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 Occupational stress: Reflections on theory and practice
Dianna T. Kenny
Chapter 20, (pp 375-396), Kenny, D. T., Carlson, J. G., McGuigan, F. J., & Sheppard, J. L. (Eds.) (2000). Stress and health: Research
and clinical applications (467 pages). Amsterdam, The Netherlands: Gordon Breach/Harwood Academic Publishers. ISBN 90 5702
376 8.
INTRODUCTION
Whether burdened by an overwhelming flurry of
daily commitments or stifled by a sense of social
isolation (or, oddly both); whether mired for hours
in a sense of life’s pointlessness or beset for days
by unresolved anxiety; whether deprived by long
work weeks from quality time with one’s offspring
or drowning in quality time with them – whatever
the source of stress, we at times get the feeling that
modern life isn’t what we were designed for (Wright,
1995, p.62).
Occupational stress is currently one of the most
costly occupational health issues (Cooper & Cart-
wright, 1994; Cooper, Luikkonen & Cartwright,
1996; Cotton & Fisher, 1995; Karasek & Theorell,
1990; Kottage, 1992). The deleterious implications
for individuals and organisations are manifold, and
can result in serious physical and psychological ill-
ness for individuals, and major resource loss for or-
ganisations. The extent and progression of the prob-
lem over the past 20 years have been eloquently
documented elsewhere [see Levi (this volume); &
Spielberger, Reheiser, Reheiser, & Vagg (this vol-
ume)].
Occupational stress research has concentrated on
aetiology (Hart & Wearing, 1993; Toohey, 1993),
measurement (Spielberger, 1998), and tertiary inter-
ventions. These have focused on either enhancement
of the individual’s coping capacity (Murphy, 1988)
or broader organisational level changes such as in-
creased worker participation in decision making,
job enlargement and enrichment, redesign of jobs
and working environment, and creation of a more
supportive work environment through a range of
human resource management interventions (Coop-
er et al, 1996; Hart & Wearing, 1995; Levi, 1990).
As effective as some of these strategies are in large
scale restructuring enterprises, many organisations
are deterred from such global changes as a means of
preventing and managing occupational stress. This
is due to the cost and intrusion of such strategies and
the relatively small numbers of employees mani-
festing stress conditions that impair occupational
functioning at any one time in any one work place
Occupational Stress 16
(Cooper & Payne, 1992). There will always, there-
fore, be a need to cope with occupational stress on
both the macro (organisational, structural, political)
and micro (individual, dyadic, triadic) levels. This
paper contributes to the enhancement of managing
occupational stress at the micro level.
Firstly, a systemic model for understanding occu-
pational stress is proposed. Some extant theories of
occupational stress will then be reviewed, and in-
terventions arising from these theories are assessed.
Finally, an intervention for the rehabilitation of oc-
cupational stress based on the proposed model and
theoretical discussion is outlined.
THE MODEL
In a series of recent studies (Kenny, 1995a, 1995b,
1995c, 1995d, 1995e, 1995f, 1995g, 1996), Kenny
explored the causes of the failure of occupational
rehabilitation to effect a sustainable return to work
following workplace injury. She concluded that a
systemic framework provided both the most heu-
ristic explanation for such failures and a workable
model on which to base subsequent rehabilitation
interventions. Accordingly, the model for both un-
derstanding occupational stress and to occupational
stress interventions, proposed in this chapter is in-
formed by systemic theories, including cybernetics,
communication theory, family therapy as applied to
the systems (ie workplaces, organisations and work-
ers’ compensation system) in which the worker is
located, and current theories of occupational stress
which embrace a systemic epistemology (Bowen,
1987; Cottone, 1991; Hart & Wearing, 1995; Kara-
sek & Theorell, 1990; Kenny, 1995e).
A systemic theoretical model for tertiary rehabili-
tation of occupational stress (Cottone & Emener,
1990; Kenny, 1995g) is different to other models in
that the focus is on neither the individual, nor the
organisation, but on the system as a whole. In this
model, occupational stress is understood as the sys-
tem’s attempt to maintain equilibrium or to restore
homeostasis (Hart & Wearing, 1995; Hoffman,
Kenny D.T., 1999
1981). Occupational stress is not considered to be
symptomatic of intra psychic pathology of the iden-
tified client, as in the medical model, or a result of
environmental factors, as in the sociological mod-
el. In the proposed model, a circular epistemology
(Hoffman, 1981; Keeney, 1987) informs the rehabil-
itation process by conceptualising relationships and
processes within the system as the proper subject of
investigation and intervention, thereby illuminating
a range of intervention strategies at both the indi-
vidual and organisational levels. Another important
feature of a systems theory framework that differs
from current approaches is the temporal location,
which is focused heuristically upon the present and
future, rather than on a forensic establishment of
fact based upon past actions and processes.
THEORIES OF OCCUPATIONAL STRESS
Psychological theories
The predominant paradigm for understanding
the causes of occupational injury and illness is the
medical model (Quinlan & Bohle, 1991; Quinlan &
Johnstone, 1993). With its emphasis on individuals
rather than groups, on treatment rather than preven-
tion, and on technological intervention rather than
environmental change, the medical model has been
very influential in controlling both the way in which
occupational injuries and illnesses have been de-
fined and the means by which they are managed.
The major criticism of the medical model has been
its focus on treating sick or injured workers rather
than on producing healthy working environments
(Biggins, 1986). The outcome of this approach was
to perpetuate the notion that workplace injuries are
‘accidents’ which were not preventable and to lo-
cate the blame for the injury in the individual work-
er or in the hazardous nature of the work (Davis &
George, 1993; Ferguson, 1988; James, 1989).
The disciplines of industrial, occupational and
health psychology have not lived up to their early
promise because they have adopted a managerialist
orientation akin to the medical model. That is, they
tend to focus on the characteristics and behaviours
of individual workers and avoid addressing the role
that the structure of power and authority in indus-
try play in occupational well-being (Bohle, 1993).
For example, although the relationship between
monotonous, deskilled and machine-paced work
and environmental and organisational factors such
as shiftwork, piece work, excessively high or low
work demands, and poor working conditions on
psychological and physiological stress responses
Chapter 20, Stress and Health
in workers have been demonstrated (Clegg & Wall,
1990), their impact is predominantly assessed in re-
lation to individual attitudes and behaviour, rather
than in relation to the structure of workplaces and
the organisation of labour (Quinlan, 1988).
Sadly, the history of psychological theories of oc-
cupational stress, and indeed occupational injury
generally, has been one of finding victims to blame,
and then to intervene in a linear way to alter the per-
formance of the latest scapegoat. Proponents of these
models have variously blamed the job, blamed the
equipment, blamed the worker, and blamed manage-
ment (Cooper, 1995; Kenny, 1995e; Habeck, 1993;
Quinlan, 1988; Willis, 1994). Such theories have
spawned an enormous amount of research searching
for the putative factors responsible for occupational
stress. Personality and organisational factors have
been identified as the major culprits.
Personality has always been considered a major
mediator of stress reactivity. That is, although cer-
tain events are regarded as normatively stressful,
sensitivity to stressors varies between individuals.
That is, individuals with different personalities will
respond similarly to physical threats, but different
responses to ego threats are related to personality
differences (Eysenck, 1988). Most theories of oc-
cupational functioning agree that personality makes
a significant contribution to performance and well-
being, while acknowledging that the relationship
between personality and environmental factors is
dynamic and complex. For example, Work Adjust-
ment Theory (Rounds, Dawis, & Lofquist, 1987) is
founded on the notion that stable cognitive, behav-
ioural and emotional dispositions underpin work
adjustment, but that situational influences impact
upon these stable dispositions for adaptation and
change, in both positive and negative ways. Simi-
larly, Headey & Wearing (1992) found that endur-
ing personality characteristics, such as neuroticism
and extraversion, determine people’s daily work
experiences, use of coping strategies, and levels of
psychological distress and well-being. Extraversion
has been positively correlated with subjective well-
being (Costa & McRae, 1980), while introversion
and neuroticism are associated with increased stress
(Fontana & Abouserie, 1993), emotional exhaustion
and depersonalisation (Piedmont, 1993).
