CH. 4_Worker Psychological Health.pdf

Worker Psychological Health Kristen Jennings Black and Christopher J. L. Cunningham In this chapter, we explore what it means to be psychologically healthy and how work-related experiences can contribute to good, bad, and in-between forms of psychological health among workers. A worker’s psychologic...

Worker Psychological Health Kristen Jennings Black and Christopher J. L. Cunningham In this chapter, we explore what it means to be psychologically healthy and how work-related experiences can contribute to good, bad, and in-between forms of psychological health among workers. A worker’s psychological health has many implications for their personal well-being and organizational functioning. Without a psychologically healthy workforce, there are some real limits to the potential productivity and enjoyment of work. Knowing that this connection between work and psychological health is important, we highlight intervention strategies that can increase positives states and reduce the experience of negative states. Employee Assistance Programs (EAPs), peer and climate focused interventions, and additional techniques are discussed as particularly relevant intervention strategies that can be applied to promote and protect workers’ psychological health. When you are finished reading this chapter, you should be able to: LO 4.1: Explain how work both affects psychological health and is affected by psychological health. LO 4.2: Describe common negative psychological states and how they relate to work. LO 4.3: Describe common positive psychological states and how they relate to work. LO 4.4: Suggest and explain the value of an intervention technique for promoting psychological health, given information on a specific workplace context. What it Means to be Psychologically Healthy A good place to begin this chapter is by ensuring that we all understand what it means to be psychologically healthy. This concept is defined and operationalized as multiple different constructs in occupational health psychology (OHP) research and practice, including psychological health, mental health (the predominant term in clinical psychology), behavioral health, or well-being. We use “psychological health” through most of this chapter as an inclusive label that captures a wide range of related cognitive and emotional states. Our view of psychological health aligns with how the American Psychological Association (APA; 2020) defines mental health as, “a state of mind characterized by emotional wellbeing, good behavioral adjustment, relative freedom from anxiety and disabling symptoms, and a capacity to establish constructive relationships and cope with the ordinary demands and stresses of life” (“mental health” entry). The World Health Organization (WHO; 2018) further emphasizes that mental health means “an individual realizes his or her own abilities . . . can work productively, and is able to make a contribution to his or her community” (para. 2). An implication of these definitions is that OHP professionals can best impact worker health, safety, and well-being (WHSWB) when we view psychological health as more than the absence of symptoms or negative emotions, but also experiencing a sense of meaning and purpose, which can often come from one’s work (Rosso et al., 2010). The Complex Connection between Work and Psychological Health The topic of psychological health is somewhat complicated to address because it seems so personal. As a result, it is easy for organizational leaders to assume that protecting workers’ psychological health is not an organizational responsibility. It is true that many risk factors for poor psychological health, like genetic predispositions and nonwork stress, are not under direct organizational control. However, organizations do control the structuring and assignment of work tasks, the presence of stressors and absence of work-related resources, the safety and quality of work experiences, and the compensation and benefits packages that help support workers’ general peace of mind. When we consider this, and the opportunities for work to generate a sense of purpose and meaning, it is easy to agree with Blustein’s (2008) argument that “work plays a central role in the development, expression, and maintenance of psychological health” (p. 228) and that organizations have a responsibility and opportunity to protect and promote workers’ psychological health. Psychological States and Conditions Over the past few decades, research has consistently shown connections between work-related stress and poor psychological health (Stansfield & Candy 2006), but work experiences also have the potential to generate positive psychological states (e.g., Crawford et al., 2010). These positive states are really valuable personal resources (discussed more in Chapter 6) that facilitate the development and maintenance of other resources (Hobfoll, 1989, 2001); for example, a good mood helps you focus on your work, do an exceptional job, and feel a sense of esteem that carries over into life outside of work. In contrast, the absence of positive states and presence of negative states sets workers up to lose more resources and generally struggle when facing work demands (e.g., feeling exhausted or burned out makes it hard to do good work). These examples illustrate how work can both contribute to workers’ psychological health and be affected by workers’ psychological health. Through the rest of this section, we provide an overview of primary psychological health-related constructs that OHP professionals study and work to address or change in WHSWB interventions. Our review of some of the key concepts and findings in this field starts with everyday states of affect, mood, and emotion and then moves to more specific states connected to cognitive and emotional energy and those associated with connectedness (i.e., to people and tasks) and purpose at work. We finish the section with a review of some common psychological disorders. Affect, Mood, and Emotion Having good or bad feelings is the most basic way that workers experience psychological states. Theories in this arena distinguish between emotion, mood, and