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The Theory of Preventive Stress Management: A 33-year Review and

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CONCEPTUAL REVIEW
The Theory of Preventive Stress Management:
A 33-year Review and Evaluation
M. Blake Hargrove1*†, James Campbell Quick1,2, Debra L. Nelson3 & Jonathan D. Quick4
1
The University of Texas at Arlington, Arlington, TX, USA
2
Lancaster University Management School, Lancaster, UK
3
Oklahoma State University, Stillwater, OK, USA
4
Management Sciences for Health, Cambridge, MA, USA, and Harvard Medical School, Boston, MA, USA

Abstract
The theory of preventive stress management (TPSM) has contributed to theoretical understanding, empirical
exploration and organizational practices since its introduction in 1979. This paper describes the theoretical concepts
contained in the theory, reviews the empirical findings based on the theory and outlines the organizational practices
associated with the application of the theory. Special attention is given to the contribution of the three principal
authors associated with the theory as well as the work of their key collaborators. The impact of the theory is evalu-
ated and discussed. Opportunities for future research based on the TPSM are offered. Copyright © 2011 John Wiley
& Sons, Ltd.

Keywords
preventive stress management; TPSM; stress; distress; eustress; strain; stress response; occupational stress

*Correspondence
M. Blake Hargrove, The University of Texas at Arlington, Department of Management, 701 S. West St., Arlington, TX 76019, USA.
†
Email: hargrove@uta.edu

Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/smi.1417

Introduction the public health notions of prevention into an organi-

Cooper (1998) identified 12 leading theories of organi-
zational stress, which range from Maslach’s (1998)
theory of burnout and Edwards, Caplan, and Van
Harrison (1998) person–environment fit theory to
Siegrist’s (1998) effort–reward imbalance theory, Theo-
rell’s (1998) job demand–control model and Quick,
Quick, and Nelson’s (1998) theory of preventive stress
management (TPSM). At the time of Cooper’s review,
the TPSM had been in existence for about 20 years, and
its origins in public health and preventive medicine had
never been fully explored. Rather, the resulting trans-
lated framework was what appeared in the scientific and
professional literature. At 33 years since conception, this
is an excellent time to review the original construction
and theory development as well as to update advance-
ments and offer a critique for future consideration.
The ‘Eureka!’ moment from which the TPSM sprang
from was during the Quick brothers’ graduate studies,
one in medicine and public health (Jonathan) and
the other in management and psychology (Jim). The
former was attuned to physiological stress while the
latter was attuned to organizational stress. The creative
insight came from Jonathan who envisioned translating
zational stress context, thus giving birth to the TPSM
(Quick & Quick, 1979). The term preventive stress man-
agement is now in the lexicon of psychology and the
APA Dictionary of Psychology (Vandenbos, 2007). The
most scientific presentation of the theory and its six
hypotheses and one corollary is in Quick et al. (1998).
The most comprehensive discussion of the context, five
principles and practices associated with the TPSM is in
Quick, Quick, Nelson, and Hurrell (1997).
The conceptual model of the TPSM is presented in
Figure 1 and is composed of a platform and a translated
overlay. The platform specifies the organizational stress
process and is represented by the unshaded boxes. The
process flows from stressors to stress response to out-
comes. Stressors are the causal factors that are some-
times labelled demands, which may be environmental
or self-imposed. Exposure to stressors triggers the stress
response; the stress response may be positive leading
to eustress, or negative leading to distress. The stress
response, originally labelled the emergency response by
Cannon (1915), is the psychophysiological response of
the individual as well as the activation processes of
a group or organization to fight or to flee (Quick &
Spielberger, 1994). The stress response in turn leads to

182 Stress and Health 27: 182–193 (2011) © 2011 John Wiley & Sons, Ltd.
M. B. Hargrove et al.
Primary Secondary
Prevention Prevention
Stressors
Figure 1 Preventive stress management model—stressors, stress response (eustress or distress) and outcomes resulting from stress as
moderated by preventive management interventions. [Adapted from Figure 11.1 in Pandey et al. (2010) and Figure 8.1 in Quick et al.
(1997)]
a range of outcomes. The outcomes are either positive,
such as heightened alertness and enhanced perfor-
mance, or negative, such as medical, psychological and
behavioural distress.
The translated overlay onto this organizational stress
process platform is composed of the preventive inter-
ventions from public health (see Quick et al., 1998 for
a discussion of the public health context from which
the theory was then translated into an organizational
context). The three stages of prevention captured in
Figure 1 are primary prevention, secondary prevention
and tertiary prevention, and are represented by the
shaded boxes. Primary intervention is aimed at reduc-
ing stressors. Secondary intervention is aimed at mod-
erating the stress response. Tertiary intervention is
aimed at moderating the outcomes associated with
distress.
The primary purpose of this paper was to review the
contribution of the TPSM within the organizational
literature with special attention to the work of the the-
ory’s three principal authors and more than 30 of their
key collaborators. The review begins with basic cover-
age of the fundamental elements of organizational
stress within the TPSM framework. The paper contin-
ues with a discussion of the organizational outcomes
associated with stress in organizations. Next, the guiding
principles of TPSM are presented along with organiza-
tional practices designed to create healthier and more
productive employees and organizations. The hypoth-
eses that anchor the theory are included along with a
critique at the close of the review.
Stressors
An explanation of the TPSM begins with the stimuli
that trigger the stress response. Stressors are the physi-
cal and psychological demands that initiate the stress
response within individuals (Pandey, Quick, Rossi,
Nelson, & Martin, 2010; Quick et al. 1997). Stressors
arise from a variety of sources within organizations.
One fairly well-understood source is organizational
change. Mack, Nelson, and Quick (1998) argued that
Stress and Health 27: 182–193 (2011) © 2011 John Wiley & Sons, Ltd.
The Theory of Preventive Stress Management
Tertiary
Intervention
Distress
Stress
Response Outcomes
Eustress
as individuals anticipate and perceive change, stress
responses are initiated. Another generalized source of
stress related to change is technological adoption and
innovation (Nelson, 1990). Although some stressors are
general in nature, Quick and Quick (1979) offered a
theoretical framework that categorizes factors that
cause stress into four groups: role factors, job factors,
physical factors and interpersonal factors.
Role factors are those stressors that arise from the
role-based expectations placed upon an individual
within an organization (Quick & Quick, 1979, 1984). In
general, stress levels increase if role expectations are
confusing, ambiguous or conflicting. Stress caused by
confusion and ambiguity can be either cognitive or
objective. In other words, one individual can experience
stress because she does not comprehend her organiza-
tional role, while another could experience stress
because his organizational role is functionally unclear.
Role factors related to conflict can result from a number
of sources. Because expectations at work often conflict
with expectations at home, work–family conflict often
stimulates a stress response (Quick et al., 1997). As any
working parent of a dependent child can attest, conflicts
between work expectations and parenting opportuni-
ties are common and inevitable. Each of these conflicts
has the potential to be a source of role-based stress.
Another source of potential conflict causing role-based
stress involves poor person–role fit (Quick et al., 1997;
Quick, Nelson, Quick, & Orman, 2001). Individuals
who find themselves in organizational roles for which
they are not suited would be expected to experience a
significant amount of role-based conflict. For example,
a highly creative, free-thinking, extroverted individual
would likely experience significant role-based conflict if
required to spend most of each work day doing restric-
tive and repetitive tasks, such as tax preparation, in an
isolated work environment.
