STRESS MANAGEMENT IN SCHOOL TEACHERS:
PERSONAL AND/OR WORKSITE CHANGE?
Sibilia Lucio
Department of Clinical Sciences, Università degli Studi di Roma "La Sapienza" (Italy)
Borgo Stefania
Center for Research in Psychotherapy - Roma (Italy)
in cooperation with: Provveditorato agli Studi di Roma e Provincia
Problem. This study assessed the feasibility and effectiveness of a cognitive-behavioural intervention program
aimed at reducing psychosocial stress and preventing burn-out in school teachers, both by teaching and
fostering individual self-management skills and targeting awareness of context-dependent stress factors.
Procedure. 50 school teachers were selected by several Schools of the County of Rome to participate to the
Program, among those who had the responsibility of health education, 15 others voluntarily joined. The
assessment battery comprised an ad hoc questionnaire for "Stress Symptoms" (SS) and the Automatic
Thought Questionnaire (ATQ) by S. Hollon & P. Kendall, for anxious and depressive thinking.
Method. The program was implemented in six 5 hour workshops in one of the Schools. The group was
divided into 2 parallel sub-groups to allow for individual participation. Basic notions about psychosocial
stress were taught; techniques used were emotional and cognitive self-monitoring, muscular relaxation, and
basic information about dysfunctional beliefs and imagery. Moreover, a group work was carried on for
identifying work-site stress factors, and for constructing in a co-operative climate an assessment instrument.
Results. Compared to baseline, final measures showed a significant reduction in ATQ scores (from 45.8 to
41.2, p<.007), and a more pronounced reduction in SS (from 24.45 to 15.15, p<.05). Albeit the
seasonal differences between baseline and final assessment could only exert a contrasting influence, the
program was felt as useful for managing stress at personal level, albeit its introductory nature, and provided
evidence of reduction of stress scores up to 38% and improvement of well-being in participants.
Key-words: Stress Management, Self-Monitoring, Worksite Health Promotion, School Teachers.
Background
School teachers as a professional group are exposed to high risk of developing stress-
related conditions and burn-out (Capel, 1987; Hisashige, 1993; Knoop, 1989; Fontana &
Abouserie, 1993; van Horn, Schaufeli, Greenglass, Burke, 1997; Georgas & Giakoumaki,
1984), for a number of reasons:
· Pupils' misbehaviour, especially from low income areas (Boyle, Borg, Falzon, Baglioni,
1995; Anonymous, 1993; Kornblit, 1992; Williams, Winfree, Clinton, 1989; Cotten,
Resnick, Browne, Martin, McCarraher, Woods, 1994).
· Difficulties stemming from lack or scarcity of time or of other resources, specially
those related to organizational changes (Malanowski & Wood, 1984; Hart, Wearing,
Conn, 1995).
· Unfulfilled needs of professional recognition (Boyle et al., 1995; Pedrabissi, Rolland,
Santinello, 1993).
· Poor relationships with peers, administration or parents (Knoop, 1994; Boyle et al.,
1995).
Stress Management in School Teachers: personal and/or worksite change? ___________________________
Such occupational stress has been shown so far to produce:
· Low job satisfaction, rise in absenteeism (DeFrank & Stroup, 1989; Pierce & Molloy,
1990; Galloway, Panckhurst, Boswell, Boswell, Green, 1984; Santangelo & Lester,
1985).
· Age-related decreases in performance efficiency (Dalbokova & Kolev, 1994).
· Increase in blood pressure as compared to other occupations groups (Deianov,
Khadzhiolova, Mincheva, 1995).
· Higher rates of severe psychological distress (Finlay-Jones, 1986; Sapir, Keidar,
Mathers-Schmidt, 1993).
· Use of ineffective or counterproductive teaching strategies (McNeill & Jordan, 1993;
Messing, Seifert & Escalona, 1997; Kagan, 1989; Knoop, 1989).
