What Is Occupational Stress?

Occupational stress refers to those physical or psychosocial conditions in the workplace environment that lead to physical or psychological strain outcomes. Given early knowledge of the effects of stress on the body (Selye, Reference Selye1946) and increased understanding of the negative impact of workplace psychosocial conditions, such as long work hours, low control over work, and role stress (e.g., Katz & Kahn, Reference Katz and Kahn1978), on both worker health and organizational outcomes, addressing workplace stress is important to both organizational scholars and practitioners. Workplace stress is closely related to worker well-being and costs up to $190 billion annually in the United States (Goh et al., Reference Goh, Pfeffer, Zenios and Rajpal2015). This is consistent with Ganster and Rosen’s (Reference Ganster and Rosen2013) review of work stress and health, with evidence that job stressors predict several indicators of cardiovascular disease, depression, type 2 diabetes, and higher employee healthcare costs (Ganster & Rosen, Reference Ganster and Rosen2013). Given that the impact of occupational stress on individual and organizational costs is high, it is vital for organizational scholarship and practice to investigate and understand interventions that may reduce such costs.

What Is Well-Being?

Warr (Reference Warr2011) defines well-being as a combination of physical, mental, and social health. More recently, Chari et al. (Reference Chari, Chang, Sauter, Sayers, Cerully, Schulte, Schill and Uscher-Pines2018) defined worker well-being as “an integrated concept that characterizes quality of life with respect to an individual’s health and work-related environmental, organizational, and psychosocial factors” (p. 590). Well-being is characterized by positive experiences and emotions and reflected in such outcomes as life satisfaction, positive health, and happiness. In this chapter, we focus on worker physical and psychological health that is impacted by manager interventions. Given researchers have grouped together and examined health, safety, and well-being as similar constructs (Zwetsloot et al., Reference Zwetsloot, Van Scheppingen, Bos, Dijkman and Starren2013), we also believe that perceived safety is an aspect of worker well-being and therefore have included interventions that impact worker safety outcomes in this review. With reports of extreme levels of psychological distress among the general population in relation to the COVID-19 pandemic (American Psychological Association, 2020), there has never been a more important time to pay attention to the psychological health and well-being of employees. Managers may be the best positioned to have a significant impact on employees (see Chapters 5 and 15 in this book), yet only recently has employee well-being been given serious attention in the leadership literature (Inceoglu et al., Reference Inceoglu, Thomas, Chu, Plans and Gerbasi2018).

Job Stress Interventions

Job stress interventions refer to those implemented with the explicit focus of reducing exposures to stressors in the workplace. We have not seen a systematic review of job stress interventions since the LaMontagne et al. (Reference LaMontagne, Keegel, Louie, Ostry and Landsbergis2007) review that included both organizational level and individual level interventions. LaMontagne et al. (Reference LaMontagne, Keegel, Louie, Ostry and Landsbergis2007) reviewed interventions involving both organizational level and individual level approaches (e.g., employee-level personal changes to reduce stressors such as personal coping strategies) and rated these interventions in terms of the degree to which a systems approach was applied to job stress reduction. A high systems approach was defined as both organizationally and individually focused, versus moderate (organizational only) and low (individual only). Moderate ratings were those interventions that only used primary prevention/organizational approaches. With the focus on employee job stress as the outcome, LaMontagne identified 30 studies rated as a high systems organizational level interventions approach (30/90 = 33%); 17 moderate (19%), and 43 low (48%). These high systems approach interventions included managerial interventions, which are a subset of organizational level interventions and the focus of this chapter. The most effective interventions were those that were either organizationally focused or both organizationally and individually focused (LaMontagne et al., Reference LaMontagne, Keegel, Louie, Ostry and Landsbergis2007), a conclusion consistent with that of Semmer (Reference Semmer2007), who characterized job stress interventions as those that were focused on improving employee health and well-being by changing task characteristics, work conditions, or social aspects of work.

Total Worker Health Interventions

Total Worker Health^® (TWH) is a program that was launched by NIOSH in 2011 (Schill & Chosewood, Reference Schill and Chosewood2013) and is based on the premise that individuals’ experiences, exposures, health, and well-being both affect and are affected by their work (Feltner et al., Reference Feltner, Peterson, Palmieri Weber, Cluff, Coker-Schwimmer, Viswanathan and Lohr2016). TWH is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being (Tamers et al., Reference Tamers, Chosewood, Childress, Hudson, Nigam and Chang2019). The TWH approach is focused on workplace hazard reduction and its impact on employee health, safety, and well-being. While such hazards can come in the form of safety hazards that are part of the physical work environment, they can also be psychosocial stress hazards associated with unhealthy work that directly affects employee health and well-being (Schnall et al., Reference Schnall, Dobson and Rosskam2009). TWH approaches emphasize the importance of interventions that integrate changing the employee, other people in the employee’s workplace (supervisors or coworkers), the employee’s job characteristics, or the organization’s climate. Managers and supervisors can be the target of interventions in any of these areas, but most commonly the last three (i.e., other people in the employee’s workplace, the employee’s job characteristics controlled by managers, or the organization’s climate impacted by managers). While much evidence points to the critical role of managers, supervisors, and leaders in impacting employee well-being (Chapter 5 in this book; Arnold, Reference Arnold2017; Hammer et al., Reference Hammer, Kossek, Zimmerman, Daniels, Perrewé and Ganster2007; Inceoglu et al., Reference Inceoglu, Thomas, Chu, Plans and Gerbasi2018; Kelloway & Barling, Reference Kelloway and Barling2010), there is less systematic research on the effectiveness of such approaches.

Search Procedure

We conducted an initial search in PsycINFO, PubMed, Medline, and Google Scholar between the years 2000 and 2020 using the search terms “manager”, “supervisor”, “leader”, “occupational stress”, “well-being”, “intervention”, “training”, and “program” combined with “workplace” or “occupation”. Any abstract that suggested the article contained an occupational stress and well-being intervention, training, or program in which managers/supervisors/leaders played a critical role and reported occupational stress and well-being outcomes for employees was then reviewed in detail and coded by at least one of the authors. A total of 106 articles met these criteria and hence were reviewed in detail. After reviewing the articles, duplicates were removed, as well as review articles, interventions that were not RCTs, interventions that did not examine employee outcomes, and any interventions that did not explicitly have supervisors/managers/leaders as a main part of the intervention. We were left with a total of 29 articles that met the final inclusion criteria of being an RCT involving a manager/leadership intervention that was designed to impact employee occupational stress and well-being outcomes (see Table 12.1). Such interventions can be both proactive/preventative and reactive/responsive. We coded for type of intervention, type of employee outcome, type of primary effect (main, mediation, moderation), and significance of the effects.

