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Stress Reduction ~9
testing (Novaco, Sarason, Cook, Robinson, ~ Cunningham, 1979; Sarason, Novaco,
Robinson, & Cook, 1981). These studies pointed to the social environment
established by drill instructor teams as a key factor determining attrition,
adjustment, and performance.
STRESS REDUCTION
Both individuals and organizations act
become victims of it.
as architects of stress as well as
The objective, traditions, and policies of
organizations shape the work social environment, affecting the demands and
contingencies that impinge on its members. Correspondingly, the goals,
habits, and expectancies of individuals create recurrent behavioral contexts
and activate events that cause stressful dimensions. Because of these
proactive and transactional aspects of person-environment relationships,
strategies of stress reduction should not be preoccupied with after-the-fact
intervention. While empirical research on this point is grossly lacking,
stress reduction theoretically and pragmatically can be achieved by optimizing
environments and behavior patterns.
Comprehensively, stress reduction entails remediation procedures,
regulatory techniques, and preventive strategies. Remediation Procedures are
interventions implemented to curtail and treat stress reactions. Various
psychological and medical procedures are available for such therapeutic
action. Regulatory techniques are psychological coping tactics utilized to
counteract precursors or elements of stress reactions, particularly with
regard to tension, emotion, and cognition predisposed to stress. Behavior
patterns linked with recurrent stress episodes might also be modified in a
self-regulatory effort. Preventive strategies involve proactive personal and
oganizational action design Lo reduce exposure to stressors, to develop skills
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Strew Reduction ~0
for dealing with environmental demands,
social resources that promote well-being.
and to augment environmental and
The following section will expand upon these stress reduction methods,
using less abstract categories. The various procedures, techniques, and
strategies can be alternatively grouped in terms of (a) arousal reduction, (b)
cognitive restructuring, (c) problem-solving skills, (d) behavioral coping
skills, and (e) environmental modification. In addition, a model known as
stress inoculation represents an attractive aggregate of available methods and
can usefully be applied to military populations.
Arousal Reduction
Since physiological activation constitutes a core component of stress
reactions, procedures designed to reduce arousal are commonly part of stress
management programs. Both mental as well as physical relaxation are
emphasized. As Davison (1967; 1969) observed, relaxation procedures teach
cognitive as well as somatic lessons, teaching that tension can be controlled
and regulated.
Jacobson's (1938) progressive relaxation procedure of systematically
tensing and then relaxing sequential sets of skeletal muscles was the first
structured approach in the medical/psychological literature, although it is
widely recognized that ancient Eastern religions predated the more
contemporary clinical approaches. While practices such as yoga and Tai Chi
perpetuated the philosophical and spiritual elements of Taoism and Buddhism
among secular populations, it was not until the emergence of Transcendental
Meditation cults in the 1960s and 70s with Hindu origins that Eastern ideas
about relaxation gained considerable popularity. Highly significant degrees
of arousal reduction across many physiological channels were found to be
associated with TM practice (Wallace, 1970). In a study of corporate
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Stress Reduction _1
businessmen, Frew (1974) fount higher levels of job satisfaction,
productivity, and work relationships among those who meditated on a regular
basis.
Benson's (1975) study of meditation, however, led to a demystified view
of the process, and he devised a simplifies set of instructions to elicit what
he termed, "the relaxation response." Basically, in the Benson technique, the
person sits comfortably in a quiet place, closes his eyes, focuses on
breathing, and repeats the word "one" silently to himself. This is practiced
for ten to twenty minutes, once or twice daily. Peters, Benson, and Peters
(1977) reported that significant decreases in blood pressure were found under
experimental conditions to be associated with tally relaxation practice in a
corporate environment.
Another relaxation induction procedure is autogenic training, developed
by Schultz and Luthe. Autogenic training was conceived by Schultz, a German
psychiatrist, as a form of self-hypnosis that could be used to create mental
resolve for behavior change, as well as to modify physiological conditions in
specific organ areas. The techniques.emphasizes smooth, rhythmic breathing,
self instructions of calmness, and the use of suggestions of "heaviness" and
"warmth' for body regions' especially limbs.
