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Preconditions for Coping with Time and Performance Pressure in Different Ways


Anika Schulz-Dadaczynski ,

Federal Institute for Occupational Safety and Health, DE
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Hanna Janetzke

University of Applied Sciences Neubrandenburg, DE
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Time and performance pressure (TPP) is one of the most prevalent job demands in todays’ working world. TPP often elicits coping behaviours of work extension (e.g., working overtime) and intensification (e.g., skipping breaks) that can be detrimental to employee health and well-being, at least in the long run. Therefore, a central research question is which preconditions employees need to cope differently, in a more problem-focused and healthy way with TPP. We addressed this question with research case studies in four different companies, integrating multiple stakeholders and using a multimethods approach. The primary method within the case studies were qualitative interviews with employees performing service or knowledge work. We could identify structural as well as climatic and personal factors. Factors lie on four different levels (organization, task, team, and individual) as important preconditons for alternative coping behaviours. Results of a two-step cross-case analysis show that preconditions on the task level, such as control at work, seem to be very central. Preconditions on the different levels are closely intertwined and some themes can be found across levels, such as “control at and over work” or the theme of “care”. The identified preconditions are important starting points for interventions to foster alternative coping with TPP.
How to Cite: Schulz-Dadaczynski, A. and Janetzke, H., 2020. Preconditions for Coping with Time and Performance Pressure in Different Ways. Scandinavian Journal of Work and Organizational Psychology, 5(1), p.10. DOI:
  Published on 08 Oct 2020
 Accepted on 11 Sep 2020            Submitted on 25 Nov 2019


Time and performance pressure (TPP) is one of the most prevalent job demands in todays’ working world and has remained on a continuously high level for over a decade (BAuA, 2016; Eurofound, 2017; Green and McIntosh, 2001; Kubicek, Paskvan, and Korunka, 2015; Ulferts, Korunka, and Kubicek, 2013). Therefore, many employees experience TPP and must cope with this job demand. Not only the demands themselves but also the exercised coping strategies play in their own right an important role for employee health and well-being (Baethge et al., 2019; Demerouti, 2014; Dewe, O’Driscoll, and Cooper, 2010). Sometimes, certain coping behaviours are more a constraint than a choice and a functional and (seemingly) necessary coping behaviour to get the work done, such as under TPP.

TPP seems to challenge employees to work longer and harder, that is to devote an additional amount of time and energy to work (Johnstone and Johnston, 2005; Ng and Feldman, 2008; Podsakoff, LePine, and LePine, 2007). Thus, TPP often elicits coping behaviours of work extension (e.g., working overtime, working long hours) as well as intensification (e.g., skipping breaks, working at a high speed; Dewe et al., 2010; Mazzetti, Schaufeli, and Guglielmi, 2014; Schulz-Dadaczynski, 2017; Snir and Harpaz, 2012). These behaviours are more a reaction to TPP without changing the demand itself (Schulz-Dadaczynski, 2017).

While those behaviours may be functional with regard to the attainment of work goals, they can be detrimental to employee well-being and health, at least in the long run (Crawford, LePine, and Rich, 2010; Dettmers et al., 2016; Houlfort et al., 2014; Podsakoff et al., 2007; Stab and Schulz-Dadaczynski, 2017). Snir and Harpaz (2012) define behaviours of work extension and intensification as “heavy work investment”. Other researchers examine those behaviours as “self-endangering work behaviour” (Dettmers et al., 2016). The terms to label these behaviours already indicate that these coping strategies may have negative consequences for employees. Studies show, for example, that they adversely affect necessary recovery processes of employees (Meijman and Mulder, 1998; Wendsche and Lohmann-Haislah, 2017) as well as their work-life balance (Holland, 2007). An impairment of well-being and health is also possible (Baethge et al., 2019; Clark et al., 2016; Ng and Feldman, 2008). More specifically, relationships between long working hours, working overtime, and incident coronary heart disease, as well as stroke and major depressive episodes have been demonstrated (Kivimäki et al., 2015; Virtanen et al., 2010; 2012; 2018). Negative consequences are not only possible at the individual but also at the team or organizational level, such as through fostering destructive organizational behaviours (Galperin and Burke, 2006) or severe errors at work (Olds and Clarke, 2010).

The high probability of negative consequences of working extensively and intensively classify those behaviours as rather maladaptive coping strategies and call for studies which investigate alternative ways of coping with TPP and their preconditions.

Alternative Coping with Time and Performance Pressure: Limiting and Focusing

There are first studies that shift their focus to coping strategies with TPP that are not only functional for goal attainment but also for employee health and well-being. A study of Krause et al. (2017) shows that the strategies of “clarifying demands” and “setting priorities” on team level had a buffering effect on the relation between time pressure and exhaustion. The active role of employees to be able to choose between different behaviours to cope with TPP is increasingly acknowledged as important in terms of health-related outcomes (Baeriswyl, 2016; Baeriswyl, Krause and Kunz Heim, 2014; Baethge et al., 2019). Coping behaviours that actively address job-related demands themselves, such as TPP, are also discussed within the concept of job crafting (Demerouti, 2014).

Job crafting is defined as a self-initiated behaviour where employees modify aspects of their own job within the boundaries of their tasks (Bindl et al., 2019). TPP is discussed as a reactive motive for job crafting behaviours because it stimulates employees to change their work situation (Lazazzara, Tims, and de Gennaro, 2020). Tims et al. (2012) integrated the job crafting concept into the well-known job demands-resources model (Bakker and Demerouti, 2007). They differentiate three types of job crafting behaviours: (1) increasing job resources, (2) increasing challenging job demands, and (3) decreasing hindering job demands. As one example for the job crafting behaviour of increasing job resources they gave seeking social support, as one example for decreasing hindering job demands they gave delegating tasks when deadlines are too tight. Therefore, these two types of job crafting behaviours may also include addressing the specific job demand of TPP through alternative behaviours to work extension and intensification.

Alternative ways of coping with TPP represent counter-strategies to the behaviours of work extension and intensification because they prevent or at least reduce those rather maladaptive coping strategies. The term “Limiting and Focusing” (LAF) will be used hereinafter to label more constructive, problem-focused strategies to deal with TPP. LAF should be understood as encompassing coping behaviours that prevent or reduce the extension of work, for example by setting priorities, delegating tasks or by a rigid boundary management between work and private life, as well as behaviours that primarily enable concentrated and temporally equalized work, for example by avoiding interruptions or by a proactive planning of work.

