Protective Mechanisms Between Bullying and Post Traumatic Stress Disorder

Abstract

The current, quantitative study, replicates and adapts Nielson, Matthiesen, and Einarsen’s research (2008) which investigated a sense of coherence (SOC) lessening the relationship between exposure to bullying and symptoms of post-traumatic stress disorder. Adaptation of the study will include administration of the surveys online and utilizing members of the American Counseling Association that are licensed, professional counselors. The findings will add to the sparse knowledge concerning licensed professional counselors, bullying, and the long-lasting effect of post-traumatic stress. Additionally, the empirical data will provide a basis for training interns, continuing education of already licensed counselors, and a focal point to open a dialogue between counseling professionals.

Introduction and statement of the problem

Introduction to the Problem

In common with industrial and white-collar work settings, health care organizations have seen their fair share of workplace bullying (WB). Broadly defined as negative acts that degrade and even physically harm the victim, workplace bullying in healthcare settings was already recognized in the professional literature more than three decades previously (Madden et al., as cited in Rippon, 2008, p. 453) and has since been revealed as widespread (Lipscomb & Love, 1992). Between 35 and 82 percent of healthcare professionals have endured at least verbal abuse and even physical assault (Whitehorn & Nowland, 1997), with psychological trauma a near-inevitable consequence. No less than the independent Joint Commission (2008), tasked to accredit health care establishments, has sounded the call for management professionalism not only to protect the victims of workplace bullying but also to preserve standards of patient care, forestall medical errors, bolster patient satisfaction, thwart adverse outcomes, and minimize staff turnover.

Leymann (1996) elaborated on the nature of WB as “a repeated hostile and unethical communication occurring frequently, at least once a week, over a long period of time, usually 6 months” (p.252). Being sustained and chronic, WB can result in psychological, psychosomatic, and social suffering.

Paradoxically, licensed professional counselors (LPC) whom enlightened managements call on to help with bullying interventions may themselves be at risk. Vignettes, anecdotal evidence and peer-reviewed research (e.g. Nielsen, Matthiesen, & Einarsen, 2008) suggest that counselors themselves are subjected to bullying by peers, patients, and superiors. Beyond characterizing the prevalence of the phenomenon, there is a paucity of extant research into applicable interventions when LPC’s themselves are victimized and their effectiveness at helping others presumably diminished by a reduced sense of self-worth and, in some cases, symptoms of frank post-traumatic stress disorder (PTSD).

Nielson, Matthiesen, and Einarsen (2008) therefore turned to investigating the aftereffects of WB in point of harm done to health and emotional wellbeing. At the time, there was mounting evidence that at least some WB targets manifested symptoms of PTSD (Leymann & Gustafsson, 1996; Tehrani, 2004; Matthiesen & Einarsen, 2004). Extant research did not, however, clarify why the progression to PTSD above DSM-IV cut-off levels was variable. Nielsen et al. therefore hypothesized that some disposition was a mitigating factor. The research team then considered Antonovsky’s (1987) sense of coherence (SOC) theory, which itself evolved from the salutogenic model (Bengel, Strittmatter & Willmann, 1999; Antonovky, 1996), as a possible protective factor for targets of WB. SOC was offered as an explanation for some individuals managing stress and evincing better health than others, regardless of their status as victims or witnesses of bullying.

SOC is a personality disposition defined as a “global orientation that expresses the extent to which one has a pervasive, enduring (albeit dynamic) feeling of confidence” that one’s environment is “comprehensible, manageable, and meaningful” (Antonovsky, 1987, p. 19). The author elaborates on this by defining three central components (see below).

Source: Antonovsky, 1987

These SOC components describe the origins of health (Olson, Hansson, Lundblas, & Cederblad, 2006) through “identifying a particular coping strategy that seems most appropriate for dealing with the stressor being confronted” (Antonovsky, 1987, p 138). As a resource for resisting stress, SOC is thought to be supportive of health in general and analogous to hardiness, self-esteem, and dispositional optimism (Bengel, Strittmatter, & Willmann, 1999). SOC is therefore important for understanding individual stress reactions and offers one explanation why some individuals are more resistant to stress and have better health than others (Eriksson & Lindstrom, 2005). On the whole, SOC should predispose to general mental health, resilience and appropriate selection of resources in response to stimuli from the environment. Poor or nonexistent SOC, on the other hand, is associated with rigidity and disproportionate reactions.

Prior to this work by Nielsen et al., there had been no attempt to demonstrate the moderating effect of SOC on the relationship between workplace bullying and PTSD symptoms. However, a mediating effect had been repeatedly shown for other workplace stressors and indicators of physical or mental health.

Professional counselors may seek an enhanced sense of identity while working in the service of self and others (Farber & Manevich, 2005). The need to present creative silence and self-denial to offer as much leeway as possible for clients to reveal much of themselves is, according to Owen (1993), a core skill of counseling. Counselors’ sense of self worth results from helping and nurturing others (Farber and Manevich, 2005; Meader, 1989) “knowing or unknowingly, by the position of authority, by the dependence of others, by the image of benevolence, by the promise of adulation, or by the hope of vicariously helping themselves through helping others” (Owen, 1993, p. 37). The ideals of professional counselors are shaped and formed by training, preventative information, and experience. But even buttressed by SOC, such altruistic qualities may not help a counselor targeted by a bully because the perpetrator cannot be reasoned with or dealt with in a logical manner.

Few studies in the United States have examined the long-lasting effects of workplace bullying and measures that may protect professional counselors from personal distress (Mikkelson & Einarsen, 2002) and diminished effectiveness. The goal of this study is therefore to adapt the Nielsen, Matthiesen, and Einarsen research (2008) and explore the possible role of counselors’ SOC as a protective mechanism against symptoms of PTSD when victimized by bullying. Conclusions from the research can be used for counselor self-care, preventive programs and policy-making. Additionally, training afforded counselor interns, licensed counselors seeking continuing education, and the organizations in which they work will have the benefit of the findings of this study as empirically-solid support.

Background of the Study

Bullying at work has been a topic of interest for researchers at least since 1963. At that time, Lorenz (1963) coined the term “mobbing” after drawing an analogy with a flock of crows that would “put a hate on” a nocturnal predator spotted in the daytime and subsequently attack the latter. More recently, Westhues (2007) drew even deeper on naturalistic similes when he claimed that mobbing is a natural impulse to assure group safety and, ultimately, the protection of the species.

Leymann (1996) sought to distinguish the terms by pointing out that “mobbing” was more descriptive and a better fit for the negative behaviors associated with aggression in the workplace while “bullying” connoted more strongly the physical aggression and threats observed in schoolyards. Other expressions for negative workplace behavior were “harassment” or “psychological terror” (Leymann, 1996, p. 167). Preferring to use “mobbing,” Leymann nonetheless formulated the classic description for the interrelated terms “mobbing,” “workplace bullying,” “harassment” and “psychological terror” at work.

Mobbing is an unethical communication which is directed in a systematic way by one or a few individuals toward an individual who, due to mobbing, is pushed into a helpless and defenseless position, being held there by a means of continual mobbing activities. These actions occur on a very frequent basis (statistical definition: at least once a week) over a long period of time (statistical definition: at least six months of duration).” (Leymann, 1996, pp. 167-9).

In explaining various facets of mobbing and the occupations more vulnerable to workplace bullying, Leymann attracted a following in Scandinavian countries and subsequently, around the world. The work that made the greatest impression was an extensive research project that involved 24,528 subjects and explored social expulsion, mobbing and victimization at work. The findings included PTSD being the most prevalent and long-lasting consequence (95 percent or virtually all bullying targets) (Leymann, 1996; 1992a).

As Leymann pioneered research in the academic setting, the publicist and broadcast journalist Andrea Adams was using the media to spotlight harassment at work, bringing hope to employees who otherwise deemed themselves workplace outcasts. She coined “workplace bullying” in 1992, applying the term to adult misery at work (as cited in Namie, 2003). The success of two documentaries encouraged Andrea to write a book titled Bullying at Work, published in 1992. Diagnosed with cancer and succumbing in 1995, Adams left a legacy of newfound awareness regarding the age-old issue of bullying in the workplace.

Just as Adams started the discourse about workplace bullying and Leymann opened the academic discourse to findings about PTSD, Antonovsky (1979; 1987) postulated that a sense of coherence (SOC) is a way to view the world that promotes health and mitigates the vulnerability of victims to PTSD. In turn, Nielsen, Matthiesen, and Einarsen (2008) hypothesized that a person with a higher SOC would react differently to bullying than persons with a lower SOC. They investigated this hypothesis about the possible role of SOC as a protective mechanism in the relationship between exposure to workplace bullying and symptoms of PTSD. Study participants were recruited from two Norwegian support associations for targets of bullying at work. The quantitative study implemented three self report questionnaires:

1. The Negative Acts Questionnaire (NAQ, formulated by Einarsen and Raknes, 1997), measuring exposure to bullying at the workplace;
2. The Impact of Events Scale-Revised (IES-R, by Weiss and Marmar, 1995) that measured three core components of PTSD;
3. The Orientation to Life Questionnaire (Antonovsky, 1987), a self report instrument measuring SOC, i.e. assessing the degree to which an individual views his immediate environment with the three frameworks specific to the theory: comprehensibility, manageability and meaningfulness.

These instruments will be explained in detail in Chapters 2 and 3. Briefly, the Nielsen et al. study suggested that, “SOC offers more protective benefits when bullying is mild; however the benefits diminish as bullying becomes more severe” (2008, p. 132).

With SOC, according to Birkland, Matthiesen, and Einarsen (2008), the coping skills of WB targets just may not be an adequate protective factor. The components of SOC are qualities that counselors and counseling interns might deem as important primary traits for the helping profession. One might question if counselors themselves must possess the senses of comprehensibility, meaningfulness, and manageability in order to thwart workplace violence. As it is, counselors high in self-monitoring have a demonstrably low tolerance for ambiguity (Smith, Michael, Smaaby, Maddux, Torres-Riverea, & Edeil, 2005), which can render them indecisive when confronting the kind of vague and confusing cues that supervising a bullying case often entails. Such could be the case with counselors or counselor interns that are giving the bully the benefit of the doubt because they have not been forewarned about workplace bullying and its long-lasting effects on their careers. For this reason, a replication of this study, using Licensed Professional Counselors as participants, will pursue as the main research purpose precisely that undertaken by Nielsen et al., “explore the possible role of an individual’s SOC as a protective mechanism in the relationship between exposure to bullying and symptoms of posttraumatic stress” (2008, p. 128).