Hobfoll (1994), reacting to what he perceives to
be the current over-emphasis on environmental fac-
tors, has urged a re-consideration of the role of per-
sonality in the aetiology of occupational stress. He
states that we can Ano longer pretend that there is an
objective way to define stress at the level of environ-
Occupational Stress 17
mental conditions without reference to the charac-
ter of the person@ (p 24). In similar vein, Roskies,
Louis-Guerin, & Fournier, (1993) concluded that
“personality can cushion as well as aggravate the
impact of occupational stress” (p. 616-7); with neg-
ative personality dispositions transforming stressors
into strains and strains into symptoms. Negative af-
fectivity, for example, has been associated with in-
terpersonal conflict (Spector & O’Connell (1994),
negative emotions (Chen & Spector (1991), psycho-
logical distress, physical symptoms (Watson, Pen-
nebaker, & Folger, 1986), and job strain (Decker &
Borgen, 1993). The relationship between role stress
and role distress has been found to be moderated
by a range of personality characteristics includ-
ing intolerance of ambiguity, dependency, strong
affiliation needs, low risk propensity (Siegall &
Cummings (1995), and high self-focused attention
(Frone, Russell, & Cooper, 1991). On the positive
side, humour and optimism can significantly mod-
erate the relationship between daily hassles, self-es-
teem maintenance, emotional exhaustion and physi-
cal illness (Fry, 1995).
Despite the enthusiasm for the view that person-
ality characteristics are fundamental to an under-
standing of occupational stress, empirical support
for such moderating effects has been mixed (Frone
& McFarlin, 1989). Moreover, much of the research
has been atheoretical or exploratory, and it is dif-
ficult to formulate interventions based on findings
that a small amount of variance in the experience
of occupational stress is accounted for by a particu-
lar personality characteristic. Researchers working
within this framework would, of course, recom-
mend that interventions be aimed at increasing hu-
mour, optimism and tolerance of ambiguity and de-
creasing negative trait affectivity, neuroticism and
dependency. However, the literature is replete with
evidence that personality characteristics are notori-
ously difficult to modify (McRae & Costa, 1994).
Even if it were possible to change personality in the
desired direction, it is not certain that workplace
difficulties would improve without simultaneously
attending to extrinsic organisational factors that
may be operating. Moreover, personality traits may
be fixed to some extent, but their place in the sys-
tem as antecedents or consequences will depend
on the nature of the interaction between individual
and environmental systems, and to any changes that
may occur within that system. Personality may also
be defined as a function of coping style (Eysenck,
1988); consistent with a systemic framework, cop-
ing behaviours will also be influenced by the sources
of occupational stress (O=Driscoll & Cooper, 1994)
Occupational Stress 18
and the resources and external support available for
dealing with them (Hart & Wearing, 1995).
Research into the role of organisational factors in
the aetiology of occupational stress has followed a
similar trajectory to the one outlined above for per-
sonality. Ever lengthening lists of putative factors
have been identified. In two reviews of occupational
stress, Cooper (1983; 1985) summarised and cate-
gorised six groups of organisational variables, out-
lined below, that may cause stress in the workplace.
These are
1. Factors intrinsic to the job (eg heat, noise,
chemical fumes, shiftwork)
2. Relationships at work (eg conflict with co-
workers or supervisors, lack of social sup-
port)
3. Role in the organisation (eg role ambiguity)
4. Career development (eg lack of status, lack of
prospects for promotion, lack of a career path,
job insecurity)
5. Organisational structure and climate (eg lack
of autonomy, lack of opportunity to participate
in decision making, lack of control over the
pace of work)
6. Home and work interface (eg conflict between
domestic and work roles; lack of spousal sup-
port for remaining in the workforce).
There is, of course, a complex relationship be-
tween occupational and organisational factors and
psychological characteristics. Interpersonal conflict
in the workplace, increasingly recognised as a major
contributor to work disability, has a complex aetiol-
ogy. Dissatisfaction with life, daily stress, neuroti-
cism and hostility were all found to be significant
risk factors for interpersonal conflicts at work for
both men and women (Appelberg, Romanov, Hon-
kasalo, & Kosdenvuo, 1991)
Responses arising from a psychological frame-
work have focused on tertiary and secondary inter-
ventions. Tertiary interventions include individual
counselling, stress management programs, employ-
ee assistance programs, and workplace mediation
for conflict resolution (Appelberg, Romanov, Heik-
kila, Honkasalo, & Kosdenvuo, 1996). Second-
ary interventions include training and education
(Mackay & Cooper, 1987; Bohle, 1993). This is not
to say that such interventions are never effective in
reducing occupational stress. In a recent study, Rey-
nolds (1997) reported that individual counselling
improved psychological well-being while organisa-
tional level interventions (ie increasing employees’
participation and control) did not. However, Bohle
Kenny D.T., 1999
(1993) argued that, in general,
Interventions of this nature imply that the prob-
lem of stress lies primarily with the individual,
that the responsibility for change consequently lies
primarily with workers, and that organisations are
only responsible for assisting individual workers
to change. …since no attempt is made to reduce or
remove environmental stressors, interventions can
best be seen as attempts to increase workers’ tol-
erance of noxious and stressful organisational, task
and role characteristics” (p.111).
While advancing our understanding to some de-
gree, both personality and organisational factors re-
search has remained wedded to the dominant medi-
cal and psychomedical paradigms outlined above.
Although they highlight important putative factors
that may contribute to occupational stress, these
factors, considered separately, do not inform the re-
habilitation process. Let us now turn to other mod-
els and approaches that may assist in this regard.
Sociological theories
The most radical departure from the medical
model has been the approach of industrial sociolo-
gists who have brought the social organisation of
work as the primary determinant of occupational
injury, illness, and stress into sharp focus (Berger,
1993; James, 1989; Williams & Thorpe, 1992). The
medical model’s notion of health and illness is re-
jected as reductionist, individualistic and interven-
tionist, in which subjects are considered as unique
cases, independent of cultural, social, political, and
economic structures and processes. Industrial soci-
ologists argue that power structures, the institution-
alised conflicts of interest between safety and pro-
ductivity, the social division of labour, the labour
process, industrial relations and politics are the root
causes of occupational illness and stress (McIntyre,
1998; Peterson, 1994).
Recent changes to legislation in occupational
health and safety and workers’ compensation have
shifted the perception of occupational health from
an individual and marginalised process to a proc-
ess with major economic and political implications
(Kenny, 1994a; 1994b; Willis, 1989). These chang-
es have led to the revised view that occupational ill-
ness is a social process, the dimensions of which are
not individualised, unique or specific. Further, soci-
ologists argue that for every occupational illness or
injury, there are physiological and ergonomic com-
ponents whose effects are mediated by the social
environment, specifically, the organisation of work
and the sociology of medical knowledge surround-
Chapter 20, Stress and Health
ing the illness or injury (Figlio, 1982). Negotiation
over the social and political meaning of occupation-
al illnesses and their various economic and social
implications occurs prior to their being awarded the
status of a syndrome (Willis, 1994). The irony of
such a process is that while gaining recognition that
such conditions are public issues, solutions continue
to be sought in the individual. With some notable
exceptions (Levi, 1998), this has been the case for
occupational stress.
The major contribution of sociological approaches
to occupational illness is that “occupational health
and safety has increasingly become an industrial
relations issue between capital and labour;…it has
increasingly come to mediate the social relations of
production” (Willis, 1994, p.138). In other words,
the focus has shifted from a fatalistic acceptance
that there will be casualties of the work process to a
legislated requirement that employers provide a safe
workplace for all employees. The cost of compen-
sation is increasingly shaping occupational health
and safety practices and procedures and hence the
labour process itself (McIntyre, 1998).
Negotiating safety in reference to occupational
stress is, of course, more difficult than negotiating
safety with respect to the physical hazards of the
workplace. Occupational stress currently occupies
a similar nebulous position in the medical nomen-
clature that RSI (Repetitive Strain Injury) occupied
in the last decade. One must demonstrate that the
incidence of illness (presence of symptoms) is con-
nected to the organisation of work, and as stress is a
transactional process involving interactions between
physiological, psychological, behavioural and or-
ganisational variables, demonstrating the causal
nexus is not an easy matter. Moreover, the legislated
requirements may in fact have worked against the
resolution of issues related to occupational stress,
requiring as they do the certification of a specific
illness on the Workers’ Compensation certificate.
Legitimating the experience of occupational stress
medically may militate against an organisational or
transactional solution to the problem, since certifi-
cation, a process achieved through political action,
has individualised the problem and returned full cir-
cle to the victim blaming approach of the medical
model.
Systemic theories
In advocating a systemic/transactional approach
to occupational stress, it needs to be stated that there
are circumstances in which either personality is so
damaged or environmental conditions are so ad-
verse, that the relational context of one to the other
Occupational Stress 19
is irrelevant. These special cases must be dealt with
on a case-by-case basis requiring unique solutions,
ranging from the individual to the political.