affect (Rosenberg, 1998). An emotion is a fairly short-term response to a specific stimulus (e.g., joy when you get the best parking space as you pull into work). A mood lasts longer than an emotion, several hours or an entire day, and is not tied to a specific event. A worker’s affective state is broader and includes more transient experiences (including emotions and moods), while affective traits refer to an underlying disposition toward experiencing positive or negative emotion. An important implication of all of this is that affective states, which are more stimulus-specific and short in duration, can be more easily altered than trait affect (Weiss & Cropanzano, 1996). Affective states are typically categorized as positive (e.g., joy, excitement) or negative (e.g., worry, anger). Positive states unsurprisingly tend to be more consistently linked to favorable personal and work-related outcomes than negative states (Fredrickson, 2000; Weiss & Cropanzano, 1996). Perhaps one of the most common and relevant examples of this is the “happy-productive worker” hypothesis—it is both conceptually and empirically evident that happy workers do indeed seem to perform better on the job (Judge et al., 2001; Warr & Nielsen, 2018) and are even likely to go beyond their formal job duties (Kleine et al., 2019; Whitman et al., 2010). Despite this evidence, even this simple hypothesis is more complex than it seems—questions remain about whether happiness causes good performance or is caused by good performance; both pathways are probably true to some extent (Judge et al., 2001). An important practical perspective to keep in mind here is that regardless of how positive states originate, they are desirable because they can be a key resource that helps workers meet work goals and offset otherwise negative effects of job demands, as outlined in the job demands and resources (JD-R) model (Demerouti et al., 2001) and conservation of resources (COR) theory (Hobfoll, 1989), and because positive emotions may broaden or improve workers’ cognitive processing (cf., the Broaden and Build perspective of Fredrickson, 1998). Together, these models reinforce the idea that positive states are a resource themselves, are a mechanism for further resource gain, and can be a protective factor in the presence of stressors. In the same way, negative sates can be part of resource loss and impede the ability to gain new resources. Energy-Related Psychological States Workers often experience good or bad psychological health in the forms of cognitive and emotional energetic states. We can lack energy that leaves us feeling more negative emotions or we can feel a sense of energy and connection to work. Often these states are considered by OHP researchers as forms of resources within the COR theory just mentioned. We believe these states deserve more attention, though, given how directly they can be addressed with intervention efforts. Fatigue and Boredom Fatigue and boredom are often overlooked, yet important psychological states characterized by low cognitive and emotional energy. Fatigue is psychologically experienced as mental tiredness, low energy, and cognitive impairment in functioning lasting a few hours or weeks at a time. Fatigue is the body’s adaptive response to being overworked, a signal to slow down from continuing to perform demanding activities that could lead to exhaustion (i.e., a state of extreme fatigue where resources feel nearly or entirely “used up”; Van Dijk & Swaen, 2003). Chronic emotional fatigue, essentially losing the energy to care, can prevent empathy toward others and is a primary component of employee burnout (Maslach & Jackson, 1981), which we discuss in the next section. Boredom comes from being under-stimulated, as when work-related tasks are monotonous, repetitive, or insufficiently challenging (Smith, 1955; Vodanovich & Watt, 2016). Because boredom is perceptual in nature and individuals differ in their susceptibility to boredom, it is imprecise to consider tasks themselves as inherently boring (Loukidou et al., 2009; Smith, 1955). Instead, boredom can be viewed as the result of poor alignment between workers’ abilities or skills and work demands, such that the demands require much less than what one is capable of doing. This is a challenge at the heart of organizational talent management, matching workers with the right tasks, given that the same tasks may be extremely boring to one worker, but satisfying to another. Burnout and Engagement Worker burnout is perhaps the most researched and popularized negative psychological state targeted by OHP professionals. In popular culture, feeling “burned out” is used to describe feeling exhausted or overwhelmed by work. By definition, though, burnout is a more specific and serious multidimensional phenomenon characterized by chronic emotional and physical exhaustion, cynicism, feelings of inefficacy, and/or depersonalization and disconnection from one’s work (e.g., Demerouti et al., 2001; Maslach & Jackson, 1981). Initially this was thought to be a phenomenon unique to workers who interact heavily with people (e.g., healthcare workers, counselors), but recent perspectives suggest burnout could be experienced in many different work environments (Ahola, Honkonen, Isometsa, et al., 2006; Demerouti et al., 2001). Some key elements to understand are that burnout is a serious chronic state, meaning it does not just develop from one tough week at work. The global prevalence and severity of burnout has garnered the attention of the WHO (2019), which has listed burnout in the international classification of diseases (ICD-11) as a serious occupational phenomenon and is “about to embark on the development of evidence-based guidelines on mental wellbeing in the workplace” (para. 7), adding to their existing efforts for improving mental health in the workplace. As our understanding of burnout increased, researchers began to also recognize an opposing phenomenon now known as engagement. As highlighted by Schaufeli et al. (2002), engagement is generally characterized by vigor (a state of high energy), dedication (a sense of pride or significance in relation to work), and absorption (being immersed in work). Though related, burnout and engagement are not simply opposing ends of the same continuum (Schaufeli et al., 2008). In fact, workers can experience engagement and burnout simultaneously (Timms et al., 2012). There are many individual differences and work and nonwork environmental factors that may contribute to burnout and engagement. In work settings, there is evidence that both engagement and burnout are strongly connected to the balancing of work-related demands and resources. More specifically, and in-line with the JD-R model (discussed more in Chapter 6), burnout develops from a combination of high demands and insufficient resources to meet those demands; engagement is more likely to occur when there are sufficient or abundant resources to meet work demands (Alarcon, 2011; Christian et al., 2011; Demerouti et al., 2001; Lee & Ashforth, 1996). Connectedness and Purpose at Work Decades of social science research have documented that humans have an inherent desire to feel connected to one another and to have a sense of purpose or meaning in life. The absence of social connection and purpose is distressing, while the presence of meaningful connections is fulfilling. This is why a third essential dimension to psychological health involves connections and meaning at work. Loneliness and Isolation In recent years, the “loneliness epidemic” has gained the attention of all kinds of health researchers and media outlets (e.g., National Public Radio; Chatterjee, 2018). Loneliness is not just an undesirable feeling, but a serious risk to our health (Holt-Lunstad, 2017). In a work context, loneliness depends on whether affiliation needs are being met in a worker’s organization (Ozcelik & Barsade, 2018). Related to this, isolation is characterized by insufficient interaction and/or friendship with coworkers, or a general perception of insufficient work-based support from a supervisor or the broader organization (Marshall et al., 2007). Implicit in this definition is that loneliness is perceptual, so one person could feel lonely in the exact same setting that another does not. Unfortunately, loneliness is likely to increase in prevalence and severity as the nature of work changes and remote work arrangements become more common. Meaning, Purpose, and Thriving at Work Having a sense of meaning and purpose in life is an innate human desire, which can seriously impact our health and even our lifespan (Alimujiang et al., 2019). For many people, work is a major source of personal meaning and purpose (i.e., a life aim that creates goals for living; Rosso et al., 2010). Meaningful work or meaningfulness is concerned with the amount of significance that an individual attaches to work and can be conceptualized in a number of ways, such as perceiving the work tasks as personally meaningful, finding meaning in life through one’s work, and generally having a motivation to do “good” through work (Steger et al., 2012). The job characteristics model (Hackman & Oldham, 1976) proposes that meaningfulness is one of three key psychological states generated by certain task characteristics (e.g., skill variety, autonomy, task significance), which together result in an internal motivation to work. Task significance, in which work “matters” for social good, is a particularly strong correlate with meaningfulness (Allan, 2017). Positive states like thriving or flourishing often arise from purposeful work, further creating an enhanced capacity to build and sustain more resources (Fredrickson, 1998, 2000). Flourishing has been described as an optimal state of both experiencing positive emotions and effectively performing in one’s life roles (Keyes, 2002). Thriving is a more specific experience, described as a feeling of personal progress, personal growth through learning, and a sense of vitality (Spreitzer et al., 2005). Spreitzer and colleagues’ (2005) model of thriving at work starts with the premise that thriving is an outcome of active and purposeful behavior at work. You probably have personal examples of this, when your work has allowed you to explore new ideas, feel connected to others, or simply when you truly desire to be doing the work you are doing. Thriving at work is also linked to individual differences (e.g., proactive personality, positive affect) as well as work-related resources that promote thriving (e.g., supportive leaders and coworkers, trust and connection in workgroups; Carmeli & Spreitzer, 2009; Kleine et al., 2019). Psychological Health Disorders Affected by Work Research spanning 33 years and 63 different countries provided estimates that around one in five individuals experiences a serious psychological health problem or disorder in any given year (Steel et al., 2014). Although the severity of psychological disorders and their prevalence within certain populations is quite varied, the important point is that psychological health disorders are not uncommon in the general population. It should be no surprise, therefore, that these disorders are also present in every organization. The underlying causes of psychological disorders are complex, originating from a variety of biological, psychological, and social factors, many of which are present in work environments and associated with work experiences. Table 4.1 summarizes symptoms of several common psychological health disorders and provides examples of how these conditions can affect or be affected by work experiences. Our goal with this table is to improve your general awareness of the signs and symptoms of these disorders, which you may encounter in work settings. Please note that if any long-lasting signs or symptoms like these are observed in yourself or coworkers, it is important to seek help from a mental health professional (as outlined in Figure 4.1). Not all forms of work present the same risks or challenges to workers’ psychological health. At the high end of this risk spectrum, military personnel and first responders are especially likely to experience traumatic events while working, creating a direct and substantial risk for the development of psychological health disorders. Proactive interventions for high-risk contexts to