title: Stress management in work settings: a critical review of the health effects.
abstract: OBJECTIVE
  To review critically the research literature on the health effects of worksite stress-management interventions.
  
  
  METHODS
  Stress-management interventions were defined as techniques that are designed to help employees modify their appraisal of stressful situations or deal more effectively with the symptoms of stress. Stress-management studies that were worksite based, assessed a health outcome, and were published in the peer-reviewed literature were included in this review. The main search method was the one described in the lead article to this special issue of the JOURNAL, but supplementary sources included prior reviews of the research literature and expert contacts. Sixty-four studies met the criteria for inclusion in this review.
  
  
  RESULTS
  A variety of stress-management techniques was used in worksite studies, including muscle relaxation, meditation, biofeedback, cognitive-behavioral skills, and combinations of these techniques. The most common techniques used were muscle relaxation, cognitive-behavioral skills, and combinations of two or more techniques. Outcome measures to evaluate the success of stress interventions included physiologic and psychologic measurements, somatic complaints, and job-related measures. Nearly three-fourths of the studies offered the training to all workers and did not specifically recruit high-stress employees. Over half the studies were randomized control trials, but only 30% conducted posttraining follow-up evaluations. The effectiveness of stress interventions varied according to the health-outcome measure used; some techniques were more effective for psychologic outcomes (e.g., cognitive-behavioral skills), whereas others were more effective for physiologic outcomes (e.g., muscle relaxation). Biofeedback was the least frequent technique used in work settings and also seemed to be the least effective technique. Meditation produced the most consistent results across outcome measures but was used in only six studies. In general, studies using a combination of techniques (e.g., muscle relaxation plus cognitive-behavioral skills) seemed to be more effective across outcome measures than single techniques.
  
  
  CONCLUSIONS
  The large number of different stress-management techniques coupled with the wide range of health outcome measures used in stress intervention studies makes it difficult to draw firm conclusions about the efficacy of each technique and each outcome. Also, the quality of the methodology varied substantially among studies. Nevertheless, the most positive results across the various health outcomes were obtained with a combination of two or more techniques. None of the stress interventions was consistently effective in producing effects on job/organization-relevant outcomes, such as absenteeism or job satisfaction. To produce changes on these types of measures, stress interventions will need to alter or modify the sources of stress in the work environment. It can be said that stress management in work settings can be effective in enhancing worker physical and psychologic health, but the choice of which stress-management technique to use should be based on the specific health outcomes that are targeted for change.
authors.affiliation: National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio 45226, USA.
authors.forename: L R
authors.initials: LR
authors.lastname: Murphy
mesh_terms: D002055:Burnout, Professional / Q000517:prevention & control*; D006801:Humans; D009786:Occupational Health Services / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D012064:Relaxation Therapy / Q000592:standards*; D012107:Research Design; D017132:Workplace