Most previous research concerning dealing with TPP has focused on facets of work intensification and extension such as working long hours, working overtime, or skipping rest breaks, and their potential negative consequences (Clark, Michel, and Stevens, 2015; Ng and Feldman, 2008; Wendsche and Lohmann-Haislah, 2017), overlooking the availability of alternative coping strategies and the conditions under which alternatives can and will be applied. Job crafting research – especially quantitative studies – also has its focus on the consequences of different types of job crafting behaviours (Bruning and Campion, 2018; Tims, Bakker, and Derks, 2013; Tims et al., 2013). Even if some studies examine antecedents (Lazazzara, Tims, and de Gennaro, 2020), most research so far focuses on personal correlates for coping behaviours (Bindl et al., 2019; Burke, Matthiesen, and Pallesen, 2006; Clark et al., 2016), remarkably fewer studies on organizational or task-related factors (Snir and Harpaz, 2012; Mazzetti et al., 2014). There is still a research gap concerning the question under which conditions employees can avoid the widespread coping behaviours of work intensification and extension and cope differently with TPP, that is, in a problem-focused, healthier way through LAF.

As (work) behaviours always emerge embedded in the (work) context, qualitative field studies in real work contexts can especially contribute to an understanding of concrete work behaviours. As one of the few studies, a qualitative study of Kirrane, Breen, and O’Connor (2018) investigated the origins of excessive work behaviour and concluded that not only dispositional and socio-cultural factors of the employees but also organizational norms play a central role. A study of Janetzke and Ertel (2017) used a comparative case study design to investigate success factors for the implementation of a psychosocial risk management and identified not only personal but also structural and organizational cultural factors. To be able to capture personal correlates as well as organizational and task-related factors and their interplay, we also conducted a research case study in four different companies. Their primary aim was to explore the conditions fostering LAF, in other words, which prerequisites for alternative coping strategies with TPP do employees need in organizational contexts. With our study, we have pursued the following research questions:

  1. What preconditions for behaviours of LAF do employees consider as important? (2) Which manifestations of preconditions (factors) are described as beneficial respectively hindering for LAF? (3) What interplay between different factors could be identified? (4) Which factors could be identified as central to successful or unsuccessful LAF?

Through addressing these research questions, our study contributes to close the research gap concerning antecedents of alternative coping behaviours. Furthermore, we did not examine coping with demands in general but with the specific demand of TPP. Applying an explorative case study design, we wanted to be able to capture a broad scope of not preselected kinds of factors that enable or hinder behaviours of LAF.

The Research Case Study

We conducted the research case study between June and December 2017 in the sector of service and knowledge work. We selected the sector of service and knowledge work because this sector accounts for the greatest workforce demand in todays working world and is especially affected by TPP (Hirvonen and Husso, 2012; Grant and Parker, 2009). We investigated as cases four different German organizations: (1) an institute for ecological research and consulting (ECO), (2) a company in the cultural sector (CUL), (3) a local branch of a financial institution (FIN), and (4) an institution for social-psychiatric services (SOC). All companies were medium-sized and interested to participate in the research case study because according to information from management TPP was an important demand for a majority of staff. Company leaders got written and personal information about the research case study before they agreed to participate.


In each of the four organizations, the research case study comprised a sequence of research steps with different methods. A multimethods approach and the integration of multiple stakeholders characterizes case study research in general (Hartley, 2004; Yin, 2003).

In a first step, there were preliminary discussions with one or more employees in leading positions such as human resources managers, employee representatives, or managing directors. These preliminary discussions had the aim of once again clarifying the benefits, procedure, and requirements of the case study, of gaining an insight into the company and its divisions, of understanding the extent and causes of TPP in the company in more detail and, finally, of carefully preselecting divisions and employees who should participate in the subsequent steps of research because TPP was an important issue for them.

In a second step, we conducted one to three structured interviews in each company with employees who were prepared and able to give more insight into the divisions selected for participation. These interviews had a duration of 1 to 1.5 hours and predominantly took place with division managers. The interviews had the principal aim of thoroughly contextualizing the following step of research. Therefore, the interview guideline included several questions about specific characteristics of the division such as the composition of staff, represented occupations, regulation of working time, performance management, horizontal and vertical hierarchies, and an assessment of the TPP situation of the selected employees from the perspective of the division managers. Additionally, documents such as organization charts or job descriptions were considered to get a more profound impression of the divisions.

In a third step, the methodological core of the case study took place, which was semi-structured interviews with employees (Flick, 2018; Kruse et al., 2014). In total, 36 interviews were conducted (8 to 10 per company) with a duration of 1 to 1.5 hours. Each interview started with a detailed introduction that contained on the one hand a presentation of the case study by the researcher. Participants were informed about the objectives of the study, the duration of the interview and the use of the data. Data protection and anonymity of the result feedback and publication were assured. Participation was voluntary and could be revoked at any time. A written declaration of consent was obtained from each participant. On the other hand, the introduction included a comprehensive description of the job and tasks performed by the employee and employees’ appraisal of their TPP. Afterwards, the main part of the interview dealt with three topics of interest: (1) Coping with TPP, (2) preconditions of described coping strategies, and (3) consequences of coping. The clear focus was to explore especially the preconditions of different coping strategies with TPP in more detail. The main part of the interview contained open, narrative and illustrative passages, and deepening questions following the open parts, with preferably little guidance from the researcher. Each interview was recorded for subsequent verbatim transcription.


The final sample of the employee interview study consisted of 36 employees (23 female and 13 male). All employees were highly skilled and performed service or knowledge work in a variety of jobs. In the ECO environmental scientists, lawyers, or sociologists participated, in the CUL, cultural scientists or musicologists. In the FIN, economists or qualified bank clerks were interviewed, in the SOC, social education workers and therapists. The majority of employees of the ECO and CUL performed project work in national as well as international projects whereas employees of the FIN and SOC mostly performed more constant, regular tasks. Seven of the interviewed employees worked in middle management. The broad scope of jobs was intended to reach the largest possible heterogeneity for the sub-sample of qualified knowledge and service work, applying the strategy of maximum variation sampling (Patton, 1990). A precondition for participation in the interview study was the existence of TPP as a central job demand and therefore the necessity to cope with that demand. The following Table 1 gives a description of our sample per company case.

Table 1

Characteristics of the employee interview sample per company.