promote psychological resilience are exemplified in programs like Comprehensive Soldier Fitness training (Lester et al., 2011) and peer interventions for responding to acute stress (Adler et al., 2020; Svetlitzky et al., 2019). For all organizations, it is important to recognize that regardless of whether a psychological health disorder is work-related, there is potential for work-related experiences to exacerbate symptoms or be affected by symptoms, as well as for work connections to facilitate help-seeking. Why Worker Psychological Health Matters As noted early in this chapter, psychological health is often seen as a personal problem. Having read up to this point, however, we hope you see that organizations have a responsibility and opportunity to promote and protect workers’ psychological health. In this section, we discuss three main reasons why psychological health is an important resource for organizations. Table 4.1 Symptoms and Work Conditions of Commons Psychological Disorders Psychological Disorder Common Symptoms Connections to Work Major Depressive Disorder (MDD) • • Depressed Mood Little or no interest in activities A general lack of energy Feelings of worthlessness • Anxiety about specific triggers (e.g., social anxiety, phobias) • • • Anxiety • • • Symptoms may interfere with work performance (Kessler et al. 2008) Psychosocial demands increase risk (Wang et al., 2002) workplace social support decrease risk (Netterstrom et al., 2008) Symptoms may interfere with work performance (Kessler et al., 2008) Psychosocial work demands increase GAD risk (Melchiorr et al., 20770 Alcohol Abuse • • • Consuming large amounts of alcohol Difficulty cutting down on use Being distracted by a desire for alcohol at the cost of normal activities • • • ASR includes: • Could occur in response to o Feeling anxious or trauma on-the-job, particularly dazed following a for those in high-risk jobs traumatic event (Bennett et al., 2004; Porter et o Symptoms lasting al., 2018) more than a few • Could occur for an employee weeks may involved in a traumatic incidence characterize Acute outside of work and affect work Stress Disorder performance (ASD) • PTSD includes: o Symptoms last for several weeks or months after a traumatic event o Re-experiencing the event (dreams, flashbacks) o Sensitivity to cues associated with the event o Changes in thoughts or behavior patterns (irritability, easily startled) Note: Disorder Descriptions from the Diagnostic and Statistic Manual of Mental Disorders (DSM-5) and National Center for PTSD (Psychological Health Disorders Affected by Work) https://www.ptsd.va.gov/understand/what/index.asp Acute Stress Response (ASR) and Post Traumatic Stress Disorder • Work stressors exhibit small, significant correlations with alcohol and drug use (Frone, 2008) Consuming alcohol on the job, before a job, or working with a hangover occurs at non-trivial rates (Frone, 2005) Risk may be higher when access is easier (e.g., restaurants) Figure 4.11 Signs That Professional Help Is Needed to Manage a Psychological Disorder Ripple Effects of Good and Bad States It makes sense for organizations to work to promote worker engagement, purpose, and connectedness, as these are positive states that are associated with other positive states and attitudes, including job satisfaction and job involvement (e.g., Christian et al., 2011). Positive states tend to facilitate more positive states and can also mitigate the occurrence and impact of negative states (Allan, 2017; Fredrickson, 1998). Organizations can also directly and actively work to minimize negative states from developing. This guidance is supported by many studies highlighting serious health consequences of negative work-related psychological states. For example, burnout has been related to symptoms of anxiety, depression, sleep disturbances, and alcohol dependence (Ahola, Honkonen, Pirkola, et al., 2006; Peterson et al., 2008). Poor psychological health can also contribute to physical health concerns, such as musculoskeletal pain (Peterson et al., 2008) and other psychosomatic complaints, discussed in Chapter 5. Supporting Psychological Health is Good for Business Meta-analyses show that negative psychological states and conditions (e.g., negative affect, burnout, depression, anxiety) can negatively impact job performance (Ford et al., 2011; Kaplan et al., 2009), work attitudes, and turnover intentions (Alarcon, 2011; Lee & Ashforth, 1996). In contrast, positive psychological states, such as positive affect, thriving, and engagement have been associated with better individual task and 1 We acknowledge and thank Dr. Ashley Howell for her review of this figure and insight based on her Clinical Psychology training and experience. extra-role performance (Christian et al., 2011; Kaplan et al., 2009; Kleine et al., 2019) and business outcomes, like profit, customer satisfaction, and productivity (Harter et al., 2002). Considering a financial argument in more detail, Goetzel and colleagues (2004) estimated that a single American worker experiencing a psychological health concern (i.e., depression, mental illness, or sadness) could cost a company $348 per year (based on an average salary). This cost was associated with absences, employer-provided costs for treatment, and lost productivity due to symptoms. Other estimates suggest that the costs of presenteeism (i.e., being at work while experiencing psychological health symptoms) are three times that of costs associated with absence or turnover (Hampson et al., 2017). With these figures, we are not advocating for workers to stay home when struggling with psychological health challenges; indeed, work can often provide muchneeded resources (e.g., social support, achievement) that help with managing these challenges (Karanika-Murray & Biron, 2019). Rather, these financial estimates highlight costs that could be avoided or reduced through efforts to promote and protect workers’ psychological health. Related to this, there is increasing evidence that supporting workers’ psychological health can generate a positive return on investment (ROI), potentially as high as 4.2:1 (Hampson et al., 2017). Quasi-experimental studies have