Changing stress levels through gaining information on stress

Ab stra c t Objective: The aim of this research was to find out the effect of the Information Phase of a Stress Management Program (SMP) on the perceptions of participants about their stress levels. Method: A total sample of 100 workers (nursing staff, private business men and women, laboratory assistants, the protective services [foreman and security staff], as well as people in human resources departments) took part in this study. All the participants were from the Northern and Gauteng Provinces in South Africa. The Combined Hassles and Uplifts Scale (Folkman & Lazarus, 1989) was used as an instrument to measure the perceived stress level of participants in a SMP. Result: A significant reduction in stress levels was achieved among those who received the Information Phase of the SMP only, as well as those who received the whole stress management techniques. There was no significant difference between the amount of reduction in perceived stress-levels achieved among those that received the Information Phase of the SMP only, compared to that of those who received the whole techniques. Conclusion: The authors conclude that where the resources are limited, only the information phase of a SMP may be given to desiring clients. That should help to save time and money spent on participating in SMPs. This should however not discourage the use of the whole SPM, where affordable.


Introduction
M ost current stress m anagem ent program m es that exist have an introductory stage where inform ation is given on w hat stress is and the influences o f stress on the person (B riner, 1997: 61-67).H ow ever, research on the effe c tiv en e ss o f the In fo rm atio n P hase, usually p re sented in such program m es is lacking in South A frica generally.The questions that im m ediately com e to m ind are: W hat is the effect o f this first phase of an SM P on the p a rtic i pants in a SM P? D oes it have an effect on the self-p er ceptions o f p articip an ts regarding their stress levels?A nsw ers to th ese q u e stio n s could be u sed to shape SM Ps in tim e and m oney spent on participating in such program m es -especially with regard to participants' per ceived am ount o f control over their situations.A ccording to the H um an Sciences R esearch C ouncil (H SRC, 1997: 1-10), South A frica loses about R500 m il lion per year due to the loss o f productivity as a result of stress.It is not ju s t only in the best interest o f the South A frican econom y to address this issue regarding stress, but it is also for the individuals who need the SMP.M uch research (De A nda, 1998(De A nda, : 73-85: H oldevici, 1995: 161-171;: 161-171;Kantor, Schom er & Louw, 1997: 16-21;Kline & Snow, 1994: 105-121;M cC ain & Sm ith, 1994: 221-227;M cC ourt-M ooney, 2000: 98-104;M cN ally & Solom on, 1999: 20-26;Ross, N iebling & H eckert, 1999: 312-316) has been done on the d ifferen t techniques being im ple m ented in stress m anagem ent program m es (SM P).H ow ever, none o f them have looked at the influence o f the introductory phase o f the SM Ps to im prove a co ncep tual understanding o f stress or stress m anagem ent and its c o n se q u en ce s.N icholson, Duncan, Hawkins, Belcastro & Gold, (1988: 637 641) evaluated 62 published reports on SM Ps from nu m er ous fields (see also Briner, 1997: 61-67).T heir suggestion is that research needs to focus on levels and com ponents o f SM Ps.Only one published research finding could be traced on the evaluation o f an eclectic m odel as a basis for a stress m anagem ent program m e in South A frica (Kantor, Schom er & Louw, 1997: 16-21).Short-and long-term changes in the lifestyles w ere researched and the course included the fo l low ing aspects: healthy eating lifestyles, fitness, general health aspects and the application thereof, relationships, occupational stress and stress m anagem ent resources.The researchers felt that the aspect o f resources o f stress m a n agem ent was not fully utilised.This aspect only included the spending o f free time.O nce again, the use o f the in fo r m ation gaining-phase and its im pact w ere not covered.
U hlem ann and Plater (1990: 3-16) suggest that inform ation should be gathered in a situation with the aim o f goal plan ning.According to McCain and Smith (1994: 221-227) a corre lation exists between a person's evaluation of a situation and illn e s s e s .D im e n sio n s o f the situ a tio n (u n d e s ira b le s , unpredictability, uncontrollability, extent and the aspect of duration or time), are helpful in giving a more objective view of the relationship between situations and their relationship with illnesses.These dimensions are perceived to be related to the person's beliefs, values, relationships and coping resources.
The importance o f giving patients suffering from chronic ill nesses more inform ation regarding their illnesses has been suggested by a num ber of researchers (Johnson, 1988;Olson, Huszti, M eason & Seibert, 1989;1-21;Weist, Finney, Barnard. Davis & Olledick, 1993: 11-28) as this is likely to help the per son suffering from an illness to gain more control over the illness.
In many parts o f Africa, where, on the one hand, financial re sources are often very limited, and on the other hand, many workers suffer from stress and other stress-related illnesses (Ebigbo, 1993(Ebigbo, :396-401,1996: 28-49;: 28-49;Bhana & Haffejee. 1996: 431 -434;Pretorius, 1993Pretorius, : 10-14,1994: 771-777;: 771-777;Struem pfer& Bands, 1996:67-75;van Wijk, 1997:707-710), an inquiry into a time-and cost-effective method of reducing stress, is a neces sity.The purpose of this study, therefore, is to investigate the effectiveness of the Information Phase of a SMP, and if found effective, to recommend it where time-and cost-effective meth ods o f reducing stress is a necessity.No study of this kind has been conducted in South Africa.Therefore, this study will pro vide some baseline information on the m atter in South Africa.
The hypotheses for this study are: 1.A significant reduction in stress levels will be achieved among those who received the Information Phase of the SMP only, as well as those who re ceived the whole stress management techniques.2. There will be no significant difference between the amount of reduction in perceived stress-levels achieved among those that received the Inform ation Phase of the SMP only, compared to that of those who received the whole techniques.