Job stressors include those directly related to the
quality and quantity of work performed as well as the
feedback and appraisals that individuals receive regard-
ing their job performance. Among information tech-
nology workers, for example, both work deadlines and
183
The Theory of Preventive Stress Management
performance evaluations were identified as significant
stressors (Sethi, King, & Quick, 2004). Among physi-
cians, job-related stressors include prolonged exposure
to critical decision making and patient complaints
(Sime, Quick, Saleh, & Martin, 2007). Physical stressors
stem from the work environment and include all condi-
tions that affect the senses, such as light, noise, vibra-
tion, smell, temperature, etc. (Quick et al., 1997). A vent
blowing cold air on a worker in an air-conditioned
office could stimulate a stress response as could the sun
beating down on another individual working on a hot
asphalt surface.
Interpersonal stressors arise from the demands of rela-
tionships (Quick & Quick, 1979). Relationship demands
exist both at work and at home; at work, these demands
may come from customers, vendors, co-workers, sub-
ordinates and superiors. The relationship demands
placed upon a newcomer in a workplace can stimulate
a stress response as the newcomer becomes socialized
(Nelson, 1987). Interpersonal stressors also arise from
personality clashes, leadership styles and diversity
(Quick et al., 1997). Empirical findings provide evi-
dence that interpersonal conflict can result in psycho-
logical strain and exhaustion especially when the
response is passivity, yielding or avoidance (Dijkstra, De
Dreu, Evers, & van Dierendonck, 2009). Stereotyping
is one interpersonal stressor. Research indicates that
even positive stereotypes can initiate a stress response
(Cocchiara & Quick, 2004). One stream of research
identified the unique interpersonal stressors that
women may encounter in the workplace (Nelson &
Burke, 2000; Nelson, Quick, & Hitt, 1989; Nelson,
Quick, Hitt, & Moesel, 1990). Finally, social isolation
can also function as an interpersonal stressor; senior
executives encounter particular risks because of social
isolation and the loneliness of command (Quick, Gavin,
Cooper, & Quick, 2000).
Not all stressors that impact the workplace originate
in the workplace. One example of this is family to work
stressors. For example, a colleague of ours recently suf-
fered the tragic and unexpected death of a spouse. This
external stressor affects our colleague, our organization
and other individuals working in our organization.
Results of a longitudinal study among newcomers in
three organizations suggested that individuals bring to
the job a large proportion of the symptoms they experi-
ence off the job (Nelson & Sutton, 1990). For example,
empirical evidence from a study of pastors indicated
that revenge behaviours resulted from distressful levels
of family to work conflict (Little, Simmons, & Nelson,
2007).
The stress response
A central assertion of the TPSM is that stimuli in and
of themselves do not generate individual outcomes.
Rather, the outcomes resulting from stressors are medi-
ated by the response of the individual to those stressors.
184
M. B. Hargrove et al.
The first two hypotheses in the formal statement of the
theory address this concept (Quick et al., 1998).
Hypothesis 1: Intense, frequent, prolonged orga-
nizational demands increase the stress response
in people at work.
Hypothesis 2: Intense, frequent, prolonged
elicitation of the stress response increases the
risk and incidence rates of distressful healthy
consequences.
Quick et al. (1997) define the stress response as the
‘generalized, patterned, unconscious mobilization of
the body’s natural resources when confronted with a
demand or stressor’ (p. 3). Four mind-body changes
characterize the stress response via the sympathetic
nervous system and the endocrine system:
(1) Redirection of the blood to the brain and large
muscle groups allows the body to prepare physio-
logically for a legitimate emergency.
(2) The reticular activating system in the brain stem is
activated, resulting in a heightened sense of alert-
ness and increased sensory awareness.
(3) Release of glucose and fatty acids as fuel to sustain
the individual during the response.
(4) A shutting down of the digestive, restorative and
immune systems in order to make more resources
available for the emergency response.
These mind–body changes constitute a normal, healthy
response that physiologically and psychologically pre-
pares an individual to act (Quick, 1998).
The TPSM recognizes that stress responses have the
potential to be both positive (eustress) and negative
(distress) responses to stressors. Eustress is the positive,
healthy response that leads to motivation and challenge.
Cannon (1915) viewed the psychosomatic stress res-
ponse as a great gift to be exploited to advantage, rather
than a curse to be avoided. Eustress occurs under condi-
tions of moderate stress arousal, when the mind–body
changes serve an individual in such a way to improve
their ability to react to a given set of stimuli. For
example, the saleswoman who sees her top client’s
number appear on her caller identification may well
respond with increased alertness, mental acuity and
energy. Recently, it was suggested that eustress is char-
acterized by short-duration stress that results in immu-
nopreparatory or even immunoenhancing physiological
changes (Dhabar, 2011). One key to the functional
properties of the eustress response is the rapid response
and rapid recovery. This is in contrast to the allostatic
load placed on the individual by the wear-and-tear of
chronic stressors. The bulk of evidence for the positive
Stress and Health 27: 182–193 (2011) © 2011 John Wiley & Sons, Ltd.
M. B. Hargrove et al.
immune properties of eustress is from animal studies,
so human studies are called for.
On the other hand, when the stress response or an
absence of the stress response leads to decreased per-
formance, a state of strain or distress results. Distress is
the ‘physiological, behavioural and/or psychological
deviation from healthy functioning resulting from a
stress response’ (Quick et al., 2006, p. 217). Distress
occurs under conditions of both low and high stress
arousal. When individuals are understimulated by
stressors, they do not have the resources that are mobi-
lized by the healthy stress response. Distress resulting
from underarousal is associated with poor physical,
psychological and cognitive performance. Distress
resulting from overarousal occurs because the stress
response is too frequent, too intense or too prolonged
(Quick et al., 1997). This type of distress, also termed
strain, results in reduced performance because of the
onset of negative behavioural, psychological and physi-
cal symptoms.
Whether the experience of stress leads to eustress or
distress is importantly influenced by modifiers of the
stress response. Two broad categories of modifiers are
vulnerability factors, such as genetic predispositions,
and protective mechanisms, such as social supports.
The theory’s third hypothesis and corollary address vul-
nerability modifiers and protective mechanisms that
impact eustress and distress (Quick et al., 1998).
Hypothesis 3: Individuals high in vulnerability
modifiers are at greater risk of distress than indi-
viduals low in vulnerability modifiers.
Corollary: Individuals high in protective mecha-
nisms and defences are immunized against the
risk of distress more than individuals low in these
factors.
Individual outcomes associated with
eustress
The stress response, when properly functioning, pro-
vides individuals with extra resources to deploy in reac-
tion to a stressor. Pre-performance anxiety such as
‘butterflies’ is common among actors, athletes and
public speakers. This nervousness is the normal and
constructive response to the stress of performance and
often translates into energy on the field or stage. Simi-
larly, emergency workers and police may experience
anticipatory and positive anxiety when they receive an
emergency call. In more typical workplaces, employees
also experience this positive stress response. One
example found in the research indicates that time pres-
sure is positively related to performance (Peters,
O’Connor, Pooyan, & Quick, 1984). As deadlines neared,
workers became more anxious about those deadlines,
and this anxiety produced increased performance.
Stress and Health 27: 182–193 (2011) © 2011 John Wiley & Sons, Ltd.
The Theory of Preventive Stress Management
One stream of research explored the effects of
healthy attachment on the stress response. Findings
indicated that self-reliance and interdependent attach-
ment increase the likelihood of eustress responses.
Empirical research among military trainees demon-
strated that self-reliant individuals were more likely to
have a positive stress response than overdependent
trainees, indicated by better performance as assessed by
training instructors and by higher graduation rates
(Quick, Joplin, Nelson, Mangelsdorff, & Fiedler, 1996).