found that employees who utilize their organization’s EAP end up reporting fewer absences, utilizing less sick leave, and demonstrating less presenteeism (Nunes et al., 2017; Richmond et al., 2017). Although employees are not equally likely to use available psychological health resources, like EAPs, when they experience personal challenges, the available empirical evidence does suggest these programs may be valuable and worth providing and promoting (Spetch et al., 2011). Organizations Can Initiate Larger-Scale Change There is a real opportunity to work through organizations to protect and promote worker psychological health, and thereby positively impact workers, their families, communities, and society more broadly. Psychological health problems are expensive to address and collectively present a global public health issue; depression alone is a leading cause of disability worldwide (WHO, 2020). Beyond the economic costs, more attention to psychological health is critical in building greater awareness of common psychological health concerns and reducing stigma that can be a substantial treatment barrier (Clement et al., 2015). Proactive efforts by employers to counter stigma associated with psychological health and provide practical resources and benefits to support psychological health (e.g., EAP, educational workshops) can improve workers’ access to care and likelihood of actually seeking help when needed. Methodological Considerations and Practical Recommendations Building on what we have discussed about essential “good” and “poor” psychological states and the impact these states can have on workers and organizations, we can now focus on how work can be designed, modified, and experienced to promote psychological health. Measuring and Monitoring Psychological Health Efforts to support workers’ psychological health often start by gathering and analyzing a variety of data. Self-report methods are commonly used when assessing psychological states, which are inherently personal and perceptual in nature. Basic measures of positive or negative states can be easily incorporated into employee surveys, including established measures for engagement and burnout (Schaufeli et al., 2002), positive and negative affect (Watson et al., 1988), boredom (Vodanovich & Watt, 2016), or meaningfulness of work (Steger et al., 2012). There are also validated assessments for psychological disorders, but we would caution against using these measures haphazardly in an employment setting to limit unintended and illegal consequences associated with resulting scores and to ensure that they are not used without a plan for responding to indicators of a clinically significant disorder. Beyond assessing psychological states, you may want to know about the psychological health climate that workers perceive in an organization. A positive psychological safety climate, in which workers feel that the organization values psychological health, can be associated with less job strain and fewer depressive symptoms (Bailey et al., 2015). There are also measures that individuals, particularly managers, can complete to indicate personal stigmatizing beliefs about mental health problems (Martin & Giallo, 2016). Self-reported, cross-sectional surveys are valuable tools for efficiently gathering data to describe the state of psychological health within an organization, but other methods may also be helpful and more appropriate in some situations. Longitudinal surveys can gather evidence pertaining to stability or change in psychological states, which can be important to track if there are specific organizational events happening that might contribute to or detract from worker psychological health (e.g., critical incidents, organizational restructuring, workspace upgrades). Experience sampling or daily diaries may be necessary for understanding short-lived psychological states, such as feelings of connectedness, boredom, or frustration associated with specific work tasks or situations (e.g., Daniels et al., 2012; Dimotakis et al., 2011). Finally, organizational metrics (e.g., absences, short-term disability claims, performance ratings) can be decent indicators of psychological health concerns (Goetzel et al., 2002) and are useful when working to show intervention-related cost savings or ROI. These data need to be analyzed and interpreted with care as their meaning is not always crystal clear (e.g., a recorded absence may be health-related, or due to lack of transportation or motivation). Intervening to Support Psychological Health We want to close out this chapter by exploring strategies for improving worker psychological health through interventions at a variety of levels. Note that these recommendations apply to efforts to protect and promote generally positive psychological health; more severe negative psychological health matters may require person-specific, clinical interventions managed by a licensed mental health care professional. Strategies for Individuals Many training options and resources can help workers gain the knowledge and skills needed to be psychologically healthy. One large area of research that supports worker psychological health pertains to stress and recovery management, which we discuss more in Chapter 6. Other options target psychological health at the person level more directly. Perhaps the most researched interventions to protect worker psychological health come from interventions originally developed for military personnel, but which have clear translational potential to other work environments. As one example, the “Comprehensive Soldier Fitness (CSF) program likely represents the largest deliberate psychological intervention in history…” (Lester et al., 2011, p. 77). Based on positive psychology principles, CSF involves proactively assessing workers’ emotional, social, family, and spiritual fitness, to then offer individualized modules for building fitness (i.e., resources) in each domain. The “fitness” label is a smart strategy to contextualize psychological health into a language that is particularly valued in the military, but also likely to translate well into other work settings. Group trainings to facilitate