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Stress management

Author: Ivan Robertson


  • Employers have a legal duty to manage the risks to employees' health and safety, including the risks arising from stress. (See The legal duty)
  • Following a good practice approach to managing stress is likely to have organisational benefits, including reducing sickness absence. (See Building a business case for stress management)
  • Employers can use the "6 essentials of workplace wellbeing" as a framework for managing stress. (See A framework for managing stress)
  • Psychological wellbeing and resilience training are key to preventing stress. (See Stress, psychological wellbeing and resilience)
  • Employers should manage situational and personal factors to minimise the risk of stress. (See Causes of stress)
  • Where an employee's stress stems from factors outside the workplace, the organisation should take steps to help the employee, because his or her work may be affected. (See Personal stress)
  • Stress management should be undertaken by teams and individuals throughout the organisation. (See Ownership of stress management)
  • Organisational commitment to stress management is essential to the success of the organisation's stress-management programme. (See Organisational buy-in)
  • Employers should conduct a stress audit (also known as a stress risk assessment) to identify sources of stress and what effect they have on employees. (See Stress audits)
  • A stress policy is essential to raising awareness about the organisation's commitment and approach to managing stress. (See Stress policy)
  • Interventions that can help to deter stress include having a stress-prevention strategy, raising awareness about the organisation's stress-prevention activities and considering the potential for stress during role design and recruitment. (See Primary interventions)
  • Informing and training employees and line managers on stress, enabling them to take exercise and teaching them relaxation techniques can help them to recognise stress and take action to deal with it if it occurs. (See Secondary interventions)
  • Where an employee experiences stress, support for the employee on return to work and employee assistance programmes or in-house counselling can help him or her to manage it. (See Tertiary interventions)
  • Organisations should examine the effect of their interventions to prevent and manage stress. (See Evaluation)


This section of the XpertHR Good practice manual focuses on what employers can do to deter stress and, where employees experience stress, rehabilitate them, including by promoting psychological wellbeing. It sets out: the reasons for observing good practice; a framework that organisations can adopt to manage stress; and the different interventions that are available.

Employers have a duty to identify potential causes of stress and reduce them before they have an impact on employees. The Management of Health and Safety at Work Regulations 1999 (SI 1999/3242) require employers to undertake a suitable and sufficient assessment of the risks to employees, including the risk of stress-related ill health, arising from workplace activities. The Health and Safety at Work etc Act 1974 requires employers to take measures to control these risks.

The law does not set out a process for employers to follow to meet these requirements, but official guidance is available. The Health and Safety Executive (HSE) Management standards for work-related stress provide a framework that employers can use to meet the legal requirements. Robertson Cooper's "6 essentials of workplace wellbeing", which have been identified by comprehensive research into the enablers of, and barriers to, psychological wellbeing, provide a practical approach for achieving wellbeing, and can be aligned with the HSE's management standards. Improving psychological wellbeing reduces the risk of stress, and has other positive individual and business outcomes, including acting as a foundation for sustainable employee engagement (see A framework for managing stress).

Building a business case for stress management

Stress has a significant impact on the bottom line:

  • In 2015/16, 11.7 million working days were lost due to work-related stress, depression or anxiety, which is an average of 23.9 days per condition.
  • Sickness absence is costly. The XpertHR absence rates and costs survey 2016 found that the median cost of sickness absence for respondents stood at £455 per employee per year in 2015.
  • In 2011, stress became the primary cause of long-term sickness absence for manual and non-manual workers.

When making the business case for investment in stress management, employers should not look at these figures in isolation. They should determine how they relate to their organisation, by identifying the bottom-line metrics that are likely to be affected by stress-prevention and rehabilitation measures and, where possible, calculating potential savings in these areas using their own statistics.

The starting point for working out how much money an organisation is likely to save by investing in stress management is to calculate how much it would save on sick pay for stress-related sick leave. The organisation should also calculate potential savings relating to:

  • the cost of temporary staff to cover for employees who are absent on stress-related sick leave;
  • time spent managing employee stress;
  • lost sales flowing from stress-related sick leave;
  • reduced productivity resulting from employees working while stressed or being absent on stress-related sick leave; and
  • employee turnover resulting from employees leaving the organisation because of stress or stress-related sickness absence.

Absences that relate to stress may be more frequent than at first appears. Although stress is not a physical condition, it can have physiological effects, including headaches and trouble sleeping, and it may lead to an increased risk of having a heart attack. There is also evidence of a link between short-term causes of sickness absence, for example colds and flu, and psychological wellbeing.

Taking a good practice approach to managing stress is likely significantly to reduce the possibility of costly personal injury and disability discrimination claims and the impact that they can have on the cost of employment liability insurance.

Taking a good practice approach to stress management may have other, less tangible, benefits:

  • Employees are becoming increasingly concerned about the ethical behaviour of their employer, including how it treats its employees. A good practice approach to stress management is likely to improve the internal and external organisational brands, which can have a positive effect on the organisation's ability to recruit talented candidates and on talent management.
  • To inspire commitment and loyalty from employees, employers need to be committed to the employer/employee relationship. Taking a good practice approach to stress management demonstrates an organisation's commitment to this relationship.

To build a business case for investment in stress prevention and rehabilitation, an organisation should consider the views of all relevant stakeholders on the organisation's approach to stress. It should consult employees, senior managers, the HR department, the occupational health team, health and safety staff and trade unions. Consulting with these groups, either on a face-to-face basis or through questionnaires, will help to ensure that any initiatives that the organisation takes to prevent and manage stress will be welcomed and implemented throughout the organisation.

