Professor
1500 UniversityDrive
Department of Health, Physical Education & Human Service
Montana State University-Billings
Billings, Montana 59101-0298
406-657-2123
406-657-2399 fax
E-mail: randolfi@msubillings.edu
randolfi@imt.net
Key Words: Worksite Health Promotion, Stress Management, Relaxation
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Stress management programming is an important component of any worksite health promotion program. One innovative approach to the delivery of stress management services entails the development of a stress management and relaxation center. Analogous to a fitness center, the purpose of this facility is to provide employees with an area, equipment, and qualified staff to encourage learning about and practicing stress management and relaxation techniques. Components of this center include a restricted environmental stimulation technique or therapy (REST) flotation room; electromyograph (EMG), galvanic skin response (GSR), and skin temperature biofeedback instruments; light/sound brainwave entrainment machines; a massage table; computerized stress assessments; a VCR and monitor; a stereo system; a reclining lounge chair; and an extensive audio, video, and text lending library. Suggestions for staffing, management, and marketing are provided.
Introduction
When completing interest surveys of preferred worksite health promotion
activities, employees consistently identify stress management programs as a top
priority. Workers understand the role that stress plays in their lives, and are
searching for assistance in how to keep stress under control. In a national
survey conducted by the Northwestern Life Insurance Company (1992) seven in ten
American workers indicated that job stress is causing frequent health problems
and has made them less productive. Among these same employees, 46 percent
reported that their job was very stressful, 34 percent thought about quitting
their jobs because of workplace stress, and 14 percent did leave their job
because of stress. Further evidence provided by Metropolitan Life Insurance
Company estimates that an average of one million workers are absent on any
given day largely due to stress disorders (Rosch & Pelletier, 1984), and a
study by the American Academy of Family Physicians (1979) found job stress to
be the greatest cause of poor health habits.
The influence of stress on physical and psychological well being is well documented.
Stress has been implicated in heart disease, eating disorders, stroke,
insomnia, ulcers, accident proneness, cancer, decreased immunity, chronic
headaches, diabetes, depression, substance abuse, chronic pain, irritable bowel
syndrome and chronic fatigue. In fact, estimates are that 50 to 80 percent of
all physical disorders have psychosomatic or stress related origins (Rice,
1992). As reported in the Northwestern National Life Insurance Company's stress
in the workplace study (1992), workers who report high stress are three times
more likely than workers reporting low stress to suffer from frequent illness.
These stress related illnesses severely impact on the employer as well as
individual employees. Donatelle and Hawkins (1989) determined that stress on
the job costs businesses over 150 billion dollars per year. Scott and Jaffe
(1994) reported that stress related disability cases have doubled in the last
ten years. They go to cite that in California, the average cost of each claim
is $73,270 (California Worker's Compensation Institute, 1990).
In response to this health and economic threat, many worksite health
promotion programs are attempting to help individuals learn to control the
harmful stress in their lives. A national survey by the Office of Disease
Prevention and Health Promotion (1993) found that 37% of worksites offered some
form of stress reduction activities. According to the government document,
Healthy People 2000, (1990) by the year 2000 the goal is to raise this to at
least 40%. In Stress and Well-Being at Work, Quick, Murphy, and Hurrell, (1992)
have suggested a model for occupational well-being and distress prevention
which focuses on: (a) primary prevention to reduce risk factors or change the
nature of occupational stressors, (b) secondary prevention to alter the ways in
which individuals respond to the risks and stressors, and (c) tertiary
prevention to heal those who have been traumatized or distressed at work. A
comprehensive approach to stress control at the worksite will offer the most
effective measure of dealing with stress related illnesses and losses in
productivity. In discussing examples of each of these approaches, Scott and
Jaffe (1994) offer a succinct overview of worksite stress management programs.
Employers may choose to address organizational factors that contribute to
workplace stress, offer rehabilitation services for stress related illnesses,
or promote individual coping skills to deal with daily stress.
Stress is not the same for all people and one approach will not work for all
employees. As an example, providing employee training in individual coping
techniques as a preventive measure without also correcting negative stressful
working environments is short sighted and may be viewed by some as blaming the victim
for the problems of the corporation. Additionally, many personal stressors are
not work related and will not be improved through environmental or
organizational changes. The NWNL study (1992) determined that two out of three
employees felt stressed by factors outside the workplace. Clearly, an effective
stress reduction program must be broad based enough to deal with a host of
stress related causes and outcomes.
