Stress and health - particularly the relationship between psychosocial factors and disease (cardiovascular disease and infectious illness), and how individuals recover from work demands and illness
The first international workshop on 'Recovery from Work' was held at the University of Surrey, on the 31st March and 1st of April 2008. The focus was on how workers respond to the physical and mental demands of their workplace both during and after working hours.
On the 3rd of June 2010, Mark Cropley (Department of Psychology) & Jason Devereux (QST) organised a one-day workshop at the University of Surrey to disseminate and discuss recent findings in the area of ‘Recovery from Work’.
Title: Nicotine addiction: neurochemical and behavioural mechanisms
Title: Health consequences of inadequate recovery from work: the relationship between work-related rumination, sleep quality and work-related fatigue
The perseverative cognition hypothesis suggests that worry/ruminative thinking prolongs stress-related physiological activation. This study explored the association of work-related rumination with salivary cortisol sampled at 10pm and the cortisol awakening response (CAR) the following morning. On a mid-week evening, 108 school teachers completed a small diary about their work-related thoughts and gave a saliva cortisol sample at 10pm. The following morning, they gave four additional saliva samples: at awakening and at 15, 30 and 45min after awakening, along with a rating of their anticipatory thoughts about work. The CAR was calculated as the percentage increase in cortisol secretion from awakening to 30min, and the sample was divided at their respective medians to classify participants into low and high rumination groups. Cortisol secretion was found to be significantly greater in the high compared with the low ruminators at 10pm, and this effect was not related to leisure activities or work patterns during the evening. For the morning measures, high ruminators demonstrated a flattened CAR relative to the low ruminators, and this effect appeared to be associated with sleep disturbance during the night. Ruminating about work-related issues is associated with cortisol secretion, and our findings support the perseverative cognition hypothesis. © 2013 John Wiley & Sons, Ltd.
Perseverative cognitions such as rumination and worry are key components of mental illnesses such as depression and anxiety. Given the frequent comorbidity of conditions in which rumination and worry are present, it is possible that they are underpinned by the same cognitive process. Furthermore, rumination and worry appear to be part of a causal chain that can lead to long-term health consequences, including cardiovascular disease and other chronic conditions. It is important therefore to understand what interventions may be useful in reducing their incidence. This systematic review aimed to assess treatments used to reduce worry and/or rumination. As we were interested in understanding the current treatment landscape, we limited our search from 2002 to 2012. Nineteen studies were included in the review and were assessed for methodological quality and treatment integrity. Results suggested that mindfulness-based and cognitive behavioural interventions may be effective in the reduction of both rumination and worry; with both Internet-delivered and face-to-face delivered formats useful. More broadly, it appears that treatments in which participants are encouraged to change their thinking style, or to disengage from emotional response to rumination and/or worry (e.g., through mindful techniques), could be helpful. Implications for treatment and avenues for future research are discussed.
If perfectionists avoid engaging in preventive health behaviours, they may be putting their long-term health and well-being at risk. Correlational analyses based on a sample of 370 university students identified maladaptive perfectionism to be associated with decreased levels of engagement in preventive health behaviours, life satisfaction and well-being and increased levels of self-concealment and psychological distress. Adaptive perfectionism was associated with higher levels of engagement in preventive health behaviours. Self-concealment was identified as a partial mediator in the relationship between maladaptive perfectionism and both engagement in preventive health behaviours and psychological distress. Implications of the findings are discussed.