Method
The experim ental method was used in this study, with pre-, between-and post-repeated measurements.This method was appropriate in this study since each participant formed part of both the experim ental and the control groups (De Anda, 1998: 73-86;Rose & Fiore, 1999:235-252).

Participants:
Institutions and private business sector considered to be high in job-related stress levels were approached by one of the au thors for possible participation of their workers in the study.Once an institution or business sector had accepted to partici pate, no other similar one was approached for the study.The reason for this exclusion was to ensure a wide representation of the target population is included in the study.A total of 100 participants took part in this study.They volunteered and reg istered for a stress m anagem ent workshop for two weeks as part o f their personnel development and skill training options.The first 20 participants who volunteered from each of the populations m entioned below were chosen for the study.The population were from the nursing staff of a psychiatric hospi tal in Pretoria, private business men and women in Pretoria and Johannesburg (chosen at random from telephone directories), laboratory assistants in Phalaborwa, the protective services (foreman and security staff at companies from Phalaborwa), and workers in the Human Resources D epartm ents (person nel) in Pietersburg.Participation in the study was voluntary and was given free of charge; however, a prerequisite for partici pation was at least a Grade 12 educational level.
There were altogether 56 blacks and 44 whites; 46 males and 54 females.Among the blacks, there were 23 males and 33 fe males.Among the whites, there were 23 males and 21 females.Among all the participants, 16 % were between 20 and 29 years old, 50% were between 30 and 39 years old, 24% were between 40 and 49 years old, and 10% were 50 years old or above.

