaviors affected by stress, such as substance abuse and sleep.
Mindfulness-based programs for workplace stress. A 2018 systematic review and meta-analysis of nine studies examined mindfulness-based programs with an employee sample, which targeted workplace stress or work engagement, and measured a physiological outcome. The review found that mindfulness-based interventions may be a promising avenue for improving physiological indices of stress.
Meditation is generally considered to be safe for healthy people.
A 2019 review found no apparent negative effects of mindfulness-based interventions and concluded that their general health benefits justify their use as adjunctive therapy for patients with anxiety disorders.

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Hypnosis has been studied for anxiety related to medical or dental procedures. Some studies have had promising results, but the overall evidence is not conclusive.

A 2022 systematic review and meta-analysis of 19 trials found positive effects of hypnotherapy for reducing dental anxiety and fear during dental treatment. However, the reviewers noted that despite positive effects of hypnotic interventions in the systematic review, the results of the meta-analysis are very heterogeneous.
The 2023 joint guideline issued by the Society for Integrative Oncology and the American Society for Clinical Oncology recommends that hypnosis may be offered to people with cancer to improve anxiety symptoms during cancer-related diagnostic and treatment procedures (Type: Evidence based; Quality of evidence: Intermediate; benefits outweigh harms; Strength of recommendation: Moderate).
Hypnosis is a safe technique when practiced by a trained, experienced, licensed health care provider.

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Carlson LE, Ismaila N, Addington EL, et al. Integrative oncology care of symptoms of anxiety and depression in adults with cancer: Society for Integrative Oncology-ASCO guideline . Journal of Clinical Oncology. 2023;41(28):4562-4591.
Chugh-Gupta N, Baldassarre FG, Vrkljan BH. A systematic review of yoga for state anxiety: considerations for occupational therapy . C anadian Journal of Occupational Therapy . 2013;80(3):150-170.
Cillessen L, Johannsen M, Speckens AEM, et al . Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: a systematic review and meta-analysis of randomized controlled trials . Psychooncology . 2019;28(12):2257-2269.
Cramer H, Lauche R, Anheyer D, et al. Yoga for anxiety: a systematic review and meta-analysis of randomized controlled trials . Depress Anxiety . 2018;35(9):830-843.
Goessl VC, Curtiss JE, Hofmann SG. The effect of heart rate variability of biofeedback training on stress and anxiety: a meta-analysis . Psychological Medicine . 2017;47(15):2578-2586.
Goldin PR, Thurston M, Allende S, et al . Evaluation of cognitive behavioral therapy vs mindfulness meditation in brain changes during reappraisal and acceptance among patients with social anxiety disorder: a randomized clinical trial . JAMA Psychiatry . 2021;78(10):1134-1142.
Goyal M, Singh S, Sibinga EMS, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine . 2014;174(3):357-368.
Greenlee H, Balneaves LG, Carlson LE, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer . Journal of the National Cancer Institute Monographs. 2014;50:346-358.
Heckenberg RA, Eddy P, Kent S, et al. Do workplace-based mindfulness meditation programs improve physiological indices of stress? A systematic review and meta-analysis . Journal of Psychosomatic Research. 2018;114:62-71.
Hoge EA, Bui E, Mete M, et al. Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: a randomized clinical trial . JAMA Psychiatry . 2023;80(1):13-21.
James-Palmer A, Anderson EZ, Zucker L, et al. Yoga as an intervention for the reduction of symptoms of anxiety and depression in children and adolescents: a systematic review . Frontiers in Pediatrics . 2020;8:78.
Liu X, Li R, Cui J, et al. The effects of tai chi and qigong exercise on psychological status in adolescents: a systematic review and meta-analysis . Frontiers in Psychology . 2021;12:746975.
Klainin-Yobas P, Oo WN, Suzanne Yew PY, et al. Effects of relaxation interventions on depression and anxiety among older adults: a systematic review . Aging and Mental Health . 2015;19(12):1043-1055.
Montero-Marin J, Garcia-Campayo J, López-Montoyo A, et al. Is cognitive-behavioural therapy more effective than relaxation therapy in the treatment of anxiety disorders? A meta-analysis . Psychological Medicine . 2018;48(9):1427-1436.
Saeed SA, Cunningham K, Bloch RM. Depression and anxiety disorders: benefits of exercise, yoga, and meditation . American Family Physician . 2019;99(10):620-627.
Simon NM, Hofmann SG, Rosenfield D, et al. Efficacy of yoga vs cognitive behavioral therapy vs stress education for the treatment of generalized anxiety disorder: a randomized clinical trial . JAMA Psychiatry . 2021;78(1):13-20.
Thabrew H, Ruppeldt P, Sollers JJ 3rd. Systematic review of biofeedback interventions for addressing anxiety and depression in children and adolescents with long-term physical conditions . Applied Psychophysiology and Biofeedback . 2018;43(3):179-192.
Wolf TG, Schläppi S, Benz CI, et al. Efficacy of hypnosis on dental anxiety and phobia: a systematic review and meta-analysis . Brain Sciences . 2022;12(5):521.

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Article contents

Work, stress, coping, and stress management.

Sharon Glazer Sharon Glazer University of Baltimore
and Cong Liu Cong Liu Hofstra University
https://doi.org/10.1093/acrefore/9780190236557.013.30
Published online: 26 April 2017

Work stress refers to the process of job stressors, or stimuli in the workplace, leading to strains, or negative responses or reactions. Organizational development refers to a process in which problems or opportunities in the work environment are identified, plans are made to remediate or capitalize on the stimuli, action is taken, and subsequently the results of the plans and actions are evaluated. When organizational development strategies are used to assess work stress in the workplace, the actions employed are various stress management interventions. Two key factors tying work stress and organizational development are the role of the person and the role of the environment. In order to cope with work-related stressors and manage strains, organizations must be able to identify and differentiate between factors in the environment that are potential sources of stressors and how individuals perceive those factors. Primary stress management interventions focus on preventing stressors from even presenting, such as by clearly articulating workers’ roles and providing necessary resources for employees to perform their job. Secondary stress management interventions focus on a person’s appraisal of job stressors as a threat or challenge, and the person’s ability to cope with the stressors (presuming sufficient internal resources, such as a sense of meaningfulness in life, or external resources, such as social support from a supervisor). When coping is not successful, strains may develop. Tertiary stress management interventions attempt to remediate strains, by addressing the consequence itself (e.g., diabetes management) and/or the source of the strain (e.g., reducing workload). The person and/or the organization may be the targets of the intervention. The ultimate goal of stress management interventions is to minimize problems in the work environment, intensify aspects of the work environment that create a sense of a quality work context, enable people to cope with stressors that might arise, and provide tools for employees and organizations to manage strains that might develop despite all best efforts to create a healthy workplace.

stress management
organization development
organizational interventions
stress theories and frameworks

Introduction

Work stress is a generic term that refers to work-related stimuli (aka job stressors) that may lead to physical, behavioral, or psychological consequences (i.e., strains) that affect both the health and well-being of the employee and the organization. Not all stressors lead to strains, but all strains are a result of stressors, actual or perceived. Common terms often used interchangeably with work stress are occupational stress, job stress, and work-related stress. Terms used interchangeably with job stressors include work stressors, and as the specificity of the type of stressor might include psychosocial stressor (referring to the psychological experience of work demands that have a social component, e.g., conflict between two people; Hauke, Flintrop, Brun, & Rugulies, 2011 ), hindrance stressor (i.e., a stressor that prevents goal attainment; Cavanaugh, Boswell, Roehling, & Boudreau, 2000 ), and challenge stressor (i.e., a stressor that is difficult, but attainable and possibly rewarding to attain; Cavanaugh et al., 2000 ).

Stress in the workplace continues to be a highly pervasive problem, having both direct negative effects on individuals experiencing it and companies paying for it, and indirect costs vis à vis lost productivity (Dopkeen & DuBois, 2014 ). For example, U.K. public civil servants’ work-related stress rose from 10.8% in 2006 to 22.4% in 2013 and about one-third of the workforce has taken more than 20 days of leave due to stress-related ill-health, while well over 50% are present at work when ill (French, 2015 ). These findings are consistent with a report by the International Labor Organization (ILO, 2012 ), whereby 50% to 60% of all workdays are lost due to absence attributed to factors associated with work stress.

The prevalence of work-related stress is not diminishing despite improvements in technology and employment rates. The sources of stress, such as workload, seem to exacerbate with improvements in technology (Coovert & Thompson, 2003 ). Moreover, accessibility through mobile technology and virtual computer terminals is linking people to their work more than ever before (ILO, 2012 ; Tarafdar, Tu, Ragu-Nathan, & Ragu-Nathan, 2007 ). Evidence of this kind of mobility and flexibility is further reinforced in a June 2007 survey of 4,025 email users (over 13 years of age); AOL reported that four in ten survey respondents reported planning their vacations around email accessibility and 83% checked their emails at least once a day while away (McMahon, 2007 ). Ironically, despite these mounting work-related stressors and clear financial and performance outcomes, some individuals are reporting they are less “stressed,” but only because “stress has become the new normal” (Jayson, 2012 , para. 4).

This new normal is likely the source of psychological and physiological illness. Siegrist ( 2010 ) contends that conditions in the workplace, particularly psychosocial stressors that are perceived as unfavorable relationships with others and self, and an increasingly sedentary lifestyle (reinforced with desk jobs) are increasingly contributing to cardiovascular disease. These factors together justify a need to continue on the path of helping individuals recognize and cope with deleterious stressors in the work environment and, equally important, to find ways to help organizations prevent harmful stressors over which they have control, as well as implement policies or mechanisms to help employees deal with these stressors and subsequent strains. Along with a greater focus on mitigating environmental constraints are interventions that can be used to prevent anxiety, poor attitudes toward the workplace conditions and arrangements, and subsequent cardiovascular illness, absenteeism, and poor job performance (Siegrist, 2010 ).

Even the ILO has presented guidance on how the workplace can help prevent harmful job stressors (aka hindrance stressors) or at least help workers cope with them. Consistent with the view that well-being is not the absence of stressors or strains and with the view that positive psychology offers a lens for proactively preventing stressors, the ILO promotes increasing preventative risk assessments, interventions to prevent and control stressors, transparent organizational communication, worker involvement in decision-making, networks and mechanisms for workplace social support, awareness of how working and living conditions interact, safety, health, and well-being in the organization (ILO, n.d. ). The field of industrial and organizational (IO) psychology supports the ILO’s recommendations.

IO psychology views work stress as the process of a person’s interaction with multiple aspects of the work environment, job design, and work conditions in the organization. Interventions to manage work stress, therefore, focus on the psychosocial factors of the person and his or her relationships with others and the socio-technical factors related to the work environment and work processes. Viewing work stress from the lens of the person and the environment stems from Kurt Lewin’s ( 1936 ) work that stipulates a person’s state of mental health and behaviors are a function of the person within a specific environment or situation. Aspects of the work environment that affect individuals’ mental states and behaviors include organizational hierarchy, organizational climate (including processes, policies, practices, and reward structures), resources to support a person’s ability to fulfill job duties, and management structure (including leadership). Job design refers to each contributor’s tasks and responsibilities for fulfilling goals associated with the work role. Finally, working conditions refers not only to the physical environment, but also the interpersonal relationships with other contributors.

Each of the conditions that are identified in the work environment may be perceived as potentially harmful or a threat to the person or as an opportunity. When a stressor is perceived as a threat to attaining desired goals or outcomes, the stressor may be labeled as a hindrance stressor (e.g., LePine, Podsakoff, & Lepine, 2005 ). When the stressor is perceived as an opportunity to attain a desired goal or end state, it may be labeled as a challenge stressor. According to LePine and colleagues’ ( 2005 ), both challenge (e.g., time urgency, workload) and hindrance (e.g., hassles, role ambiguity, role conflict) stressors could lead to strains (as measured by “anxiety, depersonalization, depression, emotional exhaustion, frustration, health complaints, hostility, illness, physical symptoms, and tension” [p. 767]). However, challenge stressors positively relate with motivation and performance, whereas hindrance stressors negatively relate with motivation and performance. Moreover, motivation and strains partially mediate the relationship between hindrance and challenge stressors with performance.

Figure 1. Organizational development frameworks to guide identification of work stress and interventions.

In order to (1) minimize any potential negative effects from stressors, (2) increase coping skills to deal with stressors, or (3) manage strains, organizational practitioners or consultants will devise organizational interventions geared toward prevention, coping, and/or stress management. Ultimately, toxic factors in the work environment can have deleterious effects on a person’s physical and psychological well-being, as well as on an organization’s total health. It behooves management to take stock of the organization’s health, which includes the health and well-being of its employees, if the organization wishes to thrive and be profitable. According to Page and Vella-Brodrick’s ( 2009 ) model of employee well-being, employee well-being results from subjective well-being (i.e., life satisfaction and general positive or negative affect), workplace well-being (composed of job satisfaction and work-specific positive or negative affect), and psychological well-being (e.g., self-acceptance, positive social relations, mastery, purpose in life). Job stressors that become unbearable are likely to negatively affect workplace well-being and thus overall employee well-being. Because work stress is a major organizational pain point and organizations often employ organizational consultants to help identify and remediate pain points, the focus here is on organizational development (OD) frameworks; several work stress frameworks are presented that together signal areas where organizations might focus efforts for change in employee behaviors, attitudes, and performance, as well as the organization’s performance and climate. Work stress, interventions, and several OD and stress frameworks are depicted in Figure 1 .

The goals are: (1) to conceptually define and clarify terms associated with stress and stress management, particularly focusing on organizational factors that contribute to stress and stress management, and (2) to present research that informs current knowledge and practices on workplace stress management strategies. Stressors and strains will be defined, leading OD and work stress frameworks that are used to organize and help organizations make sense of the work environment and the organization’s responsibility in stress management will be explored, and stress management will be explained as an overarching thematic label; an area of study and practice that focuses on prevention (primary) interventions, coping (secondary) interventions, and managing strains (tertiary) interventions; as well as the label typically used to denote tertiary interventions. Suggestions for future research and implications toward becoming a healthy organization are presented.

Defining Stressors and Strains

Work-related stressors or job stressors can lead to different kinds of strains individuals and organizations might experience. Various types of stress management interventions, guided by OD and work stress frameworks, may be employed to prevent or cope with job stressors and manage strains that develop(ed).

A job stressor is a stimulus external to an employee and a result of an employee’s work conditions. Example job stressors include organizational constraints, workplace mistreatments (such as abusive supervision, workplace ostracism, incivility, bullying), role stressors, workload, work-family conflicts, errors or mistakes, examinations and evaluations, and lack of structure (Jex & Beehr, 1991 ; Liu, Spector, & Shi, 2007 ; Narayanan, Menon, & Spector, 1999 ). Although stressors may be categorized as hindrances and challenges, there is not yet sufficient information to be able to propose which stress management interventions would better serve to reduce those hindrance stressors or to reduce strain-producing challenge stressors while reinforcing engagement-producing challenge stressors.

Organizational Constraints

Organizational constraints may be hindrance stressors as they prevent employees from translating their motivation and ability into high-level job performance (Peters & O’Connor, 1980 ). Peters and O’Connor ( 1988 ) defined 11 categories of organizational constraints: (1) job-related information, (2) budgetary support, (3) required support, (4) materials and supplies, (5) required services and help from others, (6) task preparation, (7) time availability, (8) the work environment, (9) scheduling of activities, (10) transportation, and (11) job-relevant authority. The inhibiting effect of organizational constraints may be due to the lack of, inadequacy of, or poor quality of these categories.

