The Problem with Stress "Management"

Psychophysiological (mind/body) stress in the workplace has a great impact on personal and organizational "health." Annually, $300 billion are lost due to stress-induced absenteeism, accidents, replacement costs, and insurance fees. While there are multitudes of "stress management" programs, there is no inexpensive and objective way to measure psychophysiological improvement and relate it to the desired outcome.

Historically, the recommendation of doctors and wellness specialists has been to "just relax." That is, apply some sort of intervention, technique or training class that breaks the stress cycle or reduces the amount of stress exposure. Yet, in spite of the best intentions, the rate of stress-related injury and illness continues to rise.

The Number Don't Look So Good

It is no secret that stress is America's number one health problem, but most individuals or organizations appear to have little idea about how much employee stress actually costs them each year.

A 1990 study by the Princeton, NJ, firm of Foster Higgins & Co. states that corporate health benefits cost the average company 45 percent of its after-tax profits. With research implicating stress in 60 percent to 90 percent of medical problems, companies cannot afford to ignore the huge health-care expense employee stress creates.

The American Institute of Stress, a clearing house for stress-related information and statistics, reports that:

• 43% of all adults suffer adverse health effects due to stress.
• 75-90% of all visits to primary care physicians are for stress-related complaints or disorders.
• Stress has been linked to all of the leading causes of death, including heart disease ( CHD , MI ), cancer, lung ailments, accidents, cirrhosis, and suicide.
• An estimated 1 million workers are absent on an average workday because of stress related complaints. Stress is said to be responsible for more than half of the 550,000,000 workdays lost annually because of absenteeism.
• A three-year study conducted by a large corporation showed that 60% of employee absences were due to psychological problems such as stress.
• Nearly half of all American workers suffer from symptoms of burnout, a disabling reaction to stress on the job.
• The proportion of workers who reported "feeling highly stressed" more than doubled from 1985 to 1990.

Furthermore:

• Job stress is estimated to cost U.S. Industry $300 billion annually, as assessed by absenteeism, diminished productivity, employee turnover, direct medical, legal and insurance fees, etc. Sixty to 80% of industrial accidents are due to stress. Some, like the Exxon Valdez oil spill and Three Mile Island nuclear disaster, have direct cleanup costs of billions of dollars, not to mention environmental damage that cannot even be estimated.
• Workers' compensation awards for job stress, rare two decades ago, have skyrocketed and threaten to bankrupt the system in some states. California employers paid out almost $1 billion for medical and legal fees alone. Nine out of ten job stress suits are successful, with an average payout more than four times that for regular injury claims.
• Forty percent of worker turnover is due to job stress. The Xerox Corporation estimates that it costs approximately $1-$1.5 million to replace a top executive, and average employee turnover costs between $2,000 to $13,000 per individual.
• Workplace violence is rampant. There are almost 2 million reported instances of homicide, aggravated assault, rape or sexual assaults. Homicide is the second leading cause of fatal occupational injury and the leading cause of death for working women.
• Finally, the market for stress management programs, products, and services was $9.4 billion in 1995, and was projected to be $11.31 billion for 1999.

If You Can't Reduce Stress . . . Reduce the effects of stress

Stress, in its simplest form, is defined as “…bodily or mental tension resulting from factors that tend to alter an existent equilibrium.” That is, stress is anything that causes our bodily systems to adjust to maintain balance.

A stress response is the compensatory reaction the body makes to the stressor. It is important to remember that a simple stress response is not "disease" - but merely a normal adaptive response to maintain homeostasis (balance) while the system responds to the stressor.

The danger of the effects of stress increase when the homeostatic mechanisms become “overloaded” and can no longer recover fully from the stress stimulus. We use the notion of reducing the “effects of stress” rather than simply “reducing stress” itself because stress is not going to be significantly reduced in the American corporate environment, at least in the short-term.

Are current stress management approaches adequate?

Whether you call it "management", "reduction", "abatement", "relief", or some other term, its purpose is the same--intervene in the stress response and return your Autonomic Nervous System to a state of dynamic balance and response-ability.

Nearly one-half of large companies in the US provide some type of stress management training for their workforces. The current efforts to stem the effects of workplace stress have much “face validity” and are well accepted. Unfortunately, they are largely ineffective. Thus, in spite of the tremendous focus on reducing stress in the workplace, stress is increasing.

There are several factors to consider when discussing the effectiveness of stress interventions:

• The results of such programs tend to be focused on just the subjective or self-report domain and ignore the two other important domains—physiological and motoric/behavioral. Stress management trainers appear to assume that synchrony holds for these 3 response domains, but de-synchrony is more the rule than the exception. Workers who report improvement may well be unaware of deleterious physiological and behavioral effects. Further, the effects of job stress interventions on self-report measures tend to be less clear-cut and can take a long time to appear. Until recently, the self-report of the perception of stress had not been correlated to an objective physiologic index of stress in real-time.
• Well-intentioned attempts at improvement are often sabotaged because program leaders ignore the connection between stress and the fear of change. This hardwired survival mechanism wreaks havoc in today's climate of rapid organizational change. As a person's stress level increases, that person is more likely to operate out of this primitive, hardwired response - clinging to the old ways, the tried and true, even if they are no longer effective.
• Research shows that stress is also connected with "neophobia" - fear of novelty. Animals, which are naturally curious and motivated to explore new environments, avoid new objects and places when under stress. We see this throughout organizations everyday. As people experience increased stress, things that are new and different trigger fear. Millions of dollars are wasted on organizational change efforts that end up being sabotaged and on program implementation delays caused by this innate resistance to change and novelty triggered by stress.
• Most traditional stress management program focus on reducing sympathetic arousal rather than increasing parasympathetic responsivity.

In the typical approach to stress management, workers leave their job area and attend special classes in a more relaxed and stress-free environment. After being exposed to new and sometimes complex skills, the employee returns to the work environment, without follow-up assistance, to face:

• lost productive time which must be recovered
• the daunting task of implementing new skills (behaviors) that must be incorporated in order to overcome the effects of previous stress
• an increased stress load from the first two issues

The wisdom of such “one-shot” programs, with limited to no follow-up training, has been questioned on a number of grounds. In fact, many stress management programs, while educational in nature, have even negatively impacted expenses without making measurable improvement to the profit bottom line and employee health.

A New Approach

At Advanced CardioLogix, we feel that a new approach is warranted, one that utilizes a more direct measure of stress (in addition to self-report) in the situation where it is actually occurring (real-time psychophysiological responding). We have created an innovative approach that:

• Is inexpensive to implement and maintain
• Accurately measures and strengthens the responsiveness of the parasympathetic interactions as a function of HRV
• Is not narrowly focused on the contribution of the sympathetic nervous system or tied to any one stress management program or technique
• Reveals the efficacy of a current stress management campaign
• Is non-invasive
• Is independent of motor or cognitive competence
• Requires minimal time away from the job and does not significantly add to the existing stress load
• Is simple enough to be completed in real-time at the workstation level
• Is sensitive to, and supportive of, the impact of various other stress abatement procedures and programs

Our approach can be implemented as part of an overall stress abatement program that takes into account other aspects of the organizational environment. Job stress remediation does not end with evaluation. Rather, job stress reduction should be seen as a continuous process that uses evaluation data to refine or redirect the intervention strategy. Additionally, when the effects of stress are reduced via the strengthening of parasympathetic influences, more benefit can be derived from a current stress management program because the confounding factors, discussed earlier, are less of an issue.

HRV as a valid measure of stress in the workplace

Advanced CardioLogix and Biocom products, drawing upon cutting-edge biofeedback technology, have incorporated the new emerging technology of Heart Rate Variability (HRV) and introduced it, inexpensively and seamlessly, into the corporate environment.

Heart Rate Variability (HRV) is a reflection of beat-to-beat oscillations in the cardiac sinus rate (firing rate of the sino-atrial node). These oscillations are influenced primarily by the individual‘s respiration rate described as “respiratory sinus arrhythmia (RSA).“ Intrapleural pressure shifts during respiration affect venous pressures that, in turn activate reflex actions leading to changes in the beat-to-beat deviation. Chemoreceptor feedback also plays a role in the oscillatory quality of sinus rhythms. The phasic, respiratory-driven changes in the beat-to-beat interval (RSA) are controlled by the parasympathetic branch of the autonomic nervous system while the tonic control of the heart is mainly sympathetically influenced. In short, RSA is the change in heart rate in conjunction with respiration; heart rate increases during inhalation and decreases during exhalation and is critical for proper nervous system function.

