Topic 9 - occupational stress Flashcards

1
Q

Occupational Stress

A
  • A physiological and psychological response to events or conditions in the workplace that is detrimental to health and well-being. It is influenced by factors such as autonomy and independence, decision latitude, workload, level of responsibility, job security, physical environment and safety, the nature and pace of work and relationships with coworkers and supervisors.
  • Occupational stress is huge cost to organizations globally.
  • Lots of stress occurring outside work hours - e.g. You get text messages / emails etc - contributes to ongoing occupational stress.
  • Is it work stress or occupational stress? Lots of debate whether these terms should be defined based on person or environment or a combination. Lots of fragmentation within research - lack of publication in leading journals (because of fragmentation) = slow integration of this area of psychology within general public understanding of the area.
  • Most research looking at specific jobs (e.g. Nurses, teachers, etc), less unifying research / overarching models or theories driving the research
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2
Q

Industrial and Organizational Psychology (and occupational stress)

A
  • Occupational stress is own unique area of psychology, falls under area industrial and Organizational Psychology
  • = The study of human behaviours in organizations and the workplace
  • Specialized training in science of behavior in workplace, understanding of organizational and career development, decision theory, human performance, consumer behavior, small group theory, job and task analysis, individual assessment.
  • Requires understanding of special ethical considerations related to business and group and understanding of case laws and executive orders in workplace. (eg. How many hours people are allowed to work, rules regarding to accommodation, making sure job is set up in non-harmful way, etc - stuff going beyond just the field of psychology)
  • People showing up to therapy with workplace stress can be treated by clinical psychologist (e.g. Building interpersonal or coping skills, managing stress and anxiety)
  • Difference is, as occupational therapist/psychologist, what you are doing is that you are looking at individual AND environment, trying to figure out how to make those two systems work together better.
  • In individual setting of person coming in with workplace stress, you focus on the PERSON (e.g. managing stress response, help them find new job?), not the larger organization/setting/issue.
  • Organizational psychologist may also work as a consulting role, work for a specific organization, or work in private practice.
  • Growing area - more businesses hiring organizational psychologists, making sure their business practices are operating in way that facilitate good employer-employee relationships
  • You can work in many areas, e.g. Recruiting and selecting employees, workplace motivations, quality of worklife, performance management, training and development, etc.
  • These people can be found anywhere, also on their own (e.g. As consultants)
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3
Q

Epidemiology of occupational stress - the 3 stages of how occupational stress comes about

A

Stages are a way of conceptualizing how occupational stress might come about

  • Three stages
  • Stage 1 = causes of stress (known risk factors, e.g. High demand job like ER doctor) stage is about understanding the CAUSES of stress.
  • Stage 2 = about stress response (which is normal to have) – how one reacts to stress
  • Stage 3 = consequences of development of either distress (negative stress, e.g. Medical, psychological, behavioral issues) or eustress (e.g. Increased motivation)
  • Once you have understanding of different stages, you can better understand where to intervene / or where to increase because it promotes something positive
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4
Q

Stressors and Strain Approach

A
  • Theory
  • Stress occurs when work characteristics contribute to poor psychological or physical health (Beehr, 1995)
  • Stressors
  • Refer to work-related characteristics, events or situations that give rise to stress
  • E.g. downsizing, shift in management, etc – giving rise to stress.
  • Strain
  • Refers to employee physiological or psychological responses to stress

It is an APPROACH, not a THEORY
Lack of agreement on what occupational stress is -this disagreement has allowed this approach to become dominant in the field

There is presumed relationship between stressor and strain, which is not explained by theory.

Main take away:
This approach is a theory that works towards explaining occupational stress - become dominant because of lack of agreement of definition on occupational stress in litterature.
And then the stuff mentioned on the slide.

Four assumptions
they pertain directly to the stressors and strain approach.

These are generally accepted as “a given” in field of occupational stress, despite evidence against them in other fields of psychology. – these assumptions are rarely tested within occupational stress research.