Workplace Mistreatment

Workplace mistreatment presents a cluster of interpersonal variables, such as interpersonal conflict, bullying, incivility, and workplace ostracism (Hershcovis, 2011 ; Tepper & Henle, 2011 ). Typical workplace mistreatment behaviors include gossiping, rude comments, showing favoritism, yelling, lying, and ignoring other people at work (Tepper & Henle, 2011 ). These variables relate to employees’ psychological well-being, physical well-being, work attitudes (e.g., job satisfaction and organizational commitment), and turnover intention (e.g., Hershcovis, 2011 ; Spector & Jex, 1998 ). Some researchers differentiated the source of mistreatment, such as mistreatment from one’s supervisor versus mistreatment from one’s coworker (e.g., Bruk-Lee & Spector, 2006 ; Frone, 2000 ; Liu, Liu, Spector, & Shi, 2011 ).

Role Stressors

Role stressors are demands, constraints, or opportunities a person perceives to be associated, and thus expected, with his or her work role(s) across various situations. Three commonly studied role stressors are role ambiguity, role conflict, and role overload (Glazer & Beehr, 2005 ; Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964 ). Role ambiguity in the workplace occurs when an employee lacks clarity regarding what performance-related behaviors are expected of him or her. Role conflict refers to situations wherein an employee receives incompatible role requests from the same or different supervisors or the employee is asked to engage in work that impedes his or her performance in other work or nonwork roles or clashes with his or her values. Role overload refers to excessive demands and insufficient time (quantitative) or knowledge (qualitative) to complete the work. The construct is often used interchangeably with workload, though role overload focuses more on perceived expectations from others about one’s workload. These role stressors significantly relate to low job satisfaction, low organizational commitment, low job performance, high tension or anxiety, and high turnover intention (Abramis, 1994 ; Glazer & Beehr, 2005 ; Jackson & Schuler, 1985 ).

Excessive workload is one of the most salient stressors at work (e.g., Liu et al., 2007 ). There are two types of workload: quantitative and qualitative workload (LaRocco, Tetrick, & Meder, 1989 ; Parasuraman & Purohit, 2000 ). Quantitative workload refers to the excessive amount of work one has. In a summary of a Chartered Institute of Personnel & Development Report from 2006 , Dewe and Kompier ( 2008 ) noted that quantitative workload was one of the top three stressors workers experienced at work. Qualitative workload refers to the difficulty of work. Workload also differs by the type of the load. There are mental workload and physical workload (Dwyer & Ganster, 1991 ). Excessive physical workload may result in physical discomfort or illness. Excessive mental workload will cause psychological distress such as anxiety or frustration (Bowling & Kirkendall, 2012 ). Another factor affecting quantitative workload is interruptions (during the workday). Lin, Kain, and Fritz ( 2013 ) found that interruptions delay completion of job tasks, thus adding to the perception of workload.

Work-Family Conflict

Work-family conflict is a form of inter-role conflict in which demands from one’s work domain and one’s family domain are incompatible to some extent (Greenhaus & Beutell, 1985 ). Work can interfere with family (WIF) and/or family can interfere with work (FIW) due to time-related commitments to participating in one domain or another, incompatible behavioral expectations, or when strains in one domain carry over to the other (Greenhaus & Beutell, 1985 ). Work-family conflict significantly relates to work-related outcomes (e.g., job satisfaction, organizational commitment, turnover intention, burnout, absenteeism, job performance, job strains, career satisfaction, and organizational citizenship behaviors), family-related outcomes (e.g., marital satisfaction, family satisfaction, family-related performance, family-related strains), and domain-unspecific outcomes (e.g., life satisfaction, psychological strain, somatic or physical symptoms, depression, substance use or abuse, and anxiety; Amstad, Meier, Fasel, Elfering, & Semmer, 2011 ).

Individuals and organizations can experience work-related strains. Sometimes organizations will experience strains through the employee’s negative attitudes or strains, such as that a worker’s absence might yield lower production rates, which would roll up into an organizational metric of organizational performance. In the industrial and organizational (IO) psychology literature, organizational strains are mostly observed as macro-level indicators, such as health insurance costs, accident-free days, and pervasive problems with company morale. In contrast, individual strains, usually referred to as job strains, are internal to an employee. They are responses to work conditions and relate to health and well-being of employees. In other words, “job strains are adverse reactions employees have to job stressors” (Spector, Chen, & O’Connell, 2000 , p. 211). Job strains tend to fall into three categories: behavioral, physical, and psychological (Jex & Beehr, 1991 ).

Behavioral strains consist of actions that employees take in response to job stressors. Examples of behavioral strains include employees drinking alcohol in the workplace or intentionally calling in sick when they are not ill (Spector et al., 2000 ). Physical strains consist of health symptoms that are physiological in nature that employees contract in response to job stressors. Headaches and ulcers are examples of physical strains. Lastly, psychological strains are emotional reactions and attitudes that employees have in response to job stressors. Examples of psychological strains are job dissatisfaction, anxiety, and frustration (Spector et al., 2000 ). Interestingly, research studies that utilize self-report measures find that most job strains experienced by employees tend to be psychological strains (Spector et al., 2000 ).

Leading Frameworks

Organizations that are keen on identifying organizational pain points and remedying them through organizational campaigns or initiatives often discover the pain points are rooted in work-related stressors and strains and the initiatives have to focus on reducing workers’ stress and increasing a company’s profitability. Through organizational climate surveys, for example, companies discover that aspects of the organization’s environment, including its policies, practices, reward structures, procedures, and processes, as well as employees at all levels of the company, are contributing to the individual and organizational stress. Recent studies have even begun to examine team climates for eustress and distress assessed in terms of team members’ homogenous psychological experience of vigor, efficacy, dedication, and cynicism (e.g., Kożusznik, Rodriguez, & Peiro, 2015 ).

Each of the frameworks presented advances different aspects that need to be identified in order to understand the source and potential remedy for stressors and strains. In some models, the focus is on resources, in others on the interaction of the person and environment, and in still others on the role of the person in the workplace. Few frameworks directly examine the role of the organization, but the organization could use these frameworks to plan interventions that would minimize stressors, cope with existing stressors, and prevent and/or manage strains. One of the leading frameworks in work stress research that is used to guide organizational interventions is the person and environment (P-E) fit (French & Caplan, 1972 ). Its precursor is the University of Michigan Institute for Social Research’s (ISR) role stress model (Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964 ) and Lewin’s Field Theory. Several other theories have since evolved from the P-E fit framework, including Karasek and Theorell’s ( 1990 ), Karasek ( 1979 ) Job Demands-Control Model (JD-C), the transactional framework (Lazarus & Folkman, 1984 ), Conservation of Resources (COR) theory (Hobfoll, 1989 ), and Siegrist’s ( 1996 ) Effort-Reward Imbalance (ERI) Model.

Field Theory

The premise of Kahn et al.’s ( 1964 ) role stress theory is Lewin’s ( 1997 ) Field Theory. Lewin purported that behavior and mental events are a dynamic function of the whole person, including a person’s beliefs, values, abilities, needs, thoughts, and feelings, within a given situation (field or environment), as well as the way a person represents his or her understanding of the field and behaves in that space. Lewin explains that work-related strains are a result of individuals’ subjective perceptions of objective factors, such as work roles, relationships with others in the workplace, as well as personality indicators, and can be used to predict people’s reactions, including illness. Thus, to make changes to an organizational system, it is necessary to understand a field and try to move that field from the current state to the desired state. Making this move necessitates identifying mechanisms influencing individuals.

Role Stress Theory

Role stress theory mostly isolates the perspective a person has about his or her work-related responsibilities and expectations to determine how those perceptions relate with a person’s work-related strains. However, those relationships have been met with somewhat varied results, which Glazer and Beehr ( 2005 ) concluded might be a function of differences in culture, an environmental factor often neglected in research. Kahn et al.’s ( 1964 ) role stress theory, coupled with Lewin’s ( 1936 ) Field Theory, serves as the foundation for the P-E fit theory. Lewin ( 1936 ) wrote, “Every psychological event depends upon the state of the person and at the same time on the environment” (p. 12). Researchers of IO psychology have narrowed the environment to the organization or work team. This narrowed view of the organizational environment is evident in French and Caplan’s ( 1972 ) P-E fit framework.

Person-Environment Fit Theory

The P-E fit framework focuses on the extent to which there is congruence between the person and a given environment, such as the organization (Caplan, 1987 ; Edwards, 2008 ). For example, does the person have the necessary skills and abilities to fulfill an organization’s demands, or does the environment support a person’s desire for autonomy (i.e., do the values align?) or fulfill a person’s needs (i.e., a person’s needs are rewarded). Theoretically and empirically, the greater the person-organization fit, the greater a person’s job satisfaction and organizational commitment, the less a person’s turnover intention and work-related stress (see meta-analyses by Assouline & Meir, 1987 ; Kristof-Brown, Zimmerman, & Johnson, 2005 ; Verquer, Beehr, & Wagner, 2003 ).

Job Demands-Control/Support (JD-C/S) and Job Demands-Resources (JD-R) Model

Focusing more closely on concrete aspects of work demands and the extent to which a person perceives he or she has control or decision latitude over those demands, Karasek ( 1979 ) developed the JD-C model. Karasek and Theorell ( 1990 ) posited that high job demands under conditions of little decision latitude or control yield high strains, which have varied implications on the health of an organization (e.g., in terms of high turnover, employee ill-health, poor organizational performance). This theory was modified slightly to address not only control, but also other resources that could protect a person from unruly job demands, including support (aka JD-C/S, Johnson & Hall, 1988 ; and JD-R, Bakker, van Veldhoven, & Xanthopoulou, 2010 ). Whether focusing on control or resources, both they and job demands are said to reflect workplace characteristics, while control and resources also represent coping strategies or tools (Siegrist, 2010 ).

Despite the glut of research testing the JD-C and JD-R, results are somewhat mixed. Testing the interaction between job demands and control, Beehr, Glaser, Canali, and Wallwey ( 2001 ) did not find empirical support for the JD-C theory. However, Dawson, O’Brien, and Beehr ( 2016 ) found that high control and high support buffered against the independent deleterious effects of interpersonal conflict, role conflict, and organizational politics (demands that were categorized as hindrance stressors) on anxiety, as well as the effects of interpersonal conflict and organizational politics on physiological symptoms, but control and support did not moderate the effects between challenge stressors and strains. Coupled with Bakker, Demerouti, and Sanz-Vergel’s ( 2014 ) note that excessive job demands are a source of strain, but increased job resources are a source of engagement, Dawson et al.’s results suggest that when an organization identifies that demands are hindrances, it can create strategies for primary (preventative) stress management interventions and attempt to remove or reduce such work demands. If the demands are challenging, though manageable, but latitude to control the challenging stressors and support are insufficient, the organization could modify practices and train employees on adopting better strategies for meeting or coping (secondary stress management intervention) with the demands. Finally, if the organization can neither afford to modify the demands or the level of control and support, it will be necessary for the organization to develop stress management (tertiary) interventions to deal with the inevitable strains.

Conservation of Resources Theory

The idea that job resources reinforce engagement in work has been propagated in Hobfoll’s ( 1989 ) Conservation of Resources (COR) theory. COR theory also draws on the foundational premise that people’s mental health is a function of the person and the environment, forwarding that how people interpret their environment (including the societal context) affects their stress levels. Hobfoll focuses on resources such as objects, personal characteristics, conditions, or energies as particularly instrumental to minimizing strains. He asserts that people do whatever they can to protect their valued resources. Thus, strains develop when resources are threatened to be taken away, actually taken away, or when additional resources are not attainable after investing in the possibility of gaining more resources (Hobfoll, 2001 ). By extension, organizations can invest in activities that would minimize resource loss and create opportunities for resource gains and thus have direct implications for devising primary and secondary stress management interventions.

Transactional Framework

Lazarus and Folkman ( 1984 ) developed the widely studied transactional framework of stress. This framework holds as a key component the cognitive appraisal process. When individuals perceive factors in the work environment as a threat (i.e., primary appraisal), they will scan the available resources (external or internal to himself or herself) to cope with the stressors (i.e., secondary appraisal). If the coping resources provide minimal relief, strains develop. Until recently, little attention has been given to the cognitive appraisal associated with different work stressors (Dewe & Kompier, 2008 ; Liu & Li, 2017 ). In a study of Polish and Spanish social care service providers, stressors appraised as a threat related positively to burnout and less engagement, but stressors perceived as challenges yielded greater engagement and less burnout (Kożusznik, Rodriguez, & Peiro, 2012 ). Similarly, Dawson et al. ( 2016 ) found that even with support and control resources, hindrance demands were more strain-producing than challenge demands, suggesting that appraisal of the stressor is important. In fact, “many people respond well to challenging work” (Beehr et al., 2001 , p. 126). Kożusznik et al. ( 2012 ) recommend training employees to change the way they view work demands in order to increase engagement, considering that part of the problem may be about how the person appraises his or her environment and, thus, copes with the stressors.

Effort-Reward Imbalance

Siegrist’s ( 1996 ) Model of Effort-Reward Imbalance (ERI) focuses on the notion of social reciprocity, such that a person fulfills required work tasks in exchange for desired rewards (Siegrist, 2010 ). ERI sheds light on how an imbalance in a person’s expectations of an organization’s rewards (e.g., pay, bonus, sense of advancement and development, job security) in exchange for a person’s efforts, that is a break in one’s work contract, leads to negative responses, including long-term ill-health (Siegrist, 2010 ; Siegrist et al., 2014 ). In fact, prolonged perception of a work contract imbalance leads to adverse health, including immunological problems and inflammation, which contribute to cardiovascular disease (Siegrist, 2010 ). The model resembles the relational and interactional psychological contract theory in that it describes an employee’s perception of the terms of the relationship between the person and the workplace, including expectations of performance, job security, training and development opportunities, career progression, salary, and bonuses (Thomas, Au, & Ravlin, 2003 ). The psychological contract, like the ERI model, focuses on social exchange. Furthermore, the psychological contract, like stress theories, are influenced by cultural factors that shape how people interpret their environments (Glazer, 2008 ; Thomas et al., 2003 ). Violations of the psychological contract will negatively affect a person’s attitudes toward the workplace and subsequent health and well-being (Siegrist, 2010 ). To remediate strain, Siegrist ( 2010 ) focuses on both the person and the environment, recognizing that the organization is particularly responsible for changing unfavorable work conditions and the person is responsible for modifying his or her reactions to such conditions.

Stress Management Interventions: Primary, Secondary, and Tertiary

Remediation of work stress and organizational development interventions are about realigning the employee’s experiences in the workplace with factors in the environment, as well as closing the gap between the current environment and the desired environment. Work stress develops when an employee perceives the work demands to exceed the person’s resources to cope and thus threatens employee well-being (Dewe & Kompier, 2008 ). Likewise, an organization’s need to change arises when forces in the environment are creating a need to change in order to survive (see Figure 1 ). Lewin’s ( 1951 ) Force Field Analysis, the foundations of which are in Field Theory, is one of the first organizational development intervention tools presented in the social science literature. The concept behind Force Field Analysis is that in order to survive, organizations must adapt to environmental forces driving a need for organizational change and remove restraining forces that create obstacles to organizational change. In order to do this, management needs to delineate the current field in which the organization is functioning, understand the driving forces for change, identify and dampen or eliminate the restraining forces against change. Several models for analyses may be applied, but most approaches are variations of organizational climate surveys.

