stress management for school personnel: stress-inoculation training and exercise

314 Rik Carl D’Amato and Raymond S. Dean

STARR, A. (1977). Rehearsal for living: Psychodrama. Chicago: Nelson Hall. TANNER, F. A. (1966). Basic drama projects. Pocatello, ID: Clark. TORTO, J., 8t CORNYETZ, P. (1945). Psychodrama as expressive and projective technique. Psychodrama

Monographs, 14, 1-22. URTZ, F. P., dt KAHN, K. B. (1982, Jan.). Using drama as an outreach and consultation tool. Personnel

and Guidance Journal, 326-328. VANDENBOS, G . R. (Ed.). (1986). Special issue: Psychotherapy research. American Psychologist, 41(2). YABLONSKY, L. (1976). Psychodrama: Resolving emotional problems through roleplaying. New York: Basic

Books.

Psychofogy in the Schools Volume 25, July 1988

STRESS MANAGEMENT FOR SCHOOL PERSONNEL: STRESS-INOCULATION TRAINING AND EXERCISE

BONITA C. LONG

University of British Columbia

This study evaluated the effectiveness of Stress-Inoculation Training (SIT) with and without an exercise component and a Minimal exercise treatment (MIN) on trait anxiety, teacher stress, and coping strategies among 66 school personnel. The findings indicate that the 8-week SIT with an exercise component was more effective than MIN in reducing anxiety and teacher stress. Both groups significantly decreased emotion- focused coping and increased preventive coping; however, problem-focused coping did not change. SIT without an exercise component did not significantly affect anxiety, stress, or coping strategies; however, there is some evidence that this was due to the cyclical nature of stress in the schools. Changes in teacher stress and coping strategies occurred mainly for those who were below the median of the sample on physical fitness and anxiety prior to beginning the program. Implications of these findings for school-based stress management programs are discussed.

Sources of stress in the school environment have been well documented (Kyriacou & Sutcliffe, 1977); however, there is a paucity of studies evaluating worksite stress- reduction programs (Murphy, 1984). A cognitive-behavioral approach, Stress-Inoculation Training (SIT), has met with some success with this population. Forman (1982) and Sharp and Forman (1985) assessed the efficacy of SIT for inner-city teachers, as well as urban and suburban teachers (elementary and secondary). Using this approach, Sharp and Forman found improvements in teachers’ affect and classroom behavior; however, changes in coping strategies, which may provide the link between treatment and behavioral change, were not directly assessed. Lazarus and Folkman (1984) postulate two basic coping dimensions based on individuals’ perceptions that can function separ- ately or in conjunction with one another: (a) emotion-focused coping, which is likely to occur when the situation is appraised such that nothing can be done to change it; and (b) problem-focused coping, which is more likely to be used when situations are appraised as possible to change. Problem-focused coping is generally considered to be the more effective of the two (Andrews, Tennant, Hewson, & Vaillant, 1978; Billings & Moos, 1981); for example, satisfactory outcomes of stressful events in work-related situations have been characterized by greater use of problem-focused coping (Folkman, Lazarus, Dunkel-Schetter, Delongis, & Gruen, 1986).

Reprint requests should be sent to Bonita C. Long, Dept. of Counselling Psychology, 210-5780 Toronto Rd., University of British Columbia, Vancouver, B.C., Canada, V6T lL2.

Stress-Inoculation and Exercise 315

SIT generally contains a relaxation component that may be conceptualized as a palliative or emotion-focused coping strategy, as its function is to relieve distress and foster emotional regulation (Lazarus & Folkman, 1984).

Physical activity, and in particular aerobic conditioning, also has been suggested as mediating stress through palliative coping (Gal & Lazarus, 1975; Long, 1984). Re- cent research has provided some support for the therapeutic effects of aerobic exercise (Folkins & Sime, 1981). In particular, Long and Haney (1988) found progressive relaxation and aerobic exercise programs equally effective in reducing anxiety and increasing self-efficacy for stressed working women. Similarly, Long (1984) reported that SIT and aerobic exercise were equally effective in reducing anxiety for community residents.