Purpose of the Study

The purpose of this proposed study is to a) quantify the extent to which licensed professional counselors are themselves subject to WB, b) assess the prevalence of above-threshold symptoms of PTSD as an aftereffect attributable to WB, and c) whether moderate or high SOC in the counselor is inversely correlated with symptoms of PTSD. Ultimately, such an understanding could well buffer the self-efficacy of LPC’s and bolster evidence-based interventions for reducing their own victimization to WB.

Rationale

The findings of this research will heighten awareness, add to the body of knowledge, and launch discourse in the profession concerning the long-lasting effects of WB on counselors and how a sense of coherence could be a protective factor. Counselors working in a treatment center environment and confronting questions concerning workplace harassment face a dearth of empirical data specifically related to their professional discipline. On the other hand, one has the paradigm of the Nielsen, Matthiesen and Einarsen (2008) research, in which the participants were members of two Norwegian support associations for targets of bullying. Formulating local training and prevention programs based on results from Norwegian culture may be too much of a leap for valid replication. For this reason, replicating the above research on American counselors could provide a more reliable foundation for training programs.

If the results are as hypothesized, the proposed study would generate awareness that will serve several purposes. First, the study results could fashion a consensus that counselors are not immune to WB; second, provide research evidence as a reference source; and third, bridge the gap between research findings from other cultures and foreign professional populations to the domestic counterpart.

In a pragmatic sense, this replication bears undertaking if only to confirm, first of all, that LPC’s are themselves victimized by workplace aggression to such an extent as to degrade their effectiveness at providing counseling, guidance and sustained therapy to both targets and perpetrators of WB. If LPC victimization is widespread and sustained, with even less known by way of support and potential remedies, every kind of organization is also weakened by the diminished capacity to deal with WB in the workforce at large.

Research Question

The proposed study addresses the following research questions and their associated null hypotheses:

RQ¹ What is the past-year incidence of workplace bullying that Licensed Professional Counselors are subjected to?

H₀¹: There is no difference in self-reported bullying incidence between licensed counselors and typical American workers.

RQ² Do counselors subjected to bullying evince symptoms of PTSD?

H₀²: There is no difference in self-reported PTSD symptoms whether counselors endure workplace bullying or not.

RQ³ Does SOC ameliorate the PTSD-linked aftereffects of being a bully victim?

H₀³: High, moderate or low SOC makes no difference in the development of PTSD-linked aftereffects in response to bullying.

Significance of the Study

The Nielsen et al. (2008) study revealed that those succoring bullying victims were themselves targeted by peers, superiors and patients. The value of the proposed study lies not so much in confirming that victimization of LPC’s domestically runs at a lower, equal or greater rate than for the American workers in general. Rather, one aims to replicate the phenomenological investigation of the repercussions of bullying in point of self-reported PTSD and the extent to which SOC buffers such negative consequences.

Should empirical support be found for the aforementioned hypotheses, the evident beneficiaries are LPC’s themselves and, by extension, the WB targets they succor. Counselors would realize that the persistent verbal and non-verbal assaults they endure do not reflect any significant professional shortcoming. Indeed, realizing that the vague unease, uneven health and fractured wellbeing they suffer can be attributed to the intimidating behavior of habitual bullies can prove a welcome insight and may well prove to be the essential first step in the healing process (MacIntosh, 2005).

Affirming that SOC is a protective disposition at one or all levels of bullying intensity that predispose to stress (Antonovsky, 1987) should stand LPC’s in good stead as a new paradigm for understanding WB consequences. Learning about SOC is apt to focus more attention on a heretofore-untapped inclination for a comprehensible, manageable and meaningful world view. LPC’s will more readily recognize this in themselves and be able to better assess how the WB victims they counsel stand on this predisposition.

If the proposed study merely replicates the results obtained by Nielsen et al. – that bullying predisposes to overt symptoms of PTSD and that SOC exerts the strongest protective effect at low levels of bullying – it is nevertheless very likely that the profession will a) learn to be more watchful for the manifestations of the disorder and b) be impelled to launch other research on factors or interventions that more effectively address the aftermath of moderate-to-high WB.

Definition of Terms

Bullying. The combination of verbal abuse and behaviors that are humiliating, threatening or intimidating to the victim (Namie, 2007).

Downward bullying is defined as a form of workplace mobbing by a superior against a subordinate (Vandekerckhove & Commers, 2003).

Empathy gap is defined as fundamental lack of understanding of the lived experience of “the other” (Turney, 2003; Geertz, 1993).

Hierarchal bullying is defined as bullying occurring with the hierarchy (Turney, 2003), the relatively rare form that is directed upward, from subordinate to superior.

Horizontal bullying is defined as occurring between individuals of equal power (Turney, 2003).

Mobbing is often regarded as a dishonorable, humiliating communication process which is aimed at abusing a person in the communication process. The abused person is often pushed into a helpless situation, and kept in such situation by the means of numerous and continuing mobbing activities. (Leymann, 1996).

Psychological terror is a hostile and humiliating communication style which is organized by a group of persons against one individual (Leymann, 1990).

Sense of coherence is a personality disposition, by definition global, that one’s environment is wholly meaningful, can be fully understood in two-way communication, and is therefore manageable (Antonovsky, 1987).

Scapegoating is defined as a situation where a concentration or polarization of group aggression is directed at an individual “innocent” object, that is, a person or group who does not, in fact, threaten or frustrate the group (Agervold, 2007; White and Lippitt, 1968, p. 328).

Strain time is defined as the length of time during which the patients were subjected to mobbing activities resulting in emotional strain. This has reference to general strain theory (Agnew & White, 1992) and its applications to social anomie, delinquency and cyberbullying.

Target is another term for “victim” that is less derogatory. Both terms apply to an individual in a helpless situation and otherwise at the mercy of others.

Upward bullying is defined as mobbing up the ladder (Vandekerckhove & Commers, 2003). See also “hierarchical bullying,” above.

Victim is defined as an individual in a helpless situation and at the mercy of another (Steinman, 2003).

Workplace incivility is defined as deviant behavior, featured with low force aggression and with the indefinite purpose to abuse the target by violating of workplace norms. (Milam, Spitzmueller & Penny, 2009; Anderson & Pearson, 1999) Cortina, Magley, Williams, and Langhout (2001) describe incivility as “disrespect, condescension and degradation” (p. 64).

At core, the hypothesized relationship among the key variables consists of WB as the independent variable and SOC as the intervening variable that mitigates the likelihood of a target demonstrating symptoms exceeding the threshold for PTSD.

Nature of the Study

Having taken note of anecdotal evidence that American LPC’s experience bullying by clients, staff, administrators and peers, as well as a UK National Workplace Bullying Advice Line (2005) report that social workers and social services employees accounted for a third-ranked 10 percent of total calls to the Advice Line, the learner proposes to replicate in a local setting the Nielsen et al. (2008) research done among Norwegian bullying support workers. Hence, this will be a quantitative phenomenological study about the extent to which SOC mediates WB-induced symptoms of PTSD. Given that the universe is dispersed throughout all 50 states, fieldwork will be carried out online, via the Web-only service, Survey Monkey.

Procedurally, the first step is to convert the three aforementioned study instruments into the HTML format that Survey Monkey employs. This has the virtue of uniform appearance no matter which of the major Internet browsers study participants use. In addition, the learner can reduce the tedium of answering all 57 questions by breaking up the lists of scale items into three to five at each screen.

The second step is recruitment, accomplished by sending out a mass mailing to the entire email database of American Counseling Association (ACA) members. The introductory email will induce participation by disclosing the learner’s credentials and affiliation, briefly explaining the potential value of the study to the counseling discipline, addressing privacy concerns, and offering an incentive (please refer to Chapter 3 for complete details). The mechanics of reaching the survey site are simplified by including a link to Survey Monkey and a password in the email. As long as survey participants take ordinary precautions with their electronic mailboxes, no one else will be able to access, and tamper with, the study instruments online.

After a reasonable waiting period, the learner will download the stored database of responses and analyze this with a suitable statistical software package.

Assumptions and Limitations

Assumptions

The researcher assumes that the respondents will be honest and forthright when answering the survey questionnaire. Since the surveys are online, it is further presumed that the respondents are computer literate and will be able to navigate through the online surveys with ease. Having an email address bolsters the assumption that target subjects have both the basic PC system and the Internet subscription that will permit them to access the online survey website. Since the list of target participants will be obtained from the email address database of the American Counseling Association, it is also assumed that all addressees are employed or provide third-party services as LPC’s in a workplace setting.

The main methodological assumption of the proposed study is that LPC’s will be amenable to accomplishing a total of 57 psychometric scale items (across all three study instruments) online, not counting essential background information such as educational attainment, gender, age, organizational rank and work setting. In chapter 3, the learner makes one provision for motivating study participants to complete the total length of the study instruments.

Limitations

Weighed against that methodological assumption is the comparative novelty of online administration for a personality inventory. Owing to the need for highly trained administrators and interpreters, much professional assessment still takes place with “paper-and-pencil” forms and under controlled conditions. Nonetheless, the International Test Commission (2005) already acknowledges the feasibility of “controlled mode” online testing where authoritative study instruments are made available only to the authorized test-takers even in the absence of professional supervision. The researcher has this facility since the survey website controls access via a link embedded in the introductory emailed invitation that gives access just once. Consequently, even the study participants gain confidence that the survey instruments cannot be abused through repeated access by unauthorized test-takers. One also takes notes of the fact that even the most respected personality inventories – the Myers-Briggs Type Indicator and Cattell’s 16 Personality Factor (16PF) – can now be administered online and remotely, albeit under strict access controls (Online Testing Centre, 2008; Institute for Personality and Ability Testing, 2010; Reinhold Development, 2009; Chartered Institute of Personnel and Development, 2009).

Other than what is directly asked by the Einarsen and Raknes Negative Act Questionnaire, an online survey method limits the degree of probing that can be done with respect to the bullying behaviors counselors are subjected to. There may, for example, be extenuating circumstances to workplace bullying, including the conscious or unconscious role LPC’s may have played to invite such aggression.