Through organizational surveys, workers provide management with a snapshot view of how they perceive aspects of their work environment. Thus, the view of the health of an organization is a function of several factors, chief among them employees’ views (i.e., the climate) about the workplace (Lewin, 1951 ). Indeed, French and Kahn ( 1962 ) posited that well-being depends on the extent to which properties of the person and properties of the environment align in terms of what a person requires and the resources available in a given environment. Therefore, only when properties of the person and properties of the environment are sufficiently understood can plans for change be developed and implemented targeting the environment (e.g., change reporting structures to relieve, and thus prevent future, communication stressors) and/or the person (e.g., providing more autonomy, vacation days, training on new technology). In short, climate survey findings can guide consultants about the emphasis for organizational interventions: before a problem arises aka stress prevention, e.g., carefully crafting job roles), when a problem is present, but steps are taken to mitigate their consequences (aka coping, e.g., providing social support groups), and/or once strains develop (aka. stress management, e.g., healthcare management policies).

For each of the primary (prevention), secondary (coping), and tertiary (stress management) techniques the target for intervention can be the entire workforce, a subset of the workforce, or a specific person. Interventions that target the entire workforce may be considered organizational interventions, as they have direct implications on the health of all individuals and consequently the health of the organization. Several interventions categorized as primary and secondary interventions may also be implemented after strains have developed and after it has been discerned that a person or the organization did not do enough to mitigate stressors or strains (see Figure 1 ). The designation of many of the interventions as belonging to one category or another may be viewed as merely a suggestion.

Primary Interventions (Preventative Stress Management)

Before individuals begin to perceive work-related stressors, organizations engage in stress prevention strategies, such as providing people with resources (e.g., computers, printers, desk space, information about the job role, organizational reporting structures) to do their jobs. However, sometimes the institutional structures and resources are insufficient or ambiguous. Scholars and practitioners have identified several preventative stress management strategies that may be implemented.

Planning and Time Management

When employees feel quantitatively overloaded, sometimes the remedy is improving the employees’ abilities to plan and manage their time (Quick, Quick, Nelson, & Hurrell, 2003 ). Planning is a future-oriented activity that focuses on conceptual and comprehensive work goals. Time management is a behavior that focuses on organizing, prioritizing, and scheduling work activities to achieve short-term goals. Given the purpose of time management, it is considered a primary intervention, as engaging in time management helps to prevent work tasks from mounting and becoming unmanageable, which would subsequently lead to adverse outcomes. Time management comprises three fundamental components: (1) establishing goals, (2) identifying and prioritizing tasks to fulfill the goals, and (3) scheduling and monitoring progress toward goal achievement (Peeters & Rutte, 2005 ). Workers who employ time management have less role ambiguity (Macan, Shahani, Dipboye, & Philips, 1990 ), psychological stress or strain (Adams & Jex, 1999 ; Jex & Elaqua, 1999 ; Macan et al., 1990 ), and greater job satisfaction (Macan, 1994 ). However, Macan ( 1994 ) did not find a relationship between time management and performance. Still, Claessens, van Eerde, Rutte, and Roe ( 2004 ) found that perceived control of time partially mediated the relationships between planning behavior (an indicator of time management), job autonomy, and workload on one hand, and job strains, job satisfaction, and job performance on the other hand. Moreover, Peeters and Rutte ( 2005 ) observed that teachers with high work demands and low autonomy experienced more burnout when they had poor time management skills.

Person-Organization Fit

Just as it is important for organizations to find the right person for the job and organization, so is it the responsibility of a person to choose to work at the right organization—an organization that fulfills the person’s needs and upholds the values important to the individual, as much as the person fulfills the organization’s needs and adapts to its values. When people fit their employing organizations they are setting themselves up for experiencing less strain-producing stressors (Kristof-Brown et al., 2005 ). In a meta-analysis of 62 person-job fit studies and 110 person-organization fit studies, Kristof-Brown et al. ( 2005 ) found that person-job fit had a negative correlation with indicators of job strain. In fact, a primary intervention of career counseling can help to reduce stress levels (Firth-Cozens, 2003 ).

Job Redesign

The Job Demands-Control/Support (JD-C/S), Job Demands-Resources (JD-R), and transactional models all suggest that factors in the work context require modifications in order to reduce potential ill-health and poor organizational performance. Drawing on Hackman and Oldham’s ( 1980 ) Job Characteristics Model, it is possible to assess with the Job Diagnostics Survey (JDS) the current state of work characteristics related to skill variety, task identity, task significance, autonomy, and feedback. Modifying those aspects would help create a sense of meaningfulness, sense of responsibility, and feeling of knowing how one is performing, which subsequently affects a person’s well-being as identified in assessments of motivation, satisfaction, improved performance, and reduced withdrawal intentions and behaviors. Extending this argument to the stress models, it can be deduced that reducing uncertainty or perceived unfairness that may be associated with a person’s perception of these work characteristics, as well as making changes to physical characteristics of the environment (e.g., lighting, seating, desk, air quality), nature of work (e.g., job responsibilities, roles, decision-making latitude), and organizational arrangements (e.g., reporting structure and feedback mechanisms), can help mitigate against numerous ill-health consequences and reduced organizational performance. In fact, Fried et al. ( 2013 ) showed that healthy patients of a medical clinic whose jobs were excessively low (i.e., monotonous) or excessively high (i.e., overstimulating) on job enrichment (as measured by the JDS) had greater abdominal obesity than those whose jobs were optimally enriched. By taking stock of employees’ perceptions of the current work situation, managers might think about ways to enhance employees’ coping toolkit, such as training on how to deal with difficult clients or creating stimulating opportunities when jobs have low levels of enrichment.

Participatory Action Research Interventions

Participatory action research (PAR) is an intervention wherein, through group discussions, employees help to identify and define problems in organizational structure, processes, policies, practices, and reward structures, as well as help to design, implement, and evaluate success of solutions. PAR is in itself an intervention, but its goal is to design interventions to eliminate or reduce work-related factors that are impeding performance and causing people to be unwell. An example of a successful primary intervention, utilizing principles of PAR and driven by the JD-C and JD-C/S stress frameworks is Health Circles (HCs; Aust & Ducki, 2004 ).

HCs, developed in Germany in the 1980s, were popular practices in industries, such as metal, steel, and chemical, and service. Similar to other problem-solving practices, such as quality circles, HCs were based on the assumptions that employees are the experts of their jobs. For this reason, to promote employee well-being, management and administrators solicited suggestions and ideas from the employees to improve occupational health, thereby increasing employees’ job control. HCs also promoted communication between managers and employees, which had a potential to increase social support. With more control and support, employees would experience less strains and better occupational well-being.

Employing the three-steps of (1) problem analysis (i.e., diagnosis or discovery through data generated from organizational records of absenteeism length, frequency, rate, and reason and employee survey), (2) HC meetings (6 to 10 meetings held over several months to brainstorm ideas to improve occupational safety and health concerns identified in the discovery phase), and (3) HC evaluation (to determine if desired changes were accomplished and if employees’ reports of stressors and strains changed after the course of 15 months), improvements were to be expected (Aust & Ducki, 2004 ). Aust and Ducki ( 2004 ) reviewed 11 studies presenting 81 health circles in 30 different organizations. Overall study participants had high satisfaction with the HCs practices. Most companies acted upon employees’ suggestions (e.g., improving driver’s seat and cab, reducing ticket sale during drive, team restructuring and job rotation to facilitate communication, hiring more employees during summer time, and supervisor training program to improve leadership and communication skills) to improve work conditions. Thus, HCs represent a successful theory-grounded intervention to routinely improve employees’ occupational health.

Physical Setting

The physical environment or physical workspace has an enormous impact on individuals’ well-being, attitudes, and interactions with others, as well as on the implications on innovation and well-being (Oksanen & Ståhle, 2013 ; Vischer, 2007 ). In a study of 74 new product development teams (total of 437 study respondents) in Western Europe, Chong, van Eerde, Rutte, and Chai ( 2012 ) found that when teams were faced with challenge time pressures, meaning the teams had a strong interest and desire in tackling complex, but engaging tasks, when they were working proximally close with one another, team communication improved. Chong et al. assert that their finding aligns with prior studies that have shown that physical proximity promotes increased awareness of other team members, greater tendency to initiate conversations, and greater team identification. However, they also found that when faced with hindrance time pressures, physical proximity related to low levels of team communication, but when hindrance time pressure was low, team proximity had an increasingly greater positive relationship with team communication.

In addition to considering the type of work demand teams must address, other physical workspace considerations include whether people need to work collaboratively and synchronously or independently and remotely (or a combination thereof). Consideration needs to be given to how company contributors would satisfy client needs through various modes of communication, such as email vs. telephone, and whether individuals who work by a window might need shading to block bright sunlight from glaring on their computer screens. Finally, people who have to use the telephone for extensive periods of time would benefit from earphones to prevent neck strains. Most physical stressors are rather simple to rectify. However, companies are often not aware of a problem until after a problem arises, such as when a person’s back is strained from trying to move heavy equipment. Companies then implement strategies to remediate the environmental stressor. With the help of human factors, and organizational and office design consultants, many of the physical barriers to optimal performance can be prevented (Rousseau & Aubé, 2010 ). In a study of 215 French-speaking Canadian healthcare employees, Rousseau and Aubé ( 2010 ) found that although supervisor instrumental support positively related with affective commitment to the organization, the relationship was even stronger for those who reported satisfaction with the ambient environment (i.e., temperature, lighting, sound, ventilation, and cleanliness).

Secondary Interventions (Coping)

Secondary interventions, also referred to as coping, focus on resources people can use to mitigate the risk of work-related illness or workplace injury. Resources may include properties related to social resources, behaviors, and cognitive structures. Each of these resource domains may be employed to cope with stressors. Monat and Lazarus ( 1991 ) summarize the definition of coping as “an individual’s efforts to master demands (or conditions of harm, threat, or challenge) that are appraised (or perceived) as exceeding or taxing his or her resources” (p. 5). To master demands requires use of the aforementioned resources. Secondary interventions help employees become aware of the psychological, physical, and behavioral responses that may occur from the stressors presented in their working environment. Secondary interventions help a person detect and attend to stressors and identify resources for and ways of mitigating job strains. Often, coping strategies are learned skills that have a cognitive foundation and serve important functions in improving people’s management of stressors (Lazarus & Folkman, 1991 ). Coping is effortful, but with practice it becomes easier to employ. This idea is the foundation for understanding the role of resilience in coping with stressors. However, “not all adaptive processes are coping. Coping is a subset of adaptational activities that involves effort and does not include everything that we do in relating to the environment” (Lazarus & Folkman, 1991 , p. 198). Furthermore, sometimes to cope with a stressor, a person may call upon social support sources to help with tangible materials or emotional comfort. People call upon support resources because they help to restructure how a person approaches or thinks about the stressor.

Most secondary interventions are aimed at helping the individual, though companies, as a policy, might require all employees to partake in training aimed at increasing employees’ awareness of and skills aimed at handling difficult situations vis à vis company channels (e.g., reporting on sexual harassment or discrimination). Furthermore, organizations might institute mentoring programs or work groups to address various work-related matters. These programs employ awareness-raising activities, stress-education, or skills training (cf., Bhagat, Segovis, & Nelson, 2012 ), which include development of skills in problem-solving, understanding emotion-focused coping, identifying and using social support, and enhancing capacity for resilience. The aim of these programs, therefore, is to help employees proactively review their perceptions of psychological, physical, and behavioral job-related strains, thereby extending their resilience, enabling them to form a personal plan to control stressors and practice coping skills (Cooper, Dewe, & O’Driscoll, 2011 ).

Often these stress management programs are instituted after an organization has observed excessive absenteeism and work-related performance problems and, therefore, are sometimes categorized as a tertiary stress management intervention or even a primary (prevention) intervention. However, the skills developed for coping with stressors also place the programs in secondary stress management interventions. Example programs that are categorized as tertiary or primary stress management interventions may also be secondary stress management interventions (see Figure 1 ), and these include lifestyle advice and planning, stress inoculation training, simple relaxation techniques, meditation, basic trainings in time management, anger management, problem-solving skills, and cognitive-behavioral therapy. Corporate wellness programs also fall under this category. In other words, some programs could be categorized as primary, secondary, or tertiary interventions depending upon when the employee (or organization) identifies the need to implement the program. For example, time management practices could be implemented as a means of preventing some stressors, as a way to cope with mounting stressors, or as a strategy to mitigate symptoms of excessive of stressors. Furthermore, these programs can be administered at the individual level or group level. As related to secondary interventions, these programs provide participants with opportunities to develop and practice skills to cognitively reappraise the stressor(s); to modify their perspectives about stressors; to take time out to breathe, stretch, meditate, relax, and/or exercise in an attempt to support better decision-making; to articulate concerns and call upon support resources; and to know how to say “no” to onslaughts of requests to complete tasks. Participants also learn how to proactively identify coping resources and solve problems.

According to Cooper, Dewe, and O’Driscoll ( 2001 ), secondary interventions are successful in helping employees modify or strengthen their ability to cope with the experience of stressors with the goal of mitigating the potential harm the job stressors may create. Secondary interventions focus on individuals’ transactions with the work environment and emphasize the fit between a person and his or her environment. However, researchers have pointed out that the underlying assumption of secondary interventions is that the responsibility for coping with the stressors of the environment lies within individuals (Quillian-Wolever & Wolever, 2003 ). If companies cannot prevent the stressors in the first place, then they are, in part, responsible for helping individuals develop coping strategies and informing employees about programs that would help them better cope with job stressors so that they are able to fulfill work assignments.

Stress management interventions that help people learn to cope with stressors focus mainly on the goals of enabling problem-resolution or expressing one’s emotions in a healthy manner. These goals are referred to as problem-focused coping and emotion-focused coping (Folkman & Lazarus, 1980 ; Pearlin & Schooler, 1978 ), and the person experiencing the stressors as potential threat is the agent for change and the recipient of the benefits of successful coping (Hobfoll, 1998 ). In addition to problem-focused and emotion-focused coping approaches, social support and resilience may be coping resources. There are many other sources for coping than there is room to present here (see e.g., Cartwright & Cooper, 2005 ); however, the current literature has primarily focused on these resources.

Problem-Focused Coping

Problem-focused or direct coping helps employees remove or reduce stressors in order to reduce their strain experiences (Bhagat et al., 2012 ). In problem-focused coping employees are responsible for working out a strategic plan in order to remove job stressors, such as setting up a set of goals and engaging in behaviors to meet these goals. Problem-focused coping is viewed as an adaptive response, though it can also be maladaptive if it creates more problems down the road, such as procrastinating getting work done or feigning illness to take time off from work. Adaptive problem-focused coping negatively relates to long-term job strains (Higgins & Endler, 1995 ). Discussion on problem-solving coping is framed from an adaptive perspective.