positive psychological health have also been developed for building resources in several domains. For instance, “social fitness” has been targeted through social resilience training, which can increase social awareness skills and reduce loneliness (Cacioppo et al., 2015). Battlemind training is another example, designed to help Soldiers return to civilian life, following a combat deployment (Adler et al., 2011). Central goals of this training are to increase perceptions of control and normalize adjustment difficulties a Soldier may experience. These concepts could apply to any worker navigating an important change, like a stressful new job assignment or returning from leave. Psychological health can be targeted in any setting with positive psychology type interventions. Kaplan and colleagues (2013) compared two such online interventions targeting gratitude and social connection among university workers. The implementation itself was pretty simple: Email reminders asked workers to pause during the day to think about things they were grateful for at work or ways they had attempted to connect with others. Both the gratitude and social connectedness interventions related to fewer work absences; the gratitude intervention also related to experiencing more positive states. These findings are really promising, as they suggest that small intentional efforts in the workplace can positively affect worker psychological health and actual behaviors. Any type of person-level intervention, however, will only be successful when supported by others in the organization. For instance, offering a gratitude intervention in a toxic work culture (e.g., asking workers to be grateful when they feel entirely uncared for by the organization) could do more harm than good. Similarly, efforts to promote psychological health are unlikely to be successful in organizations that simultaneously impose overwhelming work demands or require workers to function in physically unhealthy environments. Strategies for Groups Workgroup interventions can also be an effective way to promote and protect worker psychological health. Workgroups tend to experience similar emotions (Barsade & Gibson, 2012), so a positive or negative emotional tone in a workgroup is likely to engender corresponding positive or negative worker emotions. Similarly, workgroup norms that support psychological health can positively impact worker psychological health. Unfortunately, unsupportive norms and perceived stigma around psychological health disorders can be a big barrier to treatment (Clement et al., 2015) and even reduce workers’ desire to disclose psychological health concerns (Meinert, 2014). Training focused on improving workgroup climate around seeking psychological health treatment has been effective in military settings (e.g., Britt et al., 2018; Start et al., 2020) and likely could translate well into any work environment by encouraging workers to talk more openly about psychological health concerns and learn how to support each other. Along these lines, studies have found that interventions to improve workplace social support can reduce burnout and benefit psychological health (Heaney et al., 1995; Le Blanc et al., 2007). Workgroups can also be a resource by monitoring and detecting psychological problems in peers, particularly if workers are trained on what to watch for. Acknowledging this, the Israeli Defense Forces developed the YaHaLOM training (Svetlitzky et al., 2019) to help Soldiers provide peer support to team members experiencing an acute stress reaction while in a combat or otherwise dangerous situation. This intervention involved a few key steps to quickly try to shift a traumatized person’s state of helplessness to one of effective functioning: connect with the person, ask simple questions, confirm what has happened and what will happen, and provide a direct action to reestablish a sense of mastery. Trained Soldiers reported greater knowledge and confidence for managing an acute stress reaction of a peer. This intervention, renamed iCOVER, has also been implemented in the U.S. Army (Adler et al., 2020) and the principles in this approach can apply just about anywhere—if you see a worker who seems overwhelmed, talk with them. Can you help them to re-establish a sense of control or mastery in that immediate moment? Remember, OHP interventions do not have to be complex. Strategies for Leaders Leader interventions are a third approach to promoting worker psychological health. For interested readers, the Chartered Institute of Personnel Development, in collaboration with Mind (based in the United Kingdom; 2018) put together a practical guide for managers to support psychological health and well-being. Here are a few key ways leaders can support worker psychological health: (1) proactively manage work in a way that supports psychological health, given the control leaders have (e.g., over work tasks; scheduling); (2) control personal emotional displays, since workers tend to experience states similar to that displayed by their leader (Johnson, 2008); and (3) minimize practical barriers to treatment seeking (e.g., time to attend appointments). One strong strategy is to train leaders to recognize common symptoms of a psychological health concern and teach them how to appropriately respond. A strong example of this is the mental health awareness training (MHAT) developed for supervisors (Dimoff et al., 2016). The MHAT is based on the idea that knowledge and awareness of psychological health disorders tends to increase the likelihood of people speaking up when there is a problem and watching out for problems in others. The key mechanism here is knowledge transfer and changes in attitudes, with the ultimate goal of influencing the behavior of leaders and those they supervise. In a couple of different samples, the MHAT improved supervisor knowledge, attitudes, and self-efficacy around supporting mental health. In one sample, there was even a significant decrease in length of mental health disability claims in the nine months following the intervention, providing a powerful financial argument for the training’s value. Data gathered from subordinates of trained