Several theories of occupational stress that utilise
social systems theory have been developed (Bach-
arach, 1991; Edwards, 1992; Furnham & Schaeffer,
1984; Frone & McFurlin, 1989; Hart & Wearing
(1995); Hobfoll, 1989; Karasek, 1979; Karasek &
Theorell, 1990; Lazarus & Folkman, 1984; Mc-
Grath 1976). Space permits only a brief summary of
the relevant models here, and the interested reader
is referred to the many excellent reviews available
for a comprehensive coverage.
Person-Environment Fit Theories
Person-Environment (P-E) Fit theories (Caplan &
Harrison, 1993; Furnham & Schaeffer, 1984) were
early precursors to the dynamic systemic theories
described in the next section. Caplan (1987) used
P-E fit theory as a method for understanding the
process of adjustment between employees and their
work environment. According to this framework,
occupational stress is defined in terms of work char-
acteristics that create distress for the individual due
to a lack of fit between the individual=s abilities and
attributes and the demands of the workplace. Caplan
(1987) suggested that recollections of past, present,
and anticipated P-E fit might influence well being as
well as performance.
Interventions are directed at measuring fit prior
to vocational placement, or measuring discrepancy
in fit in the identification of occupational stress ae-
tiology. Interactions between person (eg personal-
ity traits, vocational orientation, and experience)
and environment variables have been found to be
better predictors of strain than either person or en-
vironmental variables considered separately (An-
tonovsky, 1987a; Caplan, Cobb, & French, 1975).
However, characteristics of jobs and characteristics
of workers may influence each other in dynamic re-
ciprocal ways. Most P-E fit theories are static and
failed to address the ongoing, reciprocal influenc-
es of environment and person (Kulik, Oldham, &
Hackman, 1987).
Demand-Control theories
A development and expansion of job strain mod-
els, the demand-control model (Karasek, 1979)
concerns the joint effects of job demands and job
control on worker well being. Demand is subdivid-
ed into workload, work hazards, physical and emo-
tional demands and role conflict. Control relates
to substantive complexity of work, administrative
Occupational Stress 20
control, control of outcomes, skill discretion, super-
vision, decision authority and ideological control
(Muntaner & Schoenbach, 1994; Soderfeldt, Soder-
feldt, Munstnaer, O’Campo, Warg & Ohlson, 1996).
Based on the dimensions of demand and control,
jobs have been classified into four categories. These
are high strain jobs (high demand/low control); low
strain jobs (low demands/high control); active jobs
(high demands/high control); and passive jobs (low
demands/low control) (Landsbergis, Schnall, Dietz,
Friedman, & Pickering, 1992). In general, psycho-
logical distress is predicted by high demand/low
control combinations (Karasek, 1990). Conversely,
an increase in control is positively correlated with
job satisfaction (Murphy 1988). Control has also
been implicated in occupational stress arising from
organisational change processes, where control is
conceptualised as a stress antidote (Sutton & Kahn,
1986). The perception of control can also be linked
to personality factors, such as locus of control and
private self-consciousness (Frone & McFarlin,
1989; Kivimaki & Lindstrom, 1995).
Johnson and Hall (1988) have expanded the mod-
el to include a support component incorporating
coworker and supervisor social support. Social sup-
port has positive effects on well-being and buffers
the impact of occupational stressors on psychologi-
cal distress (Karasek, Triantis, & Chaudry, 1982).
Low social support has been associated with greater
symptomatology, and a significant interaction with
demand and control has been observed for job dis-
satisfaction (Landsbergis, Schnall, Dietz, Friedman,
& Pickering, 1992).
Communication theory
Karasek and Theorell (1990) view occupation-
al stress as a strategic communication of distress.
Toohey, (1993, 1995) has expanded this concept into
a model of functional communication. In this model,
dissatisfaction at the workplace may be expressed
through illness behaviour (ie occupational stress),
which is assessed as “a safe and acceptable manner
in which to communicate distress” (Toohey, 1995,
p 57). It is certainly debatable as to how expressing
one’s distress in this way is either safe or acceptable
in a workplace context, especially given the social
stigma attached to both mental illness, and to work-
ers’ compensation claims generally. However, these
methods are obviously more acceptable than out-
bursts of anger, physical violence or criminal acts
such as theft or destruction of property. This model
is just a step away from the systemic analysis of the
function of the symptom in the system in which it
occurs (Hoffman, 1981; Palazzoli et al., 1986), to
Kenny D.T., 1999
which we will shortly turn our attention.
Dynamic equilibrium theory
A recent innovative approach to understanding oc-
cupational stress has been proposed by Hart, Wear-
ing, & Heady, 1993c; Hart & Wearing, 1995; Head-
ey & Wearing, 1992). They challenge the prevailing
Cannon (1929) Selye (1975) view of stress which is
based on an engineering model where stress is un-
derstood as the force exerted on a structure, which
may then show signs of strain in response to that
force. The missing part of this formulation are those
characteristics which create susceptibility to strain,
either through innate personality traits, behaviours,
resources, or organisational factors. According to
the dynamic equilibrium theory, stress is not defined
as a demand, a response or a process, but as a state
of disequilibrium that arises when a change occurs
that affects the individual’s normal levels of psy-
chological distress and well-being. To understand
the cause of this change, it is necessary to separately
assess the impact of personality, organisation, cop-
ing processes and both positive and negative work
experiences. People may respond with both positive
and negative affect to the same environment (Di-
ener & Emmons, 1985), and psychological well-be-
ing is therefore determined by the balance between
separate positive (eg extraversion, salutogenic life
events) and negative (eg neuroticism, adverse life
events) factors (Bradburn, 1969), each one of which
has its own unique set of causes and consequences
(Hart, 1994). Hart and Wearing (1995) argue that
both stable personality characteristics and the dy-
namic interplay between coping and daily work ex-
periences together account for changes in levels of
psychological distress and well-being.
Although often used interchangeably in the occu-
pational stress literature, Hart and Wearing (1995)
have demonstrated that psychological distress and
morale operate as separate dimensions and make
independent contributions to the quality of work
life. That is, positive work experiences impact upon
morale, and negative work experiences impact upon
psychological distress. This suggests that morale
may be improved by increasing positive work ex-
periences and that psychological distress can be re-
duced by decreasing negative work experiences. In
addition, research with teachers and police officers
has indicated that these professional groups are not
stressed so much by the nature of their work, but by
the organisational context in which the work occurs
(Headey & Wearing, 1992). The implication of this
finding is that intervention should focus on develop-
ing a supportive organisational climate that enables
Chapter 20, Stress and Health
workers to cope more adaptively with operational
work demands, rather than to direct change efforts
at the nature of the work per se. A core set of organi-
sational factors, among them staff relationships and
leadership quality, is related to both psychological
distress and morale. Other factors, such as excessive
work demands, are negative and relate only to psy-
chological distress, while factors such as opportuni-
ties for advancement, are positive and relate only to
morale (Hart, Conn, Carter, & Wearing, 1993). That
is, strain occurs when excess elements (eg demands)
may threaten one need and deficit elements (eg lack
of communication or support) may threaten another.
Careful analysis of both positive and negative or-
ganisational characteristics is therefore needed be-
fore intervening to ameliorate identified problems.
Cybernetics and Systems Theory
Cybernetics and General Systems Theory were
developed concurrently and are based on similar
theoretical principles. Social systems theory empha-
sises wholeness, the interaction of component parts,
and organisation as unifying principles (Goldenberg
& Goldenberg, 1985, p28); incorporates non-linear
theories of causation (Cottone 1991); and is based
upon a circular epistemology (Hoffman, 1981).
Cybernetics has been defined as a science of
communication and control in man and machine
(Edwards 1992; Frone & McFarlin, 1989; Weiner,
1948); an epistemological foundation for personal
and social change (Bateson 1972), which focuses on
mental process (Keeney, 1983), whereby individu-
als monitor their psychological and physiological
reactions to various stressors@ (Frone & McFarlin,
1989, p876). In cybernetic theory, the concept of
feedback is the pivotal process. Feedback describes
a process whereby the system initiates homeostat-
ic mechanisms based upon information received.
Hoffman (1981) describes feedback loops as either
deviation amplifying or deviation counteracting,
whereby a system either stabilises, moving to a state
of equilibrium, or destabilises, moving to a state of
disequilibrium. According to a cybernetic analysis,
systems or organisations may undergo first or sec-
ond order change. In first order change, negative
feedback is the process whereby systems maintain
their organisation through deviation-counteracting
mechanisms such as homeostasis, morphostasis,
and self-correction (Sluzki, 1985). In second order
change, positive feedback loops amplify deviation
(ie create change rather than maintain stasis).