Aims: To conduct an updated systematic review and the first meta-analysis of experimental trials investigating the acute effects of short bouts of physical activity (PA) on strength of desire (SoD) and desire to smoke (DtS) using individual participant data (IPD). Methods: A systematic review of literature and IPD meta-analyses included trials assessing the acute effects of shorts bouts of PA on SoD and DtS among temporarily abstaining smokers not using pharmaceutical aids for smoking cessation. Authors of eligible studies were contacted and raw IPD were obtained. Two-stage and one-stage IPD random-effects meta-analyses were conducted. Participants engaging in PA were compared against control participants, using post-intervention SoD and DtS with baseline adjustments. Results: A two-stage IPD meta-analysis assessing effects of PA on SoD yielded an average standardized mean difference (SMD) between PA and control conditions (across 15 primary studies) of -1.91 [95% confidence interval (CI): -2.59 to -1.22]. A two-stage IPD meta-analysis assessing effects of PA on DtS yielded an average SMD between PA and control conditions (across 17 primary studies) of -2.03 (95% CI: -2.60 to -1.46). Additional meta-analyses, including those using a one-stage model, those including only parallel arm studies and meta-analyses comparing only moderate exercise against a control condition, showed significant craving reduction following PA. Despite a high degree of between-study heterogeneity, effects sizes of all primary studies were in the same direction, with PA showing a greater reduction in cravings compared with controls. Conclusions: There is strong evidence that physical activity acutely reduces cigarette craving. © 2012 Society for the Study of Addiction.
Background. Patient-centered measures of the inpatient neurorehabilitation experience are needed to assess services. Objective. The objective of this study was to develop a valid and reliable Neurorehabilitation Experience Questionnaire (NREQ) to assess whether neurorehabilitation inpatients experience service elements important to them. Methods. Based on the themes established in prior qualitative research, adopting questions from established inventories and using a literature review, a draft version of the NREQ was generated. Focus groups and interviews were conducted with 9 patients and 26 staff from neurological rehabilitation units to establish face validity. Then, 70 patients were recruited to complete the NREQ to ascertain reliability (internal and test-retest) and concurrent validity. Results. On the basis of the face validity testing, several modifications were made to the draft version of the NREQ. Subsequently, internal reliability (time 1 α = .76, time 2 α = .80), test retest reliability (r = 0.70), and concurrent validity (r = 0.32 and r = 0.56) were established for the revised version. Whereas responses were associated with positive mood (r = 0.30), they appeared not to be influenced by negative mood, age, education, length of stay, sex, functional independence, or whether a participant had been a patient on a unit previously. Conclusions. Preliminary validation of the NREQ suggests promise for use with its target population.
Inability to unwind about work during leisure time has been associated with a number of negative health outcomes. This study was concerned with a possible behavioural pathway between unwinding and disease and examined the relationship between work-related rumination and food choice. Work-related rumination is arguably a core to understanding the ‘unwinding process’, and food choice is a well-established indicator of nutritional health. Two hundred and sixty-eight full-time workers from a range of white-collar occupations completed a self-report measure of ruminative thinking about work and an eating behaviour questionnaire. Three types of ruminative thinking were identified by factor analysis and labelled affective rumination, problem-solving pondering and detachment. In terms of food choice, high-relative to low-affective ruminators reported eating more unhealthy foods, and low detachers reported eating less cooked meals and more processed foods compared to high detachers. Problem-solving pondering was not associated with food choice, and none of the factors were associated with healthy food choice. It was concluded that failure to unwind from work is not necessarily related to unhealthy food choices. What appears to be the crucial factor is the type of perseverative thinking that people engage in post-work. Limitations and future directions are discussed.
Objective: This study examined the association between three conceptualisations of work-related rumination (affective rumination, problem-solving pondering and detachment) with sleep quality and work-related fatigue. It was hypothesised that affective rumination and poor sleep quality would be associated with increased fatigue; and problem-solving pondering, and detachment would be associated with decreased fatigue. The mediating effect of sleep quality on the relationship between work-related rumination and fatigue was also tested. Method: An on-line questionnaire was completed by a heterogeneous sample of 719 adult workers in diverse occupations. Results: The following variables were entered as predictors in a regression model: affective rumination, problem-solving pondering, detachment, and sleep quality. The dependent variables were chronic work-related fatigue (CF) and acute work-related fatigue (AF). Affective rumination was the strongest predictor of increased CF and AF. Problem-solving pondering was a significant predictor of decreased CF and AF. Poor sleep quality was predictive of increased CF and AF. Detachment was significantly negatively predictive for AF. Sleep quality partially mediated the relationship between affective rumination and fatigue; and between problem-solving pondering and fatigue. Conclusions: Work-related affective rumination appears more detrimental to an individual’s ability to recover from work than problem-solving pondering. In the context of identifying mechanisms by which demands at work are translated into ill-health, this appears to be a key finding; and suggests that it is the type of work-related rumination, not rumination per se, that is important.