Instruments
The Questionnaire: The first part of the questionnaire contains the following de mographic questions: gender, skin colour and age.The second part contains the Combined Hassles and Uplifts Scale devel oped by Folkman & Lazarus (1989).The questionnaire is a self administered questionnaire, consisting of 53 items that are scored ranging from 0 (not applicable) to 3 (a great deal).The potential sources of hassles or uplifts covered by the ques tionnaire can be grouped into the following subheadings: fu ture security, time, work, household responsibilities, health, inner concerns, financial responsibilities and environment.Questions are in English and stated in such a way that they are open to projection and thus also to subjectivity.In their ap proach, questions were phrased in such a way that they meas ure the individual's appraisal of potential threat, harm, loss or challenge.The Combined Hassles and Uplifts Scale can be used to investigate stress either as an independent or a de pendent variable.
Instructions on how to answer the questionnaire were that the questions had to be answered on both the Hassles and Uplifts scores and within a period o f one week (for the past week).Scoring the CHUS on uplifts has two advantages: (I) It may point to aspects that serve as a buffer for negative experiences or consequences to stressors, and (ii) it de-em phasises the negative effect of answering and focussing only on negative stre sso rs as a c o n seq u e n ce o f the te stin g p ro c ed u res.Chronbach Alpha and Split-half reliability for the whole scale used were .81and .72 respectively for this sample.The global validity o f the scale has been established since it correlates significantly (r=0.82,p<0.0001) with the global experience of stress (Dumont, Tarabulsy, Gagnon, Tessier & Provost, 1998: 57-71).

The Stress Management Programme:
Since many authors pointed to the preference o f using an ec lectic model in compiling SMPs (Brems, Amodei & Scott, 1989: 175-179;Courtney & Escobedo, 1990: 306-310: Kushnir & M alkinson. 1993: 195-206;M cCain & Smith, 1994:221-227;Nicholson et al., 1988: 637-641), one of the authors used this approach in compiling the whole SMP.The A-B-C-Theory of Albert Ellis (Corey, 1996) was used as an introduction to clarify the importance of perspectives and beliefs in experiences.The advantage of forming belief systems or a frame of reference was explained in that a situation does not always have to be evaluated as being something totally unique.Disadvantages, however, could be that a person does not always see the differ ences between situations and could therefore have a narrowed perception of the situation and make less realistic evaluations in the given situation.
The basis of the theoretical perspective in the SM P was the Transactual Theory o f Lazarus and Folkman (1984).While using this theory the A -B-C-Theory (Corey, 1996) was inte grated with regard to perceived interpretation of a situation into the Transactual Theory (Lazarus & Folkman;1984).Specific attention is given to the way assumptions are formed and the advantages and disadvantages of assum ptions and belief systems.By focussing on the realistic evaluation of stres sors, the amount of control a person perceives to hold is being introduced.The terms, internal and external locus of control, were then explained and used to introduce the medical model of Fisher (1996: 16-22) and the "Fight-or-Flight-Reaction" (Everley, 1989) to explain related illnesses.Since the work of Fisher (1996: 16-22) seems somewhat complicated and too rich in neurological terminology, this theory was merely mentioned with referrence to the aspect of control and the different physi ological consequences this holds.
The stress management program m e consists of two distinct phases: The information phase, Phase 1, is normally presented as the introductory phase during the first three sessions within the first week; and coping strategies, Phase 2, is presented during the last three sessions within the second week to the participants.This is the stage where the Stress M anagement Techniques are presented.A session lasts for about one hour thirty minutes.The employers of the participants or the partici pants themselves could afford a maximum of two weeks for the whole exercise.

Contents of the Programme
The information phase focuses on information on the physical and psychological symptoms o f stress, the influence thereof on the person, as well as the theoretical perspective o f the programme on which it is based.It is also used to find out the methods they currently use to attend to the stressful situa tions they experience.Lastly, information is given on alterna tive coping styles.During the second phase, role-playing is used to bring about new perspectives.By m aking use of this technique, group members get the chance of practising new techniques in a con trolled environment (Corey, Corey, Callanan & Russell, 1992).The new techniques can be categorised into the following two broad areas: (1) Emotional: It includes the following technique: relaxation, shifting of focus, denial, expression o f emotions, and humour; (2) Problem-orientated: It includes: problem-solv ing, communication, and social ability techniques.