Type of Leadership Intervention

In the present review, all intervention programs are categorized as managerial training and educational programs. Five broad categories were identified based on the substantive content focus of the training program and the outcomes the intervention was expected to impact for employees. These include managerial training and educational programs that were focused on improving: (a) job design/ergonomic workplace conditions (N = 3) (i.e., Eklöf et al., Reference Eklöf and Hagberg2006; Kajiki et al., Reference Kajiki, Izumi, Hayashida, Kusumoto, Nagata and Mori2017; Linton et al., 2015); (b) employee psychological health (N = 5) (i.e., Dimoff & Kelloway, Reference Dimoff and Kelloway2019; Kawakami et al., Reference Kawakami, Kobayashi, Takao and Tsutsumi2005, Reference Kawakami, Takao, Kobayashi and Tsutsumi2006; Milligan-Saville et al., Reference Milligan-Saville, Tan, Gayed, Barnes, Madan, Dobson, Bryant, Christensen, Mykletun and Harvey2017; Takao et al., Reference Takao, Tsutsumi, Nishiuchi, Mineyama and Kawakami2006); (c) employee physical health (N = 4) (i.e., Karlqvist & Gard, Reference Karlqvist and Gard2013; Ketelaar et al., Reference Ketelaar, Schaafsma, Geldof, Kraaijeveld, Boot, Shaw, Bültmann and Anema2017; Morken et al., Reference Morken, Moen, Riise, Hauge, Holien, Langedrag, Olson, Pedersen, Saue, Seljebø and Thoppil2002; Stansfeld et al., Reference Stansfeld, Kerry, Chandola, Russell, Berney, Hounsome, Lanz, Costelloe, Smuk and Bhui2015); (d) employee safety (N = 7) (i.e., Amiri et al., Reference Amiri, Khademian and Nikandish2018; Hammer & Truxillo et al., Reference Hammer, Wan, Brockwood, Bodner and Mohr2019; Hammer et al., Reference Hammer, Truxillo, Bodner, Rineer, Pytlovany and Richman2015; Mullen & Kelloway, Reference Mullen and Kelloway2009; Shaw et al., Reference Shaw, Robertson, McLellan, Verma and Pransky2006; Zohar, Reference Zohar2002; Zohar & Polachek, Reference Zohar and Polachek2014); and (e) employee received and perceived supervisor social support (N = 10) (i.e., Crain et al., Reference Crain, Hammer, Bodner, Olson, Kossek, Moen and Buxton2019; Hammer et al., Reference Hammer, Kossek, Anger, Bodner and Zimmerman2011, Reference Hammer, Johnson, Crain, Bodner, Kossek, Davis and Berkman2016, Reference Hammer, Brady and Perry2020; Hammer & Wan et al., Reference Hammer, Wan, Brockwood, Bodner and Mohr2019; Hurtado et al., Reference Hurtado, Okechukwu, Buxton, Hammer, Hanson, Moen, Klein and Berkman2016; Kelly et al., Reference Kelly, Moen, Oakes, Fan, Okechukwu, Davis, Hammer, Kossek, King, Hanson, Mierzwa and Casper2014; Kossek et al., Reference Kossek, Thompson, Lawson, Bodner, Perrigino, Hammer, Buxton, Almeida, Wipfli, Berkman and Bray2019; Moen et al., Reference Moen, Kelly, Fan, Lee, Almeida, Kossek and Buxton2016; Olson et al., Reference Olson, Crain, Bodner, King, Hammer, Klein, Erickson, Moen, Berkman and Buxton2015). It should also be noted that some of these programs were also designed to affect what we refer to as secondary outcomes of leader knowledge and organizational climate outcomes, which are addressed later in our review.

Type of Employee Outcomes

We identified the general employee outcome categories of physical health, psychological health, and safety, consistent with our focus on occupational stress and well-being interventions. While most intervention evaluation studies included multiple outcomes at multiple levels, our interest was in employee outcomes that are indicators of reduced occupational stress and improved well-being. Also, given the vast number of outcomes included in many studies, we focused on the key or primary employee outcome that was of interest as noted by the authors. Within these three categories, employee outcomes included a number of physical health outcomes, including sleep – actigraphic total sleep time, actigraphic wake after sleep onset (WASO), insufficiency, insomnia (i.e., Crain et al., Reference Crain, Hammer, Bodner, Olson, Kossek, Moen and Buxton2019; Olson et al., Reference Olson, Crain, Bodner, King, Hammer, Klein, Erickson, Moen, Berkman and Buxton2015); musculoskeletal symptoms; and eye discomfort. Psychological health outcomes include emotional distress, willingness to use resources, employee perceptions of leaders’ communication about mental health and resources, and employee perceptions of leader consideration for struggling employees, all of which lead to improved psychological health outcomes for employees (e.g., Dimoff & Kelloway, Reference Dimoff and Kelloway2019; Moen et al., Reference Moen, Kelly, Fan, Lee, Almeida, Kossek and Buxton2016). Safety and ergonomic outcomes include support for patient safety and employee perceptions of patient safety. Ergonomic outcomes include quality of modifications in the ergonomic and psychosocial environment and modification activity.

Type of Effect

In addition to intervention main effects, which are very difficult to detect in intervention research (e.g., Adler et al., Reference Adler, Bliese, Pickering, Hammermeister, Williams, Harada and Ohlson2015), we were interested in noting intervention mediators that provide information on the process by which the intervention impacts employee outcomes, and moderators which provide information on the contextual conditions under which interventions impact employee outcomes. Examples of potential mediators and moderators are provided in Chapter 5 of this book.

Employee Physical Health Outcomes

Employee physical health outcomes were investigated in 11 articles (Crain et al., Reference Crain, Hammer, Bodner, Olson, Kossek, Moen and Buxton2019; Hammer et al., Reference Hammer, Kossek, Anger, Bodner and Zimmerman2011, Reference Hammer, Truxillo, Bodner, Rineer, Pytlovany and Richman2015, Reference Hammer, Truxillo, Bodner, Pytlovany and Richman2019b, Hurtado et al., Reference Hurtado, Okechukwu, Buxton, Hammer, Hanson, Moen, Klein and Berkman2016; Kajiki et al., Reference Kajiki, Izumi, Hayashida, Kusumoto, Nagata and Mori2017; Karlqvist & Gard, Reference Karlqvist and Gard2013; Ketelaar et al., Reference Ketelaar, Schaafsma, Geldof, Kraaijeveld, Boot, Shaw, Bültmann and Anema2017; Linton et al., 2015; Milligan-Saville et al., Reference Milligan-Saville, Tan, Gayed, Barnes, Madan, Dobson, Bryant, Christensen, Mykletun and Harvey2017; Olson et al., Reference Olson, Crain, Bodner, King, Hammer, Klein, Erickson, Moen, Berkman and Buxton2015). These included both objective and subjective reports of employee sleep-related outcomes, incident rates for lower back pain, physical fitness, smoking, blood pressure, perceived overall health, sick leave utilization, and absenteeism.

In terms of sleep-related outcomes, a work–family and educational intervention, as part of the Work, Family, and Health Network (WFHN), used supervisor and employee facilitated sessions aimed at identifying ways of increasing control over work, in addition to a supportive supervisor training program. Results demonstrated significant direct effects of the intervention on employee total sleep duration at 12 months, with approximately 8 minutes of more sleep per night compared to the control condition (Olson et al., Reference Olson, Crain, Bodner, King, Hammer, Klein, Erickson, Moen, Berkman and Buxton2015). Furthermore, researchers using data from the WFHN expanded upon the prior intervention by Olson and colleagues (Reference Olson, Crain, Bodner, King, Hammer, Klein, Erickson, Moen, Berkman and Buxton2015) and demonstrated significant intervention effects on sleep quality and sleep quantity at both 6 months and 18 months postintervention, with individuals in the treatment group experiencing approximately 9 minutes more sleep per night at 6 months and approximately 13 minutes more sleep per night at 18 months (Crain et al., Reference Crain, Hammer, Bodner, Olson, Kossek, Moen and Buxton2019).

Research also provides evidence for improvements in employee physical health outcomes unrelated to sleep such as decreased incident rate ratios for lower back pain shortly after a participatory workplace intervention where leaders were trained in methods of ergonomic improvement and assessment (Kajiki et al., Reference Kajiki, Izumi, Hayashida, Kusumoto, Nagata and Mori2017). However, these effects did not endure over time at the 10-month follow-up. Additionally, a supervisor coaching intervention found that employee physical fitness levels increased from baseline to follow-up after supervisors were coached on promoting employee health through organizational and lifestyle factors (Karlqvist & Gard, Reference Karlqvist and Gard2013). This study also found significant effects of supervisor stress and well-being interventions on objective health measures. Another study based on data from the WFHN showed direct effects of the supervisor training intervention on employees who were identified as smokers, reducing cigarette consumption by about seven cigarettes per week (Hurtado et al., Reference Hurtado, Okechukwu, Buxton, Hammer, Hanson, Moen, Klein and Berkman2016). Notably, this intervention prevented declines in employee perceptions of family-supportive supervisor behaviors (FSSBs) at 6 months, specifically among employees who categorized themselves as smokers (Hurtado et al., Reference Hurtado, Okechukwu, Buxton, Hammer, Hanson, Moen, Klein and Berkman2016). Researchers examining the Safety and Health Improvement Program (SHIP) among construction workers reported significant positive intervention effects for employee objective blood pressure at 12 months postintervention (Hammer et al., Reference Hammer, Truxillo, Bodner, Rineer, Pytlovany and Richman2015). Both Hammer et al. (Reference Hammer, Kossek, Anger, Bodner and Zimmerman2011) and Hammer et al. (Reference Hammer, Truxillo, Bodner, Pytlovany and Richman2019b) showed significant intervention effects on employee reports of perceived physical health.