supervisors affirmed that workers also perceived changes in their supervisor’s support for mental health (Dimoff & Kelloway, 2019) and were more willing to seek out and use mental health resources compared to those with supervisors who were not trained. Similar short and internet-based trainings along these lines, have also shown promise for improving supervisor attitudes toward mental health concerns by increasing awareness and demonstrating the business case for proper treatment of symptoms (Shann et al., 2019). Strategies for Organizations As emphasized throughout this chapter, there is a lot that can be done organization-wide to support worker psychological health. Combining organizational interventions with person-level efforts can yield results greater than either approach separately (Awa et al., 2010). At a basic level, organizational policies and practices regarding the design and structuring of work matter. Consistent with JD-R theory, high workloads without sufficient corresponding resources can result in poor psychological health and burnout (Bowling et al., 2015) and can make it difficult for workers to foster social connections, which are increasingly recognized as essential to our psychological health (Holt-Lunstad, 2017). Hollis (2019) and Stallard (2019) use the Mayo Clinic as an example of an organization that made changes to facilitate social connections among physicians. Specifically, they changed their pay system for physicians to more stable salary-based structure, to increase cooperation instead of competition among physicians. They also started a program that facilitated more frequent physician interaction. Strategic and flexible scheduling throughout an organization can not only increase opportunities for connection and collaboration, but it can also provide more opportunities for recovery which has a number of benefits for psychological health (discussed more in Chapter 6). When significant psychological health concerns do arise, organizations need to be prepared to help, regardless of whether such concerns originate from work or nonwork factors. There are unfortunate stories of organizations attempting to ignore such issues, even to the point of terminating employees who disclose a psychological disorder (Meinert, 2014); this is not an acceptable practice (nor is it legal, in many countries). Instead, organizations have a responsibility and opportunity to provide resources to promote and protect worker psychological health. For example, providing access to an EAP that includes psychological health benefits is an example of an organization-level intervention that supports workers and also may benefit the organization by reducing absences and sick time, and increasing productive time at work (Nunes et al., 2017; Richmond et al., 2017). Such programs can also provide needed resources and even cost savings when critical organizational incidents occur (Attridge & VandePol, 2010). Even if your organization does not have the means to provide an EAP or other formal program, any organization can make an effort to provide a list of mental health professionals and other resources for workers, and flexibility to attend appointments when needed. Organizations of all forms can also develop and sustain cultures in which psychological health is valued and protected, and those working to improve their psychological health are supported and encouraged. Such actions can make a huge difference in employees getting the help they may need when encountering a psychological health concern. Evaluating Psychological Health Interventions In addition to the guidance on intervention evaluation covered in Chapter 2, there are a few essential evaluation recommendations to especially keep in mind with psychological health interventions. Be creative and think broadly about data that can be monitored as indicators of workers’ psychological health. Gathering data on changes in workers’ psychological states is a good place to start, but ongoing measurement of worker perceptions of psychological safety, support for psychological health, and personal willingness to utilize psychological health resources or talk with peers or supervisors about psychological health concerns may also be valuable. Psychological health is a broad area of study and impact, so it is important to cast a wide net, as Dimoff and colleagues did when evaluating the MHAT (Dimoff & Kelloway, 2019; Dimoff et al., 2016). Gathering additional data from spouses, significant others, and/or family members may also be valuable, particularly in research efforts to more fully understand the impact of intervention efforts. Because psychological health interventions may take a long time to yield their full effects, it is important to develop an evaluation strategy that involves data gathered over time. Long-term impact can be assessed in various ways, including workplace absences, disability claims, or even costs associated with prescription drug use, which was an outcome of interest in a recent study by Dahl and Pierce (2020). With any of these outcomes, we have to think realistically about how long these effects would take to occur and adjust our assessment timeline accordingly. It is also important not to interpret single data points in the absence of the broader context that longitudinal data can provide – for example, a mental health awareness training may initially result in more employees reporting psychological health concerns than were reported prior to the training. This outcome does not mean the training was ineffective or harmful; instead, these results may indicate improved recognition of symptoms and support for the disclosure of such concerns. Open-ended interview or focus group data may be really important in helping you understand some of these types of unexpected results (e.g., Shann et al., 2019). Concluding Thoughts and Reality Check In this chapter, we have explored how work affects our psychological health and how our psychological health affects our work. When psychological health among workers is not positive and strong, the whole organization can suffer. This makes managing workers’ psychological health an organizational