It is then legitimate to assume that the morale, the quality of life itself of teachers -
apart from the quality of teaching - would benefit from a stress management program
(Kornblit, 1992; Sibilia & Borgo, 1993; Vonken & Sibilia, 1993).
Acceptance, perceived benefits and true effectiveness of such an intervention has not been
properly evaluated so far.
It was decided that intervention would have been best implemented in the worksite,
not only for practical reasons, but also for addressing context-dependent sources of
stresses (Allegrante & Michela, 1990; Sibilia, Fida, Clemente, Valeo, Borgo, 1987).
Finally, intervention has been implemented using cognitive-social learning methods, as it has been
posited that it should be best accepted than other approaches, given the teachers'
professional conceptual framework and familiarity with learning methods (Stanton, 1989).
General Research Design
This study has been conceived as a preliminary study for a more general
intervention program, aiming at reducing psychosocial stress in the professional group of
teachers of the County of Rome. Moreover, the study has been designed to provide a
detection and measurement instrument, in the form of a questionnaire, to assess teachers'
sources of stress, to use in future screenings. The foreseen phases therefore are as follows:
1. Feasibility study (the present study)
2. Screening for:
A. stress symptoms/problems, and
B. working stressors of teachers
3. Intervention study:
a) Information about work stress, stressors, and coping.
b) Stress management groups, to foster effective coping and cooperative climate to
address organisational changes aiming at reducing stressors.
c) Psychotherapic info/referral consultation service.
d) Working groups at local level for organisational change, and transfer of
knowledge about professional stress.
Aims of the Study
This study aimed at assessing the feasibility and the effectiveness of a cognitive-
behavioural intervention program aimed at reducing psychosocial stress and preventing
burn-out in school teachers, implemented in a group format in the worksite. The program
was devised to pursue these above goals by:
342
__________________________________________ Neuropsychophysiology and Behavioural Intervention
1. teaching and fostering individual self-management skills,
2. increasing the cooperative climate of the school, and
3. targeting awareness of context-dependent stress factors.
Subjects
50 school teachers were selected by the Administration of several Schools of the
County of Rome to participate to the Program, among those who had the responsibility of
health education. A few others voluntarily joined. Final participants were N=65. They were
22% males, 78% females, of average age 47 years of age, with an average 20 years of
teaching.
Assessment
The assessment was performed twice: at the beginning of the first encounter and at
the end of the last. The battery comprised two questionnaires:
"Stress Symptoms" Questionnaire (SSQ): It measures stress-related somatic symptoms and
complaints. A scale prepared ad hoc for this study, by translating and adapting a
questionnaire by L.H. Miller, composed of 69 Lickert-type items. It includes 7 subscales:
1. Muscular and joint complaints
2. Parasympathetic symptoms
3. Orthosympathetic symptoms
4. Emotional problems
5. Cognitive dysfunctions
6. Endocrine symptoms
7. Immunological disorders
Automatic Thoughts Questionnaire (ATQ): It is a self-administered questionnaire by S. Hollon
and P. Kendall (1986, translated by L. Sibilia), composed of 30 Lickert-type items (5 steps);
it measures the frequency of automatic self-thoughts producing troubling emotions such as
anxious and depressive mood, a common component of distressing conditions. The scores
may vary from 30 up to 150.
Intervention Method
The program was implemented in six 5 hour workshops in one of the Schools,
convened every two weeks, for a total professional time (including assessment) of 30 hours,
from Nov. 1998 to Jan. 1999.
Each workshop, run during the afternoon, was composed of two units, each
comprising a lecture and practical training.
The group was divided into 2 parallel sub-groups to better allow for individual
participation. Each sub-group followed the same program and was lead by one of the
Authors.
Basic notions about psychosocial stress were initially provided.
Reciprocal interviewing techniques were taught and practised to foster a cohesive
group climate (Rose, Tolman, Tallant, 1985).
Techniques used were emotional and cognitive self-monitoring and muscular
relaxation, the latter implemented in the school gym. Self-monitoring was given as
homework and then verified.