Case no. Company Interviewees Gender Range of Tenure Work Time Employment Leadership responsibility

1 ECO 10 7 Female/3 Male <5–15 years 8 Part Time/2 Full Time 10 Permanent Contract 7 None/3 Middle Management
2 CUL 9 5 Female/4 Male <5–25 years 2 Part Time/7 Full Time 4 Permanent Contract/5 Temporary Contract 7 None/2 Middle Management
3 FIN 8 5 Female/3 Male 5–>25 years 3 Part Time/5 Full Time 8 Permanent Contract 7 None/1 Middle Management
4 SOC 9 6 Female/3 Male <5–15 years 4 Part Time/5 Full Time 8 Permanent Contract/1 Temporary Contract 8 None/1 Middle Management
Total 36 23 Female/13 Male <5–>25 years 17 Part Time/19 Full Time 30 Permanent Contract/6 Temporary Contract 29 None/7 Middle Management


All recorded interviews were transcribed verbatim using the transcripts afterwards as primary material for analysis. A systematic qualitative content analysis (Kohlbacher, 2006; Mayring, 2003; 2005) was performed using the software MAXqda (version 11). Qualitative content analysis was chosen because it allows to systematically identify themes from qualitative interview material and is appropriate to be combined with case study research (Kohlbacher, 2006).

First, the material was structured via a system of categories. The first step of structuring the material was the deductive category application. Deductive categories were derived from the interview manual and correspond with the three topics of interest: (1) Coping with TPP, (2) preconditions of described coping strategies, and (3) consequences of coping. Within those deductive categories the inductive category development was realized in several steps to organize the data around emerging key themes. Seven interviews were used initially to test the deductive category application and the inductive category development. The coding of the remaining 29 out of the 36 interviews was done by two coders independently from each other with several interpretation meetings in-between to reach not only a high level of reproducibility of categories but also to consider communicative validation of results.

Afterwards, the procedures of explication and summary were realized within the qualitative content analysis. The primary aim of explication was to contextualize the emerging key themes through annotations (code-memos), explanations, and clarifications using also the data generated during the first steps of research (preliminary discussions and structured interviews). The aim of the summary was to further reduce and organize the data through paraphrasing and arranging. The qualitative content analysis was the basis for a pooled analysis to filter out key themes and subthemes across all interviews and companies.

In addition to the content-related structuring process (with nominal category systems, Mayring, 2014), each interview was classified by the coders according to certain criteria for subsequent cross-case analysis, that is comparison and contrasting of interviews with an ordinal category system (Livne-Tarandach, 2016; Mayring, 2014). One important criterion was the categorization of the level of TPP as comparatively high or low. TPP was assessed as comparatively high when the employee regularly had many and/or demanding tasks to fulfil in a too restricted time frame. TPP was assessed as comparatively low when the tasks to fulfil and the provided time frame were in a good ratio. For this categorization the appraisal and descriptions of employees were complemented by the assessment and descriptions of the division managers during the structured interviews (second step of the research case study). Another important criterion was successful vs. unsuccessful LAF. It was assessed as successful when coping strategies of LAF were applied and worked; this means that they could be implemented and lead to a reduction of work extension and intensification. LAF was assessed as unsuccessful when strategies of LAF were not applied or, despite of being applied, did not work, because they could not be implemented or did not lead to a notable reduction of work extension and intensification. For determining the intercoder-reliability, Cohens Kappa was calculated for the two criteria separately (κ1 = 1,1 κ2 = .72). With κ being >0.70 intercoder-reliability is satisfactory (Bortz and Döhring, 1995, 254). Discrepancies of assessment were discussed until a consensus could be reached.

Overall, the iterative qualitative content analysis should cover the complexity of the social situations under examination and, at the same time, reduce complexity to filter out the main points (Kohlbacher, 2006). The results of these analyses will be presented in the following section for the preconditions of LAF. First, the results for the pooled analysis across all employee interviews will be given, afterwards results of the cross-case analysis will be shown.


The pooled analysis across all interviews revealed a big variety of characteristics, which employees consider as important for the application and success of LAF (answering research question 1). These characteristics can be organized around key themes and assigned to different levels of (1) the organization, (2) the task, (3) the team, and (4) the employee, which are commonly used levels in organizational culture and climate or work psychology research (Cambré et al., 2012; Chao and Moon, 2005). The following Table 2 gives a first overview about all detected themes and subthemes on the different levels.

Table 2

Different levels with identified key themes and subthemes across interviews and companies.

Key Themes Subthemes

Organizational Level
Structures and procedures Hierarchies and bureaucracy
Terms of employment and personnel policy
Working time and workplace arrangements
Climate of performance Organizational performance expectations
Attitude of management towards employees
Relationships between divisions
Climate of care Offer of professional trainings
Reactions to employees’ overload
Passing on of economic pressure
Task Level
Control at work Autonomy
Time constraints
Role clarity Content of tasks and responsibilities
Expectations on quality of work
Team Level
Proactive coordination Forward-looking work planning
Transparency of task distribution
Possibility of mutual task compensation
Team structure and composition Minimum team size
Homogeneity vs. heterogeneity
Team autonomy
Protective team climate Leadership commitment
Accepted role models and performance standards
Mutual care taking
Employee Level
Experience and development Competencies off the job
Competencies and attitudes on the job
Personal Characteristics Core beliefs and attitudes
Personality Traits
Awareness Performance limits and needs
Work as one life domain among others

Now, each level will be described with its key themes and associated subthemes, which could foster or hinder behaviours of LAF depending on their manifestation (answering research question 2). In doing so, also some examples of concrete behaviours of LAF are given.

Organizational Level

The first identified key theme on the organizational level is “structures and procedures”. As a first subtheme, employees described flat hierarchies and little bureaucracy as helpful for coping behaviours of LAF, such as a reasonable structuring of work or adapting work routines. Pronounced hierarchies and bureaucracy were described as rather hindering because they lead to delayed decisions, many directives, and rigid work procedures. As a second subtheme, the terms of employment and personnel policy were highlighted as crucial for concrete coping behaviours. Permanent contracts and adequate staffing were described as favourable to fixed-term contracts and insufficient staffing because they lead for example to well-functioning teams, thus they are also important for coping with TPP on team level. Permanent contracts help also to have enough individual courage to try out other ways of coping with TPP such as signalling performance-limits or seeking social support. Finally, flexible working time arrangements as well as flexible workplace regulations, such as possibilities for home office, were described as beneficial for LAF when they enable to adapt working time to employees` biorhythm or to do special tasks at more quiet times or places. However, employees are aware of the ambiguity of these flexibilities, because they could also foster behaviours of work extension such as to continue to work at home.