Problem-focused coping is featured as an extension of control, because engaging in problem-focused coping strategies requires a series of acts to keep job stressors under control (Bhagat et al., 2012 ). In the stress literature, there are generally two ways to categorize control: internal versus external locus of control, and primary versus secondary control. Locus of control refers to the extent to which people believe they have control over their own life (Rotter, 1966 ). People high in internal locus of control believe that they can control their own fate whereas people high in external locus of control believe that outside factors determine their life experience (Rotter, 1966 ). Generally, those with an external locus of control are less inclined to engage in problem-focused coping (Strentz & Auerbach, 1988 ). Primary control is the belief that people can directly influence their environment (Alloy & Abramson, 1979 ), and thus they are more likely to engage in problem-focused coping. However, when it is not feasible to exercise primary control, people search for secondary control, with which people try to adapt themselves into the objective environment (Rothbaum, Weisz, & Snyder, 1982 ).

Emotion-Focused Coping

Emotion-focused coping, sometimes referred to as palliative coping, helps employees reduce strains without the removal of job stressors. It involves cognitive or emotional efforts, such as talking about the stressor or distracting oneself from the stressor, in order to lessen emotional distress resulting from job stressors (Bhagat et al., 2012 ). Emotion-focused coping aims to reappraise and modify the perceptions of a situation or seek emotional support from friends or family. These methods do not include efforts to change the work situation or to remove the job stressors (Lazarus & Folkman, 1991 ). People tend to adopt emotion-focused coping strategies when they believe that little or nothing can be done to remove the threatening, harmful, and challenging stressors (Bhagat et al., 2012 ), such as when they are the only individuals to have the skills to get a project done or they are given increased responsibilities because of the unexpected departure of a colleague. Emotion-focused coping strategies include (1) reappraisal of the stressful situation, (2) talking to friends and receiving reassurance from them, (3) focusing on one’s strength rather than weakness, (4) optimistic comparison—comparing one’s situation to others’ or one’s past situation, (5) selective ignoring—paying less attention to the unpleasant aspects of one’s job and being more focused on the positive aspects of the job, (6) restrictive expectations—restricting one’s expectations on job satisfaction but paying more attention to monetary rewards, (7) avoidance coping—not thinking about the problem, leaving the situation, distracting oneself, or using alcohol or drugs (e.g., Billings & Moos, 1981 ).

Some emotion-focused coping strategies are maladaptive. For example, avoidance coping may lead to increased level of job strains in the long run (e.g., Parasuraman & Cleek, 1984 ). Furthermore, a person’s ability to cope with the imbalance of performing work to meet organizational expectations can take a toll on the person’s health, leading to physiological consequences such as cardiovascular disease, sleep disorders, gastrointestinal disorders, and diabetes (Fried et al., 2013 ; Siegrist, 2010 ; Toker, Shirom, Melamed, & Armon, 2012 ; Willert, Thulstrup, Hertz, & Bonde, 2010 ).

Comparing Coping Strategies across Cultures

Most coping research is conducted in individualistic, Western cultures wherein emotional control is emphasized and both problem-solving focused coping and primary control are preferred (Bhagat et al., 2010 ). However, in collectivistic cultures, emotion-focused coping and use of secondary control may be preferred and may not necessarily carry a negative evaluation (Bhagat et al., 2010 ). For example, African Americans are more likely to use emotion-focused coping than non–African Americans (Knight, Silverstein, McCallum, & Fox, 2000 ), and among women who experienced sexual harassment, Anglo American women were less likely to employ emotion focused coping (i.e., avoidance coping) than Turkish women and Hispanic American women, while Hispanic women used more denial than the other two groups (Wasti & Cortina, 2002 ).

Thus, whereas problem-focused coping is venerated in Western societies, emotion-focused coping may be more effective in reducing strains in collectivistic cultures, such as China, Japan, and India (Bhagat et al., 2010 ; Narayanan, Menon, & Spector, 1999 ; Selmer, 2002 ). Indeed, Swedish participants reported more problem-focused coping than did Chinese participants (Xiao, Ottosson, & Carlsson, 2013 ), American college students engaged in more problem-focused coping behaviors than did their Japanese counterparts (Ogawa, 2009 ), and Indian (vs. Canadian) students reported more emotion-focused coping, such as seeking social support and positive reappraisal (Sinha, Willson, & Watson, 2000 ). Moreover, Glazer, Stetz, and Izso ( 2004 ) found that internal locus of control was more predominant in individualistic cultures (United Kingdom and United States), whereas external locus of control was more predominant in communal cultures (Italy and Hungary). Also, internal locus of control was associated with less job stress, but more so for nurses in the United Kingdom and United States than Italy and Hungary. Taken together, adoption of coping strategies and their effectiveness differ significantly across cultures. The extent to which a coping strategy is perceived favorably and thus selected or not selected is not only a function of culture, but also a person’s sociocultural beliefs toward the coping strategy (Morimoto, Shimada, & Ozaki, 2013 ).

Social Support

Social support refers to the aid an entity gives to a person. The source of the support can be a single person, such as a supervisor, coworker, subordinate, family member, friend, or stranger, or an organization as represented by upper-level management representing organizational practices. The type of support can be instrumental or emotional. Instrumental support, including informational support, refers to that which is tangible, such as data to help someone make a decision or colleagues’ sick days so one does not lose vital pay while recovering from illness. Emotional support, including esteem support, refers to the psychological boost given to a person who needs to express emotions and feel empathy from others or to have his or her perspective validated. Beehr and Glazer ( 2001 ) present an overview of the role of social support on the stressor-strain relationship and arguments regarding the role of culture in shaping the utility of different sources and types of support.

Meaningfulness and Resilience

Meaningfulness reflects the extent to which people believe their lives are significant, purposeful, goal-directed, and fulfilling (Glazer, Kożusznik, Meyers, & Ganai, 2014 ). When faced with stressors, people who have a strong sense of meaning in life will also try to make sense of the stressors. Maintaining a positive outlook on life stressors helps to manage emotions, which is helpful in reducing strains, particularly when some stressors cannot be problem-solved (Lazarus & Folkman, 1991 ). Lazarus and Folkman ( 1991 ) emphasize that being able to reframe threatening situations can be just as important in an adaptation as efforts to control the stressors. Having a sense of meaningfulness motivates people to behave in ways that help them overcome stressors. Thus, meaningfulness is often used in the same breath as resilience, because people who are resilient are often protecting that which is meaningful.

Resilience is a personality state that can be fortified and enhanced through varied experiences. People who perceive their lives are meaningful are more likely to find ways to face adversity and are therefore more prone to intensifying their resiliency. When people demonstrate resilience to cope with noxious stressors, their ability to be resilient against other stressors strengthens because through the experience, they develop more competencies (Glazer et al., 2014 ). Thus, fitting with Hobfoll’s ( 1989 , 2001 ) COR theory, meaningfulness and resilience are psychological resources people attempt to conserve and protect, and employ when necessary for making sense of or coping with stressors.

Tertiary Interventions (Stress Management)

Stress management refers to interventions employed to treat and repair harmful repercussions of stressors that were not coped with sufficiently. As Lazarus and Folkman ( 1991 ) noted, not all stressors “are amenable to mastery” (p. 205). Stressors that are unmanageable and lead to strains require interventions to reverse or slow down those effects. Workplace interventions might focus on the person, the organization, or both. Unfortunately, instead of looking at the whole system to include the person and the workplace, most companies focus on the person. Such a focus should not be a surprise given the results of van der Klink, Blonk, Schene, and van Dijk’s ( 2001 ) meta-analysis of 48 experimental studies conducted between 1977 and 1996 . They found that of four types of tertiary interventions, the effect size for cognitive-behavioral interventions and multimodal programs (e.g., the combination of assertive training and time management) was moderate and the effect size for relaxation techniques was small in reducing psychological complaints, but not turnover intention related to work stress. However, the effects of (the five studies that used) organization-focused interventions were not significant. Similarly, Richardson and Rothstein’s ( 2008 ) meta-analytic study, including 36 experimental studies with 55 interventions, showed a larger effect size for cognitive-behavioral interventions than relaxation, organizational, multimodal, or alternative. However, like with van der Klink et al. ( 2001 ), Richardson and Rothstein ( 2008 ) cautioned that there were few organizational intervention studies included and the impact of interventions were determined on the basis of psychological outcomes and not physiological or organizational outcomes. Van der Klink et al. ( 2001 ) further expressed concern that organizational interventions target the workplace and that changes in the individual may take longer to observe than individual interventions aimed directly at the individual.

The long-term benefits of individual focused interventions are not yet clear either. Per Giga, Cooper, and Faragher ( 2003 ), the benefits of person-directed stress management programs will be short-lived if organizational factors to reduce stressors are not addressed too. Indeed, LaMontagne, Keegel, Louie, Ostry, and Landsbergis ( 2007 ), in their meta-analysis of 90 studies on stress management interventions published between 1990 and 2005 , revealed that in relation to interventions targeting organizations only, and interventions targeting individuals only, interventions targeting both organizations and individuals (i.e. the systems approach) had the most favorable positive effects on both the organizations and the individuals. Furthermore, the organization-level interventions were effective at both the individual and organization levels, but the individual-level interventions were effective only at the individual level.

Individual-Focused Stress Management

Individual-focused interventions concentrate on improving conditions for the individual, though counseling programs emphasize that the worker is in charge of reducing “stress,” whereas role-focused interventions emphasize activities that organizations can guide to actually reduce unnecessary noxious environmental factors.

Individual-Focused Stress Management: Employee Assistance Programs

When stress become sufficiently problematic (which is individually gauged or attended to by supportive others) in a worker’s life, employees may utilize the short-term counseling services or referral services Employee Assistance Programs (EAPs) provide. People who utilize the counseling services may engage in cognitive behavioral therapy aimed at changing the way people think about the stressors (e.g., as challenge opportunity over threat) and manage strains. Example topics that may be covered in these therapy sessions include time management and goal setting (prioritization), career planning and development, cognitive restructuring and mindfulness, relaxation, and anger management. In a study of healthcare workers and teachers who participated in a 2-day to 2.5-day comprehensive stress management training program (including 26 topics on identifying, coping with, and managing stressors and strains), Siu, Cooper, and Phillips ( 2013 ) found psychological and physical improvements were self-reported among the healthcare workers (for which there was no control group). However, comparing an intervention group of teachers to a control group of teachers, the extent of change was not as visible, though teachers in the intervention group engaged in more mastery recovery experiences (i.e., they purposefully chose to engage in challenging activities after work).

Individual-Focused Stress Management: Mindfulness

A popular therapy today is to train people to be more mindful, which involves helping people live in the present, reduce negative judgement of current and past experiences, and practicing patience (Birnie, Speca, & Carlson, 2010 ). Mindfulness programs usually include training on relaxation exercises, gentle yoga, and awareness of the body’s senses. In one study offered through the continuing education program at a Canadian university, 104 study participants took part in an 8-week, 90 minute per group (15–20 participants per) session mindfulness program (Birnie et al., 2010 ). In addition to body scanning, they also listened to lectures on incorporating mindfulness into one’s daily life and received a take-home booklet and compact discs that guided participants through the exercises studied in person. Two weeks after completing the program, participants’ mindfulness attendance and general positive moods increased, while physical, psychological, and behavioral strains decreased. In another study on a sample of U.K. government employees, study participants receiving three sessions of 2.5 to 3 hours each training on mindfulness, with the first two sessions occurring in consecutive weeks and the third occurring about three months later, Flaxman and Bond ( 2010 ) found that compared to the control group, the intervention group showed a decrease in distress levels from Time 1 (baseline) to Time 2 (three months after first two training sessions) and Time 1 to Time 3 (after final training session). Moreover, of the mindfulness intervention study participants who were clinically distressed, 69% experienced clinical improvement in their psychological health.

Individual-Focused Stress Management: Biofeedback/Imagery/Meditation/Deep Breathing

Biofeedback uses electronic equipment to inform users about how their body is responding to tension. With guidance from a therapist, individuals then learn to change their physiological responses so that their pulse normalizes and muscles relax (Norris, Fahrion, & Oikawa, 2007 ). The therapist’s guidance might include reminders for imagery, meditation, body scan relaxation, and deep breathing. Saunders, Driskell, Johnston, and Salas’s ( 1996 ) meta-analysis of 37 studies found that imagery helped reduce state and performance anxiety. Once people have been trained to relax, reminder triggers may be sent through smartphone push notifications (Villani et al., 2013 ).

Smartphone technology can also be used to support weight loss programs, smoking cessation programs, and medication or disease (e.g., diabetes) management compliance (Heron & Smyth, 2010 ; Kannampallil, Waicekauskas, Morrow, Kopren, & Fu, 2013 ). For example, smartphones could remind a person to take medications or test blood sugar levels or send messages about healthy behaviors and positive affirmations.

Individual-Focused Stress Management: Sleep/Rest/Respite

Workers today sleep less per night than adults did nearly 30 years ago (Luckhaupt, Tak, & Calvert, 2010 ; National Sleep Foundation, 2005 , 2013 ). In order to combat problems, such as increased anxiety and cardiovascular artery disease, associated with sleep deprivation and insufficient rest, it is imperative that people disconnect from their work at least one day per week or preferably for several weeks so that they are able to restore psychological health (Etzion, Eden, & Lapidot, 1998 ; Ragsdale, Beehr, Grebner, & Han, 2011 ). When college students engaged in relaxation-type activities, such as reading or watching television, over the weekend, they experienced less emotional exhaustion and greater general well-being than students who engaged in resources-consuming activities, such as house cleaning (Ragsdale et al., 2011 ). Additional research and future directions for research are reviewed and identified in the work of Sonnentag ( 2012 ). For example, she asks whether lack of ability to detach from work is problematic for people who find their work meaningful. In other words, are negative health consequences only among those who do not take pleasure in their work? Sonnetag also asks how teleworkers detach from their work when engaging in work from the home. Ironically, one of the ways that companies are trying to help with the challenges of high workload or increased need to be available to colleagues, clients, or vendors around the globe is by offering flexible work arrangements, whereby employees who can work from home are given the opportunity to do so. Companies that require global interactions 24-hours per day often employ this strategy, but is the solution also a source of strain (Glazer, Kożusznik, & Shargo, 2012 )?

Individual-Focused Stress Management: Role Analysis

Role analysis or role clarification aims to redefine, expressly identify, and align employees’ roles and responsibilities with their work goals. Through role negotiation, involved parties begin to develop a new formal or informal contract about expectations and define resources needed to fulfill those expectations. Glazer has used this approach in organizational consulting and, with one memorable client engagement, found that not only were the individuals whose roles required deeper re-evaluation happier at work (six months later), but so were their subordinates. Subordinates who once characterized the two partners as hostile and akin to a couple going through a bad divorce, later referred to them as a blissful pair. Schaubroeck, Ganster, Sime, and Ditman ( 1993 ) also found in a three-wave study over a two-year period that university employees’ reports of role clarity and greater satisfaction with their supervisor increased after a role clarification exercise of top managers’ roles and subordinates’ roles. However, the intervention did not have any impact on reported physical symptoms, absenteeism, or psychological well-being. Role analysis is categorized under individual-focused stress management intervention because it is usually implemented after individuals or teams begin to demonstrate poor performance and because the intervention typically focuses on a few individuals rather than an entire organization or group. In other words, the intervention treats the person’s symptoms by redefining the role so as to eliminate the stimulant causing the problem.

