MEDICAL FACTORS

ARTICLE #7. STRESS MANAGEMENT AND WORKPLACE DISABILITY

The source of this article is RTWKnowledge.org

At a glance:
Stress causes psychological and biochemical changes in the body, including suppressing the immune system and increasing depression. Stress influences the course of an illness or recovery from an injury.

In stress management programs, individuals are taught to become aware of their own response to stressful events and develop techniques for coping effectively.

When implemented quickly after an injury or illness, stress management programs significantly reduce the amount of time needed off work and the risk of developing a long-term disability. Stress management programs reduce the human and financial costs of work disability.

PERSPECTIVES:

Employee
Stress is the reaction of your body and mind to a demanding situation. Most people already know about the effect of stress on conditions like heart disease and high blood pressure, but not everyone realizes that stress influences all illness and disability. Disability can be extremely stressful, and this stress affects physical and mental health.

Learning stress-management can have significant, measurable effects on your condition. It can reduce the impact of symptoms in your daily life and help you return to work sooner. Some of the conditions that have shown improvement after stress-management training include chronic pain, chronic fatigue and carpal-tunnel syndrome. Stress-management involves becoming aware of the way your body and your mind react to stress, and developing strategies to improve those reactions. It can also include relaxation training, physical exercise and improving social support.

This article gives an overview of what to expect from a stress-management program. If you think stress-management might benefit your condition you can talk to your doctor or employer about where programs are available.

Employer
The physical and psychological effects of stress can delay recovery and return to work after an illness or injury. It's important to acknowledge stress as a legitimate concern – disability affects the whole person, not just their physical abilities.

Stress-management should be a component of disability management. It has measurable benefits, including improved health outcomes and reduced sick leave. Stress management programs can be implemented in large businesses. Smaller businesses might not have the resources to have a program at the workplace, but employers could help their employees to find an appropriate program.

Stress-management programs are cost-effective, with reduced medical expenses and work absence offsetting the initial costs.

Treater
Including stress-management as a component of disability management can improve health measures and return to work outcomes. Stress has become more widely recognized in the community as a legitimate health concern. A recommendation from a health professional could help patients embrace a treatment that might once have been considered unconventional or “airy fairy'.

Insurer
When included as a component of disability management, stress-management can improve health measures and return to work outcomes. Stress-management programs have also been shown to be cost-effective, with reduced medical expenses and work absence offsetting the initial costs.

Original Article, Authors & Publication Details:
D. L. Jones, T. Tanigawa and S. M. Weiss. (2002).

Stress Management and Workplace Disability in the US, Europe and Japan. Journal of Occupational Health, 45:1-7.

1Department of Psychology, Barry University, USA
2Institute of Community Medicine, University of Tsukuba, Japan
3Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, USA

Background, Study Objectives, How It Was Done:
Stress causes psychological and biochemical changes in the body, including suppression of the immune system and increased depression. Stress influences the course of an illness or recovery from an injury.

When implemented soon after an injury or illness, stress management programs significantly reduce the amount of time needed off work and the risk of a long-term disability. Stress management programs reduce the human and financial costs of work disability.

This article is an overview of stress management for disability.

Study Findings:
In stress management programs, individuals are taught to become aware of their own response to stressful events and develop techniques for coping more effectively.

Stress management techniques include:

• Self-management skills
• Relaxation training
• Biofeedback
• Behavior modification
• Cognitive behavioral therapy
• Social support
• Emotional expression
• Physical activity

Stress management programs can be in the form of education/support groups that focus on improving quality of life for people with disabilities (e.g. by reducing symptoms, improving function and reducing the adverse effects of medical treatments). Specific programs have been developed for a variety of conditions, including back pain and other musculoskeletal disorders, high blood pressure, chronic fatigue and psychological distress.

Stress management programs are typically run over 6 – 10 weeks.

They consist of three stages:

Education

Participants are taught to identify stress and stressors (things that cause stress). They learn that stress can have negative effects on their health, and can worsen any illness or injury. During this stage, participants also gain social support by meeting with others in the group.

In cognitive-behavioral stress management programs, participants are taught techniques to reframe their beliefs and expectations and might be taught assertiveness or anger-management techniques.

Social support and education improve a patient's health and reduce costs for a number of conditions, including chronic pain, musculoskeletal disorders, surgery, diabetes and stress-related conditions.

Skills acquisition

Patients observe their own behavior. They take note of the situations they find stressful and their physical, emotional and behavioral reactions to that stress. They may be encouraged to keep a stress diary. They also explore the role of their illness or injury in causing their stress, and any negative thoughts that might lead to feelings of hopelessness (e.g. “I can't do anything any more' or “I can't cope').

Participants also learn skills to help them cope with stress. This might include time-management, exercise or nutrition plans and relaxation techniques.

Relaxation training aims to decrease the body's physical reaction to stress. Relaxation techniques include:

• Progressive muscle relaxation
• Learning to recognize feelings of tension and relaxation by tensing and relaxing different groups of muscles, often combined with breathing exercises. This technique is used for chronic pain and muscle or tissue injury.
• Meditative relaxation
• Mindfulness relaxation
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• Becoming peacefully aware of thoughts and sensations without judging or reacting to them. This technique is more effective than medication, physiotherapy or antidepressants for self-managing pain.
• Guided imagery
• Focusing on a peaceful image.

In a cognitive behavioral stress management program, participants develop problem-solving skills and emotion-focused coping skills. The latter is used for problems that can't be solved by action and have to be tolerated emotionally. Participants might also learn assertiveness or anger management, both of which involve communication skills.

Practice

In the final phase of a stress-management program, participants apply their skills to stressful situations, and evaluate the usefulness of the techniques. They may revise their goals. The aim is not to decrease symptoms, but to change behaviors and reactions to stress.

The health benefits of reduced stress are well-known. In previous studies various stress-management programs have produced the following results:

• Improved health outcomes and decreased medical visits for people with psychosomatic symptoms (symptoms that are influenced or brought about by psychological factors). Approximately 60% of visits to medical practitioners relate to psychosomatic symptoms.
• 36% decrease in visits to the doctor, and a decrease in anxiety, hostility and depression in chronic pain patients.
• A shorter hospital stay (1.5 – 2 days) for surgical patients.
• Decreased risk of heart attack in high stress individuals.

Conclusions:
Psychological factors influence all medical conditions. When combined with medical care, psychological interventions, including stress management, can improve recovery, prevent disability and increase general health and wellbeing. When implemented early after an illness or injury, interventions can improve the patient's prognosis and overall functioning. Stress-management programs are cost-effective, with reduced medical expenses and work absence offsetting the initial costs.

Reducing a person's stress reduces their chance of developing diseases such as hypertension and immune suppression, or engaging in stress-related behaviors such as smoking, substance use, poor sleep or limited exercise. Stress management can provide support while people adjust to a disability, and can also improve relations between staff and management.

There are a variety of publications available to help businesses set up a stress management programs. Employee assistance programs also offer on and off-site stress management programs. Many companies offer counseling services. Smaller businesses may lack the resources to manage disabilities within the workplace and therefore need to use external health services.

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