Another key theme on the organizational level is the prevailing “climate of performance”. It comprises, as one important subtheme for LAF, the perceived organizational performance expectations such as expected readiness to invest overtime, engagement, or availability after work. The higher these expectations are, the harder behaviours of LAF could be realized. Another subtheme is the perceived attitude of the management towards its employees, which should be characterized by appreciation and trust as well as involvement in organizational decisions and change. Such an attitude enables behaviours of LAF such as optimizing processes, delegating, or refusing tasks. Finally, the relationships between different organizational divisions were described as important, more specifically if they were perceived as cooperative or rather competing. Cooperative and supportive relationships were described as helpful for LAF, because they lead more easily to a good distribution of work with no need for any extra effort to highlight group or individual performance.

The last identified key theme on the organizational level is the existing or non-existing “climate of care” which becomes visible through different artefacts. First, for employees it makes a difference if the organization not only offers functional professional trainings such as project management or product training but also trainings for coping with TPP or job demands in general such as recovery or mindfulness trainings. Furthermore, it is important how the organization reacts to signals or even clear indicators of overload, if they are taken seriously or rather ignored or even regarded as undesirable. Last, a crucial aspect is to what extent the management passes on economic pressure to its employees or whether and to what extent it acts as a buffer. The perception of a climate of care encourages employees to try out behaviours of LAF such as refusing additional tasks or seeking support from colleagues and supervisors.

Task Level

Concerning the task level “control at work” could be identified as one key theme for LAF. This control includes as one subtheme firstly the task characteristic of autonomy as an important enabler of LAF. Employees need to have the freedom to determine how to perform their tasks, that helps e. g. to set priorities or to adapt work routines. As a second element of control at work, time constraints should be moderate to have some time flexibilities and buffers in task performace. Too many time-bound activities with fixed deadlines or timeframes impede behaviours of LAF. As a last subtheme, dependencies of the task should be rather low, that is, dependencies on input from others or agreements. Too many dependencies reduce the predictability of task performance, which was emphasized as impeding for behaviours of LAF, such as acting and planning proactively.

The second identified key theme on task level is “role clarity”. Employees highlighted two aspects as very important for the possibility and success of LAF. First, employees need to know exactly what activities belong to their task spectrum and what responsibilities they have. The content of tasks and responsibilities has to be clear. Beyond that, the expectations in dealing with these responsibilities have to be clear, such as what behavioural standards exist when dealing with clients or patients. A lack of role clarity strongly impedes possibilities of LAF such as to refuse certain requirements or to prioritize activities.

Team Level

Also, on the team level there are specific characteristics that influence how TPP is dealt with. As a first key theme, “proactive coordination” was identified which comprises as a first subtheme a forward-looking work planning on team level. That means a realistic planning in process chains, considering the contributions of different teams and calculating the time needed (including buffers) until the next step can be fulfilled. Clear agreements on work steps and individual contributions allow a better coordination and thus make individual LAF easier. Transparency of task distribution also belongs to a proactive team coordination. There are different ways to create transparency, for example, by informing about individual workload in regular team meetings or in informal conversations. Transparency on team level makes it easier to detect and prevent individual task accumulation. Last, the possibility of mutual task compensation is important, especially in the case of absence of team members due to vacation or illness or to buffer unexpected extra-tasks.

Second, “team structure and composition” is another important key theme on team level. Depending on team size and structure (homogeneous or diverse tasks within the team) common planning and mutual compensation are facilitated or impeded. For example, it is easier to substitute each other from a certain team size on. In a homogeneous team where team members have similar tasks common planning including mutual agreements and mutual representation in case of absence can be easier than in diverse teams where every team member comes from a different background and is responsible for his or her specific tasks. On the other hand, heterogeneity in competences and preferences can be an advantage for focusing on preferred tasks: in the FIN for example younger team members took over the IT related tasks for their older colleagues, who took over administration-related tasks for their younger colleagues in exchange. Team autonomy points to the dependence on contributions from other teams or persons inside or outside the organization for fulfilling the team task. When the team can decide by itself how to plan its work, frictions at the interfaces are more easily prevented which in turn makes it easier to focus on the key tasks.

Finally, a “protective team climate” is another key theme on team level to support LAF with commitment of team leaders as the first important subtheme. Commitment presupposes that leaders are sensitive to the topic of strain and realize high TPP among individual team members. Furthermore, it is important that they can assess and shape or change sources of TPP (e.g. by improving role clarity or allowing an overarching coordination without getting lost in details) and actively invite their subordinates to use constructive strategies to deal with TPP. Finally, it is relevant that they are ready to intervene and protect team members externally (e.g. towards other teams within the organization or towards external customers). Accepted role models among the leaders as well as among the colleagues who pursue constructive strategies also contribute to a team climate that makes it easier for team members to limit themselves and/or to focus without remorse. Finally, mutual care taking is a central aspect of a protective team climate. Mutual care taking manifests itself by the readiness to take over additional or unpopular tasks when overload of colleagues is obvious. It is based on openness within the team to indicate work overload and to admit personal performance limits which, in turn, needs mutual trust in the engagement of the individual team members and the belief that mutual support would not be misused.

Employee Level

Finally, yet importantly, employees were very aware of their own contributions to their behaviours. In total, three key themes could be identified on the employee level, one of them “experience and development”. First, employees described a wide range of helpful competencies for LAF, which they acquired off the job. They regarded stress or time management trainings or the acquisition of communication and negotiation skills as very helpful. Communication and negotiation trainings, for instance, can help to make restrictions clear or to focus on agreed tasks. Besides, employees described an even broader range of relevant competencies and attitudes that they developed over time on the job. Among other things, they depicted the development of professional self-confidence, reputation, work routines, work-related intuition, or situational serenity as empowering for dealing with TPP through LAF. Broad knowledge and long-term experience within one organization are two aspects that make it easier to address the right people and that allow work that is more autonomous. Growing self-confidence following growing experiences makes it easier to define the own limits.