Organization-Focused Stress Management

At the organizational level, companies that face major declines in productivity and profitability or increased costs related to healthcare and disability might be motivated to reassess organizational factors that might be impinging on employees’ health and well-being. After all, without healthy workers, it is not possible to have a healthy organization. Companies may choose to implement practices and policies that are expected to help not only the employees, but also the organization with reduced costs associated with employee ill-health, such as medical insurance, disability payments, and unused office space. Example practices and policies that may be implemented include flexible work arrangements to ensure that employees are not on the streets in the middle of the night for work that can be done from anywhere (such as the home), diversity programs to reduce stress-induced animosity and prejudice toward others, providing only healthy food choices in cafeterias, mandating that all employees have physicals in order to receive reduced prices for insurance, company-wide closures or mandatory paid time off, and changes in organizational visioning.

Organization-Focused Stress Management: Organizational-Level Occupational Health Interventions

As with job design interventions that are implemented to remediate work characteristics that were a source of unnecessary or excessive stressors, so are organizational-level occupational health (OLOH) interventions. As with many of the interventions, its placement as a primary or tertiary stress management intervention may seem arbitrary, but when considering the goal and target of change, it is clear that the intervention is implemented in response to some ailing organizational issues that need to be reversed or stopped, and because it brings in the entire organization’s workforce to address the problems, it has been placed in this category. There are several more case studies than empirical studies on the topic of whole system organizational change efforts (see example case studies presented by the United Kingdom’s Health and Safety Executive). It is possible that lack of published empirical work is not so much due to lack of attempting to gather and evaluate the data for publication, but rather because the OLOH interventions themselves never made it to the intervention stage, the interventions failed (Biron, Gatrell, & Cooper, 2010 ), or the level of evaluation was not rigorous enough to get into empirical peer-review journals. Fortunately, case studies provide some indication of the opportunities and problems associated with OLOH interventions.

One case study regarding Cardiff and Value University Health Board revealed that through focus group meetings with members of a steering group (including high-level managers and supported by top management) and facilitated by a neutral, non-judgemental organizational health consultant, ideas for change were posted on newsprint, discussed, and areas in the organization needing change were identified. The intervention for giving voice to people who initially had little already had a positive effect on the organization, as absence decreased by 2.09% and 6.9% merely 12 and 18 months, respectively, after the intervention. Translated in financial terms, the 6.9% change was equivalent to a quarterly savings of £80,000 (Health & Safety Executive, n.d. ). Thus, focusing on the context of change and how people will be involved in the change process probably helped the organization realize improvements (Biron et al., 2010 ). In a recent and rare empirical study, employing both qualitative and quantitative data collection methods, Sørensen and Holman ( 2014 ) utilized PAR in order to plan and implement an OLOH intervention over the course of 14 months. Their study aimed to examine the effectiveness of the PAR process in reducing workers’ work-related and social or interpersonal-related stressors that derive from the workplace and improving psychological, behavioral, and physiological well-being across six Danish organizations. Based on group dialogue, 30 proposals for change were proposed, all of which could be categorized as either interventions to focus on relational factors (e.g., management feedback improvement, engagement) or work processes (e.g., reduced interruptions, workload, reinforcing creativity). Of the interventions that were implemented, results showed improvements on manager relationship quality and reduced burnout, but no changes with respect to work processes (i.e., workload and work pace) perhaps because the employees already had sufficient task control and variety. These findings support Dewe and Kompier’s ( 2008 ) position that occupational health can be reinforced through organizational policies that reinforce quality jobs and work experiences.

Organization-Focused Stress Management: Flexible Work Arrangements

Dewe and Kompier ( 2008 ), citing the work of Isles ( 2005 ), noted that concern over losing one’s job is a reason for why 40% of survey respondents indicated they work more hours than formally required. In an attempt to create balance and perceived fairness in one’s compensation for putting in extra work hours, employees will sometimes be legitimately or illegitimately absent. As companies become increasingly global, many people with desk jobs are finding themselves communicating with colleagues who are halfway around the globe and at all hours of the day or night (Glazer et al., 2012 ). To help minimize the strains associated with these stressors, companies might devise flexible work arrangements (FWA), though the type of FWA needs to be tailored to the cultural environment (Masuda et al., 2012 ). FWAs give employees some leverage to decide what would be the optimal work arrangement for them (e.g., part-time, flexible work hours, compressed work week, telecommuting). In other words, FWA provides employees with the choice of when to work, where to work (on-site or off-site), and how many hours to work in a day, week, or pay period (Kossek, Thompson, & Lautsch, 2015 ). However, not all employees of an organization have equal access to or equitable use of FWAs; workers in low-wage, hourly jobs are often beholden to being physically present during specific hours (Swanberg McKechnie, Ojha, & James, 2011 ). In a study of over 1,300 full-time hourly retail employees in the United States, Swanberg et al. ( 2011 ) showed that employees who have control over their work schedules and over their work hours were satisfied with their work schedules, perceived support from the supervisor, and work engagement.

Unfortunately, not all FWAs yield successful results for the individual or the organization. Being able to work from home or part-time can have problems too, as a person finds himself or herself working more hours from home than required. Sometimes telecommuting creates work-family conflict too as a person struggles to balance work and family obligations while working from home. Other drawbacks include reduced face-to-face contact between work colleagues and stakeholders, challenges shaping one’s career growth due to limited contact, perceived inequity if some have more flexibility than others, and ambiguity about work role processes for interacting with employees utilizing the FWA (Kossek et al., 2015 ). Organizations that institute FWAs must carefully weigh the benefits and drawbacks the flexibility may have on the employees using it or the employees affected by others using it, as well as the implications on the organization, including the vendors who are serving and clients served by the organization.

Organization-Focused Stress Management: Diversity Programs

Employees in the workplace might experience strain due to feelings of discrimination or prejudice. Organizational climates that do not promote diversity (in terms of age, religion, physical abilities, ethnicity, nationality, sex, and other characteristics) are breeding grounds for undesirable attitudes toward the workplace, lower performance, and greater turnover intention (Bergman, Palmieri, Drasgow, & Ormerod, 2012 ; Velez, Moradi, & Brewster, 2013 ). Management is thus advised to implement programs that reinforce the value and importance of diversity, as well as manage diversity to reduce conflict and feelings of prejudice. In fact, managers who attended a leadership training program reported higher multicultural competence in dealing with stressful situations (Chrobot-Mason & Leslie, 2012 ), and managers who persevered through challenges were more dedicated to coping with difficult diversity issues (Cilliers, 2011 ). Thus, diversity programs can help to reduce strains by directly reducing stressors associated with conflict linked to diversity in the workplace and by building managers’ resilience.

Organization-Focused Stress Management: Healthcare Management Policies

Over the past few years, organizations have adopted insurance plans that implement wellness programs for the sake of managing the increasing cost of healthcare that is believed to be a result of individuals’ not managing their own health, with regular check-ups and treatment. The wellness programs require all insured employees to visit a primary care provider, complete a health risk assessment, and engage in disease management activities as specified by a physician (e.g., see frequently asked questions regarding the State of Maryland’s Wellness Program). Companies believe that requiring compliance will reduce health problems, although there is no proof that such programs save money or that people would comply. One study that does, however, boast success, was a 12-week workplace health promotion program aimed at reducing Houston airport workers’ weight (Ebunlomo, Hare-Everline, Weber, & Rich, 2015 ). The program, which included 235 volunteer participants, was deemed a success, as there was a total weight loss of 345 pounds (or 1.5 lbs per person). Given such results in Houston, it is clear why some people are also skeptical over the likely success of wellness programs, particularly as there is no clear method for evaluating their efficacy (Sinnott & Vatz, 2015 ).

Moreover, for some, such a program is too paternalistic and intrusive, as well as punishes anyone who chooses not to actively participate in disease management programs (Sinnott & Vatz, 2015 ). The programs put the onus of change on the person, though it is a response to the high costs of ill-health. The programs neglect to consider the role of the organization in reducing the barriers to healthy lifestyle, such as cloaking exempt employment as simply needing to get the work done, when it usually means working significantly more hours than a standard workweek. In fact, workplace health promotion programs did not reduce presenteeism (i.e., people going to work while unwell thereby reducing their job performance) among those who suffered from physical pain (Cancelliere, Cassidy, Ammendolia, & Côte, 2011 ). However, supervisor education, worksite exercise, lifestyle intervention through email, midday respite from repetitive work, a global stress management program, changes in lighting, and telephone interventions helped to reduce presenteeism. Thus, emphasis needs to be placed on psychosocial aspects of the organization’s structure, including managers and overall organizational climate for on-site presence, that reinforces such behavior (Cancelliere et al., 2011 ). Moreover, wellness programs are only as good as the interventions to reduce work-related stressors and improve organizational resources to enable workers to improve their overall psychological and physical health.

Concluding Remarks

Future research.

One of the areas requiring more theoretical and practical attention is that of the utility of stress frameworks to guide organizational development change interventions. Although it has been proposed that the foundation for work stress management interventions is in organizational development, and even though scholars and practitioners of organization development were also founders of research programs that focused on employee health and well-being or work stress, there are few studies or other theoretical works that link the two bodies of literature.

A second area that requires additional attention is the efficacy of stress management interventions across cultures. In examining secondary stress management interventions (i.e., coping), some cross-cultural differences in findings were described; however, there is still a dearth of literature from different countries on the utility of different prevention, coping, and stress management strategies.

A third area that has been blossoming since the start of the 21st century is the topic of hindrance and challenge stressors and the implications of both on workers’ well-being and performance. More research is needed on this topic in several areas. First, there is little consistency by which researchers label a stressor as a hindrance or a challenge. Researchers sometimes take liberties with labels, but it is not the researchers who should label a stressor but the study participants themselves who should indicate if a stressor is a source of strain. Rodríguez, Kozusznik, and Peiró ( 2013 ) developed a measure in which respondents indicate whether a stressor is a challenge or a hindrance. Just as some people may perceive demands to be challenges that they savor and that result in a psychological state of eustress (Nelson & Simmons, 2003 ), others find them to be constraints that impede goal fulfillment and thus might experience distress. Likewise, some people might perceive ambiguity as a challenge that can be overcome and others as a constraint over which he or she has little control and few or no resources with which to cope. More research on validating the measurement of challenge vs. hindrance stressors, as well as eustress vs. distress, and savoring vs. coping, is warranted. Second, at what point are challenge stressors harmful? Just because people experiencing challenge stressors continue to perform well, it does not necessarily mean that they are healthy people. A great deal of stressors are intellectually stimulating, but excessive stimulation can also take a toll on one’s physiological well-being, as evident by the droves of professionals experiencing different kinds of diseases not experienced as much a few decades ago, such as obesity (Fried et al., 2013 ). Third, which stress management interventions would better serve to reduce hindrance stressors or to reduce strain that may result from challenge stressors while reinforcing engagement-producing challenge stressors?

A fourth area that requires additional attention is that of the flexible work arrangements (FWAs). One of the reasons companies have been willing to permit employees to work from home is not so much out of concern for the employee, but out of the company’s need for the focal person to be able to communicate with a colleague working from a geographic region when it is night or early morning for the focal person. Glazer, Kożusznik, and Shargo ( 2012 ) presented several areas for future research on this topic, noting that by participating on global virtual teams, workers face additional stressors, even while given flexibility of workplace and work time. As noted earlier, more research needs to be done on the extent to which people who take advantage of FWAs are advantaged in terms of detachment from work. Can people working from home detach? Are those who find their work invigorating also likely to experience ill-health by not detaching from work?

A fifth area worthy of further research attention is workplace wellness programing. According to Page and Vella-Brodrick ( 2009 ), “subjective and psychological well-being [are] key criteria for employee mental health” (p. 442), whereby mental health focuses on wellness, rather than the absence of illness. They assert that by fostering employee mental health, organizations are supporting performance and retention. Employee well-being can be supported by ensuring that jobs are interesting and meaningful, goals are achievable, employees have control over their work, and skills are used to support organizational and individual goals (Dewe & Kompier, 2008 ). However, just as mental health is not the absence of illness, work stress is not indicative of an absence of psychological well-being. Given the perspective that employee well-being is a state of mind (Page & Vella-Brodrick, 2009 ), we suggest that employee well-being can be negatively affected by noxious job stressors that cannot be remediated, but when job stressors are preventable, employee well-being can serve to protect an employee who faces job stressors. Thus, wellness programs ought to focus on providing positive experiences by enhancing and promoting health, as well as building individual resources. These programs are termed “green cape” interventions (Pawelski, 2016 ). For example, with the growing interests in positive psychology, researchers and practitioners have suggested employing several positive psychology interventions, such as expressing gratitude, savoring experiences, and identifying one’s strengths (Tetrick & Winslow, 2015 ). Another stream of positive psychology is psychological capital, which includes four malleable functions of self-efficacy, optimism, hope, and resilience (Luthans, Youssef, & Avolio, 2007 ). Workplace interventions should include both “red cape” interventions (i.e., interventions to reduce negative experiences) and “green cape” interventions (i.e., workplace wellness programs; Polly, 2014 ).

A Healthy Organization’s Pledge

A healthy workplace requires healthy workers. Period. Among all organizations’ missions should be the focus on a healthy workforce. To maintain a healthy workforce, the company must routinely examine its own contributions in terms of how it structures itself; reinforces communications among employees, vendors, and clients; how it rewards and cares for its people (e.g., ensuring they get sufficient rest and can detach from work); and the extent to which people at the upper levels are truly connected with the people at the lower levels. As a matter of practice, management must recognize when employees are overworked, unwell, and poorly engaged. Management must also take stock of when it is doing well and right by its contributors’ and maintain and reinforce the good practices, norms, and procedures. People in the workplace make the rules; people in the workplace can change the rules. How management sees its employees and values their contribution will have a huge role in how a company takes stock of its own pain points. Providing employees with tools to manage their own reactions to work-related stressors and consequent strains is fine, but wouldn’t it be grand if organizations took better notice about what they could do to mitigate the strain-producing stressors in the first place and take ownership over how employees are treated?

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Recent developments in stress and anxiety research

Published: 01 September 2021
Volume 128 , pages 1265–1267, ( 2021 )

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Stress and anxiety are virtually omnipresent in today´s society, pervading almost all aspects of our daily lives. While each and every one of us experiences “stress” and/or “anxiety” at least to some extent at times, the phenomena themselves are far from being completely understood. In stress research, scientists are particularly grappling with the conceptual issue of how to define stress, also with regard to delimiting stress from anxiety or negative affectivity in general. Interestingly, there is no unified theory of stress, despite many attempts at defining stress and its characteristics. Consequently, the available literature relies on a variety of different theoretical approaches, though the theories of Lazarus and Folkman ( 1984 ) or McEwen ( 1998 ) are relatively pervasive in the literature. One key issue in conceptualizing stress is that research has not always differentiated between the perception of a stimulus or a situation as a stressor and the subsequent biobehavioral response (often called the “stress response”). This is important, since, for example, psychological factors such as uncontrollability and social evaluation, i.e. factors that may influence how an individual perceives a potentially stressful stimulus or situation, have been identified as characteristics that elicit particularly powerful physiological stressful responses (Dickerson and Kemeny 2004 ). At the core of the physiological stress response is a complex physiological system, which is located in both the central nervous system (CNS) and the body´s periphery. The complexity of this system necessitates a multi-dimensional assessment approach involving variables that adequately reflect all relevant components. It is also important to consider that the experience of stress and its psychobiological correlates do not occur in a vacuum, but are being shaped by numerous contextual factors (e.g. societal and cultural context, work and leisure time, family and dyadic systems, environmental variables, physical fitness, nutritional status, etc.) and dispositional factors (e.g. genetics, personality, resilience, regulatory capacities, self-efficacy, etc.). Thus, a theoretical framework needs to incorporate these factors. In sum, as stress is considered a multi-faceted and inherently multi-dimensional construct, its conceptualization and operationalization needs to reflect this (Nater 2018 ).

