Mediating the relation between workplace stressors and distress in ID support staff: Comparison between the roles of psychological inflexibility and coping styles

Highlights

• Understanding mechanisms of workplace stress may increase ID staff effectiveness.

• Several mediation models from two distinct theories were compared.

• Psychological inflexibility was a more robust mediator than wishful thinking coping.

Abstract

The present study examined how different patterns of coping influence psychological distress for staff members in programs serving individuals with intellectual disabilities. With a series of path models, we examined the relative usefulness of constructs (i.e., wishful thinking and psychological inflexibility) from two distinct models of coping (i.e., the transactional model and the psychological flexibility models, respectively) as mediators to explain how workplace stressors lead to psychological distress in staff serving individuals with intellectual disabilities. Analyses involved self-report questionnaires from 128 staff members (84% female; 71% African American) from a large, state-funded residential program for individuals with intellectual and physical disabilities in the southern United States of America. Cross-sectional path models using bootstrapped standard errors and confidence intervals revealed both wishful thinking and psychological inflexibility mediated the relation between workplace stressors and psychological distress when they were included in separate models. However, when both variables were included in a multiple mediator model, only psychological inflexibility remained a significant mediator. The results suggest psychological inflexibility and the psychological flexibility model may be particularly useful for further investigation on the causes and amelioration of workplace-related stress in ID settings.

Introduction

Staff serving those with intellectual disabilities (ID) may experience significant work-related stress (Skirrow & Hatton, 2007) which may lead to deleterious mental health outcomes such as burnout and increased general psychological distress (Devereux, Hastings, & Noone, 2009). Such heightened levels of stress may lead to unwanted performance outcomes such as increased absenteeism and staff turnover (Hastings, Horne, & Mitchell, 2004), as well as fewer positive interactions between staff and the individuals they serve (Lawson and O’Brien, 1994, Rose et al., 1998).

Inadequate training, long hours, lack of opportunity for advancement, exposure to challenging client behaviors, and a sense of disparity between job demands and rewards have been identified as correlates of job related stress in ID settings (Hatton, Emerson, et al., 1999, Hatton and Lobban, 2007, Skirrow and Hatton, 2007). Further, staff members reporting high levels of stress also tend to feel unclear about job roles and to experience conflicting demands at work or between work and home (Hatton & Lobban, 2007). Stressed staff also report feeling unsupported by their coworkers and supervisors, and may use maladaptive coping strategies in dealing with clients (Hatton, Emerson, et al., 1999).

Although changes in the structure of treatment settings, such as hiring better-trained staff, improving compensation of workers, or altering the level of control workers exert over their work environments would be beneficial, such interventions are often impractical for financial and structural reasons. However, we can readily provide in-service interventions to these staff which target coping processes that may be of relevance in altering the ways that staff members relate to work stressors, thus improving well-being at work and attenuating associated unwanted outcomes such as turnover, absenteeism, and decreased client contact. However, the development of such interventions would need to be predicated on an understanding of the relationship between work stressors, coping, and psychological distress. To this end, the current study examines the usefulness of constructs from two distinct theoretical models in explaining how work stressors may lead to psychological distress in staff providing services to individuals diagnosed with ID.

Research suggests that coping strategies may be important variables in determining whether staff serving those with ID experience negative psychological outcomes in the presence of perceived work stressors (Devereux, Hastings, & Noone, 2009). One predominant coping model is the cognitive-behavioral model (i.e., the transactional model) based in the work of Lazarus and Folkman (1984). According to this framework, stress is neither inherent in the person nor the work environment, but results from the transactional relationship between the person and the environment. Thus, individuals may differ in their stress response, even when they are exposed to similar situations (Devereux, Hastings, & Noone, 2009).

The development of stress is influenced by the processes of appraisal and coping. Appraisal concerns the initial evaluation of a situation, and is comprised of two types: primary and secondary appraisal. Primary appraisal concerns the assessment of a situation to determine whether a threat or stressor is present. Secondary appraisal involves making a judgment about whether one is able to cope with a stressor and deciding how to cope with the stressor. Coping has been defined as the “cognitive and behavioral efforts a person makes to manage demands that tax or exceed his or her personal resources” (Lazarus, 1995, p. 6). Coping is suggested to act as a mediator of the emotional outcome of an encounter with a perceived stressor (Lazarus, 1999).

Lazarus (1995) describes two main types of coping. Problem-focused, or practical, coping involves the individual changing his or her overt behavior in order to change the environment such that the stressor is removed or attenuated. Emotion-focused coping seeks to manage emotional distress associated with the stressor. This may be accomplished through avoidance, denial, or attempting to change one's emotional reaction to the situation, rather than the situation itself (Devereux, Hastings, & Noone, 2009).

Studies that have employed the cognitive-behavioral framework to examine coping among staff in ID programs have generally shown positive relationships between emotion-focused coping and staff stress (Devereux et al., 2009b, Hastings and Brown, 2002, Hatton et al., 1999b). For example, Devereux, Hastings, Noone, Firth, et al. (2009) examined the roles of practical coping and wishful thinking as mediators of the relation between work stressors and psychological distress in support staff serving individuals with ID. Wishful thinking is an emotion-focused coping strategy characterized by attempting to avoid or alter one's emotional reactions to a stressful situation, rather than attempting to alter the situation itself (Hatton & Emerson, 1993). Devereux, Hastings, Noone, Firth, et al. (2009) found that wishful thinking coping partially mediated the relationship between work stressors and burnout in support staff, such that staff who engaged in wishful thinking reported higher levels of burnout. Practical coping was not found to mediate the relation between work stressors and burnout, but rather was found to be a positive predictor of staff perceptions of personal accomplishment in their work (Devereux, Hastings, Noone, Firth, et al., 2009). The authors further suggested that psychological interventions designed to reduce avoidance-based coping strategies, such as Acceptance and Commitment Therapy, might be useful to enhance well-being at work.

