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Using and Interpreting StressScan. Definition of Stress.

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definition of stress
Definition of Stress

“It seems wise to use “stress” as a generic term for the whole area of problems that includes the stimuli producing stress reactions, the reactions themselves and the various intervening processes. It defines a large, complex, amorphous, interdisciplinary area of interest and study.” (Lazarus, 1966)

what are your major work and life stressors
What Are Your Major Work and Life Stressors?






stress response
Stress Response

Sympathetic Nervous System (SNS)

  • Epinephrine (Ep also known as adrenaline) an norepinephrine (NEp) activate/arouse us during stress
  • Immediate response to stressor (within seconds)

Hypothalamic Pituitary-Adrenal Axis (HPA)

  • Releases stored energy (glucose/fatty acids) to deal with emergencies via glucocorticoids (e.g., cortisol)
  • Slower onset following stressor (within minutes)
stress response pattern
Stress Response Pattern




“Fight or Flight” activation of the autonomic nervous system (e.g., heart rate, blood pressure, cortisol, etc.)

Immune suppression reaction, release of endorphins and growth hormone

Exhaustion phase contributing towards stress related illness and exacerbation of medical conditions

stress response pattern7

Stage 1

Stage 2

Stage 3




Response to

stressful event

Normal level

of resistance

Stress Response Pattern
stress response tend and befriend model
Stress Response“Tend-and-Befriend Model”
  • A team of researchers headed by Shelley Taylor, a psychologist at the University of California, Los Angeles, reviewed over 1,000 human and animal stress response studies
  • Men and women also react with a “tend-and-befriend” approach in the face of work and life stress
  • Females respond to stressful situations by protecting themselves and their young through nurturing behaviors--the "tend" part of the model--and forming alliances with a larger social group, particularly among women--the "befriend" part of the model
  • Males, in contrast, show less of a tendency toward tending and befriending, sticking more to the fight-or-flight response

Taylor, Shelley (2002). The Tending Instinct: Women, Men and the Biology of Nurturing. New York: Times Books

stress and health important points
Stress and Health: Important Points
  • Sickness and disease are not the same
  • Stressors do not make you sick
  • Stressors make you more likely to get diseases that make you sick
  • Chronic stress exacerbates pre-existing conditions, rather than, causing disease directly
  • There exists substantial individual variability in response to disease
the mind body connection chronic stress
The Mind-Body Connection: Chronic Stress

Problems Associated with Chronic Stress

  • Cardiovascular (e.g., arteriosclerosis)
  • Digestion (e.g., ulcers, decreased nutrient absorption)
  • Bone (e.g., osteoporosis, stunted growth)
  • Glucose (e.g., late onset diabetes)
the mind body connection i immunocompetence
The Mind-Body Connection I Immunocompetence
  • Acute (e.g., final exams, sleep deprivation) and chronic (e.g., bereavement, marital conflict, care giving) stressors are significantly associated with immunosuppression in over 30 years of research
  • Negative appraisal, realistic acceptance, suppression of negative/trauma related thoughts and pessimism appear to directly contribute adversely to immune function
the mind body connection ii repressive coping
The Mind-Body Connection II Repressive Coping

Definition of Repressive Coping:

Repressive coping is a personality trait characterized by low self-reports of anxiety in stressful situations and high scores on defensiveness and social desirability

the mind body connection ii repressive coping and health
The Mind-Body Connection II: Repressive Coping and Health

Overall, the evidence suggests a signifcant association between repressive coping and immunosuppression, cardiovascular reactivity and elevated blood pressure

Schwartz, G. (1990). The psychobiology of repression and health. In J. Singer (Ed.), Repression and dissociation (pp. 405-434). Chicago: University of Chicago Press.

