Tuesday, April 19, 2011

Interventions in the Workplace to reduce psychosocial stressors

This blog is the first of a series that will address ways to intervene at the workplace to reduce psychosocial stressors and create a healthier workplace. Our colleague Dr. Tores Theorell, who with Dr. Robert Karasek created the Job Strain model (a leading model of workplace psychosocial stress) has been conducting research intended to shed light on improving the workplace. Here is his blog (at the end of the blog is a short list of references for those interested in more information on this topic). Dr. Theorell is Professor Emeritus in Psychosocial Environmental Medicine, Karolinska Institute, Sweden

How do we increase empathic awareness in managers of the importance of
psychosocial environment at work?

I have been involved in research on adverse psychosocial working
conditions and their effects on employee health since the late 1960's. 

There is no doubt that a change in attitude and knowledge among managers
could be of fundamental importance to the improvement of psychosocial
working conditions for workers in the US and in the whole world. Of course
working with the whole organisation may even be better but to start with
the managers could be a good idea. Peter Schnall and others have discussed
this in the book Unhealthy Work. According to their findings many managers
do not know and even more importantly do not seem to see the importance of
psychosocial working conditions to the health of their workers. They are
also unaware of their organisation´s extensive financial costs caused by
unhealthy working conditions. But how to change such attitudes? In our
first experiment which was evaluated using a controlled design (Theorell et
al Psychosomatic Medicine 2001, see above, open access) a good education
program was used lasting for a year. The manager education was mandatory
for all managers in the ”experimental” part of the organisation. They met
every second week at the work place for a short lecture lasting half an
hour and then split up in discussion groups with 7 participants in each.
The two-week period between sessions was used for practical application and
discussions with manager colleagues and other colleagues. Another part of
the organisation with very similar work tasks and organisation served as
control group. Measurements of psychosocial working conditions and morning
plasma cortisol were performed both in the managers themselves and in their
employees in both groups. During the study year, the morning plasma
cortisol decreased in the employees in the experimental group whereas no
change at all was seen in the comparison group. Also the standard measure
of decision authority showed a significantly better development in the
employees in the experimental group. It should be pointed out that a
strength in this study was that the participating managers were all working
in the same organisation and they supported one another during the process.

I would, however, like to bring your attention to a recently published
article from our group which brings up a topic that could be of major
importance to our ways of dealing with psychosocial work environments. This
project will be discussed in the upcoming Work and Stress congress in
Orlando, Florida, in May 2011. It describes an RCT (randomly controlled design)
experiment comparing two manager education programs and their effects on employees.

Participating managers had to accept in advance that they would be
randomized. A three-day course introducing good management principles was
the start for both groups. They were then randomized to two groups.
Managers attending these two different kinds of education lasting for a
year were followed as well as their subordinates (four subordinates for
each manager) with measurements before start, after one year and then after
a follow-up period of 6 months. Sessions of similar length took place
approximately once a month in both groups. A good established manager
education program (very similar to the one used in the previous study) in
this case constituted the “comparison” condition and it was compared with a
program which included exposure to art experiences (poetry “amplified” by
music) designed to evoke discussions regarding choices in ethically
difficult situations. Group discussions and diaries were used very actively
to structure these ethical discussions. Significantly more beneficial
effects on the employees (mental health using standardised questionnaires
and plasma levels of DHEA-s, a hormone with regenerative/anabolic function
as well as plasma cortisol) were observed half a year after the end of the
two programs after the "new" program compared to the "established"
(actually very good) one, indicating (as one would logically think) a
slightly delayed effect of the program on the employee conditions. Season
effects (May compared to follow-up in November) were balanced by the

It is speculated that effects on empathy were more pronounced on the
managers in the new program with artistic components. Our results indicate
that the employees also seem to experience that there is a change in
attitude (more courage and more agreeableness) in their managers compared
to the employees in the other group. The artistic component represents an
educational principle to be tested in other manager education programs.
However such programs have to be carefully adapted to specific
circumstances. They could perhaps be used as a supplement to other
education. In the comparison between the two programs it should be
mentioned that in the second study the participating managers were “loners”
in the sense that they did not come from one and the same organisation and
accordingly they did not have support from colleagues in the process. This
may be less important in the artistic program in which more individual
effects were likely to arise.

