case study on stress management with questions and answers

Workplace Stress Management: 11 Best Strategies & Worksheets

An American Psychological Association survey found that 31% of staff felt stressed out during their workday (cited in Tetrick & Winslow, 2015).

Help is available. Workplace stress management and wellness programs can help reduce the degree and impact of stress and restore an employee’s depleted psychological resources (Tetrick & Winslow, 2015).

This article explores what we mean by workplace stress management and introduces mechanisms and activities that can provide relief and help staff cope.

Before you continue, we thought you might like to download our three Stress & Burnout Prevention Exercises (PDF) for free . These science-based exercises will equip you and those you work with with tools to manage stress better and find a healthier balance in your life.

This Article Contains:

What is workplace stress management, how to prevent stress at work: 3 strategies, 2 helpful coping mechanisms for employees, stress relief at work: 3 worksheets to reduce stress, 3 activities & worksheets to cope with stress, how to craft prevention programs & workshops, assessing stress: 4 questionnaires & scales, best stress-relief tools from positivepsychology.com, a take-home message.

The relationship between the workplace and our psychological, cognitive, and physiological responses to stress is complex, impacted by “a broad set of occupational and work demands as well as environmental stressors” (Quick & Henderson, 2016, p. 2).

And yet, our stress response at work can typically be attributed to one of the following four workplace demands (Quick & Henderson, 2016):

• Task demands Job insecurity, workload, occupation, etc.
• Role demands Role conflict and ambiguity
• Physical demands Workplace, lighting, and temperature
• Interpersonal demands Staff density, leadership style, and personality conflicts

Workplace stress management (WSM) has been significantly influenced by the theory of preventive stress management, introduced in 1979, which proposes that it is not the stimuli that decide the degree of stress experienced by the individual, but the individual’s response to those stressors (Hargrove, Quick, Nelson, & Quick, 2011).

Over the years, many theoretical frameworks and organizational wellness programs that fall under the umbrella term of WSM have been proposed to understand occupational stress and employee wellbeing. WSM aims to understand specific stressors and take positive steps to reduce their effects (Tetrick & Winslow, 2015).

WSM interventions are typically divided into three types:

• Primary Proactive and involved in preventing stress and promoting employee wellbeing (including wellness programs, conflict management, etc.)
• Secondary Proactive and reactive, to help remove risk factors (including coping skills, employee fitness programs, job redesign)
• Tertiary Reactive, for employees who need help (including counseling, employee assistance programs, and Cognitive-Behavioral Therapy)

Stress interventions include (modified from Tetrick & Winslow, 2015):

• Cognitive-behavioral interventions Primary and secondary interventions. Changing cognitions and reinforcing active coping skills .
• Relaxation techniques Secondary and tertiary interventions. Physical and mental relaxation techniques to help cope with the consequences of stress.
• Multimodal programs Secondary interventions. Acquiring passive and active coping skills. They consist of a combination of approaches, including relaxation and cognitive-behavioral skills.
• Organization-focused interventions Mostly primary interventions, but some considered secondary. Organizational development and job redesign.
• Individual-level interventions Secondary or tertiary interventions, including relaxation, meditation, and cognitive-behavioral skills training.
• Organizational-level interventions Primary and secondary interventions, including changing working conditions and employee participation.
• Systems approach Primary and secondary, combining individual and organizational interventions.

Such interventions are often used in combination to prevent, reduce, and cope with stress.

While many of the following strategies appear simple, they require focus and commitment. Others foster a new mindset and change how we relate to work and occupational stress.

1. Controlling your stress

Our brains are constantly flooded with increasing demands and information, causing us stress and reducing our ability to focus and solve problems.

There are many steps we can take to avoid or reduce stress, including promoting positive emotions, taking physical care of our brain, and becoming more organized (modified from Hallowell, 2014).

• Ensure you get adequate sleep (don’t eat late at night and reduce caffeine and alcohol intake).
• Enjoy a balanced diet and stay hydrated.
• Exercise throughout the week and get time away from your desk, preferably in nature.
• Schedule regular catch-ups with people you value.
• Break large tasks into smaller ones.
• Maintain a tidy work environment.
• Schedule some ‘think time’ in your busy schedule.
• Allocate time for lunch and take it away from your desk.
• Recognize when you do your best work. Plan your most demanding tasks for those times.
• Walk around more, stand, or listen to music, depending on what works best for you.
• Set reminders for a ‘hard stop’ at the end of the workday.

2. When you feel overwhelmed

• Slow yourself down. When stressed, we often move into panic mode.
• Take time to perform a calming exercise.
• Move around. Walk outside or head to the break room/kitchen.
• Ask for help. Seek out people you trust.

3. Managing your energy

Demanding jobs, long hours, and increasing workloads can leave us feeling emotional, disengaged, stressed, and exhausted (Schwartz & McCarthy, 2014).

Creating a series of habits , practices, and rituals can promote your physical, emotional, mental, and spiritual energy (modified from Schwartz & McCarthy, 2014).

Physical energy

• Recognize times in the day when you feel tired or unable to concentrate. Step away from the desk, meet colleagues, or perform something interesting.
• Aim to focus for 90 to 120 minutes at a time, taking regular breaks.
• Eat smaller, lighter meals during the day to maintain energy.

Emotional energy

• Practice abdominal breathing to manage negative emotions , such as irritability, anxiety, and impatience.
• Express gratitude and appreciation for others while adopting self-compassion for yourself.
• Use a reverse lens to see a situation from the other person’s point of view. Use a long lens to consider how we might look at the issue in six months. Use a wide lens to consider the bigger picture.

Mental energy

• Switch off email and move phones away to perform high-concentration tasks.
• Schedule specific times in the day to answer and respond to emails.
• At the end of each day, make a list of key actions for tomorrow.

Spiritual energy

• Identify when you perform at your best. What strengths do you enjoy using, and how can you use them more often?
• On your commute home, or the last 20 minutes of your day when working remotely, relax. This may mean sitting mindfully or listening to music before returning to home life.
• Recognize your core values. Reflect on whether you are using and showing them to others around you. Find opportunities to be your authentic self.

We all have finite limits before reducing energy levels and increasing stress interrupt what we can achieve. Investing in healthy work habits can maintain productivity and performance throughout the day.

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How we experience and handle stress changes its cognitive, emotional, and behavioral impact (Crum & Crum, 2018). The following two coping mechanisms offer practical approaches for managing stress in the workplace and can be implemented with little training.

Mindfulness

Research has confirmed the success of mindfulness at reducing perceived stress and emotional exhaustion, and improving sleep quality and job satisfaction (Tetrick & Winslow, 2015).

While we may sometimes think of mindfulness as passive and accepting, it is often the first step toward growth and change. While incredibly valuable for handling life stresses, it is also powerful enough to enrich positive and happy times in our lives (Shapiro, 2020).

Mindfulness expert Shauna Shapiro (2020) considers three points essential to mindfulness:

• Intention – why we pay attention
• Attention – attending to the present
• Attitude – how we pay attention (compassion, kindness, etc.)

A review of the literature confirms that mindfulness is a powerful and cost-free approach to coping with stress (Shapiro, 2020).

Reframing stress

While we are familiar with the negative impacts of stress, we sometimes forget that achieving a stress-free life is unlikely and, perhaps, impossible (Crum & Crum, 2018).

We must recognize that some degree of stress is crucial to our personal and professional growth. Stress reminds us that something is important to us, that we care.

People who adopt a “stress is enhancing” mindset rather than a “stress is debilitating” mindset perform better and experience fewer negative health consequences (Crum & Crum, 2018).

But how do we see stress differently?

We can rethink stress using the following three steps (Crum & Crum, 2018; Crum, Salovey, & Achor, 2013):

• See it Rather than deny stress, you must recognize and name the stress you are facing.

“I am stressed about my job interview.” “I am stressed about finals.”

Acknowledging stress can help you move brain activity from being automatic and reactive to conscious and deliberate.

• Own it Recognize that what you are stressing about must be important to you. “Owning this realization unleashes positive motivation” (Crum & Crum, 2018, p. 73).
• Use it Stress is not designed to kill us, but to boost our mind and body, and prepare for the challenge ahead. By reframing your stress response as something positive, such as eustress , you can use your heightened energy and awareness to improve your performance.

Even with long-term, chronic stress at work, you can recognize opportunities for learning, growth, or the motivation to change yourself or your situation. While it may not always be possible, if you can find a way to embrace stress, it can become a “powerful tool for helping you overcome the inevitable challenges that can – and will – arise” (Crum & Crum, 2018, p. 75).

Identifying Your Stress Resources

Your resources (internal and external) provide a potentially limitless amount of support that will sustain you during challenging times and stressful situations (Niemiec, 2019).

The Identifying Your Stress Resources worksheet helps you recognize your resources and identify how they can support your strengths.

Stress Decision Framework

Decision-making takes time. The effect of weighing up pros and cons uses up precious resources and risks adding to an already stressful workload.

The Stress Decision Framework worksheet helps you put decision-making in context, aiming for a good enough , not perfect , decision (Armstrong, 2019).

Vicious Versus Virtuous Stress Thinking

Stress is a choice, yet it is often perpetuated by negative (vicious) cycles of thinking (Armstrong, 2019).

It doesn’t have to be this way.

Using a cognitive-behavioral approach, it is possible to reframe unhelpful beliefs and thinking, and adopt a virtuous cycle of thinking.

The Vicious Versus Virtuous Stress Thinking worksheet helps you compare unhelpful and helpful thinking regarding an event (Armstrong, 2019).

The cost of workplace stress – and how to reduce it – Rob Cooke

Coping with stress can often be about gaining control of what is – or, more importantly, what we perceive to be – within our control. The following activities and exercises can help.

One-Hour Stress Plan

When we feel overwhelmed, we get stressed, which can damage our focus and cloud our thinking. “Working within a limited time frame is important because the race against time keeps you focused” (Bregman, 2014, p. 157).

Use the One-Hour Stress Plan worksheet when stressed to plan and work through what you can in 60 minutes. At the end of the hour, you will have progressed and can repeat the exercise as many times as you like (modified from Bregman, 2014).

Stress as a Stimulus for Change

Sometimes stress is a good indication that something in your life needs to change.

The Stress as a Stimulus for Change worksheet can capture what you wish to change in your life and begin the transformation process .

Workplace Mindfulness

Mindfulness can be a powerful way to adopt a state of loving-kindness about yourself and others, and has significant benefits to how you handle stress (Shapiro, 2020; Tetrick & Winslow, 2015).

The Workplace Mindfulness worksheet can help decrease stress and improve workplace satisfaction through a series of simple questions asked when relaxed and present.

Instead, a multimodal approach should be considered when crafting prevention programs and workshops (Tetrick & Winslow, 2015).

Most likely, it will be necessary to put in place learning and education that are both proactive and reactive.

Proactive interventions

Focus on preventing stress (removing risk factors) and promoting positive actions for all employees.

Interventions are likely to include:

• Conflict management
• Employee wellness
• Job redesign and the organization of work
• Coping skills
• Employee fitness programs (for employees with known risk factors)

Reactive interventions

Focus on helping employees who need assistance.

• Cognitive-Behavioral Therapy
• Rehabilitation after illness or returning to work
• Employee assistance programs

A multimodal approach combines multiple intervention styles and techniques, and can be rolled out across the organization while focusing on the individual (Tetrick & Winslow, 2015).

The following questionnaires measure a respondent’s current degree of stress and assess their risk of experiencing future stress.

Perceived Stress Scale

The Perceived Stress Scale is one of the most widely used measures of the perception of stress (Cohen, 1994; Cohen & Williamson, 1988).

The 10 questions are answered with a rating between 0 (never) and 4 (very often).

For example:

In the last month, how often have you been upset because of something that happened unexpectedly?

In the last month, how often have you felt nervous and “stressed”?

Life Events and Difficulties Schedule (LEDS) and Stress and Adversity Inventory (STRAIN)

LEDS is a structured interview used to assess stressor exposure over a lifetime. It has since been turned into an online version known as STRAIN (Crosswell & Lockwood, 2020).

“Both measures provide a comprehensive assessment of stressor exposures across the lifespan” (Crosswell & Lockwood, 2020, p. 2) and can be valuable for research and therapy.

Stress Mastery Questionnaire (SMQ)

The American Institute of Stress offers the SMQ as an online self-assessment of stress risk.

The results, plus a 66-page Stress Mastery Guide and Workbook , provide a personalized stress risk profile that can help you lead a less stressed, more enjoyable life.

You’ll find a range of powerful stress-related interventions and assessment tools available throughout our site. Check out the following for some of our favorites:

• Radical Acceptance of a Distressing Situation This worksheet presents a sequence of eleven questions to help clients reflect on a current or past distressing situation and work toward radically accepting the reality of that event.
• Changing Physical Habits This worksheet helps clients reflect on their vulnerabilities and routines surrounding aspects of their physical health and consider steps to develop healthier habits.
• Coping With Stress This two-part exercise invites clients to list experienced physiological and emotional symptoms of stress and brainstorm strategies to reduce, cope with, or eliminate these sources of stress.
• Coping: Stressors and Resources This worksheet helps clients identify past, present, and future stressors and link them with coping resources they can use to overcome them.
• Squeeze and Release This group activity helps participants discover the energizing potential of positive stress, known as eustress , which can help improve motivation, performance, and emotional wellbeing.
• 13 Stress-Relief Books About the Science of Managing Anxiety This article provides an excellent selection of stress-relief books .
• 17 Stress & Burnout Prevention Exercises If you’re looking for more science-based ways to help others manage stress without spending hours on research and session prep, check out this collection of 17 validated stress-management tools for practitioners . Use them to help others identify signs of burnout and create more balance in their lives.

Our physical and mental wellbeing, work environment, and the demands of our job all impact our degree of stress. They also influence our performance and productivity in the workplace.

Reducing stressors and managing their impact by adopting effective coping mechanisms help us regain a sense of control (Quick & Henderson, 2016).

According to Angela Armstrong (2019), stress is a choice. Appropriate workplace stress management (personal and organizational) helps us identify ways to control what we can and learn how to see things differently when we cannot.

