Job Stress and Distress

Note: Dr. Matheson prepared this introduction to the Personal Prayer Relaxation audio exercise for a small group experience in which he assisted at Windsor Crossing Community Church in Chesterfield, Missouri in March 2009.  The introduction and audio are focused at a Christ-centered approach to handling stress so that it does not interfere with making good life choices.  If you are uncomfortable with a Christian approach, the Personal Mantra Relaxation audio exercises may be more appropriate.  Please download either audio and enjoy the benefits.  We welcome any feedback.

God has wired us so that low or moderate levels of stress can be beneficial, but sustained stress gets in the way of what He wants us to do with our life.  When stress becomes distress, God’s guidance can sometimes be hard to discern.  We can learn to do something about this, which is our focus today.

Let’s begin by taking a look at the difference between stress and distress.  Stress is a short-term response to a threat that focuses our attention and prepares us to defend ourselves.  The stress response is an important way in which we take care of ourselves. 

Distress occurs after the threat has passed, but our stress response remains at a high level.  Once the threat has ceased, our blood pressure and heart rate and breathing should subside to normal over about 90 seconds.  Blood that was shunted to the vital organs should move back into homeostatic balance in the hands and feet. 

Distress also occurs when the threat persists for a long period of time, locking in the “fight or flight” response.  This brings about dozens of unhealthy changes, including headache, hypertension, heart disease, and stroke.  One unhealthy consequence of distress that has received little attention until recently is neurophysiologic exhaustion or “brain fatigue”. 

I want to focus on brain fatigue briefly because it lowers our ability to stop stress from becoming distress. 

When we have brain fatigue, lower levels of stress cause us to get locked into distress.  On the other hand, if we are not experiencing brain fatigue, normal stresses of the day are handled appropriately and do not become distress. 

Brain fatigue is especially important when we are experiencing persistent stress, such as when we are struggling in a relationship or in our career or when need to look for a new job.  Persistent stress can cause brain fatigue so that stressful events that we would normally handle well become distressing. 

God has wired our brains so that we can interact with the stress response.  This is both good news and bad news because we can make the stress either better or worse.  You have had lots of examples in your life in which you have done both, with minor stressful events blown out of proportion and becoming distressing, and other major stressful events handled very well.

I think God wants us to do everything that we can to improve our brain’s ability to handle stress in a healthy way.  Research shows that combining a healthy prayer life in community with others who are successfully dealing with stressors sets the stage for using neuropsychological strategies such as personal prayer relaxation to help prevent stress from becoming distress.

Personal prayer relaxation is based on the idea that we can use a thought to trigger a relaxation response and interrupt the stress-distress cycle.  The personal prayer is a word or short phrase that you practice linking to a state of deep relaxation.  Once it is linked, the prayer itself will trigger a relaxation response.  Let’s begin by selecting a personal prayer.

Recall a time or place or experience that was especially soothing, in which you felt safe and secure.  If you are spiritual person it may well involve an experience in which you surrendered control and let God take over or recognized the transcendent nature of God.  It may have happened when you were baptized or it may have been later when you were out in nature or with loved ones or in some other circumstance in which you became aware of God’s presence and safety. 

My personal prayer is “Hosanna”, which recalls July 11, 1991 when I was camping in the Sierras with my son, the night after a total solar eclipse.  I awoke Jonathan at midnight to experience the Milky Way with the sun and moon in conjunction; the night would never be darker.  Away from the lights of civilization, at 10,000 feet in the dry Sierras, the Milky Way exploded with light!  With my five-year-old son on my shoulders, we stood in awe, looking at billions of stars in the unmistakable pattern of our galaxy.  I was strongly aware of God’s presence and said a quiet prayer that He would sustain us and help me be a capable husband and father.

Many years later, I chose the word “Hosanna” to recall that experience and I have practiced linking “Hosanna” to a state of profound relaxation.  Now, when I say to myself, “Hosanna”, I can see and hear and feel and smell that moment, and I have a profound sense of God’s presence.  I feel both relaxed and safe. 

I use my personal prayer to put myself asleep each night after a gratitude prayer, and if I awaken during the night with anxiety triggered by stress, I pray once again and use my personal prayer to fall back asleep.  No matter what, I do not continue to think about the stressor, realizing that in about 90 seconds, the neurochemical stress response will pass and allow me to return to sleep using my prayer.

Personal prayer relaxation is a skill that must be practiced in order to be effective.  After the basic introduction, the personal prayer relaxation process requires about 20 minutes without interruption in a quiet location.  Listen to and follow the recorded audio instructions as best you can, allowing thoughts to come and go with the commitment that any important thought will return later and can be addressed after you have practiced linking your personal prayer to a state of deep relaxation. 

If you are like most people, you will almost immediately begin to feel the beneficial effects and within about two weeks you will be able to use your personal prayer to get better control of your stress response.  The more you practice, the better you will become. 

Combined with a reasonable diet and good exercise and regular prayer, personal prayer relaxation will help you to gradually address problems with mental fatigue, improving your ability to handle the temporary increase in stress that normally occurs with job-seeking.  You will sleep better and think more clearly. 