The same study found that self-reliant trainees reported
lower levels of burnout, higher levels of self-esteem and
higher levels of health. Support for attachment theory
was found when empirical evidence suggested that dis-
tress resulting from unhealthy forms of attachment
such as overdependence was negatively related to health
(Joplin, Nelson, & Quick, 1999). Subsequent research
focused on better understanding the positive nature of
healthy attachment styles. In a study of 175 home
health nurses, it was found that the positive effect of
interdependent attachment on health was mediated by
hope (Simmons, Nelson, & Quick, 2003). This suggests
that interdependent individuals are healthy, in part,
because they are hopeful. Individuals with secure
attachment formed more trusting relationships with
their supervisors, which ultimately has a positive effect
on their work performance (Simmons, Gooty, Nelson,
& Little, 2009).
Eustress has psychological and physiological effects.
Lazarus and Folkman’s (l984) research on cognitive
appraisals of stressors demonstrated that appraisals can
be positive (challenge) or negative (threat), and these
are not poles of a single continuum. The primary proxi-
mal effects of positive appraisals are positive emotions
(Folkman & Lazarus, 1985). Building upon this work,
LePine, Podsakoff, and LePine’s (2005) meta-analysis
indicated that challenge stressors had a positive direct
effect on performance, as well as offsetting indirect
effects on performance through strains (negative) and
motivation (positive).
The physiological support for eustress shows that
there are both positive and negative physiological mani-
festations of the stress response (Nelson & Simmons,
2004). Frankenhauser (1979, 1983, 1986) demonstrated
in a series of experiments that different psychological
processes affect the physiological response pattern
in different ways. Two components of psychologi-
cal arousal determined cortisol and catecholamine
responses. The psychological state characterized by
positive emotions was labelled ‘effort’, and the psycho-
logical state characterized by negative emotions was
labelled ‘distress’.
Rose’s (1987) longitudinal study of air traffic con-
trollers provided further evidence of the ways in which
cognitive appraisals affect the stress response. Air
traffic controllers who showed the highest increases in
cortisol in response to increased workload reported
greater job satisfaction, were rated by peers as more
185
The Theory of Preventive Stress Management
competent and had lower illness rates than those with
lower cortisol levels. Whereas Rose described the con-
trollers who experienced cortisol increases associ-
ated with challenging work as engaged, Ganster and
Schaubroeck (1991) described the healthy state experi-
enced by the controllers as eustress. The work attitude
positive affect (PA), meaningfulness, manageability
and hope may be good indicators of eustress (Simmons,
2000; Simmons & Nelson, 2001; Simmons, Nelson, &
Neal, 2001). These constructs all represent an aspect of
engagement, one of the primary indicators of the
eustress response.
Studies have also examined the positive impact of
eustress at work. In a sample of pastors, eustress, as
operationalized by PA, was positively related to health
perceptions (Little et al., 2007). Despite the fact that the
pastors experienced significant work-related stressors,
those who responded positively to those stressors
reported better health than those who responded to
stressors with negative affect. Even with the highly
demanding nature of their jobs, nurses reported a high
degree of hope (Simmons et al., 2003; Simmons &
Nelson, 2001). The nurses remained actively engaged in
their work, and the positive response to the demands
was positively related to well-being. Critical care nurses,
whose work involves dealing with death, were even
more hopeful and engaged in their work than were their
colleagues, which may be as a result of their seeing an
end to patient suffering and pain. Taken together, these
studies show that even in extremely distressful jobs,
eustress can be experienced.
Individual outcomes associated with
distress
Negative outcomes associated with distress can be cat-
egorized into three domains: behavioural consequences,
psychological consequences and medical consequences
(Quick et al., 1997). One category of behavioural conse-
quences includes problems related to tobacco, alcohol
and substance abuse. Distressed individuals whose
coping mechanisms include tobacco, alcohol and sub-
stance abuse accrue the many well-documented costs of
these behaviours. Alcohol and other substance abuse
are some of the most potentially destructive forces in
family life; abusers harm themselves, their significant
others and their children (Quick, Henley, & Quick,
2004). Eating disorders are another group of negative
behaviours associated with distress. Individuals who
cope with distress with dysfunctional eating behaviours
may develop follow-on medical conditions of anorexia,
bulimia or, more commonly, obesity (Quick et al.,
1997).
Other serious behavioural consequences of distress
include bullying and violence. Workplace bullying is
associated with high levels of interpersonal conflict
(Pandey et al., 2010). Bullying behaviours may in turn
cause stressors to those who witness the behaviours and
186
M. B. Hargrove et al.
those who are victimized by the behaviours. Violent
behaviours may include spousal abuse, child abuse,
assault, sexual assault and even murder. Unfortunately,
violence is one predictable outcome associated with
distress (Quick et al., 1997).
Psychological consequences are also associated with
distress. Psychological consequences may result directly
from distress or may manifest as follow-on symptoms
caused by behaviours associated with distress. One such
psychological consequence is worker burnout. Burnout
is a risk for those in the helping occupations, and for
any workers who are highly invested or committed to
work. Such employees may neglect outside sources
of support such as family and friends (Quick et al.,
1997). Empirical evidence suggests a strong negative
relationship between social support and burnout
(Bodensteiner, Gerloff, & Quick, 1989). Other psycho-
logical consequences also cross the work to home
boundary. For example, sleep disorders and distur-
bances such as insomnia affect not only individuals but
also their families (Quick et al., 2004).
Additional psychological consequences of distress
include anxiety disorders and depression (Quick et al.,
1997). Anxiety disorders comprise a wide variety of
distress-related diagnoses, such as acute stress disorder,
post-traumatic stress disorder and panic disorders.
Each of these disorders may be antecedents of other
psychological and medical consequences. Depression is
another potentially serious consequence of distress.
Stressors can serve as triggers of depressive episodes. In
some cases of depression aggravated by distress, suicide
can be the tragic result, as was the case of a chief execu-
tive officer of a restaurant chain who killed himself
despite the outward appearance of success (Cooper &
Quick, 2003). In this case, the distress caused by the
loneliness of command may have been a contributing
factor.
Medical consequences of distress often flow from
behavioural and psychological consequences. Heart
disease and stroke are among the most serious health
threats facing modern populations (World Health
Organization, 2004; Xu, Kochanek, Murphy, & Tejada-
Vera, 2010), and distress is a known significant con-
tributor to heart disease and stroke (Quick et al., 1997).
This is particularly true of executives who are routinely
exposed to high levels of stressors (Gavin, Quick,
Cooper, & Quick, 2003). Behaviours such as smoking,
alcohol drinking and unhealthy eating habits are well-
documented predictors of heart disease and stroke.
Other medical consequences associated with distress
include cancer, back pain, gastrointestinal conditions
and headaches (Quick et al., 1997).
Organizational outcomes
Organizational health is a necessary but not sufficient
condition for high levels of organizational achieve-
ment (Quick, 1999a). Individual and organizational
Stress and Health 27: 182–193 (2011) © 2011 John Wiley & Sons, Ltd.
M. B. Hargrove et al.
outcomes associated with distress are not independent.
Instead, organizational stressors can generate individ-
ual distress, and individual distress can cause organiza-
tional dysfunction (Quick et al., 1997). One of the
principal visions in the field of occupational health psy-
chology is to create healthy workplaces—places in
which individuals are valued as they produce, serve and
develop. In such organizations, people use their skills
and abilities to achieve high performance (Quick et al.,
1997). Unhealthy organizations fail to create the condi-
tions for high individual performance, which results in
suboptimal organizational performance.