Feedback loops are initiated when an individual
identifies a discrepancy between a perceived current
state that creates imbalance and discomfort, and an-
Occupational Stress 21
other desired psychological and/or physiological
state (Frone & McFarlin, 1989). The individual then
assigns significance (importance) to the discrepan-
cy (Carver & Scheier, 1981; Cummings & Cooper,
1979; Edwards, 1992). The importance or mean-
ing accorded this discrepancy determines whether
a feedback mechanism is initiated (Edwards 1992).
In an interesting variation of this theme, Buunk and
Ybema (1997) have proposed that experiencing oc-
cupational stress, or any form of uncertainty, insti-
gates a desire for social comparison information,
that is, a need to discover how other people feel
about the situation. Contact with similar others may
lead the individual to adapt his/her stress response
to those of other group members. Such a process
may account, in part, for particular patterns of oc-
currence of occupational stress or illness that have
been identified (Willis, 1994).
Consistent with circular causality and the muta-
bility of causal direction in relation to key variables,
coping is defined as discrepancy reduction behav-
iour (Frone & McFarlin, 1989); an outcome of the
stress process (Edwards, 1992), as a component of
the intrapersonal variables which make up personal-
ity, which influence both the initial susceptibility to
perceived stressors (variables such as ego strength,
hardiness etc) and the ability to respond to the threat
to homeostasis in systemic terms (or the discrepan-
cy occurring between perceived and desired states
in cybernetic theory). The application of a circular
epistemology resolves current disagreement over the
function and consequences of coping as either a me-
diator of the stress-strain relationship or as a mod-
erator (stress buffer) of the relationship (O’Driscoll
& Cooper, 1994). Edwards (1992) describes stress
explicitly as a discrepancy between perceptions and
desires, rather than a conflict between demands and
abilities, as in Selye’s model (Selye, 1975), which
Edwards views as predictors of coping efficacy,
rather than stress per se (p 246).
Although the parallel is rarely drawn, there is a
strong philosophical relationship between the con-
cept of ‘discrepancy’ in systems theory, ‘alienation’
in Marx’s theory of the pathology of social change
(Marx, 1982), and Durkheim’s (1952) ‘anomie.’ Su-
san Sontag (1978) conceived of ‘illness as metaphor’
within sociological theorising at about the same
time that psychologists and family therapists were
embracing the notion of the symptom in the iden-
tified patient as a metaphor of family dysfunction
(Bowen, 1978; Haley, 1964; Minuchin, 1974; Pal-
azzoli, 1986). Similar analogies have been offered
subsequently, for example, Willis’s (1994) analysis
of RSI as a metaphor for alienation. Applying these
Occupational Stress 22
concepts to occupational stress, one could argue
that occupational stress arises when, through either
individual or organisational change processes, a dis-
crepancy occurs between the personal values of the
worker and the values of the organisation to which
s/he belongs. Because managers and supervisors
are key representatives of organisational culture, it
is most often within the relationship between the in-
dividual and the supervisor that the individual will
experience alienation (McIntyre, 1998).
The experience of occupational stress and its
concrete manifestation ie the lodging of a workers’
compensation claim, is the functional communica-
tion of distress brought about by alienation (Kara-
sek & Theorell, 1990). In Edward’s (1992) theory,
alienation may be understood in terms of thwarted
desires, which produce negative emotions such as
anger, disillusionment, or the desire for retribution
or revenge. Decreased worker morale, in dynamic
equilibrium theory (Hart & Wearing, 1995), may be
conceptualised as a precursor to alienation if steps
are not taken to remedy the morale problem early in
the cycle. Similarly, Kenny (1995c; 1995d) argued
that the failure of some injured workers to return to
work following workplace injury was due, at least
in part, to a failure of management to either believe
that the injury was genuine or to show care, concern
and respect to the injured worker. These failures set
up a negative feedback loop in which workers ex-
perienced a narcissistic injury that resulted in anger,
hostility, and a desire for revenge against manage-
ment, which of course, leads to alienation between
worker and management.
REHABILITATION OF
OCCUPATIONAL STRESS
Occupational rehabilitation theories have followed
the dominant paradigms of occupational stress and
can be summarised using four broad categories.
These are a) expert technical approaches that fo-
cus on the physical environment of work and work
practices; b) work psychology, which attributes ill-
ness to worker behavioural characteristics as well
as to some immediate organisation behaviours such
as pay systems, supervising environments, etc.; c)
pseudo-psychology, a victim-blaming approach
which focuses on individual worker behaviour such
as malingering and accident proneness, and leads
to relatively inexpensive employer corrective ac-
tivities such as pre-employment health assessments,
worker education, and drug tests; and d) sociologi-
cal approaches which focus on broader social issues
such as power structures, profit/production impera-
Kenny D.T., 1999
tives and gender, ethnic and class divisions as well
as organisational behaviour (Johnstone & Quinlan,
1993).
The expert technical approach has improved the
ergonomic environment of workers, but on its own,
cannot account for all problems related to occupa-
tional injury or occupational stress. Willis (1994),
for example, questioned why some workers devel-
oped RSI after years of using the same equipment,
or continued to develop RSI after ergonomic furni-
ture, pause strategies and exercises, and work rede-
sign had been introduced into the workplace. The
work psychology and pseudo-psychology models
are still generally based upon a medical model of
linear causality, which has hitherto provided the
dominant paradigm in tertiary rehabilitation (Cot-
tone & Emener, 1990; Kenny, 1995c). Its basic re-
quirement is the attachment of a medical or psycho-
logical diagnostic label to the claimant. In so doing,
the intervention becomes focused upon only one
component of a complex system (Toohey 1993),
namely the putative psychopathology of the indi-
vidual. This approach militates against a successful
rehabilitation outcome, leading as it does, to victim
blaming (Davis & George, 1993; Kenny, 1995e).
Conversely, the political/advocacy approach, based
on a sociological analysis, attempts to resolve the
environmental issues to the exclusion of intra-psy-
chic problems.
The ecological view of humans as living systems
dependent upon a healthy relationship with the envi-
ronment is one of some currency in political, public
health and philosophical realms. The development
of this perspective into a model for explicating the
antecedent processes of occupational stress based
on cybernetics and systems theory has been fore-
shadowed, but not yet realised (Cottone & Emener
1990; Cox, 1987; Edwards 1992; Hart & Wearing
1995; Kenny 1995e; Tate, 1992). The ecological
view of occupational stress is succinctly summa-
rised, as follows:
Work related psychosocial stressors originate in
social structures and processes, affect the human or-
ganism through psychological processes, and influ-
ence health through four types of closely interrelat-
ed mechanisms – emotional, cognitive, behavioural
and physiological. Situational (eg social support)
and individual factors (eg personality, coping rep-
ertoire) modify the health outcome. The work-envi-
ronment-stress-health system is a dynamic one with
many feedback loops…the approach (to interven-
tion) should be systems-oriented, interdisciplinary,
problem-solving oriented, health (not disease) ori-
Chapter 20, Stress and Health
ented, and participative (Levi, 1990, p1142).
Extant theories of occupational stress focusing on
cybernetics go some way towards operationalising
the concepts and exploring aspects of the model, but
not in relation to the design of interventions from
either a preventive or management perspective (Ed-
wards, 1992; Frone & McFarlin, 1989).
The processes involved in occupational rehabili-
tation can be conceptualised cybernetically, in terms
similar to those of systemic family therapy. Bowen
(1966, 1978) was a systemic family therapist who
postulated the importance of the role played by tri-
angles in family interaction. This process, called tri-
angulation, occurs in all social groups, as twosomes
form to the exclusion of, or against a third party. Bo-
wen proposed that a two-person system may form a
three-person system under stress. For instance, ten-
sion might arise between the two and the one who
feels most uncomfortable or vulnerable may ‘trian-
gle in’ a third party, to relieve tension and to restore
the power balance. The third party, once drawn in,
may form his/her own set of alliances, thus creating
shifting power balances. The action may not remain
localised within the original triangle, as more and
more stakeholders become involved in the ongoing
struggle. Bowen associates pathology with rigidity
and suggests that, although all systems create triadic
patterns, these patterns will become more rigid dur-
ing periods of crisis or stress. The rigidity of the re-
sponse patterns set up by injury/occupational stress
and the central players’ initial response to the claim
follow a limited and predictable path and set up a
highly restricted set of choices for the stakeholders
involved.