  • Occupational stress is associated with aversive emotional states that are experienced as a consequence of work
  • Generally, belief occupational stress is NEGATIVE emotional state that is consequence of their work - but lack of distinguishment between stress and psychological DISTRESS (which isn’t always true), which theory doesn’t touch on - some occupational stress might be helpful in e.g. increasing motivation.
  • People experience stress at the expense of more pleasurable emotions
  • Because they experience stress, it decrease their ability to feel positive emotions – implies a continuum, when one goes up, the other goes down – it is not either-or, that they can only experience one or the other, but that stress (partially) reduces feeling of positive emotions.
  • Stress can be measured by a single variable
  • We often see single-measure use, and there is lot of debate whether this measure is good - do you assess individual’s RESPSONSE to environment, are you measuring something IN the environment, etc - if you only measure one thing, are you really capturing the whole experience?
  • Stress is caused by, mostly, adverse work experiences
  • This assumption contributes (partly) to why researchers focus on NEGATIVE work experiences and psychological outcomes, but also why NEGLECT of more positive experiences.

Criticisms of approach:

Single-measurement approach: you don’t capture whole picture.
Lacks coherent theory behind it, and despite this, it is still used - because lack of coherent theory, researchers tend to focus on specific groups, and try to interrelate findings into more general terms - it is good info to have on e.g. Nurses, teachers, etc, it doesn’t help to give us better understanding of e.g. consequences of organizational stress in the larger picture. (not unified field of occupational Stress) (The approach kinda goes back to lack of definitions in the field as a whole)

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5
Q

4 assumptions of the stressors and strains approach

A

Four assumptions
they pertain directly to the stressors and strain approach.

These are generally accepted as “a given” in field of occupational stress, despite evidence against them in other fields of psychology. – these assumptions are rarely tested within occupational stress research.

  • Occupational stress is associated with aversive emotional states that are experienced as a consequence of work
  • Generally, belief occupational stress is NEGATIVE emotional state that is consequence of their work - but lack of distinguishment between stress and psychological DISTRESS (which isn’t always true), which theory doesn’t touch on - some occupational stress might be helpful in e.g. increasing motivation.
  • People experience stress at the expense of more pleasurable emotions
  • Because they experience stress, it decrease their ability to feel positive emotions – implies a continuum, when one goes up, the other goes down – it is not either-or, that they can only experience one or the other, but that stress (partially) reduces feeling of positive emotions.
  • Stress can be measured by a single variable
  • We often see single-measure use, and there is lot of debate whether this measure is good - do you assess individual’s RESPSONSE to environment, are you measuring something IN the environment, etc - if you only measure one thing, are you really capturing the whole experience?
  • Stress is caused by, mostly, adverse work experiences
  • This assumption contributes (partly) to why researchers focus on NEGATIVE work experiences and psychological outcomes, but also why NEGLECT of more positive experiences.

Criticisms of approach:

Single-measurement approach: you don’t capture whole picture.
Lacks coherent theory behind it, and despite this, it is still used - because lack of coherent theory, researchers tend to focus on specific groups, and try to interrelate findings into more general terms - it is good info to have on e.g. Nurses, teachers, etc, it doesn’t help to give us better understanding of e.g. consequences of organizational stress in the larger picture. (not unified field of occupational Stress) (The approach kinda goes back to lack of definitions in the field as a whole)

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6
Q

process theories of occupational stress

A
  • Growing body of research involving process theories of occupational stress
  • This has been developed to try and give more coherent theory.
  • One (typical) commonality in these theories are that they tend to be based on the transactional approach to stress
  • Some more based in employee life, some in something else, but transactional theory typically in common.

Transactional theory: stressor –> primary appraisal –> secondary appraisal –> coping response.
= The ground level base theory. - treats stress as DYNAMIC, involves interaction between person and environment (over time)

Unfortunately, lots of organizational stress research done cross sectionally rather than longitudinally - path for future research! (especially since field is growing)

Take away: growing focus on process theories + these are based on transactional theory

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7
Q

Is all occupational stress bad?

A

• Often when talking about stress, we are referring to DISTRESS - but EUSTRESS also exists (e.g. Facilitating motivation) = not all occupational stress is bad, but occupational stress usually refers to distress.

2 of 4 assumptions of stressors strain approach focus on that occupational stress is bad (it leads to aversive emotional states) and are results of adverse experiences at work = inherent focus on NEGATIVE aspects.

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8
Q

Signs and Symptoms (of occupational stress)

A
  • Sleep difficulties
  • Physical health issues (high blood pressure, decreased appetite, headaches etc.)
  • Anxiety
  • Depression
  • Decreased productivity
  • Decreased frustration tolerance

The signs and symptoms are not surprising – typically the “bad” signs we see when someone is stressed.

common coping strategies to deal with occ stress:
• Early on: someone tries to work harder. “presenteeism” = when someone is attending work even when sick/injured etc - when someone doing this, it is not healthy - not helpful to neither individual nor organization.