Leaders have a duty to create healthy organizations
in which their employees can thrive and produce (Quick
& Quick, 2004; Quick et al. 1997). Authentic leadership
has been proposed as an effective approach for this
pursuit (Macik-Frey, Quick, & Cooper, 2009). In order
to create healthy organizations, leaders must themselves
be healthy. In fact, healthy leaders may be at the heart
of organizational health (Quick, Macik-Frey, & Cooper,
2007). To minimize the negative impact of distress and
maximize the positive impact of eustress, leaders should
be aware of their own individual strengths and weak-
nesses. Individual weaknesses need to be developed and
individual strengths need to be built upon (Gavin et al.,
2003).
Negative organizational outcomes associated with
distress can be dichotomized into two categories: direct
costs and indirect costs (Quick et al., 1997). Direct costs
incurred by organizations as a result of distress include
reduced satisfaction, poor job performance, greater fre-
quency of accidents, increased health-care costs and
expensive legal judgments (Quick et al., 1997). Lower
job satisfaction is likely related to the additional orga-
nizational expenses resulting from high absenteeism
and high turnover. Costs associated with poor job per-
formance and low productivity may exceed direct
medical costs (Macik-Frey, Quick, & Nelson, 2007).
Distress is associated with both on-site and off-site acci-
dents (Macik-Frey et al., 2007). On-the-job accidents
produce higher workers’ compensation costs and may
result in costly litigation. Because the US model for
health care relies principally on employer-based insur-
ance, individual psychological and medical outcomes
associated with distress directly affect insurance premi-
ums and thus organizational bottom lines.
Indirect costs, although more difficult to measure,
are another set of organizational problems associated
with distress. Indirect costs include loss of vitality,
breakdowns in communication, reduced quality of rela-
tionships, violence and bullying, and opportunity costs
(Quick et al, 1997). Distress generates opportunity costs
because individuals within an organization may be too
busy fighting fires to effectively identify or exploit the
opportunities as they arise. Organizational resources
that could be spent productively on potential profit-
making activities are diverted to repairing unhealthy
individuals or organizational conditions.
Stress and Health 27: 182–193 (2011) © 2011 John Wiley & Sons, Ltd.
The Theory of Preventive Stress Management
Principles and practice of
the TPSM
Preventive stress management shares the same public
health lineage as public sanitation and personal hygiene
programs and the widespread deployment of vaccines
and antibiotics (Quick, 1989). Within the TPSM, pre-
ventive stress management is defined as ‘an organiza-
tional philosophy and set of principles that employs
specific methods for promoting individual and organi-
zational health while preventing individual and organi-
zational distress’ (Quick et al., 1997, p. 149). In this
sense, preventive stress management is an important
tool for promoting individual health, organizational
health and ultimately organizational performance.
Although the targets of preventive stress manage-
ment activities exist at every level of the organization,
effective preventive stress management is dependent
upon committed leadership. Leaders have the responsi-
bility to build and promote positive health within their
organizations (Macik-Frey et al., 2009). Chief executive
officers and other senior leaders have key roles in build-
ing and maintaining a culture; cultures determine the
contexts in which individuals learn to cope with stress-
ors (Quick, 1992). Not only should leaders strive to
produce healthy organizations, but should also strive to
build happy organizations (Quick & Quick, 2004). As
with most organizational goals, commitment from top
leadership is critical for the effective implementation
of preventive stress management programs (Adkins,
1999).
A critical consideration in preventive stress manage-
ment is the ability to assess the effects of stress on indi-
viduals within an organization and the organization as
a whole. A variety of measures and metrics exist that
organizations can employ to assess stress (Hurrell,
Nelson, & Simmons, 1998; Quick et al., 1997). As with
most management activities, sound managerial deci-
sions are dependent upon good information. Preventive
stress management activities should be designed based
upon the best data available (Adkins, 1999). Effective
preventive interventions are also designed in a cultur-
ally appropriate manner. Bhagat, Steverson, and Segovis
(2007) found that stress-reduction interventions in
non-Western organizations are often tailored to fit the
cultural demands of the societies in which they operate.
Interventions targeted at reducing stress within an
organization take many forms and utilize numerous
strategies. In a comprehensive review of interven-
tion studies, LaMontagne, Keegel, Louie, Ostry, and
Landsbergis (2007) identified 99 published interven-
tions between 1990 and 2005. All interventions can be
divided into three stages of preventive stress manage-
ment. Primary interventions are techniques for directly
managing or changing the stressor, or one’s perception
of it (Quick, 1999b; Quick et al., 1997). Primary inter-
ventions are truly preventive because they focus on
modifying the cause of stress. Secondary interventions
187
The Theory of Preventive Stress Management
are those actions designed to improve individual stress
responses, such as those that improve individual coping
(Quick, 1999b; Quick et al., 1997). Tertiary interven-
tions are those aimed at treating the symptoms of
distress, for example, Employee Assistance Programs
(EAPs) (Quick, 1999b; Quick et al., 1997).
Primary prevention
Primary prevention and interventions focus on stress-
ors and health risk factors, as addressed in the formal
statement of the theory (Quick et al., 1998).
Hypothesis 4: Primary prevention interventions
to reduce, modify or manage the intensity,
frequency and/or duration of organizational
demands reduce the stress response in people at
work.
The objective of primary intervention is not to elimi-
nate all stress, because the elimination of stress in orga-
nizations would lower individual and organizational
performance. Managers should attempt to eliminate
only those extreme stressors, which have no possibility
of producing positive responses, e.g. violence, hazard-
ous conditions, etc. Because eradication of stress is not
the principal goal, primary intervention should seek to
reduce stressors to levels that promote positive stress
responses and create conditions of eustress. Primary
interventions, in addition to reducing stressors, may
also be effective at developing psychological capital
among employees and improving employee well-being
(Avey, Luthans, Smith, & Palmer, 2010).
Primary interventions include a variety of manage-
rial actions. Proactive steps should be taken to limit the
frequency of predictable counterproductive stressors.
For example, in order to reduce the incidence of sexual
harassment, policies should be communicated, training
should be offered and risk factors should be regularly
assessed (Bell, Quick, & Cycyota, 2002). Training pro-
grams have also been utilized to help individuals
prepare for stressful situations (Adkins, 1999). Training
is effective when it places more coping resources at the
disposal of individuals. Improving the availability of
psychological resources enhances satisfaction and well-
being (Davidson et al., 2010). Another preventive
measure is to provide structured periods of rest or sab-
batical leave. For instance, academics who take sabbati-
cals gain psychological resources and decrease levels of
distress and burnout (Davidson et al., 2010).
Social support is an important primary prevention
method. Other individuals may provide direct aid in
dealing with a stressor, or may help individuals reframe
their stressful experience. Social support may reduce
the intensity and duration of stressors by buffering or
protecting individuals from sources of stress (Quick
et al., 1997). For example, a woman being bullied by
some of her co-workers may experience less intense
stress stimuli if she feels other co-workers and her boss
188
M. B. Hargrove et al.
are ‘on her side’. An employee who receives no such
support may well be exposed to a far more intense and
dramatic stress stimulus.
The presence of social support systems such as
buddies, senior workers or mentors predicts positive
psychological and emotional adjustment among new-
comers (Nelson & Quick, 1991). Other avenues for
social support include improving the flow of informa-
tion and increasing emotional understanding among
employees (Quick & Quick, 1984). Informational and
emotional support should be coupled with instrumen-
tal support that helps individuals meet job demands,
and appraisal support that facilitates role clarity and
provides concrete performance feedback (Quick &
Quick, 1984). Mentoring relationships might be par-
ticularly valuable for professional women, especially if
a female mentor is available (Nelson & Quick, 1985).