With the right mindset, seeing stress as enhancing, we can increase our motivation and see challenges as opportunities for growth rather than debilitating obstacles (Crum et al., 2013).

There are powerful tools to help. In recent years, mindfulness in particular has become increasingly popular for stress reduction, helping individuals to confront situations “in an accepting, nonjudgmental manner” (Tetrick & Winslow, 2015, p. 8).

Why not review some strategies, techniques, and tools in this article and identify what can help you, your employees, or your clients manage the impact of stress or turn it into something positive and life enhancing?

We hope you enjoyed reading this article. Don’t forget to download our three Stress & Burnout Prevention Exercises (PDF) for free .

• Armstrong, A. (2019). Resilience club: Daily success habits of long-term high performers . Rethink Press.
• Bregman, P. (2014). A practical plan when you feel overwhelmed. In HBR guide to managing stress at work (pp. 27–50). Harvard Business Review Press.
• Cohen, S. (1994). Perceived Stress Scale . Mind Garden. Retrieved September 1, 2021, from https://www.mindgarden.com/documents/PerceivedStressScale.pdf
• Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States . In S. Spacapan & S Oskamp (Eds.), The social psychology of health . Sage.
• Crosswell, A. D., & Lockwood, K. G. (2020). Best practices for stress measurement: How to measure psychological stress in health research. Health Psychology Open , 7 (2).
• Crum, A., & Crum, T. (2018). Stress can be a good thing if you know how to use it. In HBR’s 10 must reads: On mental toughness (pp. 71–75). Harvard Business Review Press.
• Crum, A. J., Salovey, P., & Achor, S. (2013). Rethinking stress: The role of mindsets in determining the stress response. Journal of Personality and Social Psychology , 104 (4), 716–733.
• Hallowell, E. M. (2014). Overloaded circuits. In HBR guide to managing stress at work (pp. 27–50). Harvard Business Review Press.
• Hargrove, M. B., Quick, J. C., Nelson, D. L., & Quick, J. D. (2011). The theory of preventive stress management: A 33-year review and evaluation. Stress and Health: Journal of the International Society for the Investigation of Stress , 27 (3), 182–193.
• Niemiec, R. (2019). Strength-based workbook for stress relief: A character strengths approach to finding calm in the chaos of daily life . New Harbinger.
• Quick, J., & Henderson, D. (2016). Occupational stress: Preventing suffering, enhancing wellbeing. International Journal of Environmental Research and Public Health , 13 (5), 459.
• Schwartz, T., & McCarthy, C. (2014). Manage your energy not your time.  Harvard Business Review Press.
• Shapiro, S. L. (2020). Rewire your mind: Discover the science + practice of mindfulness . Aster.
• Tetrick, L. E., & Winslow, C. J. (2015). Workplace stress management interventions and health promotion. Annual Review of Organizational Psychology and Organizational Behavior , 2 (1), 583–603.

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What our readers think.

I’m looking for an active stress avoidance / proactive approach to a stress-free work experience. This article appears to focus on alleviating the effects of stress rather than designing a work experience that removes it, and/or deals with those in positions of power in the workplace who rely on others for results and enforce this through control techniques, resulting in high employee stress, since the techniques are seldom nice, polite, sustainable or implemented with the employee’s long term well being in mind. I need workplace strategies that negate those manipulations and exploitations put in place by the hierarchy to simply get more work from employees, no matter what. Engagement surveys, annual reviews, and many workplace methodologies are in fact trojan horses. Please advise, many thanks Alvin Zest

Thanks for your comment; I completely understand where you’re coming from. Many of the dominant approaches to addressing strain, stress, and high work demands in organizations are largely reactive and center on ‘undoing’ the harm (i.e., stress) done to employees after it’s already done, rather than being proactive and creating conditions that prevent the harm in the first place. However, more research is coming out that’s looking at these proactive strategies.

Research is a long way from identifying a complete solution, but I would encourage you to look into the research and efforts by a researcher named Sharon Parker and her colleagues at the Center for Transformative Work Design. Some of the videos on this page might begin pointing you in the right direction and highlight the path research has taken so far.

I hope this helps.

– Nicole | Community Manager

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Workplace stress: an occupational health case study

This case study on workplace stress shows how the evidence base for occupational health underpinned a successful intervention. Anne Donaldson and Anne Harriss explain.

Stress, anxiety or depression underpin much work-related ill health, accounting for 9.9 million days of sickness absence in 2014-15, with, on average, 23 days lost per person. It resulted in 35% of all days missed from work due to ill health. Industries reporting the highest prevalence of ill health from work-related stress included health and social care, teaching, public administration and defence (HSE, 2015).

The Mental Health Foundation claims 12 million adults consult their GP each year due to mental illness, much of it stress related; one in six of the population experiences anxiety (MHF, 2014).

The main causes of work-related stress reported to GPs (THOR – GP) were workload pressures, interpersonal relationships, including bullying, harassment and difficulty with superiors, and work changes, including responsibilities and reduction of resources (HSE, 2014). A YouGov survey (2012) found 48% of the British workforce said they were stressed most of the time and 47% cited performance issues as key reasons.

Impact of workplace stress on individuals and work colleagues

Stress wanes when stressors are reduced. Conversely, anxiety can persist without a clear cause to the individual.

Anxiety and stress are closely linked with similar signs and symptoms; anxiety may be associated with depression as the most common mood disorder seen in primary care (Kumar and Clark, 2012). People with low psychosocial resources are more likely to succumb to mood disturbance when stress levels increase despite experiencing few stressors (DeLongis et al, 1988).

Colleagues often undertake the work responsibilities of absent staff. This may lead to spiralling absences among co-workers, who are stressed because of the additional responsibility (HSE, 2014). This case study presents the assessment of an employee, Norman, in order to ensure his fitness to return to his role without impacting on his health (Palmer et al, 2013).

The objectives of the consultation were two-fold:

• evaluating whether work had adversely affected Norman’s health and whether it may continue to do so; and
• providing impartial advice to management regarding his sickness absence, suggesting modifications for their consideration in order to support a successful return to work.

Norman’s referral by management was precipitated by a four-week absence related to stress and anxiety. There had been four further single-day absences in the preceding six months attributed to gastrointestinal upsets.

The consultation

Norman, a 22-year-old part-time receptionist and administrative assistant, had been employed in this role for 10 months working 30 hours per week. He had been absent from work for a month on the day of the consultation and was preparing to return to work. On entering the department, his mobility difficulties and an obviously awkward gait and altered balance were noted. He disclosed treatment by his GP for stress, anxiety and depression.

He described previous short-term absences resulting from nausea and vomiting, relating these to his anxiety at attending work. In the previous five to six weeks, in addition to nausea he also referred to difficulty sleeping, restlessness, loss of appetite, palpitations and rumination on his low self-esteem. Rumination can be a negative effect of stress. Genet and Siemer (2012) claim that rumination moderates the relation between unpleasant daily effects and negative mood.

Although excessive rumination is maladaptive, McFarland et al (2007) agree that some limited self-focus can be beneficial. Norman felt anxious about returning to the same situation and was accessing counselling support to help anxiety management. Hunsley et al (2014) suggest that psychological treatments are of at least equal benefit to medication for common mental disorders.

He had been prescribed 75mg of Venlafaxine a day with good effect. Venlafaxine is a serotonin and noradrenaline re-uptake inhibitor used to treat depression or generalised anxiety disorder. His GP also prescribed 5mg of diazepam – a long-acting benzodiazepine anxiolytic – to be taken as required. Recently he had not taken this as he felt better.

Past health and social history

Norman had cerebral palsy and experienced difficulty walking during his early years. Achilles tendon surgery in childhood improved this, although surgery left him with residual lower leg discomfort if he walked too far or stood for sustained periods without resting. The orthopaedic team monitored him every 18 months.

Norman described excellent family support. A non-smoker and non-drinker of alcohol, he took no formal exercise but walked as much as he felt able. Increasing physical activity within his ability was advised as it is found to improve mental health (Crone & Guy, 2008; McArdle et al, 2012).

Work issues

Norman generally enjoyed his role, shared with an able-bodied colleague with whom he alternated his reception duties. He indicated the interface with the public could be challenging and stressful. His workload had increased in the previous four months following the resignation of a colleague who indicated that he too found this role stressful. Financial constraints resulted in this position remaining unfilled, increasing Norman’s responsibilities. Stress is recognised as contributing to high staff turnover and low morale (Wolever et al, 2012).

Although working primarily at the reception desk, Norman frequently got up from his chair to deal with customers and to undertake photocopying duties. On one occasion he spent an afternoon mostly standing, which resulted in leg discomfort. No workplace adjustments had been effected to support his disability.

On recruitment, his manager had enquired whether he required any adjustments. Norman declined this offer, not wanting to “make a fuss”. He had not disclosed his disability at pre-employment screening (PES) as he did not consider himself disabled.

Many of Norman’s perceived stressors are normal daily occurrences of reception duties, but his physical disability exacerbated this. As he had not requested adjustments, there was nothing in place to support him in relation to his mobility difficulties.

Although his disability had not been disclosed at PES, under s.2 of the Health and Safety at Work etc Act 1974, Norman’s employer has a duty of care to him. Withholding information at PES that later comes to light could lead to disciplinary action but Norman considered that declaring his disability may have precluded his employment.

Cerebral palsy describes a group of childhood syndromes, apparent from birth or early childhood, characterised by abnormalities in motor function and muscle tone caused by genetic, intrauterine or neonatal insults to brain development. Resulting disabilities, of varying degrees, may be physical and mental.

A full functional capability assessment should have been performed at the start of his employment, facilitating adjustments enabling him to function effectively (Palmer et al, 2013). This had not been undertaken.

Norman usually managed his leg discomforts but occasionally had been unable to rest them at work. A study of workers with rheumatoid arthritis suggested that the workers reported greater discomfort on the days when they experienced more undesirable work events or job “strain” (Fifield et al, 2004).

Although this study looked at rheumatoid arthritis, issues concerning chronic pain and discomfort are relevant in this case. Although ultimately a legal decision, Norman was likely to be covered under the Equality Act 2010 as he had a long-term disability.

Withholding information at PES was fundamental to the case of  Cheltenham Borough Council v Laird (2009) . The council accused Laird of lying on her PES questionnaire by not disclosing her mental health history. She had been taking long-term antidepressants that kept her depression under control, but after some work problems her health deteriorated and she retired on health grounds. The judge confirmed there was no general duty of disclosure of information that was not specifically requested.

Thus, if a PES form does not directly ask about cerebral palsy, disclosure was not required. Kloss (2010) mentions these types of dilemmas are often only answered through the courts, but unless the employer is given information regarding disability, he cannot reasonably put adjustments in place. In the case of  Hanlon v Kirklees Metropolitan Council and others , the employee declined to consent to the disclosure of medical records, arguing this would contravene his right to privacy, and subsequently lost his case of disability discrimination.

The Health and Safety Executive (HSE 2007) defines stress as: “The adverse reaction people have to excessive pressures or other types of demand placed on them at work.”

The stress response

Stressors initiate physiological responses, evolved to protect and preserve the individual in times of threat by ensuring a reaction (Alexander et al, 2006).

This response is triggered by the limbic system within the brain. This is a series of centres controlling emotions, reproductive and survival behaviours (Blows, 2011). When survival is threatened, the system is instantly triggered into action to protect the individual, regardless of the threat magnitude.

A chain reaction occurs: the hypothalamus mediates the autonomic nervous system (Alexander et al, 2006), resulting in a sequence of physiological changes. The initial reaction is very fast, and only when the information reaches the cerebrum can the urgency of the situation be determined and responses modified (Blows, 2011).

The initial flight-or-fight response acts on the sympathetic division of the autonomic nervous system. Noradrenaline from the adrenal medulla immediately prepares the body for physical activity, mobilising glucose and oxygen to the heart, brain and skeletal muscles, preparing for flight or fight.

Non-essential functions, including digestion, are inhibited. Reduced bloodflow to the skin and kidneys promote the release of rennin, triggering the angiotensin – aldosterone pathway leading to fluid retention and hypertension. The resistance reaction results from corticotropin-releasing factor from the hypothalamus, stimulating the release of adrenocorticotropic hormone from the pituitary. This effects a release of cortisol from the adrenal cortex.

Cortisol effects are far-reaching, including lipolysis, gluconeogenesis and reducing inflammation. (Tortora and Grabowski, 2003). The body compensates for the effects of stress as long as possible. Three phases of stress are described as the general adaptation syndrome: alarm phase, resistance and exhaustion (Blows, 2011). The resistance and exhaustion phases may lead to immunosuppression and consequent disease (Tortora and Grabowski, 2003).

There is a reciprocal feedback link between the thalamus and amygdala. When the amygdala becomes overactive, fear and anxiety result. While adrenaline keeps the stress response active, endorphins protect the brain from the effects of fear (Blows, 2011). With so many physiological responses, there are numerous symptoms of stress that vary with each individual.

Significantly, stress causes muscle tension (HSE, 2007), exacerbating Norman’s discomfort, influencing his quality of life. As Kumar and Clark (2012) note, this is associated with depression.

The HSE (2007) management standards for work stress cover six main areas of primary work design that can contribute to stress if not properly managed. These include:

• Demands – including work patterns, workloads and work environment.
• Control – the extent of the worker’s job control.
• Support – provided by the organisation, management and colleagues.
• Role – understanding of their role and avoiding role-conflict.
• Change – management and communication of organisational change.
• Conflict – avoiding conflict, unacceptable behaviour and promoting positive working.

Fitness to work

The fitness-for-work assessment was based on a phenomenological appraisal as the effects of stress vary with each individual and their resilience (Alexander et al, 2006). A bio-psychosocial model informed the assessment. Norman stated that his condition was improving and he was ready to return to work. He no longer experienced symptoms that had taken him to the GP, but he was concerned at ending up in the same situation as before.

A patient health questionnaire (PHQ-9), providing an indication of depression, could have been used to assess Norman. Arroll et al (2010) found that the PHQ-9 is unreliable for diagnosing depression, whereas Manea et al (2012) refutes this assertion. At the time it seemed to be of limited value as he was making good progress.