Diagnosis and treatment of fibromyalgia syndrome (FMS) currently focuses on the experience of widespread pain. However, the symptom experience described by patients with FMS in clinical practice is far more diverse. This study aims identify the most common and severe symptoms in female patients diagnosed with FMS.
From an original sample of 2454 participants free of self-reported psychological distress, 1463 workers completed a 15-month follow-up. Baseline measures included exposure to job demands, decision latitude, social support and need for recovery. Psychological distress was assessed using the General Health Questionnaire at baseline and at follow-up. The findings showed that medium and high exposure to job demands and social support increased the risk of reporting psychological distress at 15-months (relative risk (RR) = 1.65, 1.45). The highest adjusted RR was observed for workers reporting a high need for recovery after work (RR 2.12, 1.90) and this finding was independent of the effects of job demands, decision latitude and social support. Neither decision latitude, nor low back problems increased the risk of reporting future psychological distress, although neck problems (RR = 1.66) and hand/wrist problems (RR = 1.45) did. It was concluded that need for recovery appears to be an important indicator of individual workers who are at risk of developing psychological distress long term. Statement of Relevance: This paper reports the findings of a longitudinal study showing that need for recovery from work was the strongest predictor, relative to psychosocial work characteristics (job demands, decision latitude and social support), and musculoskeletal problems, of psychological distress 15 months later in individuals initially free from distress.
The long-term impact of role stress (conflict and ambiguity), cognitive rumination and their interaction were analysed upon morning and evening saliva cortisol secretion. The sample consisted of 52 male and 24 female British white-collars who had participated in a survey study on psychosocial working conditions 3.5 years earlier. Saliva cortisol secretion was measured over seven consecutive days with two measures: in the morning on awakening and at 22.00 hours. Stepwise linear multiple regression analyses was used for the statistical analyses. Role ambiguity at baseline and the interaction between role ambiguity and trait rumination contributed to explaining elevations in morning saliva cortisol secretion 3.5 years later (R(2) = 0.045; F = 4.57; p < 0.05), while role conflict at baseline significantly predicted increases in long-term evening saliva cortisol (R(2) = 0.057; F = 8.99; p < 0.01). The findings support a long-term relationship between chronic stress exposure and saliva cortisol secretion and some support for the assumption of cognitive rumination moderating the stressor-strain relationship. STATEMENT OF RElevance: The study is of interest for ergonomics practice because it demonstrates that work role ambiguity and role conflict, typically associated with organisational downsizing and restructuring, may contribute to long-term psycho-physiological reactivity. This could expose workers to increased health risks. Therefore, stress management programmes should include the concept of role stress, especially at a time where many work organisations are undergoing significant change. Management should also be made aware of the importance of communicating clear goals, objectives and lines of authority as well as providing sufficient training for those in new job roles.
Smoking during pregnancy is widely known to increase health risks to the foetus, and understanding the quitting process during pregnancy is essential in order to realise national government targets. Qualitative studies have been used in order to gain a greater understanding of the quitting process and the objective of this systematic review was to examine and evaluate qualitative studies that have investigated the psychological and social factors around women attempting to quit smoking during pregnancy. Electronic databases and journals were searched with seven articles included in this review. The findings demonstrated that women were aware of the health risks to the foetus associated with smoking; however knowledge of potential health risks was not sufficient to motivate them to quit. Several barriers to quitting were identified which included willpower, role, and meaning of smoking, issues with cessation provision, changes in relationship interactions, understanding of facts, changes in smell and taste and influence of family and friends. A further interesting finding was that cessation service provision by health professionals was viewed negatively by women. It was concluded that there is a shortage of qualitative studies that concentrate on the specific difficulties that pregnant women face when trying to quit smoking.
Physical rehabilitation day hospitals are widely used community‐based services designed to meet the medical and rehabilitation needs of older people. While there is evidence for the effectiveness of these services, concerns about the shortcomings of how this is measured have led to the recommendation that the achievement of individually tailored goals be used to assess outcomes. This study considered whether such goal achievement demonstrated validity with respect to a standardised measure. The association between goal achievement and change in Nottingham Health Profile‐Part 1 (NHP‐1) scores was considered for 102 people attending four physical rehabilitation day hospitals. The predicted significant positive relationship between the percentage of goals achieved by participants and NHP‐1 scores was not found. This remained evident when functional goals were considered separately to medical goals. Further subsidiary analyses identified a complex relationship between goal achievement and NHP‐1 change scores. For those with higher change scores, there was a significant negative association between NHP‐1 change and goal achievement; while for those with lower (or negative) change scores, there was a significant positive association. A curve estimate regression confirmed a highly significant quadratic (curvilinear) relationship. Possible reasons for this finding might include the timing and nature of the goals set, the potential complication of some participants having cognitive impairment, as well as the use of the NHP‐1 as a comparison measure. At this time it is recommended that goal achievement only be used alongside other measures of day hospital outcome.
Purpose. Sleep disturbance affects a high proportion of people with fibromyalgia syndrome (FMS). This study aims to explore people's perceptions of their sleep quality and the influence sleep has on their symptoms and daily lives. Method. Semi-structured interviews were conducted with sixteen participants diagnosed with primary FMS, covering all aspects of the sleep experience. The audio recorded qualitative interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. Results. Poor sleep dominated participants' lives, affecting levels of pain and fatigue, engagement in daily activities and ability to cope. Participants reported experiencing blocks of sleep, with the most profound difficulty for participants being able to go back to sleep after a night time awakening. They also felt a lack of control in their ability to manage their sleep difficulties and use of day-time napping appeared to be the only perceived beneficial coping strategy for relieving daytime sleepiness and symptoms of fatigue. Conclusions. Greater emphasis on screening for sleep disorders and how to manage poor sleep is needed in rehabilitation programmes provided for patients with FMS.
Aims To examine the acute effects of a guided relaxation routine (body scan) and isometric exercise on desire to smoke and tobacco withdrawal symptoms. Design Experimental comparison of three conditions. Participants Forty-eight individuals reporting smoking ≥10 cigarettes daily. Intervention Random assignment to one of three interventions delivered via a 10-minute audio: isometric exercise (IE, n = 14), body scanning (BS, n = 18) or a reading about natural history (control group, n = 16). Interventions were delivered twice on the same day: in the laboratory, then in their ‘normal’ environment. Measurements Desire to smoke (primary outcome) and withdrawal symptoms were rated at pre-intervention and up to 30 minutes post-intervention. Findings Controlling for baseline scores, post-intervention desire to smoke and withdrawal symptoms were significantly lower for IE and BS groups, compared with the controls, in both environments. There were no significant differences for IE versus BS. For desire to smoke, controlling for baseline values, ratings in the laboratory were significantly lower for IE and BS versus the control up to 30 minutes post-intervention. In the normal environment, these ratings were significantly lower only up to 5 minutes post-intervention. Conclusions Brief IE and BS interventions are effective for reducing desire to smoke and withdrawal symptoms in temporarily abstaining smokers. These interventions were found to be more effective in the laboratory than in the smoker's normal environment, but this may be an artefact of there not being a sufficient ‘wash-out’ period between interventions. These techniques may be beneficial for managing desire to smoke and tobacco withdrawal.
There is growing interest in how workers recover and unwind from work during leisure, as poor unwinding has been associated with negative health. This research explores the recovery process to gain a greater understanding of how individuals switch‐off from work‐related thoughts post work. Specifically, we conducted interviews with workers who habitually find it difficult to switch‐off from work (i.e. high ruminators), and workers who find it easy to switch‐off from work (i.e. low ruminators). Three master themes were elicited using Interpretative Phenomenological Analysis: (1) work philosophy, (2) coping strategies and (3) coping outcomes. The findings revealed differences in core beliefs about work; high ruminators perceive blurred boundaries between work and home life, and they allowed work to mentally predominate during their leisure time, whereas low ruminators viewed their work and leisure as two distinct spheres, and actively developed strategies to switch‐off and disengage from work. Both high and low ruminators acknowledged the health benefits of unwinding post work, yet only low ruminators managed to successfully do so. It was concluded that there is a need for organisations to educate their employees, particularly high ruminators, about the importance of strategic unwinding post work to optimise the quality of leisure time and prevent them from becoming fatigued and burnt out.