A framework for managing stress

Robertson Cooper's "6 essentials of workplace wellbeing" identify the key areas that have the potential to cause stress at work:

  • Resources and communication: Employers should give employees the tools they need to do their job, for example by providing adequate training and equipment. They should also keep them informed about relevant matters.
  • Control and autonomy: Employers should not unnecessarily limit employees' freedom to do the job in their way. They should involve employees in setting targets and objectives.
  • Balanced workload: Employees should have a good work-life balance, and employers can help them to achieve this by ensuring that they take regular breaks from work. Employers should also ensure that employees do not have too heavy a workload.
  • Job security and change: Organisations should keep employees' transferable skills up to date and manage change actively, empowering people to respond to change positively.
  • Work relationships: Employees should be treated with respect by their managers and colleagues.
  • Job conditions: Employers should give employees the best working conditions that they can, including salary and other benefits.

Employers can use the "6 Essentials of workplace wellbeing" as a framework for their psychological wellbeing activity. For example, they can use it as the foundation for a wellbeing risk assessment, refer to it in training to explain what impact wellbeing has on individuals and the organisation, and use it as the foundation for interventions to reduce stress, which should aim to have a positive impact on one or more of the six essentials.

Where an organisation is already engaged in stress-prevention and management activities, but not within a specific framework, it will not need to begin its activities again. However, it should consolidate its activities by conducting an overview of what it is doing and adopting a stress policy and stress-prevention strategy. This will help the organisation to improve the effectiveness of any activities that it undertakes and, if required to do so as part of any legal action, demonstrate that it has complied with the law.

Stress, psychological wellbeing and resilience

For many years, occupational psychology focused on stress management in a reactive capacity, by attempting to deal with the effects of stress and minimise the impact of stress. However, the organisational benefits of psychological wellbeing have become increasingly understood, and organisations have started to embrace this concept. Where organisations manage the "6 essentials of workplace wellbeing" positively, they can improve the psychological wellbeing of the workforce. Psychological wellbeing can safeguard against stress, acting as a preventative measure, and helps to instil a sense of purpose in individuals.

The 6 essentials of workplace wellbeing model

Figure 1

This section of the XpertHR Good practice manual focuses on preventing and managing stress, including the initiatives that organisations can take to improve psychological wellbeing.

Stress-prevention training is increasingly being referred to as "resilience" training. It aims to prepare employees to deal with pressure and to help line managers reduce the risks of stress for their team members. Resilience training is designed to develop a strong sense of purpose, positive emotions, confidence and adaptability, and to encourage access to social support, to help individuals overcome setbacks and face challenges positively.

Causes of stress

Stress is not the same as pressure, but the two terms are frequently used indistinguishably, which can hinder efforts to prevent and cure stress. Positive pressure is a good thing: it provides motivation and, for some people, is a significant driver of performance. Challenging but achievable goals allow people to feel a sense of achievement and growth, which is psychologically healthy. Stress occurs when pressure becomes overwhelming or relentless: an employee experiences stress when he or she feels that his or her capacity to cope is being exceeded by demands and it may lead to "burn out".

The other end of the spectrum is known as "rust out", where stress is a result of apathy and boredom. This could be because the role is not demanding enough and/or because the employee does not feel valued by the organisation.

Figure 1

With both rust out and burn out, the organisation should differentiate between quantitative problems (where the individual has too much or too little to do) and qualitative problems (where work is too hard or too easy), and bear this in mind during job design and recruitment.

There are two approaches to preventing and minimising stress, which organisations should adopt simultaneously. The first is to deal with the situational causes of stress. Employers should consider how the work environment and the nature of the role pose, or could pose, a risk to the individual. For example, positive working relationships can be a huge source of support during difficult times, and can encourage people to share their problems before they escalate. However, negative working relationships can be incredibly stressful and one of the most common reasons why people leave their job.

Employers can use the "6 essentials of workplace wellbeing" framework (see A framework for managing stress) to break down the situational factors into more manageable sections. They should evaluate the environment on this basis to reduce any existing or potential stressors. They should also use the framework to improve these factors in a preventative capacity.

The second approach relates to personality factors. Employers should consider the characteristics that individuals have that may make them more susceptible to stress, and their ability to deal with pressure before it becomes stress.

Five main elements make up personality, which are:

  • openness (the extent to which an individual is intellectually curious and open to new ideas, and has a preference for variety);
  • conscientiousness (the extent to which an individual is dependable, methodical and achievement striving);
  • extraversion (the extent to which an individual is gregarious, active and assertive);
  • agreeableness (the extent to which an individual is sympathetic, cooperative and trusting); and
  • neuroticism (the extent to which an individual is emotionally unstable, anxious and irritable).

These factors have an impact on people's behaviour at work. For example, being conscientious and having a low level of neuroticism are linked to success across nearly all occupational areas. However, some roles may require a more dominant characteristic, for example a customer-facing or caring role could be challenging for someone who has low levels of agreeableness, even if his or her conscientiousness is high.

Understanding the role of personality helps employers to determine a good job/employee fit. A job that may be stressful for one person may be exciting and fulfilling for another. Considering candidates' personality during recruitment is likely to improve the chances of effective performance and can help to reduce stress, because individuals will be able to use their strengths in the role.

An individual's personality is fairly fixed, but training and development can help people to overcome their limitations and maximise the benefits of their natural style. Employers should factor this into their development programmes to reduce the risk of stress and improve wellbeing.

Personal stress

Employees may experience stress as a result of personal, non-work-related factors. Whether problems start at home or at work, they are likely to cross from one domain to the other, so employers should help employees who are experiencing problems in their personal life.