Provided aerobic exercise is performed at a minimum intensity of 60-65% of maximum heart rate, occurs for a duration of 15 to 30 min. or more and at a minimum frequency of 3 times per week, cardiovascular benefits will follow (American College of Sports Medicine, 1978). Such strenuousness may not be necessary in order to effec- tively reduce stress, as some studies indicate that participation per se in an exercise program will result in enhanced mood states (Fremont & Craighead, 1987; Goldwater & Collis, 1985; Long, 1984). To date, specific exercise dosehesponse levels have yet to be determined. Whether the effect is secondary to the perception of change (Heaps, 1978) or to other psychological or physiological mechanisms, aerobic conditioning is considered a viable alternative to relaxation training, especially since it has many physiological health- related benefits (Blomqvist & Saltin, 1983). Furthermore, there is some evidence that sedentary and highly stressed individuals will benefit the most from regular exercise (Wilfley & Kunce, 1986).

While comparisons of exercise to other treatments have been made, the efficacy of exercise as an adjunct to cognitive therapy for stressed individuals has yet to be examined. In order to determine how exercise might best be used, the present study was designed to examine separate and combined effects of SIT and nonsupervised aerobic exercise programs. This study focused on worksite programs for stressed teaching personnel in a large metropolitan school district. Such individuals might be considered mildly or moderately stressed. Due to the limited evidence of the use of aerobic exercise for more severely stressed individuals, such persons were not the focus of the initial investiga- tion. Since the cost-effectiveness of worksite programs is also of concern, this study included a minimum exercise intervention (exercise testing, feedback, and a nonsupervised exercise program). This group was treated as a delayed treatment control, as these individuals eventually received SIT. Thus, the reactive nature of both fitness testing and encouragement was controlled for, and program credibility was maintained.

The present study compared the effectiveness of: (a) SIT with an exercise component (SITE), (b) a Minimal exercise treatment (MIN), and (c) SIT alone. Further, it was expected that the treatments would be of most benefit to the high anxious and low physically fit subjects.

METHOD Subjects

The Employee Health Service of a large urban school system (109 schools) recruited volunteers after conducting a district-wide needs assessment (survey questionnaire) that established both expressed and real need for stress-management and exercise programs (Long, Schutz, Kendall, & Hunt, 1986). Of 13 schools with sufficient volunteers ( > 5 ) ,

316 Bonita C. Long

8 were selected to represent geographic areas and teaching levels (2 secondary, 6 elementary). The schools were randomly assigned to either SITE or MIN/SIT interventions (4 each). The original subject sample consisted of 75 teachers (30 men and 45 women), which represented most teaching areas.

Subjects ranged in age from 26 to 61 years (M= 41, SD = 7.8), with 80% employed for 4 or more years with the district. Sixty percent of the subjects were married, and 89% were employed full time. Cardiovascular fitness, as measured by maximal oxygen uptake (expressed in milliliters per kilogram body weight per min., ml/kg/min) ranged from low to high fit categories (24 to 65, M = 38, SD = 10.3).

Sixty-six completed pre- and posttest assessments (SITE = 34; MIN = 32; 4 dropped out of SITE, 5 refused [MINI to be reassessed at posttest), and 56 were available at follow-up (3 dropped out of SIT, 7 refused [SITE] to be reassessed at follow-up). Design

The interventions were conducted in two measurement waves, with the first wave (8 weeks) consisting of the SITE treatment and the MIN session. The second wave (8 weeks) began at time 2, with the SITE group receiving no additional treatment and the MIN subjects receiving the SIT treatment (8 weeks). All subjects were assessed at time 1, 2, and 3. The SIT treatment was implemented from time 2 to 3, during the SITE follow-up. The different time periods that the treatments were offered introduced a confound that will need to be evaluated at some point. However, the choice was made to implement the two exercise treatments initially (SITE, MIN), for reasons mentioned earlier, and since the seasonal variation of exercise patterns would also create a confound. Treatments

The subjects met in groups ranging in size from 7 to 12 subjects each for a series of 8 1 % hour weekly sessions with no cost to the participant. Sessions were held in the school immediately following the last class of the day (March-April, May-June). The four female cotherapists were experienced group leaders. The SIT exercise component and the MIN session were led by two leaders who were also trained in exercise management. The treatments (SITE, SIT) were administered according to detailed treatment manuals in order to standardize procedures across groups (available from the author on request).