Organization of the Remainder of the Study

To this point, the Proposal has established the persistence of the phenomenon that is workplace bullying. Estimates of incidence vary, as do the acts of omission, verbal and physical abuse that perpetrators inflict on victims of unequal status. It is nevertheless clear that bullying targets endure serious and long-lasting aftereffects. As well, the Proposal has already revealed two findings about the vulnerability of LPC’s, the discipline that has primary responsibility for intervening in school, industrial and substance-abuse settings for WB. Prior to detailing plans for Methodology in Chapter 3, chapter 2 of this Proposal explores in greater depth what is known about the antecedents of bullying in the workplace, examines the constructs that define such aggressive behavior, cites language that targets may employ to report victimization, and shows the relative prevalence of PTSD among the aftereffects for those victimized.

Literature review

Introduction to the Literature Review

The purpose of this quantitative study is to investigate whether a licensed professional counselor’s sense of coherence (SOC) is a protective factor in reducing self-reported symptoms of post-traumatic stress disorder (PTSD), one consequence of being subjected to workplace bullying and mobbing. If replicated and broadened in an American setting, such an advance in knowledge could, at the very least, provide LPC’s greater insight into professional self-efficacy when they themselves are repeatedly the target of bullying attacks. Shaping such an empirically-driven framework could also commence new discourse within the Sociology and Human Service disciplines about differential approaches to bullied clients who demonstrate varying levels of SOC and about identifying other evidence-based interventions

The search of the literature about workplace bullying and mobbing covered ethical internet sites (including the University Library), research articles posted on the World Wide Web, electronic journal databases (e.g. Psych Articles and EBSCO), and textbooks. Owing to disparate streams of investigations into workplace bullying that proceeded on both sides of the Atlantic (Namie, 2002), the learner also made sure to follow domestic issues commencing with sources such as the Workplace Bullying and Trauma Institute, the Campaign against Workplace Bullying, and the National Institute of Occupational Safety and Health, as well as Ståle Einarsen’s Bergen Bullying Research Group in Norway.

In brief, the central theoretical framework for the proposed study is that unwarranted and unresolved workplace bullying of individuals precipitates repercussions on organic and mental health that extend to trauma and PTSD. Workplace bullying deserves investigation by sheer prevalence and the degree of overlap the phenomenon shares with legally-proscribed racism, discrimination and harassment. Victimization is all the more damaging when LPC’s tasked with remediation roles and restorative interventions are themselves targets. This review of extant theory then examines sense of coherence (SOC) as a protective predisposition, alongside other moderators such as negative reciprocity or social competence reinforcement.

Research Design

The design of the research is based on analyzing the SOC concept (sense of coherence), which is regarded as the key scholar concept associated with bullying, and stress management principles. The necessity to base the research on the aspects of this concept is explained by the overarching frameworks for the offered topic, and the specific nature of interpersonal violence in the workplace and the harm that targeted individuals endure. Additionally, it should be emphasized that the antecedents of work-related aggression, the remedial roles expected of counselors, and factors that mitigate the harm done to bullying victims should be analyzed, and represented from the perspective of theoretical concepts, represented in literature. Thus, the key aspect of SOC, which forms the conceptual basis of the research is closely linked with the strong determination of positive health and successful copying, described in the research by Trochim and Donnelly (2008). Though, the fact is often applied for clinical and medical researches, it will be used for overcoming the consequences and harms of workplace stress. Thus, the research will implement the possible psychological aspects of SOC, derived from medical practice.

Conceptualization of Research

The Sense of Coherence concept generally represents the actual situation, when people are subjected to continuous stress conditions. In fact, the long-time stress may cause the harmful behavior of some personalities, while the others stay stable and mentally healthy. In accordance with Antonovsky – the researcher who implemented this concept – the sense of coherence is generally regarded as the extent, to which one person experiences the continuous and developing feeling of confidence that all the things and events are reasonably expected from the perspective of environment structure, and the mix of control and optimism of a person’s temper. (Sandvik-Lutgen, 2008) Additionally, this concept is featured with three key components, which define the aspects of harm and fatigue of the teams. These components are as follows:

• Comprehensibility. This factor represents the extent to which events are associated with deriving the logical sense in connection with the surrounding working environment.
• Manageability. This is the factor of control of the happened situation, and the assuredness in the opportunity to cope with the difficulties
• Meaningfulness. The factor of feeling the clear sense of the actions which need to be performed and tasks that need to be accomplished, when a person knows that all the challenged are worthy of commitment and may be overcome easily.

In fact, the concept itself is closely associated with the aspects of personal coping style, allocation of financial resources, as well as social and business support of the team. As it is stated by Robinson and Bennett (1995, p 561):

Stress is known to alter the pain threshold, so SOC has been put forward as a factor in pain perception and symptom reporting. This link has been investigated in many studies over the past fifteen years. They show that a low SOC predicts musculoskeletal symptoms (neck, shoulder, and low-back) in later life, and is a predictor of response to pain management programs for chronic pain sufferers. It is linked to pain levels in cancer patients. SOC also predicts the outcome of low-back surgery, possibly through increasing ability to cope with pain.

Considering the aspects of workplace bullying, SOC may be regarded as the reason of headaches among workers, and cause serious medical consequences. Hence, strong stresses and high difficulties impacts the daily activity of the workers and their health in general. However, a strong SOC may protect from depression and the feeling of fatigue, as it gives strong self-confidence and helps to identify people who may be subjected to particular types of psychological interventions. Additionally, it is aimed at improving the level of life satisfaction, and it is closely associated with the reducing of the feeling of loneliness and anxiety. In accordance with the research by Pfeffer (1993) This feature is useful from for overcoming the stresses, originated by working environment and bullying, in general. Thus, from the perspectives of bullying, it should be emphasized that the actual importance of SOC against depression and PTSD is explained by the importance of the links between self-assessment of health and SOC in workers, who are subjected to bullying and increased stress rates on their working places.

From the perspective of problem conceptualization, it should be emphasized that large health problems are the large stress factors themselves, as person is focused on the health issues instead of concentrating on work related assignments and tasks. Bullying may be regarded as the essential violation of workplace norms (Notelaers, Einarsen, De Witte, Vermunt, 2006), thus, is may be equaled to medical problem, associated with mental health of the workers. This concept defines the actuality of the SOC levels jointly with the consequences of bullying. As it is stated by Neuman and Baron (1998, p. 145):

It is not surprising that those with serious health problems score lower on meaningfulness, and their sense of manageability may be eroded by high levels of stress. When both are assessed simultaneously, no firm conclusion can be drawn. Additionally, symptoms of bullying and the SOC aspects within workers often are both self-reported, so could be picking up on the same characteristics. Both might be measuring a tendency to dissatisfaction, for example. An additional drawback is that SOC may not be as stable over the lifetime as first envisioned.

In general, it is believed that the SOC concept may be regarded as a reliable stabilizer in any working place, as radical and challenging situations, which may cause stress, and all the related consequences, rarely happen in a row. (Notelaers, Einarsen, et.al. 2006). However, it also should be emphasized that SOC is more common for older and more experienced workers, however, the low SOC level within young workers is compensated by the increased vital energy level.

The key problem for SOC is the impossibility to perform accurate measurement of the energy, control level and stress endurance of the personnel, using the SOC concept. However, it is useful enough for counseling and stress management practices within companies. Nevertheless, it is unknown how to influence SOC, and how it may be changed. (Peek-Asa, Runyan and Zwerling, 2001).

In fact, the SOC concept is useless by itself in business stress management, however, it may be applied for the model of exposure to aggression, bullying and violence at work, which causes the health changes among workers.

The original model is aimed at conceptualizing the bullying effects, and the objects, which is may affect. SOC, if applied for the mediating factor, may be regarded as the stabilizing principle for overcoming the consequences of bullying and stress.

In accordance with the research by Varcoe (2001), stresses fill the business sphere, independently on the occupation type, however, workers are obliged to manage stressful events, and the consequences of these events by themselves. Thus, as Preece, Johanson and Hitchcock (2009, p. 256) stated:

Several factors contribute to the individual’s ability to successfully manage this stressful life event; some factors are related to the actual skills needed to make an effective decision, and others are related to the individual’s psychological resources. One kind of psychological resource, sense of coherence, has been shown to have a mediating effect on an individual’s ability to globally manage stressful life events. Several individuals have suggested that making an effective career choice may also be stressful, causing the individual confusion and anxiety.

In the light of this perspective, the SOC concept is closely associated with the complexity and importance of making effective choices and implementing the required decisions. Thus, the experience and age are the key factors for SOC increase, and these factors are crucial for creating the basis of comprehensibility which is aimed at reinforcing the personal belief’s in the opportunity of successful management of the situation.

Foundation of the Study and Research Problem

The study is based on analyzing the protective mechanisms, aimed at protecting personnel of business teams from high stress levels, caused by bullying. Considering the fact that the key reasons for busying are race and gender, the age categories, described in the study will not differ for these categories. However, it should be emphasized that the general factor, associated with the matters of bullying, represents the increased stress factor for workers subjected to bullying, and the key aim of the paper is to analyze the protecting mechanisms from bullying and related activity. In accordance with the study by Rippon (2008), there is strong necessity to emphasize that the key application sphere of the analyzed mechanisms are medical sphere, and psychology of medicine. However, the research will be aimed at deriving the possible medical experience for applying the protective mechanisms for the business sphere. Thus, as it is stated by Rutherford and Rissel (2004, p. 336):

It is important not only to study the workplace limitations but also to examine resources and strengths in relation to coping with loss and to study why older people may manage well despite impaired physical capacity and adversity. Thus, this study explored the idea that focusing on resources and capacity is more important than focusing on disease and/or impairment in promoting healthy well-being among older people.

Considering such a complex nature of the SOC concept, the study design should be cross sectional, and it should link all the protecting concepts, associated with the matters of health care. On the one hand, the offered protecting mechanisms are linked with the aspects of health care, as bullying causes increased stress level which, in its turn, harms mental and physical heath of workers. On the other hand, the mechanisms are closely associated with the principles of stress management and effective decision-making which is required for effective business performance, and which provides the increased self-confidence and sense of coherence.