There are a few reports of the use of arousal reduction procedures with
military persons. Herrell (1971) successfully used systematic desensitization
in treating a 19 year old private who became uncontrollably angry whenever he
was given orders. This was a lifelong problem, often accompanied by acts of
aggression. He had received four nonjudicial punishments prior to the start
of treatment and one other early in the treatment period (for kicking his
sergeant during a game of pool).
After eight weeks of therapy (18 sessions)'
the client's self-reported improvement was verified by his commenting
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Stress Reduction 42
officer. Another arousal reduction intervention was that of Brooks and
Scarano (1985) who used an experimental design to study transcendental
meditation as a treatment for Vietnam veterans with PTSD. They randomly
assigned 18 male veterans to either a TM or a psychotherapy condition for a
three month treatment period. The TM group, compared to the psychotherapy
group, was significantly more improved on degree of PTSD, emotional numbness,
anxiety, depression, alcohol consumption, insomnia, and family problems.
There was also a trend toward improvement on physiological arousal to noise
(called a stressful stimulus by the authors,
that a bit doubtful). Those in the IM group
they no longer felt the intensity of tension,
had practiced their mediation twice daily for
weekly follow-up meetings with the instructor.
While arousal reduction procedure are
for treating stress disorders. it should
but the 85 decibel level makes
reported that after meditation
rage, and guilt inside. They
20 minute periods and also had
the intuitively sensible approach
be added that counter-intuitive
methods have also been used. Fairbank and Keane (1982) sequentially treated
Two Vietnam veterans having PTSD by using imaginal flooding. In the first
case the flooding decreased SUDS ratings and flashbacks. For the second case,
physiological recordings were also made for skin conductance ant heart rate.
Again SUDS ratings and flashbacks were decreased considerably, and the
physiological measures for the anxiety scenes decreased to non-anxiety
baseline levels or lower.
Cognitive Interventions
Various procedures are being extensively used in clinical work to modify
cognitive dimensions of stress disorders. Changing belief systems, modifying
perceptions, altering attentional focus, eliminating intrusive thoughts, and
adjusting expectations are among the tactics utilized to help clients
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Stress Reduction
restructure how they view the world and themselves. The treatment efficacy of
such procedures has been extensively documented in edited volumes by Kendall
and Hollon (1979) and Kendall (1982). The problems of impulsive children,
delinquents, anxiety disorders, depression, assertivenss, pain, eating
disorders, anger, alcoholism, and smoking have each had multiple treatment
studies produce successful results with cognitively based behavioral
programs. Cognitive-behavioral interventionists have built upon the work of
Meichenbaum (1977), Beck (1976), and Ellis (1962), their precursor. The field
has reached a point of maturity, becoming a major form of psychotherapy that
has been extended to many field settings.
An important element of cognitive-behavioral interventions is problem-
solving. D'Zurilla and Goldfried (1971) outlined five stages of problem-
solving as (1) general orientation or "set," (2) problem definition, (3)
generation of alternatives, (4) decision making, and (5) verification. The
components of alternative thinking and the means-end aspects of decision
making have been developed by Platt and Spivak (1975). A variety of problem-
solving approaches have been successfully utilized with delinquents (Little &
Kendall, 1979), and social problem-solving treatments have produced effective
outcomes with a wide range of adult clinical problems (D'Zurilla & Nezu,
1982), although there are difficulties with control groups and outcome
measures.
With regard to stress, the process of coping effectively involves the
ability to ascertain the nature of problems, think of alternative solutions,
identify steps to solution, anticipate obstacles, and utilize feedback from
coping efforts. However, as Lazarus and Folkman (1984) point out, this
suggests a mastery model, and not all sources of stress are amenable to
mastery. Natural disasters, aging, disease, and the death of loved ones are
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Stress Reduction
examples of such conditions. The concept of coping, however, acknowledges
that there may well be constraints on possible outcomes and the availability
of means. Effective coping entails the ability to gather information, analyze
the problem situation, weigh alternatives, and then select and implement an
action plan. The armed forces have incorporated such ideas in their officer
training programs by the use of problem situations presented to candidates as
"What Now, Lieutenant?" scenarios.