Norman was advised to discuss his work concerns with his manager. With Norman’s consent, his manager was contacted and advised to carry out a comprehensive stress risk assessment as per the HSE management standards. It was suggested to Norman that he contact the organisation’s employee assistance programme and Access to Work, which offers grants for practical support for individuals with disabilities/health conditions to assist them with starting and staying at work. A phased return to work was formulated assisting Norman back into work and supporting him to stay at work. The following work regime was recommended:

• Week 1: Four hours on two days.
• Week 2: Four hours on four days.
• Week 3: Six hours on four days.
• Week 4: Full working week with the option of a review should Norman struggle.

Norman was to meet with his manager at the end of each week to review his progress, with the option to delay the next stage if this programme proved ineffective. In general, Norman had indicated that he had let his concerns take over without making any attempt to talk with his managers. He realised he should have discussed his work issues with his managers at an earlier stage. As Waddell and Burton (2006) note, early interventions are more effective at reducing long-term sickness absence and keeping workers at work.

Norman’s case illustrates how lack of control and apparent excessive demands and change can influence stress at work to negatively affect health. It reached a successful conclusion, but Norman’s case may have been prevented from requiring OH intervention had he been able to discuss his concerns and feelings with his manager in the first instance and a proactive approach, including the use of HSE stress management standards, been used at an earlier stage.

Anne Donaldson is an occupational health adviser. Anne Harriss is associate professor and course director, London South Bank University.

Alexander MF, Fawcett JN, and Runciman PJ (2006). Nursing Practice: Hospital and Home. 3rd edition. Edinburgh, Elsevier.

Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, Falloon K, and Hatcher S (2010). Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. vol.8(4), pp.348-353. doi: 10.1370/afm.1139.

Blows W (2011). The biological basis of mental health nursing. 2nd edition. Abingdon, Oxon. Routledge.

Crone D, and Guy H (2008). “I know it is only exercise, but to me it is something that keeps me going: a qualitative approach to understanding mental health service users’ experiences of sports therapy”. International Journal of Mental Health Nursing, vol.17(3), pp.197-207.

DeLongis A, Folkman S, and Lazarus Richard S (1988). “The impact of daily stress on health and mood: psychological and social resources as mediators”. Journal of Personality and Social Psychology, vol.54(3), pp.486-495. Available online. Accessed 19 April 2014.

Fifield J, McQuillan J, Armeli S, Tennen H, Reisne S, and Affleck G (2004). “Chronic strain, daily work stress and pain among workers with rheumatoid arthritis: does job stress make a bad day worse?” Work & Stress, vol.18(4), pp.275-291. Accessed 12 April 2014.

Genet JJ and Siemer M (2012). “Rumination moderates the effects of daily events on negative mood: results from a diary study”. Emotion, vol.12(6), pp.1,329-1,339.

Health and Safety Executive (2007). Managing the causes of work-related stress. A step-by-step approach using the management standards. 2nd edition HSE books. Available online. Accessed 12 April 2016.

Health and Safety Executive (2015). Stress-related and psychological disorders in Great Britain (2014). Available online. Accessed 22 April 2016.

Hunsley J, Elliott K, and Therrien Z (2014). “The efficacy and effectiveness of psychological treatments for mood, anxiety and related disorders”. Canadian Psychology/Psychologie Canadienne, vol.55(3), pp.161-176.

Kloss D (2010). Occupational Health Law, 5th edition, Oxford Wiley Blackwell.

Kumar P and Clark M (2012). Clinical Medicine, 8th edition, Edinburgh, Saunders Elsevier.

Manea L, Gilbody S, and McMillan D (2012). “Optimal cut-off score diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis”. CMAJ, vol.184(3). doi: 10.1503/cmaj.110829.

McArdle S, McGale N, and Gaffney P (2012). “A qualitative exploration of men’s experiences of an integrated exercise/CBT mental health promotion programme”. International Journal Of Men’s Health, vol.11(3), pp.240-257. doi:10.3149/jmh.1103.240.

McFarland C, Buehler R, von Rüti R, Nguyen L, and Alvaro C (2007). “The impact of negative moods on self-enhancing cognitions: the role of reflective versus ruminative mood orientations”. Journal of Personality And Social Psychology, vol.93(5), pp.728-750.

Mental Health Foundation (2014). Mental Health Statistics Available online. Accessed 17 April 2016.

Palmer K, Brown I, and Hobson J (2013). Fitness for Work, 5th edition, Oxford University Press.

Tortora G and Grabowski S (2003). Principles of anatomy and physiology, 10th edition, Hoboken NJ, John Wiley & Sons.

Waddell G, Burton K, and Kendall N (2008). Vocational Rehabilitation, what works, for whom and when? London: TSO pdf. Available online. Accessed 19 April 2016.

Wolever RQ, Bobinet KJ, McCabe K, Mackenzie ER, Fekete E, Kusnick CA, and Baime M (2012). “Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial”. Journal of Occupational Health Psychology, vol.17(2), pp.246-258.

YouGov (2012). Stress Survey. Available online. Accessed 19 April 2016.

Cheltenham Borough Council v Laird [2009] IRLR 621.

Hanlon v Kirklees Metropolitan Council and others [2004] EAT 0119/04 (IDS Brief 767).

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Revealing the Hidden Consequences: Real-life Case Studies in Stress and Anxiety

In today's fast-paced world, stress and anxiety are part and parcel of everyday life. While they are natural reactions to challenging circumstances, persistent, poorly managed stress can result in serious health outcomes. The stress behind the development of these illnesses is often not seen or well-treated since it is invisible and doesn't show up on x-rays or lab tests.

Case Study 1: The Physical Toll of Chronic Stress and Anxiety

John, a middle-aged executive, experienced chronic stress due to work and family pressure, leading to a range of health issues. Having never learned good stress management skills, John overate, drank too much coffee in the daytime and alcohol in the evening, and made no time for exercise or relaxation in his overbusy days. 

He didn’t complain or even recognize how stressed he was since all his colleagues and friends seemed to be dealing with the same issues.  He didn't recognize the signs of stress but over a few years accumulated a number of medical diagnoses and medications to go with them.

• Eating on the run and too much coffee and alcohol gave him chronic heartburn, diagnosed as “GERD” (GastroEsophageal Reflux Disease) and treated with omeprazole and antacids
• John developed high blood pressure and high cholesterol, putting him at high risk for heart disease and stroke, so was given blood pressure medications and statin medication
• His increasingly poor sleep was treated with Trazodone, a medication that knocked him out but left him feeling groggy and starting his day with 2 or 3 large cups of coffee
• As he became increasingly exhausted and using more alcohol, he got crankier and more irritable, early signs of depression in men. His doctor started him on an antidepressant which helped his mood, but didn't help him change his lifestyle which was at the root of all these “diagnoses.”

Case Study 2: Mental and Emotional Consequences

Susan, a school teacher, faced constant anxiety due to high workload and financial problems. This prolonged exposure to unmanaged stress and anxiety led to:

• Emotional Burnout: Over time, Susan experienced emotional exhaustion leading to feelings of detachment, a condition often referred to as burnout.
• Cognitive Difficulties: Chronic stress and burnout affected her ability to concentrate, plan, and make good decisions.
• Depression: Eventually, persistent stress and anxiety triggered the onset of depression in Susan

Case Study 3: The Social Impact

Emma, a college student suffering from chronic stress, worry, and anxiety, exhibited changes in her social behavior:

• Isolation: She started withdrawing from her friends and social activities, leading to feelings of loneliness and even more stress.
• Conflict: Her stress made her irritable, leading to increased conflict in her personal relationships, worsening her isolation and loneliness.

Identifying these signs of too much stress is the first step towards recovery. None of these people had an illness or disease – they were overstressed and didn't have the tools or support to help them manage it.  There are many techniques and tools that can help to keep stress and anxiety at manageable levels:

• Mindfulness and Meditation: Techniques like these helped John stay focused on the present moment, reducing his stress levels.
• Physical Activity: Regular exercise assisted Susan in reducing her stress. It served as a natural mood enhancer and distracted her from constant worry.
• Balanced Diet: Emma found that a healthy diet helped combat her stress. Certain foods even assisted in reducing stress, such as those rich in omega-3 fatty acids and vitamin C.
• Guided Imagery: Upon recognizing the detrimental effects of stress and anxiety on their daily lives, John, Susan, and Emma decided to learn how to reduce stress and manage it better when it couldn’t be avoided.  Either on their own or with the urging of a therapist, they discovered relaxation and guided imagery. The skills and practices they learned became a keystone of their healthy lifestyle, playing a significant role in alleviating their stress and anxiety and guiding them towards recovery.

Recognizing the signs of excessive stress and anxiety is the first step towards effectively managing them. Learning good elf-care stress and anxiety reduction skills is the second step. If you’re too overwhelmed or mired down in the stress, professional help you dig out of it. Remember, seeking help and making strides towards a healthier life is absolutely okay. Living a life free from the burden of constant worry is your right. The journey to that life begins now.

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Stress can be defined as a state of worry or mental tension caused by a difficult situation. Stress is a natural human response that prompts us to address challenges and threats in our lives. Everyone experiences stress to some degree. The way we respond to stress, however, makes a big difference to our overall well-being.

Stress affects both the mind and the body. A little bit of stress is good and can help us perform daily activities. Too much stress can cause physical and mental health problems. Learning how to cope with stress can help us feel less overwhelmed and support our mental and physical well-being.

Stress makes it hard for us to relax and can come with a range of emotions, including anxiety and irritability. When stressed, we may find it difficult to concentrate. We may experience headaches or other body pains, an upset stomach or trouble sleeping. We may find we lose our appetite or eat more than usual. Chronic stress can worsen pre-existing health problems and may increase our use of alcohol, tobacco and other substances.

Stressful situations can also cause or exacerbate mental health conditions, most commonly anxiety and depression, which require access to health care. When we suffer from a mental health condition, it may be because our symptoms of stress have become persistent and have started affecting our daily functioning, including at work or school.

No, everyone reacts differently to stressful situations. Coping styles and symptoms of stress vary from person to person. ​​

Yes, it is natural to feel stressed in challenging situations such as job interviews, school exams, unrealistic workloads, an insecure job, or conflict with family, friends or colleagues. For many people stress reduces over time as the situation improves or as they learn to cope emotionally with the situation. Stress tends to be widespread during events such as major economic crises, disease outbreaks, natural disasters, war, and community violence. 

Most of us manage stress well and continue to function. If we have difficulties coping with stress, we should seek help from a trusted health-care provider or from another trusted person in our community.

Learn stress management

WHO’s stress management guide – Doing what matters in times of stress – aims to equip people with practical skills to cope with stress. A few minutes each day are enough to practise the guide’s self-help techniques. The guide can be used alone or with its accompanying audio exercises.

Keep a daily routine

Having a daily schedule can help us use our time efficiently and feel more in control. Set time for regular meals, time with family members, exercise, daily chores and other recreational activities. 

Get plenty of sleep

Getting enough sleep is important for both body and mind. Sleep repairs, relaxes and rejuvenates our body and can help reverse the effect of stress.

Good sleep habits (also known as sleep hygiene) include:

• Be consistent. Go to bed at the same time each night and get up at the same time each morning, including on the weekends.
• If possible, make your sleeping area quiet, dark, relaxing and at a comfortable temperature.
• Limit your use of electronic devices, such as TVs, computers and smart phones, before sleeping.
• Avoid large meals, caffeine and alcohol before bedtime.
• Get some exercise. Being physically active during the day can help you fall asleep more easily at night.

Connect with others  ​

Keep in touch with family and friends and share your concerns and feelings with people you trust. Connecting with others can lift our mood and help us feel less stressed.

Eat healthy​

What we eat and drink can affect our health. Try to eat a balanced diet and to eat at regular intervals. Drink enough fluids. Eat lots of fresh fruits and vegetables if you can.

Exercise regularly ​

Regular daily exercise can help to reduce stress. This can include walking, as well as more intensive exercise.

Limit time following news ​

Spending too much time following news on television and social media can increase stress. Limit the time you spend following the news if it increases your stress.

Doing What Matters in Times of Stress: An Illustrated Guide

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Stress management interview questions and answers

Use these sample stress management interview questions to discover how candidates perform under pressure and how they approach stressful situations at work.

An experienced recruiter and HR professional who has transferred her expertise to insightful content to support others in HR.

10 good stress management interview questions

• How do you prepare for a presentation to important [clients/stakeholders/the executive board] the day before it’s due?
• How would you respond if your manager gave you negative feedback in front of your peers?
• What’s the most stressful situation you’ve faced at work so far? How did you handle it?
• How do you prevent a situation from getting too stressful to manage?
• What advice would you give to calm down a colleague who’s stressed out about a deadline?
• Can you describe a time when your stress resulted in making errors at work?
• How would you deal with frequent changes at work? For example, if stakeholders were indecisive about a project’s requirements, or if new members joined your team.
• If assigned with multiple tasks at the same time, how would you organize yourself to produce quality work under tight deadlines?
• Describe a time you had to make a tough decision (e.g. fire a team member or choose between two job offers.) How did you make sure you were objective?
• How do you ensure that stressful situations in your personal life don’t affect your work performance?

Stress is an inevitable part of most jobs. However, how one manages and responds to stress can greatly influence their effectiveness and productivity. Here are 10 questions to gauge a candidate’s stress management skills.

1. How do you prepare for a presentation to important [clients/stakeholders/the executive board] the day before it’s due?

This question assesses a candidate’s ability to handle pressure and prioritize tasks.

Sample answer:

“I break down the presentation into smaller tasks, allocate specific time slots for each, and ensure I have all the necessary information. I also practice multiple times to ensure clarity.”

2. How would you respond if your manager gave you negative feedback in front of your peers?

This question gauges emotional resilience and professionalism.

“I would listen calmly, ask for specific examples, and request a private meeting to discuss further. It’s essential to focus on improvement rather than reacting defensively.”

3. What’s the most stressful situation you’ve faced at work so far? How did you handle it?

This question evaluates problem-solving skills under pressure.