Finally, developing interdependent workers with healthy
attachments to each other leads to more sound psycho-
logical contracts and a pipeline of individuals who
can sustain themselves in stressful environments
without becoming distressed (Nelson, Quick, Eakin, &
Matuszek, 1995).
Because leaders are so pivotal to the success of orga-
nizations and because they predictably encounter sig-
nificant stressors, organizations may be well served by
targeting primary interventions towards senior leader-
ship. Prevention techniques that may suitable for execu-
tives include executive coaching, peer support and
journal writing (Cooper & Quick, 2003). Senior leaders,
of necessity, may be regularly exposed to intense stress-
ors such as high impact decision making. Because they
experience unique stressors, executives are often at
increased and different risks of distress than are subor-
dinate employees.
Secondary prevention
Secondary prevention is aimed at placing ready
resources at the disposal of workers who are experienc-
ing the inevitable and necessary demands of work
(Quick, 1999b). Secondary stress prevention is not an
alternative to primary stress prevention. Instead, it is a
complement that creates resilient and healthy individu-
als, as addressed in the formal statement of the theory
(Quick et al., 1998).
Hypothesis 5: Secondary prevention interven-
tions to moderate individuals’ stress responses
reduce the intensity, frequency and/or duration
of the individuals’ experience of the stress
response.
Secondary interventions may be especially appro-
priate when workers regularly encounter high levels
of stressors. Empirical evidence suggests that the
higher the level of work stressor, the more likely avoid-
ance will be used as opposed to active coping (Snow,
Swan, Raghavan, Connell, & Klein, 2003). Secondary
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M. B. Hargrove et al.
interventions focus on providing individuals with a
toolbox of coping methods for dealing with stressors.
Some tools that may be of utility during the stress
response phase include relaxation techniques, medita-
tion techniques, hypnosis and biofeedback training
(Quick et al., 1997). Individuals can be trained in the
utilization of many of these tools as a primary interven-
tion strategy. Another resource that may aid in faci-
litating positive stress response includes faith and
spirituality-based practices (Quick et al., 1997). Provid-
ing outlets for emotional expression is another poten-
tially useful secondary intervention (Quick et al., 1997).
A comprehensive meta-analysis found that cognitive-
behavioural and relaxational secondary interventions
were most effective (Richardson & Rothstein, 2008).
Allowing employees to express themselves emotionally
either in private venues or in supportive group sessions
provides a helpful outlet especially with regard to inter-
personal conflict. Providing regular information ses-
sions and briefings has been shown to be a meaningful
secondary intervention tactic (Adkins, 1999).
Perhaps the most common secondary prevention
techniques are exercise and wellness programs. Good
exercise programs include aerobic training, strength
training and flexibility exercises (Quick et al., 1997).
Wellness programs designed to improve diet and
promote weight loss serve a similar function. Lately,
many organizations have sponsored ‘biggest loser’ team
contests in which workers join together in teams to
improve their diet and exercise behaviours. Evidence
indicates that wellness and exercise programs, relaxation
and prayer are useful in reducing distress symptoms
(Nelson et al., 1989; Nelson, Quick, & Quick, 1989).
Tertiary prevention
Tertiary prevention is the last line of defence for stress
management and may be considered treatment inter-
vention or therapy, as specified by the formal theoretical
statement (Quick et al., 1998).
Hypothesis 6: Tertiary prevention interventions
to minimize distress and provide therapy shorten
and improve the healing process from stressful or
traumatic events in organizations.
At this stage, the stressors have stimulated negative
responses and the negative responses are beginning to
generate negative outcomes. Tertiary prevention is
designed to treat and heal individual symptoms of dis-
tress (Quick, 1999b) as well as repair negative orga-
nizational outcomes that have accrued because of
individual distress (Quick et al., 1997). An example
of such an intervention is that conducted in the wake
of the 2009 Fort Hood shooting; the Army offered Fort
Hood soldiers and employees treatment and counsel-
ling to deal with the distress caused by the violence.
Because tertiary prevention is aimed at symptoms, it
is crucial for managers to monitor employees who may
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The Theory of Preventive Stress Management
be experiencing negative stress outcomes. In order to
facilitate this monitoring, measures and metrics should
be utilized that aid in the identification of symptoms
(Adkins, 1999; Hurrell et al., 1998; Quick et al., 1997).
Appropriate metrics include productivity data, health-
care utilization rates and workers’ compensation costs
(Adkins, 1999).
Symptoms of individual distress are expressed behav-
iourally, psychologically and medically; thus, tertiary
interventions should be aimed at all three levels. Behav-
ioural symptoms might include increased smoking,
alcohol abuse or extreme weight gain. Each of these
symptoms presents an opportunity for interventions,
such as smoking cessation programs, alcohol and sub-
stance abuse treatment programs, and diet and exercise
programs. Other behavioural symptoms include harass-
ment behaviours, family violence and workplace
violence. Often, the managerial response to these
behaviours is dismissal of the perpetrator. When appro-
priate, alternatives such as diversity training, sexual
harassment training and anger management programs
may be employed. Good tertiary intervention also
includes providing resources to treat the witnesses and
victims of distress-related behaviours.
Psychological and medical symptoms require treat-
ment by trained professionals. Although many organi-
zations lack the internal resources to provide in-house
psychological and medical care, most medium and large
businesses can and do provide insurance to support the
care. The role of management in providing psychologi-
cal and medical help is often to identify risk signs and
encourage employees to seek assistance. Because of
their surveillance role, managers need to be familiar
with the common symptoms of such psychological and
medical conditions, such as anxiety disorders, depres-
sion, hypertension and heart disease.
Tertiary intervention also includes the repair of nega-
tive organizational outcomes. Organizations incur both
direct and indirect costs as a result of distress. To reduce
the direct costs associated with distress, managers prac-
tising tertiary intervention must seek to mitigate each
individual cost. For example, poor employee perfor-
mance must be addressed using all the managerial tools
at the disposal of the organization (behaviour modifi-
cation, coaching, team building, etc). Indirect costs pose
a difficult challenge for a manager attempting to prac-
tise tertiary intervention. Indirect costs such as oppor-
tunity costs are difficult to observe and quantify. Many
opportunities are missed precisely because they could
not be identified. Perhaps, the best tertiary intervention
regarding opportunity costs is to maintain and promote
mission focus even during periods when resources are
required to repair the consequences of distress.
Critique of TPSM
There are four critiques of TPSM that should be con-
sidered. These are that it is a macrotheory, that it has a
189
The Theory of Preventive Stress Management
narrowly targeted impact, that it has not fully developed
the eustress dimension and that it was slow to draw on
the coping framework. Since 2000, over 30 studies have
drawn on TPSM as an element in the architecture of
the field (cf. Avey et al., 2010; Bhagat et al., 2007; Bond
& Bunce, 2001; Chen, Westman, & Eden, 2009; Kompier,
Cooper, & Geurts, 2000; LePine et al., 2005; Wright &
Cropanzano, 2000).
Firstly, TPSM is a macrotheory that is systemic in
nature. Given the origins of TPSM in public health, the
theory is not discrete or narrowly specified like the
theory of burnout (Maslach, 1998), person–environ-
ment fit theory (Edwards et al., 1998), effort–reward
imbalance theory (Siegrist, 1998) and job control–
demands model (Theorell, 1998; Theorell & Karasek,
1996). These discrete and narrowly specified theories
and models have been extensively and intensively
tested over the decades as within the stress domain.