When a worker is injured/stressed, the matter is
initially dealt with in the injured worker-employer
dyad. If the worker and employer deal with the mat-
ter to their mutual satisfaction, no other parties need
become involved, other than in a service provision
capacity. That is the employer will notify the in-
surer, who will organise payment, and the injured
worker may contact a health professional for treat-
ment. However, if the employer is dissatisfied with
the injured worker’s response to his injury (eg by
taking too much time off work, or by remaining on
shortened hours of work), he may call in the insurer,
not as a service provider, but as an ally against the
injured worker. The insurer will respond by disput-
ing the claim for workers’ compensation, ordering
expert medical opinion and instructing the worker
to attend a doctor appointed by the insurance com-
pany. The injured worker may respond by attending
his own doctor, no longer only as a service provider,
Occupational Stress 23
but also as an ally who will assist the injured worker
to restore the power balance by organising medi-
cal specialist opinion which is frequently contrary
to the insurance doctor’s opinion. The parties may
then become polarised in an apparently unresolv-
able dilemma. One of the reasons for this is that the
issue of how best to manage the injury is replaced
with the issue of stakeholder integrity, particularly
that of the injured worker. The genuineness of the
injury becomes the focus of stakeholder involve-
ment, rather than searching for the best ‘social fit’
for the worker and his/her employer. The more par-
ties who become involved, the poorer the commu-
nication between them and the greater the suspicion
and hostility. Recourse to the legal profession with
protracted legal proceedings is often the next step in
this process of triangulation.
Systemic concepts such as Bowen’s notion of
triangulation (Bowen, 1966, 1978), and Karasek’s
notion of stress as a form of strategic or functional
communication (Karasek & Theorell, 1990), have
the capacity to provide a firm underpinning to the
model of tertiary rehabilitation described in this
chapter.
The proposed systemic model is particularly rel-
evant to the analysis and case management of oc-
cupational stress. It suggests that the intervention of
the rehabilitation case manager should be directed
at identifying the dyadic and triadic relationships
and at providing clients with a functional means
of communicating their distress. It is vital that this
process allows the real sources of stress to be identi-
fied. In an interesting and provocative paper, Maho-
ny (1996), building on Goffman’s (1971) distinction
between ‘front stage’ and ‘back stage’ explana-
tions of behaviour, argues that certain occupational
groups present ‘front stage’ explanations only for
the causes of their occupational stress. Front stage
refers to those explanations that are most likely to
have currency with prevailing social norms, man-
agement, and in the case of claims for occupational
stress, the Workers’ Compensation authorities. She
sights the example of prison officers, whose front
stage explanations for occupational stress included
daily exposure to personal risk, resulting in safety
fears, including fears of injury and death at the
hands of violent criminals. The back stage reality,
that were the underlying causes of absenteeism, sick
leave and occupational stress was the inherent bore-
dom of the job (eg standing in a tower on guard for
eight hours) and stigmatisation by outsiders. These
putative back stage factors would receive much less
support from management or Workers’ Compensa-
tion authorities. Therefore, workers may collude in
Occupational Stress 24
propagating the front stage reality to the detriment
of developing appropriate interventions for change.
Careful analysis is required to avoid intervening on
the basis of front stage interpretations of the prob-
lem. This may lead to impasses, stalemates, anger,
hostility, and industrial action.
Provision of the opportunity to deal with both
front stage and back stage issues, that may include,
among others, medical or treatment issues, industri-
al and legal issues, change management problems,
family problems, life cycle issues, underlying or
consequent psychological or psychiatric conditions,
and competence and training difficulties, is a neces-
sary component in the rehabilitation process. If suc-
cessful, this communication will free both the client
and significant stakeholders from the aggregation of
issues (eg searching for truth or blame and appoint-
ing scapegoats) that has resulted in triangulation
processes (see Kenny, 1995b, 1995e) that were both
precursors to the claim and impediments to success-
ful return to work. This analysis also serves to clar-
ify expected outcomes of the rehabilitation process,
as distinct from other (eg industrial/legal) processes
which may have a bearing on the resolution of the
problems (Nowland, 1997).
Due to the complex nature of the rehabilitation
process and the large number of stakeholders in-
volved, the role of the case manager is central and
pivotal (Kenny, 1995c; Weil & Karls, 1985). The
adoption by the rehabilitation professional of an ad-
vocacy or adversarial role, either on behalf of the
worker, or on behalf of one of the other stakeholders
(usually the employer) may create a major barrier
to successful rehabilitation (Kenny, 1995a, 1995f;
Shrey, 1993). A systemically based intervention
will resolve these errors by clarifying the role of
the case manager within this system as an advocate
for the rehabilitation process, rather than for any of
the stakeholders. A systems framework emphasises
the importance of professional neutrality, providing
clear roles and functions based upon the profession-
al’s relationship to the system as a whole, rather than
to any one component (Furlong & Young, 1996).
This approach also serves to clarify expected out-
comes of the rehabilitation process, as distinct from
other (eg industrial/legal) processes that may have a
bearing on the resolution of the problems.
The focus of the systemic intervention is the re-
lationship between the injured worker and the sys-
tem rather than an exploration of the individual’s
traits, skills and capacities in isolation. It is based
on the cybernetic model outlined above which has
in turn been informed by the theories and processes
Kenny D.T., 1999
described in the preceding sections. In this model,
developed by Nowland (1997), and enlarged upon
here, the case manager should
1) Map the stakeholders and their inter-re-
lationships. Both the client and the case manager
need to understand who is involved, either overtly
or covertly. A field map is then constructed of the
overall system of stakeholders and their relation-
ships to one another in the system. Figure 1 presents
a prototypical example of a field map. This map in-
cludes all most stakeholders who may become in-
volved once a claim for workers’ compensation is
made. Not all clients will come into contact with all
parties outlined in Figure 1. However, the schematic
representation of the field brings into sharp focus all
the possible dyadic and triadic relationships that can
occur in the post-injury period.
Fig.1 A model of the proximal and distal stakeholders in the post-injury period and communication pathways
WCA
RP
E I
RC
IW
TD
SG
S
2) Identify sub-systems. Sub-systems are
identified by the commonality of their purpose and
rules. Different stakeholders may belong to more
than one sub-system, and through a process of iden-
tifying sub-system membership, conflicts of interest
and alliances and coalitions may be clarified (ie Bo-
wen’s triangulation processes). The client is inevi-
tably a member of a large number of sub-systems
simultaneously (ie workplace, medical and rehabili-
tation systems, family systems and social systems).
It is important to determine the relative strength and
influence of each of these systems. The more inten-
sive, committed, and socially integrated a setting,
the greater is its potential impact on the outcome
Chapter 20, Stress and Health
(Moos, 1987). In addition, the relationship of the
worker to his/her work in terms of demand/control/
social support may further illuminate the putative
sources of stress currently experienced. It may also
be possible to identify the dominant source of stress
within one of the identified sub-systems.
3) Identify the rules governing the operation
of the sub-systems. The rules governing the behav-
iour of the sub-systems may not be consistent with
the purpose of the overall system, nor to be in the
best interest of successful rehabilitation. The case
manager needs to identify any homeostatic mecha-
nisms that would operate to threaten change, and to
make these rules and mechanisms explicit.
4) Identify the issues for the client. This step
assists the client to understand the systemic causal
relationship between his/her stress response and in-
Legend
WCA Work Cover Authority
ID RP Rehabilitation Provider
InI E Employer
I Insurer
IW Injured Worker
TD Treating Doctor
ID Insurance Doctor
InI Insurance Investigator
SG Support Groups
S Solicitor
RC Rehabilitation Coordinator
dividual and systems variables. This process will
highlight the initial factors as well as to identify
potential barriers to resolution of the problem. A
number of structured exercises can facilitate this
process (Brassard & Ritter, 1994). During this
stage, it is important that the case manager obtain
a clear understanding of the ‘back stage’ issues for
the client, and to allow ample opportunity for the
functional communication of distress that may con-
stitute one of the underlying impediments to the res-
olution of the issues. Clarifying and separating both
positive and negative work experiences may assist
the client to gain some conceptual clarification of
the causes of their psychological distress, as distinct
Occupational Stress 25
from vocational dissatisfaction or morale. This step
can then lead into stage 5 of the process.
5) Apportion responsibility for management of
the factors. Different issues may need to be referred
to different personnel, either within or outside the
organisation. Possible sources of additional support
include union representative or other employee ad-
vocate, individual counsellor, or line manager. The
rehabilitation case manager co-ordinates and moni-
tors these referrals and acts as a conduit and liaison
between the client and other stakeholders.
6) Plan and implement the rehabilitation in-
tervention. Once the aggregation of issues has been
dealt with, the case manager can then prepare the
client for return to work. During this phase, the case
manager gradually relinquishes responsibility to the
client and other key stakeholders in the workplace.