The goal of the World Association for Stress Related and Anxiety Disorders (WASAD) is to promote and make available basic and clinical research on stress-related and anxiety disorders. Coinciding with WASAD’s 3rd International Congress held in September 2021 in Vienna, Austria, this journal publishes a Special Issue encompassing state-of-the art research in the field of stress and anxiety. This special issue collects answers to a number of important questions that need to be addressed in current and future research. Among the most relevant issues are (1) the multi-dimensional assessment that arises as a consequence of a multi-faceted consideration of stress and anxiety, with a particular focus on doing so under ecologically valid conditions. Skoluda et al. 2021 (in this issue) argue that hair as an important source of the stress hormone cortisol should not only be taken as a complementary stress biomarker by research staff, but that lay persons could be also trained to collect hair at the study participants’ homes, thus increasing the ecological validity of studies incorporating this important measure; (2) the incongruence between psychological and biological facets of stress and anxiety that has been observed both in laboratory and field research (Campbell and Ehlert 2012 ). Interestingly, there are behavioral constructs that do show relatively high congruence. As shown in the paper of Vatheuer et al. ( 2021 ), gaze behavior while exposed to an acute social stressor correlates with salivary cortisol, thus indicating common underlying mechanisms; (3) the complex dynamics of stress-related measures that may extend over shorter (seconds to minutes), medium (hours and diurnal/circadian fluctuations), and longer (months, seasonal) time periods. In particular, momentary assessment studies are highly qualified to examine short to medium term fluctuations and interactions. In their study employing such a design, Stoffel and colleagues (Stoffel et al. 2021 ) show ecologically valid evidence for direct attenuating effects of social interactions on psychobiological stress. Using an experimental approach, on the other hand, Denk et al. ( 2021 ) examined the phenomenon of physiological synchrony between study participants; they found both cortisol and alpha-amylase physiological synchrony in participants who were in the same group while being exposed to a stressor. Importantly, these processes also unfold over time in relation to other biological systems; al’Absi and colleagues showed in their study (al’Absi et al. 2021 ) the critical role of the endogenous opioid system and its relation to stress-related analgesia; (4) the influence of contextual and dispositional factors on the biological stress response in various target samples (e.g., humans, animals, minorities, children, employees, etc.) both under controlled laboratory conditions and in everyday life environments. In this issue, Sattler and colleagues show evidence that contextual information may only matter to a certain extent, as in their study (Sattler et al. 2021 ), the biological response to a gay-specific social stressor was equally pronounced as the one to a general social stressor in gay men. Genetic information is probably the most widely researched dispositional factor; Kuhn et al. show in their paper (Kuhn et al. 2021 ) that the low expression variant of the serotonin transporter gene serves as a risk factor for increased stress reactivity, thus clearly indicating the important role of dispositional factors in stress processing. An interesting factor combining both aspects of dispositional and contextual information is maternal care; Bentele et al. ( 2021 ) in their study are able to show that there was an effect of maternal care on the amylase stress response, while no such effect was observed for cortisol. In a similar vein, Keijser et al. ( 2021 ) showed in their gene-environment interaction study that the effects of FKBP5, a gene very closely related to HPA axis regulation, and early life stress on depressive symptoms among young adults was moderated by a positive parenting style; and (5) the role of stress and anxiety as transdiagnostic factors in mental disorders, be it as an etiological factor, a variable contributing to symptom maintenance, or as a consequence of the condition itself. Stress, e.g., as a common denominator for a broad variety of psychiatric diagnoses has been extensively discussed, and stress as an etiological factor holds specific significance in the context of transdiagnostic approaches to the conceptualization and treatment of mental disorders (Wilamowska et al. 2010 ). The HPA axis, specifically, is widely known to be dysregulated in various conditions. Fischer et al. ( 2021 ) discuss in their comprehensive review the role of this important stress system in the context of patients with post-traumatic disorder. Specifically focusing on the cortisol awakening response, Rausch and colleagues provide evidence for HPA axis dysregulation in patients diagnosed with borderline personality disorder (Rausch et al. 2021 ). As part of a longitudinal project on ADHD, Szep et al. ( 2021 ) investigated the possible impact of child and maternal ADHD symptoms on mothers’ perceived chronic stress and hair cortisol concentration; although there was no direct association, the findings underline the importance of taking stress-related assessments into consideration in ADHD studies. As the HPA axis is closely interacting with the immune system, Rhein et al. ( 2021 ) examined in their study the predicting role of the cytokine IL-6 on psychotherapy outcome in patients with PTSD, indicating that high reactivity of IL-6 to a stressor at the beginning of the therapy was associated with a negative therapy outcome. The review of Kyunghee Kim et al. ( 2021 ) also demonstrated the critical role of immune pathways in the molecular changes due to antidepressant treatment. As for the therapy, the important role of cognitive-behavioral therapy with its key elements to address both stress and anxiety reduction have been shown in two studies in this special issue, evidencing its successful application in obsessive–compulsive disorder (Ivarsson et al. 2021 ; Hollmann et al. 2021 ). Thus, both stress and anxiety are crucial transdiagnostic factors in various mental disorders, and future research needs elaborate further on their role in etiology, maintenance, and treatment.

In conclusion, a number of important questions are being asked in stress and anxiety research, as has become evident above. The Special Issue on “Recent developments in stress and anxiety research” attempts to answer at least some of the raised questions, and I want to invite you to inspect the individual papers briefly introduced above in more detail.

al’Absi M, Nakajima M, Bruehl S (2021) Stress and pain: modality-specific opioid mediation of stress-induced analgesia. J Neural Transm. https://doi.org/10.1007/s00702-021-02401-4

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Can scientists ‘solve’ stress? They’re trying.

From cardiovascular disease and obesity to a weakened immune system, the side effects of stress can be life-altering. But there may be a way to prevent those outcomes.

Three young girls eat bowls of cereal at the dining table as their mother and father stand distracted in the back of a cluttered kitchen.

As modern-day stress ratchets up to what feels like unbearable levels, researchers are striving to learn more about the precise mechanisms through which it affects our body and mind. The hope is that by unlocking more about how stress works physiologically, we can find ways to prevent it from permanently harming people.

Over the last five decades, scientists have established beyond doubt that persistent stress really can poison our overall health. In addition to increasing the risk of cardiovascular disease , stress plays a role in obesity and diabetes and can weaken the immune system , leaving us more vulnerable to infectious diseases. You can recover swiftly from an episode of acute stress—for example, the alarm one might feel when caught unprepared for a presentation. Chronic stress, on the other hand, is more toxic as it is an unrelenting circumstance that offers little chance for a return to normalcy. Financial strain, having a bully for a boss, and social isolation are all examples.

A man wearing a harness walks on a treadmill apparatus towards an old photograph of himself as a war soldier projected on the screen in front of him. A woman stands on his left for support.

Today chronic stress seems to be increasing worldwide, as people grapple with rapid socioeconomic and environmental change. A 2023 national survey by the American Psychological Association found that stress has taken a serious toll since the start of the pandemic , with the incidence of chronic illnesses and mental health problems going up significantly, especially among those ages 35 to 44.

( Do you have chronic stress? Look for these signs. )

So far, one of the major realizations among scientists is that stress harms all of us in different and powerful ways. But is there any way to avoid it—or at least recover more quickly? Some promising avenues of research offer hope for the future.

A teen girl wearing a white hijab and blue scrubs sits on an MRI table.

Preventing chronic stress from harming you in the first place

Groundbreaking studies in orphans showed how stress in early life can leave an indelible mark on the brain.

“Chronic stress in early life has more serious and lasting effects, because that’s when a lot of connections are being laid down in the brain,” says Aniko Korosi, a researcher at the University of Amsterdam who has been conducting experiments on mice to elucidate that link between early-life stress and brain development.

Korosi may have found a surprising link between stress and the resulting nutrient composition in the brain . She and her colleagues noticed that mouse pups that had been exposed to stress in the first week of their lives—having been moved from their mother’s care to a cage—had lower levels of certain fatty acids and amino acids in their brains compared with pups being raised in a stress-free environment.

She wondered if it was possible to normalize a stressed pup’s development by feeding it a diet rich in the specific nutrients its brain would be lacking. To find out, the researchers first fed a supplemented diet to the mothers so it would pass through their milk, then continued to provide it in the pups’ feed for two weeks after they were weaned. A few months later, the researchers tested the now adult mice in learning and memory. Unlike stressed mice that had never received an enriched diet, these mice did not display cognitive impairments.

( How wild animals cope with stress—from overeating to sleepless nights. )

A black mouse on a silver table looks down over the edge.

“I was surprised that changing the nutrition could have such a powerful effect, because it’s such an easy intervention,” Korosi says.

If further studies provide more evidence of the nutritional pathway, she says, there would be a strong basis for supplementing the diets of infants born to mothers living in stressful conditions.

Developing an early warning system for stress

Katie McLaughlin, a psychologist at the University of Oregon, is investigating how mental health problems arise in adolescents as they’re going through a particularly vulnerable time in their lives, transitioning to adulthood.

She and her colleagues are still collecting data , but a smaller, precursor study tracking 30 teenagers offers clues about what the researchers might learn—and how it might help them identify stress before it goes too far.

Monochromatic brain scan of a young girl highlights two sections in bright orange where emotional stimuli indicates signs of child maltreatment.

In that study, McLaughlin found that the extent of stress experienced by a subject in the month before their lab visit changed how their brain responded to emotionally impactful information such as when they were shown a picture of a threatening face. The brain’s prefrontal cortex, which helps regulate emotions, showed less activation when the subject had experienced higher levels of stress.

McLaughlin is optimistic that data from the ongoing study will help pinpoint changes in behavior as well as brain activity that predict the emergence of mental health problems like anxiety and depression. This could enable the development of targeted interventions delivered to teenagers at just the right time, she says. If the identified marker of stress were a sudden decrease in sleep duration or a sharp decline in social interactions, for example, it would be possible to push the intervention out to the individual on their smartphone.

“Like, here’s a reminder about good sleep hygiene, or this might be a good time to check in with your counselor at school about what’s been going on in your life,” McLaughlin explains.

( ‘Hysterical strength’? Fight or flight? This is how your body reacts to extreme stress. )

Learn more about stress and how to manage it

Preventing inflammation caused by chronic stress.

Gaining a deeper understanding of how stress affects the immune system may also help find a way to reverse those effects.

Does meditation actually work? Here’s what the science says.

Do natural adaptogens like ginseng actually combat stress?

How to cope with stress at work—and avoid burning out

In the 1980s, psychologist Janice Kiecolt-Glaser and her virologist husband, Ronald Glaser, began exploring the physiological impact of stress on two notably stressed segments of society: medical students and older caregivers. The researchers found the students’ immune systems were less robust when they were taking exams than during non-exam times—and that stress altered the body’s response to vaccines.

A man lies in bed covered with a dusty blue sheet and a red plaid quilt as his wife leans close by his side.

Researchers then administered the flu and pneumonia vaccines to individuals responsible for a spouse with dementia. Unlike medical students taking exams, who were likely stressed only in the short term, these people were experiencing unrelenting stress. When tested at set periods after inoculation, they had fewer antibodies compared with a control group —they couldn’t maintain their protective response. “That gave us good evidence that the changes brought on by stress were biologically meaningful,” says Kiecolt-Glaser, now an emeritus professor at the Ohio State University.

Around the same time, researchers led by Sheldon Cohen, now emeritus professor of psychology at Carnegie Mellon University, delivered cold-causing viruses into the nostrils of about 400 adult volunteers in the U.K. “The more stress they reported prior to our exposing them to a virus, the higher the risk was for them to develop a cold,” says Cohen. The duration and type of stress mattered: Chronic economic or interpersonal stress were what really put people at high risk—and the longer it went on, the greater the susceptibility to falling sick.

Two men in a classroom wearing safety helmets and protective gear hold out their guns as a another man lays on the ground facing the ceiling.

Cohen and his colleagues also learned that when exposed to viruses, chronically stressed people tended to produce an excess of cytokines—proteins that serve as messengers of the immune system, traveling to sites of infection and injury and activating inflammation and other cellular processes to protect the body. Too many cytokines cause an excess of inflammation.

Researchers still don’t know enough about how stress alters the immune system’s ability to regulate cytokines to devise an intervention to reduce the inflammation, but in one way, these findings signal some hope: There are clear targets for more work to be done.

Understanding stress on a cellular level

The future of understanding and combating stress may lie in our DNA.

In 2023, Ursula Beattie, then a doctoral student at Tufts University, and her colleagues found possible evidence that stress can overwhelm DNA’s repair mechanisms . In their study, researchers repeatedly tapped on sparrow cages with pens, played the radio loudly, and other actions designed to cause distress but no physical harm. Blood and tissue samples from the sparrows after three weeks of this unpleasant treatment revealed damage to the DNA. “It’s like if you had two pieces of string coiled up, just like DNA, and you took a pair of scissors and cut them,” Beattie says.

A woman's hand firmly holds a sparrow. Below on a marble table sit five vials in an organized tray.

While these kinds of double-strand breaks in DNA occur all the time in sparrows and other species, including humans, the damage is typically reversed through self-repair mechanisms. In a chronic-stress setting, “those repair mechanisms get overwhelmed, which is how we see a buildup of DNA damage,” Beattie explains. The damage in the birds appears to be the most severe in cells of the liver, she adds, suggesting that for humans, too, the extent and type of damage inflicted by stress might be different for different tissues of the body.

Separately, Kiecolt-Glaser and psychologist Lisa Christian at OSU are conducting a longitudinal study to determine whether chronic stress ages you more quickly. If results support a smaller, earlier study, it appears that chronically stressed caregivers not only are more likely to get sick and heal more slowly but they also show signs of accelerated aging.

We’re still learning how deep stress goes into our bodies. But these exploratory findings mean we’re getting closer to solving the puzzle that is stress, which promises a future where we can better meet the ongoing demand for change.

( 20 stress-relief gifts for the frazzled friend in your life. )

A women wearing glasses and a blazer stands next to a woman in a red top holding her baby to her chest as they stand over a baby's crib.

How chronic stress and racial trauma are related

20 stress-relief gifts for the frazzled friend in your life

‘Hysterical strength’? Fight or flight? This is how your body reacts to extreme stress

Are ultra-processed foods as addictive as cigarettes?

Epidurals may do more than relieve pain—they could save lives

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Originally published on July 24, 2017

How to Be Better at Stress

By Tara Parker-Pope

Illustrations by Sam Kalda

Stress is unavoidable in modern life, but it doesn’t have to get you down. Work, money and family all create daily stress, while bigger issues like the global pandemic and politics contribute to our underlying stress levels. But approach it the right way, and it won’t rule your life — it can even be good for you. Here are ways to deal with stress, reduce its harm and even use your daily stress to make you stronger.

