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

design.

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,

2009.

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.