The program consisted of three components based upon Meichenbaum’s (1985) stress-inoculation training manual: (a) presentation of a conceptual framework, (b) skills acquisition (training in cognitive restructuring and self-statement modification), and (c) rehearsal and application. The role of self-statements in emotions and behaviors was discussed, irrational beliefs were examined, and imagery exercises were taught. Participants identified thoughts, feelings, and behaviors in specific stress situations, and devised alternatives to cope with the situations more constructively. Finally, these reactions were rehearsed through role-play and imagery. The last % hour of each session focused on physical activity. In the first session, participants were given feedback on their fitness assessment and received an in- dividualized exercise program based on self-monitored heart rate and perceived exertion. They set realistic exercise goals to increase their activity level (e.g., 3 times per week for 30 min.) and monitored their progress on weekly recording charts. In the follow-

Stress-Inoculation Training and Exercise (SITE).


ing sessions, discussions were held on the psychological and physiological benefits of regular exercise, and educational materials were provided on related topics. Participants were given encouragement to maintain their exercise programs, and problems were dealt with from a problem-solving perspective.

Minimal Treatrnent/Stress Inoculation Training (MIN/SIT). A minimal exercise treatment was provided to delayed-treatment subjects in order to address the reactive nature of both fitness testing and encouragement, and to maintain program credibility. Subjects were provided a one-hour session consisting of: (a) fitness testing results (bicycle ergometer test), (b) educational information and material on beginning an aerobic exercise program, and (c) encouragement to begin an exercise program. Subjects identified realistic exercise goals and were provided self-monitoring charts. The session was provided at each school the same week the SITE sessions started. Subjects were informed that stress-management programs would be available to them in 8 weeks, at which time they were reassessed and provided SIT.

Measures

Anxiety was measured with the trait anxiety inventory (STAI-T) developed by Spielberger, Gorsuch, and Lushene (1970). Extensive evidence has been presented to support the validity of the STAI (Spielberger et al., 1970), and reliability and validity coefficients are well within acceptable tolerance levels (.73 to .92).

A teacher stress measure developed by Pettegrew and Wolf (1982) was shortened for this study by deleting three subdomains due to their reported low reliability or little predictability. The resulting 50-item questionnaire was scored on a 1- to 5-point scale from “not at all” to “completely,” with only the total score utilized. In this study, the alpha of internal consistency for the total test was .78.

Wong and Reker (1983) developed a coping inventory modelled after Lazarus and Folkman’s (1984) Ways of Coping Checklist. The inventory contains 57 items grouped into five broad categories of coping strategies. Subjects identify a recent stressful event and then indicate the extent to which they use or rely upon specific coping strategies to cope with the event. The inventory is scored on a 1- to 5-point scale from “not at all” to “a great deal.” In the current study, practical limitations allowed the administra- tion of only three scales, chosen because of their theoretical import in the coping literature: (a) problem-focused or instrumental coping - ways of coping aimed at solving an existing problem by changing either the situation or one’s own behavior, or both; (b) emotion-focused or palliative coping - ways of coping that regulate one’s emotional reaction or make one feel better without actually solving the problem or changing the situation; (c) preventive coping - ways of coping aimed at promoting one’s well-being and reducing the likelihood of anticipated or potential problems. Support for the validity of the subscales is provided by Wong and Reker (1984a,b). In this study, alphas for internal consistency range from .64 to .84. The mean response to the 5-point scale for each subdomain was utilized for analysis.

Cardiovascular fitness was assessed with a continuous submaximal bicycle ergometer test that predicts maximum oxygen uptake (V02 max) from heart rate responses to different workloads. With a similar protocol, Olha, Thompson, Skoryna, and Klissouras (1980) demonstrated satisfactory correlations with predicted V02 max and obtained V02

318 Bonita C. Long

max, and acceptable (.93) test-retest reliability coefficients have been found (Bouchard, Boulay, Thibault, Carrier, & Duluc, 1980). V02 max was reported in milliliters per kilogram body weight per min.

Participation in physical activity was assessed with a self-report 7-day recall pro- cedure (Blair, 1984) whereby subjects recorded their pattern of physical activity over the past week. In addition to type of activity, subjects recorded frequency (in days), duration (in minutes), and intensity. Intensity was recorded as the subjects’ subjective feelings of fatigue, with each activity rated on a scale of 6 to 20 (Borg, 1973). Activities rated as less than 11 (fairly light) were not included, as these activities tended to be routine housework, activity at work, or light gardening. Similar 7-day recall measures have been used successfully in large scale studies (Sallis et al., 1985) with acceptable test-retest (2 weeks) reliabilities ranging from .75 to .83. A composite score, the product of duration and intensity, was utilized in this study.