Finally, three different studies found significant supervisor training intervention effects on employee-reported sick day use and absenteeism, purportedly due to poor physical health. Linton and colleagues (2015) implemented a supervisor worker and workplace intervention aimed at minimizing the impact of workplace psychosocial risk factors and creating a more supportive workplace. The intervention resulted in significant differences in employee work absences due to pain at follow-up. Additionally, employees in the treatment as usual condition were also four times more likely to seek out healthcare compared to the intervention group, and those participants in the intervention group reported fewer healthcare visits and improvement in perceived health at follow-up (Linton et al., 2015). Mental health training for managers demonstrated reduced sickness absence reports for the intervention group compared to the control group of employees (Milligan-Saville et al., Reference Milligan-Saville, Tan, Gayed, Barnes, Madan, Dobson, Bryant, Christensen, Mykletun and Harvey2017). In addition, although not approaching significance, another intervention found greater reductions in average employee sick days in the intervention condition from baseline (i.e., 4.6 days) to follow-up (i.e., 2.4 days) compared to the control group at baseline (i.e., 3.8 days) to follow-up (i.e., 3.6 days), after a multifaceted supervisor intervention involving supervisor training on employee sick leave and supervisor coaching (Ketelaar et al., Reference Ketelaar, Schaafsma, Geldof, Kraaijeveld, Boot, Shaw, Bültmann and Anema2017).

Overall, leadership intervention studies aimed at improving physical health of employees ranged from supervisor social support training interventions (N = 4) to safety-related supervisor training (2), job design/ergonomic training (2), manager physical health-related training (1), and manager mental health training (2). These interventions were effective at improving employee sleep, pain, cigarette smoking, physical fitness, blood pressure, missing work, and perceived health. Many of these physical health outcomes are critically linked to employee outcomes. For example, sleep has been identified as a major contributor to a variety of employee outcomes such as job strain, work–family conflict, engagement, job satisfaction, turnover, cognition, counterproductive work behavior, hostility, positive affect, and relaxation (Litwiller, Reference Litwiller, Snyder, Taylor and Steele2017), and thus, they have broader implications beyond physical health.

Employee Psychological Health Outcomes

Employee psychological health outcomes were examined in 11 supervisor intervention studies (Dimoff & Kelloway, Reference Dimoff and Kelloway2019; Eklöf et al., Reference Eklöf and Hagberg2006; Kawakami et al., Reference Kawakami, Kobayashi, Takao and Tsutsumi2005, Reference Kawakami, Takao, Kobayashi and Tsutsumi2006; Kelly et al., Reference Kelly, Moen, Oakes, Fan, Okechukwu, Davis, Hammer, Kossek, King, Hanson, Mierzwa and Casper2014; Kossek et al., Reference Kossek, Thompson, Lawson, Bodner, Perrigino, Hammer, Buxton, Almeida, Wipfli, Berkman and Bray2019; Milligan-Saville et al., Reference Milligan-Saville, Tan, Gayed, Barnes, Madan, Dobson, Bryant, Christensen, Mykletun and Harvey2017; Moen et al., Reference Moen, Kelly, Fan, Lee, Almeida, Kossek and Buxton2016; Morken et al., Reference Morken, Moen, Riise, Hauge, Holien, Langedrag, Olson, Pedersen, Saue, Seljebø and Thoppil2002; Stansfeld et al., Reference Stansfeld, Kerry, Chandola, Russell, Berney, Hounsome, Lanz, Costelloe, Smuk and Bhui2015; Takao et al., Reference Takao, Tsutsumi, Nishiuchi, Mineyama and Kawakami2006). These employee outcomes tend to be self-reported and include reports of perceived control, perceived supervisor support for family and for mental health, and psychological distress. Note that each of these could also serve as mediators to explain the effects of supervisor interventions on employee psychological or physical health outcomes.

The WFHN study focused on training supervisors to be more supportive of employees who were managing work and family demands and involved facilitated sessions prompting employees to discuss where and when they work in two different industry sectors: information technology and healthcare. Researchers found that the intervention increased employees’ schedule control and significantly increased employee perceptions of their supervisor eliciting supervisor support for family and personal life and decreased work–family conflict and family time adequacy reported by information technology employees (Kelly et al., Reference Kelly, Moen, Oakes, Fan, Okechukwu, Davis, Hammer, Kossek, King, Hanson, Mierzwa and Casper2014). Likewise, Moen et al. (Reference Moen, Kelly, Fan, Lee, Almeida, Kossek and Buxton2016) found that the WFHN intervention had significant effects on reduced burnout, perceived stress, and psychological distress, as well as increased job satisfaction among information technology workers. Kossek et al. (Reference Kossek, Thompson, Lawson, Bodner, Perrigino, Hammer, Buxton, Almeida, Wipfli, Berkman and Bray2019) evaluated the effects of the WFHN intervention among healthcare workers and found that it decreased psychological distress for employees with elder care responsibilities. Thus, this leader intervention with a primary component focused on improving social support provided by managers and supervisors demonstrated significant effects on employee psychological health outcomes, hence improving well-being.

Furthermore, a web-based training for supervisors on workplace mental health was found to provide significant effects on employee perceptions of their supervisor eliciting greater supervisor support for mental health and reduced employee psychological distress (Kawakami et al., Reference Kawakami, Kobayashi, Takao and Tsutsumi2005). Similarly, another leader-focused mental health training showed improvements in employees’ willingness to use and seek out available mental health resources (Dimoff & Kelloway, Reference Dimoff and Kelloway2019). Manager mental health training given to firefighter supervisor leads showed significant decreases in employee work-related sick leave use by approximately 6.45 hours per employee and reduced the overall levels of employees taking standard sick leave at 6 months following the intervention (Milligan-Saville et al., Reference Milligan-Saville, Tan, Gayed, Barnes, Madan, Dobson, Bryant, Christensen, Mykletun and Harvey2017). Additionally, employee reports of their leaders’ communication about mental health and subsequent mental health resources significantly increased at both follow-up time points of 6 and 12 weeks postintervention. Employees also reported their leaders as being more considerate toward employees who were struggling, showing significant increases at the time three 12-week follow-up (Dimoff & Kelloway, Reference Dimoff and Kelloway2019). Finally, Takao and colleagues (Reference Takao, Tsutsumi, Nishiuchi, Mineyama and Kawakami2006) found significant intervention effects on employee psychological distress postimplementation of an educational program for supervisors centered around mental health workplace manager responsibilities aimed at reducing stress among subordinate employees. Notably, however, this was only significant for young white-collar male subordinates.

Although no statistically significant intervention effects were found, a few interventions have demonstrated improvements in employee psychological health outcomes via occupational stress and well-being interventions involving managers and/or supervisors. For example, organizations can implement one-hour feedback sessions (i.e., evaluative information is provided about specific behaviors or events in one-on-one or group-based discussions) with their supervisors to potentially and positively impact employees’ and workgroups’ perceptions of social support (Eklöf et al., Reference Eklöf and Hagberg2006). Additionally, Stansfeld and colleagues (Reference Stansfeld, Kerry, Chandola, Russell, Berney, Hounsome, Lanz, Costelloe, Smuk and Bhui2015) found employees whose manager completed an online educational well-being intervention had higher well-being scores at baseline and follow-up, suggesting that intervention group supervisors already had employees who exhibited higher levels of well-being to begin with. Similarly, Morken and colleagues (Reference Morken, Moen, Riise, Hauge, Holien, Langedrag, Olson, Pedersen, Saue, Seljebø and Thoppil2002) found that a musculoskeletal health intervention program improved coping strategies among employees with musculoskeletal disorders and injuries (e.g., working more slowly, taking more or longer breaks, asking colleagues for help with strenuous tasks) as well as social support from both coworkers and supervisors. Overall, past occupational stress and well-being interventions involving managers or supervisors have provided important evidence that utilizing supervisors as a point of intervention can have beneficial downstream outcomes for employee psychological health and well-being.