“I once had to handle a major client issue due to a product defect. I coordinated with the team, communicated transparently with the client, and ensured a timely resolution.”

4. How do you prevent a situation from getting too stressful to manage?

This question assesses proactive stress management techniques.

“I prioritize tasks, break them into manageable steps, and ensure clear communication with my team. Regular breaks and mindfulness exercises also help.”

5. What advice would you give to calm down a colleague who’s stressed out about a deadline?

This question gauges empathy and teamwork.

“I’d listen to their concerns, offer assistance if possible, and suggest taking a short break or using relaxation techniques.”

6. Can you describe a time when your stress resulted in making errors at work?

This question evaluates self-awareness and accountability.

“Yes, I once missed a minor detail in a report due to tight deadlines. I acknowledged the mistake, corrected it, and implemented a checklist system to prevent future oversights.”

7. How would you deal with frequent changes at work? For example, if stakeholders were indecisive about a project’s requirements, or if new members joined your team.

This question assesses adaptability.

“I’d maintain open communication, document changes, and ensure everyone is aligned. Regular team meetings can also help in such scenarios.”

8. If assigned with multiple tasks at the same time, how would you organize yourself to produce quality work under tight deadlines?

This question evaluates organizational skills under pressure.

“I use task management tools, prioritize based on urgency and importance, and delegate when necessary. Setting clear milestones also helps.”

9. Describe a time you had to make a tough decision (e.g. fire a team member or choose between two job offers.) How did you make sure you were objective?

This question gauges decision-making skills under stress.

“I gathered all relevant information, consulted with mentors, and weighed the pros and cons. Ensuring I was not influenced by emotions was crucial.”

10. How do you ensure that stressful situations in your personal life don’t affect your work performance?

This question assesses personal stress management techniques.

“I practice mindfulness, ensure work-life balance, and seek support when needed. It’s essential to compartmentalize personal issues from professional responsibilities.”

Why it’s important to ask stress management interview questions

Most jobs have stressful aspects, like reaching a quarterly goal, presenting an idea to managers or meeting a tight deadline. Employees with good stress management skills perform better because they:

• Reach objective decisions
• Keep those around them calm
• Come up with solutions in trying times

Employees who can’t manage stressful situations struggle to complete their duties, even if they possess the required skills and knowledge for the job. Some positions (like managerial roles) face more pressure than others. That’s why it’s important to identify candidates who can handle stress while remaining productive.

How to assess candidates’ stress management skills

• Use a combination of behavioral and situational interview questions. You’ll have the chance to find out how candidates handled stress in past positions, but also how they’ll manage stressful situations in their new role, if hired.
• Generic questions like “How do you handle stress?” will yield equally generic answers. Ask candidates to describe specific work examples of when they beat stress.
• Deliberately being persistent or even aggressive won’t give you a clear idea of how candidates react under pressure. Use realistic examples, instead. For example, if you’re hiring salespeople , ask how candidates would address the most common customer issues.
• Compare candidates’ answers to common problems related to the position. Opt not only for people who offer the best solutions, but for those who are able to maintain composure even during unexpected circumstances.
• Candidates might already be prepared to describe a situation where they successfully handled stress. So, use the interview to gauge their stress management skills. Do they feel uncomfortable when you ask tough questions or are they able to remain calm?
• Don’t be fast to reject candidates who seem on edge at first, as job interviews are stressful by nature. If, though, they remain stressed throughout the interview, you might want to reconsider their candidacy, especially in roles that require more socializing.
• They obsess over the stressor. Identifying who or what causes stress is only the first step in dealing with it. Candidates who fixate on the stressor, instead of taking action, are less likely to actually manage the situation.
• They cause stress. Bad habits, like procrastination or poor time-management skills, put people in needlessly stressful situations. Hire candidates who can get themselves out of such situations and not candidates who create them.
• They get stressed over little things. Pay attention to what makes candidates get stressed. If they mention regular, daily tasks, rather than bigger challenges, they mightn’t be suitable for this role.
• Their body language shows discomfort. Pose some tough, but realistic, problems to candidates. If they’re nervous when trying to find a solution, they’re likely to get stressed when actual problems arise on the job.
• They never experience stress. Most people get stressed by work at some point. Candidates who claim they never get stressed might take problems too lightly.

Don’t miss: The best interview questions to ask candidates

Frequently asked questions

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A CASE STUDY ON STRESS MANAGEMENT WITH REFERENCE TO LAKSHMI NISSAN AUTOMOTIVES PVT.LTD, HYDERABAD

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Stress management interview questions (and answers)

25 Stress management interview questions to see how well your candidates deal with stress at work

Home » Resource Library » Competency based interview questions » Stress management interview questions & answers

25 good stress management interview questions

• How do you define stress management, and why is it important in the workplace?
• Describe a situation when you felt overwhelmed with work or a challenging project and how you handled it.
• How do you maintain a healthy work-life balance to prevent burnout and excessive stress?
• Share an example of a time when you effectively handled pressure and remained calm during a high-stakes situation.
• How do you prioritise tasks and manage deadlines during busy periods to reduce stress?
• Describe a time when you successfully supported a team member or colleague who was experiencing stress or pressure.
• How do you handle stress from unexpected setbacks or changes in the workplace?
• Share an example of a time when you practiced mindfulness or relaxation techniques to manage stress effectively.
• How do you handle conflicting priorities and time-sensitive tasks without succumbing to stress?
• Describe a time when you took proactive measures to prevent stress or burnout in a team or project setting.
• How do you handle stress in situations of ambiguity or uncertainty, such as when faced with complex or challenging problems?
• Share an example of a time when you managed a high-pressure project without compromising your well-being or mental health.
• How do you foster a culture of well-being and stress management within your team or organisation?
• Describe a time when you effectively delegated tasks to team members to alleviate your workload during a stressful period.
• How do you manage stress when working with tight deadlines and complex deliverables?
• Share an example of a time when you effectively communicated with superiors or team members about unrealistic expectations or excessive workload.
• How do you handle stress in situations of high uncertainty or crisis, such as during organisational changes or economic downturns?
• Describe a time when you effectively managed stress during a project with multiple stakeholders and conflicting interests.
• How do you handle stress when working with challenging or difficult colleagues or supervisors?
• Share an example of a time when you effectively managed stress while juggling multiple projects and responsibilities simultaneously.
• How do you promote resilience and mental well-being within your team, especially during challenging periods?
• Describe a time when you sought feedback from colleagues or mentors to improve your stress management strategies.
• How do you manage stress during high-volume or fast-paced work environments, such as during peak seasons or critical periods?
• Share an example of a time when you effectively balanced short-term demands with long-term well-being and stress management.
• How do you handle stress when facing setbacks or failures in your work or projects?

1. How do you define stress management, and why is it important in the workplace?

What to look for:

Candidates who understand the significance of effectively managing stress for personal well-being and productivity.

Suggested answer:

“Stress management involves adopting strategies to cope with and reduce stress levels. It’s important in the workplace as it promotes overall well-being, enhances focus, and improves performance.”

2. Describe a situation when you felt overwhelmed with work or a challenging project and how you handled it.

The candidate’s ability to recognise and address stress effectively.

“During a busy period, I prioritised tasks, set realistic deadlines, and sought support from my team. I also practiced mindfulness techniques to stay focused and composed.”

3. How do you maintain a healthy work-life balance to prevent burnout and excessive stress?

Candidates who prioritise work-life balance and self-care.

“To maintain work-life balance, I set boundaries on work hours, engage in hobbies outside of work, and make time for family and friends. Taking breaks and exercising also help me recharge.”

4. Share an example of a time when you effectively handled pressure and remained calm during a high-stakes situation.

Evidence of the candidate’s ability to handle pressure with composure.

“During a critical project presentation, I focused on my preparation and took deep breaths to stay composed. I viewed the pressure as an opportunity to excel, which helped me deliver a successful presentation.”

5. How do you prioritise tasks and manage deadlines during busy periods to reduce stress?

Candidates who can effectively manage their workload and prioritise tasks.

“During busy periods, I use to-do lists and prioritise tasks based on urgency and importance. I also communicate with my team to adjust deadlines when needed and ensure realistic expectations.”

6. Describe a time when you successfully supported a team member or colleague who was experiencing stress or pressure.

The candidate’s ability to offer support and empathy to others during stressful situations.

“A team member was feeling overwhelmed with deadlines, so I offered to help with some tasks. I also listened to their concerns and provided encouragement, which helped alleviate their stress.”

7. How do you handle stress from unexpected setbacks or changes in the workplace?

Candidates who can adapt to change and manage stress effectively.

“When faced with unexpected setbacks, I focus on finding solutions rather than dwelling on the problem. I seek support from colleagues and maintain a positive mindset to handle the situation proactively.”

8. Share an example of a time when you practiced mindfulness or relaxation techniques to manage stress effectively.

Evidence of the candidate’s commitment to stress-relief techniques.

“During a busy week, I practiced meditation and deep breathing exercises during breaks. It helped me stay centred, reduce stress, and regain focus on my tasks.”

9. How do you handle conflicting priorities and time-sensitive tasks without succumbing to stress?

Candidates who can manage competing demands effectively.

“When facing conflicting priorities, I communicate openly with stakeholders about deadlines and set realistic expectations. I break tasks into manageable steps, focusing on one thing at a time to reduce stress.”

10. Describe a time when you took proactive measures to prevent stress or burnout in a team or project setting.

The candidate’s ability to address stress proactively within a team.

“Before a demanding project, I organised a team meeting to discuss potential stressors and implement strategies for work-life balance. We encouraged open communication to ensure everyone felt supported.”

11. How do you handle stress in situations of ambiguity or uncertainty, such as when faced with complex or challenging problems?

Candidates who can manage stress in dynamic and unpredictable situations.

“In ambiguous situations, I break down the problem into smaller components and seek input from team members. I focus on what I can control and take decisive action, which helps me manage stress effectively.”

12. Share an example of a time when you managed a high-pressure project without compromising your well-being or mental health.

Evidence of the candidate’s ability to maintain well-being under pressure.

“During a high-pressure project, I maintained a healthy work-life balance by taking breaks, exercising, and practicing stress-relief techniques. It allowed me to stay focused and perform at my best without burning out.”

13. How do you foster a culture of well-being and stress management within your team or organisation?

Candidates who prioritise promoting well-being among their team members.

“I foster a culture of well-being by encouraging work-life balance, organising team-building activities, and providing resources for stress management and mental health support.”

14. Describe a time when you effectively delegated tasks to team members to alleviate your workload during a stressful period.

The candidate’s ability to delegate tasks and seek support when needed.

“During a busy period, I identified tasks suitable for delegation and empowered team members to take on additional responsibilities. It allowed me to focus on critical tasks while maintaining a manageable workload.”

15. How do you manage stress when working with tight deadlines and complex deliverables?

Candidates who can maintain composure and productivity under pressure.

“When faced with tight deadlines, I prioritise tasks, seek support from colleagues, and maintain open communication to manage expectations. I focus on the quality of my work while managing my stress levels.”

16. Share an example of a time when you effectively communicated with superiors or team members about unrealistic expectations or excessive workload.

Evidence of the candidate’s assertiveness in managing stress from unrealistic expectations.

“When confronted with unrealistic expectations, I communicated openly with my superiors, explaining the workload challenges and proposing adjustments to ensure a manageable and sustainable pace.”

17. How do you handle stress in situations of high uncertainty or crisis, such as during organisational changes or economic downturns?

Candidates who can remain resilient and composed during crises.

“In times of uncertainty or crisis, I stay informed, seek support from leadership and colleagues, and focus on factors within my control. I also practice self-care to maintain mental and emotional well-being.”

18. Describe a time when you effectively managed stress during a project with multiple stakeholders and conflicting interests.

Evidence of the candidate’s ability to navigate stress in complex projects.

“In a project with diverse stakeholders, I actively engaged all parties, sought alignment on project goals, and communicated openly to address conflicting interests, which helped reduce overall stress.”

19. How do you handle stress when working with challenging or difficult colleagues or supervisors?

Candidates who can manage stress in interpersonal dynamics professionally.

“When working with challenging colleagues or supervisors, I focus on maintaining professionalism and open communication. I seek support from mentors or colleagues to navigate the situation constructively.”

20. Share an example of a time when you effectively managed stress while juggling multiple projects and responsibilities simultaneously.

Evidence of the candidate’s multitasking and stress management abilities.

“During a period with multiple projects, I prioritised tasks based on deadlines and importance. I broke down complex projects into manageable steps, ensuring I allocated time effectively to manage stress.”

21. How do you promote resilience and mental well-being within your team, especially during challenging periods?

Candidates who prioritise supporting the mental well-being of their team members.

“To promote resilience, I encourage open discussions on stress and mental health, provide resources for support, and lead by example in maintaining work-life balance.”

22. Describe a time when you sought feedback from colleagues or mentors to improve your stress management strategies.

Evidence of the candidate’s willingness to seek self-improvement.

“To enhance my stress management, I sought feedback from colleagues, mentors, or coaches. I used their insights to adjust my strategies and develop healthier coping mechanisms.”

23. How do you manage stress during high-volume or fast-paced work environments, such as during peak seasons or critical periods?

Candidates who can maintain focus and performance in demanding environments.

“During high-volume periods, I maintain focus on essential tasks, delegate when possible, and seek support from team members. I also practice time management techniques to handle the workload effectively.”

24. Share an example of a time when you effectively balanced short-term demands with long-term well-being and stress management.

Evidence of the candidate’s ability to maintain a balanced perspective on stress management.

“While managing short-term deadlines, I ensured I took breaks and practiced self-care to maintain long-term well-being. Balancing short-term demands with self-care is crucial to managing stress effectively.”

25. How do you handle stress when facing setbacks or failures in your work or projects?

Candidates who can cope with stress resulting from setbacks or failures positively.

“When facing setbacks, I practice resilience by acknowledging the situation, learning from it, and using the experience as an opportunity for growth. I focus on finding solutions and maintaining a positive outlook.”

The suggested answers here are only examples, and your candidates should (and hopefully will) provide unique responses based on their experiences. 

As a recruiter, focus on the candidate’s ability to recognise and manage stress effectively, prioritise self-care and work-life balance, and stay composed under pressure. 

