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continuous adaptation by the worker. When these transactions are perceived as uncontrollable, the event or situation generates a condition of psychological distress that, if persistent or repeated, can lead to negative health outcomes. The first component of this stress model includes social structures (such as workplace, family) and social processes (events that take place within the social structure). These structures and events are continuously perceived, appraised, and evaluated by the individual. When there is a persistent discrepancy between the worker's abilities, personal needs, expectations, environmental demands, and the opportunities, potential outcomes, social structures, and/or events, or when transactions are perceived as threats, then a complex emotional, cognitive, behavioral, and physiological reaction is evoked.

This response can result in transitory disturbances in mental and physical function (stress response) that, if prolonged, can eventually lead to persistent feelings of distress (frustration, anger, anxiety, dysphoria) and subsequently to physical disorders. Presumably, this response to stress is affected by early environmental influences and genetic factors. It is proposed that this cascade of events can be modified by a number of “interacting variables,” including, for example, a worker's coping repertoire and skills, and the availability and use of social support. These models typically propose the existence of a set of stressors, which are generally defined as environmental demands, and responses to these stressors, often referred to as strains. These strains are the acute effects of the exposure to stressors. A set of intervening factors plays a role in modulating the effect of the demands on strain. As indicated earlier, these intervening factors can include coping skills, problem solving abilities, past learning and exposure, and biological predisposition to react to stress. It is important to note that there are other models of occupational stress (e.g., Hurrell, 1987; Karasek and Theorell, 1990) that have not been reviewed in this chapter. The purpose of this section is not to provide an exhaustive review of models but rather to provide a general overview of the components of most models.

BIOLOGICAL RESPONSE

Work can trigger a complex set of behavioral, cognitive, and physiological responses or strains, commonly referred to as the stress response. The stress response is typically associated with systemic and localized physiological changes that are intended to reestablish a biological state of homeostasis (Selye, 1956). It is postulated that recurrent or chronic exposure to a wide range of intrinsic or extrinsic stressors or demands repeatedly evokes a stress response, which, in turn, contributes to the etiology, exacerbation, and maintenance of a number of prevalent health problems



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