The aerobics model resonates with TPSM because of
its origins in preventive medicine. However, the aero-
bics model is an individual one that can be applied
extensively throughout an organization and working
population. Similarly, the job strain model is focused
on individual jobs and examines discrete ways of man-
aging the two key job dimensions of demands and
control. As a systemic theory, TPSM serves more
as a backdrop or framing theory in a range of work
(cf. Avey et al., 2010; Lepine et al., 2005; Wright &
Cropanzano, 2000).
Secondly, TPSM has had a narrowly targeted impact.
The cross-disciplinary nature of the theory has not led
to broad impact within one or another discipline.
However, the theory has seen sustained if narrowly tar-
geted impact over time. We cite three examples. The
first is from the use of TPSM in management education.
Griffin and Moorhead (1986) adopted TPSM to frame
the stress chapter in their leading organizational behav-
iour textbook and maintained TPSM as the stress
framework over the subsequent 25 years (Griffin &
Moorhead, 2011). The second is from the application
of TPSM in the Department of Defense, starting with
Air Force Materiel Command (Adkins, 1999) and
extending to Colonel Adkins’s work on the Air Staff in
the creation of chief psychological officers in each of
the 50 states’ National Guard organizations. The third
is the infusion of TPSM into Levi’s (2000) public policy
guidance on work-related stress for the European
Commission.
Thirdly, TPSM has not fully developed the positive
dimension of eustress. While eustress was acknowledged
from the outset, the core of TPSM focused on the pre-
vention of distress. Even in the explicit statement of the
theory (Quick et al., 1998), only the Corollary suggests
the positive and eustress. Even that does not explicitly
develop eustressful and positive dimension of stress.
Given the emergence of positive psychology, positive
organizational behaviour and positive organizational
scholarship over the past 10 years (cf. Nelson & Cooper,
190
M. B. Hargrove et al.
2007), this may be the most important new dimension
of TPSM that calls for fuller and clearer elaboration. For
example, Nelson & Simmons (2004) and Simmons &
Nelson (2007) suggested the concept of eustress gener-
ation—a generation accustomed to a near-constant
flow of diverse stimuli. Eustress generation is proposed
as a complement to distress prevention
Fourthly, TPSM explicitly sidestepped ‘coping’ at the
outset and came slowly to its incorporation into the
theory. Lazarus and Folkman (1984) made an impor-
tant contribution to the stress domain with their con-
cepts of appraisal and coping. While there are parallels
in problem-focused coping to primary prevention and
emotion-focused coping to secondary prevention, the
original presentation of TPSM emphasized a language
of ‘managing’ versus ‘coping’. As TPSM evolved, there
was recognition that these two approaches were not
mutually exclusive, and by the late 1990s there was a
move toward integration (cf. Quick et al., 1997). What
may be most important in the coping and appraisal
framework is the positive and negative valence that
becomes attached to a stressor through the appraisal
process. Prior to appraisal, it has been argued that
stressors have no valence for individuals. This means
that stressors are neither positive nor negative until a
person evaluates and appraises the stressor.
Conclusion
The TPSM has contributed to research on professional
women’s stress and gender differences; stress in military
services including the US Army, the US Navy and the
US Air Force; executives coping and stress management
strategies; and chronic organizational problems, such as
workplace violence and sexual harassment (Quick,
Wright, Adkins, Nelson, & Quick, 2013). The theory
and research are concerned with the burden of suffering
that employees and managers alike may experience in
organizations (Macik-Frey et al., 2007). The important
role leaders can play in alleviating this burden of suf-
fering is acknowledged and addressed as one element
in the practice of TPSM.
Adkins’ (1999) pioneering work in extending the
theory into an organizational health centre led by a
chief psychological officer has seen positive conse-
quences and results. In the case of the San Antonio Air
Logistics Center during a 6-year organizational inter-
vention, Klunder (2008) was the chief psychological
officer applying the theory. As the commanding gen-
eral’s organizational clinical psychologist, he was able
to put into action surveillance systems through a major
industrial organization in concert with the organiza-
tion’s leadership. Identifying high risk and vulnerable
employees early in the organization’s downsizing and
closure led to early preventive interventions. This 6-year
preventive stress management intervention led to the
prevention of suicides (there were none!), workplace
violence (there was none!) and cost avoidance of over
Stress and Health 27: 182–193 (2011) © 2011 John Wiley & Sons, Ltd.
M. B. Hargrove et al.
US $33,000,000 because of complaints and conflicts
that never happened, as estimated by the civilian per-
sonnel office (Klunder, 2008).
While the research and practice under the umbrella
of the TPSM have resulted in a range of positive impacts,
there are under-researched areas and other limitations.
There is a dearth of preventive intervention studies and
difficulties in conducting research where intervention
studies do occur. There are real challenges obtaining
good data on the costs of distress and the research on
eustress is still limited. Finally, we need to know more
about individual differences and the modifiers (vulner-
ability factors and protective mechanisms) of the stress
response.
In addition, there are several new, productive lines of
research that may be brought more squarely into orga-
nizational contexts. These include mindfulness-based
stress management, other cognitive intervention tech-
niques and interventions to create healthy organiza-
tional cultures aligned with the principles and practice
of the TPSM. We encourage comparison studies that
examine stress-infected leaders with those leaders who
are more naturally prevention agents.
Finally, a deep dive into the role of emotion and
emotion regulation for both leaders and followers may
be powerfully important in our understanding of pre-
ventive stress management practices for healthier,
happier and more productive organizational life.
Acknowledgments
The authors would like to thank Lee Brown for his
research assistance during the development of this
article.
REFERENCES
Adkins, J.A. (1999). Promoting organizational health: The
evolving practice of occupational health psychology. Pro-
fessional Psychology, Research and Practice, 30(2), 129–137.
Avey, J.B., Luthans, F., Smith, R.M., & Palmer, N.F. (2010).
Impact of positive psychological capital on employee
well-being over time. Journal of Occupational Health Psy-
chology, 15(1), 17–28.
Bell, M.P., Quick, J., & Cycyota, C.S. (2002). Assessment and
prevention of sexual harassment of employees: An applied
guide to creating healthy organizations. International
Journal of Selection & Assessment, 10 (1/2), 160–167.
Bhagat, R.S., Steverson, P.K., & Segovis, J.C. (2007). Inter-
national and cultural variations in employee assistance
programmes: Implications for managerial health and
effectiveness. Journal of Management Studies, 44(2),
222–242.
Bodensteiner, W.D., Gerloff, E.A., & Quick, J.C. (1989).
Uncertainty and stress in an R & D project environment.
R & D Management, 19(4), 309–323.
Bond, F.W., & Bunce, D. (2001). Job control mediates
change in a work reorganization intervention for stress
Stress and Health 27: 182–193 (2011) © 2011 John Wiley & Sons, Ltd.
The Theory of Preventive Stress Management
reduction. Journal of Occupational Health Psychology,
6(4), 290–302.
Cannon, W.B. (1915). Bodily changes in pain, hunger, fear
and rage: An account of recent researches into the function
of emotional excitement. New York: Appleton-Century-
Crofts.
Chen, S., Westman, M., & Eden, D. (2009). Impact of
enhanced resources on anticipatory stress and adjust-
ment to new information technology: A field-experi-
mental test of conservation of resources theory. Journal
of Occupational Health Psychology, 14(3), 219–230.
Cocchiara, F.K., & Quick, J. (2004). The negative effects of
positive stereotypes: Ethnicity-related stressors and
implications on organizational health. Journal of Organi-
zational Behavior, 25(6), 781–785.
Cooper, C.L. (1998). Theories of organizational stress.
Oxford, UK: Oxford University Press.
Cooper, C.L., & Quick, J. (2003). The stress and loneliness
of success. Counselling Psychology Quarterly, 16(1), 1–7.