Personal problems can be a difficult area for employers to address, because employees are not obliged to disclose details of their personal life to their employer, and managers and colleagues are unlikely to wish to overstep the mark.

To help employees experiencing non-work-related stress, line managers should:

  • be sympathetic and proactive;
  • give employees the opportunity to raise any problems, for example through regular formal and informal "catch-up" meetings;
  • arrange a confidential meeting with an employee who appears to be experiencing stress, to give him or her the opportunity to discuss any problems;
  • allow enough time in meetings to express their concerns and clarify whether the employee's problems are work related or personal; and
  • do whatever they can to manage work-related sources of pressure, including making reasonable allowances for someone who is finding it difficult to cope with his or her work because of problems at home.

However, line managers should not put other members of their team under undue pressure as a result of their efforts to support one person.

Training for line managers can help them to support employees experiencing non-work-related stress.

Stress and depression

Stress is not a medical condition, but depression is. There is often a link between two. If a manager suspects that an employee is depressed, he or she should refer the employee to the organisation's occupational health department and advise the employee to contact his or her GP, because treatment is available for depression.

The organisation should manage a return to work from sickness absence because of depression with care. There should be regular contact between the line manager and the employee, beginning with a return-to-work interview. The employer should support the employee, for example a change to working hours or access to a stress-management course or counselling might be appropriate. The manager should ensure that any adjustments that he or she makes to the employee's role or working pattern do not put other members of the team under undue pressure.

Ownership of stress management

Stress management should not be the sole responsibility of the HR, health and safety or occupational health department. While one of these teams may have overall ownership of the stress-management programme, depending on the size and structure of the organisation, responsibility should be assumed by other areas of the organisation too, for example the organisational development, talent management, learning and development and rewards and benefits teams.

Individuals within the organisation should also have responsibility for managing stress:

  • The CEO and senior board members (or the equivalent senior management team) need to be on board with the stress-management agenda and should be responsible for creating a culture where it is taken seriously (see Organisational buy-in).
  • Line managers have a crucial role to play in stress management, because they are best placed to recognise the signs of stress within their team.
  • Employees have a responsibility to manage their own health and work-life balance. They should cooperate with the organisation's actions to prevent stress and rehabilitate them if they experience stress.

A stress-prevention strategy group could bring the different stakeholders together. The strategy group could include a core team that meets regularly, and additional stakeholders could be invited to participate as necessary. Such groups can help to ensure that stress-prevention and wellbeing activities are aligned with the organisation's strategic goals, and that the stress-prevention strategy, stress policy and the business case are updated regularly to reflect business needs.

Getting started

The first step that an organisation should take to prevent and manage stress depends on several factors, including:

  • whether or not the organisation has already undertaken stress-management activities; and
  • the size and culture of the business.

Therefore, the organisation may need to follow the steps set out in this section of the Good practice manual in a different order. It may also need to repeat some of the steps. For example, if the organisation is conducting a stress audit, it should obtain organisational buy-in in advance, and again before implementing initiatives based on the results of the audit. Stress prevention and management is an ongoing activity that will evolve depending on the needs of the organisation.

Organisational buy-in

In the past, stress management focused on individual rehabilitation for employees experiencing stress. More recently, employers have begun to focus on taking preventative activity at an organisational level, which can help to deter stress. An organisational approach is also likely to lead to greater efficiency in managing stress, because it will enable the organisation to target resources where they are needed most and to identify and replicate good practice.

To ensure the success of an organisational approach, the CEO and senior board members (or the equivalent senior management team) need to buy into the business case for stress management (see Building a business case for stress management).

Once organisational buy-in to preventing and managing stress is secured, the senior management team should demonstrate its commitment through:

  • effective communication with the workforce about the organisation's commitment to stress management;
  • exhibiting healthy behaviours and work patterns, because failing to do so will make it difficult for the organisation to encourage behaviour change among employees; and
  • appointing one or more senior managers who understand the benefits of stress management and are willing to undertake the role to champion the wellbeing cause.

The senior management team should develop a culture that encourages open discussion around the subject of stress. Senior members of staff experiencing stress should be open about seeking help and participate visibly in stress-prevention services. It is unlikely that employees will be open about experiencing stress if they think that more senior employees will see it as weakness.

Employers should appreciate the difference between taking an organisational approach to stress management and taking a "blanket" approach. When implementing stress-management initiatives, the organisation should be aware that different employees and different parts of the organisation have different needs. The organisation's stress-management strategy, policy and interventions should take into account the possible inability of those targeted to access the organisation's resources (whether due to timing, location or technology) and the possible unwillingness of people to access the help provided (whether due to personal attitude or a fear of how others will perceive accessing help).

Stress audits

Employers should use stress audits (also known as stress risk assessments) to identify sources of stress in their organisation and what effect they have on employees.

Organisations should use different methods to ensure that their stress audit is comprehensive. Questionnaires and surveys are useful as an organisation- or team-wide tool. Their format will depend on various factors, for example the size of an organisation and the nature of activities carried out are likely to dictate the breadth of a survey. Focus groups and interviews enable employers to explore the results of a questionnaire or survey in more detail.

Whatever method an organisation uses, it should:

  • identify who needs to be involved in the audit;
  • determine the goals and objectives of the audit;
  • determine what the starting point of the audit should be;
  • identify what the organisation is already doing to manage stress, and what existing measures tell it;
  • undertake any additional audits and assessments as necessary;
  • use the findings of the audit to create action plans and implement interventions; and
  • evaluate the success of its stress-management activities.

