FIRST PUBLISHED IN THE RATIONAL EMOTIVE BEHAVIOUR THERAPIST, 3, 1, 45-55, 1995.
Copyright, Palmer, 1999

ABSTRACT

Industrial interventions at three levels and the use of the Occupational Stress Indicator are described. Then the contents of a typical stress management or managing pressure workshop are given with recommendations for the minimum skills and knowledge that may be required by the trainer to run such a course.

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INTRODUCTION
Essentially, the rational emotive behavioural therapy approach is psycho-educational and it adapts easily to the field of industrial stress management and associated interventions (see Criddle, 1993; Ellis, 1972; Ellis & Blum, 1967; DiMattia, 1991; Kirby, 1993; Klarreich, 1993; Lange & Grieger, 1993; Miller & Yeager, 1993; Morris, 1993; Neenan, 1993a,b; Palmer, 1993a; Richman, 1993; Timofeev, 1993; Woods, 1987). In recent years a psychometric instrument, the Occupational Stress Indicator (OSI) (Cooper et. al., 1988) has been developed that can aid industrial REBT stress management trainers or educators to give helpful feedback to workshop participants. This article briefly covers a comprehensive REBT based industrial stress management workshop and how the OSI can be used.

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INDUSTRIAL INTERVENTIONS
Organisational interventions can be made at three different levels (Cox, et. al. 1990):

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Primary: Remove hazard or reduce employees' exposure to it,
or its impact on them.

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Secondary:Improve the organisation's ability to recognise
and deal with stress related problems as they
occur.

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Tertiary: Help employees cope with and recover from work
related problems

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In Britain under the Management of Health and Safety at Work Regulations 1992, employers must assess risks to health and safety and implement avoidance and control measures. Stress is a hazard that could be included in the risk assessments and the avoidance and control measures are primary interventions which should be an organisation's top priority. Unfortunately tertiary interventions help employees deal with the impact of stress once they are suffering from it and include stress counselling or medical assistance such as medication or surgery. Although these methods are important, they do not focus on removing the stressor.

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REBT based stress management interventions which concentrate on the employees' appraisal of situations and potential stressors are useful at both the secondary and tertiary intervention levels. However, one of the goals of using REBT in industry would be prevent employees from becoming unnecessarily stressed in the first place, and to be able to recognise the true source of stress i.e. is it from internal or external pressures. Once this has been understood then the employee may be in a better position to deal with or change the stressor. A common problem in industry are employees who hold rigid, inflexible, beliefs about performing extremely well under all conditions as they are more likely to suffer from higher levels of stress when compared to employees who hold more helpful flexible beliefs and standards. The so called 'perfectionist' may paradoxically be less productive and attain lower standards of work due to their anxiety about failing.

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THE OCCUPATIONAL INDICATOR
Before any workplace intervention to reduce stress is made, it is important to assess the needs of the organisation and its employees as it should not be assumed that a stress management workshop would be helpful in all situations. At this stage questionnaires completed by staff or key personnel can provide useful information. The OSI can be used as it evaluates occupational stress by analysing five key factors:

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Sources of pressure:
Factors intrinsic to the job itself
The managerial role
Relationships with other people
Career and achievement
Organisational structure and climate
Home/work interface

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Individual characteristics (Type A):
Attitude to living
Style of behaviour
Ambition
Total type A

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Locus of control:
Organisational forces
Management processes
Individual influence
Total control

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How the individual copes with the stress experienced:
Involvement
Time
Home and work relationships
Logic
Task strategies
Social support

The effects of stress:
Personal relationships
Organisational processes
Organisational design and structure
The job itself
Achievement, value and growth
Total job satisfaction
Mental health
Physical health

This provides a wealth of information about how the staff perceive the organisation and the effects of stress upon them. In addition to the individual profile of an employee, a group profile is also provided which highlights what employees believe are the main causes of their stress. If the management, trade unions, the employees and other relevant parties agree that a stress management workshop or course may be beneficial then a pilot scheme can be set up. In some cases the decision to run a stress management course may only be taken by the management. This can lead to problems of implementation if employees and the trade union perceive that the management are totally blaming the staff for their own levels of occupational stress.

A month prior to the workshop, employees are asked to complete the OSI questionnaire. They are informed that only the trainer/consultant (and themselves) will see the questionnaire and the subsequent printed report, which will highlight their own perceived occupational stressors and recommendations to help them reduce their levels of stress. They are also asked to keep a stress diary for a typical work day i.e. monitor and record the (apparent) causes of stress.

WORKSHOP CONTENTS

Generally, in my experience, 1-day stress management workshops based on rational emotive behavioural interventions are too short to discuss relevant work-related issues, what is stress and how to reduce it. Two day workshops with a half-day follow-up are preferable. The 'managing pressure to increase performance' or 'stress management' workshops I run tend to share similar themes depending upon the needs of the group (adapted Palmer & Dryden, 1995; abridged Clarke & Palmer, 1994) :

