84 STRESS AND HEALTH
appraisals of stressful situations, inhibit automatic thoughts and enhance coping skills.
Some people exacerbate the stress they experience by negative cognitions. Thus, for
example, when faced with a disagreement with a work colleague about how to do a
piece of work, a typical thought might be ‘he obviously does not like me, maybe no-
one likes me’. This irrational response illustrates personalizing and catastrophizing. This
would be explored with the individual and different responses considered, e.g. ‘We
obviously do not see eye to eye on this task. How can we resolve this difference?’
This response is much less likely to generate stress and depression and more likely to
lead to constructive problem solving. Stress management techniques that draw on
cognitive behaviour therapy involve people examining their reactions and developing
skills to stop what for many are automatic negative thoughts and to replace them with
more constructive cognitions. This then leads to rehearsal of different appraisals and
new coping skills. These kinds of techniques have been demonstrated to be effective
in therapeutic interventions (e.g. DeRubeis and Crits-Christoph, 1998).
Stress management training courses vary greatly in the length of the course and the
components used within the course. In the workplace they may consist of very brief
one-off sessions for participants who are not particularly stressed at the outset. It is not
surprising if evaluations of such interventions show little improvement. However,
rigorous evaluations of longer training interventions for individuals with high levels
of anxiety show significant improvements in well-being (e.g. Ganster et al., 1982).
Identifying which components are responsible for benefits has proved more difficult
(see Chapter 9). Comparisons between different methods often show all techniques
to be equally successful. However, meta-analytic reviews of workplace interventions
have found those based on cognitive behavioural approaches to be most effective
though other techniques such as relaxation also show benefits (e.g. van der Klink et
al., 2001; Richardson and Rothstein, 2008).
A number of new developments in stress management training have been introduced
in recent years. The success of therapies based on the concept of mindfulness has meant
this has inevitably had an influence on approaches to dealing with employees.
‘Mindfulness’ involves deliberate focus on an awareness of what is happening in the
present moment (Kabat-Zinn, 2003). Mindfulness-based therapies (such as mindfulness-
based stress reduction and mindfulness-based cognitive therapy) aim to help people to
cope more effectively with experiences, by accepting emotions and discomforts and
paying attention to experiences without analytic or dysfunctional thought processes.
Mindfulness exercises utilize meditation extensively to encourage focus on the present
moment. Clinical trials have shown these approaches to be effective in reducing anxiety
and depression (Piet, Wurtzen and Zachariae, 2012). In the work environment,
mindfulness approaches have successfully been used as stress management training
for local government employees (e.g. Flaxman and Bond, 2010) and as part of an
intervention to help people return to work after stress-related sickness absence
(Netterstrom, Friebel and Ladegaard, 2013). Mindfulness interventions have also been
shown to be helpful in improving balance between work and home life (Michel, Bosch
and Rexroth, 2014) and to be effective when delivered online (Morledge et al., 2013).
Counselling
The provision of counselling services for distressed employees is now a popular form
of intervention that primarily aims to treat rather than prevent stress. This is now