The aim of this study was to investigate the long-term effects of need for recovery from work and trait rumination on saliva cortisol secretion. The sample consisted of 76 white-collar workers, 52 men and 24 women who had previously provided baseline data four years earlier and volunteered to participate in the present study. In the present study, saliva cortisol secretion was measured over seven consecutive days, on awakening, and at 10 p.m. No relationships were found between the independent variables and morning saliva cortisol levels. High trait rumination at baseline, however, was significantly related to higher evening cortisol levels for both women and men. Baseline need for recovery from work was strongly related to evening cortisol secretion for women, but in the opposite direction than expected. The present results add to the small but equivocal body of literature that has examined the long-term effects of work strain on cortisol secretion.
This is the protocol for a review and there is no abstract. The objectives are as follows: 1. To review the efficacy of mind and body therapies in comparison to standard care 2. To review the efficacy of mind and body therapies in comparison to an attention placebo 3. To review the comparative efficacy of different types of mind and body therapies 4. To compare the efficacy of mind and body therapies at 1, 3 and 6 month follow-up
Sleep disturbance is a widely reported and debilitating concomitant of fibromyalgia syndrome (FMS) and plays a pivotal role in exacerbating patients’ reporting of symptoms. Bigatti and colleagues report a longitudinal study that examined self-reported sleep, pain, depression and physical functioning in FMS patients at baseline and again at a 12-month follow-up. Their results support previous research in showing that there is a bidirectional correlation between sleep and pain experience. Moreover, the results demonstrated that sleep predicted pain, pain predicted physical functioning, and physical functioning predicted depression, although causality was not actually demonstrated. Nonetheless, this research highlights the prevalence of sleep problems in FMS, and the critical role sleep plays in the quality of life for many patients.
The objective of this study was to assess long-term job strain impact on morning and evening salivary cortisol secretion. In all 77 white-collar workers (31% women; sample mean age, 42 years at baseline) volunteered to sample morning (immediately after waking up) and evening (10 p.m.) salivary cortisol for 7 consecutive days. By median split on aggregated self-reported isostrain from three consecutive questionnaires distributed in a period of approximately 3.5 years the participants were classified into a high or low long-term isostrain condition. Regardless of strain condition, there was a significant reduction in morning salivary cortisol secretion from the working week to the weekend, whereas evening salivary cortisol secretion showed no significant variation during the week. Although chronic isostrain did not affect the morning saliva cortisol measures, evening cortisol secretion was significantly elevated in the chronic high isostrain group throughout the whole week. The elevated evening cortisol measures associated with chronic high strain are concordant with the findings in other studies on long-term strain. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The objective of this review was to evaluate the effectiveness of smoking cessation interventions prior to surgery and examine smoking cessation rates at 6 months follow-up. The Cochrane Library Database, PsycINFO, EMBASE, Medline, and Cinahl databases were searched using the terms: smok$, smoking cessation, tobacco, cigar$, preop$, operati$, surg$, randomi*ed control$ trial, intervention, program$, cessation, abstinen$, quit. Further articles were obtained from reference lists. The search was limited to articles on adults, written in English and published up to December 2006. Only randomized control trials (RCTs) that incorporated smoking cessation interventions to patients awaiting elective surgery were included. Seven studies met the inclusion criteria. Methodological quality was assessed by all the authors. The findings revealed that short-term quit rates (or a reduction by more than half of normal daily rate) ranged from 18% to 93% in patients receiving a smoking intervention (mean 55%), compared with a range of 2%-65% of controls (mean = 27.7%). Two studies examined smoking status at 6 months but these revealed no significant difference in abstinence rates between patients who had received an intervention and those that had not. Studies that incorporated counseling in addition to nicotine replacement therapy appeared to show greater benefits. It is concluded that smoking cessation interventions prior to surgery are effective in helping patients to quit smoking. However, such effects appear to be short-lived. Future research needs to examine intervention and patient factors to see whether tailoring the smoking cessation intervention specifically to the patient improves overall abstinence rates.
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