Occupational Health Science

, Volume 2, Issue 4, pp 385–407 | Cite as

Neuropattern, a Translational Tool to Reduce Stress at Work – a Pilot Study

  • C. Contreras
  • Juliane HellhammerEmail author
  • F. Gerhards
  • D. H. Hellhammer
Original Research Article


Changing working conditions demand adaptation, resulting in higher stress levels in employees. In consequence, decreased productivity, increasing rates of sick leave, and cases of early retirement result in higher direct, indirect, and intangible costs. The aim of the study was to test the usefulness of a novel translational tool, Neuropattern, for early detection, prevention, and personalized treatment of stress-related disorders. The trial was designed as a pilot study with a wait list control group. In this study, 70 employees of the Forestry Department Rhineland-Palatinate, Germany were block-randomized and either underwent Neuropattern immediately, or after a waiting period of three months. After the diagnostic assessment, they received an explanatory disease model and individualized online counseling while their physicians were provided with diagnostic results and treatment recommendations. In order to assess possible beneficial effects of Neuropattern, questionnaires regarding health (SF-12), stress perception (PSS), emotional exhaustion (MBI), work stress (ERI) and work ability (WAI) as well as questions on health behavior were included at several time points. The application of Neuropattern resulted in significantly higher increase in measures of mental health and sporting activity and a significantly stronger decrease in perceived stress, emotional exhaustion and overcommitment, as compared to the control group. No such differences were found with regard to subjects’ physical health, current work ability, reward, effort-reward ratio and practice of relaxation methods. In addition, we unexpectedly found that subjects of the experimental group became significantly more pessimistic regarding their future work ability and showed higher rates of sick leave than control subjects did. These changes remained consistent during 3 and 6 months of follow-up. The present study encouraged the application of Neuropattern to early intervention in non-clinical populations. However, further research is required to determine the best operating conditions.


Work stress Burnout Prevention Conceptual Endophenotypes Personalized Medicine Neuropattern 



The authors would like to thank [name deleted to maintain the integrity of the review process] for her contribution in planning this project, as well as [names deleted to maintain the integrity of the review process] and the participating employees of Landesforsten Rheinland-Pfalz for their support.

Conflict of Interests

[name deleted to maintain the integrity of the review process] owns a trade mark protection for Neuropattern in the US and her company provides Neuropattern for clinical trials and patients. [name deleted to maintain the integrity of the review process] received a salary from the [name deleted to maintain the integrity of the review process] as a study manager during data collection. Data management, data analysis as well as writing the manuscript were part of her dissertation project, conducted externally, not as an employee of the [name deleted to maintain the integrity of the review process]. [name deleted to maintain the integrity of the review process] applies Neuropattern in his private practice. The authors state that there are no further conflict of interests.

Statement of Authorship

[names deleted to maintain the integrity of the review process] and [name deleted to maintain the integrity of the review process] were responsible for conception and design of the RCT. [name deleted to maintain the integrity of the review process] drafted the manuscript, [name deleted to maintain the integrity of the review process] and [name deleted to maintain the integrity of the review process] performed the statistical analyses. [name deleted to maintain the integrity of the review process] helped with interpretation of the data. All authors helped writing and reviewing the manuscript and have approved the final article.

Supplementary material

41542_2018_25_MOESM1_ESM.pdf (656 kb)
ESM 1 (PDF 656 kb)
41542_2018_25_MOESM2_ESM.pdf (200 kb)
ESM 2 (PDF 199 kb)
41542_2018_25_MOESM3_ESM.pdf (394 kb)
ESM 3 (PDF 393 kb)


