Worked example 1
A junior doctor reports burnout from 60-hour weeks, sleep deprivation, and anxiety before night shifts.
(a) Using Lazarus & Folkman's model, explain the doctor's stress response. [4 marks] (b) Outline Stress Inoculation Training (SIT) and one other stress management technique suitable for this case. [4 marks] (c) Evaluate problem-focused vs emotion-focused coping for workplace stress. [6 marks]
Show solution outline
(a) Transactional model applied:
- Primary appraisal: Doctor evaluates 60-hour weeks as threat to health, relationships, and patient safety — high perceived severity.
- Secondary appraisal: Coping resources feel insufficient — cannot easily reduce hours (systemic constraint), lacks control (Karasek high-strain job).
- Stress response: Emotional (anxiety before shifts), physiological (sleep disruption, elevated cortisol), behavioural (burnout, possible errors).
- Reappraisal failure: Does not reframe night shifts as manageable challenge — fixed threat appraisal maintains distress.
(b) Interventions:
- SIT (Meichenbaum): Phase 1 — doctor learns to identify stress triggers and catastrophising thoughts. Phase 2 — acquires skills (progressive relaxation, positive self-talk). Phase 3 — practises coping during simulated high-pressure scenarios.
- Biofeedback: Monitor heart rate and muscle tension during pre-shift period; learn to reduce physiological arousal through breathing techniques before anxiety escalates.
(c) Evaluation — problem vs emotion-focused coping:
Problem-focused:
- Strengths: Addresses root cause — e.g. negotiating rota changes, reporting unsafe hours to BMA; most effective when stressor is controllable.
- Limitations: NHS systemic issues (understaffing) may be unchangeable by an individual doctor — problem-focused attempts fail, increasing helplessness.
Emotion-focused:
- Strengths: Useful when stressor cannot be changed — SIT, mindfulness, social support reduce distress without requiring system change; immediate relief.
- Limitations: Does not fix organisational cause — risk of blaming the individual for systemic burnout; emotion-focused alone may normalise exploitative working conditions.
Judgement: Best approach combines both — organisational problem-focused (workplace wellness programmes, 3.5.2) plus individual emotion-focused (SIT, biofeedback). Neither alone is sufficient for occupational stress.