Furthermore, “personal characteristics” of employees are important. Employees have certain core beliefs and attitudes, which can be helpful or difficult for coping behaviours of LAF. For example, employees who have a fundamentally positive attitude, basic trust in “happy endings” and who believe that they do not have to be perfect, apply more easily behaviours of LAF such as signalling their limits or reducing work quality. On the other hand, employees who believe that they are irreplaceable or that mistakes are a personal failure, have more difficulties with LAF. Closely related to core beliefs and attitudes are personality traits which also have a relevance for LAF. Personality traits, which are basically very positive, like reliability, conscientiousness, or helpfulness sometimes, seem to be a hindrance to distancing oneself from work through LAF.

Finally, “awareness” could be identified as a third key theme. Employees who are aware of their own performance limits and needs seem to apply more easily behaviours of LAF than employees who see their own performance as an inexhaustible resource. In some cases, employees described drastic experiences such as the burnout of a colleague or an illness as triggers for their awareness and for a behavioural change in dealing with TPP. Furthermore, the awareness about work as one life domain among others seems to be a very important factor. Employees who attribute a reasonable importance to work and have lead an overall fulfilled life more easily limit and focus than employees who are extremely committed to work and see their job as their “lifeblood” or “baby”.

Cross-Case Analysis

After the pooled analysis across all interviews and companies, a two-step cross-case analysis wa s performed within the multiple, embedded case study design (Yin, 2003). The cross-case analysis allows us to complement the descriptive results of the pooled analysis by shedding light on the relevance of the depicted preconditions and their interplay across and within levels (answering research questions 3 and 4). First, the four different companies were regarded as cases to identify which special breeding ground they offer for LAF. Second, the interviewed employees within one company were analysed in more detail. Results for both analyses will be presented below.

Cross-Case Company Analysis – Favourable or Unfavourable Preconditions for Limiting and Focusing?

The pooled analysis revealed a wide range of themes across interviews and companies which are important for successful coping behaviours of LAF and which jointly provide a good breeding ground to cope with TPP in a problem-focused way. In the cross-case company analysis for each of the four companies (the institute for ecological research and consulting [ECO], the cultural company [CUL], the financial institution [FIN], and the institution for social-psychiatric services [SOC]) (see section “The research case study”), preconditions for LAF were analysed across levels. For each level within one company, it was assessed what preconditions were similarly described as rather favourable or unfavourable for LAF by the majority of interviewed employees within that company. This analysis also contributes to a clarification of the interrelationship of the four levels (answering research question 3). In addition to that, preconditions that were highlighted by a large part of interviewed employees within one company were identified as central preconditions in that company.

The following Table 3 gives an overview about the assessment of the companies regarding their preconditions for LAF on the different levels.

Table 3

Preconditions for limiting and focusing in the different companies on the different levels.

Favourable Preconditions Unfavourable Preconditions

Organizational Level ECO and SOC CUL and FIN
Task Level ECO and SOC CUL and FIN
Team Level ECO, SOC, and FIN CUL
Employee Level ECO, SOC, FIN, and CUL

Note: ECO = institute for ecological research and consulting, SOC = institution for social-psychiatric services, CUL = cultural company, FIN = financial institution.

On the organizational level there is a high degree of agreement within one company on the description of the factors as beneficial or hindering for LAF. According to these descriptions, there is a clear contrast between preconditions of the ECO and SOC on the one side, and the CUL and FIN on the other side. While employees of the ECO and SOC described preconditions almost exclusively as favourable, employees of the CUL and FIN reported almost exclusively unfavourable ones.

The ECO can be characterized in particular and in contrast to the other companies by supporting structures and procedures, meaning flat hierarchies, as little bureaucracy as possible and extremely flexible working time and working place arrangements. In addition to that, the climate of performance is characterized by a very high level of involvement and appreciation as well as cooperative relationships between the different divisions. In the SOC the climate of performance was also described as positive but especially the climate of care was highlighted in contrast to the other companies. There seems to be a high degree of sensitivity towards the workload of employees, constructive and helpful reactions to overload, and a buffering of economic pressure from top management.

In the CUL and FIN the same themes were picked up on organizational level but in the contrary described as rather hindering for LAF. The CUL is especially characterized by a personnel policy of short fixed-termed contracts for a majority of staff as well as a very unfavourable climate of performance with very high expectations for overtime readiness and availability after work. The FIN can be distinguished in particular by a non-existing climate of care. Economic pressure is passed on to employees resulting in permanent process optimization and management by objectives with little employee involvement and almost only functional professional trainings such as effective project management or product trainings, neglecting the relevance of soft skills and interpersonal relationships.

On the task level the same contrast between the ECO and SOC and the CUL and FIN persists. While in the ECO and SOC rather favourable task conditions were reported, in the CUL and FIN the same task conditions were described, but as almost exclusively unfavourable.

The most critical characteristics for LAF in the CUL were the high mutual dependencies of tasks (within the overall workflow) and high time constraints, meaning tight deadlines and many appointments, which have to be considered for task performance. In the FIN limited autonomy and dependencies of tasks were most problematic for exercising LAF.

In the ECO, on the other hand, autonomy and role clarity were described as very high. In the SOC autonomy and role clarity also play a central role for LAF although some restrictions and some time constraints were described making the contrast to the CUL and FIN a little less clear than on the organizational level.

On the team level only in the CUL mainly unfavourable team preconditions were described, however with exceptions for some teams. As the biggest obstacle for practicing LAF, the lack of a protective team climate was described with very difficult leadership behaviours prevailing as well as high performance standards and lacking role models for LAF within the team. In great contrast to the other companies team autonomy was depicted as rather low and the composition of teams as changing permanently due to the unfavourable personnel policy described on the organizational level.

In the FIN, however, teams seem to buffer the unfavourable organizational preconditions so that the breeding ground on team level can be characterized as predominantly fostering for LAF. A good team cooperation and an existing protective team climate are the main reasons for this shift to helpful preconditions. In the ECO team structures as well as team cooperation were highlighted as very fostering for LAF with an especially high team autonomy and transparency of task distribution. In the SOC above all the very protective team climate was highlighted.

The low contrast between the company cases on team level suggests that teams have the potential to make up for unfavourable organizational conditions and act as separate units within one company, at least to some extent.

Finally, on the employee level a cross-case company contrast can no longer be observed. In all four companies employees can be found who show unfavourable characteristics on individual level as well as those who show favourable characteristics for LAF. No tendency could be found that rather problematic prerequisites for LAF on the other levels (e.g. in the CUL) produce or accumulate more employees with problematic personal characteristics or a low awareness. Therefore, the employee level seems to be largely independent from the other levels.

Cross-Case Interview Analysis – What makes the Difference?