  1. Ahola, K., Honkonen, T., Isometsä, E., Kalimo, R., Nykyri, E., Aromaa, A., & Lönnqvist, J. (2005). The relationship between job-related burnout and depressive disorders—Results from the Finnish health 2000 study. Journal of Affective Disorders, 88(1), 55–62. Scholar
  2. Aronsson, G., Gustafsson, K., & Dallner, M. (2000). Sick but yet at work. An empirical study of sickness presenteeism. Journal of Epidemiology and Community Health, 54(7), 502–509. Scholar
  3. Badura, B., Schröder, H., Klose, J., & Macco, K. (Eds.). (2010). Fehlzeiten-Report 2010: Vielfalt managen: Gesundheit fördern-Potenziale nutzen. Springer-Verlag.Google Scholar
  4. Bakker, J., Holenderski, L., Kocielnik, R., Pechenizkiy, M., & Sidorova, N. (2012, January). Stess@ work: From measuring stress to its understanding, prediction and handling with personalized coaching. In Proceedings of the 2nd ACM SIGHIT International health informatics symposium (pp. 673–678). ACM. doi:
  5. Bellingrath, S., & Kudielka, B. M. (2008). Effort-reward-imbalance and overcommitment are associated with hypothalamus–pituitary–adrenal (HPA) axis responses to acute psychosocial stress in healthy working schoolteachers. Psychoneuroendocrinology, 33(10), 1335–1343. Scholar
  6. Bergström, G., Bodin, L., Hagberg, J., Lindh, T., Aronsson, G., & Josephson, M. (2009). Does sickness presenteeism have an impact on future general health? International Archives of Occupational and Environmental Health, 82(10), 1179–1190. Scholar
  7. Bruhn, K., (2014). Optimierung der Depressionsbehandlung durch die Neuropattern™ - Diagnostik. Shaker.Google Scholar
  8. Bullinger, M. & Kirchberger, I., (1998). Der SF-12. SF-36 Fragebogen zum Gesundheitszustand. Handanweisung, 65–71. Göttingen: Hogrefe.Google Scholar
  9. Bullinger, M. (1995). German translation and psychometric testing of the SF-36 health survey: Preliminary results from the IQOLA project. International Quality of Life Assessment. Soc Sci Med, 41(10), 1359–1366. Scholar
  10. Cancelliere, C., Cassidy, J. D., Ammendolia, C., & Côté, P. (2011). Are workplace health promotion programs effective at improving presenteeism in workers? A systematic review and best evidence synthesis of the literature. BMC Public Health, 11(1), 395. Scholar
  11. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New Jersey: Lawrence Erlbaum.Google Scholar
  12. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 385–396. Scholar
  13. Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease. Journal of the American Medical Association, 298(14), 1685–1687. Scholar
  14. Cohen, S., & Janicki-Deverts, D., (2012). Who's stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. Journal of Applied Social Psychology, 42(6), 1320–1334, doi: CrossRefGoogle Scholar
  15. Cole, J. C. (2008). How to deal with missing data. Best practices in quantitative methods, 214–238.Google Scholar
  16. Crum, A. J., Salovey, P., & Achor, S. (2013). Rethinking stress: The role of mindsets in determining the stress response. Journal of Personality and Social Psychology, 104(4), 716. Scholar
  17. Crum, A. J., Akinola, M., Martin, A., & Fath, S. (2017). The role of stress mindset in shaping cognitive, emotional, and physiological responses to challenging and threatening stress. Anxiety, Stress & Coping, 30(4), 379–395. Scholar
  18. De Jonge, J., Bosma, H., Peter, R., & Siegrist, J. (2000). Job strain, effort-reward imbalance and employee well-being: A large-scale cross-sectional study. Social Science & Medicine, 50(9), 1317–1327. Scholar
  19. De Kloet, E. R., Joëls, M., & Holsboer, F. (2005). Stress and the brain: From adaptation to disease. Nature Reviews Neuroscience, 6(6), 463–475. Scholar