343
Stress Management in School Teachers: personal and/or worksite change? ___________________________
Basic information about dysfunctional beliefs and imagery was provided, together
with practice with examples from the participants.
A group work was also carried out for identifying occupational stress factors in the
worksite, and for constructing an assessment instrument reflecting the participants'
experience, in a co-operative climate.
A final discussion was guided in order to strengthen the motivation to use the
learned techniques, and to assess the chances of (and build-up the motivation for) changing
the identified organisational factors.
Results
Effectiveness
Results are reported in the following Table and Figures. Table 1 show Average
scores of Stress Symptoms Questionnaire (with subscales) and of Automatic Thoughts
Questionnaire at baseline and at the end of the Stress Management Program, with
Student's t comparisons.
Baseline End p(t)
Somatic symptoms of stress
Total score 24.45 15.15 .049
Muscular and joint complaints 3.29 1.95 n.s.
Parasympathetic symptoms 2.67 1.95 n.s.
Orthosympathetic symptoms 3.76 2.86 n.s.
Emotional problems 5.38 3.62 n.s.
Cognitive dysfunctions 3.81 2.57 .046
Endocrine symptoms 2.33 .095 .008
Immunological disorders 2.50 .80 .023
Automatic Thoughts
Questionnaire
(Anxiety/Depress.): 45.8 41.2 .007
TAB. 1
Fig. 1 show average scores of SSQ and ATQ at baseline and at end of the Stress
Management Program; and fig. 2 show average scores of SSQ subscales at baseline and at
end of the Stress Management Program
344
__________________________________________ Neuropsychophysiology and Behavioural Intervention
FIG. 1
FIG. 2
345
Stress Management in School Teachers: personal and/or worksite change? ___________________________
Participants' evaluation
A self-administered questionnaire at the end of program provided the following
data:
I have participated to the Course (in order to judge it) enough or in full 96.3%
The Course goals match my expectations enough - very
much 92.9%
The Course achieved its goals enough - highly 92.9%
The Course has balanced theory and practice enough or much 78.6%
Clarity of theoretical lectures has been enough - very high 100.0%
Practical trainings have received supervision enough or high 92.9%
Duration of the Course (total hrs.) has been insufficient 46.4%
Duration of each Workshops (hrs.) has been enough or marked 77.7%
Number of participants has been enough 78.6%
Resources and format (schedules, facilities) have been
adequate enough 75.0%
I consider to have gained awareness of stress problems enough or marked 100.0%
I have gained new knowledge on stress in teaching
profession enough or much 85.2%
I have gained better skills in appraising/managing my enough - very
own stress much 85.2%
I have gained better skills in appraising/managing
others' stress enough or much 51.8%
I consider I am able to use what I learned in my
profession scarcely 46.4%
I consider I am able to use what I learned in my private enough - very
life much 89.3%
I consider the usefulness to develop some of the Course
topics enough or high 74.1%
Summary
Effectiveness: as compared to baseline, the final measures showed a significant
marked reduction in the frequency of anxious-depressive thinking (ATQ scores: from 45.8
to 41.2, p<.007), and a more pronounced reduction in stress-related somatic symptoms
(SSQ scores: from 24.45 to 15.15, p<.05).
Participants' evaluation: the program was felt as satisfactory in many respects, and
useful for monitoring and managing stress at personal level, albeit its introductory nature,
and its duration which was considered insufficient by many.
It is to note that it was not possible to use a control group for organisational
reasons. However, it is very unlikely that the seasonal differences between the baseline
period (early November) and the moment of the final assessment (late January) have
exerted an influence favouring a reduction in target measures.
A contrasting influence towards the effects of the program is rather more likely: in
fact, teachers' activity was unanimously appraised as more stressful and hectic in the latter
period as compared to the baseline, still close to the beginning of the school year.
346
__________________________________________ Neuropsychophysiology and Behavioural Intervention
Comments
The study has provided evidence that a cognitive-behavioural stress management
program targeted to school teachers, and implemented in the worksite, is feasible, well
accepted, and efficient in the short term, to reduce subjective symptoms and problems
related to psychosocial stress. Effects have been found most significantly both in terms of
reduction of distressful thinking, and of reduced complaints pertaining to cognitive
dysfunctions, endocrine and immunological systems.