At the first treatment session, subjects listed three goals they expected to achieve upon completion of the program. At the end of treatment, they estimated on a 5-point scale to what extent they had achieved each goal. In addition, they indicated on open-ended questions what they were doing differently, how they felt differently, and what was most useful to them.

As a check on the possibility that the experimen- tal conditions generated different demand characteristics, ratings of “confidence in treatment” were obtained at the end of the first treatment session (SITE, SIT). Further, a 28-item Helping Process Questionnaire (Wollert, Levy, & Knight, 1982), with each item describing a help-giving activity, was used to assess the perceived frequency of helping activity within the treatment groups. Assessment Procedures

All testing was done in the schools with subjects individually scheduled for assessment. The assessment procedures were explained, an informed consent form was signed, and the questionnaires were then completed (Trait Anxiety, Teacher Stress, Coping Ques- tionnaire, 7-Day Recall, and demographics). Exercise and 24-hour medical history, blood pressure, and weight (kg) were recorded, followed by a standard bicycle test protocol (Astrand & Rodahl, 1977). Briefly, it consisted of subjects pedalling a mechanically braked Monark bicycle ergometer at 100 rpm for a series of 6-min. work bouts that progress higher in load at a level dependent on the participant’s heart rate response. Heart rate was determined from an ECG strip during the last min. of the test (3-lead electrodes). The workload was increased to achieve a heart rate between 120 and 160 bpm by the end of the 4th min. When heart rate stabilized over a 2-min. period, this heart rate was used along with workload, age, and weight of the subject to estimate aerobic power (V02 max) according to the nomogram developed by Astrand and Ryhm- ing (1954). Two exercise-management graduate students trained in cardiopulmonary resuscitation conducted the bicycle ergometer testing. Data Analysis

Correlations were computed among all the variables under study. The treatment effects were analyzed by 2 x 2 (SITE,MIN x Pre,Post) MANOVAs, with time as the repeated factor. Similar MANOVAs were conducted from time 2 to 3 to test the maintenance of SITE treatment effects compared to the SIT training. The dependent variables were clustered as follows for separate analysis: (a) trait anxiety and teacher

Evaluation of treatment.

Therapy manipulation checks.

Stress-Inoculation and Exercise 3 19

stress; (b) problem-focused, emotion-focused, and preventive coping; and (c) level of fitness and physical activity. The treatment x time interaction evaluates differential group change.

RESULTS AND DISCUSSION Preliminary Analyses

Post hoc checks indicated that the distribution of age, sex, marital status, and years of experience were not significantly different across conditions (SITE,MIN/SIT, Dropouts). Although there were more females than males, the disproportionality of gender is representative of school district staff.

Preliminary analyses (MANOVA) indicated no therapist or school effects on any of the dependent variables, so data for the four therapists and eight schools were pooled by treatment. To determine whether dropouts differed from treated subjects, and whether treatment groups (SITE,MIN) differed initially, dependent variables were entered in a MANOVA comparing the treatment groups and the dropouts. The overall group test was not significant (F< 1). A similar test conducted on the exercise composite and V02 max variables also was not significant.

There were no significant differences between groups on ratings of perceived treatment effectiveness (Ms = 13.7, 13.9, SITE and SIT, respectively). The total score on the helping process questionnaire was entered as a dependent variable in an ANOVA comparing the eight schools. One school (SITE) was significantly different from the others (i.e., less helping activity); however, when analyzed comparing the two treatments (SITE, SIT), the test was not significant. Therefore, with one exception, perceived helping activity within the groups was similar across treatments. The median percent of treatment sessions attended was 80% for both treatment groups (SITE,SIT). Trait Anxiety and Teacher Stress

A repeated measures 2 x 2 (SITE,MIN x Pre,Post) MANOVA with one between- subject factor (Treatment) and one within-subject factor (Time) was performed in order to compare treatment effects over time. Means and standard deviations are shown in Table 1 for time 1, 2, and 3 (pre, post, follow-up) by group.