Through its positive effect on your mental fatigue, personal prayer relaxation will help you to be ready for the opportunities that God is preparing for you.

Is FCE Valid?

This question must be addressed within the context of all issues that determine the worthiness of every functional evaluation procedure endorsed or recognized as crucial by the major professional associations and government bodies that have addressed the issue of functional evaluation, such as the American Psychological Association (American Psychological Association, American Educational Research Association, & National Council on Measurement in Education, 1999), the National Institute of Occupational Safety and Health (Chaffin, Herrin, & Keyserling, 1978), the American Physical Therapy Association (American Physical Therapy Association, 1997), the American Congress of Rehabilitation Medicine (Johnston, Keith, & Hinderer, 1992) , and the American College of Sports Medicine (American College of Sports Medicine, 2000) . These issues, presented in hierarchical order, are:

 
1. Safety – Given the known characteristics of the evaluee, the procedure should not be expected to lead to injury;
2. Reliability – The test score should be dependable across evaluators, evaluees, and the date or time of test administration;
3. Validity – The interpretation of the test score should be able to predict or reflect the evaluee’s performance in a target setting. The formal definition of validity is “the degree to which all of the accumulated evidence supports the intended interpretation of test scores for the intended purpose”. [3]
4. Practicality -The cost of the test procedure should be reasonable and customary. Cost is measured in terms of the direct expense of the test procedure plus the amount of time required of the evaluee;
5. Utility – The usefulness of the procedure is the degree to which it meets the needs of the evaluee and referrer.

This hierarchy requires that each of the factors presented earlier must be maintained as subsequent factors are addressed. For example, it is not permissible to sacrifice safety for the sake of practicality. In addition, the first four factors must be adequately addressed for the purpose of the evaluation to be achieved.
When applied to work disability, functional capacity evaluation has three primary purposes. The first purpose is to determine whether or not the evaluee is able to return to work at his or her usual and customary job and, if not, to identify what the evaluee needs to improve or the employer needs to modify before a return to work is reasonable. If there is not a job to which the evaluee can return, the second purpose is to identify functional abilities that could be used in alternate occupations. The third purpose is to quantify functional limitations in terms that are useful in the disability determination process.

 
By what standard can each of the individual factors be measured? In the past, the answer to this question was readily available, with simple statistical standards used for each factor. However, since the 1999 publication of the APA/AERA/NCME Standards and the adoption of the new definition of “validity” in the Standards by the United States Equal Employment Opportunity Commission (EEOC, 2008), a simple answer is no longer acceptable. Best practices in evaluation require a broad look at the test factors hierarchy, with a focus on validity that must now take into account a broad range of issues with the overriding goal being increased fairness in the evaluation process.

 
The reader is encouraged to obtain the APA/AERA/NCME standards for specific information. In the meantime, one approach to the consideration of the adequacy of the standards that can be considered is to rely on whether utility was achieved. Given that utility is the ultimate factor, requiring that all of the other factors be adequately addressed, if there is utility the factors in the hierarchy must have been handled appropriately. If there is not utility, one or more of the factors was not handled appropriately.

 
What this means in practice is that we must always start by asking whether there was a useful outcome. For example, in the 1986 workers’ compensation study (Matheson, 1986), functional capacity evaluation results were helpful in resolving several cases, after each injured worker had received a permanent and stationary rating with work restrictions. Although individual indicators for each of the factors in the hierarchy were available and presented in the original research, the ultimate determination of test worthiness is that the FCE process led to a useful outcome. Vert Mooney, M.D. is fond of saying that “the test result has got to tell you what to do next”. There are many tests that are reliable and valid in and of themselves that don’t guide the professionals in terms of what to do next and don’t have utility in terms of contributing to a useful outcome. Adoption of this broader view of the properties of tests, beyond their psychometric properties, is likely to lead to a new generation of functional capacity evaluation tests and test batteries that are more likely to meet the needs of evaluees and referral sources.

 
References
American College of Sports Medicine. (2000). Guidelines for exercise testing and prescription (6th ed.). New York: Lippincott Williams & Wilkins.
American Physical Therapy Association. (1997). Occupational health guidelines: Evaluating functional capacity. Alexandria, VA: American Physical Therapy Association.
American Psychological Association, American Educational Research Association, & National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: Author.
Chaffin, D., Herrin, G., & Keyserling, W. (1978). Preemployment strength testing. An updated position. J Occup Med, 20(6), 403-408.
EEOC, U. S. E. E. O. C. (2008). Employment tests and selection procedures. Retrieved September 20, 2009
Johnston, M., Keith, R., & Hinderer, S. (1992). Measurement standards for interdisciplinary medical rehabilitation. Archives of Physical Medicine Rehabilitation, 73, S3-S23.
Matheson, L. (1986). Evaluation of lifting and lowering capacity. Vocational Evaluation and Work Adjustment Bulletin, 19(4), 107-111.