In light of the available research, it is unfortunate that so few of the
worksite health promotion programs offer more than the occasional seminar on
stress or time management for employees. Many corporations may have enlisted
the services of employee assistance programs for the treatment of stress
related disorders, but too often preventive programs are lacking. In examining
other aspects of the health promotion program, it is common to see extensive
fitness and exercise facilities staffed by well-trained personnel. One is much
less likely to see qualified staff and facilities devoted to the prevention of
employee stress.
A Stress Management and Relaxation Center
The following is an overview of the development and implementation of a
facility for the purpose of personal stress management and relaxation training
in a worksite setting. A stress management and relaxation center is analogous
to a fitness center. Employees should have somewhere that they can go,
preferably on site, to train and learn new skills to help them deal with
stress. The purpose of the center is to provide: individual stress management
assessments and prescriptions, followed by exploration and practice in various
techniques, and finally skill development. This model is based on an existing
program and facility at Ohio University, in Athens, Ohio.
The emphasis of this center is on providing a number of approaches for the
control of harmful stress. Health promotion programs would not prescribe the
same form and intensity of physical exercise for all employees, and the same
should be true for stress management programming. Some employees will benefit
most from instruction in time management, others will need to learn a
relaxation skill, and still others will need to focus on how to change their
thinking about stressful situations. A holistic or comprehensive approach
provides greater assurance that the employee will receive the assistance they
need.
In this program, employees schedule appointments with the center's
coordinator who oversees operations and is available for individual
consultation. First time visitors are offered a comprehensive computerized
stress management assessment and a tour of the facility. This allows the
coordinator to identify which techniques may be most appropriate for each
individual. Employees are introduced to an assortment of equipment and learning
materials including a restricted environmental stimulation technique or therapy
(REST) flotation room; electromyograph (EMG), galvanic
skin response (GSR), and skin temperature biofeedback
instruments; light/sound brainwave entrainment
machines; a massage table; and an extensive audio, video, and text lending
library. Equipment use is facilitated by learning modules designed for
independent operation. Printed instructions are written in layman's terminology
and laminated for extended use. All of these items are housed in adjoining
rooms equipped with a VCR, monitor, stereo system and a reclining lounge chair.
Organization and Facility Planning
The stress management and relaxation center can be situated within an employee
assistance program, a worksite medical facility, or adjacent to a fitness
facility. Decisions concerning location and management will be based upon the
existing organizational framework of the health promotion program and possibly
to some extent on existing space allocations. As with any facility of this type
one would hope for a location that is convenient and easily accessible to all
employees.
The room or rooms for a stress management and relaxation center need not be
very large. How much space is needed is difficult to anticipate without knowing
how many workers will wish to use the facility at one time. Whether it is an
unused office, or part of a storage space, the room/s should be quiet and relatively
private. The lay out and requirements of the facility will depend on its
function and the equipment to be utilized. It may be as extensive as providing
the plumbing and shower for a REST flotation room, or as basic as a cubicle
with a lounge chair and some shelving.
Equipment and Supplies
Equipment purchased for this facility can include a computer system and printer
with basic word processing, data base management and stress assessment
software; instructional audio cassette tapes, video tapes and books;
biofeedback equipment with electromyograph (EMG), temperature, and galvanic
skin response (GSR) monitors; light/sound machines; a (REST) flotation room; a
reclining lounge chair, a massage table, a VCR with monitor; and a stereo
system with headphones. A list of some selected vendors is included in the
appendix of this article.
Planners of the stress management and relaxation center may wish to start
small by assembling a lending library of relevant educational materials. Good
quality relaxation cassette tapes, self-help books on tape, printed materials
including books and workbooks, and the instructional video tapes are available
for topics ranging from time management to self hypnosis. Materials should be
screened as well as possible for their scientific validity and appropriateness
for use with the intended audience. Unhealthy diet and weight management
programs would never be promoted by a responsible health promotion program, the
same should be true regarding endorsement of stress management materials.
Compiling an annotated bibliography of educational resources may assist
employees in selecting appropriate materials.
With the establishment of a resource library, one may wish to expand the
center to include other devices to assist employees in learning methods of
relaxation. Biofeedback equipment is used in relaxation training to monitor
stress related physiological processes such as muscular tension, heart rate,
peripheral temperature and perspiration. By providing feedback of physical
effects that one is normally unaware of, an individual can learn how to alter
their physiology in a stress modifying way. As an example, by measuring the
electrical activity in a muscle group with the use of an EMG monitor, one can
quickly learn how to decrease audio or visual feedback associated with the
electrical activity in a muscle group. Muscles continue to hold residual
tension as a by product of the stress response. This accumulated tension is the
opposite of relaxation. When one becomes proficient at lowering measures of
residual muscular tension, then they have learned a skill for relaxation and
will no longer need the EMG monitor.
