Author(s):  Tom Cox, Raymond Randall & Amanda Griffiths           Level of Intervention: Primary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

In the UK, the Management of Health and Safety at Work Regulations 1992 and its revision in 1999 require employers to undertake assessments for all risks to health. Managers were advised by the Health and Safety Executive (1995) to include work-related stress in their assessment of risks. This would fulfil both UK and European legal obligations that ask employers to assess and manage any type of risk to workers’ health, including psychosocial risks. The risk management process is driven by active participation of employees in a series of stages: familiarisation (including the formation of the steering group and workplace visits), risk assessment (using methods such as surveys, group discussions and individual interviews), audit of management systems and employee support, action innovation (defining risk reduction interventions on the basis of the risk assessment results) and evaluation). The process promotes a continuous improvement cycle. The tools and methods used to conduct an effective risk assessment are tailored to the size of the group and the nature of the work in the organisation.

Implementation:

At the beginning of the risk management process, a steering group should be established. The central responsibility of this group is overseeing and facilitating the risk management process. Typically, this group is comprised of management, staff representatives (in some cases union representatives), occupational health, health and safety and human resources specialists. Publicity of the risk management project is of central importance; this ensures transparency of the process and recruits the widespread involvement of the organisation. Prior to commencing risk management, considerable consultation between stakeholders and experts should be conducted; with a concentrated focus of setting appropriate expectations, schedules and identifying communication channels.

Risk Assessment: The aim of the risk assessment stage is to identify, for a defined group, significant potential sources of stress (psychosocial hazards) relating to employees’ work and working conditions; and examine their overall indices relating the health of the individual and the organisation. Subsequently, an audit of management systems and employee support is conducted which identifies and assesses current management systems in relation to the control and management of the hazards and the experience of work-related stress, and in relation to the provision of support for employees experiencing problems.

Translation / Action Innovation: The results of the risk assessment are fed back to the organisation and the steering group, which form the basis of discussion among the stakeholders. This information, and the resulting discussion, is used to develop a plan of action (i.e., a package of interventions) that are reasonable and practicable; the aim of which is to reduce likely risk factors for stress in at work. These are also discussed with workers so as they are actively involved in the design of the interventions and have ownership of the actions to be taken.

Intervention/ Risk reduction: Developing an action plan involves deciding upon what is being targeted, the methods being used, those responsible, the proposed time schedule, the resources required and how the intervention will be evaluated. The primary aim of the action plan is in reducing likely risk factors that have the potential to cause stress. The change initiatives identified through this process, can be integrated into existing management plans for change; thus, minimising the degree of disruption within the organisation.

Evaluation: The next step in the risk management process is the evaluation of the action plan.

Practical applications:

The risk management framework has been used effectively to identify and reduce work-related stress (psychosocial hazards) in a number of organisations. It is applicable in large enterprises as well as SMEs.

Innovative aspects:

The process is driven by active participation of employees through all stages, including intervention design. A number of methods are combined in the risk management process. The evaluative step in the risk management process addresses the question of whether the intervention was effective in reducing stress and it allows for the reassessment of the situation and the identification of further problems needing to be addressed. This process of reassessment feeds into a cycle of continuous improvement within the company; thereby yielding a basis for organisational learning.

Evaluation (including process issues, outcomes and sustainability):

The objectives of the evaluation stage are to determine: whether the intervention was implemented effectively, and whether the intervention had any impact on the problems identified during the risk assessment. This can be accomplished through several methods, which can be tailored/adapted to size of the group being assessed and the nature of work in the particular organisational context. Several evaluation tools can be utilized: interviews with key stakeholders, interviews with staff, surveys (including measures of work and well-being used in the risk assessment), group discussions and review of organisational data. The evaluation tools contain three elements, each of which yields important information, specifically, they measure: the level of awareness, participation and reaction to the intervention; the impact of the intervention of changes to working conditions; and whether the intervention has made an impact on the health and wellbeing of employees.

Benefits (including cost effectiveness):

A number of benefits have been demonstrated of the risk management intervention in research and implementation in organisations. The majority of groups involved in the risk management process improved their working conditions, and employees’ reactions to the risk management interventions have been favourable and generally positive. There were observed positive trends towards improvement of employee wellbeing. Additional benefits were observed in regards to the risk management process. Firstly, it was seen as a useful tool for stimulating new ideas and ways of thinking about problems. Secondly, it quantified problems, which could be used to inform prioritisation of the identify issues and the required resources required. Thirdly, it focused efforts and actions to promote a coherent and targeted approach to action. Finally, it yielded a framework for evaluating progress and monitoring change – a strategy that could be used to evaluate employees’ planned and unplanned change.