Look for real-life examples that demonstrate their stress management skills and how they have maintained productivity and well-being during challenging times.

How to measure stress management 

Measuring stress management skills involves assessing an individual’s ability to cope with and effectively handle stressors in both personal and professional settings. 

Self-awareness:

Assess a candidate’s level of self-awareness regarding their stress triggers and coping mechanisms. Inquire about their understanding of how stress manifests for them personally.

Previous stressful situations:

Ask candidates to share examples of situations where they faced high levels of stress. Evaluate their responses to understand how they navigated and coped with challenging circumstances.

Time management:

Stress often arises from tight deadlines and competing priorities. Assess a candidate’s time management skills by inquiring about experiences where they successfully juggled multiple tasks under pressure.

Coping strategies:

Inquire about the candidate’s coping strategies for managing stress. Strong candidates will have a range of healthy coping mechanisms, such as exercise, mindfulness, or seeking support from colleagues.

Resilience:

Evaluate a candidate’s resilience in the face of adversity. Ask about instances where they encountered setbacks or challenges and how they bounced back from those situations.

Adaptability to change:

Stress can be heightened during periods of change. Assess a candidate’s ability to adapt to changes in the workplace and their strategies for maintaining composure and focus during transitional periods.

Work-life balance:

Inquire about a candidate’s approach to maintaining a healthy work-life balance. Candidates who prioritise balance tend to be more adept at managing stress associated with demanding work environments.

Communication under pressure:

Evaluate a candidate’s communication skills in high-pressure situations. Ask about instances where they had to communicate effectively during stressful times, demonstrating their ability to stay composed and convey information clearly.

Mindfulness and relaxation techniques:

Assess whether candidates incorporate mindfulness or relaxation techniques into their daily routine. What specifically do they do, and how do they deal with stress at work when it arises? These practices can indicate a proactive approach to managing stress.

Conflict resolution in stressful situations:

Stress can contribute to conflicts in the workplace. Inquire about instances where candidates successfully resolved conflicts during stressful times, demonstrating their ability to navigate challenging interpersonal dynamics.

Seeking support:

Assess a candidate’s willingness to seek support from colleagues, supervisors, or other resources when facing high levels of stress. Candidates who recognise the importance of seeking help demonstrate emotional intelligence.

Measuring stress management skills requires a holistic approach, considering both the strategies candidates employ to manage stress and their overall mindset and resilience in challenging situations. It’s important to tailor the assessment to the specific stressors prevalent in the role and organisational context.

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30 Stress Quiz Questions and Answers

A stress quiz is a set of questions designed to assess an individual’s level of stress and their ability to cope with it. It helps individuals gain insight into their stress levels, identify potential stressors, and understand their stress management skills. Stress quizzes typically consist of multiple-choice questions that cover various aspects of stress, its causes, symptoms, and coping strategies.

Article outline

Part 1: 30 stress quiz questions & answers.

1. What is stress? a) A state of relaxation b) A natural response to a perceived threat or challenge c) A form of meditation d) A state of boredom Answer: b) A natural response to a perceived threat or challenge

2. What are common physical symptoms of stress? a) Increased energy levels b) Headaches and migraines c) Improved digestion d) Clear and focused thinking Answer: b) Headaches and migraines

3. Which of the following is a potential cause of stress? a) Having a balanced lifestyle b) Engaging in regular exercise c) Financial difficulties d) Maintaining strong social connections Answer: c) Financial difficulties

4. How does chronic stress differ from acute stress? a) Chronic stress is short-term, while acute stress is long-term. b) Chronic stress is a response to a specific event, while acute stress is ongoing. c) Chronic stress lasts for an extended period, while acute stress is temporary. d) Chronic stress is beneficial, while acute stress is harmful. Answer: c) Chronic stress lasts for an extended period, while acute stress is temporary.

5. Which coping strategy involves avoiding or ignoring stressful situations? a) Problem-solving b) Social support c) Emotional release d) Avoidance Answer: d) Avoidance

6. What is the term for a stress management technique that involves consciously focusing attention on the present moment? a) Procrastination b) Mindfulness c) Self-criticism d) Overthinking Answer: b) Mindfulness

7. How does exercise help in managing stress? a) It increases stress levels b) It promotes relaxation and releases endorphins c) It worsens physical symptoms of stress d) It has no impact on stress levels Answer: b) It promotes relaxation and releases endorphins

8. Which of the following is an effective way to manage stress? a) Ignoring stress and hoping it goes away b) Isolating oneself from social support c) Engaging in hobbies and enjoyable activities d) Consuming excessive amounts of caffeine Answer: c) Engaging in hobbies and enjoyable activities

9. What is the term for the body’s physiological response to stress, involving the release of hormones like cortisol and adrenaline? a) Relaxation response b) Fight-or-flight response c) Resilience response d) Coping response Answer: b) Fight-or-flight response

10. How can social support help in managing stress? a) By increasing feelings of isolation and loneliness b) By providing a sense of belonging and understanding c) By exacerbating stress levels d) By creating more stress through conflicts and disagreements Answer: b) By providing a sense of belonging and understanding

11. What is the term for stress resulting from excessive work demands and pressures? a) Academic stress b) Relationship stress c) Burnout d) Financial stress Answer: c) Burnout

12. Which of the following is an example of an unhealthy coping mechanism for stress? a) Engaging in physical exercise b) Seeking social support c) Smoking or excessive alcohol consumption d) Practicing deep breathing techniques Answer: c) Smoking or excessive alcohol consumption

13. How can deep breathing exercises help in managing stress? a) By increasing heart rate and blood pressure b) By promoting relaxation and reducing anxiety c) By worsening symptoms of stress d) By distracting from stressors Answer: b) By promoting relaxation and reducing anxiety

14. What is the term for a state of emotional, physical, and mental exhaustion caused by prolonged stress? a) Anxiety b) Depression c) Fatigue d) Burnout Answer: d) Burnout

15. Which of the following is a common symptom of burnout? a) Increased motivation and productivity b) Decreased energy and motivation c) Improved sleep quality d) Enhanced concentration and focus Answer: b) Decreased energy and motivation

Part 2: Download stress questions & answers for free

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16. How can time management help in reducing stress? a) By increasing workload and responsibilities b) By providing structure and organization c) By promoting procrastination and disorganization d) By reducing productivity and efficiency Answer: b) By providing structure and organization

17. What is the term for a coping strategy that involves seeking advice, encouragement, or assistance from others? a) Problem-solving b) Social support c) Distraction d) Avoidance Answer: b) Social support

18. How does chronic stress affect the immune system? a) It strengthens the immune response b) It has no impact on the immune system c) It weakens the immune response d) It alters the body’s sleep patterns Answer: c) It weakens the immune response

19. What is the term for stress resulting from difficulties in interpersonal relationships? a) Work stress b) Academic stress c) Relationship stress d) Financial stress Answer: c) Relationship stress

20. Which coping strategy involves reframing negative thoughts and focusing on positive aspects of a situation? a) Emotional release b) Problem-solving c) Positive reframing d) Avoidance Answer: c) Positive reframing

21. What is the term for stress resulting from financial difficulties and pressures? a) Work stress b) Academic stress c) Relationship stress d) Financial stress Answer: d) Financial stress

22. How can maintaining a healthy lifestyle contribute to stress management? a) By increasing stress levels b) By promoting relaxation and overall well-being c) By worsening physical symptoms of stress d) By interfering with daily routines and responsibilities Answer: b) By promoting relaxation and overall well-being

23. What is the term for a stress management technique that involves writing down thoughts and emotions to gain clarity and perspective? a) Meditation b) Deep breathing c) Journaling d) Exercise Answer: c) Journaling

24. Which of the following is a symptom of excessive stress? a) Increased concentration and focus b) Decreased appetite and weight loss c) Improved sleep quality d) Irritability and mood swings Answer: d) Irritability and mood swings

25. How can humor and laughter help in managing stress? a) By increasing stress levels b) By promoting relaxation and reducing tension c) By worsening physical symptoms of stress d) By distracting from stressors Answer: b) By promoting relaxation and reducing tension

26. What is the term for stress resulting from academic pressures and challenges? a) Work stress b) Academic stress c) Relationship stress d) Financial stress Answer: b) Academic stress

27. How can setting boundaries help in managing stress? a) By increasing workload and responsibilities b) By promoting work-life balance and self-care c) By creating conflicts and disagreements d) By reducing productivity and efficiency Answer: b) By promoting work-life balance and self-care

28. Which coping strategy involves engaging in enjoyable activities or hobbies to reduce stress? a) Problem-solving b) Social support c) Emotional release d) Recreation and leisure Answer: d) Recreation and leisure

29. How can proper sleep hygiene help in managing stress? a) By increasing stress levels b) By promoting relaxation and improving overall well-being c) By worsening physical symptoms of stress d) By interfering with daily routines and responsibilities Answer: b) By promoting relaxation and improving overall well-being

30. What is the term for a stress management technique that involves breaking tasks into smaller, more manageable steps? a) Procrastination b) Time management c) Prioritization d) Goal setting Answer: b) Time management

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Stress Management : A Case study of Employees in ONGC, Karaikal

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Stress Management Harvard Case Solution & Analysis

Home >> Harvard Case Study Analysis Solutions >> Stress Management

Stress Management Case Solution

Stress management.

A good stress management program will not only improve the mental health, but it will also improve the relationships with others. It will also help them to feel happier and more productive. It will also help to cope with the stresses of the life.

Stress Management Techniques

The first step is to identify the stressful situations in the life. They should be able to recognize the triggers of those situations and develop coping mechanisms. By doing this, they will be able to manage the stress and stay healthy. There is one way to reduce the symptoms of stress is to practice self-care, also known as managing stress because stress affects sleep. Getting quality sleep is a vital part of stress management. A proper sleep can improve the physical health and reduce the stress that experienced throughout the day.

Practicing meditation could also reduce the stress that the experience throughout the day. But long sessions are not as effective as short sessions. A five-minute session can calm the mind and body. The key is to be consistent.Exercising can reduce stress levels and improve overall health. Getting moving regularly will not only keep them in better shape, but it will also decrease the level of anxiety and improve the mood.

It is concluded that when all experience some stress, learning about these factors and how to manage them can help to reduce overall level of stress. Managing stress is an ongoing process that will help to maintain a healthy life. Learning how to manage the stress is important for the health and well-being. Effective stress management can help to enjoy a happier, healthier, and more productive life . In addition to this, it helps to become resilient and cope with pressure. Stress can be very harmful to the body and mind. It can cause a number of physical and mental symptoms. It is important to understand how to cope with stress. During stressful times, a healthy lifestyle can make a huge difference. They will feel better if they can deal with stress in a productive and balanced way. Fortunately, there are ways to manage the stress and get more rest. By following some basic tips, they can reduce the level of stress and improve health. They may find it useful to keep a stress diary. They can find a healthy way to handle the stress by focusing on the things that are in control.

Recommendations

It is recommended to use multiple methods because it is not necessary that one single method will work for everyone. Here, the key is to find the right combination of techniques that work for them. There is no set formula for how to do this; it may take several tries to find the right balance. Keeping a daily routine can help them to cope with stress. They may find it useful to keep a stress diary to track the types of stress they experience and make any necessary changes. This will help them to better understand their own unique needs and patterns.The first step in treating this disorder is to determine what kind of stress is causing the symptoms. A medical doctor can determine the severity of the condition by examining the patient's mental health and conducting a mental exam (Wang, 2020). They should try to avoid those people that are making them to feel stressed. If these people are the boss, they should talk to them to discuss the situation and how to deal with them. They might be able to find the solution for themselves, but they can still manage the stress in the long run by making changes. In addition to this, they can try to avoid stressful situations by letting themselves relax when they are feeling tense.............................

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Q1. Which of the following statements is true

• In small quantities, stress is good
• Too much stress is harmful
• All stress is bad
• Only ‘1’ & ‘2’ are right

Q2. Stress management is about learning

• How to avoid the pressures of life
• How to develop skills that would enhance our body’s adjustment when we are subjected to the pressures of life
• Both ‘1’ & ‘2’ are true
• None of the above

Q3. Which of the following statements is true about stress management

• Stress management is learning about the connection between mind and body
• Stress management helps us control our health in a positive sense
• Stress management teaches us to avoid all kinds of stress

Q4. Which of the following are the basic sources of stress

• The Environment
• Social Stressors
• Physiological
• All of the above

Q5. Examples of environmental stressors are

• Financial problems
• Substandard housing
• Only ‘1’ , ‘2’ & ‘4’ are right

Q6. Examples of social stressors are

• Loss of a loved one
• Job interviews

Q7. Examples of physiological stressors are

• Giving birth
• Sleep disturbances
• Relationship problems
• Only ‘1’, ‘2’, & ‘3’ are true

Q8. The following are the characteristics of Positive Stress

• It improves performance
• It feels exciting
• It motivates

Q9. The following are the characteristics of Negative Stress

• It causes anxiety
• It feels unpleasant
• It decreases performance

Q10. Which of the following statements is true

• Positive stress is short-term
• Negative stress can be short or long-term
• Negative stress can lead to mental as well as physical problems
• Negative stress is perceived within our coping abilities
• All except ‘4’ is true

Q11. The following are the examples of negative stressors

• Unemployment
• Legal problems

Q12. The following are the examples of positive stressors

• Having a child
• Buying a home

Q13. Which of the following statements is true

• Habitual behaviour patterns like over scheduling, procrastination, etc. Can cause negative stress
• Thoughts like fear, worrying about future etc. can cause negative stress

Q14. Which of the following are the physical symptoms of anxiety

• Racing heart
• Sweaty palms
• Flushed cheeks

Q15. What are the behavioural reactions to anxiety

• Avoiding situation where there are chances of experiencing anxiety
• Escaping situations when feelings of anxiety begin
• Both ‘1’ and ‘2’ are true

Q16. Anxiety can cause the following moods

Q17. What thoughts come to the mind when you’re under negative stress

• You think that you can cope with the situation
• You think that you cannot cope with the situation
• You think that everything will get fine eventually
• You think that you will get hep immediately