Employers can conduct their stress audit internally or with the assistance of an external party. The primary benefit of an internal audit is cost savings. However, it may put unrealistic demands on staff. Where an organisation engages a third party to conduct the audit, this may be more successful, because participants may have more confidence in its confidentiality so may be more likely to engage with it.

The organisation should analyse the stress audit in terms of the "6 essentials of workplace wellbeing" framework (see A framework for managing stress). It should find out if any of the six areas identified as having the potential to cause stress exist and, if they do, how much they bother employees, so as not to spend significant resources on addressing something that people do not consider to be a problem, and failing to address a more significant issue.

Employers should assess all roles in relation to stress. However, while all jobs are potentially stressful, some are more likely to put staff at risk than others. Shift workers, lone workers and people who deal with the public (and who are therefore at risk of customer bullying) fall into the high-risk category.

Therefore, organisations should analyse the results of their stress audit to find out if a particular team or demographic group is experiencing a problem. This may not be apparent from examining results at an organisational level. If, for example, all of the employees in a department are reporting issues that have a negative impact on one of the six essentials, the organisation could conduct focus groups to gather more information and take further action as necessary.

Organisations can also use stress audits to measure staff attitudes to existing stress-management practices.

Stress policy

A policy on stress is an essential stress-management tool. It demonstrates that preventing and managing stress is important to the organisation and can encourage good practice.

The policy should:

  • address the different stakeholders that were identified during the business-case process (see Building a business case for stress management);
  • set out the organisation's approach and commitment to stress prevention and management;
  • set out the organisation's procedures that relate to stress, so that managers from across the organisation understand what its processes are, for example how to handle a sensitive conversation about stress, how to refer an employee to occupational health and how to communicate with GPs; and
  • explain the processes that employees should use to access support when experiencing stress, and reassure them that access is encouraged and will have no detrimental impact on how the organisation perceives their performance.

There are several key points that will help to make the stress policy relevant to the organisation:

  • The policy needs to serve multiple purposes, so representatives from each of the stakeholder groups should be involved in its creation. The organisation should also ensure that trade union groups are made aware of any new policy on stress or changes to an existing stress policy.
  • The organisation could base its stress policy on a model policy, but it should reflect the organisation's particular needs.
  • The stress policy should be a working document that is reviewed and updated in accordance with best practice developments and changes within the organisation and industry. The stress-prevention strategy group (see Ownership of stress management) could be responsible for this.

Employees should be able to access the stress policy easily, for example on the intranet.

Different levels of intervention

Before deciding what interventions to take, the organisation should conduct an audit to determine what interventions it already uses and to identify those that deliver the desired outcomes.

The organisation's interventions should include activities in the primary, secondary and tertiary fields. Primary-level interventions often involve making changes to core organisational processes that may be firmly embedded in the organisation and an essential component of how the organisation functions, so organisational buy-in should be secured prior to taking them.

The three levels of intervention
Level of intervention Description Examples
Primary Preventative measures to reduce the risk of stress Risk audits/assessments, careful role design and recruitment processes and raising awareness about the organisation's policies and practices
Secondary Increased awareness of stress and training to help individuals recognise and avoid stress Training and information for employees and managers
Tertiary Support for those experiencing stress Resources to support people who are experiencing stress, including counselling, employee assistance programmes, support groups and return-to-work support

Interventions can influence the situational and/or personal sources of stress (see Causes of stress). The important environmental aspects are set out in the "6 essentials of workplace wellbeing" framework (see A framework for managing stress). It is the employer's primary responsibility to ensure that these factors are optimised. Personal factors reflect the individual's ability to cope with pressure, which can be influenced through training and with the individual's cooperation.

Employers' stress-management measures

Survey analysis > Practical steps to manage stress: the 2013 survey The latest XpertHR research reports on the steps employers are taking to manage, prevent and reduce stress among employees in the workplace.

Primary interventions

Organisations can take primary-level interventions to deter stress:

Stress-prevention strategy: A stress policy is a visible document that demonstrates the organisation's approach to stress, and explains what processes are in place to facilitate it. It may change over time depending on best practice. In addition to a stress policy, organisations should put together a stress-prevention strategy to identify the organisation's long-term approach to stress. This needs to work alongside the stress policy.

The strategy can help to ensure that the organisation's stress-related activities are aligned with its strategic goals. In addition to improving the health and happiness of employees, stress management can support business-level outcomes, for example by achieving the cost benefits of reducing the number of days' stress-related sickness absence. The strategy can also facilitate implementation of the organisation's long-term wellbeing plans.

The stress-prevention strategy can help to ensure that the different elements of the stress policy do not conflict with one another. For example, the policy may equip line managers to manage stress, but the strategy could help to ensure that this does not make line managers' own role more stressful. It can also help to ensure greater efficiency of stress management, by preventing duplication of people's efforts.

Awareness: Ensuring that employees know about the organisation's resources for managing stress is fundamental to successful stress management. Some of these resources may be available all the time, for example information could be available permanently on a health and wellbeing section on the organisation's intranet, and some may be occasional, for example training.

The organisation should communicate with employees about its stress-management activities via a number of channels:

  • Wellbeing champions: The organisation could appoint wellbeing champions, who should be well acquainted with the organisation's stress-related services and direct people towards them. Champions should be appointed throughout the organisation, so that all employees can find a champion among their peers.
  • Stress and wellbeing events: Stress and wellbeing events can help to raise awareness about the organisation's stress-management activities. For example, the organisation could hold a one-day event on stress and wellbeing, or have a permanent or temporary stand in the staff canteen giving out information on stress and wellbeing.
  • Newsletters: The organisation could raise awareness about its stress-related activities through existing newsletters, or introduce a newsletter related to the issue of stress and wellbeing.
  • Group discussions: The employer could lead discussions on its stress-management resources on a regular basis, during formal and informal meetings with employees. For example, line managers could set aside time in team meetings or one-to-one conversations to discuss the issue of stress and wellbeing.
  • The intranet: The organisation could make stress-related resources available on the intranet.