Stress is inevitable; getting sick from it is not.

The Perception of Stress

While we know that stress is associated with health problems, plenty of people with high-stress lives are thriving. How is that possible? In 2012, researchers from the University of Wisconsin-Madison published a seminal study looking at how 28,000 people perceived stress in their lives. People in the study answered these two questions:

During the past 12 months, would you say that you experienced:

A lot of stress A moderate amount of stress Relatively little stress Almost no stress at all

How much effect has stress had on your health?

A lot Some Hardly any None

The researchers looked at death rates in the study group over nine years. The results are startling. The study found that having a lot of stress in your life was not linked with premature death. But having a lot of stress in your life and believing it was taking a toll on your health increased risk of premature death by 43 percent.

Changing your perception

With stress, the mind and the body are intrinsically linked. You can view stress as something that is wreaking havoc on your body (and it can) or as something that is giving you the strength and energy to overcome adversity. Here’s a quick way to think about these two very different views of stress. Read the statement, and then think about your own reaction to the biological changes that occur during times of stress. 1. When I’m stressed, my body releases adrenaline and cortisol. My heart is beating faster. This means that:

Common View: Stress is increasing my risk for cardiovascular disease and heart attack.

Alternative View: My heart is working harder and my body is mobilizing its energy to get ready for this challenge.

2. When I’m stressed, my stress response is causing my breathing rate to increase. This means that:

Common View: My fast breathing is a sign of anxiety. I worry about how stress is affecting my mental and physical health.

Alternative View: I should take a deep breath. My faster breathing means more oxygen is getting to my brain so I can think more clearly.

3. When I’m stressed, my heart and circulatory system respond, causing my blood pressure to rise. This means that:

Common View: I can feel my blood pressure rising. This can’t be good for my health.

Alternative View: Circulatory changes are allowing more oxygen and nutrients to fuel my muscles. I’m feeling stronger and ready for the challenge ahead.

It’s probably clear to you that the alternative view is the better choice for thinking about stress. It may be hard to believe that such a small shift in thinking could make a difference, but that’s what Harvard researchers found when they paid 50 study subjects $25 each to take part in a lab experiment designed to induce stress. The test involves giving a talk in front of a group of unfriendly evaluators, followed by a tricky word test. (Researchers have consistently found that this formula of public speaking plus testing in front of a hostile crowd is incredibly uncomfortable and stress-inducing for the poor people who agree to take part in the study.)

Before the social stress test, one group was allowed to play video games; another was taught to simply ignore stressful feelings if they experienced them during the test. But a third group was given advice similar to the quiz above. They got a primer about the physical stress response and were told how a higher heart rate, faster breathing and internal jitters were all tools for making you strong during a stressful event. They were told how the body’s stress response evolved to help us succeed, and that the increased arousal symptoms of stress can aid your performance during times of stress. The bottom line of the lesson was this: In a tough situation, stress makes you stronger.

The group that learned to rethink the role of stress in their lives did far better on the test. They gave better speeches and were rated as more confident. They smiled more and had more-positive body language. And physiological indicators showed that their bodies were also managing the stress response better than those of test subjects who were taught to ignore stress or given no advice at all.

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clock This article was published more than 2 years ago

Need a quick stress-reliever? Try one of these surprising science-based strategies.

There is a saying in the Balkans, where I was born and raised, that loosely translates to: “There is nothing worse than finally seeing the light, only to be plunged again into darkness.” As a psychologist, I have observed my patients’ extraordinary levels of stress and anxiety start to ease, only to be replaced by anger, disappointment and despair as coronavirus cases have resurged and the promise of the pandemic’s end has become more elusive.

The widespread return to in-person school and the uneven return to offices this fall are further contributing to the sense of being pushed to the limit. This has led many of my patients to ask what they can do in the moment when they feel frazzled, overwhelmed, panicked or tunnel-visioned. Although tried-and-true self-help strategies, such as exercise, good sleep, socializing, mindfulness, positive reframing and self-compassion, are still the best prescription for lowering stress overall, sometimes a practical solution that can provide immediate relief is what’s needed.

Here are some outside-the-box but science-based strategies that can help us calm down quickly, so we can keep functioning and doing what needs to be done.

Spur your mammalian diving reflex

One of the most effective stress resets involves submerging your face in ice-cold water while holding your breath. This activates the diving reflex , which slows the heart rate and redirects blood away from the periphery of the body, toward the heart and other vital organs. These physiological changes have been shown to decrease anxiety .

If a bowl or a bucket with icy water is not at your disposal, you can press ice packs against your eyes, upper cheeks and temples while leaning over and holding your breath.

How to handle the infuriating ‘here we go again’ feeling as the delta variant rages

“Stay like this as long as you can tolerate it. We typically recommend 15 to 30 seconds, although I’ve observed the effect [take hold] much faster,” said Jenny Taitz, a clinical psychologist in Beverly Hills, Calif., and the author of “ End Emotional Eating .”

Sheri Van Dijk, a psychotherapist in Newmarket, Ontario, and the author of “ Calming the Emotional Storm ,” warns that people with low blood pressure, heart problems or eating disorders should get clearance from their doctor before attempting this strategy.

We share the diving reflex with other air-breathing vertebrates. Think of activating your diving reflex as a way of channeling your inner dolphin.

Distract yourself with strong sensations or mental games

When we are very stressed or anxious, our attention narrows and only focuses on the negatives. If you are having a hard time objectively looking at a situation and making decisions, or if you feel mentally stuck or paralyzed, a quick distraction can allow you to reset.

Although repeatedly avoiding your negative feelings and escaping through Netflix, video games or alcohol can lead to more distress in the long run, occasionally distracting yourself by using strong sensory input or engaging in mental games can offer a respite from acute stress.

“This gives you a chance to take a psychological break, widen the lens to see the big picture and gain courage for the next step,” said Kelly Koerner, clinical psychologist, chief executive of Jaspr Health and author of “ Doing Dialectical Behavior Therapy: A Practical Guide .”

Chew on a hot pepper, listen to loud music, hold ice cubes in your hands or smell a pungent cheese to briefly shift your attention away from stress. Alternatively, you can “make an alphabetical list of car models, flowers, colors, or create a mental top 10 list of your favorite movies, novels or places,” Taitz said.

“One of my favorite tips is to suck on a lemon, or imagine doing it. You’ll start to salivate, engaging the parasympathetic nervous system, which leads to relaxation,” Van Dijk said.

Look at fractal shapes in nature or art

Nature has long been associated with relaxation , but research over the past few decades has shown that art and computer images that mimic certain natural patterns can have a similar effect . Fractals, shapes that repeat on finer and finer scales, are often found in nature. (Consider chambered nautilus shells, snowflakes, cones, tree branches or leaf veins.) They seem particularly pleasing to the human eye, and looking at them has been found to reduce physical signs of acute stress.

Branka Spehar, a psychology professor at the University of New South Wales in Australia, and her collaborators found that Jackson Pollock’s iconic paintings are also fractals . “This helps explain the immense popularity of these and similar art and architecture over the years. Humans prefer lines that are neither straight nor smooth, with [a] moderate level of complexity,” she said.

How to deal with regret and forgive yourself for making imperfect decisions

Our affinity for fractals probably came through evolution, because there are no perfect shapes or straight lines in the natural world. “Everything you see in nature has some imperfection,” Spehar said. “And a dose of imperfection is calming, like in Japanese wabi-sabi,” the aesthetic and worldview that emphasizes the acceptance of imperfection and impermanence.

Whenever possible, spend time in nature to reduce stress. Short of that, mimic natural effects by looking at perfectly imperfect fractals. As singer-songwriter Leonard Cohen put it: “There is a crack, a crack in everything. That’s how the light gets in.”

Speak to yourself in the third person

In the middle of an emotional storm, we often become fused with the catastrophizing, critical or hopeless voice in our head. Everything appears bad, now and in the future. The more we try to think our way out of it, the more we get mired in the quicksand of negativity.

To stop the spiral, change how you talk to yourself . “When you use third-person pronouns and your name to refer to yourself, you zoom out and get some distance from the current situation,” said Ethan Kross, a professor of psychology as well as management and organizations at the University of Michigan and the author of “ Chatter: The Voice in Our Head, Why It Matters, and How to Harness It .” “Your perspective shifts from being overwhelmed to seeing the problem as a challenge, from ‘I can’t’ to ‘I can.’ ”

Studies by Kross and others show that talking to yourself in the third person takes the edge off stress and defuses it, often quite quickly. Even if it seems silly or contrived, try advising or coaching yourself the way you would talk to someone you care about the next time you get stressed. Doing so silently will work, but you might want to experiment with saying the words aloud if your environment allows for it. Emulating how children talk to themselves in the third person can ensure that you do not slip into self-criticism.

The earliest study examining the calming effect of chewing gum, published in the journal Science in 1939, reported beneficial effects on muscle tension associated with stress. More recently, research has found that chewing gum can reduce anxiety, stress and cortisol while increasing alertness .

Even though a review of studies linking gum-chewing and lowered stress showed inconsistent effects, you have nothing to lose by engaging in this easy and even fun activity.

Act the opposite of the way you feel

Each emotion is associated with certain bodily postures, facial expressions and behavioral urges. For example, when you get angry, you probably tend to have an erect posture, frown and speak loudly or yell. If you find yourself getting angry when stressed, try intentionally changing your posture to a nonaggressive one, relaxing your expression into a smile and speaking very softly. Research suggests that this technique, called “opposite action,” reduces the intensity of the original emotion .

A recent review showed that even just changing your facial expression can change how you feel. For example, participants in a 2012 study reported more positive affect and had lower heart rates during stress recovery after they smiled. The effect was stronger for those who displayed a “ Duchenne smile ,” one that involves the eyes in addition to the mouth.

“Information about your facial expression travels to your brain via cranial nerves connected to your facial muscles,” said Eric Finzi, a dermatologist and clinical assistant professor of psychiatry at George Washington University and the author of “ The Face of Emotion: How Botox Affects Our Moods and Relationships .” “This happens without conscious awareness. For example, when you see a snake, your face shows a fearful expression in 40 milliseconds, before you become consciously aware of your fear.”

So, when your negative emotions seem overwhelming, try smiling for some immediate relief.

Make yourself yawn

Research led by Andrew C. Gallup, associate professor of psychology at SUNY Polytechnic Institute, suggests that yawning has a brain-cooling function in vertebrates , including humans. “Brain temperature rises during times of stress and anxiety,” Gallup said. “And yawning naturally occurs before and during stressful situations, promoting relaxation and better cognitive functioning. It has nothing to do with boredom.”

Although there is no experimental evidence that cooling the brain by inducing yawning — by, for example, watching videos of people yawning — results in stress reduction, Gallup believes the effect is likely and would be consistent with the existing findings. For now, yawn away. Who knows? Perhaps you’ll trigger yawns in others and reduce their stress, too.

Kecmanovic is the founding director of the Arlington/DC Behavior Therapy Institute and an adjunct professor of psychology at Georgetown University. Find her @DrKpsychologist.

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‘Cyclic sighing’ can help breathe away anxiety

Feeling anxious? You're far from alone. During the pandemic, rates of anxiety and depression soared around the globe, resulting in a shortage of mental health care providers and long wait times for therapy.

But, according to a new study from Stanford Medicine , there's an easy, at-home way to help lower your stress level: It's called cyclic sighing, a controlled breathing exercise that emphasizes long exhalations. What's more, it can take as little as five minutes to experience less anxiety, a better mood and even decreased rates of breathing at rest, a sign of overall body calmness.

"What's interesting about the breath is that it's right on the edge of conscious control," said David Spiegel , MD, the Jack, Lulu, and Sam Willson Professor in Medicine and associate chair of psychiatry and behavioral sciences, who co-led the study with Stanford Medicine neurobiologist Andrew Huberman , PhD, and Melis Yilmaz Balban, PhD, former Stanford Medicine senior research scientist. "Most of the time breathing is automatic, like digestion, heartbeat and other bodily functions, but you can very easily take over and control your breath, which then affects your overall physiology and stress response."

Breaking the anxiety spiral

Imagine you've just experienced something stressful -- maybe a critical email from your boss or a phone call from your child's school principal. As soon as you start to worry, your heart rate speeds, and you breathe a little more quickly. Your muscles tighten, your armpits get sweaty and you suddenly feel restless and fidgety.

For many people, especially those with anxiety disorders, these physical changes trigger a chain reaction of thoughts and fears, said Spiegel, who is the director of the Center on Stress and Health at Stanford Medicine. "As soon as you notice what's going on in your body, your brain thinks, 'Oh no, this must be really bad,' and you get more anxious. It's like a snowball rolling downhill."

But taking charge of your breathing can break the cycle, Spiegel said. "When we teach people to control the physical effects of a stressor on their body, it puts them in a better position to deal with the stressor itself."

The instructions are simple: Breathe in through your nose. When you've comfortably filled your lungs, take a second, deeper sip of air to expand your lungs as much as possible. Then, very slowly, exhale through your mouth until all the air is gone.

After one or two of these deep sighs, you may already feel calmer, but to get the full effect, Spiegel recommends repeating these deep sighs for about five minutes. Exhalation activates the parasympathetic nervous system, he said, which slows down heart rate and has an overall soothing effect on the body.

Putting cyclic sighing to the test

There's a long history of using controlled breathing in traditional practices like yoga, tai chi and meditation, but scientists are just beginning to study how these breathing exercises work and which ones are most beneficial.

Huberman and Spiegel recently led a randomized, controlled trial of cyclic sighing compared to two other types of breathing exercises, one emphasizing inhalation and another asking participants to breathe in and out for equal amounts of time. Each of the 111 healthy volunteers were asked to perform their assigned exercise for five minutes a day over the course of one month. (People with moderate to severe psychiatric conditions were not a part of this preliminary study.)

Before and after completing their daily breathing exercises, participants answered two online questionnaires: the State Anxiety Inventory, a standardized measurement of current anxiety levels, and the Positive and Negative Affect Schedule, a common research tool used to assess good and bad feelings on a scale from 1 to 5.

The trial also included a control group of participants who passively observed their breath during five minutes of mindfulness meditation.

"In mindfulness meditation, we instruct people to be aware of their breath but not try to control it," Spiegel said. "For the other groups, we asked participants to directly control an activity that normally goes on more or less automatically."

Hundreds of studies have demonstrated the benefits of mindfulness meditation for reducing stress and anxiety, and as expected, the mindfulness group reported lower anxiety and improved mood. But in this study , published Jan. 17 in Cell Reports Medicine , the controlled breathing groups reported even more improvements, with significantly greater increases in positive affect -- good feelings such as energy, joy and peacefulness.

On average, participants in the controlled breathing groups experienced a daily increase in positive affect of 1.91 points on the Positive and Negative Affect Schedule scale, compared to 1.22 points for the mindfulness meditation group, an improvement that's greater by about one-third.

"Controlled breathing exercises may have a more rapid, more direct effect on physiology than mindfulness," Spiegel said, noting that people typically meditate for 20 to 30 minutes at a time. "We wanted to see whether a quicker intervention, repeated for just five minutes over the course of 30 days, could still have lasting effects."

The researchers also hypothesized that cyclic sighing, with its focus on slow exhalation, might be more effective than the other two types of controlled breathing.