Q18. The symptoms of stress can be divided in to the following categories

• Behavioural

Q19. Which of the following statements is true

• Moodiness is a cognitive symptom of stress
• Moodiness is an emotional symptom of stress
• Poor judgement is an emotional symptom of stress
• Agitation is cognitive symptom of stress

Q20. The following are true about the behavioural symptoms of stress

• The subject’s starts eating more or less
• The subject starts sleeping more or less
• The subject isolates himself/herself from others

Q21. Aches, shallow breathing and sweating, frequent colds are

• Physical symptoms of stress
• Behavioural symptoms of stress
• Emotional symptoms of stress
• Cognitive symptoms of stress

Q22. The following are true about the effects of stress

• Hair loss and baldness
• Spasmodic pains in the neck and shoulders
• Hypertension

Q23. What are the questions you need to ask yourself while you are assessing yourself for stress

• Where do you feel stress in your body
• How do you know when you are stress
• How do you react to stress

Q24. Who was the first to describe the “fight or flight response”

• Walter B. Cannon
• Sigmund Freud
• Atkinson Potter
• Mrunal Sengupta

Q25. Which of the following are true in relation to Relaxation Response

• It is a physical state of deep rest
• Eliciting this reduces your metabolism
• Eliciting this reduces your blood pressure

Q26. Which of the following is true about eliciting the relaxation response

• Repetition of a word
• Passive disregard of everyday thoughts
• Doing weight training

Q27. Which of the following Mindfulness meditation techniques can help relieve stress

• Walking Meditation
• Mindful Eating

Q28. Which of the following are true about ‘mini-relaxation exercises’

• You can do them anywhere
• You can do them without eliciting attention from others around you
• It is most beneficial if you do it on a regular basis

Q29. Which of the following is true about ‘deep breathing relaxation technique’

• It can be self-taught
• It releases tension from the body and clears your mind
• You have to do this under-water
• Only ‘1’ & ‘2’ are true

Q30. Which of the following are true about the ‘Guided Imagery’ technique

• It is like vivid daydreaming
• You need a hypnotist for this technique
• You need to rest in a sleeping posture

Q31. Which of the following are stress busters

• Trying to find something funny in a difficult situation
• Developing a support network
• Taking a mindful walk

Jhasketan Garud

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• Open access
• Published: 26 June 2024

Exploring stress management strategies among emergency medical service providers in Iran: a qualitative content analysis

• Afshin Khazaei   ORCID: orcid.org/0000-0002-8063-3419 1 ,
• Ali Afshari   ORCID: orcid.org/0000-0002-4579-5869 2 ,
• Rasoul Salimi   ORCID: orcid.org/0000-0002-6463-6046 3 ,
• Abbas Fattahi   ORCID: orcid.org/0000-0002-8017-2069 4 ,
• Behzad Imani   ORCID: orcid.org/0000-0002-1544-8196 5 &
• Mohammad Torabi   ORCID: orcid.org/0000-0003-4150-5331 6  

BMC Emergency Medicine volume  24 , Article number:  106 ( 2024 ) Cite this article

74 Accesses

Metrics details

Emergency medical service providers are frequently exposed to a variety of stressors as a result of their work environment. These stressors can have detrimental effects on both the physical and mental well-being of individuals. This study was conducted with the aim of exploring stress management strategies in emergency medical service providers.

This study was conducted in 2023 using a qualitative approach and content analysis method. A purposive sampling method was used to include 16 emergency medical system providers from Hamadan city. Semi-structured interviews, with a duration of 45–60 min, were conducted for data collection. The Data were analyzed using Graneheim and Lundman’s conventional content analysis approach.

The analysis of the interview data revealed three themes: readiness for the worst conditions, assistance based on supportive partnerships, and striving for balance. The six categories within these three themes were mental preparation, risk management, collaborations in emergency response, supportive communication, adaptive behaviors, and maladaptive responses.

Conclusions

The results of this study shed light on the various stress management strategies employed by emergency medical service providers. Understanding and implementing effective stress management strategies can not only enhance the well-being of emergency medical service providers but also improve the quality of patient care. Further research and action are essential to promote the resilience and mental health of these professionals, ensuring their overall well-being and job satisfaction.

Peer Review reports

Introduction

Workplace stress refers to emotional, cognitive, behavioral, and physiological responses to adverse aspects of work, the work environment, and the work organization. These reactions can lead to negative psychological and physiological consequences for the individual [ 1 ]. The prehospital emergency setting is one of the most stressful areas of the healthcare system. Emergency medical service (EMS) providers, as frontline personnel providing emergency services in this setting, are exposed to numerous stressors. These stressors include exposure to accidents and harrowing scenes, as well as the need to make quick decisions to rescue the injured [ 2 , 3 , 4 ]. Some of the stress factors that EMS providers face include rescuing patients in critical condition, caring for severely ill patients, facing the death of patients, excessive expectations from people, lack of organizational support, being exposed to violence and threatening situations at the scene of an accident, and the risk of contracting diseases from patients and injured individuals [ 5 , 6 ]. Due to exposure to multiple stress factors, especially traumatic and critical incidents, EMS providers experience various health-related issues [ 7 ].

Ignoring workplace stress and neglecting prevention methods and stress reduction strategies in EMS providers can lead to various physical and psychological complications, such as anxiety, depression, sleep disorders, fatigue, digestive symptoms, unsafe behaviors, and job burnout [ 8 ]. It can also cause behavioral problems, such as a tendency to consume alcohol and cigarettes, and to quit and leave the service, ultimately leading to a lack of human resources and imposing extra costs on health systems [ 9 ]. Studies show that continuous exposure to work-related stress factors and neglecting stress reduction mechanisms in EMS providers are predisposing factors for posttraumatic stress disorder (PTSD) [ 10 , 11 ].

Sterud et al. believe that EMS providers are reluctant to seek help from psychologists or doctors [ 6 ]. Some studies have shown that when nurses do not have enough time to adapt or reduce stress after experiencing stressful incidents, it can have detrimental effects on their well-being [ 12 , 13 ]. Therefore, considering the nature of the prehospital field, it can be inferred that EMS providers will also be affected by the consequences of stress. This is due to being assigned multiple and complex missions without sufficient time for recovery [ 14 ].

Previous studies have reported that the level of stress among EMS providers in Iran is moderate to severe [ 15 , 16 ] However, coping and adapting strategies for stress in this group of people have not been investigated. On the other hand, there have been limited qualitative studies conducted on the mechanisms of stress adaptation among EMS providers. For several reasons, we used a qualitative method to investigate stress measurement strategies in this study. Qualitative methods enable a more in-depth exploration of individuals’ experiences, perceptions, and behaviors related to stress management. Qualitative research enables the collection of rich, detailed data that can provide insights into the complexities of stress management. Qualitative research allows for flexibility in data collection, enabling researchers to adapt their approach based on emerging themes and insights. Stress management is influenced by various contextual factors, such as cultural, social, and environmental factors. Qualitative methods are well suited for capturing these contextual nuances, providing a more holistic understanding of stress management practices within various populations and settings. The aim of this study was to explore the perceptions and experiences of EMS providers regarding stress management strategies in response to work-related stress factors.

In the present study, a qualitative research approach and the content analysis method were used. Qualitative research gathers participants’ experiences, perceptions, and behavior. It answers how and whys instead of how many or how much. It could be structured as a stand-alone study, relying purely on qualitative data, or it could be part of mixed-methods research that combines qualitative and quantitative data [ 17 ]. Content analysis is a method of qualitative research used to analyze information to gain a better understanding of the subject being studied [ 18 ]. In this study, the theoretical framework that guides qualitative research was social constructionism. This framework emphasizes the role of social and cultural factors in shaping individuals’ perceptions and experiences.

Participants

The research took place in the city of Hamadan, which is located in western Iran, from November 2022 to July 2023. According to the most recent statistics from December 2022, Hamadan has a population of 678,318. According to the guidelines of the Ministry of Health in Iran, cities with a population of 50,000 people should have at least one ambulance base. For every additional 60,000 people above the base population of 50,000 people, an additional ambulance base is needed. According to national standards, there should be one ambulance base every 30 km along roads. Currently, there are 12 urban ambulance bases in Hamadan, which are considered sufficient and in line with population standards. There are eight road bases in Hamadan, each located 30 km apart, according to national standards. However, the coverage of rural roads is not satisfactory, as only approximately 40% of rural areas are within a 30-kilometer radius of road ambulance bases [ 19 ]. Compared to other cities in Iran, Hamadan is considered a medium-sized city, and the number of existing ambulance bases currently complies with national standards. Unfortunately, there are no national or local guidelines for managing work-related stress in the emergency medical system in Hamadan. This is particularly concerning, especially considering that this issue became more noticeable during the COVID-19 pandemic. Furthermore, appropriate measures were not taken to manage stress, replace injured personnel, or support the staff.

The EMS in Iran is a division of the Ministry of Health, Treatment, and Medical Education. The government funds EMS delivery, which is provided free of charge. Bases are staffed with a combination of emergency medical technicians and nurses who are deployed together on missions. The dispatch center is responsible for diagnosing emergency cases and deploying operational personnel to accident scenes. The dispatch center is staffed by experienced nurses and physicians with over 5 years of experience. As soon as the personnel at the dispatch center receive the call and determine that the incident is an emergency, they transmit the received information wirelessly to the nearest base located near the incident site. During the mission, additional information such as the patient’s condition, the accident scene, and access routes to the scene are transferred to the EMS providers if needed. The dispatch center monitors the dispatch of ambulances moment by moment and responds to EMS providers’ requests during missions. This follow-up by the dispatch center personnel will continue until the mission is completed and the EMS providers return to the base. The dispatch center records the time it takes for EMS providers to prepare for their next missions in the system. Each ambulance station in Hamadan city is strategically located to cover a specific area of the city. The average response time in the city is 8 min, while for road accidents, it is 14 min. The comfort facilities in the ambulance stations are adequate, and all of them are equipped with sports equipment for the physical preparation of EMS providers. In Hamadan city, emergency medical personnel work in rotations, spending six months at road bases and the next six months at urban bases. The training of these personnel is overseen by the medical emergency system training unit, which organizes annual in-service training courses for the staff. At each ambulance base, two EMS providers provide emergency services during a 24-hour shift. EMS providers are in contact with physicians at the dispatch center by phone for consultation during critical and complex situations. The operation of the EMS in Iran is independent of other emergency and security systems (the Red Crescent, fire department and police).

In this study, all the ambulance bases in Hamadan city (12 urban and 8 road bases) were considered for selecting the participants. Since working in the emergency medical system is always accompanied by various factors such as encountering unfortunate incidents, dealing with environmental hazards, and providing assistance under unpredictable conditions, all EMS providers in this profession are exposed to occupational stress. Therefore, in this study, despite employing a purposeful sampling method, an effort was made to incorporate the maximum variation technique by considering age, work experience, ambulance station location, and educational degree. All operational personnel of the emergency medical system who were working in road and urban bases were potential participants in this study. To conduct the interviews, we visited the emergency center and obtained permission from the management of the emergency medical system. We also explained the purpose of the study. The first person interviewed had 14 years of work experience. The next participant was selected for interviews via snowball sampling among the EMS providers. Since the interviewer did not have a previous relationship with the participants, he used snowball sampling to select the participants. After interviewing the EMS providers, they were asked to identify individuals who had experienced more stressful factors in the work environment to participate in the study. The criteria for participating in the study included having at least two years of work experience in ambulance bases and a willingness to participate. In the emergency medical system of Hamadan city, there are 146 EMS providers. A total of sixteen EMS providers were invited to participate in the study. It is noteworthy that all selected participants agreed to participate in the study, and none declined or withdrew their participation.

Data collection

The semi-structured interview guide was created based on the research objectives, taking into account the input of all members of the research team. The interview guide was given to two psychology experts outside of the research team for review. At this stage, some questions were revised and modified. Two pilot interviews were conducted to ensure the accuracy of the interviews and to validate the interview guide. All authors evaluated the integrity and accuracy of these two interviews, and the final interview guide was prepared. Pilot interviews were not included in the final analysis. The data were collected by the corresponding author through individual, face-to-face, and semi-structured interviews. The interviewer, who holds a PhD in nursing and is currently a member of the Faculty of Nursing and Midwifery, had the requisite qualifications to lead this qualitative study. These qualifications encompassed extensive experience in designing, executing, and interpreting qualitative research projects, along with expertise in utilizing diverse qualitative research methods such as interviews, observations, and content analysis. Furthermore, the interviewer had undergone formal education or training in qualitative research through courses, workshops, or hands-on experience, and exhibited strong communication skills. Additionally, the interviewer has ten years of nursing experience and approximately 8 years of experience as a university faculty member. Currently, they are actively involved in multiple research projects as executives and collaborators. The interviewer did not have a previous relationship with the participants. The interviews were conducted outside of work shifts and with prior coordination with the EMS providers. The duration of each interview averaged between 45 and 60 min. The interviews were conducted in the Persian language. The interviews were conducted in a quiet environment. The interviews were conducted according to the guide and semi-structured questions (Table  1 ).

Each interview began with general questions, such as “Can you talk about your roles and responsibilities as an EMS provider in the workplace?” “Please explain to me some of the missions that have caused or exacerbated stress for you,” “Could you please tell me about the methods you employ to mitigate the impact of work-related stress?” “Please discuss support programs and protocols for personnel who experience highly stressful incidents in the workplace.” Then, based on the participants’ answers, several follow-up questions were asked to clarify the information provided. Each interview was recorded with an MP3 player and then transcribed verbatim by the corresponding author.