As part of its awareness programme, the organisation should communicate the contents of its stress policy to employees. This will demonstrate the organisation's commitment to managing stress, and outline what the practical processes for seeking help are, so that people know what to expect if they seek help. The stress policy could be made more accessible by putting together a summary of the policy, which could be made available to employees via the intranet and in an induction pack for new employees. The employer could also put together an accessible summary of the stress-prevention strategy and make it available to employees in the same way.

If employees know that colleagues have sought help for stress, they will be encouraged to seek help themselves if they experience stress. A case study that explains how the organisation has supported an employee experiencing stress could encourage employees to access help (the individual in the case study could be named or remain anonymous depending on his or her wishes).

Where few or no employees have sought help in the past, to encourage employees to come forward, the organisation should reassure them of the confidentiality of its services and explain that any information that employees provide will not be used against them, for example in a capability situation.

The stress audit could include a question to gauge the level of awareness among employees about the organisation's stress-management resources.

Role design: Employers should consider possible sources of stress, and their implications, at the role-design stage, including when a vacancy arises, when a team or the organisation is going through a period of change and when a new role is created.

The "6 essentials of workplace wellbeing" (see A framework for managing stress) can act as a checklist for considering sources of stress in any role, and should be used as the basis for role design:

  • Resources and communication: The organisation should provide employees with suitable training and equipment in a timely manner, from induction onwards.
  • Control: The organisation should involve employees in decisions about targets and ways of working.
  • Balanced workload: The organisation should give employees appropriate deadlines and ensure that staffing levels are adequate.
  • Job security and change: The organisation should consult employees on any redesign.
  • Work relationships: The organisation should consider the nature of interactions between colleagues, and how the goals of one team may affect another team.
  • Job conditions: The organisation should consider whether or not the role is too repetitive and if the employee is suitably rewarded compared to those doing similar roles.

There is evidence that work intensification has increased in recent years, for example many employees have to deal with increasing pressures and demands on their time, such as responding to emails while getting other things done. There is also evidence that levels of autonomy have decreased in recent years. Both of these trends are potential causes of stress, and the organisation should consider how they apply to the role during job design. The "creeping" nature of these trends indicates the need for roles to be reviewed on a regular basis.

Working hours have remained fairly constant over the years, but employers should still consider the potential for long working hours during the role-design process, because there is evidence that consistently working long hours may lead to psychological problems, including depression.

Even where a role appears to be intrinsically stressful, adopting a creative approach may yield solutions. For example, job rotation could address stress caused by tasks that are relatively simple but monotonous.

The stress-prevention strategy could provide for the creation of a stress-prevention group, consisting of employees who are consulted on role design. The group would not need to consist of the same employees on each occasion, and the employees would not need to receive formal training. However, the organisation should consult employees with similar responsibilities to those of the role in question, to ensure that the new or revised role is challenging but manageable.

Recruitment: Selection and promotion procedures should ensure that the organisation selects only capable candidates for job vacancies.

The organisation should provide the individuals who are involved in the recruitment process and, where appropriate, candidates, with:

  • objective criteria for the vacant role; and
  • a realistic job preview that explains the nature of the job, for example whether the individual would be working independently or as part of a team, and includes relevant comments from the existing jobholder or employees in a similar position.

The recruitment process should take into account the five areas of personality (see Causes of stress). To find out candidates' personality traits, the organisation could ask them to complete an online personality questionnaire, for example. If the organisation asks candidates to complete a questionnaire, the results would need to be interpreted by a qualified occupational psychologist and discussed at the interview stage. However, personality traits alone should not be used to dismiss a candidate, because he or she may have developed coping strategies that would enable him or her to perform well in the role.

The use of resilience questionnaires has increased in popularity, because they can give employers an indication of how an individual might cope with the pressures of a role. A questionnaire will not give a simple "yes" or "no" answer about whether or not the individual is resilient. Resilience is multidimensional, and a resilience profile that is unsuitable for one job may be well matched with another job. If the organisation asks candidates to complete a resilience questionnaire, this could highlight areas for discussion during the interview. Using a resilience questionnaire also means that, if an individual is offered a role, the organisation will already have identified where he or she may need help, enabling it give the individual support early on in the role.

Communication: The organisation should communicate with employees about its direction. Uncertainty about plans for a restructure can be a considerable source of stress for employees, so the organisation should keep them informed about any changes that are taking place in the organisation. Even if the organisation is not in a position to reveal full details about proposed changes, or where no changes are due to take place, regular updates, for example about the organisation's performance, from senior and middle managers can help to minimise the risk of stress.

Flexible working: Flexible working can help the organisation to prevent and deal with stress. It allows employees to have more control over how they work and to achieve a good work-life balance, both of which are key to improving psychological wellbeing and reducing stress.

Flexible working options include:

  • part-time working and job-sharing;
  • flexitime;
  • compressed working hours;
  • homeworking (or teleworking); and
  • time off in lieu where the employee has worked additional hours, for example to finish a particular project.

Flexible working does have some risks, for example it may take more time for an employee working flexibly to develop good working relationships with his or her colleagues, or the employee may feel a need to demonstrate his or her availability at all times by being constantly available via technology. Remote workers particularly can be at risk. The organisation can help to prevent stress by defining clearly employees' goals and targets, developing strong channels of communication and helping relationships between colleagues to develop in other ways.

