This article was published in the 1997 Summer Issue of
AWHP's Worksite Health Vol.4, No. 3, 40-44.
Ernesto A. Randolfi, Ph.D.
Associate Professor
1500 North 30th Street
Department of Health and Physical Education
Montana State University-Billings
Billings, Montana 59101-0298
406-657-2123
406-657-2399 fax
E-mail: hpe_randolfi@vino.emcmt.edu
randolfi@imt.net
Key Words: Worksite Health Promotion, Stress Management, Relaxation
Return to Optimal Health Concepts Home Page or the Web's Stress Management and
Emotional Wellness Page
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Abstract
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.
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Developing a Stress Management and Relaxation Center
for the Worksite
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 controlthe 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 enoughto 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 othercompany
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