Another approach to relaxation training is the use of light-sound machines.
Certain brainwave frequencies have been associated with relaxed emotional
states. Light-sound machines employ exposure to flashing lights and repetitive
sound impulses, set to specific frequencies to drive brainwave activity and
thus facilitate a state of relaxation. Light-sound machines with glasses and headphones
are fairly inexpensive and can be made available to employees as part of the
stress management and relaxation center.
Restricted environmental stimulation technique or therapy (REST) flotation
requires a person to float on their back in a ten inch solution of water and
Epsom salt (see Figure 2). The room used for floating is 4 feet by 8 feet by 8
feet with walls, ceiling and floor made of two inch thick insulation material
covered on the inside and out with a durable vinyl surface. The warm (94¡ f)
salt water solution is kept at a very high density so that the user will float
effortlessly on top of the water. This experience is usually described as a
feeling of weightlessness. Employees have control of an air switch that turns a
ceiling light on and off and the room is ventilated to supply fresh air. A
large walk in door allows the employee easy entrance and exit at any time. With
the door closed and the lights turned off the flotation room is sound-insulated
and very dark. When the individual settles themselves down in the solution they
experience a decrease in sensory input that allows them to enter a
hypometabolic state of deep relaxation. First time floaters are instructed to
simply lay in the water for 45 minutes to an hour and allow themselves to
relax.
Employees are required to shower and shampoo before and after floating in
order to maintain a hygienic solution and remove salt from the body when they
exit. Towels, soap, shampoo, conditioner, and ear plugs (to help keep salt out
of the ear canal) are supplied at each session. The design of a flotation room
within a stress management and relaxation center will necessitate planning for
the plumbing of a drain and water supply for the adjacent shower. Other than
general cleaning and the laundering of towels, maintenance for this facility is
relatively small. A water filtration and purification system can be automated,
negating the need for continual management. As one of the more expensive
allocations within the stress management and relaxation center, this somewhat
exotic item will serve as a centerpiece to any facility and attract a large
number of employees to the center.
The flotation room can also be equipped with speakers for the transmission of
music or instructional audio recordings to the floater. Within the center a
cassette tape player with compact disc drive stereo system can serve a dual
purpose. When the system is not being used as a sound system for the flotation
room, headphones can be plugged in and employees can listen to tapes and
compact discs from the resource library.
The purchase of a lounge chair will complete a relaxing environment for the
employees to learn about and practice techniques. A reclining lounge chair can
be purchased for a little as a $100 in discount furniture stores or as much as
$3,000 for leather chairs with sophisticated massage units built in. As with
all of the purchased items one must be aware of the potential heavy use this
equipment may receive and subsequently be concerned about maintenance costs.
Whenever possible, choose durable equipment and take the time to inquire about
repair frequency and costs prior to purchase.
In addition to the above, many occupational health promotion programs offer
yoga, meditation and relaxation classes. Others may offer the services of a
massage therapist at the worksite. The stress management relaxation center is a
logical venue for the management of group instructional classes and for the
administration of massage appointments. Exercise mats can convert an unused
aerobics exercise room into a comfortable yoga classroom. Similarly, a good
quality massage table or chair can be a useful addition to the stress
management and relaxation center. A fee can be charged to control the use of
some of the more popular components of the center (e.g., massage or use of the
flotation room) and to assist in decreasing the cost of these programs.
Personnel
Depending on the size of the workforce and the demand of the employees, it may
be possible for one person to manage the stress management and relaxation
center. From the description of the equipment and the facility, one can see
that this coordinator should have a certain degree of professional knowledge
and skills. A health educator with a graduate degree and special training in
stress management would be an ideal choice. A certified biofeedback therapist
would only be necessary if one intended to provide rehabilitation services in
addition to education. The described center is intended as an educational
facility that provides education and training not a therapeutic one that
provides treatment for specific conditions. Many individuals identify
themselves as stress management experts however, not many of these individuals
will have the breadth of knowledge necessary to deliver the comprehensive
approach promoted by a center for stress management and relaxation. One choice
is to hire someone who holds Certification in Stress Management Education
through the International Biofeedback Certification Institute. This
certification will assure at least a minimum level of knowledge and experience.
If massage, yoga, meditation and other relaxation classes are offered at the
worksite, qualified instructors can be hired on a part time basis. In contracting
with a massage therapist, one should be aware that many states require
professionals to hold a valid license.
Marketing the Program
The novelty of a new and innovative approach to health promotion, along with
general curiosity, will bring many employees to the stress management and
relaxation center. Advertising the new facility with an open house celebration
will allow many otherwise inhibited individuals to tour the facility. New
employees should certainly be introduced to the center as part of their new
employee orientation.