Data analysis

To analyze the data, the conventional content analysis method suggested by Granheim and Lundman was used. This method consists of five steps: transcribing the entire interview immediately after conducting it, reading the interview text to gain a general understanding of its content, determining the meaning units and initial codes, classifying similar initial codes into broader categories, and identifying the latent content in the data [ 20 ]. After each interview, the audio files were transcribed verbatim. The typed text was read several times to extract the meaning units. The typed interview text, along with the extracted meaning units, was provided to the participants two days after the interview. This allowed them to confirm or modify the initial codes. Some of the meaning units were modified during this process. After extracting meaning units from each interview and conducting member checking with the participants, the interview with the next participant was conducted. The meaning units were constantly compared, and the relationships between the concepts were identified. The initial codes were classified based on their similarities and differences. Data collection continued until saturation, which was achieved after twelve interviews [ 21 ]. Data saturation is commonly employed in qualitative research methodologies such as interviews, focus groups, content analysis, or ethnographic studies. During the data analysis phase, researchers assess whether they have reached data saturation by examining whether new data continue to provide unique insights or if it repeats information already collected. Four additional interviews were conducted to ensure data saturation. In this study, due to the transparency and clarity of the initial codes obtained from the interviews, repeated interviews of the participants were not conducted. Therefore, the data collection ended after 16 interviews were conducted with 16 EMS providers. In the next step, categories with similar meanings were merged into distinct groups. Finally, the main themes were extracted based on their meanings and the relationships among the categories. Some of the participants’ expressions and sentences were translated into English based on the extracted themes and are presented in this article. The collected data were analyzed in MAXQDA v. 2010. The research team consisted of five academic staff members: four individuals with PhD degrees in nursing, one individual with a specialist degree in emergency medicine, and one person holding a master’s degree in Medical Library and Information Sciences. The research team consisted entirely of men aged between 35 and 48 years. All members of the research team have experience conducting both quantitative and qualitative research.

Credibility was ensured through the researchers’ prolonged engagement with the data and member checking. Member checking involves going back to the participants of a study to verify the accuracy and interpretability of the data collected from them. This process allows participants to review the researcher’s findings, analysis, and interpretations to ensure that they accurately reflect their experiences and perspectives. Member checking helps to establish the credibility and trustworthiness of the research by confirming that the researcher’s interpretations align with the participants’ views. Confirmability was ensured through peer checking. Peer checking involves seeking feedback from colleagues, experts, or other researchers in the field to review and critique the research process, methodology, analysis, and findings. Peers provide an external perspective on the research study, offering insights, suggestions, and critiques that can help strengthen the quality and rigor of the research. In the interviews, the generated codes and categories were shared with two external experts in the field of qualitative studies to confirm and validate the coding process. Before analyzing the data, a meeting was held between the research team regarding the stages and coding process. Additionally, to ensure dependability, three members of the study team, all of whom had extensive experience in qualitative studies, independently conducted all encoding stages. They subsequently reached a consensus after participating in multiple sessions to discuss the findings of the analysis. In these sessions, according to the research objectives and interview questions, some primary codes and subcategories were modified. To ensure transferability, various methods were employed, including sampling with maximum variation, providing detailed descriptions of participants’ characteristics, and comparing the study findings with those of other studies.

Ethical considerations

This study was approved by the Institutional Review Board and the Ethics Committee of Hamadan University of Medical Sciences, Hamadan, Iran. (IR.UMSHA.REC.1401.392). Before participating in the study, participants were provided with detailed information about the research purpose and benefits. Participants were informed that participation in the study was entirely voluntary and that they could withdraw from the study at any time. The participants were asked to sign an informed consent form acknowledging their understanding and agreement to participate. To protect the identity of the participants, the researchers assigned codes to each participant in the study. All data collected during interviews, such as audio recordings, transcripts, and field notes, were securely stored and accessible only to the research team. Finally, the institution’s ethics committee ensured that the research protocols adequately protected participant confidentiality and adhered to ethical standards.

A total of sixteen EMS providers were asked to participate in the study. All participants engaged in regular exercise during the week, utilizing the sports equipment available at the bases. Among the participants, only two reported smoking (only after being in stressful situations and experiencing insomnia). Additionally, four participants exhibited irregular sleeping patterns, with an average of 12 sick days per year recorded for this group. The other demographic characteristics of the participants are shown in Table  2 . Analyses of the data obtained from the interviews revealed three themes and six categories (Table  3 ).

Description of the coding tree: Three main themes were obtained from the data analysis in this study. One of the main themes was related to the stage before exposure to the stressful factors and conditions of the work environment and various types of accidents in the prehospital field. This theme was obtained from the two main categories of mental preparation and risk management. This theme was called “Readiness for the worst conditions”. The second theme was related to seeking help and consulting from others in the early stages after facing stressful factors. This theme was obtained from the two main categories of collaborations in emergency response and supportive communication. The third theme, “Striving for Balance “, was related to the behaviors and responses that the participants used as strategies and mechanisms to adapt to stress. This theme was obtained from two main categories of adaptive behaviors and maladaptive responses.

Readiness for the worst conditions

Mental preparation.

Most missions to which the emergency medical system is dispatched are urgent. The more EMS providers possess the mental preparedness and focus necessary for rescue, along with adequate information about the conditions at the scene, the safer and less stressed they will be. The main category of mental preparation consists of two subcategories: “mental review of upcoming actions” and “Situation-based information.”

Mental review of upcoming actions

The participants mentioned that all the missions were stressful because of the unknown. However, based on the information we have received from the patient and the accident scene, we can reduce the stress of the missions to a certain extent by mentally imagining and going through the upcoming actions according to the patient’s condition.

We were sent to a mission that the operator said was a young person who had hanged himself. On the way to the scene, I went over all the actions I might need to take for this person… I can work better at the scene. (P6)

Being sent to scenes that we have experienced many times before brings us less stressful conditions. Whenever we recall our actions in previous cases, the scene of the incident no longer seems unfamiliar. (P2)

Situation-based information

Some EMS providers emphasized in interviews that staff members who possess more information, knowledge, and experience in emergency incident management will experience less stress when providing relief. Participants mentioned that before arriving at the accident scene, they received the necessary information about the incident through the ambulance radio and the dispatch center. This helps them to be more prepared.

I usually have the habit of calling the dispatch center several times on the way to the scene to gather additional and new information from the patient and the scene of the accident… This helps me to know exactly what conditions I am going to face. (P8)

I used to work in a hospital, specifically in a cardiac care unit, for a few years… I have extensive experience in caring for cardiac patients… I handle any dispatch related to a cardiac patient without stress. (P11)

Risk management

Participants in the present study expressed that work in the prehospital emergency field differs significantly from work in healthcare facilities and hospitals. During the interviews, they discussed the various risks they faced during the dispatch and rescue process. They emphasized the importance of being physically and mentally prepared for deployments. Additionally, the ability to identify and mitigate hazards at the incident scene can reduce stress during an emergency response. The main category of risk management consists of three subcategories: “safe driving”, “incident scene management " and “self-protection”.

Safe driving

One of the main duties of EMS providers is to drive the ambulance. Most of the EMS providers mentioned in the interviews that they always experience stress due to the high speed and the risk of accidents and collisions with other vehicles during missions. They emphasized that using sirens and alarms during dispatch actually adds to their stress levels.

The first year I entered this job, I drove very fast… I used to always have a racing heartbeat when driving, but now I drive better and no longer experience those symptoms. (P2)

Ever since I got into an accident while driving an ambulance, I have been following all the safety tips for driving. The work environment is stressful enough. I try to avoid adding extra stress by driving safely. (P11).

Incident scene management

The participants identified proper management of the accident scene as one of the important factors in reducing stress during missions. They emphasized that scene management ensures the safety of rescue personnel, improves the patient’s condition, and prevents secondary accidents at the scene.

The important lesson we learned from our experienced colleagues is that if we fail to manage the incident scene effectively, we will encounter more trouble and complications. (P9)

Gasoline spilled from the tanker’s reservoir onto the road surface. Many people had gathered around the tanker. The driver sustained minor injuries, so we transferred him to the ambulance. We immediately directed the people and parked cars near the accident scene to a safe place. Our priority was to prevent fires and harm to others. (P8)

Self-protection

Most of the participants discussed the importance of personal protection and safety for EMS providers, as it helps to reduce stress at the accident scene. They considered this issue to be of the highest priority in missions and emphasized the importance of ensuring safety at the scene. They emphasized the importance of taking certain measures, such as wearing personal protective equipment, using appropriate equipment, maintaining a safe distance from hazardous elements, and following the instructions provided by local authorities.

Most of the mission environments are unknown, and our first priority during the mission is to eliminate or reduce environmental risks. If our health is endangered, we cannot take action for the patient either. (P10)

The risk of contracting diseases and infections during all missions is something that causes us stress. However, wearing masks, gloves, and protective glasses, can reduce some of this stress. (P4)

Assistance based on supportive partnerships

Collaborations in emergency responses.

Collaborations in emergency responses in the EMS involve effective communication and coordination among team members. This includes sending and receiving information at the accident scene, exchanging ideas, planning, and making decisions regarding the treatment and transfer of patients, and interacting with other rescue, security, and support services, such as medical equipment and medications. The main category of collaborations in emergency response consists of two subcategories: “intra organizational cooperation” and “interorganizational interactions”.

Intra organizational cooperation

EMS providers discussed the high levels of stress associated with road accidents and multiple casualty incidents. They stated that in such situations, having the assistance and support of colleagues from nearby stations, as well as the presence of a physician at the accident scene, would alleviate their workload and stress.

In some missions where an extra ambulance is required to transport multiple injured individuals, our colleagues are dispatched promptly and with the utmost proficiency to assist personnel at the accident site. This instills confidence in us and alleviates our stress . (P5)

The psychiatric patient was uncontrollable, aggressive, and threatening… He was strong and powerful… We were scared and anxious that he would hurt us… We radioed one of the nearby EMS stations… When our colleagues arrived, there were four of us, and together we were able to restrain the patient and administer a sedative drug… (P9) .

Interorganizational interactions

Some of the missions are related to crime scenes. Some others are related to car accidents that require cutting the car body to free the injured. The participants stated that in such cases, they need to collaborate and seek assistance from agencies such as the police and fire department. The presence of these factors promotes peace of mind and reduces stress.

The firefighters arrived earlier than us because they were close to the accident site. They extinguished the fire on the bus, allowing us to safely evacuate the injured passengers. (P13)

In my opinion, the worst missions are crime scenes. If police personnel are present at the scene during these missions and establish security, we can more easily carry out rescue and relief measures. (P4)

Supportive communication

The EMS providers mentioned in interviews that discussing, conversing, and sharing experiences with colleagues regarding stressful incidents and scenes had an impact on reducing stress levels. Some participants stated that in several cases, the intensity of stress was so high that they sought psychiatric help. The main category of supportive communication consists of two subcategories: “interpersonal communication” and” stress relief consultation”.

Interpersonal communication

Most of the participants stated that they typically engage in conversations and discussions with their colleagues regarding what they observed at the accident scene after completing their missions. Others also mentioned that they sometimes share their feelings with the physician at the call center.

After stressful missions, I consult with colleagues who have more experience in the emergency medical system… it is truly helpful. (P11)

The scene of the accident was chaotic… I had a disagreement with one of the patient’s relatives and was rude to him. I was worried that he would surely file a complaint against me… A few hours later, I discussed it with one of my coworkers over the phone… I felt much better… He told me not to stress about it. (P5)

Stress relief consultation

Some EMS providers who had experience dealing with highly stressful situations, such as burns, explosions, and crush injuries, reported experiencing symptoms of posttraumatic stress disorder (PTSD) for several weeks after the incidents. They sought help from a psychiatrist and received drugs to alleviate symptoms of stress and anxiety.

Sometimes the stress level is very high, and all my thoughts become entangled. Even on days when I’m not on duty, reflecting on past missions induces stress and anxiety… I need to consult with a psychologist during these times. (P9)

Striving for balance

Adaptive behaviors.

Most participants in the interviews mentioned that they use various methods to reduce stress, especially after completing stressful missions. These methods include reading books, watching television, and engaging in sports at the base. They emphasized that these methods are helpful in managing work-related stress, concerns, and daily tensions. The main category of adaptive behavior consists of three subcategories: “distraction”, “good habits” and “spirituality”.

Distraction

Participants said that they sometimes distracted themselves and tried to reduce the stress of their shifts by listening to music or watching comedy movies.

Listening to my favorite songs during my work shift, especially before going to bed, relaxes me to some extent and reduces the stress caused during the day. (P12)

After we return from the mission, we play with the PlayStation. This helps us temporarily forget the incidents and stresses that we have experienced. (P11)

Good habits

Participants in the interviews mentioned that on days when they are not on a shift, they usually engage in regular physical activity. They stated that these activities are highly effective in reducing work-related stress levels. EMS providers referred to activities such as mountaineering, cycling, and traveling with family.

Being in nature is truly relaxing. I try to take walks in the park with my spouse on days when the weather is good. Seeing flowers, trees, and children are very soothing. (P8)

On the days when I am not on a shift, I have a gym schedule with friends. Sports programs strengthen the body and mind. In our opinion, sports should be mandatory. (P3)

Spirituality

In their talks, EMS providers referred to spirituality, faith in God and belief in the power of God and activities such as prayer and supplication. They said that spirituality can give hope and motivation to a person. This belief helps a person cope better with stress and worries.

Although our work is very stressful, I believe that because we save lives, God will surely help us. God is watching our actions… I find calmness in remembering God. (P6)

Praying and worship are fundamental practices in our religion that have been upheld since ancient times. I believe in my heart that communicating with God can help eliminate many negative thoughts, anxiety, and stress. (P13)

Maladaptive responses

A few participants mentioned using various methods to cope with workplace stress, including taking sedatives and anti-anxiety medications, smoking cigarettes, and engaging in unconventional behaviors such as aggression. The main category of maladaptive responses consists of two subcategories: “inappropriate behaviors “and” substance abuse.”

Inappropriate behaviors

Some participants mentioned that they sometimes exhibit undesirable behaviors to relieve stress. They mentioned behaviors such as aggression toward patients’ companions or colleagues in the work environment, being quiet and withdrawn in the home environment, and experiencing social isolation during the interviews.

After the shift, when I get home, I don’t talk to my family most of the time … I know it’s not the right way to alleviate fear and anxiety, but it seems to have become a habit. (P9)

Sometimes, the stress and pressure from one mission can manifest as verbal violence toward the patient or their relatives in the next mission. (P9)

Substance abuse

Some participants mentioned that they sometimes have to use sleeping pills, tranquilizers, and cigarettes. The participants were individuals who had a history of smoking and drug use a few years ago.