Results revealed a nonsignificant treatment main effect, and a significant time effect, F(2, 63) = 9.02, p< .01, which was qualified by a significant treatment x time interaction, F(2, 63) = 3.22, p< .05. Follow-up univariate analyses revealed that trait anxiety approached significance, F(1, 64) = 4.19, p < .06, while teacher stress was significant, F(1, 64) =4.19, p < .04. An examination of the means (see Table 1) revealed that the posttreatment scores showed significantly greater improvement from pretreatment scores for the SITE subjects compared to the MIN subjects.

A repeated measures MANOVA on post to follow-up (time 2,3) revealed no significant treatment (SITE,SIT), time, or treatment x time interaction effect. Thus, from posttest to follow-up, the treatment effects of the SITE groups were maintained, and the addition of SIT training did not enhance the MIN group.

Coping subdomains. A 2 x 2 (SITE,MIN x Pre,Post) MANOVA with repeated measures was performed on the three coping subdomain scores. The MANOVA treatment main effect was not significant; however, the time effect was, F(3,60) = 2.72, p < .05. Follow-up univariate analyses revealed significant time effects for emotion-focused coping, F(1,62) = 5.35, p< .02, preventive coping, F(1,62) = 4.77, p < .03, but not problem-

320 Bonita C. Long

Table 1 Group Means and Standard Deviations for Dependent Measures Over Time

Group

SITE MIN SIT (n = 34) (n = 32) (n = 29)

Variable Time M SD M SD M SD

Anxiety

Teacher Stress

Problem-Focused Coping

Emotion-Focused Coping

Preventive Coping

V 0 2 Max

Exercise (min x intensity)

pre post follow-up

pre post follow-up

pre post follow-up

pre post follow-up

pre post follow-up

pre post follow-up

Pre post follow-up

39.9 35.9 37.1

127.1

119.0 125.1

3.01 2.98 3.13 2.25 2.19 2.16 3.22 3.49 3.53

38.7 38.7 38.9

1966 2403

2390

10.1 8.5

10.7 21.6

20.1 22.7

.55

.47

.48

.61

.60

.62

.65

.70

.64 10.9 9.9 9.6

1855 2739 1819

37.7 36.2

123.6 123.2

2.90 2.94

2.18 1.98

3.36 3.49

38.5 38.1

237 1

2583

9.6 8.9 36.8

36.1 17.6 13.2 123.5

123.2 .47 .58 2.99

3.16 .46 .40 2.00

2.17

.65

.82 3.53 3.72

9.1 8.5 36.6

36.5 207 1 2200 2566

2752

9.0 9.6

13.5 18.2

.56

.52

.38

.44

.82

.7 1

7.8 7.3

2200 1683

Note. SITE = Stress Inoculation and Exercise Intervention; MIN = Minimal Exercise Intervention; SIT = Stress Inoculation Training.

focused coping, F< 1. The treatment x time interaction was not significant (p > .37). An examination of the means indicated that, for both the SITE and MIN groups, emotion-focused coping decreased and preventive coping increased from time 1 to 2.

Repeated measures MANOVA (time 2,3) revealed no significant treatment (SITE,SIT), time, or treatment x time interaction effects, indicating that the effects of MIN and SITE were maintained two months after treatment and that the addition of SIT did not affect the coping measures for the MIN group.

A 2 x 2 (SITE,MIN x Pre,Post) repeated measures MANOVA with V02 max and physical activity as dependent variables revealed no significant treatment, time, or interaction effects (all Fs< 1). Thus, there is no evidence that the SITE and MIN subjects increased their V02 max or physical activity from pre- to posttest. Furthermore, the post to follow-up MANOVA also revealed no significant treatment, time, or interaction effects.

Maximum oxygen uptake andphysicalactivity.


Finally, a 2 x 2 x 2 (V02 max x Anxiety x Pre,Post) repeated measures MANOVA was used to investigate whether initial levels of physical fitness and anxiety and their interaction were significantly related to changes over time on teacher stress, and problem-focused, emotion-focused, and preventive coping strategies. Levels of high and low fitness were defined operationally in terms of initial V 0 2 max either at or above the pretreatment group median of 38 ml/kg/min or below the median. Levels of high and low anxiety were similarly defined in terms of the pretreatment group median on trait anxiety (Med = 38).