The implemented program was also cost-effective as 65 subjects could attend the
workshops, using in total 60 hours of professional time.
Particular care seems to be necessary to secure from the School administration the
needed organisational conditions to allow full attendance of participants.
Further studies, however, would be necessary to:
1- confirm these findings, also in the long term,
2- assess its effectiveness in:
a)improving the quality of teaching,
b)reducing the teachers' risk of burn-out in the long run,
c) reducing the context-dependent sources of occupational stress.
Moreover, from the present study, it is not possible to disentangle the effects of the
stress management program implemented from those possibly deriving form the
cooperative climate produced in the common effort at identifying and defining the context-
dependent sources of professional stress.
References
Allegrante, J.P., Michela, J.L. (1990). Impact of a school-based workplace health promotion
program on morale of inner-city teachers. J Sch Health , 60 (1), 25-28.
Anonymous (1993). Expectations and ideals of the American teacher, 1992. Stat Bull Metrop
Insur Co, 74 (3),10-17.
Boyle, G.J., Borg, M.G., Falzon, J.M., Baglioni AJ, J.r. (1995). A structural model of the
dimensions of teacher stress. Br J Educ Psychol , 65 (Pt 1), 49-67.
Capel, S.A. (1987). The incidence of and influences on stress and burnout in secondary
school teachers. Br J Educ Psychol, 57 (Pt 3), 279-288.
Cotten, N.U., Resnick, J., Browne, D.C., Martin, S.L., McCarraher, D.R., Woods, J. (1994).
Aggression and fighting behavior among African-American adolescents: individual
and family factors. Am J Public Health, 84 (4), 618-622.
Dalbokova, D., Kolev, P. (1994). Mental capacity changes in school teachers. Rev Environ
Health, 10 (1), 51-56.
DeFrank, R.S., Stroup, C.A. (1989). Teacher stress and health; examination of a model. J
Psychosom Res, 33 (1), 99-109.
Deianov, K.h., Khadzhiolova, I., Mincheva, L. (1995). Chronic occupational stress and the
cardiovascular risk in teachers. Probl Khig, 20, 81-90.
Finlay-Jones, R. (1986). Factors in the teaching environment associated with severe
psychological distress among school teachers. Aust N Z J Psychiatry, 20(3), 304-313.
Fontana, D. and Abouserie, R. (1993). Stress levels, gender and personality factors in
teachers. Br J Educ Psychol, 63 (Pt 2), 261-270.
347
Stress Management in School Teachers: personal and/or worksite change? ___________________________
Galloway, D., Panckhurst, F., Boswell, K., Boswell, C., Green, K. (1984). Mental health,
absences from work, stress and satisfaction in a sample of New Zealand primary
school teachers. Aust N Z J Psychiatry, 18 (4), 359-363.
Georgas, J., Giakoumaki, E. (1984). Psychosocial stress, symptoms, and anxiety of male
and female teachers in Greece. J Human Stress, 10 (4), 191-197.
Hart, P.M., Wearing, A.J., Conn, M. (1995). Conventional wisdom is a poor predictor of
the relationship between discipline policy, student misbehaviour and teacher stress.
Br J Educ Psychol, 65 (Pt 1), 27-48.
Hisashige, A. (1993). Occupational influences relative to the burnout phenomenon among
Japanese nursery school teachers. Environ Res, 63 (2), 219-228.
Hollon,S., Kendall, P., Lumry, A. (1986) Specificity of depressotypic cognitions in clinical
depression. J Abnorm Psychol, 95, 52-59.
Kagan, D.M. (1989). Inquiry mode, occupational stress, and preferred leadership style
among American elementary school teachers. J Soc Psychol, 129 (3), 297-305.
Knoop, R. (1989). Locus of control: a work-related variable? J Soc Psychol, 129 (1), 101-106.