Employee Safety Outcomes

Six studies were identified that evaluated the effects of leadership training on employee safety outcomes (Amiri et al., Reference Amiri, Khademian and Nikandish2018; Hammer et al., Reference Hammer, Johnson, Crain, Bodner, Kossek, Davis and Berkman2016; Mullen & Kelloway, Reference Mullen and Kelloway2009; Shaw et al., Reference Shaw, Robertson, McLellan, Verma and Pransky2006; Zohar, Reference Zohar2002; Zohar & Polachek, Reference Zohar and Polachek2014). The studies include examination of managerial/supervisor training effects on employee safety behavior, reports of safety compliance, reports of injuries, use of personal protective equipment, and improved safety communication.

For example, feedback sessions with supervisors regarding safety, productivity, and teamwork showed significant improvements on employee safety behavior (Zohar & Polachek, Reference Zohar and Polachek2014). Similarly, the WFHN study, examining the intervention aimed at improving supervisor support for work and family among healthcare workers, showed significant effects on employee self-reports of safety compliance at 6 months postintervention (Hammer et al., Reference Hammer, Johnson, Crain, Bodner, Kossek, Davis and Berkman2016). This finding is consistent with prior correlational studies showing a relationship between work–family conflict and safety (e.g., Smith et al., Reference Smith, Hughes, DeJoy and Dyal2018). Furthermore, Mullen and Kelloway (Reference Mullen and Kelloway2009) implemented a transformational leadership-based intervention in the healthcare setting focusing on safety-specific aspects of transformational leadership and found significant improvements in employee ratings of leader’s safety-specific transformational leadership. Another safety-based intervention supports this argument as employees were also shown to have higher rates of earplug use in their organizational subunits after the supervisory safety intervention improved supervisory safety practices (Zohar, Reference Zohar2002). An intervention aimed at improving safety culture via supervisor training in intensive care units found significant improvements in teamwork within specific units, such as increased communication openness (i.e., ability to question decisions and speak up when concerns arise), as well as improved handoffs and transitions of patient care, which was the weakest component of the safety culture prior to the intervention (Amiri et al., Reference Amiri, Khademian and Nikandish2018). Effective safety-specific interventions are crucial, as the National Safety Council estimates that worker injury costs reached $170.8 billion in 2018 (National Safety Council, 2020). Thus, interventions including supervisors may be an effective approach to improving employee safety and preventing subsequent costs to organizations.

Overall, supervisors play a crucial role in the health, well-being, and safety of employees, especially through workplace stress and well-being interventions aimed at improving employee outcomes. Employee-level outcomes range from physical health such as improved sleep and psychological health such as decreased burnout and distress, to safety-related employee outcomes such as safety compliance. Thus, this review demonstrates that managerial occupational stress and well-being interventions have been successful in directly impacting employees’ occupational stress and well-being outcomes.

Moderators and Mediators of Stress and Well-Being Interventions on Employee Outcomes

As mentioned previously, main effects, as well as moderating effects and mediational effects, were observed in the studies included in this review. Specifically, research has examined variables that may influence the strength of the relationship between interventions and subsequent outcomes as well as specific mediating variables that determine the process through which interventions are effectively impacting employee stress and well-being outcomes. Mediators help explain how the training impacted employee outcomes (e.g., mediators captured in our review include control over work schedule, FSSB, work–family conflict, family–work conflict, family time adequacy, control over work time, emotional exhaustion (burnout), return to work practices, and immediate supervisor–subordinate relationships). Intervention moderators help explain under what conditions the interventions are effective, such as organizational context (e.g., Bell et al., Reference Bell, Tannenbaum, Ford, Noe and Kraiger2017). Given the difficulty in detecting main intervention effects, these mediators and moderators are important to consider. Intervention moderators were grouped into five overarching categories of work-specific variables (i.e., control over work time, team cohesion, schedule control, job demands, job insecurity, organization, being at risk for sick leave at baseline, decision authority, managerial status, occupation, and supervisors’ self-reported job demands), work–family variables (i.e., work–family climate, work–family conflict, family–work conflict, child at home, care for adults, and family caregiving structure), work attitudes and behaviors (i.e., supervisor attitudes, FSSBs, general supervisor support, and perceptions of supervisor leadership style), health-specific variables (i.e., general health, psychological distress, and need for recovery), and demographic variables (i.e., age, sex, gender, and level of education). These moderation and mediation variables shed light on the importance of examining the organizational context and other contextual factors that have the ability to influence supervisor stress and well-being intervention effects on various employee outcomes. When considering these effects, we found that examination by research program was most effective.

Relational Leadership Training

We refer to relational leadership training as specifically targeting leader people-skills and improving upon how they relate to employees. This includes both transformational leadership training as well as supervisor social support training. Arnold (Reference Arnold2017) provided an excellent review of the research on the relationship between transformational leadership and employee health and well-being. Unfortunately, most of the existing research on transformational leadership is based on cross-sectional research designs, and little is known about the effects of transformational leadership training on employee outcomes (for an exception, see Mullen & Kelloway, Reference Mullen and Kelloway2009). In her review of transformational leadership and well-being studies, Arnold (Reference Arnold2017) identified 40 empirical papers published between January 1980 and December 2015. An earlier review of transformational leadership and employee well-being by Kelloway and Barling (Reference Kelloway and Barling2010) demonstrated this positive relationship. While transformational leadership theory is one of the most highly studied leadership theories (Arnold, Reference Arnold2017), we have not found many studies on how to enact such leadership, as 80% of the studies noted in the Arnold review are cross-sectional studies. Furthermore, there have been serious critiques of transformational leadership theory (e.g., Van Knippenberg & Sitkin, Reference Van Knippenberg and Sitkin2013) raising serious concerns about the measurement, partially due to the conceptual confusion around the definition of charismatic-transformational leadership theory. Furthermore, Arnold also noted that we need not only rigorous studies that do not employ a cross-sectional design as to enable cause and effect relationships to be determined, but a better understanding of how, through mediation, and when, through moderation, regarding the relationship between transformational leadership and employee well-being outcomes.

We suggest that supervisor support can be considered a special case of relational transformational leadership, and it may be the key ingredient that is related to employee well-being outcomes. For example, the Hammer et al. (Reference Hammer, Kossek, Zimmerman, Daniels, Perrewé and Ganster2007) review identified the critical role of supervisor support for family in impacting employee psychological health, physical health, safety, and workplace outcomes, as they argued that the supervisor has the ability to enact both formal and informal organizational policies that support workers. Again, this review was based primarily on correlational studies. What followed the Hammer et al. review was a program of research on FSSB training interventions. A recent systematic review of social support in the management sciences points to the role of social support as a positive catalyst that can facilitate employee well-being (Bavik et al., Reference Bavik, Shaw and Wang2020). It is important to note that each of these reviews identified the critical role of the leader in impacting health, safety, and well-being of employees and called for more systematic study of the causal effects of leadership on employee well-being outcomes.

