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Models of stress

This information is in 7 sections – they are summarised on this page.

Various models of stress have been presented over the years. Each one adds some information, but may also hide things. None is complete, but each can provide food for thought and new insights about what may be going on in your situation. Each may be close to the truth in some situations, but further away in others.

Seven models are presented:

1 A traditional model

Stressors lead to a perception of stress – which can lead to mental, physical and emotional fatigue – which can result in short term safety and long term health outcomes.

2 The ‘bucket’ model

A person is like a bucket – filled with resources at the start of the day – and drained at the end of it. Normal processes overnight and at weekends normally replenish the bucket.

3 An academic model

In addition to the two above, people are active in appraising their situation, and learn from experience.

4 The demand, control, support model

Health outcomes, like heart disease and depression, are closely linked to the demands of work, the discretion people have in how they go about doing their jobs and the support they get.

5 The effort rewards imbalance model

High efforts but low rewards are likely to cause recurrent negative emotions and sustained stress responses. Conversely, positive emotions evoked by appropriate social rewards promote well-being, health and survival. (Rewards are in terms of status, self esteem and money.)

6 The ‘status syndrome’ – the effect of hierarchy

Workers at the bottom of workplace hierarchies die prematurely, get sick more often and are off work for longer than people at the top. This ‘status syndrome’ is visible across many diseases, in those who smoke and from country to country, although in differing degrees.

7 An alternative model of stress

Stress and enjoyment of work can coexist. Many 'stressors' may be matched by a corresponding 'satisfier' (e.g. ''unhappy customers' with 'satisfied customers'). However there appears to be only stress and no satisfaction associated with quantitative work overload, and no stress but only satisfaction associated with the feeling of doing a worthwhile job. Threat (an opportunity to loose) and challenge (an opportunity to win) are good terms to use when referring to the positive and negative aspects of stress.

1 A traditional model - Department of Labour. New Zealand

Commentary

This model sought to show the simple idea that stressors could lead on to the perception of not being able to cope and that this might result in fatigue, which could have both short and long term consequences.

Figure 1 - A traditional model of stress.

This model was not bad in its time and place. It acknowledged that some thing – called ‘stress’ - could happen in workplaces and could lead to undesirable outcomes.

The way in which each individual sees or evaluates his or her situation gets no mention. All people are regarded as the same and as reacting in the same way. It does not speak about positive experiences.

2 The ‘bucket’ model - E Grandjean. Switzerland

Commentary

This model began from a very simple picture of fatigue first proposed by the ergonomist Etienne Grandjean, who likened the human body to a bucket that could be ‘filled’ daily with unpleasant experiences, with sleep and recuperation emptying it for a fresh start the next day.

The Department of Labour reversed this model to show the human body as a reservoir of ability that was drained during the day and re-filled at night and weekends.

Figure 2 - The Bucket Model of stress.

Again, this model casts everyone as reacting the same.

It acknowledges undesirable possibilities, but makes little allowance for positive experiences at work - for the way in which work can be rewarding and stimulating, for example, and thus fill the bucket during the day.

3 An academic model - P Dewe et al. New Zealand

Commentary

The simplicity of the bucket model was regarded as ‘simplistic’ by some, given that it tended (only) to cast people as inevitably responding in a particular way.

Reality was closer if it could be shown that people tend to appraise their situation, rather than accept it passively.

Figure 3 - An Academic Model of stress.

Again, there is no mention of the positive experiences possible in workplaces – or delineation of ‘threat’ and ‘challenge’.

4 The demand, control, support model - R Karasek and T Theorell, Sweden

The now classic study of Karasek in 1970 set the scene for decades of research along similar lines. In his four year study of 1600 forty to sixty four year old men selected at random from the Swedish workforce, Karasek discovered that the rate of heart disease correlated strongly with how the men perceived their jobs.

This early study looked at two aspects of people’s jobs:

The graph below illustrates the percentage of men in each job category who developed symptoms of heart disease over the four years.

Prevalence of Heart Disease vs Control and Demand

Figure 4 - Prevalence of Heart Disease vs Control and Demand.

The remarkable thing about these data is that the people who worked in the most favourable circumstances showed NO symptoms of heart disease while one-fifth of those who worked in the least favourable circumstances did. It is not hard to understand that these results created a huge wave of interest and subsequent research internationally.

In table form, the extremes of the data were:

Table 1: Prevalence of Heart Disease vs Control and Demand

Percentages of men who developed symptoms of heart disease Decision Latitude
Highest Lowest
Psychological Hi 2.8 20
Demands Lo 0.0 3.2

This same pattern was repeated in several studies of both males and females for a number of different aspects of health such as depression, tendency towards alcoholism, accidents on the way to and from work, attempted suicide, gastro intestinal upset and musculoskeletal disorders.

Karasek and Theorell proposed a two factor model of health linking demand and control with these health sorts of outcomes.

