Patrick Tyler

Cognitive therapy and behavioural coping in the management of work-related stress: An intervention study

Abstract Transactional models of stress emphasize the importance of cognitive appraisal of potential stressors in the determination of the stress response. This appraisal can be modified by the use of techniques normally associated with cognitive therapy. The contribution of a specifically cognitive component when intervening in work-related stress has not been well evaluated to date. This research seeks to determine the effectiveness of stress management training in the treatment of the work-related effects of stress by comparing the role of modifying dysfunctional cognitions with the teaching of appropriate behavioural coping strategies. Participants were allocated to one of two intervention conditions or to a waiting list control group. Those in the intervention conditions received group stress management either with the focus on delivering cognitive therapy techniques or with the focus on behavioural coping skills. Measures of general health were taken at the beginning and end of intervention and at 3-month follow-up. Participants in the cognitive therapy groups who were reporting symptoms of general ill-health at the start of the intervention showed a significant improvement at follow-up. Cognitive therapy appears to have been an effective intervention in work-related stress. Those in the behavioural group showed a smaller but still clinically effective improvement. Results are discussed in terms of methodological issues and implications for future research. It is suggested that changes in cognitive appraisal may need to be developed.

Stress in Clinical Psychologists

This paper summarises the findings of a series of studies of British clinical psychologists and discusses them in relation to the (mainly US) literature. Four main questions are addressed: (1) How stressed are clinical psychologists? (2) Which psychologists are most stressed? (3) What are the main sources of stress for clinical psychologists? and (4) What coping strategies are used by clinical psychologists? A figure summarises the main risk factors emerging from the literature which appear to be important mediators between the stressor and the psychological outcome variables. These are: (1) low job satisfaction; (2) low range of active coping strategies; (3) high use of avoidance coping strategies involving denial; (4) stressor not externalised and objectified; (5) stressor threatens other roles/relationships; (6) low experience in job; (7) no quality relationship with confidant(e)/poor quality relationship with partner; and (8) female.

Stress and well-being in nurses: a comparison of the public and private sectors

Nurses in the public and private sectors were compared with regard to occupational stress and its sources and self-reported health and well-being. While both groups reported similar high levels of stress experience, most noticeably arising from high work loads and the experience of death and dying, group differences did emerge from an examination of the sources of stress. Whereas N.H.S. nurses were more troubled by high work loads, private sector nurses reported uncertainty over treatment as a more frequent source of stress than did their N.H.S. counterparts. Levels of self-reported mental and physical health symptomatology did not differ between groups. Nevertheless, overall nursing stress scores and symptomatology were significantly correlated, and workload was the best independent predictor of health and well-being status.

Stress and well­being in health­care staff: the role of negative affectivity, and perceptions of job demand and discretion

A questionnaire survey was administered to volunteer staff from the Surgical and Mental Health Directorates of an English hospital district. The aim was to investigate the relationships between job stressors, coping strategies, job satisfaction and well-being, in light of Karaseks demand–discretion model. The effects of controlling for age, gender and negative affectivity were also of interest. After controlling for these factors, there was found to be no interaction between job demand and discretion for either job satisfaction or psychological distress, so Karaseks model was not supported. Both job dissatisfaction and psychological distress were found to be influenced by lack of resources, while perception of demand was strongly influenced by workload; these were also the stressors that differentiated the two hospital directorates, with the surgical staff suffering higher levels of both. Controlling for negative affectivity had a stronger influence on the measure of distress than on job satisfaction and the two outcome measures were not interchangeable. Recommendations centred on improving structural conditions, especially for surgical staff, and on reducing levels of anxiety and hostility by promoting stress management.