Work-life balance > Flexible working deals with flexible working.

Regular checks: The organisation should conduct regular health checks to enable it to spot signs of stress among employees. This could be the responsibility of a central department, for example the occupational health department. It could train line managers to use the appraisal process and informal discussions with members of their team to check if employees are experiencing stress and unearth any problems that may give rise to stress.

Carrying out regular checks is important, because not all employees will feel comfortable to bring up the issue of stress themselves. However, this should be done with care, so that the organisation does not appear to be intrusive or discriminatory, which means that training for those involved will be necessary.

Monitoring: The organisation should monitor the effectiveness of its stress-management activities. Metrics such as sickness absence, referrals to occupational health and employee assistance programmes, and working hours can signal whether or not the organisation's stress-management programme is having the intended effects (see Evaluation).

Secondary interventions

Organisations can take secondary-level interventions to help employees recognise stress and take action to avoid it:

Employee training/information: The organisation should help employees to take care of their own health and safety by giving them training. Stress-management training for employees can teach them how to avoid stress and, if it does occur, to recognise it and access help.

Resilience training is an important part of stress-management training, as it equips employees to cope with difficult situations. However, where the organisation offers employees resilience training, this does not give it a licence to put unreasonable demands on employees. The organisation should communicate this to everyone who takes part in training, so that they do not become suspicious of the organisation's motives in offering them training.

Training should be designed to help employees respond positively to challenges and bounce back quickly from setbacks. Training for employees should:

  • explain the aims and objectives of the course;
  • define resilience and give employees an understanding of what they draw on when they need to be resilient (this can be identified using, for example, the Robertson Cooper i-resilience tool;
  • give employees interactive tips and tools for building and maintaining resilience, including: the resilience prescription (nine approaches to developing resilience, as identified by Dr Dennis Charney); thinking differently (based on cognitive behavioural principles); using signature strengths (making the most of one's natural attributes); challenge and mastery (moving beyond one's comfort zone to increase one's skill set); lifestyle management; and working smarter;
  • incorporate training materials and handouts, with tips and tools for building resilience; and
  • help to build personal resilience action plans for employees.

Training on more specific subjects, for example relationship building, assertiveness, presentation skills and time management, can give employees further help with managing stress. The organisation should decide whether this type of training should be optional or compulsory. Making it optional can be more effective, because attendees will have an interest in receiving training on the subject, and cheaper, because not everyone will volunteer for training. However, there is a risk that those who are most in need will not access support.

Line manager training: Training line managers is key to a successful stress-management programme. The relationship between an employee and his or her manager is closely linked to whether or not the employee experiences stress and his or her psychological wellbeing. Training for line managers should cover how to spot and deal with signs of stress and how to manage effectively to prevent stress from occurring.

Line managers have the potential to inspire and to discourage certain behaviours. Training can help line managers to:

  • influence whether or not employees work long hours;
  • appreciate the importance of giving staff recovery time after a busy period;
  • encourage employees to take regular breaks and annual leave;
  • develop a "no-blame" culture; and
  • give employees regular feedback on performance, including positive and negative feedback.

Training should also teach line managers to ensure that, in taking steps to mitigate the impact of stress on one individual, they do not put other employees at risk of stress.

The organisation's stress-prevention strategy should consider how to ensure that line managers are not put at an increased risk of stress through dealing with employee stress on top of other demands. Line managers need to understand what scope they have to do things on their own and when they need to refer to internal or external teams.

An effective leadership training agenda is likely to include:

  • leading change - understanding one's role;
  • creating the balance between challenge and support;
  • understanding one's leadership style;
  • work-based action plans;
  • interactive tips and tools for building and maintaining resilience; and
  • personal resilience action plans.

Evidence shows that some factors make training more effective, including:

  • face-to-face delivery;
  • longer-term training, ie a series of workshops and/or follow-up sessions to a training session; and
  • interactive sessions with the facilitator and/or other participants.

However, technology enables learning to take place outside the classroom, which means that:

  • participants can undertake training at their own convenience;
  • participants can learn new skills in manageable, bite-size chunks, because they can stagger their training;
  • the logistical difficulties of classroom training are avoided; and
  • the organisation can save money, because online learning is often more cost effective than face-to-face training.

Online learning should not replace face-to-face training, but can be used alongside it. For example, employees could discuss what they learnt in online training during a team meeting, or the employer could use online learning to engage people ahead of face-to-face training or to reinforce face-to-face training after it has taken place.

Relaxation techniques: Employers can teach employees techniques to help them to reduce the psychological and physical impact of stress, for example yoga, meditation, controlled breathing and muscle relaxation. Some of these techniques can be employed during a difficult period to minimise the possibility of a stressful response in the moment, but practising relaxation techniques on a regular basis can help to avoid stress.

Mindfulness is the practice of increasing awareness of one's thoughts and feelings to enable one to manage them more effectively. It includes some of the relaxation techniques mentioned above. The practice is growing in popularity and can be taught in seminars to relieve stress (known as mindfulness-based stress reduction or MBSR) and increase positive emotions. Further details are available from Mindfulness, a website of the Mental Health Foundation.

Some employees may resist the idea of learning relaxation techniques, so employers should also promote the idea of general relaxation. This could include taking time out during the working day, for example to go for a walk, read a book, listen to music or even just have a non-work-related conversation. The organisation could encourage this by establishing a lunchtime walking club, for example.