Procedure
The personnel m anagers o f the different participating in sti tutions asked for volunteers am ong their em ployees who would p articipate in a stress m anagem ent w orkshop.The first 20 volunteers form ed the group for the stress m anage m ent w orkshop in their in stitution.For those from the p ri vate sector, a neutral place was arranged for them in Johan nesburg.The w orkshop was organised and conducted by one o f the authors.
It was im portant to establish group cohesion as soon as pos sible during the different application procedures in the SMP.This had to be achieved without sacrificing the ethical guide lines printed by the Association for Specialists in Group Work Executive Board on June 1,1989, and reprinted by Corey, et al. (1992) with approval from the American Association for Coun selling and Development.Disclosure, confidentiality and goal of the research project were of utm ost im portance in the de velopm ent o f the SM P (Corey, et al., 1992) and, as such, each participant received his or her own SMP manual.Group m em bers were orientated with regard to the aims and purposes of the programme in the first session.Group rules were also made clear at this point.
Since the main aim of this study was to see if the self-percep tions o f the participants would change with regard to per sonal stress, by giving them inform ation on stress, the study used a subjective approach with regard to stress and stres sors.For this reason each participant was regarded as forming part of both the control group and the experim ental group and no population norms were needed to establish standardisa tion of the South African population.
During the SMP, Phase 1 was presented (within one week) as the Introductory Phase (Information Phase) during the first three sessions to all the participants, follow ed by Phase 2 (the actual stress m anagem ent technique phase) which was pre sented to only half of the participants within the second week.Participants were tested on the Hassles and Uplifts Scale be fore any subjection to the SM P com m enced (Test 1).This testing is to be used as the baseline data.
Random ised selection was used to decide on the participants for the two distinct application procedures (receiving only the first phase o f the programme or receiving the whole SMP).The second testing (Test2) was done after completion o f the first phase (first week) of the SMP.A fter Test 2, the Inform a tion group was allowed to go, while the other group rem ained for another one week.A third testing (Test 3) was done after another week (in which half of the participants received Phase 2 of the SMP).The fourth testing (Test 4) was done six months after the last testing was done, to see w hether the affected changes persisted among all the participants.A convenient date and time was fixed when the Inform ation group came back for Tests 3 and 4; and the same applied to the group for Test 4. The same Hassles and Uplifts Scale was used in each case.In each case, the Hassles and Uplifts Scale took about 5 to 10 minutes to complete.Each of the program m es and tests took place in a seminar-room setting.All tests were hand de livered and were collected thereafter.The researchers did the coding and the cross-checking.

Data Analysis
The data was analysed using the Statistical Package for Social Sciences (SPSS).The self-perceived stress level for each test was calculated by subtracting the total scores on the Uplifts Scale from the total scores on the Hassles Scale, since the increase on the score on any item in the Uplifts Scale reduces the level of perceived stress indicated on the Hassle Scale on the sam e item.The descriptive statistics and the A nalysis of Variance (ANOVA) was the statistical method used.

Result
Table 1 presents the mean scores for stress levels o f all the participants during Tests 1, 2, 3, and 4.
Table 1 : Mean scores for stress levels during Tests 1,2,3 & 4 among all the participants levels will be achieved among those who received the Informa tion Phase o f the SMP only, as well as those who received the whole stress management techniques.Analysis o f Variance (ANOVA) for Repeated M easures (General Linear Model) shows that the decrease in stress levels from Test 1 to Test 4 in each group is significant (Pillai's Trace: F=319.642,df=3, p<0.05).Thus, the hypothesis is supported.
The second hypothesis states that there will be no significant difference between the amount of reduction in perceived stress-