priority. Organizations also have an opportunity to foster positive psychological states that can yield value far beyond the boundaries of the work environment. A number of effective interventions to promote and protect worker psychological health have been developed and tested; it is possible to help workers experience positive psychological states at work. Most OHP professionals rally behind the belief that all workers deserve the opportunity to experience full psychological health. This means not just living without symptoms, but having the opportunity to flourish and thrive. Managing worker psychological health is not easy, as many workers simultaneously manage psychological health challenges linked with factors from multiple life domains (e.g., migrant workers struggling to find stable work; low-wage workers unable to make ends meet). The breadth of psychological challenges managed by workers presents an opportunity for OHP and related mental health professionals to have a broad impact by using what we know about work and what we know about psychological health to make a lasting and meaningful impact.. Media Resources • News story exploring how a construction company prioritizes psychological health: https://www.npr.org/sections/health-shots/2019/12/12/783300736/a-constructioncompany-embraces-frank-talk-about-mental-health-to-reduce-suicide • Magazine article examining how loneliness affects workers: https://www.forbes.com/sites/nextavenue/2020/02/25/whos-lonely-at-work-andwhy/#502925970379 • Trade publication article discussing the impacts of COVID-19 on workers’ psychological health: https://hrexecutive.com/american-workers-are-worried-whythats-a-problem-for-hr/?eml=20200715&oly_enc_id=0230A1877812A1U Discussion Questions 1. Psychological health is often a very personal topic. To what extent should organizations be involved in monitoring or providing support for workers’ psychological health? 2. What do we understand about the relationship between work and psychological health and well-being? 3. Pick a specific job and describe the psychological health risks that an employee in this particular job may experience, as well as opportunities for positive states they may experience from their work. Propose two or three intervention strategies to address one or two of the psychological health risks. 4. What role(s) do EAPs play in supporting workers’ psychological health? Explain the value of this type of resource for an organization and its workers. Professional Profile: Amy Adler, Ph.D. Country/region: USA, Maryland Current position title: Senior Science Consultant, Center for Military Psychiatry and Neuroscience and Acting Director, Research Transition Office at the Walter Reed Army Institute of Research Background: I have a B.A. in economics from Brown University, and a M.A. in psychology and a Ph.D. in clinical psychology from the University of Kansas. I completed an APA-approved clinical internship at the Illinois Masonic Medical Center and a fellowship at Ravenswood Hospital Medical Center, both in Chicago; I then obtained my license in clinical psychology. After my doctorate, I moved to Europe and was able to get three different jobs with the US military community: working as a clinician in an Army hospital, teaching at the University of Maryland’s overseas program, and conducting research. Eventually, I focused on research and that path has provided me with a range of amazing opportunities to work on issues impacting employees in high-risk occupations like the military. I am currently an associate editor of the Journal of Occupational Health Psychology, and am a fellow in the American Psychological Association’s Society for Military Psychology. My area of expertise is at the intersection of behavioral health, resilience, performance, traumatic stress, and leadership within high-risk occupations. I am an applied researcher, focusing on how we can use psychology to support service members effectively. I also co-manage the Army’s Psychological Health, Resilience and Well-being research program, which incorporates a range of projects from epidemiology to smallteam interventions. In addition, I lead a group responsible for developing interventions and conducting randomized trials, program evaluation and science implementation studies within the Army. How my work impacts WHSWB: Everything I work on in some way is related to the health, well-being and performance of service members, and much of what we do has direct implications for other kinds of workers, particularly those serving in high-risk occupations like firefighters and police. One of our current projects is examining an intervention we call ‘iCOVER.’ iCOVER is a new rapid, peer-based intervention for individuals to use with team members exhibiting signs of acute stress in the midst of a dangerous occupational event like combat. The concept was originally developed by the Israel Defense Forces, and we worked with the program lead to adapt the training for the US context. Before iCOVER, US service members had no systematic technique to use if one of their team members experienced an acute stress reaction, potentially endangering themselves and others. We did not even know how often acute stress reactions happened or whether this kind of temporary and shifting stress reaction increased the risk of subsequently developing mental health problems like PTSD. Since beginning the project, we have conducted a randomized trial with US service members in a realistic training setting and are now working with deployed troops. This kind of research has the potential to have a meaningful and direct impact on worker health, safety, and well-being, extending beyond the military population, to others engaged in high-risk team-oriented occupations. My motivation: It is satisfying to address real-world challenges that confront service members, knowing that our work has the potential to make a difference. The job entails a range of problem-solving tasks, and involves working with policy makers, military leaders, and expert scientists across a range of disciplines. The work is fast-paced and every day is different. 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