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9
Q

Revised Transactional Model (RTM) of Occupational Stress and Coping

A

Goh, Y.W., Swang, S., & Oei, T.P.S. (2010)

  1. Primary Appraisal (PA)
  2. Secondary Appraisal (SA)
  3. Stress Time 1 (S1)
  4. Overall Coping Strategies Employed (COP)
  5. Stress Time 2 (S2)

We look back to transactional model
RTM is basically an additional to original model. What they did, fairly complex research, identified new relationship between primary appraisal and stress at time 1 - and found relationship between stress at time 1 and time 2.

Rationale for extension is to extend prior research - found that stress outcomes function as result of cognitive appraisals - stress outcomes are result of cognitive appraisal and other coping behaviors - highlight role of cognitive appraisals and coping behaviors (which alters stress at time 2)

Research in area supports each STAGE of model, but CHRONOLOGY not completely established (not sure whether it happens one after another, if there is feedback, etc - but overall, each stage is supported)

What they added to original model (stres at time 2 + its relationship with stress at time 1 and appraisals and coping strategies)

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10
Q

Theory of preventive stress management (quick and quick 1984) and underlying principles
(individual and organization level preventive management, and stages of preventive management)

A

Stressors can be mitigated by organization level (directed towards task and physical demands, and role and interpersonal demands – aimed at organizational stressors) and individual level (stressor directed, symptom and response directed – aimed at individual stress response) preventive management – determines if distress or eustress

Underlying principles (of quick and quick theory of preventive stress management)
These principles are foundational blocks of (theory of) prevention management.
  • Principle 1
  • Individual and organizational health are interdependent
  • Organizational stressors can contribute to significant difficulties for employees and that are distressed contribute to significant organizational dysfunction
  • Principle 2
  • Management has a responsibility for individual and organizational health
  • Management must take action to look for ways to improve functioning of the organization as a whole
  • Principle 3
  • Individual and organizational distress are not inevitable
  • Task, role, physical and interpersonal demands are part of work but if these demands tip over into distressing and/or accepted as “normal” or “part of the work” (often accepted myths and standpoints) it can significant contribute to difficulties and they are in fact not inevitable to experience distress
  • Demands, including interpersonal ones, are inevitable - but distress is not inevitable - normal to be challenged, not get along with all colleagues, it is not normal for that to tip over into distress (but often just accepted as “part of work”, but that is in fact not normal)
  • Principle 4
  • Each individual and organization reacts uniquely to stress
  • Pretty straight forward
  • Principle 5
  • Organizations are everchanging
  • Preventative management understands this and the need for ongoing change and improvement and by being aware of the impacts of changes and improvement (or not)

These principles are the central tenants of the prevention management philosophy and their application requires an understanding of the three stages of prevention as well as methods of individual and organizational management

Stages of preventive management:
Primary prevention: stressor directed
E.g. Modifying the STRESSORS e.g. task demands, interpersonal demands)

Secondary prevention: response directed
Looking at individual and organizational REPSONSES to stress (e.g. Decreased productivity, showing anxiety, e.g.)

Tertiary prevention: symptom directed
When you attempt to minimize distress. ( when stressors and responses not accuractely controlled for)
When someone HAS reached distress, and you try to decrease symptoms.

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11
Q

Person-Environment (P-E) Fit

A

• Caplan (1987)

Dynamic system (inspired) theories

Method for understanding process of adjustment (between employees and work environment)
According to framework occupational stress = workplace creates stress to individual because lack of fit between individual’s abilities and the demands of the workplace.

Caplan also suggest recollection of past, present and anticipated PE fit influences wellbeing of individuals and their performances.

Intervention about measuring fit BEFORE placement in workplace - or when someone experiencing occupational stress, measure the fit

One area where PE fit (Caplan edition) falls short: measured person fit and environment fit, but didn’t measure the interaction - research has shown that interaction is big part of why someone might experience distress.