Jorgensen, R., et. al.(1996). Elevated Blood Pressure and Personality: A Meta-Analytic Review. Psychological Bulletin, 120(2), 293-315

the mind body connection ii repressive coping and cancer
The Mind-Body Connection II: Repressive Coping and Cancer
  • A recent meta-analysis examined the relationship between psychosocial factors and breast cancer
  • Average effect sizes were calculated from 46 studies for 8 major categories
  • The average woman in the breast cancer group generally used a repressive coping style to a greater extent than did 65% of the women in the control group

McKenna, Molly C.; Zevon, Michael A.; Corn, Barbara; Rounds, James (1999). Psychosocial factors and the development of breast cancer: A meta-analysis. Health Psychology. Volume 18(5) 520-531

the mind body connection ii repression and social support
The Mind-Body Connection II: Repression and Social Support
  • Individuals high in defensiveness reported significantly higher social support compared to others
  • Some limited evidence of a “super repressor” were observed in this study (high defensiveness, low anxiety, high optimism)

Nowack, K.M. (2001). Repressive coping and social support: In search of a “super” repressor. Unpublished manuscript.

repressive coping and emotional intelligence
Repressive Coping and Emotional Intelligence
  • Self-manager differences in performance ratings were studied in relation to the ratee’s personality scores for 204 managers
  • Inflated self ratings (relative to those of his/her manager) were significantly associated with higher achievement, high social confidence, high social desirability and low anxiety

Goffin & Anderson (2002). Differences in self-and superior rating of performance: Personality provides clues. Paper published at the Society of Industrial and Organizational Psychology. Toronto, Canada

repressive coping and emotional intelligence18
Repressive Coping and Emotional Intelligence
  • 84 students predicted how their best friends would respond to various inconsiderate behaviors on their part compared to their friends reactions
  • Repressor’s predictions were significantly less negative than their friends and, unlike nonrepressors, showed no association with their friends responses (i.e., low social awareness about their inconsiderate behaviors)

McKinney & Newman (2002). Anticipating responses to one’s own misdeeds: Repressive coping and the prediction of other’s reactions to inconsiderate behavior. Journal of Social and Clinical Psychology, 21, 427-437

stress response types
Stress Response Types
  • get sick in the battle of experiencing stress/change
  • get sick after the battle of experiencing stress/change
  • experience work and life stress/change without getting sick

Hot Reactors


The Hardy

stress response type hot reactors
Stress Response Type: Hot Reactors

Hot Reactors

  • 1 in every 5 people
  • Blood pressure shoots up under pressure
  • High in cynical mistrust, hostility and anger
  • Untreated, hot reactors are subject to heart disease, stroke and sudden cardiovascular death
stress response type sustainers
Stress Response Type: Sustainers


  • Experience illness or symptoms following stressful events or after the stress is over -- “Let Down Effect”
  • Happens when shifting gears from a state of high activation to one of low activation
  • Is frequently experienced after a stressful project is completed, on or after weekends, holidays, vacations, or after retirement
stress response type the hardy
Stress Response Type:The Hardy
  • Perceive less work/life stress
  • Practice daily health habits
  • Possess strong social support
  • React less frequently with Type A response to stress
  • Possess a hardy outlook and optimistic explanatory style of work and life events
  • Utilize health enhancing coping strategies and behaviors
determinants of individual health

Social Circumstances


Medical Care


McGinnis et al., 2001






Determinants of Individual Health
habits are hard to change
Habits are Hard to Change
  • NEW YEARS RESOLUTIONS: 25% abandon new behaviors after 15 weeks; 60% make the same resolution the next year
  • WEIGHT LOSS: 95% of those who lose weight regain it back within 2 years
  • SMOKING: Only 13-14% are abstinent 6 to 12 months after quitting
  • ALCOHOL: 90% of those treated have a drink within 3 months; 50% return to pre-drinking levels within a year
necessary ingredients for changing behavior
Necessary Ingredients for Changing Behavior

Nowack, K. and Heller, B. (2001). Making executive coaching work.