187. Knoop, R. (1994). Relieving stress through value-rich work. J Soc Psychol,
134(6), 829-836.
Kornblit, A.L. (1992a). Stress of teachers and students' violence. Acta Psiquiatr Psicol Am
Lat, 38 (1), 63-68.
Malanowski, J.R., Wood, P.H. (1984). Burnout and self-actualization in public school
teachers. J Psychol, 117 (1st Half), 23-26.
McNeill, J.H., Jordan, L.J. (1993). Factors that contribute to stress as reported by teachers
of deaf students at residential schools. Am Ann Deaf, 138 (3), 284-287.
Messing, K., Seifert, A.M., Escalona, E. (1997). The 120-S minute: using analysis of work
activity to prevent psychological distress among elementary school teachers. J Occup
Health Psychol, 2 (1), 45-62.
Montalvo, A., Bair, J.H., and Boor, M. (1995). Teachers' perceptions of occupational stress
factors. Psychol Rep, 76 (3, Pt 1), 846.
Pedrabissi, L., Rolland, J.P., Santinello, M. (1993). Stress and burnout among teachers in
Italy and France. J Psychol, 127 (5), 529-535.
Pierce, C.M. and Molloy, G.N. (1990). Psychological and biographical differences between
secondary school teachers experiencing high and low levels of burnout. Br J Educ
Psychol, 60 (Pt 1), 37-51.
Santangelo, S., Lester, D. (1985). Correlates of job satisfaction of public school teachers:
moonlighting, locus of control, and stress. Psychol Rep, 56 (1). 130.
Sapir, S., Keidar, A., Mathers-Schmidt, B. (1993). Vocal attrition in teachers: survey
findings. Eur J Disord Commun, 28 (2), 177-185.
Rose, S.D., Tolman, R., Tallant, S. (1985) Group process in cognitive-behavioral therapy.
Behavior Therapist, Apr 8(4) 71-75.
Sibilia L., Borgo S., (Eds., 1993) Health Psychology in Cardiovascular Health and Disease. Roma:
C.R.P.
Sibilia L., Fida A., Clemente P., Valeo M., Borgo S. (1987). First Program in Italy for
Modification of Coronary-prone Lifestyle in Healthy Subjects. In J.P. Dauwalder,
M. Perrez, V. Hobi (eds,), Controversial Issues in Behaviour Modification - Annual Series of
European Research in Behavior Therapy, 2nd vol., Amsterdam: Swets & Zeitlinger.
Stanton, H.E. (1989). Hypnosis and rational-emotive therapy--a de-stressing combination: a
brief communication. Int J Clin Exp Hypn, 37 (2), 95-99.
348
__________________________________________ Neuropsychophysiology and Behavioural Intervention
van Horn, J.E., Schaufeli, W.B., Greenglass, E.R., Burke, R.J. (1997). A Canadian-Dutch
comparison of teachers' burnout. Psychol Rep, 81(2), 371-382.
Vonken E., Sibilia L. (1993). Psicologia per la Prevenzione nella Comunità [Psychology for
Community Prevention]. Roma: C.R.P.
Williams, L.E., Winfree LT, J.r., Clinton, L. (1989). Trouble in the schoolhouse: new views
on victimization, fear of crime, and teacher perceptions of the workplace. Violence
Vict, 4 (1), 27-44.
Part of this paper was presented at the 13th Conference of the European Health Psychology Society (EHPS),
Florence, Italy October 1-3 1999, and at the CIANS Conference '99 - COGNITIVE AND BEHAVIOURAL
METHODS AND STRATEGIES IN HEALTH PROMOTION, Napoli, Italy, 27-28 November 1999
We are indebted to Prof. Paolo Norcia, Head of the Directorate of Schools of Rome and Province, for
having allowed and supported the Program with a Grant of the County of Rome (Italy).
Dr. Lucio Sibilia, MD
P.O. Marucchi, 5 - 00162 Roma (Italy)
Lucio.Sibilia@UniRoma1.it
349