Discussion
A significant reduction in stress levels was achieved among those who received the Inform ation Phase of the SM P only, as well as those who received the whole stress management tech niques.Thus, the Information Phase of the SM P alone may equally have the desired effect on the participants.This can be explained by using the A-B-C-Theory of Ellis (Corey, 1996: 10 50).Possible alternatives to stress were presented to the par ticipants by increasing the participants' information regarding stress.This might cause the participant to dispute underlying belief systems.The discrepancy that started to develop might have, therefore, then form ed the driving force to lower stress levels.According to the Transactual Theory of Lazarus & Folkman (1984:1-105), the Primary Appraisal Phase of a stress ful situation forms the first step in coping procedures.Increas ing information regarding stress might increase the perceived severity or frequency of stress and stressors.This could in turn lead to finding solutions to such stressors in order to decrease stress levels during the Secondary Appraisal Phase of this theory.W hat is thus a possible explanation to the above result is an underlying increase of the awareness of stress (whether in frequency or severity) which forms the driving force in this case to find solutions to these stressors.
Uhlem ann & Platter (1990: 3-16) explains the possibility that people might have difficulty in accepting negative thoughts or evaluations, and may therefore put greater effort into chang ing the situation.An underlying increase in 'Hassles' may there fore be present in such a way that they not only motivate the participant to change the severity or frequency of the stress or stressor, but may also cause a shift in the perception of a disstressor ( 'H assle') to an eustressor ( 'U plift').
There was no significant difference between the amount of reduction in perceived stress-levels achieved among those that received the Information Phase o f the SMP only, compared to that of those who received the whole techniques.The differ ences between the base-line scores (Test 1) and the long-term outcomes (Test 4) of those who were only exposed to the In formation Phase of the SMP, compared to that o f those who received the full SMP were seen as follows: All the groups showed lowered scores (stress level) even on a long-term out come basis regarding their self-perceptions on stress.This implies that although the whole stress management techniques have a positive impact on perceptions of stress, the Informa tion Phase of an SMP only plays also a significant and im por tant role in the reduction o f perceived stress level over a pro longed period.Thus, where financial resources are limited, the information phase alone can be given to desiring clients.A c cording to our findings, the information phase alone can give the desired significant reduction in perceived stress levels.In many parts of Africa, where, on the one hand, financial re sources are often very limited, and on the other hand, many workers suffer from stress and other stress-related illnesses (Ebigbo, 1993(Ebigbo, :396-401,1996:28-49;:28-49;Bhana& H affejee, 1996: 431-434;Pretorius, 1993Pretorius, : 10-14, 1994:771-777:771-777; Stru em pfer* Bands, 1996: 67-75; van Wijk, 1997: 707-710), this tim e-and cost-effective method of reducing stress is a necessity.This result could also point to the development of own stress man agement techniques by participants who were only exposed to the Information Phase, enhancing self-perceptions and stim u lating a greater tendency to an internal locus of control.

Limitations of the Study
Some (e.g., physiological) tests could have been used in addition to the CHUS to throw more light on the physiological aspects of stress (see also the theory of Fisher, 1996:16-22).This might also have helped in giving a more comprehensive explanation of the underlying changes in stress levels.The absence of a separate control group in this study does not allow one to find out the effect of other possible factors, like the passage of time and demand characteristics, on the stress levels.

Conclusions
The Information Phase of an SM P plays a significant role in changing self-perceptions regarding stress in a SM P and puts a question mark the necessity for the whole stress m anage m ent techniques.The authors recom m end that research on SM Ps should focus more on the processes that take place in an SM P in order to give participants more value for their time and money spent by participating in such programmes.Future presentations o f an SMP could in fact focus more on the Infor mation Phase of an SMP for an initial, and long-term decline in perceptions of stress.It could thus be an option to present only an Information Phase as an SMP, where saving time and money is a necessity.However, where time and money are avail able, participation in the whole SM P should be encouraged.
Table1shows that perceived stress continuously reduced when moving from Test 1 to Test 4 for the two groups.The first hypothesis states that a significant reduction in stress levels achieved among those that received the Information Phase of the SMP only, com pared to that of those who re ceived the whole techniques.One Way ANOVA shows that at each Test, the stress level of one group does not differ signifi Cu ratio n is Fe bru ary 200 2