• Edwards and colleagues (1998)

PE fit further developed by edwards et al.
PE defined as degree of MISFIT between individual and organization = opening up to interaction component: So individual distress/stress is determined by the MISFIT between the individual and workplace

Three basic distinctions
• Distinction between the person, their abilities/needs, environment and demands it makes on them and that which the environment supplies to them
• Distinction between the subjective and objective representations of the person and environment
• Subjective = how they view themselves, objective = how they actually are
• Section 3 can be kinda considered a part of distinction 1, but viewed as own distinction.
• 3a – distinction in fit vs. misfit between demands the environment places on the individual in terms of job requirements etc., and abilities to fulfil demands in terms of skills (e.g. training, skills, time perception) etc.
• 3b – distinction in fit vs. misfit between the needs of the individual (psychological/physiological requirements) and ability of environment to supply those in terms of extrinsic and intrinsic rewards
• Extrinsic rewards such as pay, and intrinsic rewards such as feeling of achievement

  • Three basic relationships between stressors and stress
  • Demand-ability dichotomy
  • As demand reduces below ability someone can deliver, stress may decrease (but may increase if demands falll to level where people are bored)
  • Needs-supplies dichotomy
  • When needs fail to be met (because individuals needs increase, or environment’s ability to supply decreases) = stress increase
  • Combination of demand-ability dichotomy and needs-supplies dichotomy
  • It is that there appears to be area of minimal stress when needs are NOT met but abilities are not overworked. - outside this level, stress increases.

In edward and colleageous: view that misfit is continous, and as stress increases, misfit increases as well (stressors are cumulative) = PE misfit is cumulative.

Criticisms:
Little or no attention to idea of DISTRESS vs EUSTRESS + Implicit understanding that a lack of fit in any direction (at any level) is something you DON’T want
Looks at how demands exceed ability, rather than characteristics of stress(or) = too simplistic. - Focus on AMOUNT of stress caused by misfit, issue being that it strips away characteristics of stressor.
Doesn’t consider the individual’s INTERPRETATION - do show role for interpretation in PE fit theory but lacks in expansion - not expanded enough upon.

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12
Q

PE fit: 3 basic distinctions:

A
  • Distinction between the person, their abilities/needs, environment and demands it makes on them and that which the environment supplies to them
  • Distinction between the subjective and objective representations of the person and environment
  • Subjective = how they view themselves, objective = how they actually are
  • Section 3 can be kinda considered a part of distinction 1, but viewed as own distinction.
  • 3a – distinction in fit vs. misfit between demands the environment places on the individual in terms of job requirements etc., and abilities to fulfil demands in terms of skills (e.g. training, skills, time perception) etc.
  • 3b – distinction in fit vs. misfit between the needs of the individual (psychological/physiological requirements) and ability of environment to supply those in terms of extrinsic and intrinsic rewards
  • Extrinsic rewards such as pay, and intrinsic rewards such as feeling of achievement
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13
Q

PE fit: Three basic relationships between stressors and stress

A
  • Three basic relationships between stressors and stress
  • Demand-ability dichotomy
  • As demand reduces below ability someone can deliver, stress may decrease (but may increase if demands fall to level where people are bored)
  • Needs-supplies dichotomy
  • When needs fail to be met (because individuals needs increase, or environment’s ability to supply decreases) = stress increase
  • Combination of demand-ability dichotomy and needs-supplies dichotomy
  • It is that there appears to be area of minimal stress when needs are NOT met but abilities are not overworked. - outside this level, stress increases.
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14
Q

Coping strategies

A
  • Emotional management strategies
  • Important for the initial stress response and include
  • How individual appraise the situation
  • Its degree of threat
  • And what actions are taken
  • Cognitive strategies
  • The mental approaches taken to confront and resolve stressors
  • Analyzing problems, establishing control, problem solving stuff
  • Social support strategies
  • –> better task focus when person has access to external resources (could be co workers or other people)
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15
Q

Interventions (individual vs organization focused)

A

• Individual focused
Interventions emphasize HELPING individual (stress management, minimize negative impact of stress (on work-life) - often offered employer-assistance programs, gyms, psych programs around occupational stress, training in stress management, relaxation trainign, etc
• Often inexpensive, and effective at reducing symptoms of occ-stress - but benefits are often short-term
Criticism: occupational stress is generally wide spread, so interventions targeting specific employees may not have as broad outcomes as those targeting broad spectrum of employees.
Also, often overlook source of stress - what is CAUSING the stress

• Organization focused

Looks at organization and changing it - produces longer lasting outcomes - doesn’t remove need for individual focused interventions, they are still important, but the individual ones are kinda “subsumed” under organizational focused interventions.
There are few different models for facilitating organizational change.
Elements like including those impacted by change, in the change process = foster ownership + minimize chance that needs of these people won’t be met. Using collaboration among effective parties = make sure everyone impacted is involved in process, ensures most needs are met.

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16
Q

Stages of preventive management (incl dimensions of individual vs organization level, and primary/secondary/tertiary level)

A

Primary prevention: stressor directed
E.g. Modifying the STRESSORS e.g. task demands, interpersonal demands)
• At individual level, reduce how much they are exposed to stressors (frequency and intensity)
• Organizations: controlling amount of stressors and intensity of them

Secondary prevention: response directed
Looking at individual and organizational REPSONSES to stress (e.g. Decreased productivity, showing anxiety, e.g.)
• Individual interventions main focus here. Efforts to optimize the stress response of individual experiences.
• Not that there is no role of organization

Tertiary prevention: symptom directed
When you attempt to minimize distress. ( when stressors and responses not accuractely controlled for)
• Minimizing individual discomfort and organizational cost. (e.g. Crisis interventions, and at individual level, medical and psychiatric help)

17
Q

Occupational rehabilitation theories

A
  • Four Broad Categories
  • Expert technical approaches
  • Focus on phsyical work environment (e.g. Ergonomics)
  • Work psychology
  • Attributes illness to worker behavior and immediate organization behavior
  • Pseudo-psychology
  • Focus mostly on individual and what they are doing that might contribute to problem. Tends to have victim blaming view approach/role - focus on individual worker behavior, often pre employment (incl accident proneness, drug tests and pre screenings - often not helpful in long term) - work and pseudo psychology categories focus on labels for someone to access help or assistance - largely medically based.
  • Sociological approaches
  • Focus on power structures, ethnicity, SES, gender, etc - these approaches more politically and advocacy based - rooted in sociological analysis - focus on social peace rather than internal stuff
18
Q

Occupational health and newer theories of occupational psychology and occupational stress

A

Some of newer theories of occupational psychlogy are becoming too broad to distinguish them from general psychology = one of the big concerns. Another concern is that we still need to integrate occ psych into general psych - balance of integrating, but not too much!

  • Two main differences from traditional approaches to occupational stress
  • Emphasizes need to simultaneously focus on employee well-being and an organizations ‘bottom line’
  • Little to be gained from productive organization if at expense at employees’ well being - but research rarely focus on BOTH of these, often they focus on one or the other.
  • Recognizes that employee well-being and organizational performance are both influenced by combinations of individual and organizational characteristics
  • So lot of research lookign at e.g. Personality, work experiences, psych well being, performance ratings - emphasis in organizational HEALTH is placed on organizational characteristics. But we need multilevel approach - rather than other approaches focusing on individual level. Mutlilevel understanding would increase “scope” for understanding occ. stress.
19
Q

McCormack, MacIntyre, O’Shea, Herring, and Campbell (2018) - Burnout in psychologists - this week’s reading (focus points and findings)

A
  • Burnout: the end state of long-term chronic stress (Maslach, 2003)
  • Burnout associated with symptoms of anxiety or depression
  • Gold standard: maslach 3 stage model and maslach burnout inventory (BMI)
  • Three dimensions of burnout
  • Mental fatigue/emotional exhaustion
  • Negative feelings and perceptions about the people one works with or depersonalization
  • Decrease in feelings of personal accomplishment

What the study found:
• Emotional exhaustion - Most identified kind of area/biggest piece
• Workload and perceived time - Emerged as most significant JOB demand (contributed to emotional exhaustion)
• Type of work - Workload and perceived time pressure emerged as greatest job demands contributing to emotional exhaustion and burnout
• Over-involvement - E.g. Individual interventions involve involvement of therapist with client recovery - if this goes too far, becomes over involvement = can lead to burnout
• Age - Early careers higher risk of burnout
• Co-worker support - More support, decrease in risk of burnout and emotional exhaustion

Limitations identified in study: lots of theories lack theoretical underpinnings – call for more theory driven research.

20
Q

Maslach Three-Dimensional Model (of burnout)

A
  • Core components
  • Emotional exhaustion
  • = feeling emotional overexetended and depleted of emotional resources (sources e.g. Work overload) - people feel strained, lack energy (to face?) wolrd/peers - very much an individual dimension of burnout
  • Depersonalization
  • = Often from overload, exhaustion - risk that detachment moves into dehumanization. Interpersonal dimension of burnout
  • Depersonalization = act of removing something of human characeristics (e.g. Person feels that in relation to themselves or those they work with - you might think of your clients as files e.g.) - one of biggest sign of burnout - person is not connecting with people/clients.
  • Reduced personal accomplishment
  • =Decline in feeling of productivity and confidence, inability to cope with job demands, low self-efficacy - growing sense of inadequacy in helping clients, feelings of failure - self-evaluative dimension of burnout - often exacerbated by lack of social connections at work.
21
Q

Conservation of Resources Theory (COR)

A

One of most cited theory in occ psychology.