The positive relationship between emotion-focused coping and work stress is consistent with the idea that deliberately attempting to avoid, alter, or otherwise control one's internal experiences may lead to, or exacerbate psychological distress, because when personal resources are concentrated on experiential avoidance, fewer resources are available to devote to more effective behavior. Conversely, a willingness to experience difficult thoughts and emotions, and to relinquish one's efforts to control the same, may lead to more effective behavior and less distress.

Such “psychological flexibility” (Bond et al., 2011, p. 678) in responding to aversive internal events is a major determinant of mental health and behavioral functioning according to the empirically based theory of psychopathology which underlies Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999). Psychological flexibility may be defined as “the ability to fully contact the present moment and the thoughts and feelings it contains without needless defense, and, depending on what the situation affords, persisting in or changing behavior in the pursuit of goals and values” (Bond et al., 2011, p. 678). Conversely, psychological inflexibility “entails the rigid dominance of psychological reactions over chosen values and contingencies in guiding action” (Bond et al., 2011, p. 678). Psychological inflexibility occurs when people attempt to avoid unwanted private events at the expense of personal values, and has been associated with increased levels of general psychological distress (Kashdan et al., 2006, Lloyd et al., 2013).

Studies examining the influence of psychological flexibility on work-related stress and performance outcomes have indicated that it is an important factor (Bond, Flaxman, & Bunce, 2008) For example, Lloyd and colleagues (2013) examined the effectiveness of a workplace group-based ACT intervention designed to increase psychological flexibility among human-service employees of a UK government organization. Data indicated that the ACT intervention decreased burnout and strain relative to a control condition, and that the decrease in burnout observed in the ACT condition was mediated by an increase in psychological flexibility relative to the controls.

With regard to staff in ID settings, Noone and Hastings (2011) found that psychological flexibility was negatively correlated with emotional exhaustion component of burnout in a sample of ID support staff, such that staff who reported more psychological flexibility reported less emotional exhaustion. Further, emerging evidence suggests that ACT-based interventions which aim to increase psychological flexibility are effective in reducing general psychological distress among staff serving individuals with ID (Noone and Hastings, 2009, Noone and Hastings, 2010, Bethay et al., 2013, McConachie et al., 2014), and that this can occur despite the perception of the level of work stressors remaining unchanged (Noone & Hastings, 2009, 2010; McConachie et al., 2014). Noone and Hastings (2010) have suggested that these latter findings occur due to increased psychological flexibility in response to work stressors. However, these studies did not include designs that specifically examined the potential role of psychological flexibility as a mediator of therapeutic change. Thus, only tentative conclusions can be made regarding the role of psychological flexibility as a mediator of the relation between perceived work stressors and psychological distress among staff in ID settings.

The aim of the present study is to examine how different reactions to workplace stressors (i.e., patterns of coping) influence psychological distress. Our ultimate goal is to provide clues as to which domains of focus would be useful to include in interventions designed to help ID staff more effectively deal with workplace stressors, potentially decreasing ID staff burnout and facilitating higher quality interactions between them and the individuals they serve. Toward that aim, we present a series of regression-based path models examining the usefulness of two constructs—wishful thinking (a subtype of emotion-focused coping) and psychological inflexibility—as mediators to explain how workplace stressors lead to psychological distress in ID staff.

As a baseline hypothesis, we expected perceived workplace demands would predict psychological distress, such that increases in perceived workplace demands would predict increases in psychological distress (Hypothesis 1).

Based on the findings of Devereux, Hastings, Noone, Firth, and colleagues’ (2009) application of Lazarus's (1995) coping model to ID staff, we expected that wishful thinking coping, but not practical coping, would mediate the relation between perceived workplace demands and psychological distress (Hypothesis 2). This hypothesis implied that increases in wishful thinking coping associated with perceived workplace demands would partly explain why perceived workplace demands are associated with psychological distress. However, practical coping would not mediate that relation.

Based on previous work of the psychological flexibility model applied to ID support staff (e.g., Bethay et al., 2013, Noone and Hastings, 2011) we expected that psychological inflexibility would mediate the relation between perceived workplace demands and psychological distress (Hypothesis 3). This hypothesis implied that the increases in psychological inflexibility associated with perceived workplace demands will partly explain why perceived workplace demands are associated with greater psychological distress.

In the case that variables from both the models proposed by Hypotheses 2 and 3 mediate the relation between perceived workplace demands and psychological distress, we planned to examine a multiple mediation model. Based on the previous hypotheses, we proposed (Hypothesis 4) that the multiple mediation model would include both wishful thinking coping and psychological inflexibility. Thus, this hypothesis implied that increases in wishful thinking, in psychological inflexibility, or in both will partly explain why perceived workplace demands are associated with greater psychological distress.