References:

Cox, T., Randall, R., & Griffiths, A.  (2002) Interventions to control stress at work in hospital staff. HSE report 435 Norwich: HSE books. See www.hse.gov.uk/research/crr_pdf/2002/crr02435.pdf

Comments:

Guiding principles: In planning the risk management there are several guiding principles and practical issues of importance:

·   Work with defined groups: each risk assessment is carried out within a specified and defined group (a department, company or profession).

·   Focus on work not the individual: The aim of  risk assessment is to identify the aspects of work giving rise to stress, not the individuals experiencing stress.

·   Focus on ‘big issues’:  the focus is on problems that staff agree on that staff agree on, rather than individual complaints.

·   Use of reliable measures: all methods of data collection are designed to be reliable and valid.

·   Confidentiality of information given by employees must be guaranteed; thus, data collected must be stored securely and not disclosed.

Risk reduction as a goal: risk assessment tools are designed to provide sufficient detail and context-specific information to allow for intervention design.

Author(s):   Paul. E. Flaxman & Frank W. Bond                      Level of Intervention: Secondary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The overall aim of Acceptance and Commitment Therapy (ACT) is to enhance psychological flexibility; a psychological construct that has two related components: (a) a willingness to experience all internal events (thought, feelings, etc), and include those that are undesirable without trying to control, change or remove them; and (b) a commitment to engage in goal–orientated action, even when faced with difficult psychological content. This approach promotes and teaches, through a fully developed intervention protocol, mindfulness strategies to promote acceptance, rather than change or modify difficult psychological content, and commitment and behavioural strategies to help people build larger patterns of values-based action. There is a growing body of research to demonstrate that ACT is an effective method of stress management, and has been demonstrated to significantly improve employees’ mental health and to improve work-related outcomes: such as, increased learning at work (Bond & Bunce, 2000; Dahl et al., 2004; Flaxman & Bond, 2006; Hayes et al., 2004).

Implementation:

The ACT programme can be delivered during working hours to small groups of employees at the organisation. In recent ACT research, participants received three sessions of training on two consecutive weeks, and the third, and final, session three months later. Each training session lasted approximately half a day. The training consisted of a mixture of group discussion, didactic teaching and practice of ACT techniques. Additionally, participants were also encouraged to complete homework assignments between sessions. The content of the intervention was based on the fully developed ACT protocol, and additionally two subsequent ACT manuals that have a concentrated focus on group worksite interventions.

Practical applications:

ACT has a standardized protocol manual; thus making it easily applicable at a practical level. However, the authors note that in order to implement the protocol effectively, the trainer requires a good understanding of ACT’s underlying processes (see Hayes et al., 2006). ACT has been successfully implemented in a variety of occupational sectors, including both the public and private sector; and in both medium and large scale organisations.

Innovative aspects:

Many traditional cognitive behavioural approaches are designed to instruct employees on how to change or modify ‘dysfunctional’ or (stress-related) cognitions; and , in turn, how to reduce unpleasant emotional arousal. In contrast to the traditional change-orientated cognitive behavioural approach, a ‘third-wave of cognitive behavioural therapy has emerged, which places greater emphasis on ‘acceptance’ and ‘mindfulness’. One such approach, at the forefront of this ‘third-wave’ movement in cognitive behavioural approaches, is ACT.

Evaluation (including process issues, outcomes and sustainability):

Participating individuals were randomly assigned to one of three groups: (1) acceptance and commitment training (ACT) – a mindfulness-based approach; (2) stress inoculation training (SIT) - a cognitive restructuring approach; or (3) a wait list control group. Participants were asked to complete a questionnaire assessing overall levels of wellbeing at three time points: pre-intervention (baseline), 3 months later; and at a 6 month follow up.

Benefits (including cost effectiveness):

The aforementioned evaluation of ACT demonstrated the following benefits:

• Participating employees, with high levels of distress prior to the intervention, experienced large statistically (and clinically) significant improvements in mental health

  and these observed benefits were maintained at the 6 months follow-up assessment.

The authors conclude that there is a lot of evidentiary support for the use of cognitive behavioural therapy-based interventions in improving employees’ psychological well-being. Additionally, the evidence supports the efficacy of using ACT in the workplace

References:

Bond, F. W., & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156-163.