Emotional Intelligence


about stressscan
About StressScan
  • StressScan quickly identifies individual characteristics that protect against or contribute to stress related illness
  • This validated instrument based on over 15 years of research measures 15 psychosocial risk factors including perceived stress, lifestyle management behaviors, social support, Type A behavior, cognitive hardiness, coping style and psychological well being
  • In addition, two validity scales measure inconsistent responding and responding bias
  • Norms are based on ethnically diverse sample of 1,111 men and women, ages 20 to 68 from diverse working environments
about stressscan continued
About StressScan Continued
  • StressScan is available online or scored by hand in just 15 to 20 minutes
  • The StressScan report summarizes important health risk alerts and health resources for each individual
  • StressScan has established reliability and validity based on over 15 years of research
  • StressScan is ideal for coaches who are dealing with work pressure, stress and family balance issues
  • StressScan makes an excellent health risk appraisal within organizational settings (as part of executive coaching, wellness, stress management and health promotion programs)
stressscan response bias index
StressScan: Response Bias Index

The Response Bias Index is made up of 5 true-false items such as “ I have never lied in my life.” A response in the scored direction for any of these items suggests that the respondent may be presenting him/herself in an unusual light. The Response Bias Index is the number of these items for which the scored response has been given. Scores higher than 2 may suggest a careless or unusual response bias to completing the StressScan

occupational stress
Occupational Stress
  • Measures of work and life stress are modestly associated with physical illness, job burnout and psychological distress (average r’s range between .10 to .30)
  • A 2004 survey by Consulting Tools USA revealed that 40% of all employees report they “disagreed” or “strongly disagreed” with the statement “the amount of pressure and stress on my job is reasonable and rarely excessive”
  • Reduction in perceived work and life stress have been found to be associated with immune enhancement (Nowack, 1992)
  • Individual stress-management interventions generally are effective in reducing negative individual health outcomes, but do not consistently affect outcomes such as absenteeism, turnover, accidents, health care costs, productivity or job satisfaction unless additional organizational interventions occur (Nowack, 2000)
stressscan health habits scales
StressScan: Health Habits Scales
  • Global Health Habits
  • Exercise/Physical Activity
  • Sleep/Rest
  • Eating/Nutrition
  • Prevention
  • Substance Use (alcohol, smoking)
“If I’d known I was gonna live this long, I’d have taken better care of myself”