Considering the fact that bullying is the psychological aspect of aggression, the behavior of bullies should be analyzed. In accordance with Suppe (1977, p. 227):

Bullies react aggressively in response to provocation or perceived insults or slights. It is unclear whether their acts of bullying give them pleasure or are just the most effective way they have learned to get what they want from others. Similar to manipulators, however, psychopathic bullies do not feel remorse, guilt, or empathy. They lack insight into their own behavior, and seem unwilling or unable to moderate it, even when it is to their own advantage. Not being able to understand the harm they do to themselves (let alone their victims), psychopathic bullies are particularly dangerous.

Thus, the behavioral aspects of both sides to the conflict should be analyzed from the perspectives of aggression, racial and gender discrimination, and other mechanisms, which originate aggression and bullying. Bullying itself may be either physical or psychological, however, the roots of bullying are common. Consequently various protecting mechanisms should be analyzed and applied in business sphere in order to resist aggression. Moreover, it should be emphasized that aggression, and harm, caused by aggression may be unintentional, and the mechanisms of protection from such actions will differ from the mechanisms of intentional aggression.

In order to diversify the protection mechanisms, the classification of aggression types should be analyzed. Thus, there are three aspects of aggression exist:

• Physical and Verbal
• Active and Passive
• Direct and Indirect

The first aspect is linked with physical harm like hitting, and verbal is linked with threats and abusing. Active and passive are defined by the actions, undertaken for abusing someone, thus, these actions will define the countermeasures, aimed at personal or collective protecting from aggression and bullying in particular.

The appropriate selection of the research structure is closely linked with the necessity to provide the cross sectional research which will be aimed at analyzing and applying the protective measures. In fact, most of the protection tools require proper implementation into the business sphere, thus, medical researches, associated with stress management tools will be analyzed and interpreted for the business sphere.

Work environment and social atmosphere on a working place require particular attention, that is why, all the aspects of environment analysis should be considered and applied for the protection solution.

Sense of coherence, as a protective measure against bullying and aggression is closely associated with the aspects of enduing stress factor, and overcoming the consequences of long term and heavy stress factors. In the light of this consideration, it should be stated that the principles of SOC concept are derived from post operational restoration, and mental restoration of patients with dangerous diagnoses. Additionally, PSTD management and endurance principles are mainly based on the mechanisms, which form SOC concept. Thus, the research approaches of this study will add to the restricted studies associated with LPC’s that have been exposed to workplace bully. During the last four decades, researchers (Brodsky, 1976; Baron, 1988; Einarsen, 2001) have investigated workplace bullying, the victims, and the organizations where both perpetrators and targets work. The aim of this paper is to structure and analyze the previous researches in order to create the conceptual basis for analyzing the instances of workplace bullying and selecting the proper endurance tool, aimed at resisting the stress factors, as well as bullying, and consequences of bullying and aggression in general.

Theoretical Framework

The overarching frameworks for the proposed study are the nature of interpersonal violence in the workplace and the harm that targeted individuals endure. Secondary to these major frameworks are the antecedents of work-related aggression, the remedial roles expected of counselors, and factors that mitigate the harm done to bullying victims.

The Nature of Workplace Bullying

Coming to grips with, and defining, the phenomenon of bullying is essential, by reason of both widespread incidence and the many forms it can take. The earliest recognition given such sustained and aggressive behavior appears to have been that by Brodsky (1976) who counted five types of harassment that seemed about equally frequent in the work setting: sexual harassment, name calling, scapegoating, physical abuse and relentless pressure for greater output.

Considerable time would elapse before destructive behavior again received notice in the literature. Baron (1988) drew attention to “destructive criticism” (p. 201) when he observed that supervisors were either reluctant to give performance feedback, notably to those who lagged in output, or that poor performers made no effort to improve, despite having been apprised that their work was unsatisfactory. Consequently, what verbal or nonverbal feedback occurred grew increasingly acerbic. Verbal abuse triggered demoralization and the cycle was apt to continue remorselessly.

Subsequently, bullying received closer scrutiny, particularly in the Scandinavian and Central European setting (Einarsen et al., 1996; Einarsen and Skogstad, 1996; Keashly, 1998; Leymann, 1996; Rayner and Hoel, 1996) to such an extent that Einarsen and Raknes (1997) settled on the all-encompassing “negative acts” when formulating their standardized questionnaire (see also Chapter 3 of this Proposal). Within the same decade, Neumann (2000) reports, studies of individual conflict, deliberate efforts to harm others, and other manifestations of workplace aggression had accelerated to the point of enriched taxonomy: psychological abuse, harassment, counterproductive-deviant workplace behavior, petty tyranny, incivility, workplace violence, organizational retaliatory behavior, and antisocial behavior.

In general, the review of the literature that follows defines bullying in the workplace according to character of communication, behavior, time lapse and consequence. Workplace bullying is distinct from harassment based on sexuality or race because bullying is always abrasive, aggressive and hurtful in nature. The perpetrator intimidates and demeans the target, with a view to undermining his status, self-esteem, economic means and eventually, even physical and emotional wellbeing.

Given the many levels of interpersonal communication, workplace bullying can take the form of emotional blackmail, the kind of passive aggression that underlies ostracism, political bullying when done before an audience, and verbal abuse. In blue-collar settings, there is physical intimidation and assault, often severe enough to cause injuries and hospital confinement. “Pulling rank” on others may be a normal prerogative for supervisors, managers, and officers, in the case of the military or paramilitary services. Superiors are given a certain leeway, after all, for the privileges of rank, whether these take the form of a demanding leadership style or outright abrasive personalities. Hence, interactions become bullying relationships only when superiors cross the line from intimidation to insults, humiliation, and verbal abuse, even in front of witnesses.

Over and over again, however, the preponderance of past research reveals that workplace bullying is practiced principally by peers. Meetings, whether one-on-one or group conferences, can deteriorate from healthy (if vigorous) debate of issues to scathing ad hominem character attacks, taunting, and yelling designed to humiliate and degrade. And now, in the age of Web 2.0 and social networking, intra-company conflict can take the form of “flaming” the unfortunate victim and smear campaigns done either openly or anonymously over the company intranet. Social rejection and whispering campaigns have moved from the water cooler to cyberspace, hence the term “cyberbullying.”

Diverging from certain authors that wish to take an all-encompassing view of unacceptable behavior as bullying, neither rudeness nor backbiting count. The first is endemic to the American workplace, often taking the guise of being “direct to the point.” In turn, gossiping may be vicious but it does not count as bullying for lacking the element of face-to-face confrontation and intimidation.

The General Concept of Bullying. There is a discernible attempt among scholars to over-reach and define workplace bullying as a persistent pattern of negative acts directed at a worker (Lee & Brotheridge, 2006; Baron & Neuman, 1996; Einarsen, Matthiesen & Skogstad, 1998; Keashly, 1998). This, of course, begs the definition of what constitutes “negative acts” because, for example, sexual harassment and anti-union action can be both persistent and negative but do not fall under the ambit of workplace bullying.

For the most part, researchers, and theorists in the field of workplace bullying fall back on the key elements proposed by Leymann & Gustafsson (1996) that “mobbing” includes unethical communication, directed regularly (at least once weekly) and on a sustained basis (over a period of at least six months) at a person who cannot or dare not retaliate. The nomenclature “bullying” appears to have been published first by the present leader in bullying research, the Norwegian psychologist Einarsen. (Leymann himself [1996] seems to have preferred that “bullying” apply to the common schoolyard phenomenon of physical aggression and threats carried over to the work site in adulthood. However, this may be a semantic trap more than anything else since “mobbing” happened to be the term used in the original German texts that translators were wont to either carry over or translate as “bullying”). In any case, both opinion leaders in the field, Leymann and Einarsen, shared the conceptual framework that two key elements in workplace bullying and mobbing are “negative acts” and an unequal relationship between perpetrator and victim:

Bullying takes place when one or more persons systematically and over time feel that they have been subjected to negative treatment on the part of one or more persons, in a situation in which the person(s) exposed to the treatment have difficulty in defending themselves against them. It is not bullying when two equally strong opponents are in conflict with each other. (Einarsen et al., 1994, p. 20).

Unequal status obviously differentiates workplace bullying and mobbing from sexual harassment and racial discrimination because the latter offenses can be directed upward as much as at co-equals and inferiors in the organizational hierarchy. Otherwise, the fact that victims cannot defend themselves or avoid being victimized again is common to all three forms of harassment in the workplace.

Whether stated explicitly or by implication, scholars have more recently alluded to the four elements of repeated offenses, the unequal balance of power, the inability of the target to retaliate or convince the perpetrator to stop, and intent to cause harm. This is exemplified by the Hoel, Faragher and Cooper (2004) model that adds the element of mutual aggression until one emerges victor:

Mobbing in working life means hostile and unethical communication which is directed in a systematic way by one or a numbers of persons mainly toward one individual. There are also cases where such mobbing is mutual until one of the participants becomes the underdog. These actions take place (almost every day) and over a long period (at least six months). Because of the frequency and duration, (mobbing) results in considerable psychic, psychosomatic and social misery (p. 120).

Bullying or Mobbing? Owing to the aforementioned coincidence that “mobbing” is meaningful in both German and English, the term has been interchangeable with “bullying” in Central and Northern Europe, the UK, Ireland, and Australia (Salin, 2003). In North America, “bullying” is more common as are other terms used by theorists and researchers: employee abuse, workplace aggression, victimization, interpersonal deviance, social undermining and workplace incivility (e.g. Cortina, Magley, Williams, & Langhout, 2001).

Bultena and Whatcott (2008) admit to the possibility of mobbing in the American setting as bullying so extreme that it is more troublesome than any other workplace stressor (see section below on “The Harm That Victims Endure”). In the authors’ theoretical framework of mobbing, examples could be an entire school targeting a supervisor from the local school board or the rank-and-file in private enterprise turning their collective ire on an outstanding worker who makes the rest look positively slothful or unproductive. However, the claimed effects on victimized individuals – loss of confidence and self assurance, anger, illness, frustration, unemployment, stress and doubting one’s sanity – seem to differ not at all from those observed in instances when researchers use the term “bullying.”

Intending to make the distinction from mobbing clear, Vega and Comer (2005) argued that the essence of bullying lies in the nature of the offensive acts and how they are carried out, quite irrespective of duration. In turn, Lee and Brotheridge (2006) extended the meaning of bullying from the aforementioned hostile, intimidating and humiliating acts to include even incivility. Subsequently, Milam, Spitzmueller & Penny (2009) fleshed out the concept of workplace incivility as “low intensity deviant behavior with ambiguous intent to harm the target in violation of workplace norms for mutual respect” (p. 59). The rationale for including even rudeness, the authors contended, is that such inconsiderate behavior causes humiliation, offense or distress that is not always apparent.