Karasek’s Model of Workplace Stress.

Figure 5 - Karaseks Model of Workplace Stress.

Examples given by Karasek and Theorell of jobs in the four quadrants (see the next figure) were:

Low-strain: Architect, Programmer, Lineman

Active: Farmer, Physician, Bank officer

Passive: Watchman, Miner, Sales clerk

High strain: Waitress, Sewing machinist

Karasek and Theorell later refined their model to include the concept of support. The next table shows how this measure modified the experience of depression, across the dimensions of demand decision latitude and support.

Table 2. Prevalence of Depression.

Percentages of people reporting Depression Decision Latitude
High Medium Low
Degree of support Hi Lo Hi Lo Hi Lo
Psychological Demand Low 9 17 10 19 23 32
Medium 6 13 12 22 28 36
High 9 15 8 25 27 41

 

5 The effort rewards imbalance model - J Siegrist. Germany

Commentary

Research on effort-reward imbalance and health is part of a larger scientific program that aims at understanding the contribution of social and psychological factors to human health and disease. More specifically, protective and damaging effects on health produced by peoples' behaviours, cognitions and emotions through core social roles in adult life (work role, civic roles, family roles etc.) are analysed using a specific theoretical and methodological approach.

This theoretical approach is focused on the notion of social reciprocity, a fundamental principle of interpersonal behavior and an 'evolutionary old' grammar of social exchange. Social reciprocity is characterized by mutual cooperative investments based on the norm of return expectancy where efforts are equalized by respective rewards. Failed reciprocity resulting from a violation of this norm elicits strong negative emotions and sustained stress responses because it threatens this fundamental principle.

The model of effort-reward imbalance (ERI) claims that failed reciprocity in terms of high efforts spent and low rewards received in turn is likely to elicit recurrent negative emotions and sustained stress responses in exposed people. Conversely, positive emotions evoked by appropriate social rewards promote well-being, health and survival.

A major specification of this theoretical perspective concerns the work role, and in particular its contractual basis. So far, a majority of research evidence concerns ERI at work. More recently, this perspective has been applied to additional social roles in adult life (for further information please click here).

According to the model, effort at work is spent as part of a social contract that reciprocates effort by adequate reward. Rewards are distributed by three transmitter systems: money, esteem, and career opportunities including job security. Each one of these components of work-related rewards was shown to matter for health.

The model of ERI at work claims that an imbalance between (high) effort and (low) reward is maintained under the following conditions: 1. Work contracts are poorly defined or employees have little choice of alternative workplaces (e.g. due to low level of skill, lack of mobility, precarious labor market); 2. employees may accept this imbalance for strategic reasons (this strategy is mainly chosen to improve future work prospects by anticipatory investments); 3. the experience of 'high cost / low gain' at work is frequent in people who exhibit a specific cognitive and motivational pattern of coping with demands characterized by excessive work-related commitment ('overcommitment'). Overcommitted men and women suffer from inappropriate perceptions of demands and of their own coping resources more often than their less involved colleagues, because perceptual distortion prevents them from accurately assessing cost-gain relations. A graphic representation of the model is given in the following figure.

Figure 6 - The model of effort-reward imbalance (ERI).

The following three hypotheses are derived from the ERI model:

  1. An imbalance between high effort and low reward (non-reciprocity) increases the risk of reduced health over and above the risk associated with each one of the components.
  2. Overcommitted people are at increased risk of reduced health (whether or not this pattern of coping is reinforced by work characteristics).
  3. Relatively highest risks of reduced health are expected in people who are characterized by conditions (1) and (2).

Key publications

  1. Siegrist J (1996). Adverse health effects of high effort - low reward conditions at work. Journal of Occupational Health Psychology, 1, 27-43.
  2. Siegrist J (2000). Place, social exchange and health: proposed sociological framework. Social Science & Medicine, 51, 1283-1293.
  3. Siegrist J (2002): Effort-reward Imbalance at Work and Health. In: P Perrewe & D Ganster (Eds.). Research in Occupational Stress and Well Being, Vol. 2: Historical and Current Perspectives on Stress and Health. New York: JAI Elsevier, 261-291.
  4. Siegrist J & Marmot M (2004). Health inequalities and the psychosocial environment - two scientific challenges. Social Science & Medicine, 58, 8, 1463-1473.
  5. Siegrist J, Theorell T (2006). Socioeconomic position and health: the role of work and employment. In: J Siegrist, M Marmot (Eds.). Social Inequalities in Health. New evidence and policy implications. Oxford: Oxford University Press.

6 The ‘status syndrome’ – the effect of hierarchy - M Marmot, UK

Commentary

Professor Sir Michael Marmot[1] presently leads a research project (The Whitehall II study) that has followed the health of more than ten thousand British Civil Servants in central government departments in London for nearly two decades. Summarising the findings –

Where the effects of hierarchies are less important, these workers get less sick, less often, compared to the bosses.