Eubie Blake at 100

health habits exercise
Health Habits: Exercise
  • Physical activity affects many aspects of health including protection against premature mortality, CHD, hypertension, cancer, depression and anxiety
  • Despite established benefits of regular exercise, more than 60% of adults in the US and UK are sedentary or insufficiently active
  • The US American College of Sports Medicine recommends a level of physical activity of 30 minutes on 5 or more days/week or intense activity of 30-60 minutes at least 3 days/week for protective health benefits
  • Lack of exercise has been shown to be an independent risk factor for heart disease (risk of inactivity ranges from 1.5 to 2.4, an increase in risk comparable with that observed for high cholesterol, HBP or cigarette smoking)
health habits sleep rest
Health Habits: Sleep/Rest
  • Sleep is a 24-hour circadian rhythm
  • REM and NREM sleep
  • Sleep disorders:
    • Insomnia
    • Excessive daytime sleepiness (e.g., sleep apnea, narcolepsy)
    • Circadian rhythm disorders (e.g., delayed phase, shift work, jet lag)
  • There are many causes of sleep deprivation. Some include: 1) Not allowing enough time for sleep; 2) sleep disorders; 3) excessive worry ; 4) depression; repeated awakenings from noise; 5) shift work, working at night and travel across time zones; 6) medications; and 7) medical illness causing pain, difficulty in breathing, etc.
  • Even a small loss of sleep can decrease waking performance and alertness. Research indicates that, for most people, one night with 2 hours less sleep than is usually required is sufficient to affect subsequent waking performance and alertness significantly
  • Popular sleep treatments that might be helpful for sleep problems (e.g., insomnia) include exercise, mental/physical relaxation, light therapy, melatonin, valerian and new generation sleep aids
health habits nutrition
Health Habits: Nutrition
  • Approximately 61% of American adults are overweight
  • Healthy eating and nutrition involves the following eight components: 1) high monsaturated fats found in many nuts and olive oils and low saturated fats found in most meat/dairy products; 2) moderate alcohol consumption; 3) high consumption of vegetables; 4) high consumption of cereals, grains and fiber; 5) high consumption of fruits; 6) high consumption of legumes; 7) low consumption of meat; and 8) low consumption of dairy products
  • From a long term health perspective, it appears more important to increase the number of healthy foods regularly consumed than to just reduce the number of less healthy foods regularly consumed
health habits preventive practices
Health Habits: Preventive Practices
  • The use of aspirin has been shown to have a cardiovascular health benefit
  • Some recent studies suggest that moderate use of alcohol several times a week may have some limited protective effects on the cardiovascular system
  • Lap/shoulder safety belts, when used, reduced the risk of fatal injury to front-seat passenger car occupants by 45 percent and the risk of moderate-to-critical injury by 50 percent
health habits alcohol and health
Health Habits: Alcohol and Health
  • Moderate alcohol consumption is associated with cardiovascular health benefits
  • The lowest mortality occurs in those who consume one or two drinks per day
  • Demonstrated reduction in current and future coronary heart disease (CHD) with moderate consumption of alcohol
  • About 50% of the protective effect of alcohol is mediated through increased levels of HDL cholesterol
  • Higher levels of alcohol consumption have been conclusively linked to more serious illnesses, accidents and adverse health outcomes
health habits smoking
Health Habits: Smoking
  • Smoking in adults has declined in the US from 53% in 1966 to 23% in 2001
  • Cigarette smoking is a major risk factor for CHD (30% of approximately 170,000 of all coronary deaths are directly attributed to smoking)
  • Smokers risk of heart attack is twice that of non-smokers
  • Lower stress consistently contributes to one’s ability to successfully maintain cessation in both the short and long-term
social support
Social Support
  • Cross sectional and prospective studies have consistently shown that social support can significantly reduce the severity of stress and psychological experience of it
  • Epidemiological research has established that low social support is associated with both mortality and morbidity
  • Types of social support
    • Emotional
    • Informational
    • Instrumental
  • Sources of social support, perceived availability, utility and overall satisfaction are associated with health and well-being in the face of work and life stressors
  • Positive changes in social support have been found to influence coping behaviors and immune function (Nowack, 1992)
type a behavior
Type A Behavior
  • Commonly associated with hard driving, competitive, achievement striving, impatient, hostile, energetic, fast paced and time urgent behaviors
  • The toxic components of Type A Behavior appear to be cynical mistrust and antagonistic hostility
  • Research shows a relationship between reduction of Type A Behaviors and CHD
cognitive hardiness
Cognitive Hardiness
  • View change as a challenge, rather than a threat
  • Are committed, rather than alienated, with their activities a work and home
  • Possess a more internal, rather than external, locus of control
  • Possess an optimistic explanatory style by appraising bad events as relatively external, unstable and specific
  • Report greater self-esteem, self-efficacy and lower neuroticism (core self-evaluations) associated with increased job satisfaction and job performance
  • Hardy individuals who experience stress report significantly less illness, job burnout, and psychological distress
coping style
Coping Style

Coping Styles

  • Positive Appraisal
  • Negative Appraisal
  • Threat Minimization
  • Problem-Focused Coping

In two separate longitudinal studies, high scores on the Threat Minimization coping style and exercise significantly predicted lower levels of self-reported physical illness and absenteeism (Nowack, 1994)

coping style unwinding stress
Coping Style: Unwinding Stress

Perceived Stress





religion spirituality linkages to health
Religion/Spirituality: Linkages to Health
  • Religion is a very important part of the lives of approximately 67% of the American public
  • 96% of the American public believe in God
  • 42% attend religious services regularly
  • Interest in spiritual growth is increasing with 82% expressing such interest in 1998 compared to only 58% in 1994