If domination and intimidation are very clearly intrinsic to a pattern of bullying, it stands to reason that witnesses can affirm it happening. But when done in private, between just two individuals, the event hardly counts as observable. Hence, Agervold (2007) was convinced of the need to define bullying in terms of both behavior and affective harm: “…requires two parts: an objective identification of activities that need to be recognized as bullying, and a subjective part which indicates a person’s perception of being bullied” (pp. 163-4).

Within the confines of a concededly short paper, Decision-Control-Support (DCS) theory bears at least passing mention. As originally postulated, DC theory categorized all positions in an organization in point of job demands and control. The former bespeaks requirements for action and effort while the latter is about the latitude for scheduling one’s own work throughout the day. Tuckey, Dollard, Patrick, Hosking and Winefield, (2009) maintained that the worst strain and most stressful outcomes are associated with high demand-low control jobs. By postulating the DCS model, the authors asserted that work stress is also exacerbated by absence of social support.

The Clear Element of Aggression

Griffin and Gross (2004) maintain that bullying is merely one subset of the entire complex of aggressive behaviors, whether these manifest in the workplace or earlier, in school. Certainly, the literature is replete with the implied or empirically-discovered links between aggression and bullying. Those with aggressive predispositions are more likely to engage in the social affronts and physical intimidation that constitute bullying among adults. Emotional abuse, arising from low frustration thresholds and a propensity for lashing out, is a frequent manifestation of workplace bullying (Geffner, Braverman, Galasso, & Marsh, 2005).

The link between aggression and the general framework of bullying is to be found in the characterization of bullying as social interaction in which the sender uses verbal or nonverbal communication, negative and aggressive elements of which are directed towards the personality and self esteem of the receiver. This observation led Namie and Namie (1998) to identify workplace bullying with “deliberate, hurtful … mistreatment of a target by a bully who is driven by a desire to control another person” (p. 15).

The Lexicon of Aggression. The element of hostility is underlined by terms like “social undermining” (Duffy, Gunster & Pagon, 2002), “interpersonal deviance” or “workplace deviant behavior” (Bennett and Robinson, 2003). Given that the latter is descibed as “voluntary behavior that violates significant organizational norms and in so doing threatens the well-being of an organization, its members, or both” (Robinson & Bennett, 1995, p. 555), the term covers both unethical governance as well as interpersonal deviance that has a damaging effect on workgroup and organizational output.

Owing to the many antecedents, forms and outcomes associated with interpersonal aggression, it stands to reason that Crenshaw (2009) argues for a wide spectrum of language that describes the phenomenon and helps targets articulate their experiences. In alphabetical order, the applicable vocabulary includes:

Abuse, abusiveness, aggression, bullying, bullying/mobbing, counterproductive workplace behavior, emotional abuse, emotional harassment, employee emotional abuse, generalized workplace abuse, harassment, hostile workplace behavior, maltreatment, mistreatment, mobbing, non physical aggression, nonsexual harassment, non-status-based harassment, psychological abuse, psychological aggression, psychological harassment, psychological abuse, psychological aggression, psychological terror, scapegoating, status-blind bullying, status conscious bullying, unlawful bullying, vexatious behavior, workplace abuse, workplace aggression, workplace harassment, workplace hostility, workplace incivility, and workplace psychological terror. (pp. 264-5)

Defining some of these terms, we arrive at:

(Workplace) Aggression. At its rawest, as exemplified by the somewhat animalistic views of Konrad Lorenz, aggression is at core “the fighting instinct in beast and man which is directed against members of the same species…Aggression…is an instinct like any other and in natural conditions, it helps just as much as any other to ensure the survival of the individual and the species” (2002, pp. ix-x).

Workplace aggressive behavior. The perceived or real incidents of aggression towards individuals, when aggression is directed against them, threatened or assaulted in the environment of their workplace, or out of it, but caused by the improper environment, involving a clear or vague challenge to their safety, health (mental or physical) or wellbeing (Department of Health Western Australia, 2004).

Workplace violence. An action or incident that physically or psychologically harms another person. It includes situations where employees and other people are threatened, attacked or physically assaulted at work.

Non-physical violence. Verbal abuse, intimidation and threatening behavior may also significantly affect a person’s health and wellbeing. Threats may be perceived or real and there does not have to be physical injury for the violence to be a workplace hazard. Employees may be affected by workplace violence even if they are not directly involved.

Physical violence. The use of muscular force against person or group of persons that may cause physical harm. It generally includes, pinching, biting, pushing, spitting, slapping, kicking, beating, shooting and stabbing.

Psychological violence. The use of power against another person or group that results in psychological harm or an inability to develop professionally. This includes, but is not limited to, verbal abuse, suggestive behavior, threats of physical abuse, intimidation and bullying (Department of Health Western Australia, 2004, p. 9).

In turn, Rai (2002) articulates aggression in the work setting as “any act of aggression, physical assault, threatening or coercive behavior that causes physical or emotional harm in a work setting” (p. 15).

For the purposes of this study, one contextualizes workplace aggression according to the Neuman and Baron (1998) paradigm of harmful intent only when targeted at coworkers, current employers, or past employers. It is outside the practical scope of this study to have to include, as proposed by Peek-Asa, Runyan and Zwerling (2001), those behaviors meant to harm former coworkers and outsiders as long as these take place in a work setting. This is why the latter authors include as valid subjects of aggression and bullying research acts committed against a customer of the firm. This is outside the scope of the intended study.

It helps to construct a more complete workplace bullying and aggression study instrument if one takes into account the Neumann and Baron (1998) model of three dimensions and three dichotomies. The dimensions are effectively typologies: verbal or symbolic expressions of hostility, simple obstruction and overt violence. In turn, the three dichotomies have to do with the verbal versus physical; direct versus indirect; and active versus passive. The merely passive act of not denying a false rumor about a colleague is thus considered harmful because others will conclude that silence means assent.

Antecedents and Co-Occurring Factors

Besides the prolific body of literature that describes many different forms of aggression in the workplace, there is comparatively little that rigorously profiles the personality characteristics and early childhood experiences of workplace bullies and their victims, least of all in the American setting. Instead, researchers have been more likely to offer anecdotal evidence or what must necessarily be viewed as impressionistic descriptions by the victims (Kile, 1990; Adams & Crawford, 1992; Bing, 1992).

Still, a causal reasoning framework has certainly been evident in efforts to understand both the situational and individual differences that impinge on workplace bullying and other forms of aggression. For instance, Martinko et al. (2002) proposed that both personality and context are independent variables for aggression at work, taking into account how the perpetrator responds cognitively to the situation. In an increasingly diverse America, it seems doubly significant that prior exposure to high-aggression native cultures – alongside inherent predisposition to anger, attribution style, negative affect, individual differences with respect to exacting revenge, and lack of self-control – explains nearly two-thirds of total variance when hierarchical multiple regression analysis was conducted on workplace aggression incidence in public schools and transportation (Douglas & Martinko, 2001).

In a European setting, Seigne, Coyne, Randall and Parker (2007) found that those prone to bullying are truly aggressive, besides being hostile, hyper-assertive, selfish, egocentric, highly competitive, and given to acting independently. To these, Zapf and Einarsen (2003) add low self-esteem and immature social competency. That the first set of traits also typify those who inevitably rise to positions of leadership presumably explains why the Workplace Bullying Institute (2007) survey found that over two-thirds of bullies in the workplace are the victims’ superiors. One must conceded, however, that the data are filed by disgruntled or harmed employees, hence the attribution of supervisory bullying may be exaggerated.

Field, the social worker at the forefront of anti-bullying campaigns and one of the forerunners of bullying research, also focused on individual differences. His is the distinction of verging on psychoanalytic profiling, as evinced by this definition of a bully as:

Someone who refused to recognize their weaknesses, failings and shortcomings, with a denial of responsibility for their actions and behaviors on others. If a bully is in a position of management, control or trust, then it (sic) also includes a refusal to accept the legal and moral obligations for the safety and well being of the people (he is) in charge (of). (Field, 1996, p. 51)

Going by the aforementioned Decision-Control-Support theory, Tuckey et al. demonstrated how bullying rates increased for a large sample of Australian police front-liners owing to psychosocial factors inherent in the profession and the cultural context. The constraint of low autonomy and lack of flexibility for dealing with conflicting demands in police work lead to strain and anxiety which could not be offset by the little social support available. This proved to be the case in the police force since job demands were high, personal latitude for decision-making narrow and social support very poor. Among the negative outcomes were psychosomatic ailments, “heightened arousal, aggression and anger” (Tuckey et al., 2009, p. 218), the projection of negative acts to subordinates, and consequently, a palpable prevalence for “top-down” bullying.

The Harm That Victims Endure

Bullying inevitably causes affective distress in those systematically targeted though it was left to Einarsen (2001) and Nielsen et al. (2008) to suggest that negative outcomes include trauma and PTSD. Being a form of aggression, the clearly offensive nature of bullying is perhaps most graphically encapsulated by this construct of Field (2002) regarding the consequences:

A form of thuggery that prevents people from doing their job. Where bullying exists you will find disenchantment, demotivation, demoralisation, disempowerment, disloyalty, disaffection, dysfunction, inefficiency, cynicism, alienation, an “us and them” culture, constant conflict, an unpleasant atmosphere, misery, unhappy staff, a climate of fear, high staff turnover, high absence due to sickness, low productivity, impaired performance, stifled creativity, low morale, zero team spirit, poor customer service, and mistakes in delivery of products and services. (pp. 878-879)

Tucky et al. (2009) report from a review of the literature that multiple negative outcomes have been attributed to bullying: psychological distress, lowered indices of health, diminished job satisfaction, lower creativity, ruined reputation, and reduced organizational commitment. To this Bultena and Whatcott (2008) would add direct costs to organizations that comprise higher absenteeism, turnover, and enterprise effectiveness undermined by diminished productivity. The social costs that bullying exacts on individuals is also paralleled by a tarnished image for governance when companies become involved in court litigation.