The analysis of the differential effects of exercise (see Table 2) indicated that the benefits of SITE and MIN appeared to be strongly related to the clients’ initial levels of anxiety, and, to a lesser extent, levels of fitness. Univariate follow-up tests for a significant Group x Time interaction for anxiety, p < .003, were significant for teacher stress @< .05), problem-focused coping @< .003), and emotion-focused coping @< .Ol), but not significant for preventive coping @ > .61). The pre- to posttest changes favored the high vs. the low anxious group for reducing stress, increasing problem-focused coping, and reducing emotion-focused coping. The Group x Time interaction effect for level of fitness was not significant; however, a significant 3-way univariate interaction was found for emotion-focused coping @< .02). The low-fitness high-anxious subgroup showed the greatest reductions on emotion-focused coping.

Table 2 Means for Teacher Stress and Coping Subdomains by Initial Levels of Anxiety and Physical Fitness (V02 Max)

Variable

Low Fitness High Fitness

High Low High Low Anxiety Anxiety Anxiety Anxiety

Time (n= 15) (n= 16) (n- 14) (n= 13)

Teacher Stress

Problem-Focused Coping

Emotion-Focused Coping

Preventive Coping

136.1 123.5

2.8 3.0 2.6

2.1

3.0

3.2

114.1 114.7

3.3

3.1 1.9

2.0

3.7

3.8

137.4

133.9 2.6 2.9

2.4

2.3

3.0

3.0

116.1

115.4

3 .O

2.8

2.0

1.9

3.6

3.7

Evaluation of therapy. An ANOVA on averaged goal attainment scores comparing SITE and SIT groups revealed a nonsignificant main effect for treatment (F< 1). Approximately 55% of both groups indicated that they identify and analyze inner dialogue; however, the SIT group was more likely to indicate that they were using relaxation techniques (SITE = 13%; SIT = 30%). With regard to exercise, by posttreatment 55% of SITE subjects were exercising regularly, compared to only 20% at pretest; 30% of both groups indicated they felt more relaxed, happy, and confident. The greatest group difference was reflected in the response to the question “What was most useful to you?”

3 22 Bonita C. Long

Twenty-six percent of SITE said “understanding the need for and benefits of fitness,” compared to only 4% of SIT. However, approximately 40% of both groups frequently indicated that sharing with colleagues was “most useful.”

The purpose of this study was to assess the effectiveness of Stress-Inoculation Train- ing with an exercise component as an adjunct (replacing relaxation), compared to a Minimal exercise treatment and Stress-Inoculation Training alone. Some support for SITE was found, as results indicate that participants in SITE were more successful than the MIN participants in reducing trait anxiety and teacher stress. However, while both SITE and MIN participants enhanced their coping, neither group significantly increased their exercise or fitness levels.

Although yielding data of a weaker inferential nature, the comparison of SITE with SIT at follow-up (time 2 to 3) indicates that little change occurred over that time period. However, there is evidence that June is more stressful for teachers than earlier months, and this may have confounded the treatment effects. For example, Milstein and Golaszewski (1985) reported increased stress for teachers at year end, even though they were involved in stress-management training. Similarly, Sharp and Forman (1985) reported increases in stress at 4-week follow-up assessments. Data in this study indicate that teacher stress either regressed or stayed the same from time 2 to 3, perhaps reflect- ing an increase in school stress from pretest. Since manipulation checks (Helping Ques- tionnaire and expectations) indicated that the treatment groups (SITE,SIT) did not differ on these measures, the latter explanation is more parsimonious than concluding that SIT is not as effective as SITE. However, an unambiguous interpretation is not possible, due to the history confound. Future study designs should attempt to control for cyclical changes in stress during the school year in order to determine an optimal time period for stress-management training for school personnel.

The results add to previous findings by demonstrating that coping strategies used in response to specific stressful situations changed differentially. Both the SITE group and the MIN group significantly changed on coping subdomains from pre- to posttest. More specifically, for both groups, emotion-focused coping decreased and preventive coping increased, while there was no evidence that problem-focused coping changed. This is an important finding, as it suggests that stress-management interventions may have differential effects on coping subdomains. Futhermore, these findings support other studies indicating that emotion-focused coping is associated with more negative affect (Folkman et al., 1986; Long & Haney, 1988).