Leadership Awareness Training

We found several of the articles in our review were specifically focused on improving supervisor knowledge and behaviors that could impact employee occupational stress and well-being. Below we discuss knowledge, attitudes, and behaviors that impact employee occupational stress and well-being outcomes. For example, Dimoff and Kelloway (Reference Dimoff and Kelloway2019) implemented workplace mental health training specifically for those in leadership positions. Their findings suggest mental health awareness training for supervisors significantly improved a multitude of supervisor outcomes, such as leader communication about mental health and mental health resources provided to their employees, leader actions to encourage employee mental health resource use, and leader warning sign recognition of deteriorating mental health among their subordinate employees. Interestingly, leader warning sign recognition was not significant at baseline or 6-week follow-up, but was significant at 12 weeks postintervention, suggesting delayed but longitudinal effects of the leadership mental health training on these supervisor outcomes (Dimoff & Kelloway, Reference Dimoff and Kelloway2019). Similarly, Milligan-Saville and colleagues (Reference Milligan-Saville, Tan, Gayed, Barnes, Madan, Dobson, Bryant, Christensen, Mykletun and Harvey2017) implemented manager mental health training with the goal of improving managers’ behavior toward mental health as well as improving employees’ willingness to take sickness absence. Results indicated managers in the intervention group reported significantly higher levels of mental health knowledge, knowledge of the role of a manager in mental health promotion, and confidence in communicating with their employees regarding mental illness in the workplace. Notably, however, the intervention’s effects on manager confidence in communicating with their employees regarding mental illness was the only enduring significant outcome, as no other outcomes were found to be significant at 6 months postintervention (Milligan-Saville et al., Reference Milligan-Saville, Tan, Gayed, Barnes, Madan, Dobson, Bryant, Christensen, Mykletun and Harvey2017). These mental health focused supervisor trainings, which were shown to positively influence supervisory outcomes, have the ability to then influence the willingness for employees to be able to capitalize on these intervention resources to improve their overall well-being.

Leadership Training to Improve Safety Culture

Two occupational stress and well-being interventions involving managers/supervisors have also found significant effects related to supervisor safety knowledge. Amiri and colleagues (Reference Amiri, Khademian and Nikandish2018) implemented an educational empowerment program for nurses and supervisors in adult intensive care units with the aim of improving patient safety culture. With regard to behavioral outcomes, the intervention had significant effects on manager expectations and actions promoting patient safety, which was a key dimension of patient safety culture as identified by the authors. Furthermore, Mullen and Kelloway (Reference Mullen and Kelloway2009) implemented a transformational leadership-based intervention with a focus on the difference between general transformational leadership and safety-specific transformational leadership. Researchers found that the intervention had a significant effect on manager safety attitudes, intent to promote safety, and manager self-efficacy (Mullen & Kelloway, Reference Mullen and Kelloway2009). Specifically, those supervisors randomized to the safety-specific transformational leadership group had significantly improved safety attitudes and self-efficacy compared to the general transformational leadership group and the control group. Intentions to promote safety were also higher in the safety-specific group than the general group, but this intervention effect was not statistically significant (Mullen & Kelloway, Reference Mullen and Kelloway2009).

We identified five leader training intervention studies that included outcomes focused specifically on changing the safety culture and one that was focused on changing the health culture, all with the aim of improving stress and well-being of employees. Kawakami and colleagues (Reference Kawakami, Takao, Kobayashi and Tsutsumi2006) implemented a web-based supervisor training aimed at improving health and support outcomes. Researchers found that the intervention significantly improved the friendliness of the worksite atmosphere (e.g., increased mutual support, respect, teamwork, etc.; Kawakami et al., Reference Kawakami, Takao, Kobayashi and Tsutsumi2006). For example, a safety-leadership intervention aimed at providing supervisors with weekly personal feedback on safety-related interactions with subordinates found that the intervention led to a significant decrease in micro accidents and injuries postintervention, as well as significant improvements in group safety climate (Zohar, Reference Zohar2002). Similarly, a discourse-based intervention modified daily communication messages between supervisors and subordinates to include more safety and productivity-related issues (Zohar & Polachek, Reference Zohar and Polachek2014). This intervention found that the communication modification significantly improved safety climate, safety audits performed by external safety consultants, and overall heightened perceptions of teamwork (Zohar & Polachek, Reference Zohar and Polachek2014). Another study aimed to examine the impact of an intervention for both general and safety-specific transformational leadership on an array of organizational outcomes (Mullen & Kelloway, Reference Mullen and Kelloway2009). This intervention found significant effects for perceptions of safety climate in the safety-specific transformational leadership intervention group as compared to the control group (Mullen & Kelloway, Reference Mullen and Kelloway2009). Furthermore, a study conducted by Amiri and colleagues (Reference Amiri, Khademian and Nikandish2018) employed an education empowerment program for nurses and supervisors which significantly improved patient safety culture among adult intensive care units (ICUs), with specific improvements in dimensions of patient safety culture that were previously weak prior to the intervention, such as organizational learning, organizational continuous improvement, and teamwork within units (Amiri et al., Reference Amiri, Khademian and Nikandish2018).

Outcome Goals Drive Evaluations of Effectiveness

One measure of effectiveness is return on investment (ROI). Depending on metrics and program characteristics, these interventions may elicit a positive ROI. Many corporate benefits, such as health insurance, do not return an obvious fiscal gain and are instead offered because of corporate social responsibility or common labor market practices that improve organizational attractiveness to employees and job applicants. That said, a large assessment of workplace health programs shows generally positive ROI with a mean weighted ROI of 1.38–1.80. In other words, for each dollar spent on comprehensive workplace health promotion programs, at least $1.38 was received back due to reduced turnover and other costs (Baxter et al., Reference Baxter, Campbell, Sanderson, Cazaly, Venn, Owen and Palmer2015). While the cost of more narrow stress resilience programs is likely much lower than general workplace health promotion, the returns would likely be lower as well, such that the ROI might be less visible. In addition, as a form of reciprocity, employees who are appreciative of their employer’s help with stress may work harder or perform extra helping behaviors for the organization, and it is difficult to know if these behaviors are attributable to the stress program.

That said, effectiveness of wellness programs is infrequently measured in terms of ROI, due to the excessive cost, time, and expertise (e.g., measurement and statistics, health, economics, program evaluation skills are needed) required to make these calculations. Program evaluation is difficult in general, and in this case, many well-being interventions target more than one goal (e.g., to decrease task errors and increase safety) or use multiple methods (e.g., survey feedback followed by stress management training), complicating and confounding attempts to measure effectiveness and compare one program with another. In these settings, even the best study design cannot prevent attrition from the study or workplace, low power due to the number of employees available, data with very low variance, or practical constraints prohibiting random assignment in a field setting.

ROI is not only difficult to measure but is also an overly restrictive way of considering an intervention’s value. Not all benefits will be dollar for dollar. An effective program that has a negative ROI might be useful, for example, if it improves perceptions of corporate social responsibility, or just because management or owners care about the health of their employees. Previous research has found that the most common goals include

Consequently, when we consider the effectiveness of a well-being intervention, we consider success in the broader sense.

Primary Prevention Is Most Effective

Interventions are often described from a timing perspective as primary, secondary, or tertiary (LaMontagne et al., Reference LaMontagne, Keegel, Louie, Ostry and Landsbergis2007). Primary prevention is oriented toward reducing hazards and supporting a healthy work environment or by improving individuals’ coping skills before they have suffered from stress. These interventions prevent problems before they occur by including broad groups of employees instead of targeting those who already have a health concern. Primary interventions might attempt to improve social support or identify the source of potential workplace stressor. Interventions that target the job (e.g., job control, job demands) would usually be considered primary prevention because not all workers on that job have had stress reactions yet. We note, however, exhortations to remove job stressors can be of limited value due to practical complications, and therefore employees should also receive training in coping or stress management to achieve the best prevention (Semmer, Reference Semmer, Quick and Tetrick2003).

Secondary prevention includes management of well-being decrements (e.g., depressed mood) and improving health behavior adherence after employees have had stress-related problems. This includes training and education on stress management. Tertiary interventions are similar to secondary interventions, but a distinguishing factor is how chronic the employees’ problems, like depression or hypertension, have become. They involve harm mitigation, recovery, and rehabilitation, often conducted through an employee assistance program (EAP). EAPs are worksite programs designed to help workplaces address productivity issues and help employees resolve personal problems (e.g., legal, financial, substance use; Cooper & Cartwright, Reference Cooper and Cartwright1994). These are typically delivered by external agencies. Such tertiary interventions are usually effective for alleviating individual employee’s problems, but they often appear to provide negative ROI and few visible organization-level benefits.