The signal contribution of the European thought leaders Einarsen (2001) and Leymann (1990; 1996) was to recognize that perpetrators precisely intend to stigmatize their targets and that the act induces psychological trauma sooner or later. For Einarsen, every interaction that plays out between perpetrator and victim is a four-act process: the onset of aggressive behavior, outright bullying, stigmatization and deep-seated trauma. Leymann differed in proposing that it becomes bullying only by the second phase, when aggression becomes overt, the pace is stepped up, and it becomes obvious to the perpetrator that the victim is unable to retaliate or defend himself.

In Einarsen’s (2001) discourse about the progressive build-up of aggression, the four-stage prejudice model of Alport (1954) resonates strongly. Alport had asserted that prejudice starts as views shared within a small clique with the victim left in ignorance of what is going on. Subsequently, the social circle makes their prejudices evident by first avoiding the target and secondly, by explicit exclusion and harassment. Physical attacks come in the fourth phase that Alport called “extermination” because the clique exerts its utmost to force the victim’s exit from the organization or community. For other hapless targets, of course, resolution comes in the form of suicide.

Bullying has the twin effects of drastically undermining the emotional wellbeing and even physical health of the targeted colleague (Brodsky, 1976; Einarsen & Skogstad, 1996) and of degrading the organizational consensus about the worth of the victimized employee (Einarsen, Raknes, Matthiesen, & Hellesøy, 1994; Leymann, 1996). Perversely, therefore, those in positions of authority who are called upon to review what seems a matter of plain interpersonal conflict unconsciously absorb the organization’s prejudices about the victim. This may go to the extent of perceiving that the victim gets his due for being difficult and neurotic (Einarsen et al., 1994).

To round up the emotional and psychic harm, one notes that by definition, bullying is that combination of verbal abuse and behavioral assault that can characterized as humiliating, threatening, or intimidating (Namie & Namie, 2002). The pioneering effort by Brodsky (1976) had itself viewed harassment as chronic attempts to torment, wear down, frustrate, provoke, frighten, intimidate and in all other ways, render the target uncomfortable. The contemporary lens, as exemplified by Bultena and Whatcott (2008), has advanced to include negative projection, damaged self-esteem, the aforementioned victim blaming, nearly every other form of victimization, psychological trauma, complex post-traumatic stress disorder and outright psychopathy.

PTSD as an outcome of workplace bullying was hypothesized because researchers, beginning with Zapf, Knorz and Kulla (1996), observed the relevant signals of diminished well-being. The comparison with the formally-recognized three components of PTSD is not quite complete (see table below) even as Matthiesen and Einarsen (2004) insist from a low base of 102 Norwegians that no less than three-fourths experienced some PTSD symptoms above the threshold for clinical diagnosis. Significantly, symptoms appear to persist even five years after the last experience with bullying (Einarsen, Matthiesen, & Mikkelsen, 1999).

Table 1: The Limitations of Observation and Self-Report Measurement in Bullying Research Relative to the Formal Components of PTSD

Source: National Institute of Mental Health (2009), Matthiesen & Einarsen (2004).

By way of completing the framework of bullying sequences, Neumann (2000) put forward the damaging impacts of stress owing to workplace aggression and bullying. For stress, there is the century-old but nonetheless valid insight of Yerkes and Dodson (1908) that low levels of stress leave workers complacent (and therefore content with low output) but high stress degrades performance owing to distraction and cognitive impairment. Regardless of source, secondly, elevated stress on the job fosters impatience, rudeness, psychosomatic complaints, and even more aggression. Thirdly, the combination of health problems and avoidance of a seriously aggravating workplace bears real costs: an estimated half-billion man-days lost annually and as much as $300 billion in lost profits when one counts absenteeism, reduced productivity, health care and legal costs, staff turnover, and increased insurance premiums (American Institute of Stress, as cited in Neumann, 2000).

The Remedial Role of Counselors

Licensed professional counselors (LPC’s) evaluate, manage and recommend holistic treatment to bullying victims. There are many options that can be taken. Ferris (2009) maintains, for instance, that LPC’s are vital in moving toward the goal of zero or greatly-reduced tolerance for bullying. This means participating in, and meaningfully managing, such policies and strategies as surveillance, environmental diagnosis, confrontation, coaching, training, screening of recruits, performance appraisals and rewards. Discussing these interventions in depth is, however, beyond the scope of the current paper.

In practice, the available set of organizational interventions include improving the ability of the organization to detect and remedy bullying (Ferris, 2009); heightening risk awareness at different levels of the organization; orientations about the business case, ethical and legal risks; HR and line leadership coaching. On the other hand, prevention is quite another matter from intervention. Macintosh (2006) reveals as one implication of a small-scale qualitative study that organizational policy, inter-company learning and the community itself must be marshaled in order to foster bullying-safe and productive places of work.

As will be discussed in “Bridging the Gaps” below, the effectiveness of LPC’s will obviously be degraded if they themselves suffer demoralizing assaults and their proposed courses of action are called into question by those less qualified.

Bridging the Gaps or Resolving the Controversies Mitigating Factors

This concededly brief review of the extant literature on bullying yields sparse discoveries concerning mitigating factors. Among these, however, are negative reciprocity beliefs and sense of coherence.

In the context of abusive supervision and top-down bullying, Mitchell and Ambrose (2007) hypothesized that deviance directed at the overbearing supervisor would be greater when the individuals concerned have significant negative reciprocity beliefs. The latter is defined as vengeance, the tendency for a person to retaliate for harmful aggression in kind. Even when the bully is one’s superior, stronger negative reciprocity impels deviance behavior as a reaction.

The central intervening variable in this proposed study, a sense of coherence (SOC), is a personality disposition defined as a “global orientation that expresses the extent to which one has a pervasive, enduring (although dynamic) feeling of confidence” that one’s environment is “comprehensible, manageable, and meaningful” (Antonovsky, 1987; Eriksson & Lindström, 2005). Antonovsky elaborates on this by detailing the three central components (see below) and asserting that, since this disposition crystallizes in early adulthood, little can be done to buttress it among adults experiencing bullying.

As a resource for resisting stress, SOC is thought to be supportive of health in general and analogous to hardiness, self-esteem, and dispositional optimism (Bengel, Strittmatter, & Willmann, 1999). Accordingly, SOC should predispose to general mental health, resilience and appropriate selection of resources in response to stimuli from the environment. Poor or nonexistent SOC, on the other hand, is associated with rigidity and disproportionate reactions.

Bridging the Research Gap

Prior to this work by Nielsen et al., there had been no attempt to demonstrate the moderating effect of SOC on the relationship between workplace bullying and PSTD symptoms. However, a mediating effect had been repeatedly shown for other workplace stressors and indicators of physical or mental health.

The salutogenic theory evolved from a study of the way people view their world and their ability to manage tension and stress (Antonovsky, 1978; 1979). The author questioned what creates health on a spectrum ranging from ease to disease, but generally leaning towards the healthier ease. The encouragement for scientists to think with the salutogenic orientation, “which not only opens the way for, but compels us to devote our energies to, the formulation and advance of a theory of coping” (Antonovsky, 1987, p. 13) is a segue to the concept of a sense of coherence (SOC).

Source: Antonovsky, 1987

Comprehensibility is the degree to which an individual perceives the world as predictable, ordered, explicable; manageability is the extent that an individual believes that he can have the personal and social resources to handle a demand; and, meaningfulness, perhaps the most important of the components, is the ability to believe that life is worthy of investment and commitment (Lustig & Strauser, 2002). Meaningfulness is a motivating component that compels an individual to use existing resources and then to search out new resources for managing a demand (Antonovsky, 1987). Meaningfulness emotionally explains why life makes sense. Individuals with high SOC are able to cope with life stresses, such a workplace bullying, better than an individual with a low SOC. In order to assess SOC, Antonovsky developed the Orientation to Life questionnaire.

In procedural terms, a second readily-observable gap is the specification of the universe. In particular, one notes a widespread reliance on convenience samples while conceding that there have been quantitative studies that address a broad spectrum of workers. For instance, the pioneering work by Brodsky (1976) that yielded five types of harassment was confined to one rural community whereas subsequent studies affirmed the universality of workplace bullying in urban locales, varied cultures, in healthcare, and a mélange of other industrial and white-collar contexts. The multidimensional and multi-instrument investigation by Kain (2008) faltered for relying on a convenience sample of faculty, recruited through department heads. This may have inhibited participation and frank feedback owing to the possibility of bullying by immediate superiors.

Perhaps the most glaring gap in extant research is coverage of licensed professional counselors (LPC’s), given their critical role in managing bullying interventions, the risk that they themselves are victimized, and that what is known about harm suffered by targets also extends to the self-efficacy of LPC’s. The closest one gets to the assessment of the LPC situation is the Nielsen et al. (2008) study that took a Norwegian sample of 221 study participants preponderantly from the administrative and health care sections of bullying support groups in Bergen. Even this was not a deliberate investigation of the profession as much as a convenience sample for the phenomenological study on sense of coherence as an intervening variable between being bullied and lapsing into PTSD.

Where licensed counselors in America are concerned, the empirical record is so sparse that pilot research remains a viable option. The researcher has taken note of anecdotal evidence that licensed counselors, particularly in substance abuse treatment settings, experience bullying by clients, staff, administrators and peers in the profession. The UK National Workplace Bullying Advice Line (2005) underlines the gravity of the problem with its observation that social workers and social services employees accounted for 10% of total calls to the Advice Line, ranking the profession third behind “teachers (20%) and healthcare employees (12%) and before workers from the voluntary sector (6-8%)” (para 1).

This study will add to the limited studies concerning LPC’s that have experienced or been exposed to workplace bully and enjoyed a sense of coherence as a protective factor to the potentially long-lasting effects of workplace bullying, such as Post Traumatic Stress Disorder. During the last four decades, researchers (Brodsky, 1976; Baron, 1988; Einarsen, 2001) have investigated workplace bullying, the victims, and the organizations where both perpetrators and targets work. The studies have ranged over many disciplines; however, none have focused on licensed counselors as being vulnerable to the long lasting effects of bullying at work. MacIntosh (2005), who studied workplace bullying at a rural level, recommended follow-up research around counselors who may themselves be vulnerable to bullying at work. This could be endemic among counselors who may feel emotional distress when dealing with clients (Dewa et al., 2004; Varcoe, 2001). Therefore, this study will survey counselors in an effort for them to express their exposure to, or experiences of, workplace bullying and the long-lasting effects that workplace bullying may produce. Nielsen, Matthiesen, and Einarsen (2008) suggest a high priority be given to the study of workplace bullying on an individual level. Moreover, “organizations must emphasize forms of rehabilitation that can help all targets readjust their view of the world and others so that they can become better prepared to meet the requirements of their positions” (p. 134). This study will replicate Nielsen, Matthiesen, and Einarsen (2008) and extend the sample by surveying LPC’s.