Preliminary investigation indicates that systemic
interventions have not previously been operational-
ised in this way and diverge in significant ways from
current practice. Predictions from the application of
this model include role clarification for all stake-
holders, case manager neutrality, task assignment,
increased ability to manage the multivariate factors
involved in a claim for occupational stress, chal-
lenging homeostatic mechanisms, and illuminating
a greater range of intervention strategies through the
systemic analysis of the precipitating and maintain-
ing factors.
DIRECTIONS FOR FUTURE RESEARCH
This model for rehabilitation of occupational
stress is yet to be tested empirically. Model speci-
fication and implementation would be enhanced by
the following:
i) improving identification, nomenclature and
classification of occupational stress claims and sep-
arating them from related factors such as morale,
vocational satisfaction and attitudes towards work
(Hart & Wearing, 1995).
ii) development of strategies to avoid the medi-
calisation, and otherwise inadequate clinical man-
agement, of occupational stress claims. Current
problems are due to omver-medicalisation of oc-
cupational stress (Quinlan, 1988), poor diagnostic
skills in general practitioners (Kenny, 1996), poor
clinical assessment practices, passive clinical man-
agement from rehabilitation providers and over-re-
liance on claimant self-report as the principal source
of data (Cotton, 1996).
iii) an assessment of pre-program (eg availability
of Employee Assistance Programs, grievance pro-
Occupational Stress 26
cedures, mediation services) and program (eg type
of intervention, by whom, stakeholders involved,
nature and frequency of contact) variables, which
can be linked to successful outcomes in the man-
agement of occupational stress claims. Although
there has been some recent attention to the devel-
opment of stricter procedures, protocols, and role
specification of the various stakeholders involved in
the management of stress claims, the intervention
processes that occur at the different stages of the
life of the claim, and which contribute to success-
ful/unsuccessful outcome have not, to date, been
sufficiently elucidated
REFERENCES
Appelberg, K., Romanov, K., Honkasalo, M. L., & Ko-
skenvuo, M. (1991). Interpersonal conflicts at work
and psychosocial characteristics of employees. Social
Science and Medicine, 32 (9), 1051-1056.
Appelberg, K., Romanov, K., Heikkila, K., Honkasalo,
M. L., & Koskenvuo, M. (1996). Interpersonal conflict
as a predictor of work disability: A follow-up study of
15,348 Finnish employees. Journal of Psychosomatic
Research, 40 (2), 157-167.
Bacharach, S. B., Bamberger, P., & Conley, S. (1991).
Work-home conflict among nurses and engineers: Me-
diating the impact of role of stress on burnout and sat-
isfaction at work. Journal of Organisation Behavior,
12 (1), 39-53.
Berger, Y. (1993). The Hoechst dispute: A paradigm shift
in occupational health and safety. In M. Quinlan (Ed.).
Work and health: The origins, management and regula-
tion of occupational illness. (pp. 126-139). Melbourne:
MacMillan Education.
Biggins, D. (1986). Focus on occupational health: What
can be done? New Doctor, 47, 6-10.
Bohle, P. (1993). Work psychology and the management
of occupational health and safety: An historical over-
view. In M. Quinlan (Ed.). Work and health: The ori-
gins, management and regulation of occupational ill-
ness. (pp. 92-115). Melbourne: MacMillan Education.
Bowen, M. (1966). The use of family theory in a clinical
practice. Clinical Psychiatry, 7, 345-374.
Bowen, M. (1978). Family therapy in clinical practice.
New York: Aronson.
Bradburn, N. M. (1969). The structure of psychological
well-being. Chicago: Aldine.
Brassard, M., & Ritter, D. (1994). The memory jogger.
MA: Methuen, Goal QPC.
Buunk, B. P., & Ybema, J. F. (1997). Social comparisons
and occupational stress: The identification-contrast
model. In B. P. Buunk, & F. X. Gibbons (Eds.). Health,
coping, and well-being: Perspectives from social com-
parison theory (pp. 359-388). Mahwah, NJ: Lawrence
Kenny D.T., 1999
 Erlbaum Associates.
Cannon, W. B. (1929). Organisation for physiological
homeostasis. Physiological Reviews, 9, 399-431.
Caplan, R. D. (1987). Person-environment fit theory and
organizations: Commensurate dimensions, time per-
spectives, and mechanisms. Journal of Vocational Be-
haviour, 31, 248-267.
Caplan, R. D., & Harrison, R. V. (1993). Person-envi-
ronment fit theory: Some history, recent developments,
and future directions. Journal of Social Issues, 49 (4),
253-275.
Caplan, R. D., & Jones, K. W. (1975). Effects of work
load, role ambiguity, and Type A personality on anxi-
ety, depression, and heart rate. Journal of Applied Psy-
chology, 60 (6), 713-719.
Carver, C. S., & Scheier, M. F. (1981). Attention and
self-regulation: A control theory approach to human
behavior. New York: Springer-Verlag.
Clegg, C., & Wall, T. (1990). The relationship between
simplified jobs and mental health: A replication study.
Journal of Occupational Psychology, 63, 289-296.
Cooper, C. L. (1983). Identifying stressors at work: Re-
cent research developments. Journal of Psychosomatic
Research, 27 (5), 369-376.
Cooper, C. L. (1985). The stress of work: An overview.
Aviation, Space and Environmental Medicine, 56 (7),
627-632.
Cooper, C. L. (1995). The major types of psychological
dysfunction in workplace settings. In P. Cotton (Ed.),
Psychological Health in the Workplace (pp. 87-102).
Victoria: The Australian Psychological Society.
Cooper, C.L. & Cartwright,S. (1994). Healthy mind,
healthy organisation. Human relations, 47 (4), 455-
471.
Cooper, C.L., Liukkonen, P. & Cartwright,S. (1996).
Stress prevention in the workplace. Dublin, Ireland:
European Foundation for the Improvement of Living
and Working Conditions.
Cooper, C. L., & Payne, R. L. (1992). International per-
spectives on research into work, well-being, and stress
management. In J. C. Quick, L. R. Murphy, & J. J. Hur-
rell (Eds.). Stress & well-being at work: Assessments
and interventions for occupational mental health, (pp.
348-368). Washington, DC, US: American Psychologi-
cal Association.
Costa, P. T., & McCrae, R. R. (1980). Influence of ex-
troversion and neuroticism on subjective well-being.
Journal of Personality and Social Psychology, 38,
668-678.
Cotton, P. (1995). Psychological health in the workplace.
Victoria: Australian Psychological Society.
Cotton, P. & Fisher, B.(1995). Current issues and direc-
tions for the management of workplace psychological
health issues. In P. Cotton (Ed.). (1995). Psychological
health in the workplace. Victoria: Australian Psycho-
logical Society.
Chapter 20, Stress and Health
Cottone, R. (1986). Toward a systemic theoretical frame-
work for vocational rehabilitation. Journal of Applied
Rehabilitation Counselling, 17 (4), 4-7.
Cottone, R. (1991). Counselor roles according to two
counseling worldviews. Journal of Counseling and
Development, 69, 398-401.
Cottone, R. & Emener, W. (1990). The psychomedical
paradigm of vocational rehabilitation. Rehabilitation
Counselling Bulletin, 34 (2), 91-102.
Cummings, T. G., & Cooper, C. L. (1979). A cybernetic
framework for studying occupational stress. Human
Relations, 72, 395-418.
Davis, A., & George, J. (1993). States of health: Health
and illness in Australia (2nd Edition). Sydney: Harper
& Row.
Decker, P.J. & Borgen, F. H. (1993). Dimensions of work
appraisal: Stress, strain, coping, job satisfaction, and
negative affectivity. Journal of Counseling Psychol-
ogy, 40 (4), 470- 478.
Diener, E., & Emmons, R. A. (1985). The independence
of positive and negative affect. Journal of Personality
and Social Psychology, 47, 1105-1117.
Dollard, M. F. & Winefield, A.H.(1995). Trait anxiety,
work demand, social support and psychological dis-
tress in correctional officers. Anxiety, Stress & Coping:
an International Journal, 8 (1), 25-35.
Dollard, M.F. & Winefield, A.H. (1996). Managing oc-
cupational stress: A national and international perspec-
tive. International Journal of Stress Management, 3
(2), 69-83.
Durkheim, E. (1952). Suicide: A study in sociology. Lon-
don: Routledge & Gegan Paul.
Edwards, J.R. (1992). A cybernetic theory of stress, cop-
ing, and well being in organizations. Academy of Man-
agement Review, 17 (2), 238-274.