One advantage: can make wide range of hypotheses, that are broader than those of other theories.

COR theory often noted as motivation theory - through that, it explains behaviors based on evolutionary need to gather resources to endure stressors (current and future stress)

Critical part of COR theory: individual appraisal is secondary to what is universal among people - contradictory to many theories highlighting role of individual appraisal
Commonly valued resources include family, self-esteem, sense of purpose and help.

  • Hobfoll and colleagues developed this theory
  • Central tenant
  • People work to obtain, retain, foster and protect things they value
  • Stress occurs when
  • Central or key resources are threatened with loss
  • When central or key resources are lost
  • When there is failure to gain central or key resources following effort

Principles underlying COR theory
• Primacy of loss principle
• In this principle, resource loss is more salient than resource gains.
• Resource investment principle
• People must INVEST resources in order to PROTECT against loss, to gain resources, to recover lost resources.
• Gain paradox principle
• When resource loss circumstances our high, resource gain becomes more important/gain in value
• Desperation principle
• When people’s resources are exhausted, the enter preservative mode /state of defensiveness (even irrationality) to preserve the self.

Less emphasis on role of individual, and more on role of larger organizational systems.
According to COR, resources do not exist individually, but in groups (e.g. Self esteem doesn’t just occur as self esteem, it is “attached” to other things)

People’s resources exist in state that fosters or block resource creation ( basically, they are in state where they are set up to lead to more resources, or state that leads to limitation / block of resource development)

Corollaries of COR theory
Corrolaries = add-ons (developments made AFTER theory was established)

  • Those with greater resources are less vulnerable to resource loss and more capable of resource gain
  • Resource loss cycles
  • Because loss more powerful than gain, and stress occur when resources lost. Person losing resources has fewer resources (to invest) to regain resources (resources are lost quicker than they are gained?)
  • Resource gain spirals
  • Tend to be weak and develop slowly (because resource gain is of less magnitude + slower)

Resources are all about what the organization values- if someone values autonomy, if something goes on that threatens autonomy, it causes distress.

Benefit of theory: in wider range of predictions that can be made based on principles and corrolaries.
Example: study of managerial stress - government initiatives affected differently depending on collectivist and individualistic cultures (depending on what they VALUED)

22
Q

Principles underlying COR theory

A
  • Primacy of loss principle
  • In this principle, resource loss is more salient than resource gains.
  • Resource investment principle
  • People must INVEST resources in order to PROTECT against loss, to gain resources, to recover lost resources.
  • Gain paradox principle
  • When resource loss circumstances our high, resource gain becomes more important/gain in value
  • Desperation principle
  • When people’s resources are exhausted, the enter preservative mode /state of defensiveness (even irrationality) to preserve the self.
23
Q

Corollaries of COR theory

A

Corrolaries = add-ons (developments made AFTER theory was established)

  • Those with greater resources are less vulnerable to resource loss and more capable of resource gain
  • Resource loss cycles
  • Because loss more powerful than gain, and stress occur when resources lost. Person losing resources has fewer resources (to invest) to regain resources (resources are lost quicker than they are gained?)
  • Resource gain spirals
  • Tend to be weak and develop slowly (because resource gain is of less magnitude + slower)
24
Q

Occupational Stress – Psychologists (Increases Vulnerability, potential consequences, what we can do)

A
Increases Vulnerability
•	Professional isolation
•	Poor self-care
•	Overwork
•	Unrealistic self-expectations, rigidity
•	Poor boundaries
•	Overinvolvement
•	Imbalance of caseload/professional responsibilities 
Potential consequences
•	Depression
•	Job dissatisfaction
•	Relationship conflicts
•	Unprofessional behaviours
•	Ethical violations
•	Suicide
•	Boundary violations
•	Symptom exacerbation
•	Guilt
•	Attrition
•	Cynicism 
•	disillusionment

What can we do?
• Take these risks seriously
• Honestly assess your emotional, psychological and spiritual well-being
• Seek personal psychotherapy and other resources as needed
• Consultation (Possibly best tool, consult with peers)
• Maintain professional connections
• Develop realistic expectations of workload
• Identify and access sources of support
• Take regular vacations