Dahl, J., Wilson, K. G., & Nilsson, A. (2004). Acceptance and commitment therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785-801.

Flaxman, P. E., & Bond, F. W. (2006). Acceptance and commitment therapy in the workplace. In R. A. Baer (Ed.), Mindfulness-based treatment approaches. San Diego, CA: Elsevier.

Flaxman, P.E. & Bond, F.W. (2006). For whom, and to what extent, is worksite stress management effective? In S. McIntyre & J. Houdmont Occupational Health Psychology: Key Papers of the European Academy of Occupational Health Psychology (pg.92-93).Edicoes ISMAI: Castelo da Maia, Portugal.

Flaxman, P.E. & Bond, F.W. (2006b). Cognitive-behavioural therapy (CBT) – based stress management interventions (SMIs): Investigating the mechanisms of change. Retrieved from http://www.ejtassociates.co.uk/Cognitive.pdf.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment theory: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1-25.

Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., et al. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35, 821-835.

Comments:

The authors note that ACT has been demonstrated as an effective method to address both the management of occupational stress (secondary level intervention) and in the rehabilitation of employee experiencing stress-related illness (tertiary level intervention).

Author(s):  Judy Proudfoot and her team at the Institute of Psychiatry, Kings College, London and Ultrasis plc                Level of Intervention: Tertiary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

‘Beating the Blues’ is a computerized interactive cognitive behavioural therapy programme; which seeks to help people suffering with mild and moderate depression to get better and stay better. This programme teaches individuals life-long skills to more effectively manage and cope with mental health issues and their causes and consequences. ‘Beating the Blues’ has been primarily used in primary care settings; however, more recently, this programme has been trialed in the public sector to address emotional distress in employees with recent stress-related absenteeism.

Implementation:

‘Beating the Blues’ is made up of 8 weekly sessions; with each session taking approximately 50 minutes to complete. The ‘Beating the Blues’ programme addresses both cognitive and behavioural components. The cognitive components explored during the programme are automatic thoughts, thinking errors and distraction, challenging unhelpful thinking, core beliefs and attributional style¹. The behavioural components of ‘Beating The Blues’ for tackling specific problems consist of: activity scheduling, task breakdown, problem solving, sleep management, relaxation training and biofeedback, planning and prioritizing and graded exposure. Cognitive and behavioural exercises are prescribed at the end of each session and debriefed at the start of the next. A weekly progress report of distress self-ratings and suicidal ideation is generated for the user and for the supervising clinician. The programme concludes with a programme review, goal setting and action planning.

Practical applications:

This computerized therapeutic programme has a user-friendly approach with self-guided format which can be used at the convenience and discretion of its user. Consequently, minimal input is required in the implementation of this programme by a set of professionals; albeit a supervising clinician is recommended to monitor progress and provide additional support.

Innovative aspects:

‘Beating the Blues’ is an interactive computerised cognitive behavioural therapeutic programme which guides the patient through the various stages of therapy in exactly the same way a therapist would in face-to-face sessions; whilst minimising the need for a trained professional to implement or guide the process. ‘Beating the Blues’ can respond to patients’ particular circumstances or problems; and ensure that the training of new ways of thinking and behaving is completed at a self-determined pace.

Evaluation (including process issues, outcomes and sustainability):

The effectiveness of ‘Beating the Blues’ programme was evaluated by comparing sick-listed employees randomly assigned to either an ‘intervention group’ (using the ‘Beating the Blues’ programme plus conventional care²) or a group that received solely convention care. Measurements on depression, anxiety and attributional style were taken at the end of treatment, and 1, 3 and 6 months later. Additionally, the employees’ weekly progress report was reviewed by the scientific investigator to examine participation.

Benefits (including cost effectiveness):

This study compared the effects of ‘Beating The Blues’ plus conventional care, to conventional care alone, on emotional distress in public service employees with recent stress-related absenteeism. The results of the evaluation indicate that directly following and one month later after the completion of treatment a significant reduction in employee’s depression and negative attribution scores were observed. Additionally, one month following the programme a significant reduction in employees’ anxiety scores, as compared to conventional care, were observed. These differences were not observed at 3 months and 6 months.

References:

Grime, P. R. (2004). Computerized cognitive behavioural therapy at work: a randomized controlled trial in employees with recent stress-related absenteeism. Occupational Medicine 54, 353-359.

Comments:

¹ Attributional style refers to the optimism or pessimism with which people explain why things or events occur to them.