Powell et al., 2003

religion spirituality strength of evidence linking to health
Religion/Spirituality: Strength of Evidence Linking to Health
  • Service attendance protects against death
  • Religion/spirituality protects against heart disease
  • Deeply religious people are protected against death
  • Religion/spirituality protects against disability
  • Religion/spirituality slows cancer
  • People who use religion to cope live longer
  • Religion/spirituality improves recovery from illness
  • Religion/spirituality impedes recovery from illness
  • Being prayed for improves physical recovery from illness

Powell et al., 2003, American Psychologist, 58, 36-52










approaches to preventive stress management
Approaches to Preventive Stress Management

Change Your Perception or Belief About the Stressor

Modify the Stressor

Practice Stress Inoculation Behaviors

Change Your Reaction to the Stressor

coping with stress relaxation
Coping with Stress: Relaxation

Mental Relaxation

  • Meditation
  • Breathing Exercises
  • Visualization
  • Self-Hypnosis

Physical Relaxation

  • Stretching
  • Progressive Relaxation
  • Yoga
  • Massage
coping with stress meditation
Coping with Stress: Meditation
  • Choose a quiet environment that is not too brightly lit. Allow yourself 5 minutes at first and gradually work up to 20 minutes.
  • Sit upright with your spine erect….feet should be flat on the ground with your hands resting in your lap. Close your eyes and keep your body still.
  • Start with some deep breathing: inhale and exhale deeply, letting all your breath out. Pause, then inhale letting the breath flow naturally using your abdomen muscles.
  • Now allow your breathing to become natural and slow….as you exhale count “one.” Continue counting, each time you exhale. If thoughts enter your mind and your forget to count, simply notice and dismiss the thoughts. Do the same with sounds and bodily sensations—simply notice and dismiss them.
  • If you wish to time yourself, use a non-ticking timer…When you are done, rock, gently back and forth before slowly getting up. Practice at least once daily.
coping with stress visualization
Coping with Stress: Visualization

Create Your Daydream

Picture a scene in which you are perfectly relaxed….. Perhaps you are lying at the beach on a warm breezy day….Continue to visualize this scene, noticing the warmth of the sun on your body, feeling more relaxed, while your breathing becomes slow and rhythmic.

You feel the warmth of the sun on your arms, legs, and face….how it totally relaxes and soothes all of your muscles…you actually can feel beads of perspiration form and your fingers and hands swell slightly as you continue to slow down your breathing and feel relaxed and calm…..Focus on the sounds of the waves crashing at the beach and feel the slight breeze of the wind on your face as you continue feeling calm, comfortable and very relaxed…slowly open your eyes….Practice this visualization when you experience stress and anxiety.