Eysenck, H. J. (1988). Personality, stress and cancer:
Prediction and prophylaxis. British Journal of Medical
Psychology, 61, 57-75.
Ferguson, S. (1988). Occupational medicine in Australia:
The past, the present and the future. Journal of Occu-
pational Health and Safety – Australia and New Zea-
land, 4, 481-488.
land
Figlio, K. (1982). How does illness mediate social re-
lations? Workmen’s compensation and medico-le-
gal practices, 1890-1940. In P. Wright & A. Treacher
(Eds.). The problem of medical knowledge, examining
the social construction of medicine. Edinburgh: Edin-
burgh University Press.
French, J. R. P., Caplan, R. D., & Harrison, R. V. (1982).
The mechanisms of job stress and strain. London: Wi-
ley.
Frone, M.R. & McFarlin, D.B. (1989). Chronic occupa-
tional stressors, self-focused attention, and well-being:
Testing a cybernetic model of stress. Journal of Ap-
plied Psychology, 74 (6), 876-883.
Frone, M.R., Russell, M. & Cooper, M.L. (1991). Rela-
Occupational Stress 27
 tionship of work and family stressors to psychologi-
cal distress: the independent moderating influence of
social support, mastery, active coping and self focused
attention. Journal of Social Behaviour and Personal-
ity, 6 (7), 227-250.
Fry, P.S. (1995). Perfectionism, humour and optimism
as moderators of health outcomes and determinants
of coping styles of women executives. Genetic, Social
and General Psychology Monographs, 121 (2), 211-
245.
Furlong, M., & Young, J. (1996). Talking about blame.
Australian & New Zealand Journal of Family Therapy.
17 (4), 191-200.
Furnham, A. & Schaeffer, R. (1984). Person-environ-
ment fit, job satisfaction and mental health. Journal of
Occupational Psychology, 57, 295-307.
Goffman, E. (1971). The presentation of self in everyday
life. Harmondsworth: Penguin.
Goldenberg, I. & Goldenberg, H. (1985). Family thera-
py: An overview. Brooks/Cole: Monterey,CA.
Habeck, R. (1993). Achieving quality and value in serv-
ice to the workplace. Bulletin of the Australian Society
of Rehabilitation Counsellors, 4, 15-20.
Haley, J. (1964). Strategies of Psychotherapy, New York:
Grune and Stratton.
Hart, P. M. (1994). Teacher quality of work life: Integrat-
ing work experiences, psychological distress and mo-
rale. Journal of Occupational and Organization Psy-
chology, 67, 109-132.
Hart, P. M., Conn, M., Carter, N. L., & Wearing, A. J.
(1993). Development of the School Organisational
Health Questionnaire: A measure for assessing teacher
morale and school organisational climate. Paper pre-
sented at the Annual Conference of the Australian As-
sociation for Research in Education, Fremantle, West-
ern Australia, November.
Hart, P.M. & Wearing, A.J. (1993). Problems of insta-
bility and change in quality of life research: Implica-
tions for a longitudinal model of personality, health
and well-being. Paper presented to the First Confer-
ence of the Australian Association for Social Research,
Launceston, Tasmania, January.
Hart, P.M. & Wearing, A.J. (1995). Occupational stress
and well being: A systemic approach to research, poli-
cy and practice. In P. Cotton (Ed) (1995). Psychologi-
cal health in the workplace. Victoria: Australian Psy-
chological Society.
Hart, P.M., Wearing, A.J. & Headey, B. (1993). Assessing
police work experiences: Development of the Police
Daily Hassles and Uplifts Scales. Journal of Criminal
Justice, 21, 553-572.
Hart, P.M., Wearing, A.J. & Headey, B. (1995). Police
stress and well-being: Integrating personality, coping
and daily work experiences. Journal of Occupational
& Organisational Psychology, 68 (2), 133-156.
Headey, B., & Wearing, A. J. (1992). Understanding hap-
Occupational Stress 28
piness: A theory of subjective well-being. Melbourne:
Longman Cheshire.
Hobfoll, S. E. (1989). Conservation of resources: A new
attempt at conceptualising stress. The American Psy-
chologist, 44, 513-524.
Hobfoll (1994).
Hoffman, L. (1981). Foundations of family therapy.
USA: Basic Books
Holmes, T.H. & Rahe, R.H. (1967). The social readjust-
ment rating scale. Psychosomatic Medicine, 11, 213-
218.
James, C. R. (1989). Social sequelae of occupational in-
jury and illness. Unpublished PhD thesis, Griffith Uni-
versity, Australia.
Johnstone, R., & Quinlan, M. (1993). The origins, man-
agement and regulation of occupational illness: An
overview. In M. Quinlan (Ed.). Work and health: The
origins, management and regulation of occupational
illness. (pp. 3-32). Melbourne: MacMillan Education.
Kahn, R.L., Wolfe D. M.,Quinn, R.P., Snoek, J.D. &
Rosenthal,R.A.(1964). Organizational stress: Studies
in role conflict and ambiguity. New York: Wiley.
Karasek, R. A. (1979). Job demands, job decision lati-
tude, and mental strain: Implications for job redesign.
Administrative Science Quarterly, 24, 285-308.
Karasek, R. & Theorell, T. (1990). Healthy work: Stress,
productivity and the reconstruction of working life.
New York: Basic Books.
Karasek, R. A., Triantis, K. P., & Chaudry, S. S. (1982).
Coworker and supervisor support as moderators of
associations between task characteristics and mental
strain. Journal of Occupational and Behavior, 3, 181-
200.
Keeney, B.P. (1983). Aesthetics of change. New Yok:
Guilford.
Keeney, B. P. (1987). The construction of therapeutic
realities. Special Issue: Psychotherapy with families.
Psychotherapy, 24 (3S) 469-476.
Kenny, D. T. (1994a). Determinants of time lost from
workplace injury: The impact of the injury, the injured,
the industry, the intervention and the insurer. Interna-
tional Journal of Rehabilitation Research, 17 (4) 333-
342.
Kenny, D. T. (1994b). The relationship between work-
ers’ compensation and occupational rehabilitation: An
historical perspective. Journal of Occupational Health
and Safety, 10 (2), 157-164.
Kenny, D. T. (1995a). Barriers to occupational rehabilita-
tion: An exploratory study of long-term injured work-
ers. Journal of Occupational Health and Safety- Aus-
tralia and New Zealand
Zealand, 11 (3) 249-256.
Kenny, D. T. (1995b). Common themes, different per-
spectives: A systemic analysis of employer-employee
experiences of occupational rehabilitation. Rehabilita-
tion Counseling Bulletin, 39 (1) 53-77
Kenny D.T., 1999
Kenny, D. T. (1995c). Failures in occupational rehabilita-
tion: A case study analysis. Australian Journal of Re-
habilitation Counselling, 1(1) 33-45.
Kenny, D. T. ( 1995d). Case management in occupation-
al rehabilitation: Would the real case manager please
stand up? Australian Journal of Rehabilitation Coun-
selling, 1 (2) 104-117.
Kenny, D. T. (1995e). Stressed organisations and organi-
sational stressors: A systemic analysis of workplace
injury. International Journal of Stress Management, 2,
207-220.
Kenny, D. T. (1995f). Occupational rehabilitation in New
South Wales. Sydney: The University of Sydney.
Kenny, D. T. (1995g). Barriers to return to work in New
South Wales: Research findings and theoretical con-
siderations. Proceedings of the National Occupational
Health Conference: Brisbane, Queensland (pp.75-78).
Kenny, D. T. (1996). The roles, functions, and effective-
ness of treating Doctors in the management of occu-
pational injury: Perceptions of key stakeholders. The
Australian Journal of Rehabilitation Counselling, 2
(2), 86-98.
Kivimaki, M. & Lindstrom, K. (1995). Effects of private
self-consciousness and control on the occupational
stress-strain relationship. Stress Medicine, 11 (1), 7-
16.
Kivimaki, M., Elovainio, M. & Nord, J. (1996). Effects
of components of personal need for structure on occu-
pational strain. Journal of Social Psychology, 136 (6),
769-777.
Kobak, R.& Shaver,P. (1987). Strategies for maintaining
felt security: A theoretical analysis of continuity and
change in styles of social adaptation. Paper presented
at a conference in honor of John Bowlby’s 80th birth-
day, Bayswater, London.
Kottage, B.E. (1992). Stress in the workplace. Profes-
sional Safety, 37(August), 24-26.
Kulik, C. T., Oldman, G. R., & Hackman, J. R. (1987).
Work design as an approach to person-environment fit.
Journal of Vocational Behaviour, 31, 278-296.