One promising cognitive technique that is getting extensive use in the
area of sports psychology is vi-quo-motor behavioral rehearsal (VEER). Suinn
(1972) developed this technique as a way of removing emotional obstacles to
performance and has used the procedure with Olympic skiers with favorable
results. The technique involves relaxation, visualization of performance, and
performance in a simulated stressful situation. Other investigators (Noel,
1980; Weinberg, Seabourne, ~ Jackson, 1981) have experimentally evaluated this
technique with tennis players and karate competitors in tournament
situations. Although results across dependent measures are not always
significant, there is some evidence for performance enhancement. Studies of
basketball players by Hall and Erffmeyer (1983) and DeWitt (1980) also showed
positive effects. In the use of this procedure, it is important that the
person have an accurate mental image of optimum performance and be able to
visualize the details of the behavioral sequence.
Behavioral Coping Skills
The transactional qualities of stress first emphasized by Lazarus (1966)
and intrinsic to the present view of stress reduction is the importance of
behavioral competencies in coping. Pearlin and Schooler (1978) presented a
view of coping that directed attention away from exceptional people dealing
with unusual problems in rare situations and toward "persistent hardships
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Stress Reduction ::
experienced by those engaged in mainstream activities within major
institutions" (p. 3). They distinguished three major types of coping
responses: (1) responses that modify the situation, (2) responses that
control the meaning of the problem, and (3) response that manage existing
stress. Their second category is clearly a cognitive appraisal function.
They sought to distinguish coping from personal characteristics (what one
does, as opposed to who one is). In an analysis of coping data from home
versus occupational domains, they concluded that coping (what one does) has
more of an impact in the context of marriage and parenting, while personal
characteristics have more sway in financial and job arenas. However, they
also found that the greater the scope and variety of the person's coping
repertoire, the more protection coping affords. Their conclusion about the
relative ineffectiveness of coping in occupation is, however, misleading and
is a result of their self-report questionnaire methodology which asked about
how people usually coped with general sources of stress. This can be seen as
at variance with their objective to distinguish what people do (behavior) from
who people are (traits). In contrast, Folkman and Lazarus (1980) did a more
differentiated analysis of both forms of coping and stressful encounters.
They found that work contexts favored problem focused coping, while health
contexts favored emotion-focused coping.
Pearlin and Schooler (1978) did point out that, for impersonal strains
arising from economic and occupational experiences, the most effective forms
of coping involve the modification of goals and values. Goal setting is a
cognitive-behavioral skill that has been incorporated into many stress
reduction approaches and other enterprises concerned with performance
effectiveness. It involves an assessment of personal values, the development
of short-term versus long-term goals, and a clear specification of them. A
time table with realistic expectations is a useful tool.
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S=e" Reduction to
In the field of sports psychology, for example, an athlete who may be
experiencing stress from competitive pressures and a strong desire to achieve
high levels of success can be helped, hypotheticially, by a goal setting
strategy. The athlete should be helped to map the performance requirements of
the sport component, using a quantitative approach, and correspondingly do a
realistic assessment of his or her capabilities. Using measureable
performance criteria, present performance level can be arrayed against the
goals or desired improvement levels. In conjunction with this analysis
training steps can be designed including diet, strenYth-buildinv
conditioning that remain to be behaviorally enacted.
goals, behaviorally achieved, can be a useful adjunct.
an ,,, and
The visualization of
Quick and Quick (1984) present a model for understanding the stress
reducing functions of goal setting programs which have dyadic involvement of
managers and employees, thus leading to reduced role stress. This results
from employee participation in setting task goals and frequent managerial
performance feedback. Acquiring new behavior patterns and modifying old ones
are essential to goal setting as a stress management strategy. Their review
of limited work in this area finds mixed results in empirical evaluations.