For each employee it was determined (1) whether he or she had to deal with comparatively high or low TPP and (2) whether he or she applied behaviours of LAF successfully or not (see also “Analyses”). To identify central facilitators of LAF, an outlier analysis was performed. We analysed in more detail why some employees did not apply behaviours of LAF successfully despite all other examined cases in the company were doing so, or rather why some employees use behaviours of LAF successfully despite all other interviewees in the company were not doing so. This analysis allows us not only to shed light on the relevance of the preconditions for LAF but also on their interplay. Table 4 shows the distribution of interview cases across the two dimensions level of TPP and success of LAF.

Table 4

Level of time and performance pressure and success of limiting and focusing for the different interview cases.

Cases (interviews) LAF successful LAF not successful

TPP high ECO1, ECO3, ECO4, ECO7, ECO8, ECO10

TPP low ECO5, ECO9

Note: TPP = time and performance pressure, LAF = limiting and focusing, ECO = institute for ecological research and consulting, SOC = institution for social-psychiatric services, CUL = cultural company, FIN = financial institution.

In most cases TPP was high (ECO 8 out of 10, CUL 9 out of 9, SOC 4 out of 9, and FIN 8 out of 8). It is notable that only in the companies with rather favourable preconditions for LAF cases with comparatively low TPP could be found (only in the ECO and especially SOC).

Regarding only the cases with comparatively high TPP, the majority of cases within one company followed a similar pattern concerning the success of LAF. In the ECO and SOC in most respectively all cases LAF was successful with 6 out of 8 cases, 4 out of 4 cases respectively, while in the CUL, and FIN in most cases LAF was not successful with 7 out of 9 cases and 7 out of 8 cases, respectively. However, some outliers could be detected that fell out of the majority pattern: In the cases CUL1, CUL9 and FIN8 LAF was – contrary to all other cases – successful and in the cases ECO2 and ECO5 LAF was – contrary to all other cases – not successful. These outliers are especially interesting for identifying central preconditions for LAF that make a difference (answering research question 4). Thus, they will be analysed in more detail.

Outliers of Unsuccessful Limiting and Focusing – Why?

It is necessary to look in more detail at those two cases where LAF is not successful despite the majority pattern of successful LAF and, on the whole, rather favourable preconditions.

The first outlier ECO2 worked as a researcher in the ecological institute and was involved in many different research projects. In addition to that, he had to perform many administrative tasks in addition to his key tasks. He had a full-time job and a permanent contract.

ECO2 is a case characterized by a completely unsuccessful LAF. He was to a great extent and permanently working overtime, in the evenings as well as on weekends or during vacation. The amount of overtime was so high that a large part of it was uncompensated despite pronounced possibilities for overtime compensation in the company. In addition to the extreme extension of work, he was sometimes working intensively during the working day, especially by working fragmented or doing multitasking. Breaks and social interactions with colleagues took place regularly but led to even more overtime afterwards.

As the main reason for that especially unsuccessful LAF task characteristics could be identified. His job was a combination of project work and a management position and included the involvement in different projects and important administrative tasks. Sometimes, he was involved only to a small extent in a project, and those projects were thematically very heterogeneous. This combination of activities led to many time constraints as well as many dependencies and many “setup costs” for switching between projects, resulting in a drastically reduced control at work. These unfavourable task characteristics for LAF met with other unfavourable characteristics on the team and employee level. He highlighted to often feel responsible for additional work and for relieving his colleagues and to hesitate to seek support in his team because many colleagues had family duties and no full-time job. In the course of the interview, it also became clear that he had a very high commitment for his job and a tendency towards perfectionism.

The second outlier ECO6 worked as management assistant in the ecological institute. She had a wide range of different tasks with many administrative and organizational tasks and was also leader of a small administration team. She had a part-time job and a permanent contract.

She described having tried out many coping behaviours of LAF, such as prioritizing or delegating tasks or organizing working phases without interruptions, but the majority of LAF coping behaviours could not be realized successfully and, in sum, did not reduce work extension and intensification substantially. She emphasized in the interview that she reduced her working time because of the high amount of overtime work. She used her working time reduction as a buffer for overtime and was still doing a full-time job, in her case this means that she was still doing a lot of overtime work. In addition to that, she worked very intensified during working days with fragmented work, multitasking, and especially ad-hoc acting without possibilities for proactive behaviour.

Also, in her case, characteristics of her job could be identified as the main reason for unsuccessful LAF. She had a job with many additional tasks on call and also trouble-shooting responsibilities, which impede long-term planning and forced her to react immediately to short-term requirements. In addition to that, there was often uncertainty about her responsibilities as well as the expected quality of work, which led to reduced role clarity.

In sum, both outliers of unsuccessful LAF had rather unfavourable task characteristics for LAF in contrast to the other cases with successful LAF in the ECO. A considerable reduced control at work because of the job structure was the central problem. Furthermore, both employees acted rather as “lone fighters” in their teams and sought little social support. Unfavourable task characteristics seem to make the difference, intensified by the inconvenient team role.

Outliers of Successful Limiting and Focusing – Why?

To identify preconditions for LAF that play a central role, it is also necessary to look in more detail at those three cases where LAF is successful despite the majority pattern of unsuccessful LAF and, overall, rather unfavourable preconditions, at least on the organizational level.

The first outlier CUL1 worked full-time in controlling in the cultural institution. She had a big area of responsibility in her job, which requires a high level of qualification and experience. As controller, she independently supported designated divisions of the company.

CUL1 is a case with successful LAF. She organized her work carefully, such as through prioritizing and structuring, and focused in a considered way on important and necessary aspects of her job, also by quality cutbacks. In addition to that, she used flexible working time arrangements and possibilities for home office to work in line with her preferences. At times, she was working overtime, but she managed to compensate all overtime by leisure time and took her breaks regularly during working days.

As the main reason for the success of her LAF she described her high job autonomy which comprises not only how to perform her tasks but also how to set the boundary conditions of her job (working time and working place). Her superior who always supported her if necessary but otherwise gave her great freedom and trust played a central role for the success of her LAF.

The second outlier CUL9 worked part time as a project manager in the cultural institution and had a permanent contract.

While CUL9 is a case with overall successful LAF, at the same time it has to be considered as a critical case where the assessment was difficult. She reported a lot of overtime work at times due to project work, difficulties in taking all holidays and very intensified working days with a high work pace, multitasking, and a lack of breaks. Nevertheless, she described a very positive development concerning the extension and intensification of her work, practicing a rigid boundary management, a beneficial adaptation of work routines, and seeking social support from colleagues and supervisors by now.