The efficacy of prevention over treatment is echoed in a very large study of 2 million employees across 18 years (Edington, Reference Edington2001). In this study, the average healthcare cost increased with each risk factor gained (e.g., obesity, smoking; $350), whereas the benefit when eliminating a risk factor was less (only $150). In other words, fixing problems was less profitable than preventing them in the first place, and programs that target prevention will therefore have better ROI. In general, behavioral medicine shows that prevention is more efficient than rehabilitation and cures.

Training “Dose”

Interventions have a training component in most cases. Consequently, we can consider the dose of training, reflected in terms of quantity (e.g., length, intensity) and quality (e.g., fidelity) of the training session(s). Training outcomes are reflected in a dose–response relationship, such that better training programs have better outcomes (Goetzel et al., Reference Goetzel, Henke, Tabrizi, Pelletier, Loeppke, Ballard, Grossmeier, Anderson, Yach, Kelly, McCalister, Serxner, Selecky, Shallenberger, Fries, Baase, Isaac, Crighton, Wald and Metz2014). However, the wide variance in intervention formats makes research difficult, as training characteristics tend not to be methodically manipulated, or even measured, making it difficult to separate and investigate characteristics such as management support or the employee’s prior experience in wellness programs. With that said, employee-targeted interventions often take the form of specific types of training that could have different effects (e.g., safety, stress management, communication, health behaviors). Thus, well-being interventions that adhere to the guidelines for effective training in general are more likely to be successful.

Healthy People, a US initiative to provide science-based decade-long objectives for improving health, provides a set of training guidelines for comprehensive workplace health promotion programs. These include health education, supportive social and physical environments, integration of the worksite program into organizational infrastructure, links between health promotion and related programs (e.g., EAPs), and health screenings with follow-up. However, even more narrow wellness programs (e.g., tailored to job stress) benefit from incorporating these qualities when possible, adapting screenings to match employee needs to program goals.

In another perspective, O’Donnell (Reference O’Donnell1997) emphasizes the sustainability of programs and suggests ten principles, including (1) linking of program to business objectives; (2) executive management support; (3) multiyear strategic planning; (4) employee input when developing goals and objectives; (5) a wide variety of program offerings; (6) effective targeting of high-risk individuals; (7) incentives to motivate employees to participate in the program, leading to high participation rates; (8) program accessibility; (9) effective communications; and (10) evaluation of effectiveness.

Diagnosis or Needs Assessment

Delivering training to employees who will never use the training or already have those skills wastes their time and organizational resources. These employees may lose productivity due to time spent in the inappropriate training, experience frustration and decreased morale, and still have skill deficits due to not receiving training that they actually need. Most (73%) training programs skip a needs assessment and do not bother to target the appropriate employees or establish what trainings are already provided (Saari et al., Reference Saari, Johnson, McLaughlin and Zimmerle1988) and may therefore overlap with existing training or otherwise target inappropriate goals.

Efficient training must target the gap between what employees have and what employees need, and a simple needs assessment can be used to measure employee skill levels relative to skills required. A Shortened Stress Evaluation Tool (ASSET; Cooper & Cartwright, Reference Cooper and Cartwright1994) is a self-report survey that can be used to measure job stress, identify those vulnerable, measure job attitudes and coping skills, and evaluate physical and psychological health. It also provides norms, allowing better assessment of where training is most needed. Carefully randomized and structured focused groups, representing a variety of employees, can also be useful. See Simpson et al. (Reference Simpson, O’Brien, Beehr, Rossi, Meurs and Perrewé2017) for more information on diagnosing organizational wellness problems.

Needs assessment should also consider management and executive priorities. Buy-in from upper levels of the organization provides boosters over time for the trained employees, supporting long-term outcomes, and ensures better resources for the intervention delivery.

Objectives

The objective of the training should be distilled from the needs assessment by identifying the gap between the existing employee competencies, relative to what is needed. For example, when interpersonal conflict is a central complaint, conflict negotiation or communication interventions would be more beneficial than a general stress management workshop. Conversely, if work overload is a problem, then stress management, time management, job crafting, or empowerment might be a better objective. In sum, interventions should be designed specifically to address the gap identified in the diagnosis. Specific, measurable goals should be established based on the objectives (e.g., a significant decrease in reported job stress or an increase in healthy coping behaviors). Interventions should be designed to improve these specific metrics.

Design

In-house or external training experts can design an intervention around the program objective, considering the costs and benefits of different training features. The goal is the best transfer of training (ensuring that the skills trained are able to be applied later to relevant tasks and situations on the job) given available resources (see Baldwin & Ford, Reference Baldwin and Ford1988, for more detail). For example, because training dose is such an important predictor of effectiveness, a spaced (rather than massed) intervention might be preferable. However, if resources are unavailable, then a well-designed massed intervention will likely be more effective than limited spaced delivery. Design features should also reflect employee characteristics (e.g., how they prefer to learn) and the work environment (e.g., empowerment interventions will not be successful if the managers do not allow autonomy). Training transfer is best when the intervention includes feedback, teaches general principles about why something is done (as opposed to only how to do it, so that employees know when to apply their new skills), features identical elements (e.g., a role play is more effective when acted out by two people, rather than imagined), provides overlearning to achieve automaticity, and considers the best sequencing (e.g., part versus whole instruction, spaced versus massed delivery). Delivery methods, such as online tutorial, lecture, role play, or on-the-job training, should be considered in terms of what will provide the best transfer of training (via identical elements, overlearning, etc.) given the employee learning style and workplace environment.

Delivery

After the intervention is designed to provide best transfer of training, it is delivered by an expert. Within the field of health and wellness, there may be legal considerations regarding who can deliver the training. Some benign online trainings exist and can be administered without hiring a consultant; however, the most effective interventions are be delivered by an experienced consultant or licensed health professional.

Evaluation

The final step is to evaluate the effectiveness of the program, although preparation, planning, and pretests for the evaluation need to be performed at the beginning. During the “objectives” step of the intervention design, metrics should be chosen by which to evaluate the program. By measuring the amount that employees learned from the training, or how much they liked it, intervention personnel can quickly assess if the training was effective at a superficial level. Later on, health evaluations closely tied to the objectives may be appropriate. Likewise, behaviors (e.g., number of views on a breathing app provided in a stress management workshop) can be applicable, partly to understand dosage. Whatever the evaluation chosen, it should be closely tied to the objective and solicit feedback from a diverse group of employees.

Mindfulness

Mindfulness is a relatively recent approach to treating occupational stress, but it has seen rapidly increasing usage and research evaluation in recent years. It is now becoming one of the single most used and evaluated individual treatments for occupational stress. Mindfulness treatment does not have a very narrow and concrete definition but typically involves focusing on the present moment and recognizing one’s internal states (e.g., thoughts, feelings, bodily sensations). Although it consists of a set of mental and physical activities that an employee can learn on their own with the help of freely available, often online, learning materials, it is probably more effectively learned from an expert professional mindfulness trainer. The mental activities involve concentration, awareness, calmness, and acceptance, and the physical activities can include types of breathing, relaxation, and, often implicitly, posture. Body scans are often a part of the instruction, involving concentrating on parts of the body (e.g., from head to toe) in order to become more cognitively aware of how each part of the body feels at the present moment (e.g., Crain et al., Reference Crain, Schonert-Reichl and Roeser2017; Krick & Felfe, Reference Krick and Felfe2020).

The historical background of mindfulness meditation comes from Asia and includes Buddhism (especially Zen) and yoga (especially breathing) meditation techniques (e.g., Slutsky et al., Reference Slutsky, Chin, Raye and Creswell2019). It seems to be widely useful for many types of employees, although there is at least some weak evidence that social or cultural norms of acceptance of this kind of treatment might influence how effective it is (Krick & Felfe, Reference Krick and Felfe2020). In employee treatments in the United States, however, the Eastern elements are usually deemphasized, and the interventions typically mix in elements of progressive relaxation (Benson & Klipper, Reference Benson and Klipper1975) and cognitive-behavioral therapy (e.g., Cherkin et al., Reference Cherkin, Sherman, Balderson, Cook, Anderson, Hawkes, Hansen and Turner2016) from Western psychology. A common theme when used for occupational stress is to have employees recall past stressful situations that they handled poorly and to learn to accept and be at ease with their thoughts and feelings about them (e.g., self-forgiveness; Webb et al., Reference Webb, Phillips, Bumgarner and Conway-Williams2013). They then learn how to reduce those aversive thoughts and feelings in the future by engaging in mindfulness meditation.