Time management is another commonly used component of stress programs,
especially in the corporate sphere. Temporal factors have been studied with
regard to stress among military populations, such as research done on naval
watch schedules and experimental simulation studies pertaining to aerospace
crews (Alluisi ~ Morgan, 1982). This work has sought to determine optimum
work-rest cycles, and it has applicability to unusual situations. For
example, Chiles, Alluisi, and Adams (1968) found in a continous 30 day study
of air force officers working around the clock on schedules of 4 hours work, 4
hours rest (4-4), maintained consistently better levels of performance than
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Stress Reduction 4~
those in 4-2 schedules. Curiously, during periods of confinement (four days),
subject preference and performance is better on a 4-4 schedule than for 6-6 or
8-8 (Alluisi & Morgan, 1982). These studies on work-rest cycles, and others
on vigilance and watch-keeping deal with temporal variables as fatigue
factors. Time management, alternatively, looks as temporal matters in terms
of workload regulation.
There is general agreement in the idea of human beings as multichannel
information processing systems with limits on their channel capacity
(Schneider & Shiffrin, 1977). The concept of overload has been central to
analyses of adaptation in urban environments (Milgram, 1970) and is
fundamental to Cohen's (1978) stress model. Among Cohen's basic assumptions
are that when demands exceed attentional capacity, priorities are set, and
that prolonged demands cause depletion in capacity. Intense, unpredictable,
and uncontrollable stressors create demands on attention capacity, as does
task multiplicity. Available capacity shrinks ("cognitive fatigues) when
demands on attention are prolonged. Task priorities, if not proscribed, will
be generated by an operator (Chiles, 1982). Subjects strive to prevent
decrements on what they regard as high priority tasks when workload is
increased, and this of course is contextually determined. A pilot, for
example, will carefully monitor air speed on landing approach regardless of
other inputs, while attending to air speed might receive a lower priority
enroute.
Work demands, however, may well be generated by unrealistic expectations
of personal capacity, thus creating conditions of overload. Job pressures
themselves may require very efficient allocation of attention. In these
regards, time management becomes an important stress coping skill.
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Stress Reduction 48
The first step in effective time management is overload avoidance.
Learning to avoid excessive obligations can be difficult for high achievers,
but realistic goal setting can pave the way. Systematic approaches to time
management have been outlined by Lakein (1973), who advocates a goals
statement, a priority list of tasks, and a schedule. He emphasizes a written
listing of things to do with a three tier ranking system. "Internal prime
time" and "external prime time" are distinguished to designate periods best
for concentration versus dealing with other people. Interruptions should be
minimized during internal prime time, and limits must be set on meetings,
calls, and various time drains. The core idea is to assure that high
priority, high value items are accomplished first. Charlesworth and Nathan
(1984) advocate taking a time inventory, charting one's activities as one goes
through a normal day, using 15 minute segements. In a corresponding chart,
they suggest making a satisfaction column indicating degree of satisfaction
associated with each time segment. Summary tabulations will be informative
about areas in need of adjustment.
This charting technique is a form of self-monitoring, which is a
cognitive-behavioral skill that is fundamental to coping with stress. Self-
monitoring requires accurate observation and attention, but procedurally
involves behavioral habits of charting physical states, psychological states,
and behavioral activities. Kanfer (1970) set forth a view of self-monitoring
as an initial step in self-directed behavior change, "a crucial trigger for
self-adjustive behaviors" (p. 151). The self-observation of a specific
behavior, thought, feeling, or sensation becomes a discriminative stimulus for
a self-control response. Alternatively, the process can be viewed as a
component of a feedback loop in a self-regulatory system whereby either
disturbances in homeostasis are sensed and then activate deviation counter-
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S=e" Reduction 4~
acting processes or inputs function as alarms that direct the system to avoid
disturbances. An example of this perspective is that of Notterman and
Trumbull (1950) who speculated about systems theory as a framework for stress
research and viewed self-regulation as presupposing processes of detection,
identification, and response availability. The organism must sense a
disturbance, identify its nature, and be able to make the necessary
correction. Curiously, they describe anxious individuals as having excessive
feedback requirements (send out excess "feelers" or inquires to establish the
identity of the disturbance) and use hyperventilation among Naval Aviation
cadets as an example. They called the anxious hyperventilation, "Radar
Robert, for his high need for feedback.