The organisation should also highlight to employees the value of taking time out at home to relax. Relaxing can mean sitting doing nothing, participating in a hobby or spending time with family and friends.

One way of encouraging relaxation is to focus on and promote one of the benefits of relaxation. For example, the organisation could give employees a "happiness day", ie an additional day's leave that employees may use for an activity that increases their happiness. The organisation could make it a condition of taking a happiness day that employees take a photograph of their day and share it with their team.

Physical-health programmes: Physical exercise can help to deter stress. Organisations can encourage employees to do exercise by offering them exercise classes and access to gyms and facilities that enable them to walk, run or cycle to work, for examples showers and bike racks. This can help to make exercise more accessible.

There is little point in an organisation offering these facilities if employees are unable to take advantage of them because of a heavy workload. Flexible working policies can make it easier for people to access these resources at a time that is convenient for them. For example, some people may prefer to go to the gym in the morning, so the organisation could allow them to start their working day a little later and make up the time at the end of the day. The organisation should encourage line managers to support employees who wish to participate in such activities.

The physical-health programme should not constitute the full extent of the organisation's wellbeing programme. The organisation needs to understand the broader definition of the word "wellbeing" and put in place different measures to help deter stress and enable employees to deal with it should it occur (see Stress, psychological wellbeing and resilience).

Another section of the XpertHR Good practice manual - Good practice guide on wellbeing - deals with wellbeing.

Tertiary interventions

Organisations can take tertiary-level interventions to help employees cope with stress if it occurs:

Return to work: When an employee experiences stress, he or she might need a complete break from work. However, it is important for the employee to return to work sooner rather than later because, to reduce the risk of recurring problems, the causes of stress need to be tackled at their source. To support an employee on his or her return to work, the organisation could:

  • use some of the primary- and secondary-level interventions to reduce the demands of the employee's role to bearable levels and equip the individual to respond to them in a healthy way;
  • involve occupational health and HR professionals to determine what the organisation could do to help the employee; and
  • consider making reasonable adjustments to the employee's role.

Remploy provides a free Workplace mental health support service to facilitate return to work for people with a mental-health condition.

Another section of the XpertHR Good practice manual - Sickness absence management - deals with managing return to work following sickness absence.

Employee assistance programmes/in-house counselling: Employee assistance programmes (EAPs) and in-house counselling can support individuals who are experiencing stress, and enable them to respond more effectively to potentially stressful situations in the future. EAPs and in-house counselling services should be available to all employees, and they should offer support with both personal and work-related matters.

Many organisations use an external EAP provider, which employees can access via telephone in the first instance, with the added possibility of referral to face-to-face counselling where this is offered. In-house counsellors are more likely to be located at the organisation's premises and employed directly by the organisation.

Many services aim to generate organisational benefits using a two-sided approach: by helping employees to overcome difficulties and perform at their best; and by making suggestions to the employer on how it could improve the wellbeing of its workforce based on evidence from service users.

Merits and drawbacks of EAPs and in-house counselling
EAPs In-house counselling
Some employees may feel that an external EAP provider is more confidential, so may be more likely to access the service Some employees may feel that seeking assistance via in-house counselling is more "visible", so may worry about being labelled as unable to cope
An external EAP provider is likely to know less about the organisation, so any advice it gives may not be as relevant An in-house counselling service is likely to have a better understanding of the organisation, which can result in a more relevant response to the individual's needs
An external EAP provider may have little power to make preventative changes in the organisation An in-house counselling service may be more likely to be able to advise on organisational-level changes that could help to reduce stress


Organisations should monitor the effectiveness of any interventions that they put in place to prevent and manage stress. Deciding what methods of evaluation to use is one of the key tasks of the stress-prevention strategy group. It should review existing metrics and determine what they tell the organisation, and introduce new measurements where necessary and practical.

The most immediate response to the organisation's interventions is likely to be obtained from feedback forms. For example, asking employees to complete a response form immediately after a training session will allow the organisation to determine whether or not the session has been well received. Asking them to complete another form at a later date will demonstrate whether or not the training has resulted in a lasting behaviour or attitude change. Less immediate responses that can demonstrate the effectiveness of the organisation's interventions include determining whether or not there has been a change in statistics, for example sickness absence and retention rates.

Examining the effect of interventions at the following levels will give the organisation a good indication of their value:

Evaluating different levels of intervention
Individual and team level Organisational level

The organisation could determine if the intervention has had any of the following effects:

  • Affective, for example have attitudes changed?
  • Cognitive, for example has verbal knowledge changed, ie is there an improved understanding of, and ability to use, relevant terminology (for example, if a line manager has attended training and is then able to discuss the subject accurately with his or her team)?
  • Behavioural, for example has job performance improved?
  • Instrumental, for example has it resulted in concrete recognition of improvement, such as promotions?

The organisation could determine if the intervention has had any of the following effects:

  • Financial, for example have profits increased, and has the organisation made savings from reduced sickness absence?
  • Outputs, for example has service quality changed and have customer-satisfaction survey results improved?
  • Processes, for example has work-life balance changed?
  • Resources, for example have personnel skills improved and what is the feedback from employees on leadership following development programmes?
  • Health, for example has the health of the workforce improved?

One of the greatest challenges of evaluation is establishing causality, ie whether a particular intervention has resulted in behaviour change, or whether the change is coincidental or has another cause. For example, research has demonstrated that resilience training for sales employees results in better performance. Proving this involved careful research design and the collection of data that an organisation may not be able easily to collect. Demonstrating such an effect in other organisations may be difficult, given the many factors that can influence sales. Using a pilot group, where the rest of the organisation acts as a control group, is one way of testing whether or not any changes can be attributed to a stress-management intervention.