The data accumulated is person specific, offering advantages over studies based on group averages at a single moment. Marmot found that the age standardised mortality, over a ten year period, among males aged forty to sixty four was about 3.5 times greater for those in the clerical and manual grades, compared to those in the senior administrative grades[2].

This fundamental finding is reflected in high quality research among animals.

There was a significant mortality gradient - suggestive of a dose response relationship. None of the people studied were living in poverty and all experienced similar work environments.

A mortality gradient was also found in each of a number of diseases or causes of death. Some were clearly related to smoking behaviour (‘top people’ rarely smoke, ‘bottom people’ often do), but a gradient was observed for some diseases that have no known relation to smoking.

‘Top people’ who did smoke were much less likely to die from smoking related diseases.

The summary conclusion of Marmot’s research is that something operates powerfully to influence health, and is correlated with hierarchy per se. It operates on a middle class of people and its effects are large. For both animals and humans, being near the bottom of the social ladder produces worse health outcomes than being near the top. This cannot be explained solely by diet, workload and lifestyle, which were controlled for in the analysis of the data.

Research has revealed an exactly parallel mortality gradient operating in Sweden. However, the Swedish gradient is much less steep. Perhaps hierarchies in London are more rigidly defined by class than in Sweden.

Footnotes

[1] Marmot M G, Kogevinas M and Elston M A. Social/economic status and disease. Annual Review of Public Health. 8: 111-135. 1987. See also the website for the Whitehall II Study: and Appendix 2. http://www.ucl.ac.uk/epidemiology/white/white.html

[2] Why are some people healthy and others not? The determinants of health of populations. Eds. Evans R G, Barer M L, Marmor T R. Aldine de Gruyter, New York. 1994.

[3] Bradley and Porter. Stress in “Executive” monkeys. Sci Am 1956

[4] Wiess J. Psychological factors in stress and disease. Sci. Am. 1970.

7 An alternative model of stress - D Gardner, New Zealand

Commentary

Work related stress is a major problem and its management is far from straightforward. It is important to identify, assess and control stressors – but also to avoid removing the rewarding aspects of work.

There is a need to identify and address both challenge and hindrance (or ‘threat’) stressors - and to differentiate between them by having different strategies for each. My research is showing:

I applaud the emphasis on healthy work in the DOL approach. Focusing only on stress and not the rewarding aspects of work does not recognise the full range of experiences that people have of work.

Focusing on stress is not empowering. Good employees may leave if they don't get good experiences, when alternatives are available. Many people in 'high stress' occupations (nurses, rescue helicopter pilots) love their work in spite of the demands. Unpleasant experiences may be buffered by the intrinsic meaningfulness of the work.

Some stress models cast people as passive recipients who feel things are done to them [For example, Karasek’s model – as shown above]. However, people work actively to make sense of and to cope with their situations. Alternative models need airing. When you ask many professionals what they like about their job it is difficult to get them stop talking.

Models that seem to portray people as invariably acting in a particular way in a particular environment underestimate the ways we try to manage things for ourselves. The stress literature is increasingly recognising this. Some people are tired of hearing about stress and welcome the chance to explore work-related enjoyment, engagement and wellbeing.

The diagram below represents what I have been researching. It includes the cognitive appraisal of demands and coping. Karasek's model does not allow for these or for individual differences (ability, personality etc) or situational factors (leadership, organisational climate etc).

To recap: whether a demand is seen as a threat or a challenge depends on whether there are the resources available to deal with it.

A threat appraisal: demands are perceived to exceed resources or ability to cope.

A challenge appraisal: demands are seen to match coping abilities/ resources.

Resources are of several types, as shown. In terms of Karasek’s model, control and support are resources to deal with demands. Individual characteristics like health, energy, resilience, skills, abilities etc are also resources and so are workplace characteristics like leadership, organisational culture, relationships with peers, physical work environment etc.

Which leads to my preferred definition of stress:

“a relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being” (Lazarus & Folkman, 1984).

To summarise the diagram: demands seen as challenges tend to be associated with greater use of task-focused coping (i.e. getting to grips with the demand and solving any problems) and social support. These in turn are associated with higher levels of positive emotion (enjoyment, satisfaction, engagement with the task), better job satisfaction and lower intentions to leave.

Demands seen as threats tend to be associated with more use of avoidance (procrastination, delay, distraction etc). This is associated with worse emotional and work-related outcomes: higher stress, less job satisfaction, increased intentions to leave, etc.

The exception is when someone seeks – or is given – social support (practical help or emotional support) to deal with a threat. Then outcomes tend to be positive, the person is able to address the problem and feels better about the outcomes. Social support is one of the resources that can help deal with work demands.

An alternative model for 'stress'

Figure 7 - An Alternative Model for stress.