Landsbergis, P. A., Schnall, P. L., Deitz, D., Friedman,
R., & Pickering, T. (1992). The patterning of psycho-
logical attributes and distress by “Job Strain” and so-
cial support in a sample of working men. Journal of
Behavioral Medicine, 15 (4), 379-405.
Lazarus, R. S. (1987) Individual susceptibility and resist-
ance to psychological stress. In Kalimo, R., El-Batawi,
M. A., & Cooper, C.L. (Eds.) Psychosocial Factors at
Work. World Health Organization, Geneva, 127-133.
Lazarus, R.S. (1995). Psychological stress in the work-
place. In R. Crandall & P.L.Perrewe (Eds.) Occupa-
tional Stress: A handbook. Taylor and Francis, Phila-
delphia, US. pp 3-14.
Lazarus, R.S. & Folkman, S. (1984). Stress, appraisal,
and coping. New York: Springer.
Levi, L.(1997). A biopsychosocial approach to etiology
Chapter 20, Stress and Health
and pathogenesis. Acta Physiologica Scandinavica,
161 (640), 103-105.
Levi, L. (1990). Occupational stress. Spice of life or kiss
of death? American Psychologist, 45 (10), 1142-1145.
Mackay, C. J., & Cooper, C. L. (1987). Occupational
stress and health: Some current issues. In C. L. Cooper
& I. T. Robertson (Eds.). International review of in-
dustrial and organisational psychology 1987 (pp. 167-
199). Chichester, UK: John Wiley and Sons.
Mahony, K. (1996). An argument for using qualitative
methods to reveal the multicausality of occupational
stressors in the work of Triple 0 party workers, in D.
Kenny (Ed.). Proceedings (Edited Abstracts), Interna-
tional Congress on Stress and Health, The University
of Sydney, p29.
Marx, K. (1982). Capital, Volume 1. Middlesex: Pen-
guin.
McRae, R.R. & Costa, P.T. (1994). The stability of per-
sonality: Observations and evaluations. Current Direc-
tions in Psychological Science, 3 (6), 173-175.
McGrath, J. E. (1976). Stress and behavior in organiza-
tions. In M. D. Dunnette (Ed.). Handbook of industrial
and organization psychology. Chicago, IL: Rand Mc-
Nally.
McIntyre, D. (1998). The politics and experience of oc-
cupational stressors. Unpublished PhD Dissertation.
Newcastle University.
Minuchin, S. (1978). Families and family therapy. Lon-
don, Great Britain: Tavistock Publications Ltd.
Matheny, K.B., Aycock, D.W., Pugh, J.L., Curlette, W.L.,
& Silva Canella, K.A. (1986). Stress coping:A quali-
tative and quantitative synthesis with implication for
treatment. Counseling Psychologist, 14, 499-549.
Moos, R. H. (1987). Person-environment congruence in
work, school, and health care settings. Journal of Voca-
tional Behavior, 31, 231-247.
Murphy, L.R. (1988). Workplace interventions for stress
reduction and prevention. In C.L. Cooper & R. Payne
(Eds.), Causes, coping and consequences of stress at
work. London, Wiley , (pp 310-309).
Nowland, L. (1997). Application of a systems approach
to the rehabilitation assessment of clients with an occu-
pational stress-related injury. The Australian Journal
of Rehabilitation Counselling, 3 (1), 9-20.
O’Driscoll, M. P., & Cooper, C. L. (1994). Coping with
work-related stress: A critique of existing measures
and proposal for an alternative methodology. Journal
of Occupational & Organizational Psychology, 67 (4),
343-354.
Palazzoli, M., Boscolo, L., Cecchin, G., & Prata, G.
(1986). Paradox and counter paradox. Palo Alto, Cali-
fornia: Jason Aronson
Parkes, K.R. (1994). Personality and coping as modera-
tors of work stress processes: Models, methods and
measures. Work and Stress, 8 (2), 110-129.
Peterson, C. L. (1994). Work factors and stress: A criti-
Occupational Stress 29
 cal review. International Journal of Health Services,
24 (3), 495-519.
Quick, J.C., Joplin, J. R., Nelson, D.L., & Quick, J. D.
(1992). Behavioural responses to anxiety: Self reli-
ance, counterdependence, and over dependence. Anxi-
ety, Stress and Coping: an International Journal, 5 (1),
41-54.
Quinlan, M. (1988). Psychological and sociological ap-
proaches to the study of occupational illness: A critical
review. The Australian and New Zealand Journal of
Sociology, 24 (2), 189-207.
Quinlan, M., & Bohle, P. (1991). Managing occupational
health and safety in Australia. Melbourne: Macmillan
Australia.
Reynolds, S. (1997). Psychological well-being at work:
Is prevention better than cure? Journal of Psychoso-
matic Research, 43 (1), 93-102.
Rounds, J. B., Dawis, R. V., & Lofquist, L. H. (1987).
Measurement of person-environment fit and prediction
of satisfaction in the theory of work adjustment. Jour-
nal of Vocational Behavior, 31, 297-318.
Scheier, M.F. & Carver, C.S. (1985). Optimism, coping
and health: assessment and implications of generalized
outcome expectancies. Health Psychology, 4, 219-
247.
Selye, H. (1975). The stress of life (Rev. Ed.). New York:
McGraw Hill.
Shrey, D. (1993). Workplace-based disability manage-
ment: Challenges and opportunities for joint employer
rehabilitation professional initiatives. Proceedings of
the Second National Rehabilitation Conference (pp.
27-36). Sydney, Australia: Commonwealth Rehabilita-
tion Service.
Siegall, M. & Cummings, L.L. (1995). Stress and organi-
zational role conflict. Genetic, Social and General Psy-
chology Monographs, 121 (1), 65-95.
Sluzki, C.E. (1985). A minimal map of cybernetics. Net-
worker, May-June p 26.
Spielberger, C. D., Reheise, E. C., Reheiser, J. E., &
Vagg, P. R. (1998). Measuring stress in the workplace:
the Job Stress. Survey In D. T. Kenny, J. C. Carlson,
F. J. McGuigan, & J. L. Sheppard (Eds). Stress and
health: Research and clinical applications. Ryde: Gor-
don/Breach/Harwood Academic Publishers
Spielberger, C.D. (1997). Professional manual for the
Job Stress Survey (JSS). Odessa, FL., Psychological
Occupational Stress 30
View publication stats
Assesment Resources, Inc.
Spielberger, C.D. & Reheiser, E.C. (1994). The Job Stress
Survey: measuring gender differences in occupational
stress. Journal of Social Behaviour and Personality, 9
(2), 199-218.
Spector, P.E. & O’Connell, B.J. (1994). The contribu-
tion of personality traits, negative affectivity, locus of
control and Type A to the subsequent reports of job
stressors and job strains. Journal of Occupational and
Organizational Psychology, 67 (1), 1-12.
Sutton, R.I. & Kahn, R.L. (1986). Prediction, understand-
ing and control as antidotes to organizational stress. In
J.W. Lorsch (Ed.), Handbook of organisational be-
haviour (pp272-285), Englewood Cliffs NJ: Prentice
Hall.
Tate, D. G. (1992). Factors influencing injured employ-
ees return to work.. Journal of Applied Rehabilitation
Counselling, 23 (2), 17-20.
Toohey, J. (1993). Quality of working life project: A study
of occupational stress in Commonwealth Government
Agencies. Canberra, Australia: Comcare
Toohey, J. (1995). Managing the stress phenomenon at
work. In P. Cotton (Ed) (1995) Psychological health in
the workplace (pp 51-71). Victoria: Australian Psycho-
logical Society.
Turner, J. & Spielberger, C. (1991). Job stress in man-
agers, professionals and clerical workers. Work and
Stress. 5 (3) 165-176
Watson, D., Pennebaker, J.W. & Folger, R. (1986). Be-
yond negative affectivity: measuring stress and satis-
faction in the workplace. Journal of Organizational
Behaviour Management, 8 (2), 141-157.
Weil, M., & Karls, J. M. (1985). Case management in hu-
man service practice. California: Jossey-Bass.
Weiner, N. (1948). Cybernetics or control and commu-
nication in the animal and the machines. New York:
Wiley.
Williams, C., & Thorpe, B. (1992). Beyond industrial so-
ciology: The work of men and women. Sydney: Allen
and Unwin.
Willis, E. (1989). Commentary: RSI as a social process.
Community Health Studies X (2), 210-219.
Willis, E. (1994). Illness and Social Relations. Sydney:
Allen & Unwin.
Wright, R. (1995). The evaluation of despair. Time, 11
September, 62-68.
Kenny D.T., 1999