While research shows that investment in stress-related interventions is likely to have a good return, it can be difficult for an organisation to track the overall impact that an intervention has had on the organisation. The measures set out above should help organisations to track the effect of an intervention, but will not necessarily show the full picture. Additional benefits, for example a culture change or a change in how people feel on a day-to-day basis, cannot always be captured by employers.

If a particular initiative does not have the impact that the organisation was hoping for, this does not mean that other initiatives will not be successful. The organisation should learn from what happened and respond in a positive way.

Case study

The Health and Safety Executive (HSE) has identified education as one of five high-risk sectors for stress. The University of Aberdeen has taken steps to manage stress in the context of the HSE's Management standards for work-related stress and within the framework of the Investors in People Standard and the Healthy Working Lives Award Programme.

Drivers: The university analysed sickness absence statistics and feedback from staff surveys, which indicated that there was room for improvement in relation to stress management:

  • In 2009, sickness absence cost the university £1.64 million.
  • Stress was identified as the fourth largest cause of absence at the university: 10.4% of absence was due to stress.

Aims: To address these problems, the university aimed to:

  • reduce stress-related sickness absence; and
  • improve employee responses to stress-related questions in the annual employee survey.

Action: To meet its aims, the main elements of the university's stress interventions consisted of:

  • analysing sickness absence statistics (using data from 2009 and 2010);
  • risk assessing stress (via the annual staff survey using data from 2009 and 2010);
  • implementing stress training programmes (incorporating resilience); and
  • implementing a physical-exercise programme.

Stakeholders: The staff survey (incorporating the stress risk assessment) is owned, managed and analysed by HR with input from the IT department. Consultation takes place with trade unions to agree which questions to include in the stress category. This approach was endorsed by the HSE and the university's health and safety committee as part of the overall stress-management plan.

The university meets regularly with its occupational health provider, NHS Grampian Occupational Health Service. They share statistics and NHS Grampian produces an annual performance review for the university.

Specific interventions: The university took the following interventions:

  • Briefings for managers and representative groups were introduced to raise awareness of the HSE management standards, outline the university's moral obligations towards its employees and commence stress risk assessments as part of the staff survey.
  • Improvement groups of local stakeholders were given the objective of tackling stress hot spots and implementing tangible improvements. For example, the "long hours" group introduced workload analysis/modelling, training and objective setting.
  • Stress management training was made available to all employees who felt they would benefit from it. It included general information, for example an explanation of what stress is and how to build resilience to cope with stress, and practical advice. It also included organisation-specific information, including the university's approach to managing stress, and recent case studies in higher education. One participant said: "I really enjoyed the course and feel that it will be beneficial to the majority of people, as well as broadening people's perceptions of stress. As someone who has gone through work-related stress (and hopefully come through it reasonably unscathed), it felt reassuring that feelings ... I had were quite 'normal'. I think that the tone of the course was just right for a wide audience across the university."
  • Awareness training was built into all management development courses. Modules included: maximising attendance; time management; change management; and employee wellbeing.
  • Stress advisers were introduced. These are members of the HR team who are available for consultation and can make referrals to support services. Training for them is ongoing, including through Scotland's mental health first aid training programme, delivered by NHS Health Scotland.
  • A central stress action plan was developed, which detailed responsibilities, target dates and progress.

Prominent outcomes: Both of the university's targets were achieved, reflecting the long-term organisational impact attributable to stress-related training and development:

  • Organisation-level measures showed that stress-related sickness absence reduced by an average of 21% per annum, which equates to a saving of £53,800.
  • The responses to the cluster of stress-related questions in the staff survey improved by an average 2.9%.

Evaluation of stress-related training and development activities took place immediately after activities had taken place, to measure employees' reaction, and again several months after attendance, to measure behaviour/attitude changes. This demonstrated that the university's initiatives had an impact at individual, team and organisational level. It achieved favourable training ratings; there was increased awareness among employees of the support available; and employees reported an enhanced ability to deal with stress, with 76.5% of those who had attended training saying that they agreed or strongly agreed that they felt more confident about how to tackle stress.

Management referrals to occupational health increased between 2007 and 2010. The university regards this as a positive trend, because it can help to reduce the likelihood of long-term sickness absence and prevent escalation of individual circumstances and serious illness. It also indicates the success of management training programmes covering absence and staffing policies.

Stress management activity also contributed to the achievement of the Investors in People Standard and the Healthy Working Lives bronze award (alongside activities that focused on smoking, alcohol, healthy eating and physical exercise).

Detailed evaluation of interventions (fitness measures, stress-related training and stress casework) has helped the university to decide priorities for the future, demonstrating that the purpose of evaluation is not just to evaluate the effectiveness of programmes but also to improve them.

Key references

Mental health at work: developing the business case, Policy paper by the Sainsbury Centre for Mental Health
"Positive emotional style predicts resistance to illness after experimental exposure to rhinovirus or influenza a virus", Cohen S, Alper CM, Doyle WJ, Treanor JJ, Turner RB: Psychosomatic Medicine 68, 2006, pp.809-815
"The impact of management style on mental wellbeing at work", Barling J and Carson J: State-of-science review: SR-C3, The Government Office for Science, 2008
"A review of interventions that promote mental wellbeing in the workplace", Graveling RA, Crawford JO, Cowie H, Amati C and Vohra S, 2008
"Strategic stress management: an organizational approach", Sutherland VJ and Cooper CL: Basingstoke: Macmillan, 2000

Trends in stress management

Employers are using new methods to deter stress in the workplace and help employees who experience stress to cope with it: