3.6 Occupational Health and Safety
Problem #1: Health at work
Article 1: What is stress? – Sulsky (2005)
Misconceptions about stress:
1. You should strive to eliminate all stress in your life: stress can have positive implications, this
is called eustress. The right amount of stress can make life exciting.
2. Stress is just in your head, it cannot harm you: stress is linked to mental and physical illness.
3. Stress is anxiety or nervous tension. If you could calm down, then you would not be stressed:
stress is much more than this such as physiological stress reactions.
4. Stress only implies excess: being bored or under stimulated can also be stressful.
Definitions of stress
Stimulus definitions: define stress in terms of the event or situations (stressor) in the
environment that contributes to or causes a noxious or disruptive experience. This is the
engineering or human factors definitions because it focuses on the external forces. Stress can
be defined using objective or external criteria: this can suggest direct targets of change.
Limitations: no two people respond the same & stress cannot be good according to this.
Response definitions: focusses on the reaction of the organism to the stressor. Strains are
long/term or chronic changes in response to a stressor. The responses are always internal,
but they may have overt manifestations. This is the medical or biological perspective of stress
because it focuses on the internal forces. Limitations: responses may change over time and
the body can undergo an identical response when no stressful stimulus is present (drugs).
Stimulus-response: stress is a result from interactions between environmental stimuli and
individual responses. This is a relational definitions. Stress appraisals may be affected by
characteristics of the person, group or situation. These are called modifiers or moderators.
The role of appraisal
Lazarus coined the term cognitive appraisal to describe the evaluative process. For psychosocial
stress stimuli such as a demanding job, the situation must be appraised as being successful.
1) Primary appraisal: is this situation stressful?
2) Secondary: what can I do about the stressful situation?
The physiology or stress
Fight or flight response: a chain of changes in nerves and glands in the body. The General Adaptive
Syndrome (GAS) consists of three phases:
1. Alarm stage: the first response when experiencing a stressor;
2. Stage of resistance: occurs shortly after the alarm stage. Here the chain of events is initiated
in the pituitary gland, which culminates in glucocorticoid production. At this stage, the body
seems to be recovering, but if the stressors is not eliminated, recovery is only illusory.
3. Stage of exhaustion: long-term or chronic strains. At least initially, this stage mimics the
alarm stage, when the body rallying its last round of defences.
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Article 2: Stress, adaptation and disease allostatis and allostatic load – McEwen (2006)
Systems such as the autonomic nervous system and hypothalamic-pituitary-adrenal axis, promote
adaptation (called allostasis) but these allostatic systems can also cause problems for the body if they
are overactive or underactive. Allostatic load results when the allostatic systems are either
overworked or fail to shut off after a stressful event is over or when these systems fail to response to
the initial challenge, leading other systems to overreact.
People react different to potentially stressful situations, depending on two factors: (1) how they
perceive and interpret the situation and (2) how they perceive the condition of their body.
Homeostasis, allostasis and allostatic load
The body has systems that respond to the body state and to the external environment and promote
adaptation. These systems include the HPA axis, the autonomic nervous system, the metabolic
systems and the immune system. Adaptation is referred to as allostasis and is an essential
component of maintaining homeostasis. However, adaptation to adversity has a price and we have
come to define the cost of adaptation as allostatic load.
Allostatic load is the wear and tear on the body and brain resulting from chronic overactivity
or inactivity of physiological systems that are normally involved in adaptation.
Examples of homeostasis of physiological parameters are things like blood oxygen and pH levels.
Examples of allostasis are the cardiovascular system, metabolic machinery, immune system and
central nervous systems because they show a large range of activity as a function the time of day and
in response to external and internal demands.
Anticipation implies psychological states such as worry and anxiety as well as cognitive preparation
for a coming event. Because anticipation can drive out the output of mediators (ACTH, cortisol and
adrenalin), it is likely that states of prolonged anxiety and anticipation can result in allostatic load.
Health-damaging and health-promoting behaviors may also be regarded as part of the overall notion
of allostasis because they also contribute to some ways that are known to allostatic load.
There are three types of physiological responses that make up allostatic load:
1) Frequent stress: the magnitude and frequency of responses – can lead to type 2 or 3;
2) Failed shut-down: chronic activity and failure to shut off;
3) Inadequate response: failure to respond to challenge - overreacting.
How and why do allostatic systems malfunction and lead to allostatic load?
Allostatic load refers to an imbalance in systems that promote adaptation. This can be the results of
one of the three things mentioned above. How does such imbalance arise? Repeated stress causes
systems to wear out or become exhausted, leading either to the failure of shut-off or failure to
respond. The wearing out of the mechanism that keeps HPA activity contained is likely to involve
damage to the hippocampus. Failure to mount and adequate HPA response results in increased
vulnerability to autoimmune and inflammatory disturbances.
How does this affect the immune system?
Acute stress has the effect of calling immune cells ‘to their battle stations’ and allostasis enhances
responses for which there is an immunological memory. Chronic stress suppresses the DTH response
and increases susceptibility to inflammatory and autoimmune processes.
Type 1: stress will dampen the ability of the immune system to response acutely;
Type 2: the outcome remains to be determined, although closely related to type 1;
Type 3: the insufficiency of HPA reactivity is associated with a failure of acute stress to
potentiate delayed-type hypersensitivity.
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Article 3: The effect of a cognitive and a physical stress-reducing programme on psychological
complaints – Van Rhenen (2005)
The aim of this study was to test the hypothesis that the newly developed, combined physical
intervention is more effective in reducing psychological complaints than a cognitive intervention.
Method: The study was designed as a randomised clinical trial with pre-trial, post-trial and 6-month
follow-up measures. 3842 Employees working in a telecommunications company in The Netherlands
were invited to participate in a screening programme on health experience and perceived work
environment. 130 of them were chosen for this experiment:
Physical exercise and relaxation: the aim was to provide awareness and introduction of
physical and relaxation exercises. Four sessions, 1h, were given over a period of 8 weeks.
Cognitive intervention: the aim was to restructure irrational beliefs. The participants were
presented with coping techniques, such as focusing on problems and seeking social support.
Discussion: No differential effect between the two conditions was demonstrated. It was found that
both interventions revealed a positive impact on psychological complaints, burnout and fatigue, both
in the short term and at 6-months’ follow up. There may be two explanations for this result: (1) the
length and duration of the interventions (too short) and (2) the content of the interventions. The
effect size of the physical intervention might be overestimated by the lack of a control group.
Article 4: Job burnout – Maslach (2001)
These major issues and themes have been shaped in important ways by the history of the research
on burnout. This research has gone through distinct phases of development:
1. The pioneering phase: the work was exploratory and had the goal of articulating the
phenomenon of burnout. Burnout research had its roots in care-giving and service occupations,
in which the core of the job was the relationship between provider and recipient. From the
beginning, burnout was studied not so much as an individual stress response, but in terms of an
individual’s relational transactions in the workplace. Moreover, this interpersonal context
focused attention on the individual’s emotions, and on the motives and values underlying his or
her work with recipients.
2. In the 1980s the work on burnout shifted to more systematic empirical research. This work was
more quantitative in nature, utilizing questionnaire and survey methodology and studying larger
subject populations. A particular focus of this research was the assessment of burnout, and
several different measures were developed. Burnout was viewed as a form of job stress, with
links to such concepts as job satisfaction, organizational commitment, and turnover.
What is burnout?
The only measure that assesses all three of the core dimensions is the MBI:
(1) Exhaustion is the central quality of burnout and the most obvious manifestation of this complex
syndrome. Exhaustion is not something that is simply experienced—rather, it prompts actions to
distance oneself emotionally and cognitively from one’s work, presumably as a way to cope with the
work overload. Of the three aspects of burnout, exhaustion is the most widely reported and the most
thoroughly analyzed yet not sufficient.
(2) Depersonalization is an attempt to put distance between oneself and service recipients by actively
ignoring the qualities that make them unique and engaging people.
(3) The relationship of inefficacy (reduced personal accomplishment) to the other two aspects of
burnout is somewhat more complex. In some instances it appears to be a function, to some degree,
of either exhaustion, cynicism, or a combination of the two. The lack of efficacy seems to arise more
clearly from a lack of relevant resources, whereas exhaustion and cynicism emerge from the
presence of work overload and social conflict.
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Discriminant validity
Burnout is more job-related and situation-specific than general depression. However, individuals who
are more depression-prone (higher scores on neuroticism) are more vulnerable to burnout.
Five common elements of the burnout phenomenon:
(a) There is a predominance of dysphoric symptoms such as mental or emotional exhaustion, fatigue,
and depression. (b) The emphasis is on mental and behavioral symptoms more than physical ones. (c)
Burnout symptoms are work-related. (d) The symptoms manifest themselves in “normal” persons
who did not suffer from psychopathology before. (e) Decreased effectiveness and work performance
occur because of negative attitudes and behaviors.
In the case of the distinction between job satisfaction and burnout, the issue concerns the
interpretation of the commonly found negative correlation between these two constructs. Although
the correlation is not large enough to conclude that they are identical, they are clearly linked.
Theories about burnout
(1) One theory is that it is the best and most idealistic workers who experience burnout—as captured
in the common phrase, “You have to have been on fire in order to burn out.” The notion here is that
such dedicated people end up doing too much in support of their ideals, thus leading to exhaustion
and eventual cynicism when their sacrifice has not been sufficient to achieve their goals.
(2) A second theory is that burnout is the end result of long exposure to chronic job stressors.
Consequently, burnout ought to occur later in people’s careers, rather than earlier, and it should be
relatively stable over time if people stay in the same job.
Phase model of burnout: each of the three dimensions can be split into high and low scores, so that
all possible combinations of the three dimensions result in eight patterns or phases of burnout.
In general, the research on burnout has established the sequential link from exhaustion to cynicism.
However, as mentioned earlier, the subsequent link to inefficacy is less clear, with the current data
supporting a simultaneous development of this third dimension rather than a sequential one. It is
also the case that burnout scores are fairly stable over time, which supports the notion that burnout
is a prolonged response to chronic job stressors.
Outcomes of burnout
Job performance: various forms of job withdrawal such as absenteeism, intention to leave,
and actual turnover. For people who stay on the job, burnout leads to lower productivity and
effectiveness at work. It is associated with decreased job satisfaction and a reduced
commitment to the job or the organization. People who are experiencing burnout can have a
negative impact on their colleagues, both by causing greater personal conflict and by
disrupting job tasks. Burnout may also have a negative spill-over effect.
Health: substance abuse. Burnout causes mental dysfunction—it precipitates negative effects
in terms of mental health, such as anxiety, depression, drops in self-esteem, and so forth. An
alternative argument is that people who are mentally healthy are better able to cope with
chronic stressors and thus less likely to experience burnout.
Situational factors: where does burnout occur?
Experienced workload, time pressure, role ambiguity, role conflict, lack of social support, lack
of support from supervisors (even more important!), lack of feedback and lack of control are
strongly and consistently related to burnout. Buffering hypothesis has mixed result.
Occupational characteristics: new research has focused explicitly on emotion-work variables
(e.g. requirement to display or suppress emotions on the job, requirement to be emotionally
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