Davidson, O.B., Eden, D., Westman, M., Cohen-Charash,
Y., Hammer, L.B., Kluger, A.N., . . . Spector, P.E. (2010).
Sabbatical leave: Who gains and how much? Journal of
Applied Psychology, 95(5), 953–964.
Dhabar, F.S. (2011). Effects of stress on immune function:
Implications for immunoprotection and immunopa-
thology. In R.J. Contrada, & A. Baum (Eds.), The hand-
book of stress science (pp. 47–64). New York: Springer.
Dijkstra, M.M., De Dreu, C.W., Evers, A., & van Dieren-
donck, D. (2009). Passive responses to interpersonal con-
flict at work amplify employee strain. European Journal
of Work & Organizational Psychology, 18(4), 405–423.
Edwards, J.R., Caplan, R.D., & Van Harrison, R. (1998).
Person-environment fit theory. In C.L. Cooper (Ed.),
Theories of organizational stress. Oxford, UK: Oxford
University Press.
Folkman, S., & Lazarus, R.S. (1985). If it changes it must
be a process: Study of emotion and coping during three
stages of a college examination. Journal of Personality and
Social Psychology, 48, 150–170.
Frankenhauser, M. (1979). Psychobiological aspects of life
stress. In S. Levine and H. Ursin (Eds.), Coping and health
(pp. 203–223). New York: Plenum Press.
Frankenhauser, M. (1983). The sympathetic-adrenal and
pituitary-adrenal response to challenge: Comparison
between the sexes. In T.M. Dembroski, T.H. Schmidt, &
G. Blumchen (Eds.), Biobehavioral bases of coronary heart
disease (pp. 91–105). New York: Karger.
Frankenhauser, M. (1986). A psychobiological framework
for research on human stress and coping. In M.H. Appley,
& R. Trumbull (Eds.), Dynamics of stress: Physiological,
psychological, and social perspectives (pp. 101–116). New
York: Plenum Press.
Ganster, D.C., & Schaubroeck, J. (1991). Work stress
and employee health. Journal of Management, 17(2),
235–271.
Gavin, J.H., Quick, J.C., Cooper, C.L., & Quick, J.D. (2003). A
spirit of personal integrity: The role of character in execu-
tive health. Organizational Dynamics, 32(2), 165–179.
191
The Theory of Preventive Stress Management
Griffin, R.W., & Moorhead, G. (1986). Organizational
behavior. Boston: Houghton Mifflin Co.
Griffin, R.W., & Moorhead, G. (2011). Organizational
behavior (10th ed.). Mason, OH: Cengage.
Hurrell, J.R., Nelson, D.L., & Simmons, B.L. (1998). Mea-
suring job stressors and strains: Where we have been,
where we are, and where we need to go. Journal of Occu-
pational Health Psychology, 3(4), 368–389.
Joplin, J.W., Nelson, D.L., & Quick, J. (1999). Attachment
behavior and health: Relationships at work and home.
Journal of Organizational Behavior, 20(6), 783–796.
Klunder, C.S. (2008). Preventive stress management at
work: The case of the San Antonio Air Logistics Center,
Air Force Materiel Command (AFMC). MANAGING &
LEADING: SPIM Conference and Institutes, San Antonio,
29 February.
Kompier, M.A. J., Cooper, C.L., & Geurts, S.A. E. (2000). A
multiple case study approach to work stress prevention
in Europe. European Journal of Work and Organizational
Psychology, 9(3), 371–400.
LaMontagne, A.D., Keegel T., Louie, A.M., Ostry A., &
Landsbergis, P.A. (2007). A systematic review of the job
stress intervention evaluation literature: 1990–2005.
International Journal of Occupational & Environ Health,
13(3), 268–280.
Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal, and
coping. New York: Springer.
LePine, J.A., Podsakoff, N.P., & LePine, M.A. (2005). A
meta-analytic test of the challenge stressor-hindrance
stressor framework: An explanation for inconsistent rela-
tionships among stressors and performance. Academy of
Management Journal, 48, 764–775.
Levi, L. (2000). Guidance on work-related stress: Spice of
life or kiss of death? Luxembourg: European Commis-
sion, Directorate-General for Employment and Social
Affairs, Health & Safety at Work: 100 pages.
Little, L.M., Simmons, B.L., & Nelson, D.L. (2007). Health
among leaders: Positive and negative affect, engagement
and burnout, forgiveness and revenge. Journal of Man-
agement Studies, 44(2), 243–260.
Macik-Frey, M., Quick, J., & Cooper, C.L. (2009). Authen-
tic leadership as a pathway to positive health. Journal of
Organizational Behavior, 30(3), 453–458.
Macik-Frey, M., Quick, J.C., & Nelson, D.L. (2007). Advances
in occupational health: From a stressful beginning to a
positive future. Journal of Management, 33(6), 809–840.
Mack, D.A., Nelson, D.L., & Quick, J.C. (1998). The stress of
organizational change: A dynamic process model. Applied
Psychology: An International Review, 47(2), 219–232.
Maslach, C. (1998). A multidimensional theory of burnout.
In C.L. Cooper (Ed.), Theories of organizational stress.
Oxford, UK: Oxford University Press.
Nelson, D.L. (1987). Organizational socialization: A stress
perspective. Journal of Occupational Behavior, 8(4),
311–324.
Nelson, D.L. (1990). Individual adjustment to informa-
tion-driven technologies: A critical review. MIS Quar-
terly, 14(1), 79–98.
192
M. B. Hargrove et al.
Nelson, D.L., & Burke, R.J. (2000). Women executives:
Health, stress, and success. Academy of Management
Executive, 14(2), 107–121.
Nelson, D.L., & Cooper, C. (2007). Positive organizational
behavior: Accentuating the positive at work. Thousand
Oaks, CA: Sage.
Nelson, D.L., & Quick, J.C. (1985). Professional women:
Are distress and disease inevitable? Academy of Manage-
ment Review, 10(2), 206–218.
Nelson, D.L., & Quick, J. (1991). Social support and new-
comer adjustment in organizations: Attachment theory at
work? Journal of Organizational Behavior, 12(6), 543–554.
Nelson, D.L., Quick, J.C., Eakin, M.E., & Matuszek, P.A.
(1995). Beyond organizational entry and newcomer
stress: Building a self-reliant workforce. International
Journal of Stress Management, 2(1), 1–14.
Nelson, D.L., Quick, J.C., & Hitt, M.A. (1989). Men and
women of the personnel profession: Some differences
and similarities in their stress. Stress Medicine, 5(3),
145–152.
Nelson, D.L., Quick, J.C., Hitt, M.A., & Moesel, D. (1990).
Politics, lack of career progress, and work/home conflict:
Stress and strain for working women. Sex Roles, 23(3/4),
169–185.
Nelson, D.L., Quick, J., & Quick, J.D. (1989). Corporate
warfare: Preventing combat stress and battle fatigue.
Organizational Dynamics, 18(1), 65–79.
Nelson, D.L., & Simmons B. (2004). Eustress: An elusive
construct, an engaging pursuit. In P.L. Perrewe, & D.C.
Ganster (Eds.), Research in occupational stress and well
being, Vol. 3: Emotional and physiological processes and
positive intervention strategies (pp. 265–322). Oxford:
Elsevier.
Nelson, D.L., & Sutton, C. (1990). Chronic work stress and
coping: A longitudinal study and suggested new direc-
tions. Academy of Management Journal, 33(4), 859–869.
Pandey, A., Quick, J.C., Rossi, A.M., Nelson, D.L., & Martin,
W. (2010). Stress and the workplace: 10 years of science,
1997–2007. In R.C. Cantrada, A. Baum, & R. Cantrada
(Eds.), Handbook of stress science: Biology, psychology, and
health. New York: Springer.