1 Negotiation of ground rules (including discussing the
benefits of confidentiality if unclear to the group
members).
2 Ask what they hope to learn and achieve over the next 2 days
(This confirms their requirements they sent in prior to the
course.)
3 Participants share their 'Stress Diaries' in group setting.
Trainer focuses on how different members of the group would
have felt and dealt with the disclosed stress scenarios
stressing the diverse cognitive, emotive and behavioural
dynamics.
4 Discussion of simple definition of stress e.g. too much or
too little pressure leads to stress; pressure can be
internal or external.
5 Small group work to consider symptoms of stress.
6 Debrief & discuss psychophysiology of stress. (Use suitable
video that explains the physiology of stress in simple
terms.)
7 Use of biodots (temperature sensitive biofeedback).
8 Teach the ABCDE paradigm. Illustrate how irrational beliefs
and twisted thinking (cognitive distortions) exacerbate
stress.
9 Thinking skills (challenging irrational beliefs and major
cognitive distortions) -small group work (in pm of first
day & am of second day). Participants use a 'thought form'
to aid practise of the thinking skills (see handout 1,
Neenan, 1993b).
10 Multimodal Relaxation Method (MRM) (Palmer, 1993b).
(Consists of Benson Relaxation Response, positive imagery
of each participant's choice, breathing exercise, and
mental relaxation.)
11 Then Galvanic Skin Response (GSR) biofeedback to discover
what part of the MRM helps them to relax the most.
12 GSR to illustrate thoughts and images can cause stress and
how irrational beliefs appear to exacerbate any situation.
13 Imagery techniques e.g. rational-emotive imagery, coping
and time projection imagery (see Palmer & Dryden, 1995).
14 Occupational/organisational stress discussed and
interventions developed in small groups. Stress mapping may
be used (Palmer, 1990; see handout 2, Palmer and Dryden,
1995, pp.247)
15 Type A, Locus of Control, and workplace coping strategies
discussed & assessed. What can be improved.
16 Occupational Stress Reports given out. Group and individual
debrief. Discuss what can be done about stressors.
17 Additional coping strategies e.g. assertion, stability
zones, time management etc.
18 Lifestyle interventions e.g. diet, weight, exercise, stop
smoking.
19 If appropriate, a group stress management action plan
is developed, facilitated by the trainer.
20 Individual stress management plans developed by each
participant.
21 Discussion of 'where to go from here'
22 Possibility of follow-up day discussed.
23 Feedback & evaluation.

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Ellis (see 1972; Abrams & Ellis 1994; Palmer, Dryden & Ellis, 1993, pp. 51) has found key irrational beliefs that lead to stress in employees:

Premise
I must do better
You must treat me better
My working conditions must be better
People must like me

Derivatives
I won't do well and that would be awful
I can't stand my working conditions
If people don't like me, I am pretty worthless

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It is important to help the workshop participants recognise these irrational beliefs and learn how to dispute them using REBT thinking skills. It is worth noting at that in industrial workshops to help overcome any prejudices that may be encountered involving therapeutic/psychological terms e.g. 'counselling', or 'cognitive distortions' the focus is on skills training, emotional management, and problem-solving.

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The computerised OSI report also gives feedback on how 'logical' the individual's behaviour and thinking is at work. This information is important as it is directly related to how emotionally disturbed and stressed a person becomes when dealing with a difficult situation. This can spur employees on to start using their newly acquired REBT thinking skills. The trainer can help facilitate staff, especially managers and directors, to focus on removing or reducing the impact upon employees of the stressors that the OSI group profile found. This is then helping the organisation to intervene at a primary level.

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CASE STUDY
A large corporation decided to offer its employees 'managing pressure to increase performance' or 'stress management' training. The programme started initially with managers and after the pilot scheme was evaluated the training programme was modified e.g. sections that the participants did not find particularly useful were left out. The programme later included training senior managers who wanted to discover what their staff were learning on the programme. As each workshop participant receives a personal Occupational Stress Report (Cooper et. al., 1988) during the course of the workshop it was important that all participants understood issues such as Type A behaviour, locus of control and coping strategies before reading their report. Time is set aside to see participants individually to answer any queries that may have arisen from the workshop or the OSI report. Otherwise this would be unethical use of a psychometric test and report.

At the follow-up half day sessions the majority of staff reported that they had benefited from the programme. Consistently they reported that the following had been very helpful to reduce stress:

a) Learning about stress and discussing it with colleagues.

b) Learning to 'de-awfulise' stressful situations using the 0
to 99.99% badness scale (see Palmer & Dryden 1995,
pp. 194).

c) Learning not to rate themselves by their actions using the
'Big I, little i' dispute (see Lazarus, 1977).

d) Learning how to become less 'Musty' i.e. relinquishing
their musturbatory beliefs.

e) Recognising and challenging 'all-or-nothing' thinking.

f) Learning and using relaxation techniques including imagery
techniques.

h) Realising that the company will still go on after their
own death and the latter would go almost unnoticed by
senior management anyway.

SKILLS AND KNOWLEDGE REQUIRED BY TRAINERS
Palmer and Dryden (adapted 1994, pp. 11) have suggested that stress management trainers/consultants need a range of skills and knowledge to be effective in industrial settings:

Adequate competency in:

rational emotive behavioural techniques
counselling and listening skills
group-facilitation skills
teaching related key topics
problem-solving skills/training
the use of psychometric tests
knowledge of relevant research
knowledge of lifestyle options, e.g. diet, exercise etc.
understanding of occupational, organisational, change management, family, social, and cultural issues.

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Although the stress management trainer/consultant may require some years of training to attain adequate skills and knowledge in the above areas, the purchaser of the services is more likely to receive a comprehensive programme if the consultant is aware of the different issues involved in occupational stress. The trainer is also advised to be aware of any legislation that refers directly or indirectly to stress (see Palmer, in press).

In the ideal situation the trainer will be an external consultant which helps to overcome problems of confidentiality. However, this is not always essential as it depends upon the actual and perceived ethos of the organisation.

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CONCLUSION
Unfortunately, companies tend to resist primary level organisationally-orientated interventions and this probably accounts for the lack of published research in this area and stress management workshops are often seen as the 'cheap' option. However, comprehensive rational emotive behaviour training programmes as described in this article which do not overlook the multifaceted nature of stress appear to help employees learn to use 'practical management' and 'emotional management' skills to deal with both internal and external pressures and thereby manage their stress.

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Correspondence: Centre for Rational Emotive Behaviour Therapy, 156 Westcombe Hill, Blackheath, London, SE3 7DH, England.