Pinpointing stress causes key to stress management

There is no one perfect model for an effective stress management program, but those that get results often will have several elements in common. Don R. Powell, PhD, president of the American Institute for Preventive Medicine in Farmington Hills, MI, says one of the most important elements is to have the program somewhat custom designed.

There are different time pressures, workloads and job insecurities from profession to profession and from company to company. "Are employees being pushed to perform when they are not really trained? Is there adequate compensation? Do they have control over their destiny at work? Clearly knowing how to control this can mitigate stress," he says.

Other key elements Powell recommends include:

  • teaching time-management skills;
  • relaxation training;
  • helping people diagnose the stress in their lives;
  • helping people understand the relationship between stress and change.

Addressing change also is critical to Jennifer Lim, RN, MSN, COHN-S/CM, FAAOHN, of Comprehensive Health Services, based in Vienna, VA. "We have to identify what we can control and understand where our stressors are coming from," she says. To do this, Lim employs a stress map matrix. The matrix has 10 domains — such as personal, professional, financial — each representing different components of one’s life. In each, the employee is gauged as being in a hot zone (which is highly stressed), a warm zone, an alert zone, and so on. Lim asserts that successfully making changes in one box can lead to changes in others.

She agrees with Powell on customization. "A person has to develop and customize their approach within their own style," she says. Employees also have to be helped to identify the underlying causes of stress. "Too often, we give them coping mechanisms, which are like a Band-Aid; we don’t understand there’s a deep gash below," she explains. Finally, says Lim, miscommunication in the workplace must be addressed. "It’s one of the major stressors," she asserts.

Communication also is a critical issue for Sam Moon, MD, MPH, chief of the division on environmental and occupational medicine and director of clinical and corporate affairs for the Duke Center for Integrated Medicine, Durham, NC. This is especially true, he says, when it comes to communication between managers and employees. "I see a lot of information that suggests management training is a big part of the leverage you need in the workplace to help employees deal with stress," he says. "This gets to the interaction between the employee and the job. Job strain may be no more than a mismatch between the degree of autonomy and the demands of the job. The supervisor might need to recognize that."

Moon also recommends having a gatekeeper on staff to identify and refer those employees who need to go on to more intensive therapy. Finally, he says, a well-rounded program should provide critical incident debriefing. "There were tons of these provided after 9/11," he notes. "They can also address death threats or concerns about racial tensions or upcoming downsizing."

Whatever the critical incident, Lim agrees with Moon that this should be a distinct element from basic stress management. "It’s entirely different," she says.