At the time the study was mounted, the authors report, there was mounting evidence that workplace bullying did harm to the health and emotional wellbeing of victims. The combination of symptoms reported by the hapless targets seemed to point to PTSD.

Extant research did not, however, clarify why the progression to PTSD was variable. Some victims were severely affected, others seemed to cope handily enough without reporting the signposts of PTSD. Hence, Nielsen et al. hypothesized that some disposition was a mitigating factor and took a cue from Antonovsky (1987) that a sense of coherence (SOC) seemed a likely candidate. The latter had suggested that pronounced SOC is strongly associated with better health and presumably coping better with bullying on account of an explicit resistance to stress.

The authors found, among others, that workplace bullying victims registered high on self-reported PTSD (the variable definitions and study instruments used are detailed in the section, “Study Instruments and Operationalizing the Variables” below), although the team concede that DSM-IV criteria on face-to-face assessment were beyond the scope of study methods.

References

1. Adams A. & Crawford, N. (1992). Bullying at work: How to confront and overcome it. London: Virago Press.
2. Agervold, M. (2007). Bullying at work: A discussion of definitions and prevalence, based on an empirical study. Scandinavian Journal of Psychology, 48(2), 161-172.
3. Agervold, M., & Mikkelson, E. (2004). Relationships between bullying, psychosocial work environment, and individual stress reactions. Work & Stress, 18(4), 336-351.
4. Agnew, R. & White, H. (1992). An empirical test of general strain theory. Criminology, 30 (4) 475-99.
5. Allport, G. (1954). The nature of prejudice. Reading, MA: Addison Wesley.
6. Antonovsky, A. (1987). Unraveling the mystery of health: How people manage stress and stay well. San Francisco: Jossey-Bass.
7. Antonovsky, A. (1996). The salutogenic model as a theory to guide health promotion. Health Promotion International, 11 (1) 11-18.
8. Atkinson, W. (2000). The everyday face of workplace violence. Risk Management, 47(2), 12-18.
9. Baron, R. A. (1988). Negative effects of destructive criticism: Impact on conflict, self-efficiency, and task performance. Journal of Applied Psychology, 73: 199-207.
10. Baron, R. A. & Neuman, J. H. (1996). Workplace violence and workplace aggression: Evidence on their relative frequency and potential causes. Aggressive Behavior, 22: 161-173.
11. Bengel, J., Strittmatter, R. & Willmann, H. (1999). What keeps people healthy? The current state of discussion and the relevance of Antonovsky’s salutogenic model of health. Cologne, Germany: Federal Centre for Health Education.
12. Bennett, R. J. & Robinson, S. L. (2003). The past, present and future of workplace deviance research. In J. Greenberg (Ed.), Organizational behavior: The state of the science (2nd ed., pp. 247–281). Mahwah, NJ: Erlbaum.
13. Bing, S. (1992). Crazy bosses: Spotting them, serving them, surviving them. New York: William Morrow.
14. Bradley, J. (1993). Methodological issues and practices in qualitative research. Library Quarterly, 63: 431-449.
15. Branch, S., Ramsay, S. & Barker, M.(2007). Manager in the firing line: Contributing factors to workplace bullying by staff-am interview study. Journal of Management & Organization, 13, 264-281.
16. Brodsky, C.M. (1976). The harassed worker. Toronto: Lexington Books, DC Heath and Company.
17. Broome, B. (2008). Dealing with sharks and bullies in the workplace ABNF Journal, 2008, 28-30.
18. Bultena, C. D. & Whatcott, R. B. (2008). Bushwhacked at work: A comparative analysis of mobbing & bullying at work. Proceedings of ASBBS, 15 (1) 652-616.
19. Chartered Institute of Personnel and Development (2009). Psychological testing.
20. Cobanoglu, C. & Cobanoglu, N. (2003). The effect of incentives in web surveys: Application and ethical considerations. International Journal of Market Research, 45 (Quarter 4) 475-488.
21. Cortina, L. M., Magley, V. J., Williams, J. H. & Langhout, R.D. (2001) Incivility in the workplace: Incidence and impact. Journal of Occupational Health Psychology, 6 (1) 64-80. DOI 10.1037//1076-8998.61/64.
22. Crenshaw, L. (2009). Workplace bullying? Mobbing? Harassment? Distraction by a thousand definitions. Consulting Psychology Journal: Practice and Research, 61 (3) 263-267.
23. Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches (3rd ed.). Thousand Oaks, CA: Sage Publications.
24. Davis, D. L. (2004). Business research for decision making. Boston, MA: South-Western College Pub.
25. Dawn, J., Cowie, H., & Ananiadou, K. (2003). Perceptions and experience of workplace bullying in five different working populations. Aggressive Behavior, 29, 489 – 496.
26. Department of Health Western Australia (2004). Prevention of workplace aggression and violence: Policy and guidelines. Web.
27. Dewa, C. S., Lesage, A., Goering, P., & Caveen, M. (2004) Discussion paper: Nature and prevalence of mental illness in the workplace. Healthcare Papers, 5 (2) 18.
28. Douglas, S. C. & Martinko, M. J. (2001). Exploring the role of individual differences in the prediction of workplace aggression. Journal of Applied Psychology, 86 (4) 547-559. DOI: 10.1037//0021-9010.86.4.547
29. Duffy, M. K., Ganster, D. C. & Pagon, M. (2002). Social undermining in the workplace. Academy of Management Journal, 45 (2) 331-351.
30. Einarsen, S. (2000). Harassment and bullying at work: A review of the Scandinavian approach. Aggression and Violent Behavior, 4(5): 379-401.
31. Einarsen, S., Hoel, H., Zapf, D. & Cooper, C. L. (Eds.). (2003). The concept of bullying at work: The European tradition. Bullying and emotional abuse in the workplace. International perspectives in research and practice (pp. 3–30). London: Taylor & Francis.
32. Einarsen, S. & Matthiesen, S.B. (2004). Psychiatric distress and symptoms of PTSD among victims of bullying at work. British Journal of Guidance and Counselling, 32: 335-356.
33. Einarsen, S., Matthiesen, S. B. & Mikkelsen, E. G. (1999). Does time heal all wounds? Long-term health effects of exposure to bullying at work. Bergen, Norway: University of Bergen.
34. Einarsen, S.; Matthiesen S. & Skogstad, A. (1998). Bullying, burnout and well-being among assistant nurses. Journal of Occupational Health and Safety: Australia and New Zealand, 14 (6), 563-568.
35. Einarsen, S. & Raknes, B. (1997). Harassment in the workplace and the victimisation of men. Violence and Victims, 12: 247-263.
36. Einarsen, S., Raknes, B. I., Matthiesen, S. B. & Hellesøy, O. H. (1994). Bullying and severe interpersonal conflicts. Unhealthy interaction at work. Bergen, Norway: Sigma Forlag.
37. Einarsen, S. & Skogstad, A. (1996). Bullying at work: Epidemiological findings in public and private organizations. European Journal of Work and Organizational Psychology, 5: 185–201.
38. Ellis, A. (n.d.) Bullying in the workplace – An acceptable cost?
39. Eriksson, M. & Lindström, B. (2005). Validity of Antonovsky’s sense of coherence scale: A systematic review. Journal of Epidemiology and Community Health, 59, 460–466.
40. Farber B., Manevich I., Metzgerm J., & Saypol E.(2005) Choosing psychotherapy as a career: Why did we cross that road? Wiley Interscience www.interscience.wiley.com 61(8), 1009-1031.
41. Ferris, P. A. (2009). The role of the consulting psychologist in the prevention, detection, and correction of bullying and mobbing in the workplace. Consulting Psychology Journal: Practice and Research, 61 (3): 169–189. DOI: 10.1037/a0016783.
42. Field, T. (2002) There no accounting for bullying. British Medical Journal, eletters, 324 (7342) 878-879.
43. Fisher-Blando, J. L. (2008). Workplace bullying: Aggressive behavior and its effect on job satisfaction and productivity. (Doctoral dissertation, University of Phoenix, 2001).
44. Forsyth, D. R. (2006). Group dynamics (4th ed.). Belmont, CA: Thomson Wadsworth.
45. Fox, S. & Stallworth, L. E. (2005). Racial/ethnic bullying: Exploring links between bullying and racism in the U.S. workplace. Journal of Vocational Behavior, 66, 438–456.
46. Geffner, R., Braverman, M., Galasso, J. and Janessa Marsh, eds. (2005). Aggression in Organizations: Violence, Abuse, and Harassment at Work and in Schools. New York: Routledge.
47. Griffin, R. S. & Gross, A. M. (2004). Childhood bullying: Current empirical findings and future directions for research. Aggression and Violent Behavior, 9: 379-400.
48. Hauge, L., Skogstad, A., & Einarsen, S. (2007). Relationships between stressful work environments and bullying: Results of a large representative study. Work & Stress, 21 (3), 220-242.
49. Hershcovis, M. S., Turner, N., Barling, J., Arnold, K. A., Dupre, K. E., Inness, M., LeBlanc, M. M. & Sivanathan, N. (2007). Predicting workplace aggression: A meta-analysis. Journal of Applied Psychology, 92 (1) 228–238. DOI 10.1037/0021-9010.92.1.228.
50. Hitlan, R., Cliffton, R., & DeSoto, M. (2006). Perceived exclusion in the workplace: the moderating effects of gender on work-related attitudes and psychological health. North American Journal of Psychology, 8(2), 217-235.
51. Hoel, H., Faragher, B., & Cooper, C. (2004). Bullying is detrimental to health, but all bullying behaviours are not necessarily equally damaging. British Journal of Guidance & Counselling, 32 (3), 367-387.
52. Institute for Personality and Ability Testing (2010). NetAssess.
53. International Association on Workplace Bullying and Harassment (2010). Ståle Einarsen.
54. International Test Commission (2005). International guidelines on computer-based and internet delivered testing. Leicester (UK): The Psychological Testing Centre.
55. Joint Commission, The (2008). Behaviors that undermine a culture of safety.