S.cress Inoculation
A cognitive-behavioral approach to clinical problems, particularly
stress-related disorders of anxiety, anger, and pain, is the stress
inoculation model, first developed by Meichenbaum (1975). The "inoculation"
concept is a medical metaphor, and the treatment approach involves exposing
the client to graduated dosages of a stressor that challenge but do not
overwhelm coping resources. The client is taught a variety of cognitive and
behavioral skills, which are then applied to conditions of stressor
exposure. The approach was elaborated by me to deal with problems of anger,
Is tested successfully in a series of studies with various client populations
(cf. Novaco, 1985). Extensions to the area of chronic pain have been made
primarily by Turk (1978). The treatment approach is conceptualized as having
a sequence of phases, namely (a) cognitive preparation, (b) skill acquisition,
and (c) application training. It is viewed as both a treatment and a
preventive approach (Meichenbau~ & Novaco, 1978). The volume by Meichenbaum
and Jaremko (1983) presents :he theoretical foundation and wide range of
client problems and populations -a which the approach has been applied.
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The historical precursors of the stress inoculation model, as mapped by
Epstein (1983), include classic work concerned with the mastery of stress such
as Freud's observations about wartime traumatic neuroses and Pavlov's
laboratory experiments with dogs that were discussed earlier. Epstein argues
that there is a natural process of graded stress inoculation, a sort of
adaptive defense system that seeks to pro-actively master stress. Janis
(1951), who discovered that preparatory information for impending stressors
had a beneficial effect on their emotional impact when he studied reactions to
air attacks (this is the forerunner of the Cognitive preparation" stage of
the SI model), had previously written about fear and battle inoculation" in
his work on the American Soldier project (Stouffer et al., 1949). He had
suggested that trainees be given battle inoculation not only to acquire combat
skills but to develop personal techniques for coping with emotional reactions,
such as techniques we would now refer to as attentional refocusing, task
orientation, and self-verbalizations of confidence enhancement. Janis (1971)
extended these ideas to working with hospitalized surgical patients to help
them cope with the impending stress of surgury by giving them a form of
"emotional inoculation." Curiously, he first used this term to describe a
preparedness training for the emotional reactions of relief workers in an A-
bomb disaster (Janis, 1951). Among his suggestions were exposure to realistic
color-sound films of disaster scenes and tours of the local morgue. For
surgical patients, this was a three part counseling procedure that included a
realistic assessment of the situation, reassurance about coping resources to
counteract helplessness, and encouragement to develop a personal coping plan.
Among the applications has been to recruits in Marine Corps basic
training (Novaco et al., 1983), although this particular intervention did not
entail a full implementation of the three phased approach. Pragmatic
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constraints simply did not allow for the use of the full procedure with entire
recruit cohorts in a tightly scheduled training regimen. Consequently, we
only utilized the cognitive preparation and skill acquisition components and
even abbreviated those. The program and its results, along with an account of
a much more elaborate intervention with drill instructors, is given in the
subsequent section.
Meichenbaum (1985) has recently written a clinical handbook or
practitioners guide which reviews the full range of stress inoculation work.
My own perspective differs from his by placing greater emphasis on
environmental determinants of stress and on physiological activation, both of
which are often ignored by Meichenbaum, despite my attempts to influence him
(Meichenbaum & Novaco, 1984). The divergence is rooted in my interest and
research in naturalistic settings, as well as in presuppositions about the
involvement of arousal in stress - related disorders .
UTILIZATION OF STRESS REDUCTION IN MILITARY CONTEXTS
There is very little published. research on stress reduction in the
military. There are a few clinical cases, mostly concerning PTSD described
earlier as arousal reduction treatments, and very few experimental programs.
My search has included technical report information sources, as well as books
and journals.
Clinical Interventions
Several case reports on treatment of PTSD were given in the arousal
reduction section earlier. In addition, some other reports on psychotherapy
and psychopharmacology exist. Amen (1985) described work with a 43 year-old
army first sergeant who had been a POU in Vietnam, and like a number of
others, had PTSD symptoms when the Unknown Soldier from the Vietnam War was
Representative terms from entire chapter:
arousal reduction