As the main reason for the meanwhile successful LAF, she identified a pronounced team organization: She worked in a small, established team where every team member had access to all documents and e-mails from the other colleagues. Therefore, her team had a very proactive coordination with a favourable distribution of responsibilities, a very high transparency of task distribution and therefore, pronounced possibilities for mutual task compensation. As the main reason for her rigid boundary management she reported family duties and depicted that it had been a hard process to get acceptance from superiors for this necessity. However, meanwhile, she is an accepted role model with that behaviour.

The third outlier FIN8 worked as a customer consultant in the financial institution. Like many other employees in the FIN he had predefined targets to fulfil in his job, this means in his case that he had to sell a specific amount of products to his customer base. He also reported target loops, meaning that the predefined targets were raised every year.

Nevertheless, contrary to all other cases in the FIN, he limited and focused successfully, reporting nearly no extension or intensification of his work. Like outlier CUL1, he also highlighted his good work organization that he could implement because of his high job autonomy. He planned and structured his work largely autonomously and had high working time flexibility. Like CUL1, he also mentioned his superior as being supportive and granting him a lot of freedom in job performance. He reported having no problems with the rigid management by objectives and described the importance of remaining true to oneself without permanently comparing oneself to others.

In sum, also for the outliers of successful LAF, control at work seems to be the crux of the matter. For this control team colleagues and superiors, who could foster or hinder autonomous task fulfilment and thereby successful LAF, also play a central role.


The pooled analysis across all employee interviews revealed many important themes as preconditions for coping differently with TPP. The themes lie on the different levels of the organization, the task, the team and the employee that are – however – not independent from each other but closely intertwined. The two-step cross-case analysis showed that task characteristics are often the crux of the matter for successful LAF, which demonstrates the centrality of work tasks for the possibility to cope differently, in a healthier way, with TPP. However, work tasks are not independent from the other levels but the core link to the individual (employee), teams and the organization. This primacy of the work task and their social embeddedness in teams and organizations is a long-standing assumption in work psychology and work design research (Frese and Zapf, 1994; Hornung and Höge, 2018; Ulich, 2013) which also seems to apply for coping with TPP. It seems that teams – including team leaders – can make up to a considerable extent for unfavourable conditions on other levels and also influence task characteristics in a positive way.

There are two major topics which can be found across levels as important enablers of LAF, first of them “control at and over work” which is a well established and very important construct in work psychology research (Parker, Morgeson, and Johns, 2017; Sauter, Hurrel, and Cooper, 1989). The theme of control can be found at all levels and it especially shows the intertwining of levels: At the task level, control at work with high autonomy, low dependencies, and few time constraints is crucial for successful LAF. However, this control at work is largely organizationally provided in low hierarchies with little bureaucracy, flexible working time and workplace arrangements, and a managerial attitude towards employees that is characterized by trust and involvement in organizational decisions and change. Therefore, the organizational conditions as the task environment qualify to a great extent the concrete task characteristics (Chao and Moon, 2005). Moreover, control at work is – like other task characteristics – not only “given” and to be seen as a static condition but also expanded and shaped through self-initiated behaviours, individually or together with colleagues and/or superiors (Grant and Parker, 2009). Thus, the team level has a strong link to the task level as well, where team autonomy plays an important role and control at work and role clarity are also enacted together within the team and interpersonally negotiated with superiors (Schwendener, Berset, and Krause, 2017). This shows the importance of currently discussed concepts like team job crafting (Mäkikangas, Bakker, and Schaufeli, 2017) or idiosyncratic deals (Hornung et al., 2010; 2014), which play a complimentary role for the shaping of important task characteristics. Last but not least, also individual task-focused job crafting, which is closely related to employees` characteristics (Bindl et al., 2019), contributes to job design, such as control at and over work. These results go also along with some results in job crafting research where so called supportive job design contexts versus constraining job design contexts for job crafting behaviour are discussed. Supportive job design contexts are characterized by a high degree of autonomy of the employees and freedom to choose their own course of action whereas in constraining job design contexts these freedom and control of action are strongly restricted (Lazazzara, Tims, and de Gennaro, 2020). The results underline the importance of also analysing organisational and task-related factors as prerequisites for (job crafting) coping behaviours besides personal correlates.

The second important theme for successful LAF, which relates to different levels, is the theme of “care”. On the organizational level, a climate of care with adequate reactions of the management to employees` TPP, the buffering of economic pressure and the offer of trainings for employees’ well-being and health is a central element of a fostering breeding ground for LAF. On the team level, a protective team climate represents this central element with mutual support of team members, leadership commitment also for employees` well-being and strain as well as accepted role models and performance standards in dealing with TPP through behaviours of LAF. Finally, employees also have to care for themselves and to be aware of their performance limits and needs as well as of other life domains than work. The theme of care is close to the concept of “social support at work” (Frese, 1989), encompassing instrumental as well as emotional support and a general helpful attitude of individuals, colleagues and superiors towards overload and strain. It also bears much resemblance with the concept of “organizational health climate” (Zweber, Henning, and Magley, 2016), which is considered to emerge from interactions between co-workers and with immediate supervisors but also from structural aspects. In sum, it is believed to emerge out of a combination of employee interactions with others as well as interactions with objective policies, which also make underlying values and behavioural norms visible (Schneider and Reichers, 1983). Regarding organizational climate there is also a discussion in job crafting research about supportive contexts, containing high social support and a proactive-oriented organizational culture, versus constraining contexts with low social support and little cooperation (Gascoigne and Kelliher, 2018; Lazazzara, Tims, and de Gennaro, 2020). This once again underlines not only the importance of (mutual) care but also organizational contextual factors formed by interactions of the employees with each other and the organization.

Just as the different levels with their themes are not independent from each other, some important factors for successful LAF are not selective from the reasons of TPP; this means factors, which lead to TPP in the first place. For example, inadequate staffing within an unfavourable personnel policy or a climate of performance with benchmarking between divisions or high performance expectations are prominent reasons for TPP but at the same time, important factors for dealing with TPP through behaviours of work extension and intensification, prohibiting LAF. Therefore, there is not only an interplay between levels and themes but there are also overlaps between important factors for LAF and reasons for TPP.