  20. De Zwart, B. C. H., Frings-Dresen, M. H. W., & Van Duivenbooden, J. C., (2002). Test–retest reliability of the work ability index questionnaire. Occupational Medicine, 52(4), 177–181, doi: Scholar
  21. DGPPN. (2012). Positionspapier der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) zum Thema Burnout. Berlin.Google Scholar
  22. Field, A. (2009). Discovering statistics using SPSS. Sage.Google Scholar
  23. Graham, J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60, 549–576.CrossRefPubMedGoogle Scholar
  24. Graham, J. W., & Schafer, J. L. (1999). On the performance of multiple imputation for multivariate data with small sample size. Statistical strategies for small sample research, 50, 1–27.Google Scholar
  25. Hackman, J. R., & Lawler, E. E. (1971). Employee reactions to job characteristics. Journal of Applied Psychology, 55(3), 259–286. Scholar
  26. Head, J., Kivimäki, M., Siegrist, J., Ferrie, J. E., Vahtera, J., Shipley, M. J., & Marmot, M. G. (2007). Effort–reward imbalance and relational injustice at work predict sickness absence: The Whitehall II study. Journal of Psychosomatic Research, 63(4), 433–440. Scholar
  27. Hellhammer, D., & Hellhammer, J. (Eds.). (2008). Stress: The brain-body connection. Basel: Karger.Google Scholar
  28. Hellhammer, D., & Hellhammer, J. (2011). Stress medicine: From bench to bedside. In C. L. Cooper & A. S. Antoniou (Eds.), New directions in Organisational psychology and Behavioural medicine (pp. 63–76). Furnham: Ashgate Publishing Ltd.Google Scholar
  29. Hellhammer, D., Hero, T., Gerhards, F., & Hellhammer, J. (2012). Neuropattern: A new translational tool to detect and treat stress pathology I. strategical consideration. Stress, 15(5), 479–487. Scholar
  30. Hellhammer, D., Meinlschmidt, G. and Pruessner, J., (2018). Conceptual Endophentoypes: A strategy to improve the impact of Psychoneuroendocrinology in precision medicine. Invited viewpoint, Psychoneuroendocrinology.Google Scholar
  31. Hellhammer, J., Fries, E., Schweisthal, O. W., Schlotz, W., Stone, A. A., & Hagemann, D. (2007). Several daily measurements are necessary to reliably assess the cortisol rise after awakening: State-and trait components. Psychoneuroendocrinology, 32(1), 80–86. Scholar
  32. Hemp, P. (2004). Presenteeism: At work-but out of it. Harvard Business Review, 82(10), 49–58.PubMedGoogle Scholar
  33. Hero, T., Gerhards, F., Thiart, H., Hellhammer, D. H., & Linden, M. (2012). Neuropattern™: A new translational tool to detect and treat stress pathology. II. The Teltow study. Stress, 15(5), 488–494. Scholar
  34. Hero, T. (2013). The Neuropattern pre-/postnatal stress questionnaire (NPQ-PSQ): A new tool to assess pre-and postnatal adversity. Shaker.Google Scholar
  35. Ilmarinen, J. (2007). The work ability index (WAI). Occupational Medicine, 57(2), 160. Scholar
  36. Ilmarinen, J., & Tuomi, K. (2004). Past, present and future of work ability. People and work research reports. Finnish Institute of Occupational Health, Helsinki, 65, 1–25.Google Scholar
  37. Klein, E. M., Brähler, E., Dreier, M., Reinecke, L., Müller, K. W., Schmutzer, G., et al. (2016). The German version of the perceived stress scale—Psychometric characteristics in a representative German community sample. BMC Psychiatry, 16(1), 159. Scholar
  38. Kompier, M. A., Geurts, S. A., Gründemann, R. W., Vink, P., & Smulders, P. G. (1998). Cases in stress prevention: The success of a participative and stepwise approach. Stress and Health, 14(3), 155–168.<155::AID-SMI773>3.0.CO;2-C.CrossRefGoogle Scholar
  39. Kosinski, M., Bayliss, M., Bjorner, J. B., & Ware, J. E. (2000). Improving estimates of SF-36® health survey scores for respondents in missing data. Medical Outcomes Trust Monitor, 5(1), 8–10.Google Scholar