Once the novelty of the program wears off, a broad based marketing program
can be instituted to continue to promote the center. Employees will choose to
come to the center for a variety of reasons. A successful campaign will
identify these interests and exploit them within program advertising. As an
illustration, some may be lured to the facility with the objective of increased
performance and personal effectiveness, others will be searching for relief of
some stress related condition (e.g., insomnia, tension headaches, chronic pain,
hypertension), some will be searching for experiences with altered states of
consciousness, and still others will be content to simply have a place to go
for a temporary escape from the pressures of daily life. Those designing
promotional materials should be cognizant of the range of motivations for
visiting the stress management and relaxation center and should be prepared to
address the scope of these needs.
The opportunity to visit the center will often introduce employees to the
health promotion program that have never participated in any other company
sponsored prevention efforts. Once these individuals have contact with the
program and realize the benefits of its components, they are more likely to
attend and participate in future health promotion efforts. As an example, the
sedentary worker who comes to the center complaining of stress related symptoms
may be encouraged to see the therapeutic value of participating in a fitness
program to relieve stress. Similarly, the physically fit employee may need to
be reminded of the benefits of deep relaxation as a supplement to a vigorous
exercise program.
Summary
A stress management and relaxation center should be part of any complete
worksite health promotion program. The emphasis of such a center is on allowing
individuals to experience a variety of stress management techniques and to
develop competence in one or more techniques. A commitment by the employer to
reduce work related stress while promoting the concept of a stress management
and relaxation facility, demonstrates a concern in the lives of the workers and
the stress in their lives. By empowering individuals to better manage their
stress and relax, health promotion professionals will ensure a healthier and
more productive workforce.
References
American Academy of Family Physicians (1979). A report on
lifestyles/personal health care in different occupations. Kansas City: Author.
California Workers' Compensation Institute (1990). Mental stress claims in
California workers' compensation: Incidence, costs and trends. CWCI Research
Notes (June).
Donatelle, R. J. & Hawkins, M. J. (1989). Employee stress claims:
Increasing implications for health promotion programming. American Journal of
Health Promotion, 3, 19-25.
Healthy people 2000: National health promotion and disease prevention
objectives 1990. , (DHHS Publication No. (PHS) 91-50213). Washington, DC: U.S.
Department of Health and Human Services, Public Health Service
Northwestern National Life Insurance Company (1992). Employee burnout:
Causes and cures. A research report. Part 1: Employee stress levels. Part 2:
Addressing stress in your organization. Minneapolis, MN: NWNL Employee Benefits
Division.
Office of Disease Prevention and Health Promotion (1993). National survey of
worksite health promotion programs: Executive summary. Washington, DC: National
Health Information Center.
Quick, J. C., Murphy, L. R., & Hurrell, J. J. (Eds.) (1992). Stress and
well-being at work: Assessments and interventions of occupational mental
health. Washington, DC: American Psychological Association. Rice, P. L. (1992).
Stress and health. (2nd ed.). Pacific Grove, California: Brooks/Cole.
Rosch, P. J. & Pelletier, K. R. (1984). Stress management in the workplace.
In O'Donnell, M. P. & Ainsworth, T. (Eds.), Health promotion in the
workplace. (pp. 362-390). New York: John Wiley & Sons.
Scott, C. D. & Jaffe D. T. (1994). Stress management. In O'Donnell, M.
P. & Harris, J. S. (Eds.), Health promotion in the workplace. (2nd ed.),
(pp. 390-424). Albany, New York: Delmar.
Appendix
Selected Resources
Biofeedback equipment
Bio-Medical Instruments, 2387 East Eight Mile Road, Warren, Michigan
48091-2486
800-521-4640
Stress Management and Biofeedback Certification
Biofeedback Certification Institute America, 10200 West 44th Avenue, Suite 304,
Wheat Ridge, Colorado 80033
303-420-2902
REST Flotation Rooms
Tank Alternatives Inc., 322 Buttonwood Street, Trenton, New Jersey 08619
609-587-5017
Audio Tapes
Psychology Today Tapes, Box 400421, Des Moines, Iowa 50340
800-444-7792
New Harbinger Publications, Inc., 5674 Shattuck Avenue, Oakland, California
94607
800-748-6273
Whole Person Associates, 210 West Michigan, Duluth, Minnesota, 55802-1980
800-247-6789
Light Sound Machines
Synetic Systems, Inc., PO Box 95530, Seattle, Washington 98145
800-388-6345
Computerized Stress Assessments
Computer Stress Inventory, Preventive Measures, Inc., 1115 West Campus Road,
Lawrence, Kansas 66044
913-842-5078
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