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					      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:

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__________________________________________ 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




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__________________________________________ 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.




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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.


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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




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Description: An intervention study on stress in school teachers performed in Rome, Italy.