56. Kaufer, S. & Mattman, J. W. (1997). The cost of workplace violence to American business. Workplace Violence Research Institute.
57. Keashly, L. (1998). Emotional abuse in the workplace: Conceptual and empirical issues. Journal of Emotional Abuse, 1 (1) 85-117.
58. Keashly, L.. & Jagatic, K. (2003). By another name: American perspectives on workplace bullying. In S. Einarsen, H. Hoel, D. Zapf, & C. L. Cooper (Eds.), Bullying and emotional abuse in the workplace (pp. 31-61). London: Taylor & Francis.
59. Kile, S. (1990). Helsefarlige ledere og medarbeidere [Health-dangerous leaders and their co-workers]. Oslo: Hjemmets bokforlag. (qtd. in) Matthiesen, S. B., & Einarsen, S. (2007). Perpetrators and targets of bullying at work: Role stress and individual differences. Violence and Victims, 22 (6) 735-756.
60. Lee, R. & Brotheridge, C. (2006). When prey turns predatory: Workplace bullying as a predictor of counter aggression/bullying, coping, and well-being. European Journal of Work & Organizational Psychology, 15(3), 352-377.
61. Leedy, P., & Ormrod, J. (2005). Practical Research Planning and Design. Upper sadle River: Pearson.
62. Lewis, M. A. (2005). Nurse bullying: Organizational considerations in the maintenance and perpetration of health care bullying cultures. Journal of Nursing Management, 14 (1) 52 – 58. DOI 10.1111/j.1365-2934.2005.00535.
63. Lewis, S. (2006, March). Recognition of workplace bullying: a qualitative study of women targets in the public sector. Journal of Community & Applied Social Psychology, 16 (2), 119-135.
64. Lewis, S., & Oxford, J. (2005). Women’s experiences of workplace bullying: changes in social relationships. Journal of Community & Applied Social Psychology, 15(1), 29-47.
65. Leymann, H. (1996). The content and development of mobbing at work. European Journal of Work and Organizational Psychology, 5: 165–184.
66. Leymann, H. & Gustafsson, A. (1996). Mobbing at work and the development of post-traumatic stress disorders. European Journal of Work and Organizational Psychology, 5: 251–275.
67. Lipscomb, J.A. & Love, C.C. (1992). Violence towards health care workers. Journal of the American Association of Occupational Health Nurses, 40, 219-227.
68. Lorenz, K. (2002). On aggression (2nd ed.). New York, NY: Routledge.
69. Lustig, D. C. & Strauser, D. R. (2002). The relationship between sense of coherence and career thoughts. Career Development Quarterly, 51 (1) 2-11.
70. MarketResearchTech.com (2007). Survey completion incentives: Should you do it?
71. Martinko, M. J., Gundlach, M. J., & Douglas, S. C. (2002). Toward an integrative theory of counterproductive work behavior: A causal reasoning perspective. International Journal of Selection and Assessment, 10: 36–50.
72. Matthiesen, S. & Einarsen, S. (2004). Psychiatric distress and symptoms of PTSD among victims of bullying at work. British Journal of Guidance & Counselling, 32(3), 335-356.
73. MacIntosh, J. (2006).Tackling work place bullying. Issues in Mental Health Nursing, 27: 665–679. DOI: 10.1080/01612840600642984
74. McKelvey, B. (2002). Postmodernism vs. truth in management theory. In Ed Locke (Ed.) Post-modernism & management: Pros, cons, and alternatives. Amsterdam, NL: Elsevier.
75. Mertens, D. (2005) Research and evaluation in Education and Psychology 2^nd. ed. Thousand Oaks, CA: Sage.
76. Milam, A. C., Spitzmueller, C. & Penney, L.M. (2009). Investigating individual differences among targets of workplace incivility. Journal of Occupational Health Psychology, 14 (1), 58-69.
77. Mitchell, M. S. & Ambrose, M. L. (2007). Abusive supervision and workplace deviance and the moderating effects of negative reciprocity beliefs. Journal of Applied Psychology, 92 (4): 1159–1168. DOI: 10.1037/0021-9010.92.4.1159.
78. Namie, Gary & Namie, Ruth (2002). The bully at work: What you can do to stop the hurt and reclaim your dignity on the job. Naperville (IL): Sourcebooks, Inc.
79. National Institute of Mental Health (2009). What are the symptoms of PTSD? National Institutes of Health.
80. Neumann, M. J. (2000). Injustice, stress and bullying can be expensive! Paper presented at the Workplace Bullying 2000 conference, Oakland, CA.
81. Neuman, J. H. & Baron, R. A. (1998). Workplace violence and workplace aggression: Evidence concerning specific forms, potential causes, and preferred targets. Journal of Management, 24: 391-419.
82. Nielsen, M. B., Matthiesen, S. B. & Einarsen, S. (2008). Sense of coherence as a protective mechanism among targets of workplace bullying. Journal of Occupational Health Psychology, 13 (2) 128–136.
83. Nolfe, G., Petrella, C., Blasi, F., Zontini, G., & Nolfe, G. (2007). Psychopathological dimensions of harassment in the workplace (mobbing). International Journal of Mental Health, 36(4), 67-85.
84. Notelaers, G., Einarsen, S., De Witte, H., & Vermunt, J. (2006). Measuring exposure to bullying at work: The validity and advantages of the latent class cluster approach. Work & Stress, 20(4), 289-302.
85. Office for Victims of Crime (2002). Statistical overview. Office of Justice Programs, Department of Justice.
86. Online Testing Centre, The (2008). The online testing centre: How it works.
87. Peek-Asa, C., Runyan, C. W. & Zwerling, C. (2001). The role of surveillance and evaluation research in the reduction of violence against workers. American Journal of Preventive Medicine, 20: 141-148.
88. Pfeffer, J. (1993). Barriers to the advancement of organizational science: Paradigm development as a dependent variable. Academy of Management Review, 18, 599–620.
89. Preece, M. J., Johanson, G. and Hitchcock, J. H. (2009). Online survey response rates and lottery incentives. Paper presented at the annual MWERA Annual Meeting, Sheraton Westport Chalet Hotel, St. Louis, MO
90. Rai, S. (2002). Preventing workplace aggression and violence – A role for occupational therapy. Journal of Prevention, Assessment, and Rehabilitation, 18: 15-22.
91. Rayner C. & Hoel, H. (1997). A summary review of literature relating to workplace bullying. Journal of Applied Social Psychology, 7: 181-191.
92. Reinhold Development (2009). Myers Briggs test: What is your Myers-Briggs personality type? Web.
93. Rippon, T. J. (2008). Aggression and violence in health care professions. Journal of Advanced Nursing, 31 (2), 452-460.
94. Robinson, S. L. & Bennett, R. J. (1995). A typology of deviant workplace behaviors: A multidimensional scaling study. Academy of Management Journal, 38 (2) 555–572.
95. Rutherford A & Rissel C. (2004). A survey of workplace bullying in a health sector organization. Australian Health Revue, 28 (1): 65-72.
96. Salin, D. (2003). Ways of explaining workplace bullying: A review of enabling, motivating and precipitating structures and processes in the work environment. Human Relations, 56 (10) 1213-1232.
97. Sandvik-Lutgen, P. (2008) Intensive remedial identity work: Responses to workplace bullying trauma and stigmatization. University of New Mexico, Department of Communication and Journalism, Organization Articles, 15 (1) 97-119.
98. Seigne, E., Coyne, I., Randall, P. & Parker, J. (2007). Personality traits of bullies as a contributory factor in workplace bullying: an exploratory study International Journal of Organization Theory and Behavior, 10 (1); 118-132.
99. Sproull, N.( 2002) Handbook of Research Methods: A Guide for Practitioners and Students in the Social Sciences (2^nd ed). Landlum: Scarecrow Press.
100. Suppe, F. (1977). The structure of scientific theories (2nd ed.). Chicago: University of Chicago Press.
101. Tashakkori, A., & Teddlie, C. (2003 ). Handbook of mixed methods in social & behavioral research. Thousand Oaks, CA: Sage.
102. Tehrani, N. (2004). Bullying: A source of chronic post traumatic stress? British Journal of Guidance and Counselling, 32: 358–366.
103. Trochim, W. & Donnelly, J. (2008). The research methods knowledge base (3rd ed.). Mason, OH: Cengage.
104. Tuckey, M. R., Dollard, M. F. Patrick, Hosking, J. and Winefield, A. H. (2009). Workplace bullying: The role of psychosocial work environment factors. International Journal of Stress Management, 16 (3) 215–232 DOI: 10.1037/a0016841.
105. Turney, L. (2003) Mental health and workplace bullying: The role of power, professions and ‘on the job training.’ Australian e-Journal for the Advancement of Mental Health, 2 (2), 1-9.
106. UK National Workplace Bullying Advice Line (2005). Bullying within social work.
107. Utgen-Sandvik, P. (2003, May). The communicative cycle of employee emotional abuse. Management Communication Quarterly, 16 (4).
108. Vadekerckhove,W. & Commers, M. (2003). Downward workplace mobbing: A sign of the times? Journal of Business Ethics, 45: 41-50.
109. Varcoe, C. (2001). Abuse obscured: An ethnographic account of emergency nursing in relation to violence against women. Canadian Journal of Nursing Research, 32 (4) 95-115.
110. Weiss, D. S. & Marmar, C. R. (1995). Impact of event scale – revised. In J.P. Wilson & T.M. Keane (Eds.), Assessing psychological trauma and PTSD: A Practitioner’s Handbook. New York: Guilford.
111. Whitehorn, D. & Nowland, M. (1997) Towards an aggression-free health care environment. The Canadian Nurse, 93: 24-26.
112. Wildemuth, B. M. (1993). Post-positivist research: Two examples of methodological pluralism. Library Quarterly, 63: 450-468.
113. Workplace Bullying Institute (2007). Results of the WBI U.S. workplace bullying survey.
114. Yıldız, S. (2007, August). A ‘new’ problem in the workplace: Psychological abuse (bullying). Journal of Academic Studies, 9(34) 113-128.
115. Zapf, D., & Einarsen, S. (2003). Individual antecedents of bullying. In S. Einarsen, H. Hoel, D. Zapf, & C. L. Cooper (Eds.), Bullying and emotional abuse in the workplace (pp. 165-184). London: Taylor & Francis.