Heart rate variability reflects both peripheral and central activity of the parasympathetic and sympathetic branches of the Autonomic Nervous System. Recent brain imaging studies have confirmed that one component of HRV reflects activity in areas of the brain critical to the allocation of attentional resources during stress. Thus, assessment of HRV provides a non-invasive means of evaluating central nervous systems intimately involved in the capacity of an organism to attend to and respond to a threat. HRV has been shown to be an extremely accurate predictor of individuals who are likely to experience cardiovascular and related adverse health outcomes.

While the use of HRV as a measure of occupational stress is relatively new, the number of studies focusing on this path are increasing rapidly. For example, HRV has been shown to be significantly related to stress and its associated deleterious effects in normal subjects exposed to experimental or laboratory stress, in physically fit individuals in normal day to day activities, in workers while commuting long distances to and from work, in workers exposed to environmental pollutants, and in naturalistic examinations of actual workers in varied settings.

Extensive laboratory investigation among healthy subjects shows a strong association between mental workload and the reduction of respiratory sinus arrhythmia (RSA). Over time, this can entrain compressed HRV.

The effects of stress as a function of overload promote a condition of parasympathetic withdrawal and not only sympathetic increase resulting in excessive arousal that predisposes the body toward catabolic pathology. Because parasympathetic influences drive cardiac variability, this condition is reflected in the tonic reduction of HRV resulting in poor homeostasis and an increased vulnerability to the negative effects of stress. Resulting catabolic pathology can include:

• Halt in the synthesis of protein, fat, and carbohydrates
• Increased breakdown of fat, protein, and carbohydrates (energy mobilization)
• Elevated levels of cortisol, glucose, free fatty acids, low density lipoprotein, cholesterol (for energy)
• Increased production of red blood cells and liver enzymes for energy
• Decreased repair and replacement of bone
• Decreased repair and replacement of cells with normally high turnover (gut, skin, etc.)
• Decreased production of cells for the immune system (thymus shrinks, circulating white cells decrease)
• Decrease in sexual processes
• Increased blood pressure and cardiac output
• Increased salt and water retention

In light of the statistics cited, it is imperative that the effects of stress in the workplace be reduced. .

Our simple breath training exercise using controlled, paced breathing has been shown to reduce sympathetic arousal (via increased vagal tone) and promote an anabolic state of restoration by strengthening parasympathetic influences as measured by improved RSA and HRV. Furthermore, these changes have been reported to be sustained over a period of time with the benefits remaining for up to one year. The only study performed in a work setting [41] showed promising effects.

In short, our simple Breath Training protocol has been shown to be effective in reducing the impact of stress as well as entraining a better capacity for recovery from stress.

Reducing the effects of stress saves money for the company

Recent studies of so-called healthy organizations suggest that policies benefiting worker health also benefit the bottom line. A healthy organization is defined as one that has low rates of illness, injury, and disability in its workforce and is also competitive in the marketplace.

Some employers assume that stressful working conditions are a necessary evil-that companies must turn up the pressure on workers and set aside health concerns to remain productive and profitable in today's economy. Pressures to downsize and concomitant employee fear of potential job loss further exacerbate this situation. However, research findings challenge this belief. Studies show that stressful working conditions are actually associated with increased absenteeism, tardiness, and intentions by workers to quit their jobs-all of which have negative effects on the bottom line.

Most importantly, by reducing the effects of stress in the workplace, there is the potential for preventing much illness and death. More than 50 million Americans have high blood pressure, and, in 95 percent of cases, the cause is unknown. While estimates of the proportion of heart disease possibly due to "job strain" vary greatly between studies, researchers calculate that up to 23 percent of heart disease could potentially be prevented (over 150,000 deaths prevented per year in the U.S.) if the level of "job strain" in jobs with the worst strain levels was reduced to the average of other occupations

Summary

The effects of acute and chronic workplace stress can be effectively measured using spectral Heart Rate Variability (HRV) values. Real-time, short-term (5-minute) spectral analysis of HRV is stable and reproducible, and can show the relative ability of the Autonomic Nervous System to recover from stress (stress resilience).

When recovery levels of parasympathetic influence are not present due to stress exhaustion, HRV can be increased through the application of a simple breathing technique designed to increase RSA.

Increasing HRV through RSA training reduces the effects of stress.