Peters, L.H., O’Connor, E.J., Pooyan, A., & Quick, J.C.
(1984). The relationship between time pressure and per-
formance: A field test of Parkinson’s Law. Journal of
Occupational Behavior, 5(4), 293–299.
Quick, J.C. (1989). Guest editorial: An ounce of preven-
tion. Stress Medicine, 5, 207–210.
Quick, J.C. (1992). Crafting an organizational culture:
Herb’s hand at Southwest Airlines. Organizational
Dynamics, 21(2), 45–56.
Quick, J.C. (1998). Introduction to the measurement of
stress at work. Journal of Occupational Health Psychology,
3(4), 291–293.
Quick, J.C. (1999a). Occupational health psychology: His-
torical roots and future directions. Health Psychology,
18(1), 82–88.
Quick, J.C. (1999b). Occupational health psychology: The
convergence of health and clinical psychology with
Stress and Health 27: 182–193 (2011) © 2011 John Wiley & Sons, Ltd.
 M. B. Hargrove et al.
public health and preventive medicine in an organiza-
tional context. Professional Psychology, Research and Prac-
tice, 30(2), 123–128.
Quick, J.C., Gavin, J.H., Cooper, C.L., & Quick, J.D. (2000).
Executive health: Building strength, man-aging risks.
Academy of Management Executive, 14(2), 34–44.
Quick, J.D., Henley, A.B., & Quick, J.C. (2004). The balanc-
ing act—At work and at home. Organizational Dynamics,
33(4), 426–438.
Quick, J.C., Joplin, J.R., Nelson, D.L., Mangelsdorff, A., &
Fiedler, E. (1996). Self-reliance and military service train-
ing outcomes. Military Psychology, 8(4), 279–293.
Quick, J.C., Macik-Frey, M., & Cooper, C.L. (2007). Mana-
gerial dimensions of organizational health: The healthy
leader at work. Journal of Management Studies, 44(2),
189–205.
Quick, J.C., Nelson, D.L., Quick, J.D., & Orman, D.K. (2001).
An isomorphic theory of stress: The dynamics of person-
environment fit. Stress & Health: Journal of the Interna-
tional Society for the Investigation of Stress, 17(3), 147–157.
Quick, J.C., & Quick, J.D. (1979). Reducing stress through
preventive management. Human Resource Management,
18(3), 15–22.
Quick, J.C., & Quick, J.D. (1984). How good working rela-
tionships can help relieve pressures on the job. Manage-
ment Review, 73(5), 43–45.
Quick, J.C., & Quick, J.D. (2004). Healthy, happy, produc-
tive work: A leadership challenge. Organizational Dynam-
ics, 33(4), 329–337.
Quick, J.D., Quick, J.C., & Nelson, D.L. (1998). The theory
of preventive stress management in organizations. In
C.L. Cooper (Ed.), Theories of organizational stress (pp.
246–268). Oxford, UK: Oxford University Press.
Quick, J.C., Quick, J.D., Nelson, D.L., & Hurrell, J.J. (1997).
Preventive stress management in organizations. Washing-
ton, DC: American Psychological Association.
Quick, J.C., Saleh, K.J., Sime, W.E., Martin, W., Cooper, G.L.,
Quick, J.D., Mont M.A. (2006). Stress management skills
for strong leadership: Is it worth dying for? Journal of Bone
& Joint Surgery American Volume, 88(1), 217–225.
Quick, J.C., & Spielberger, C.D. (1994). Walter Bradford
Cannon: Pioneer of stress research. International Journal
of Stress Management, 1(2), 141–143.
Quick, J.C., Wright, T.A., Adkins, J.A., Nelson, D.L., &
Quick, J.D. (2013). Preventive Stress Management in
Organizations (2nd ed.). Washington, DC: American Psy-
chological Association.
Richardson, K.M., & Rothstein, H.R. (2008). Effects of
occupational stress management intervention programs:
A meta-analysis. Journal of Occupational Health Psychol-
ogy, 13(1), 69–93.
Rose, R.M. (1987). Neuroendocrine effects of work stress.
In J.C. Quick, R.S. Bhagat, J.E. Dalton, & J.D. Quick
(Eds.), Work stress: Health care systems in the workplace.
(pp. 130–147). New York: Praeger.
Sethi, V., King, R.C., & Quick, J. (2004). What causes stress
in information systems professionals? Communications
of the ACM, 47(3), 99–102.
Stress and Health 27: 182–193 (2011) © 2011 John Wiley & Sons, Ltd.
View publication stats
The Theory of Preventive Stress Management
Siegrist, J. (1998). Adverse health effects of effort-reward
imbalance at work. In C.L. Cooper (Ed.), Theories of
organizational stress. Oxford, UK: Oxford University
Press.
Sime, W.E., Quick, J., Saleh, K.J., & Martin, W. (2007).
Critical decisions, trauma, and burnout in medicine: A
stress management challenge to physician well-being.
Biofeedback, 35(3), 95–100.
Simmons, B.L. (2000). Eustress at work: Accentuating the
positive (Unpublished doctoral dissertation). Oklahoma
State University, Stillwater, OK, USA.
Simmons, B.L., Gooty, J., Nelson, D.L., & Little, L.M.
(2009). Secure attachments: Implications for trust, hope,
burnout, and performance. Journal of Organizational
Behavior, 30, 233–247.
Simmons, B.L., & Nelson, D.L. (2001). Eustress at
work: The relationship between hope and health in
hospital nurses. Health Care Management Review, 26,
7–18.
Simmons, B.L., & Nelson, D.L. (2007). Eustress at work:
Extending the holistic stress model. In D.L. Nelson, &
C.L. Cooper (Eds.), Positive organizational behavior (pp.
40–53). Thousdand Oaks, CA: Sage.
Simmons, B.L., Nelson, D.L., & Neal, L.J. (2001). A com-
parison of the positive and negative work attitudes of
home healthcare and hospital nurses. Health Care Man-
agement Review, 26, 63–74.
Simmons, B.L., Nelson, D.L., & Quick, J. (2003). Health for
the hopeful: A study of attachment behavior in home
health care nurses. International Journal of Stress Man-
agement, 10(4), 361–375.
Snow, D.L., Swan, S.C., Raghavan, C., Connell, C.M., &
Klein, I. (2003). The relationship of work stressors,
coping and social support to psychological symptoms
among female secretarial employees. Work & Stress,
17(3), 241–263.
Theorell, T. (1998). Job characteristics in a practical health
context. In C.L. Cooper (Ed.), Theories of organizational
stress. Oxford, UK: Oxford University Press.
Theorell, T., & Karasek, R.A. (1996). Current issues related
to psychosocial job strain and cardiovascular disease
research. Journal of Occupational Health Psychology, 1(1),
9–26.
Vandenbos, G.R. (Ed.) (2007). APA dictionary of psy-
chology. Washington, DC: American Psychological
Association.
World Health Organization (2004). Annex Table 2: Deaths
by cause, sex and mortality stratum in WHO regions, esti-
mates for 2002. Retrieved from http://www.who.int/
whr/2004/annex/topic/en/annex_2_en.pdf
Wright, T.A., & Cropanzano, R. (2000). Psychological well-
being and job satisfaction as predictors of job perfor-
mance. Journal of Occupational Health Psychology, 5(1),
84–94.
Xu, J., Kochanek, K.D., Murphy, S.L., & Tejada-Vera,
B. (2010). Deaths: Final Data for 2007. National Vital
Statistics Reports, 58(19), 1–136.
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