The reduction of emotion-focused coping provides important support for the efficacy of treatment and the importance of providing programs that offer hope to the employee (Murphy, 1984). The emotion-focused coping scale contains the following strategies: (a) denial/escape, (b) wishful thinking, (c) expressiveness toward others, and (d) self- blame. In addition, the preventive coping subdomain contains strategies aimed at promoting one’s well-being and reducing the likelihood of anticipated or potential problems - objectives of employee health programs.

A surprising finding was that neither the SITE subjects nor the MIN subjects significantly increased levels of fitness or physical activity. It was expected that, since participants in each treatment group were from the same worksite, the readily available support would supplement the weekly treatment sessions and provide greater encouragement than that provided by the single MIN session. However, it appears that super-


vised exercise participation may be a critical component in increasing fitness levels for this population. Stress-management programs that have demonstrated increased fitness included supervised exercise sessions (Fremont & Craighead, 1987; Long, 1984). Another factor that may have affected the fitness results was the sample’s initial involvement in physical activity - 20% were already exercising regularly. Thus, it was difficult for the programs to bring about improvement, especially considering the large degree of varia- bility in the exercise measures that may have precluded finding statistically significant changes. Despite this, 55% of subjects in the SITE group were regularly exercising at posttreatment, compared to only 20% at pretest.

Several limitations of this study should be mentioned. As a worksite program, these interventions tended to attract the “worried well” and consequently should be considered preventive in focus. Furthermore, replications are needed in order to determine whether these responses are typical of nonvolunteers. However, an interesting finding that sup- ports other research is that the subgroups of high trait-anxious subjects experienced more favorable changes and, in particular, that the subgroup with low fit-high anxious subjects significantly reduced emotion-focused coping, compared to the more fit and less anxious subgroups (Long, 1984; Wilfley & Kunce, 1986). The differential results show that, in this sample of moderately stressed teaching personnel, the SITE program had significant results for a subgroup of participants who were highly anxious and less physically fit. Thus, for worksite programs to be maximally cost-effective, those subgroups who would benefit the most should be identified; however, this creates additional problems of differential service delivery that must be dealt with. While worksite programs should not be considered a panacea for organizational stress, the results of this study tend to support the general conclusion that stress-management programs ap- pear to have potential for helping workers cope with occupational stress. Future studies should attempt to provide an unequivocal test of the exercise components’ effectiveness, in order to determine the role of exercise as a stress-management intervention.

REFERENCES AMERICAN COLLEGE OF SPORTS MEDICINE (ACSM). (1978). Position statement on the recommended quanti-

ty and quality of exercise for developing and maintaining fitness in healthy adults. Medicine and Science in Sports, 10, 7-10.

ANDREWS, G. , TENNANT, C., HEWSON, D. M., & VAILLANT, G . E. (1978). Life event stress, social support, coping style, and risk of psychological impairment. Journal of Nervous andMental Disease, 166, 307-316.

ASTRAND, P., & RODAHL, K. (1977). ASTRAND, P., & RHYMJNG, I. (1954). A nomogram for calculation of aerobic capacity (physical fitness) from

pulse rate during submaximal work. Journal of Applied Physiology, 7, 218-221. BILLINGS, A. G., & Moos, R. H. (1981). Role of coping responses and social resources in attenuating the

stress of life events. Journal of Behavioral Medicine, 4, 139-157. BLAIR, S. N. (1984). How to assess exercise habits and physical fitness. In J. D. Matarazzo, A. Head, S .

M. Weiss, & S. M. Weiss (Eds.), Behavioral health: A handbook of health enhancement and disease prevention (pp.424-447). New York: Wiley.

BLOMQVIST, C. G., & SALTIN, B. (1983). Cardiovascular adaptations to physical training. Annual Review of Physiology, 45, 169-189.

BORG, G. A. (1973). Perceived exertion: A note on “history” and methods. Medicine and Science in Sports, 5, 90-93.

BOUCHARD, C. , BOWLAY, M., THIBAULT, M., CARRIER, R., & DULUC, S . (1980). Training of submaximal working capacity: Frequency, intensity, duration, and their interaction. Journal of Sports Medicine, 20,

Textbook of work physiology. New York: McGraw-Hill.

29-38.