causes of work stress


Task Demands

Physical Demands

Role Demands


Quick decisions

Temperature extremes

Role ambiguity

Group pressures

Critical decisions

Poorly designed office

Role conflict

Leadership styles

Incomplete informa-

Threats to health


tion for decisions


Causes of Work Stress
organizational costs of health management
Organizational Costs of Health Management
  • A 2001 Kaiser Family Foundation survey found employees with single insurance coverage are now paying 27% more on average than last year
  • The US Health Care Financing Administration forecasts for 2005 suggest a dollar increase of 57% from 2002 to 2005
  • Relatively progressive companies pay 80 times more in diagnosis and treatment than for employee preventative maintenance health programs
  • Solid evidence suggests that 50% to 70% of all diseases are associated with modifiable health risks and potentially preventable
preventive stress and health management
Preventive Stress and Health Management
  • A recent review of over 13 studies indicates an average benefit to cost ratio of $3.48 in reduced health care costs and $5.82 in lower absenteeism per dollar invested (Aldana, 2001)
  • Combined health enhancement programs focusing on lifestyle management change have been shown to yield a $3 to $6 return on investment for each dollar invested in 2 to 5 years (Pelletier, 2001)
work family balance
Work/Family Balance
  • More and more people in the workforce are putting emphasis on family as an important priority
  • Over 70% of workers do not think there is a healthy balance between work and family
  • Increasingly employees are exploring new careers because of the inability to manage work and family stressors
organizational stressors leader practices
Organizational Stressors: Leader Practices
  • 70% of employees’ perception of the organizational climate is associated with the emotional intelligence of the leader (Goleman, 2002)
  • Poorly managed workgroups are an average of 51% less productive and 44% less profitable than well managed groups
  • 80% of turnover is directly related to unsatisfactory relationships with one’s boss
consulting tools 2004 study leadership matters
Consulting Tools 2004 Study: Leadership Matters
  • Results of two company wide employee engagement surveys were analyzed for all corporate staff for a large food service corporation for 2002 and 2004
  • Employees rated leadership and management practices using a benchmarked 8-item Leadership Effectiveness Index (alpha .91)
  • Employees were asked additional questions about retention (intention to leave in 12 months), job satisfaction and perceptions of stress

Nowack, K. (2005). Does Leadership Practices affect a Psychologically Healthy Workplace?

unscheduled absence 2005
Unscheduled Absence 2005
  • Companies with poor morale have an unscheduled absence rate of 3.2% compared to 1.5% for companies reporting “good” or “very good” morale
  • Only 35% of unscheduled absences are due to actual illness
  • Estimates are that employee absenteeism costs about $660 per employee

CCH Unscheduled Absence Study 2005

organizational stressors team practices
Organizational Stressors: Team Practices
  • Positive mood of the team leader promotes worker productivity and retention
  • Team members tend to share moods, whether positive or negative, with more positive moods associated with increased performance
preventive organizational stress and health management
Organizational Demands and Stressors

Physical Demands

Task Demands

Role Demands

Interpersonal Demands

Organizational Preventive

Stress Management

Physical/Task Demands

Job/task redesign

Participative management

Flexible work schedules

Design of physical settings

Role/Interpersonal Demands

Selection/Promotion systems

Career/Talent management

Mentoring systems

Team building

Diversity workshops

Leadership development

Preventive Organizational Stress and Health Management
selected references
Selected References
  • Nowack, K. (2000). Occupational stress management: Effective or not? In P. Schnall, K. Belkie, P. Landensbergis, & D. Baker (Eds.). Occupational Medicine: State of the Art Reviews, Hanley and Belfus, Inc., Philadelphia, PA., Vol 15, No. 1, pp. 231-233.
  • Greene, R. and Nowack, K. (1996) Stress, hardiness and absenteeism: Results of a 3-year longitudinal study. Work and Stress, 9, 448-462.
  • Nowack, K. M. (1994). Psychosocial predictors of health, job satisfaction and absenteeism: Results of two prospective studies. Paper presented at the 1994 American Psychological Association National Convention, Los Angeles, CA.
  • Nowack, K. and Pentkowski, A. (1994). Lifestyle habits, substance use, and predictors of job burnout. Work and Stress, 8, 19-35.
  • Schwartz, G.E., Schwartz, J.I., Nowack, K.M., & Eichling, P.S. (1992). Changes in perceived stress and social support over time are related to changes in immune function. University of Arizona and Canyon Ranch. Unpublished manuscript.
  • Nowack, K. M. (1991). Psychosocial predictors of physical health status. Work and Stress, 5, 117-131.
  • Nowack, K. M. (1990). Initial development and validation of a stress and health risk factor instrument. Journal of Health Promotion, 4, 173-180.
  • Nowack, K. M. (1989). Coping style, cognitive hardiness, & health status. Journal of Behavioral Medicine, 12, 145-158.