Forms of mindfulness training especially used in employment settings include mindfulness-based cognitive training (MBCT) and its offshoot, mindfulness-based stress reduction (MBSR; e.g., Crain et al., Reference Crain, Schonert-Reichl and Roeser2017; Slutsky et al., Reference Slutsky, Rahl, Lindsay, Creswell, Karremans and Papies2017; Smith et al., Reference Smith, Santoro, Moraveji, Susi and Crum2020). The object of the intervention is for the employees to learn mindfulness meditation techniques through a time-limited set of training sessions, but the training educates employees on how to continue their own use of mindfulness techniques indefinitely. The time involved in mindfulness training varies greatly. It is common to attend short weekly sessions for approximately six to eight weeks, often with one or two “retreat” sessions mixed in. Whereas the weekly sessions might range from one-half hour to two and one-half hours and can be on or off the worksite, the retreats are longer in duration (up to a full day) and held at a more remote off-site location. The retreats are sometimes in a setting evoking the historical roots of mindfulness meditation, such as Buddhist and/or Tibetan pictures, objects, tapestries, and so forth. The total time involved in many of the formal mindfulness meditation employee interventions is often about 35–40 hours, with longer sessions including more periods of silent meditation (e.g., Bostock et al., Reference Bostock, Crosswell, Prather and Steptoe2019; Crain et al., Reference Crain, Schonert-Reichl and Roeser2017), although very short single sessions may have some effectiveness (e.g., Slutsky et al., Reference Slutsky, Chin, Raye and Creswell2019).

The following describes example topics of mindfulness training sessions in a typical program (e.g., Crain et al., Reference Crain, Schonert-Reichl and Roeser2017): understanding what mindfulness is and what the objectives of the program are; learning kindness, compassion, and forgiveness; becoming more aware of pleasant, unpleasant, and neutral internal and external stimuli; learning how to respond to those stimuli with calmness and acceptance; dealing with interpersonal conflict; becoming aware of and dealing with negative emotions; and instruction in future practice by oneself. These topics are learned in separate sessions of a couple of hours each and reinforced with longer retreats. The content of the mindfulness training sessions are usually very experiential, although short lectures and one-on-one and/or group discussions are common forms of instruction during at least parts of the sessions.

In mindfulness training programs, the trainer may use a standard manual prepared by someone else for instructions to deliver the training. Technology has become part of some modern mindfulness training sessions, with video and audio instruction being very common (e.g., Crain et al., Reference Crain, Schonert-Reichl and Roeser2017). More unusual, however, are some approaches that incorporate the use of moderate amounts of biofeedback, usually with wearable devices (e.g., Bostock et al., Reference Bostock, Crosswell, Prather and Steptoe2019; Smith et al., Reference Smith, Santoro, Moraveji, Susi and Crum2020). Finally, people also can learn to become mindfulness trainers through train-the-trainer type of sessions, and having a qualified mindfulness trainer in-house might be useful for some organizations (e.g., Slutsky et al., Reference Slutsky, Rahl, Lindsay, Creswell, Karremans and Papies2017).

Psychotherapy and Counseling

Formal counseling or psychotherapy is also used for treating individuals experiencing occupational stress. We assume that most employees experiencing occupational stress do not have a clinically diagnosable psychological disorder, and so the use of psychotherapy in this case is normally for prevention and growth rather than for remediating or restoring damaged mental health. However, some wellness programs, and EAPs in particular, contract with local therapists to provide clinical mental health treatment. In the United States, even for the specific purpose of treating occupational stress, professionals who offer any treatment legally classified as psychotherapy are usually required to be licensed in their state. As noted above, principles and techniques used in mindfulness meditation can overlap with some forms of psychotherapy, especially cognitive-behavioral therapy approaches (e.g., Cherkin et al., Reference Cherkin, Sherman, Balderson, Cook, Anderson, Hawkes, Hansen and Turner2016), or any approaches that emphasize physical and psychological calmness, cognitive thought, and sometimes mental imagery. When mindfulness training includes present-moment thinking about stressful work situations, being nonjudgmental about them and letting feelings about them go, it resembles some types of cognitive-behavioral therapy, especially exposure therapy.

Acceptance and commitment therapy (embracing uncomfortable internal states; e.g., Finnes et al., Reference Finnes, Ghaderi, Dahl, Nager and Enebrink2019; Lloyd et al., Reference Lloyd, Bond and Flaxman2017; Wersebe, Reference Wersebe, Lieb, Meyer, Hofer and Gloster2018) varies in length, from days of training to months. Homework and practice between sessions is important. Some of it strongly resembles mindfulness training, with acceptance of thoughts and situations being a part of it, but it is usually followed by some goal-setting and concrete action planning by the employee.

Exposure therapy, or stress inoculation, is used for treating occupational stress and is based on principles of learning to be calm rather than distressed while exposed to work demands. For example, in nursing, this might include communicating with a distressed family or a patient, or for law students may include speaking in front of a judge. Developed and used primarily for anxiety disorders, exposure therapy is most effective when employees’ anxiety (rather than, for example, behavioral withdrawal or burnout) is their predominant stress response or drives the experience of other strains. Exposure therapy consists of specific techniques derived from cognitive-behavioral approaches, mainly including types of exposure (e.g., viewing images) to anxiety-arousing situations. Treatment can include cognitive reassessment of the situation and problem-solving with the goal of allowing the employee to have practiced working in stressful situations, circumventing the automatic stress responses that accompany these workplace events.

In terms of delivery format, some form of relaxation training (e.g., progressive muscle relaxation) is often used in conjunction with exposure therapies (or can be used independently) to develop a skill the employees can use to calm their bodies and minds while exposed to the stressors. Exposure therapy can occur on different time schedules, such as 10 or 12 weekly sessions of 40–60 minutes each, or the same number of sessions collapsed into two weeks (e.g., Bryant et al., Reference Bryant, Kenny, Rawson, Cahill, Joscelyne, Garber, Tockar, Dawson and Nickerson2019; Finnes et al., Reference Finnes, Ghaderi, Dahl, Nager and Enebrink2019; Foa et al., Reference Foa, McLean, Zang, Rosenfield, Yadin, Yarvis, Mintz, Young-McCaughan, Borah, Dondanville, Fina, Hall-Clark, Lichner, Litz, Roache, Wright and Peterson2018). Spacing the sessions over a longer time period versus massing them into a shorter time may not matter in terms of effectiveness. The contents of the sessions can include education and skill-building (regarding thinking and relaxing), exposure by remembering and imagining the stressful work events, and sometimes homework and actual experience of the work situation. One study’s results showed the effects on severe problems like PTSD may be weak, however (e.g., Foa et al., Reference Foa, McLean, Zang, Rosenfield, Yadin, Yarvis, Mintz, Young-McCaughan, Borah, Dondanville, Fina, Hall-Clark, Lichner, Litz, Roache, Wright and Peterson2018) .

Mild Physical Activity

Structured strenuous aerobic or anaerobic physical exercise is often recommended for increasing physical strength, stamina, and general health that might help in stress resilience (e.g., Emerson et al., Reference Emerson, Merrill, Shedd, Bilder and Siddarth2017), but not everyone will faithfully participate in that approach to exercise. Some encouragement and support are therefore needed for many employees. Programs can enhance the psychology of employees’ exercise engagement, however, by offering multiple sessions focusing not on exercising itself but on how to get oneself and one’s coworkers to exercise consistently (e.g., Pedersen et al., Reference Pedersen, Halvari and Olafsen2019). This creates an environment that encourages and is supportive of employee exercise, by providing sessions with information about the benefits of and how to exercise, sessions with reflection by one’s self and with coworkers, and training in how to provide support for coworkers continuing to exercise.