Although I know that smoking is harmful, but in my opinion, it is a good sedative… (P7) .

Due to the intensity of work pressure and the stress of the work environment, I sometimes have to use sedatives or soporific drugs before going to sleep. (P9)

This study aimed to explore stress management methods among EMS providers. The present study shows that participants employ various strategies to manage occupational stress. The findings revealed that these strategies can be classified into three themes: readiness for the worst conditions, assistance based on supportive partnerships, and striving for balance. These findings will be discussed further.

According to the interviews, EMS providers stated that working in the prehospital emergency field is very stressful. Stress among EMS providers is a global issue that can have a detrimental impact on their health, well-being, and quality of their service [ 22 ]. The primary factors contributing to work-related stress among EMS providers are related to the incident scene, performing emergency procedures, and stabilizing and transferring patients. The findings of the present study have shown that EMS providers strive to achieve sufficient mental and physical preparedness prior to encountering and arriving at the scene, to better cope with these factors. Given the unfamiliar and uncertain conditions of the scene, as well as the uncertainty of the information received from individuals present at the incident, mental and physical preparedness can increase self-confidence during missions and reduce stress caused by stressors [ 23 ]. This preparedness is typically based on an EMS provider’s previous experiences [ 24 ]. The more information related to the patient’s emergency conditions, the location of the incident, and the atmosphere of the scene that is received and transmitted to the EMS provider by the call center, the better equipped these individuals are to provide safe and timely services to the patients through proper scene management [ 25 , 26 ]. On the other hand, improved management of the incident scene and strict adherence to safety precautions when dealing with hazardous factors can also guarantee their own security and safety [ 27 ]. Creating safe conditions at the incident scene reduces the severity of work-related stress for these individuals [ 7 ]. EMS provider, by considering the worst possible conditions at the scene and mentally imagining the patient’s condition, can reduce stress by being mentally and physically prepared, making emergency equipment available, and timely calling other emergency and security personnel [ 28 ]. Mental readiness is a complex structure that includes dimensions such as attention control, goal setting, calmness, activation, self-confidence, self-talk, and visualization [ 29 , 30 , 31 ]. Marquardt et al. showed that mental preparedness in occupations that involve emergency responses, such as firefighters and EMS providers, can reduce stress and enhance performance and success [ 32 ]. Bohstrom et al., who investigated stress management methods among ambulance nurses, reported that nurses reduce their stress by receiving accurate and complete information before being deployed on missions [ 14 ]. On the other hand, research has demonstrated that a significant factor contributing to stress in clinical and nursing professions is a lack of knowledge, awareness, and skills [ 33 ]. The results of these studies are consistent with the findings of the present study.

Another stress management strategy discussed by EMS providers in this study was risk management, which included three subcategories: safe driving, scene management, and self-protection. In Magaña’s study, which focused on risk factors in driving emergency missions, the driving process was divided into two categories: driver-related factors and environmental factors. In this study, it was suggested that safe driving and maintaining a proper longitudinal distance can help reduce driving risks [ 34 ]. In the present study, participants also employed methods such as practicing safe driving, maintaining a confident speed, and minimizing the use of sirens to reduce stress. Another stress management strategy among the participants was scene management. Afshari et al. showed that taking actions such as identifying environmental hazards, properly parking ambulances, stabilizing the scene, communicating information from the scene to the call center, triaging the injured, and estimating the number of personnel and equipment could prevent increased stress at the scene [ 7 ]. This result from the present study is not observed in other papers related to the emergency medical system. This can be attributed to the independence of the emergency medical system from other relief organizations in Iran. This has resulted in the EMS provider being the first responder in most cases of disasters and accidents. They are responsible for managing the accident scene. The coordination and summoning of other relief agencies is the responsibility of the EMS provider at the scene of the accident. Another stress-reducing factor among EMS providers is prioritizing personnel safety and using personal protective equipment during missions [ 35 , 36 ]. EMS providers often have limited information about their patients, work under uncontrolled conditions, and accompany their patients in confined ambulance spaces [ 19 , 37 ]. These individuals are at risk of contracting various infectious diseases. Therefore, implementing standard precautions and utilizing personal protective equipment will minimize the risk of transmitting infectious agents [ 38 ]. In a qualitative study conducted by Sanlıtürk, one of the stressors identified among nurses was the lack of personal protective equipment [ 39 ]. The issue of a lack of personal protective equipment (PPE) in Iran and in almost all countries, especially during the COVID − 19 pandemic, has been highlighted and is considered a significant source of stress in this profession [ 35 ].

Prehospital emergency system missions are carried out by only two personnel. However, in cases where the scene is crowded or there are multiple casualties, additional personnel are called in. A high workload, a low number of personnel at the scene, and a lack of cooperation and coordination among other relief organizations are stressful factors in the prehospital field [ 2 ]. Participants in this study indicated that consultation with colleagues on necessary actions for patients, teamwork at the scene, support from personnel and equipment from nearby bases, and the involvement of other aid and safety organizations such as the Red Crescent and Police in some operations provided peace of mind and reduced stress. Therefore, the involvement, cooperation, and support of colleagues and other organizations involved in rescue and relief operations have been identified as a solutions to prevent or reduce stress among EMS providers [ 2 ]. A study by Holmes et al. also showed that teamwork in the clinical setting reduces stress among personnel [ 40 ]. Another point mentioned by EMS providers for stress reduction was the support and understanding of colleagues and superiors for the stresses imposed on them. They said they mostly used the method of talking and conversing with colleagues or non-colleagues to express their feelings and reduce stress. Haus et al. also showed that organizational support and peer support play important roles in reducing mission-related stress [ 41 ]. In another qualitative study that examined stress coping strategies among EMS providers in 2015, peer support was identified in subgroups of informal conversations, expert and peer support, and informal clarification at the end of the shift [ 14 ], which is consistent with the findings of the present study. Some of the participants who had experience dealing with high-stress incidents indicated that the intensity of stress after the incident is so severe in some missions that there are signs of stress and anxiety for weeks, and psychologists should be consulted. Weber et al. showed in a study that psychological treatments by mental health professionals are effective and have been proven to treat PTSD [ 42 ]. In Iran, the relief systems, including the EMS and the Red Crescent Organization, as well as security and firefighting organizations, are distinct and operate independently from one another. In many incidents and missions, the presence of multiple rescue teams with various tasks is needed. On the other hand, EMS providers are usually the first to respond at the scene. Therefore, with the simultaneous or immediate presence of other security and relief organizations at the scene of the accident, the workload of EMS providers will be decrease, and they will experience less stress [ 7 ]. Currently, the emergency medical system in Hamadan city lacks specific protocols for identifying personnel experiencing stress-related issues and referring them to counseling centers. The results revealed that employees attempted to cope with work-related stress by seeking advice and talking to colleagues. In cases where these strategies were unsuccessful, they sought help from a psychiatrist without informing the emergency medical authorities.

Participants indicated that they use methods to reduce and eliminate stress after experiencing stressors related to emergency missions within the base and on days when they are not on duty. Most EMS providers cited methods such as distraction (reading books, listening to music, watching movies, and playing computer games), good habits (exercise, walking), and spiritual activities (prayer, praying, participating in religious ceremonies) to reduce stress. Fallon et al. showed that music can affect mood and physiological states. They demonstrated in an intervention study that listening to music reduced stress and enhanced mood [ 43 ]. A study by Janson and Rohleder showed that distraction, as opposed to denial, leads to early stress reduction and faster recovery in individuals experiencing stress [ 44 ]. Studies have shown that exercise and physical activity, such as walking, have significant positive effects on preventing or reducing mental illnesses, including symptoms of depression, anxiety-related disorders, and stress [ 45 , 46 , 47 ]. Considering the Islamic community in Iran and their religious beliefs, many EMS providers find that their emotional connection to God, performing religious commands, and going on pilgrimage trips are highly effective in reducing or eliminating work-related stress [ 48 ]. A study conducted on nurses in intensive care units showed that among the methods of coping with stress, belief in religion was the most common method, while substance abuse was the least common method of adaptation [ 49 ]. Another study also showed that emergency nurses primarily relied on positive spiritual coping as their main coping strategy, while demonstrating a lower inclination toward using negative spiritual coping strategies [ 50 ]. In many religions, spirituality and spiritual practices play a significant role in reducing stress and promoting adaptation. For example, visiting sacred places, participating in religious ceremonies, reciting scriptures and prayers, meditating, and focusing on God and faith in fate can help individuals cope better with life’s stresses [ 51 , 52 ]. Furthermore, many religions recommend that individuals turn to God and their faith, finding hope in them. Believing in the existence of a greater and more powerful force behind everything can give individuals a sense of peace and hope, aiding in stress reduction [ 53 ]. In addition, religious communities often provide social support and a sense of belonging, which can help individuals overcome difficult times and cope better with stress [ 54 ]. However, there are also negative aspects to consider. Some religious teachings can cause feelings of guilt, anxiety or shame, which can increase stress and contribute to mental health problems. In some cases, rigid adherence to religious beliefs can lead to feelings of judgment, exclusion or isolation, which can exacerbate stress rather than alleviate stress [ 55 ]. Considering the presence of Islam and its religious teachings in Iran, the methods and strategies discussed in this article can be interpreted and justified.

In this study, a small number of participants mentioned behaviors such as aggression, social isolation, silence, and substance abuse as coping mechanisms for reducing stress. These individuals believed that such behaviors, particularly substance abuse, were not suitable or effective methods for managing and alleviating work-related stress. However, they did not actively seek other suitable stress management methods and were more focused on seeking temporary and immediate relief from stress. Chronic stress, especially when experienced over a prolonged period, can result in lasting and progressive alterations in the brain, rendering individuals more vulnerable to drug use and addiction. These changes, which weaken and strengthen specific areas of the brain, lead to emotional states, impaired executive control, and a strong craving for certain substances [ 56 ]. Substance abuse can often be a response to stress and an attempt to cope with difficult emotions and situations. However, substance abuse is not a healthy or effective way to reduce stress or adapt to it. In fact, it often exacerbates problems and can lead to further stress and negative consequences [ 57 ].

In recent years, several studies in the field of prehospital emergency care have focused on stress management methods for EMS providers. Rojas et al. showed that EMS providers utilize methods such as support, acceptance, humor, spirituality, and religion to alleviate work-related stress [ 58 ]. Almutairi and ElMahalli’s study demonstrated that the most common strategy used for stress management among EMS providers is talking to colleagues, taking leave after stressful incidents, and reflecting on the positive aspects of work [ 59 ]. Another study conducted in 2023 on stress management methods among EMS providers using qualitative methods revealed main themes including seeking social support, self-care practices, coping mechanisms, and finding meaning and purpose at work [ 60 ]. Bohström et al. who used a qualitative approach to medical emergency personnel, showed that the strategies employed to manage mission-related stress included receiving accurate information from the call center, discussing with colleagues, advancing teamwork collaboration, and short rests between missions [ 14 ]. Most of the findings from these studies are similar to the results of the present study. A new theme identified in the present study, not previously observed in similar studies in the prehospital field, is the readiness of EMS providers for the worst conditions, encompassing two categories: mental preparation and risk management. It appears that participants in this study utilized strategies and measures to reduce stress even before facing stressful work environment factors.

Since all EMS providers in the system are male and there are currently no female personnel working in the emergency medical system of Hamadan city, a limitation of this study was the lack of female participants. The lack of female participants limits the generalizability of the study’s findings to the broader population of EMS providers. The results may not be representative of the experiences and needs of male and female EMS personnel, which limits the applicability of the recommendations made in the study. Women in male-dominated professions such as the EMS may face gender-specific stressors and barriers that are not addressed in the study. Without their perspective, the study may overlook important factors that influence female EMS workers’ coping with stress. To address these limitations, future research should aim to include a diverse range of participants, including both male and female EMS providers, to ensure a more comprehensive and inclusive understanding of stress management strategies in the profession.

The results of this study showed that the majority of dispatches in the EMS are stressed due to the unknown and unpredictable conditions of the accident scene. This stress is perceived by the EMS providers from the time of announcing the mission to delivering the patient to the treatment centers and even, in some cases, for several days after that. Participants used different strategies to prevent and reduce stress of missions. These strategies were categorized into three themes: readiness for the worst conditions, assistance and striving for balance. Due to the nature of rescue and relief operations, EMS providers used stress management methods as strategies to prevent the development and escalation of stress from the moment the mission was announced by the dispatch center. During the rescue, they attempted to control and reduce stress by managing the scene, taking timely action, and working as a team, and finally, after facing stressors, they used adaptive mechanisms to reduce or eliminate the effects of stress. The results highlight the need to obtain accurate information from the incident command center about the scene, scene management and safety, interaction with other responders, and individual and organizational support. Proper stress management and organizational support for EMS providers after stressful events can promote better adaptation and resilience to workplace stress. In addition, this can help improve the mental health of EMS providers and, consequently, enhance the quality of service delivery in the emergency medical system. It is suggested to investigate the effect of stress management training courses on the stress levels of EMS providers in future studies.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

emergency medical services

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Acknowledgements

The authors would like to express their gratitude to all EMS providers for generously sharing their valuable experiences with the study team.

This work was funded by the Vice-chancellor for Research and Technology, Hamadan University of Medical Sciences (No: 140105183710).

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Rasoul Salimi

Department of Medical Library and Information Sciences, Hamadan University of Medical Sciences, Hamadan, Iran

Abbas Fattahi

Department of Operating Room, School of Allied Medical Sciences, Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran

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AA did all the interviews, the thematic analysis, gaining ethical approval, and drafted the manuscript. RS and AKH were involved in the study conception and design, analysis, and interpretation of the results. RS and BI and MT participated to the study design, analysis and results interpretation and writing-up of the manuscript. AF contributed to analyze and interpret the data. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

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Khazaei, A., Afshari, A., Salimi, R. et al. Exploring stress management strategies among emergency medical service providers in Iran: a qualitative content analysis. BMC Emerg Med 24 , 106 (2024). https://doi.org/10.1186/s12873-024-01024-8

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