Indeed, while all three controlled breathing interventions decreased anxiety and negative mood, participants in the cyclic sighing group had the greatest daily improvement in positive feelings on the Positive and Negative Affect Schedule questionnaire. The effect increased as the study went on, suggesting that the more consecutive days they practiced cyclic sighing, the more it helped their mood.

Slower breathing rate, calmer body

In addition to tracking anxiety and mood, participants wore sensors to monitor their resting breathing rate and heart rate. Although no changes to heart rate were observed in any of the groups, participants in the cyclic sighing group significantly lowered their resting breathing rate, more than the mindfulness or other controlled breathing groups.

"They were breathing more slowly not just during the exercise, but throughout the day, indicating a lasting effect on physiology," Spiegel said.

Respiratory rate was also inversely correlated with a change in positive affect, suggesting that the participants whose breathing slowed down the most were also the ones who experienced the greatest improvement in mood.

"We know that people who are breathing very rapidly feel more anxious, such as during a panic attack," Spiegel said. "Controlled breathwork seems to be a straightforward way to do the opposite: lower physiologic arousal and regulate your mood."

Simple, quick and free

One of the best parts of cyclic sighing is that it can be done anytime, anywhere -- with zero cost and zero side effects. In fact, due to the pandemic, the team conducted the entire trial remotely.

"Now we know we can reach a much bigger and more diverse population than if we'd done everything in the lab," said Spiegel.

In the future, Spiegel and Huberman plan to use functional MRI to measure brain activity during the controlled breathing exercises, and they hope to conduct treatment studies in specific populations with anxiety or mood disorders.

"There's a growing interest in nonpharmacological ways of helping people regulate their mood," Spiegel said. "We may be able to identify certain kinds of anxiety that respond substantially to this simple treatment."

In the meantime, Spiegel says there's no harm in trying cyclic sighing for yourself.

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Chronic stress puts your health at risk

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Your body is made to react to stress in ways meant to protect you against threats from predators and other aggressors. Such threats are rare today. But that doesn't mean that life is free of stress.

Instead, you likely face many demands each day. For example, you may take on a huge workload, pay bills or take care of your family. Your body treats these everyday tasks as threats. Because of this, you may feel as if you're always under attack. But you can fight back. You don't have to let stress control your life.

Understanding the natural stress response

When you face a perceived threat, a tiny region at the brain's base, called the hypothalamus, sets off an alarm system in the body. An example of a perceived threat is a large dog barking at you during your morning walk. Through nerve and hormonal signals, this system prompts the adrenal glands, found atop the kidneys, to release a surge of hormones, such as adrenaline and cortisol.

Adrenaline makes the heart beat faster, causes blood pressure to go up and gives you more energy. Cortisol, the primary stress hormone, increases sugar, also called glucose, in the bloodstream, enhances the brain's use of glucose and increases the availability of substances in the body that repair tissues.

Cortisol also slows functions that would be nonessential or harmful in a fight-or-flight situation. It changes immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with the brain regions that control mood, motivation and fear.

When the natural stress response goes wild

The body's stress response system is usually self-limiting. Once a perceived threat has passed, hormones return to typical levels. As adrenaline and cortisol levels drop, your heart rate and blood pressure return to typical levels. Other systems go back to their regular activities.

But when stressors are always present and you always feel under attack, that fight-or-flight reaction stays turned on.

The long-term activation of the stress response system and too much exposure to cortisol and other stress hormones can disrupt almost all the body's processes. This puts you at higher risk of many health problems, including:

Depression.
Digestive problems.
Muscle tension and pain.
Heart disease, heart attack, high blood pressure and stroke.
Sleep problems.
Weight gain.
Problems with memory and focus.

That's why it's so important to learn healthy ways to cope with your life stressors.

Why you react to life stressors the way you do

Your reaction to a potentially stressful event is different from everyone else's. How you react to your life stressors is affected by such factors as:

Genetics. The genes that control the stress response keep most people at a fairly steady emotional level, only sometimes priming the body for fight or flight. More active or less active stress responses may stem from slight differences in these genes.
Life experiences. Strong stress reactions sometimes can be traced to traumatic events. People who were neglected or abused as children tend to be especially at risk of experiencing high stress. The same is true of airplane crash survivors, people in the military, police officers and firefighters, and people who have experienced violent crime.

You may have some friends who seem relaxed about almost everything. And you may have other friends who react strongly to the slightest stress. Most people react to life stressors somewhere between those extremes.

Learning to react to stress in a healthy way

Stressful events are facts of life. And you may not be able to change your current situation. But you can take steps to manage the impact these events have on you.

You can learn to identify what causes you stress. And you can learn how to take care of yourself physically and emotionally in the face of stressful situations.

Try these stress management tips:

Eat a healthy diet and get regular exercise. Get plenty of sleep too.
Do relaxation exercises such as yoga, deep breathing, massage or meditation.
Keep a journal. Write about your thoughts or what you're grateful for in your life.
Take time for hobbies, such as reading or listening to music. Or watch your favorite show or movie.
Foster healthy friendships and talk with friends and family.
Have a sense of humor. Find ways to include humor and laughter in your life, such as watching funny movies or looking at joke websites.
Volunteer in your community.
Organize and focus on what you need to get done at home and work and remove tasks that aren't needed.
Seek professional counseling. A counselor can help you learn specific coping skills to manage stress.

Stay away from unhealthy ways of managing your stress, such as using alcohol, tobacco, drugs or excess food. If you're worried that your use of these products has gone up or changed due to stress, talk to your health care provider.

There are many rewards for learning to manage stress. For example, you can have peace of mind, fewer stressors and less anxiety, a better quality of life, improvement in conditions such as high blood pressure, better self-control and focus, and better relationships. And it might even lead to a longer, healthier life.

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How stress affects your health. American Psychological Association. https://www.apa.org/topics/stress/health. Accessed March 19, 2021.
Stress effects on the body. American Psychological Association. https://www.apa.org/topics/stress/body. Accessed March 19, 2021.
Lower stress: How does stress affect the body? American Heart Association. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/lower-stress-how-does-stress-affect-the-body. Accessed March 18, 2021.
Stress and your health. U.S. Department of Health & Human Services. https://www.womenshealth.gov/mental-health/good-mental-health/stress-and-your-health. Accessed March 18, 2021.
AskMayoExpert. Stress management and resiliency (adult). Mayo Clinic. 2019.
Seaward BL. Essentials of Managing Stress. 5th ed. Jones & Bartlett Learning; 2021.
Seaward BL. Managing Stress: Skills for Self-Care, Personal Resiliency and Work-Life Balance in a Rapidly Changing World. 10th ed. Jones & Bartlett Learning; 2022.
Olpin M, et al. Stress Management for Life. 5th ed. Cengage Learning; 2020.
Hall-Flavin DK (expert opinion). Mayo Clinic. March 23, 2021.

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Int J Prev Med

The Effect of Yoga on Stress, Anxiety, and Depression in Women

Masoumeh shohani.

Department of Nursing, Faculty of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran

Gholamreza Badfar

1 Department of Pediatrics, Behbahan School of Medicine, Ahvaz Jundishapour University of Medical Science, Behbahan, Iran

Marzieh Parizad Nasirkandy

2 Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

Sattar Kaikhavani

3 Prevention of Psychosocial Injuries Research Center, Faculty of medicine, Ilam University of Medical Sciences, Ilam, Iran

Shoboo Rahmati

4 M.Sc. Student of Epidemiology, Student Research Committee, School of Health, Ilam University of Medical Sciences, Ilam, Iran

Yaghoob Modmeli

5 M.Sc. Student of Nursing, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Ali Soleymani

6 M.Sc. in Management, Department of Finance, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran

Milad Azami

7 Medical Student, Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran

Background:

In recent decades, several medical and scientific studies on yoga proved it to be very useful in the treatment of some diseases. This study was conducted to investigate the effects of yoga on stress, anxiety, and depression in women living in Ilam, Iran.

This study is a quasi-experimental study with pre-post test. To collect data, the questionnaire of DASS-21 (Depression Anxiety Stress Scale-21) was used. For eligible samples, hatha yoga exercises and training sessions were held for 4 weeks (3 time/weeks; 60-70 min each) by a specialist. Data were analyzed using SPSS version 20.

52 women with a mean age of 33.5 ± 6.5 were included for analysis. Depression, anxiety, and stress decreased significantly in women after 12 sessions of regular hatha yoga practice ( P < 0.001).

Conclusions:

Yoga has an effective role in reducing stress, anxiety, and depression. Thus, it can be used as complementary medicine.

Introduction

Complementary medicine refers to a category of treatments and interventions that have not been raised in modern medicine.[ 1 ] Yoga is a Sanskrit word meaning unity of mind and body, which has been used in Eastern societies since 5000 years ago and has recently received much attention from Western countries.[ 2 ] In recent decades, several medical and scientific studies on yoga proved it to be very useful in the treatment of some diseases.[ 3 ] Studies have demonstrated effect of yoga for many conditions, including multiple sclerosis,[ 4 ] asthma,[ 5 ] irritable bowel syndrome,[ 6 ] lymphoma,[ 7 ] hypertension,[ 8 ] drug addiction,[ 9 ] osteoarthritis,[ 10 ] and mental health issues.[ 11 ]

Increased stress, depression and anxiety are the features of modern lifestyle.[ 12 ] Due to the adverse effects of drugs in the treatment of anxiety and depression, and in some cases their lack of effectiveness, researchers seek nonpharmacological and noninvasive treatment for these disorders.[ 13 ] Yoga exercises was improved the variables of self-description, psychological status, and the quality of life.[ 14 ] Researches suggest that yoga as an intellectual and mental exercise, improves health feeling.[ 15 ] Furthermore, yoga can improve the psychological conditions for monitoring and managing stress and negative emotions, increase positive emotions, and help mental balance.[ 11 ] However, despite the popularity and the positive psychological and physiological effects of yoga, it is not widely studied to find how much it really prevents and treats mental disorders. Research in this area is limited in Iran. This study was conducted to investigate the effects of yoga on stress, anxiety, and depression in women living in Ilam from Iran, during 2014 to 2015.

Design and ethics

This study is a quasi-experimental study with pre-post test that was approved by the Ethics Committee of the Ilam University of Medical Sciences. The population consisted of all women admitted to yoga club in the city of Ilam in 2014–2015.

Inclusion and exclusion criteria

Inclusion criteria were educated, nonathlete and nonpregnant women with the ability to perform hatha yoga exercises without inability to exercise. Exclusion criteria included refusal or unwillingness to perform yoga continuously, simultaneous exercise, and receiving medication for mental disorders.

Assessment tools and management

To collect data, the questionnaire of DASS-21 (Depression Anxiety Stress Scale-21) was used. The validity and reliability of this standard questionnaire was examined by Sahebi et al . and Cronbach's alpha was estimated 0.7, 0.66 and 0.76 for depression, anxiety, and stress, respectively. in a study entitled “validation of depression anxiety and stress scale for an Iranian population”.[ 16 ] Each of the above mentioned states are assessed with seven questions. Hatha yoga exercises and training sessions were held 3 time/weeks; 60-70 min each (postures, breathing techniques, meditation) by a specialist. Before the intervention, questionnaires were completed by women. The intervention lasted 12 sessions. At the end of the 12 th session, the questionnaire of DASS-21 was again completed by women.

Statistical procedures

The obtained data were analyzed using SPSS version 20 (IBM, Armonk, NY, USA). According to the established normality, paired sample t -test was used for comparing the results before and after the intervention. The threshold of significance was set at P < 0.05.

The total eligible sample consisted of 52 women with a mean age of 33.5 ± 6.5 years. Other demographic characteristics are shown in Table 1 .

Demographic characteristics of the women

An external file that holds a picture, illustration, etc.
Object name is IJPVM-9-21-g001.jpg

The difference between mean scores of depression, anxiety, and stress before and after 12 sessions of regular hatha yoga practice was statistically significant [ Table 2 ].

A comparison of the mean scores of stress, anxiety, and depression before and after the intervention of 12 sessions of regular hatha yoga practice session ( n =52)

An external file that holds a picture, illustration, etc.
Object name is IJPVM-9-21-g002.jpg

The present study showed that 12 sessions of intervention as regular hatha yoga exercise significantly reduced stress, anxiety, and depression in women.

In other studies, including Tayyebi et al ., among hemodialysis patients,[ 17 ] Rahnama et al ., among multiple sclerosis patients,[ 15 ] Javnbakht et al ., among women living in Mashhad,[ 18 ] and Gong among pregnant women,[ 19 ] the significant positive effects of yoga in reducing stress, anxiety, and depression have been confirmed. In the study of Streeter et al .,[ 20 ] it was found that greater improvement in mood and greater decreases in anxiety during 12 week of yoga intervention compared to walking group. Oken et al .[ 4 ] did not observe any significant effect of yoga on improvement in mood in patients with MS, the limitation of this study is the small number of intervention sessions (one session per week).

Dalgas et al . proved that the nature of yoga is controlling the mind and central nervous system and unlike other sports, it has a moderating effect on the nervous system, the hormonal emissions, physiological factors, and regulation of nerve impulses; therefore, it can be effective in improving depression and mental disorders.[ 21 ]

One limitation of this study was that only the women were studied and since there were no yoga clubs for men, they have not been studied in this research.

Conclusions

Yoga has an effective role in reducing stress, anxiety, and depression that can be considered as complementary medicine and reduce the medical cost per treatment by reducing the use of drugs. Given that, the reason behind the effect of yoga on stress, anxiety, and depression is not clear for us and may be transient, and it is suggested that future studies are done to investigate the long-term effect of yoga on stress, anxiety, and depression.

Financial support and sponsorship

Ilam University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.

Acknowledgments

The authors would like to thank Ilam University of Medical Sciences for financial support and also yoga instructors (Miss. Morshedi and Miss. Khosravi) for their cooperation.

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Article contents

Introduction

Defining Stressors and Strains

Organizational Constraints

Workplace Mistreatment

Role Stressors

Work-Family Conflict

Leading Frameworks

Field Theory

Role Stress Theory

Person-Environment Fit Theory

Job Demands-Control/Support (JD-C/S) and Job Demands-Resources (JD-R) Model

Conservation of Resources Theory

Transactional Framework

Effort-Reward Imbalance

Stress Management Interventions: Primary, Secondary, and Tertiary

Primary Interventions (Preventative Stress Management)

Planning and Time Management

Person-Organization Fit

Job Redesign

Participatory Action Research Interventions

Physical Setting

Secondary Interventions (Coping)

Problem-Focused Coping

Emotion-Focused Coping

Comparing Coping Strategies across Cultures

Social Support

Meaningfulness and Resilience

Tertiary Interventions (Stress Management)

Individual-Focused Stress Management

Individual-Focused Stress Management: Employee Assistance Programs

Individual-Focused Stress Management: Mindfulness

Individual-Focused Stress Management: Biofeedback/Imagery/Meditation/Deep Breathing

Individual-Focused Stress Management: Sleep/Rest/Respite

Individual-Focused Stress Management: Role Analysis

Organization-Focused Stress Management

Organization-Focused Stress Management: Organizational-Level Occupational Health Interventions

Organization-Focused Stress Management: Flexible Work Arrangements

Organization-Focused Stress Management: Diversity Programs

Organization-Focused Stress Management: Healthcare Management Policies

Concluding Remarks

A Healthy Organization’s Pledge

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