In addition to strenuous exercise, milder but regular exercise is also an option that more people might be willing to try, and some forms of it can even be done while at work. Examples include engaging in more standing, walking, and moving around while doing everyday tasks. One such form of exercise is walking during breaks at work. A 15-minute walk every day during an employee’s lunch break can be beneficial and requires no particular training (e.g., Sianoja et al., Reference Sianoja, Syrek, de Bloom, Korpela and Kinnunen2018). Some add-on recommendations that may or may not be necessary are (1) to walk in a park or “green” area where natural surroundings might bring feelings of peace and satisfaction and (2) to avoid talking to others while walking, even when not walking alone. Talking, especially to coworkers, might become a source of stress if the topics are work-related problems, for example (e.g., Beehr et al., Reference Beehr, Bowling and Bennett2010). In addition to mild exercise during breaks, mild exercise while working is also possible. Some jobs inherently require mild-to-strong physical labor, but many modern jobs are sedentary, sometimes due to advanced technology helping reduce physical burdens. An example of technology that reverses this trend is the sit–stand desk, which makes it possible to do deskwork in a less sedentary manner. Office technology is usually designed to make it easier to accomplish most work while seated in a chair, but some office work can be done while standing or even engaging in small amounts of walking (e.g., talking on the telephone). Many office tasks can be accomplished while standing, if equipment is designed differently. Sit–stand desks are adjustable, so that an employee can use them from either a sitting or standing position. In addition to installing the adjustable equipment, a small amount of advice and training can be presented with these desks (e.g., to adjust them just right for the specific person, to arrange arm locations to avoid repetitive motion injuries, to vary standing and sitting periods, and to space out work breaks; e.g., Konradt et al., Reference Konradt, Heblich, Krys, Garbers and Otte2020).

In addition to employees’ mild exercise while at work, they can also be encouraged to engage in such activity during their off-work time. A simple aid is to offer employees some activity trackers that give them feedback on how active versus sedentary their off-work behavior is. Feedback alone is likely to encourage employees to move around a little more, if they see such activity as a positive thing. The trackers can take the form of a wristband-mounted device, and employees can also set them to emit a reminder sound after a certain amount of nonactive time. In addition, programs can be offered with the device, such as online contact with a coach who can offer information and advice, goal-setting features, and group challenges with incentives (e.g., Lennefer et al., Reference Lennefer, Lopper, Wiedemann, Hess and Hoppe2020).

Mild physical activity is more utilized when it is the default option. For example, keeping popular equipment (e.g., printers or coffee machines) in a centralized location can encourage walking at low cost. Reserving the closest parking for customers or guests can likewise increase physical activity. Informational interventions, such as providing maps to local parks for newcomers, or posting directions to the stairs near elevators, can help employees find or remember to use these options.

Coaching

Definitions of coaching can be ambiguous. Some other techniques include coaches as a small part of their program (e.g., Ebert et al., Reference Smith, Santoro, Moraveji, Susi and Crum2020; Lennefer, Reference Lennefer, Lopper, Wiedemann, Hess and Hoppe2020), but some programs are primarily based on coaching. Coaches come from a variety of backgrounds, education, and training, and there are multiple coaching credentials and certifications. Historically, coaching tends to include some one-on-one interactions, maybe making it expensive, so that it is often used for “expensive” employees, like managers and professionals. It is not possible to fully and accurately describe coaching interventions in a way that would be accurate for all of them because they vary in goals and tools with the specific setting, job, and person. They are, however, usually client-centered and involve the use of self-regulation (e.g., Bandura, Reference Bandura1991) or related theories (e.g., selection, optimization, and compensation theory; Müller et al., Reference Müller, Heiden, Herbig, Poppe and Angerer2016), with principles like developing and acting on action plans that incorporate the goals of the coachee.

One example, based on positive psychology, was coaching primary care physicians over a three-month period with meetings every two weeks (McGonagle et al., Reference McGonagle, Schwab, Yahanda, Duskey, Gertz, Prior, Roy and Kriegel2020). Because of schedule constraints of the physicians, the coaching meetings after the first one were conducted by telephone. Activities included assessing strengths, reflection and mindfulness, ways of thinking, identification of one’s ideal self, and prework or homework between sessions, among others. Each physician’s coaching experience could be different, using different activities or tools, because it is tailored to meet their needs. In a sense, many activities could be considered manualized, but the whole coaching experience was not. That is, interaction between the coach and coachee would determine which “manual” or tool was most appropriate for that particular coachee. Multiple coaches were used to coach the different physicians, and they met frequently to have discussions about how the project was going and to keep the coaching principles consistent across coaches.

A second example was of military personnel who were attending college, so that a common issue was balancing military jobs with student demands (Ebner et al., Reference Ebner, Schulte, Soucek and Kauffeld2018). Coachees chose to work on specific topics that were most relevant to themselves, such as work–life balance, time management, or general academic challenges. There were four 2-hour sessions over an 8- to 10-week period. Coaches used manuals to lead the coachee to examine problem issues, set goals, and make plans for reaching them. Homework between sessions was part of the process. Each session focused on a specific topic, including setting goals for the future, fleshing out ways to reach the goals, including necessary intermediate steps, and evaluation of the degree of success in reaching intermediate steps. Some group contexts also were used so that coaches could learn from each other.

Other Occupational Stress Treatments

There are many treatments for occupational stress that are simply called stress treatments, and they include both narrower, single method approaches and eclectic approaches using multiple methods. Sometimes these “other” treatments were developed for a specific organization or set of employees, but they could also be tailored to other sites.

The methods can include relaxation and yoga- or mindfulness-like experiential methods, self-help methods that rely on self-regulation principles like coaching does, off-shoots of cognitive-behavior therapy principles, job crafting, and time management. For example, resilience training can train employees to anticipate stressors and prepare for them in advance as well as to treat stress issues after they arise. This has been done in group sessions totaling 20 hours a few times per week for two months that included activities like work-value assessment, role play, case studies, chart presentations, positive affirmations, and homework assignments with a goal of enabling the employees to fend off the ill effects of work stressors by themselves (e.g., Chitra & Karunanidhi, Reference Chitra and Karunanidhi2018).

In contrast to such general treatments for occupational stress, some other treatments are very narrow and specific. For example, nonviolent communication training was developed to enhance employee skills in acting calmly, rationally, and effectively in tense situations of potential conflict (Wacker & Dziobek, Reference Wacker and Dziobek2018). The program was administered in groups and lasted three full days. It included education and practice through role play, verbal and nonverbal communication training, and listening skills. Another example of a specific treatment is job redesign, that is, changing the job’s tasks, the way of doing tasks, the order of tasks, or the control of these tasks’ characteristics. One program focused on giving groups of employees training on some new tasks while also giving them more control over the tasks. The sessions consisted of a two-day workshop and follow-up meetings two weeks later that could help clarify and solve problems, and weekly discussions could continue as needed (Holman & Axtell, Reference Holman and Axtell2016).

Finally, we note that many types of occupational stress treatments and training have steadily become more technology-based (and we suspect the COVID-19 pandemic might have strengthened that trend). Several of the occupational stress treatments described above use technology for communication, education, or skill-practice delivery (e.g., Crain et al., Reference Crain, Schonert-Reichl and Roeser2017; Konradt et al., Reference Konradt, Heblich, Krys, Garbers and Otte2020). One intervention lasted several weeks with multiple e-sessions per week (Ebert et al., Reference Ebert, Kählke, Buntrock, Berking, Smit, Heber, Baumeister, Funk, Riper and Lehr2018). Heavily supported by internet-based technology, it used 11 modules (e.g., time management, detaching from work, nutrition, and exercise) available to choose from, for use in the sessions, with written feedback from an e-coach (following manualized instructions) after each session. It also used texts and exercises that included interactive audio and video.