  40. LaMontagne, A. D., Keegel, T., Louie, A. M., Ostry, A., & Landsbergis, P. A. (2007). A systematic review of the job-stress intervention evaluation literature, 1990–2005. International Journal of Occupational and Environmental Health, 13(3), 268–280.CrossRefPubMedGoogle Scholar
  41. Lang, K., Koch, U., & Schulz, H. (2004). Zur Validität eines Transformationsalgorithmus’ für die Fehlerwert- ersetzung bei psychosomatischen Patienten. In C. Maurischat, M. Morfeld, T. Kohlmann, & M. Bullinger (Eds.), Lebensqualität: Nützlichkeit und Psychometrie des Short Form 12 / 36 in der medizinischen Rehabilitation (pp. 49–61). Lengerich: Pabst.Google Scholar
  42. Lee, E. H. (2012). Review of the psychometric evidence of the perceived stress scale. Asian Nursing Research, 6(4), 121–127. Scholar
  43. Lundberg, U. (2005). Stress hormones in health and illness: The roles of work and gender. Psychoneuroendocrinology, 30(10), 1017–1021. Scholar
  44. Maslach, C., Jackson, S. E., Leiter, M. P., (1996). MBI: The Maslach burnout inventory manual. Palo Alto.Google Scholar
  45. Maslach, C., & Jackson, S. E., (1981) The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113.CrossRefGoogle Scholar
  46. Maslach, C., Jackson, S. E., & Leiter M. P., (2006). Maslach burnout inventory. CPP.Google Scholar
  47. McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33–44. Scholar
  48. Melchior, M., Caspi, A., Milne, B. J., Danese, A., Poulton, R., & Moffitt, T. E. (2007). Work stress precipitates depression and anxiety in young, working women and men. Psychological Medicine, 37(08), 1119–1129. Scholar
  49. Murphy, L. R. (1996). Stress management in work settings: A critical review of the health effects. American Journal of Health Promotion, 11(2), 112–135. Scholar
  50. Naeher, K. L. (2015). Exploration von Therapieverläufen in Beobachtungsstudien: Prädiktoren für Veränderungen im Verlauf einer Therapie und Subgruppenidentifikation in messwiederholten Daten. Hochschule Koblenz-Remagen: Masterarbeit.Google Scholar
  51. National Research Council. (2011). Toward precision medicine: Building a knowledge network for biomedical research and a new taxonomy of disease. Washington: National Academies Press.Google Scholar
  52. Nuebling, A., Andersen, H., & Mühlbacher, A. (2006). Entwicklung eines Verfahrens zur Berechnung der körperlichen und psychischen Summenskalen auf Basis der SOEP – Version des SF 12 (Algorithmus). Berlin: Deutsches Institut für Wirtschaftsforschung (DIW). Google Scholar
  53. Nuebling, M., Seidler, A., Garthus-Niegel, S., Latza, U., Wagner, M., Hegewald, J., et al. (2013). The Gutenberg health study: Measuring psychosocial factors at work and predicting health and work-related outcomes with the ERI and the COPSOQ questionnaire. BMC Public Health, 13(1), 538. Scholar
  54. Rödel, A., Siegrist, J., & Hessel, A. (2004). & Brähler, E., (2004). Psychometrische Testung des Fragebogens zur Messung beruflicher Gratifikationskrisen an einer repräsentativen deutschen Stichprobe. Zeitschrift für Differentielle und Diagnostische Psychologie, 25, 227–238. Scholar
  55. Rosenthal, R. (1991). Meta-analytic procedures for social research (2nd ed.). Newbury Park, CA: Sage.CrossRefGoogle Scholar
  56. Rosenthal, R., Rosnow, R. L., & Rubin, D. B. (2000). Contrasts and effect sizes in behavioural research: A correlational approach. Cambridge: Cambridge University Press.Google Scholar
  57. Schaufeli, W., & Enzmann, D. (1998). The burnout companion to study and practice: A critical analysis. Boca Raton, FL: CRC press.Google Scholar