Moreover, there seem not to be a simple “the more, the better” relation for many characteristics that have been described or one “right dose” for every context and every employee. For example, bureaucracy in the form of standardized processes can be an extra-burden and extremely hindering for LAF when it requires excessive documentation, slows down decisions or leads to a considerably reduced control at work. On the other hand, some standardization can facilitate focusing and be a very helpful orientation, especially for those employees who coordinate processes or bring information together. A protective team climate and helpfulness of individual team members are prerequisites for an open discussion about task distribution to detect individual overload and to distribute tasks fairly. On the other hand, a very high identification with the team and very pronounced helpfulness can also lead to a high readiness to overburden oneself in favour of team goals and other team members, like in the case of ECO2. Working time and workplace arrangements also bear ambiguities: A rigid regulation of working time and workplace practices can be extremely hindering for a focused task performance when this regulation prohibits for example the adaptation of task fulfilment to individual needs and preferences or the prevention of interruptions at work. On the other hand, very flexible working time and workplace arrangements can lead to an extended availability for work and permeable boundaries between work and private life. Therefore, a context-specific and subjective optimum of characteristics for a successful LAF can be assumed, which demonstrates the important interaction between the employees and their tasks on the one side and the organization and team on the other side. However, the results of our study clearly indicate if special characteristics should be rather high or low for successful LAF, such as rather high than low task autonomy, rather flexible than inflexible working time regulations and so on, providing some directions for the design of jobs, teams, and organizations, as well as human resource development.

Practical Implications

The results suggest several starting points on the different levels to provide a good breeding ground for LAF. First, fostering structures and procedures on the organizational level as well as fostering task characteristics can be provided through activities of job and task design, such as the reduction of unnecessary bureaucracy, the provision of some working time and workplace flexibility or the reduction of dependencies and the provision of task autonomy. Besides, the organizational climate has a high importance and a helpful climate of performance as well as climate of care should be sought. Therefore, “hard” (structural) as well as “soft” (climatic) factors should be optimized side by side through appropriate interventions.

The same holds true for the team level, where structures and procedures are important with a proactive coordination of work and a good team composition and team autonomy, but a protective team climate is just as important. Structural as well as cultural team development activities can be used to optimize both kinds of factors.

Finally, yet importantly, employees with their experiences, beliefs, and attitudes are important as team and organizational members as well as individuals. Activities of human resource development off and especially on the job, such as mentoring or coaching programs but also trainings on stress, time, or recovery management can be applied to develop important competencies. Beyond that, trainings on personality development or self-awareness, at least self-reflection, can be offered to detect core beliefs and attitudes, which are problematic for successfully practicing LAF.

Limitations and Future Research Directions

The design of our study consisted of research case studies with successive research steps using different interview methods in various companies. To make the research process more transparent, some aspects will be described in more depth (Tong, Sainsbury, and Craig, 2007). Concerning reflexivity, both researchers had experience in doing qualitative research, are female, have a psychological background, but are not involved in the specific occupational backgrounds that have been studied and had no relationship with participants. The transferability of our results is enhanced by the case study design in real-company contexts, which should make it easier to understand the complexity of processes behind successful LAF. However, our sample consisted only of highly skilled employees who performed knowledge or service work. Studies in other segments of employment might discover a different set of factors relevant for dealing with TPP through LAF.

The iterative qualitative content analysis of the interview material combined pooled deductive and inductive analysis, cross-case comparisons and the interpretation of outliers. This procedure allowed us to gain a deep insight into the prerequisites for constructive strategies of dealing with TPP in organizational settings on different levels that go much beyond the individual assessment of helpful conditions and barriers. Concerning the credibility of our results, the category system was developed by two researchers, 29 interviews were coded and analysed by both of them, intercoder reliability was checked and disagreements were resolved in mutual discussion. Only categories for which a saturation of data did occur over the interview cases were included in the analysis. Regarding the conformability of our results, all information was processed and systematized in MAXQDA. Verbal information such as preliminary discussions were recorded and all employee interviews were transcribed. Category definitions and codings were carried out in MAXQDA which allowed to make the coding process transparent. Information from different methods (preliminary discussions, structured interviews, document analysis, and semi-structured interviews) was used to enhance credibility in the sense of triangulation (Yin, 1999). Furthermore, results were presented to all companies in a final workshop session. Nonetheless, the interpretations are based on interviews, mainly on the employee interview study. Although there was a high accordance across interviews, concerning the key themes and subthemes on the different levels, there might be some aspects employees were not aware of when thinking about their working conditions. Therefore, complementary observational analyses might be fruitful, which, however, was beyond the scope of our study. Important external conditions of the organizations that lay on a macro- or system-level, such as the interest rate policy for the financial institution or health system policies for the institution for social-psychiatric services, were rather seldom reflected. They were not considered in the analyses due to an already high complexity of analyses and the low possibility for organizational influence on those conditions. Nevertheless, those external conditions might be very important for the conditions on the organizational level and should be covered in future studies. Finally, yet importantly, specific single behaviours of LAF, such as prioritizing or delegating tasks, negotiating quality expectations, or proactive planning, and their relationships to relevant preconditions should be worked out in more detail.


There are different ways of how employees deal with TPP in everyday working life. Widespread coping behaviours of work extension and intensification such as working overtime, working at a high pace or skipping breaks may be functional for work performance, but can threaten employee well-being and health. Therefore, alternative coping behaviours of LAF such as prioritizing tasks, adapting work routines or reducing interruptions at work should be fostered. Employees need a range of conditions on different levels for being able to apply those alternative ways of coping successfully. Structural as well as climatic factors should be optimized jointly to provide a good breeding ground for a successful LAF, which, in turn, sometimes lead to a reduction of TPP itself, and reduces rather maladaptive coping behaviours of work extension and intensification. The interplay of the different levels – organization, team, task and employee – has to be considered for work and team design as well as for activities of personnel development and organizational and team climate development.

Additional Files

The additional files for this article can be found as follows:

Appendix 1

Interview Guide. DOI:

Appendix 2

Sample Quotations. DOI:


1Analyzing coping strategies with TPP was one aim of this study. Thus, those cases with comparatively high TPP are overrepresented in the sample (only 6 out of 29 jointly evaluated cases were classified as low TPP). This selection bias has to be considered when interpreting the high agreement on this variable (κ1=1). For the other variable positive and negative cases (κ2: successful vs. unsuccessful LAF) were distributed more equally. 

Competing Interests

The authors have no competing interests to declare.


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