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Stress management interventions in the workplace improve stress reactivity: a randomised controlled trial
  1. Heribert Limm1,
  2. Harald Gündel2,
  3. Mechthild Heinmüller3,
  4. Birgitt Marten-Mittag1,3,
  5. Urs M Nater4,
  6. Johannes Siegrist5,
  7. Peter Angerer3
  1. 1Department of Psychosomatic Medicine and Psychotherapy, Technische Universitaet Muenchen, Munich, Germany
  2. 2Department for Psychosomatic Medicine and Psychotherapy, Clinical Center, University of Ulm
  3. 3Department of Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany
  4. 4Department of Psychology, Clinical Psychology and Psychotherapy, University of Zürich, Zurich, Switzerland
  5. 5Department of Medical Sociology, Heinrich-Heine-University, Düsseldorf, Germany
  1. Correspondence to Peter Angerer, Department of Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Ziemssenstr. 1, Munich 80336, Germany; peter.angerer{at}


Objective To examine the long-term effects of a stress management intervention (SMI) based on the effort–reward imbalance (ERI) model, on psychological and biological reactions to work stress.

Methods 174 lower or middle management employees (99% male) were randomly assigned to an intervention or a waiting control group. The programme comprised 24×45 min group sessions (2 full days followed by two 4×45 min sessions within the next 8 months) on individual work stress situations. The primary endpoint was perceived stress reactivity (Stress Reactivity Scale, SRS), while secondary endpoints were salivary cortisol and α-amylase, anxiety and depression, and ERI. Assessments were repeated in 154 participants 1 year later.

Results SRS score decreased in both groups. A two-factor ANOVA with repeated measures showed a significant time×group effect (F=5.932; p=0.016) with the greater reduction in the intervention group. For SRS, the effect size (Cohen's d) after 1 year was d=0.416 in the intervention and d=0.166 in the control group. α-Amylase as a measure of sympathetic nervous system activation, decreased more strongly in the intervention group (area under the daytime curve and daytime slope: time×group effect p=0.076 and p=0.075). No difference was observed for cortisol. For depression, anxiety and ERI, improvements were higher in the intervention group but did not reach statistical significance.

Conclusions SMI based on work stress theory, is effective in reducing perceived stress reactivity and sympathetic activation in lower and middle management employees. Other mental health parameters and ERI show a tendency towards improvement. These beneficial effects are present 1 year later.

  • Stress management intervention
  • worksite
  • perceived stress reactivity
  • biological stress indices
  • effort reward imbalance
  • mental health
  • psychology
  • stress
  • health promotion
  • preventive medicine

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  • Funding This research project was funded by the Federal Ministry of Education and Research (Grant No. 01EL0415). MAN Nutzfahrzeuge AG, Munich, Germany supported the stress management workshops.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ethics Committee of the University of Munich, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.