  58. Schaufeli, W., Bakker, A. B., Hoogduin, K., Schaap, C., & Kladler, A. (2001). On the clinical validity of the Maslach burnout inventory and the burnout measure. Psychology & Health, 16(5), 565–582. Scholar
  59. Siegrist, J. (1996). Adverse health effects of high-effort/low-reward conditions. Journal of Occupational Health Psychology, 1(1), 27. Scholar
  60. Siegrist, J. (1998). Adverse health effects of effort-reward imbalance at work. In C. L. Cooper (Ed.), Theories of organizational stress (pp. 190–204). Oxford: OUP.Google Scholar
  61. Siegrist, J. (2002). Effort-reward imbalance at work and health. In P. L. Perrewe & D. C. Ganster (Eds.), Historical and current perspectives on stress and health (pp. 261–291). Emerald Group Publishing Limited.Google Scholar
  62. Siegrist, J., Wege, N., Pühlhofer, F., & Wahrendorf, M. (2009). A short generic measure of work stress in the era of globalization: Effort-reward imbalance. International Archives of Occupational and Environmental Health, 82(8), 1005. Scholar
  63. Stalder, T., Kirschbaum, C., Kudielka, B. M., Adam, E. K., Pruessner, J. C., Wüst, S., et al. (2016). Assessment of the cortisol awakening response: Expert consensus guidelines. Psychoneuroendocrinology, 63, 414–432. Scholar
  64. Tennant, C. (2001). Work-related stress and depressive disorders. Journal of Psychosomatic Research, 51(5), 697–704. Scholar
  65. Toker, S., Heaney, C. A., & Ein-Gar, D. (2015). Why won’t they participate? Barriers to participation in worksite health promotion programmes. European Journal of Work and Organizational Psychology, 24(6), 866–881. Scholar
  66. Tuomi, K., Ilmarinen, J., Jahkola, A., Katajarinne, L., & Tulkki, A. (1998). Work ability index (2nd revised ed.). Helsinki: Finnish Institute of Occupational Health.Google Scholar
  67. Tuomi, K., Vanhala, S., Nykyri, E., & Janhonen, M. (2004). Organizational practices, work demands and the well-being of employees: A follow-up study in the metal industry and retail trade. Occupational Medicine 2004, 54(2), 115–121. Scholar
  68. Unterbrink, T., Hack, A., Pfeifer, R., Buhl-Grießhaber, V., Müller, U., Wesche, H., ... & Bauer, J., (2007). Burnout and effort–reward-imbalance in a sample of 949 German teachers. International Archives of Occupational and Environmental Health, 80(5), 433–441, doi: Scholar
  69. Van der Klink, J. J., Blonk, R. W., Schene, A. H., & Van Dijk, F. J. (2001). The benefits of interventions for work-related stress. American Journal of Public Health, 91(2), 270. Scholar
  70. Van Vegchel, N., De Jonge, J., Bosma, H., & Schaufeli, W. (2005). Reviewing the effort–reward imbalance model: Drawing up the balance of 45 empirical studies. Social Science & Medicine, 60(5), 1117–1131. Scholar
  71. Wagner, G. G., Frick, J. R., & Schupp, J. (2007). The German socio-economic panel study (SOEP): Scope, evolution and enhancements. Schmollers Jahrbuch, 127, 139–170.Google Scholar
  72. Ware, J. E., & Gandek, B. (1998). Methods for testing data quality, scaling assumptions, and reliability: The IQOLA project approach. Journal of Clinical Epidemiology, 51(11), 945–952. Scholar
  73. Ware, J. E., Kosinski, M., Turner-Bowker, D. M., & Gandek, B. (2002). How to score version 2 of the SF-12 health survey (with a supplement documenting version 1). Lincoln, RI: Quality Metric. Inc.Google Scholar
  74. Yang, D. J., Kang, D., Kim, Y. K., Kim, Y. H., Yang, Y. A., Cha, S. M., et al. (2013). Reliability of self-administered work ability index questionnaire among Korean workers. Ergonomics, 56(11), 1652–1657. Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Stress Center TrierScience ParkTrierGermany
  2. 2.Department of Clinical and Physiological PsychologyTrier UniversityTrierGermany

Personalised recommendations