Psychother Psychosom 2011;80:78–87 DOI: 10.1159/000321557 (open access):
Health Effects on Leaders and Co-Workers of an Art-Based Leadership Development Program
Julia Romanowska, Gerry Larsson, Maria Eriksson, Britt-Maj Wikström, Hugo
Westerlund and Töres Theorell, Department of Public Health Sciences, Karolinska Institutet, Stress Research Institute, Stockholm University, Department of Leadership and Management, Swedish National Defense College, Stockholm , Sweden, and Akershus University College, Faculty of Health, Nutrition and Management, Oslo , Norway

Some of our more recent publications are the following:

Theorell, T., Emdad, R., Arnetz, B. and Weingarten, A-M. Employee effects
of an educational program for managers at an insurance company.
Psychosomatic Medicine, 63: 724-733, 2001.

Theorell, T., Oxenstierna, G., Westerlund, H., Ferrie. J., Hagberg, J. and Alfredsson, L. Downsizing of staff is associated with lowered medically certified sick leave in female employees. OEM 60: e9, 2003.

Theorell, T. Democracy at work and its relationship to health. In:
Research in Occupational Stress and Well being.  Emotional and
Physiological Processes and positive intervention strategies. Eds. Perrewé, M.L. and Ganster, D.C. Elsevier, vol 3, 323-357, 2004.

Liljeholm Johansson, Y. and Theorell, T. Satisfaction with work task
quality correlates with employee health. A study of 12 professional
orchestras. Medical Problems of Performing Artists. 18; 141-149, 2003.

Kivimäki, M., Theorell, T., Westerlund, H., Vahtera, J. and Alfredsson, L. Job strain and ischaemic disease: does the inclusion of older employees in the cohort dilute the association? The WOLF Stockholm Study. J Epidemiol Health. 62; 372-374, 2008.

Theorell T. Psychosocial factors in research on work conditions and health in Sweden. Scand J Work Environ Health. 2007;33 Suppl 1:20-6. No abstract available. PMID: 18389569

Hanson, L., Theorell, T., Oxenstierna, G., Hyde, M. and Westerlund, H.
Demand, control and social climate as predictors of emotional exhaustion
symptoms in working Swedish men and women. Scand J Public Health. 36(7),
737-43, 2008

Hagerman, I., Rasmanis, G., Blomkvist, V., Ulrich, R. And Theorell, T.
Influence of intensive coronary care acoustics on the quality of care and
physiological state of patients. J Acoust Soc Am. 123(5); 3094, 2008.

Nyberg, A., Westerlund, H., Magnusson Hanson, L., & Theorell, T.
Managerial leadership is associated with self-reported sickness absence and sickness presenteeism among Swedish men and women. Scand J Publ Health. 26; 803-811, 2008.

Nyberg, A., Alfredsson, L., Theorell, T., Westerlund, H., Vahtera, J. and
Kivimäki, M. Managerial leadership and ischaemic heart disease among
employees: the Swedish WOLF study. Occup Environ Med. 66;1, 51-55, 2009.

Magnusson Hansson, LL., Theorell, T., Bech, P., Rugulies, R., Burr, H.,
Hyde, M., Oxenstierna, G. and Westerlund, H. Psychosocial working
conditions and depressive symptoms among Swedish employees. Int. Arch.
Occup Environ Health. 82; 951-960, 2009 2009.

Theorell, T. Anabolism and catabolism. In: Research in occupational stress
and wellbeing, vol 7. Current perspectives on job-stress recovery. Eds.
Sonnentag, S., Perrewé, P.L., and Ganster, D.C. pp 249-276, 2009.

Hasson D, Theorell T, Liljeholm-Johansson Y, Canlon B. Psychosocial and
physiological correlates of self-reported hearing problems in male and
female musicians in symphony orchestras. Int J Psychophysiol. 74; 93-100,

Theorell, T., Andreeva, E., Leineweber, C., Hanson Magnusson, L.,
Oxenstierna, G., and Westerlund, H. Restructuring and employee health. 5th Int. Vilnius Conf., EURO Mini Conference, Sept 30 – Oct 3, 2009, Vilnius, Lithuania.

Leineweber, C., Westerlund, H., Theorell, T., Kivimäki, M., Westerholm, P. and Alfredsson, L. Covert coping with unfair treatment at work and risk of incident myocardial infarction and cardiac death among men: prospective cohort study. 2011 May;65(5):420-5. Epub 2009 Nov 24

Theorell, T., Bernin, P., Nyberg, A., Oxenstierna, G., Romanowska, J. and
Westerlund, H. Leadership and employment health. A challenge in the
contemporary workplace. In: Contemporary Occupational Health Psychology.
Global perspectives on research and practice. Vol 1. Ed. Houdmont, J. And
Leka, S. Wiley-Blackwell. J Wiley & Sons. 46-58, 2010.


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