3 24 Bonita C. Long

FOLKINS, C., & SIME, W. (1981). Physical fitness and mental health. American Psychologist, 55, 373-389. FOLKMAN, S., LAZARUS, R., DUNKEL-SCHETTER, C., DELONGIS, A., & GRUEN, R. (1986). Dynamics of a

stressful encounter: Cognitive appraisal, coping and encounter outcomes. Journal of Personality and Social Psychology, 50, 992-1003.

FORMAN, S. G. (1982). Stress management for teachers: A cognitive-behavioral program. Journal of School

FREMONT, J., B CRAIOSHEAD, L. W. (1987). Aerobic exercise and cognitive therapy in the treatment of

GAL, R., & LAZARUS, R. S. (1975). The role of activity in anticipating and confronting stressful situations.

GOLDWATER, B. C., B COLLIS, M. L. (1985). Psychological effects of cardiovascular conditioning: A con-

HEAPS, R. A. (1978). Relating physical and psychological fitness: A psychological point of view. Journal

KYRIACOU, C., & SUTCLIFFE, J. A. (1977). Teacher stress: A review. Educational Review, 29, 299-306. LAZARUS, R. S., & FOLKMAN, S. (1984). LONG, B. C. (1984). Aerobic conditioning and stress inoculation: A comparison of stress-management in-

terventions. Cognitive Therapy and Research, 8, 5 17-542. LONG, B. C., HANEY, C. J. (1988). Coping strategies for working women: Aerobic exercise and relaxation

interventions. Behavior Therapy, 9, 75-83. LONG, B. C., SCHUTZ, R. W., KENDALL, P. R., &HUNT, C. G. (1986). Employee health service for teaching

and nonteaching staff A needs assessment. Evaluation and Program Planning: An International Jour- nal, 9, 355-366.

MEICHENBAUM, D. (1985). MILSTEIN, M. M., & GOLASZEWSKI, T. J. (1985). Effects of organizationally based and individually based

MURPHY, L. R. (1984). Occupational stress management: A review and appraisal. Journal of Occupational

OLHA, A., THOMPSON, B. L., SKORYNA, S. C., & KLISSOURAS, V. (1980). Functional capacity testing in a general hospital. Journal of Sports Medicine, 20, 87-89.

PETTEGREW, L. S., & WOLF, G. E. (1982). Validating measures of teacher stress. American Educational Research Journal, 19, 313-396.

SALLIS, J. F., HASKELL, W. L., WOOD, P. D., FORTMANN, S. P., ROGERS, T., BLAIR, S. N., & PAFFENBARGER, R. S. (1985). Physical activity assessment methodology in the five-city project. American Journal of Epidemiology, 121, 9 1 - 106.

SHARP, J. J., & FORMAN, S. G. (1985). A comparison of two approaches to anxiety management for teachers. Behavior Therapy, 16, 370-383.

SPIELBERGER, C., GORSUCH, R., & LUCHENE, R. (1970). STAI manualfor the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.

WILFLEY, D., & KUNCE, J. (1986). Differential physical and psychological effects of exercise. Journal of Counseling Psychology, 33, 337-342.

WOLLERT, R., LEVY, L. H., c KNIGHT, B. G. (1982). Help-giving in behavioral control and stress coping self-help groups. Small Group Behavior, 13, 204-218.

WONG, P. T., & REKER, G. T. (1983). Validity of the coping inventory. Paper presented at the Canadian Association on Gerontology, Moncton.

WONG, P. T., REKER, G. T. (1984a). Coping behaviors of successful ager. Paper presented at the 30th Annual Meeting of the Western Gerontological Society, Anaheim, CA.

WONG, P. T., & REKER, G. T. (1984b). The matching modelof coping. Paper presented at the Annual Meeting of the Canadian Psychological Association, Ottawa, Ontario.

Psychology, 20, 180-187.

dysphoric moods. Cognitive Therapy and Research, 11, 241-251.

Journal of Human Stress, 1(4), 4-21.

trolled experiment. Psychosomatic Medicine, 47, 174-181.

of Sports Medicine and Physical Fitness, 18, 399-408.

Coping, appraisal and stress. New York: Singer.

Stress inoculation training. New York: Pergamon.

stress management effects in elementary school settings. Urban Education, 19, 389-409.

PSyChOlOgy, 57, 1-15.

stress management for school personnel: stress-inoculation training and exercise

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