Psychometric properties and cut-off scores for the Swedish version of the Negative Acts Questionnaire: The full scale and short version.

The present study investigates the psychometric properties and cut-off scores of a Swedish version of the Negative Acts Questionnaire, the most frequently used instrument to measure exposure to workplace bullying. Based on a probability sample of the Swedish workforce (n = 1853), we investigate the validity of both the full version (NAQ-R) and the short version (SNAQ). We suggest optimal cut-offs for the NAQ-R and SNAQ, and for the subscales measuring work- and person-related bullying. Based on the cut-off scores we provide estimates of prevalence in a Swedish context. The factor structure and psychometric properties are comparable to the Norwegian original and the English versions of the instrument. We also tested the criterion validity using 11 outcome and antecedent variables to bullying, and all provided support for its validity. The identified cut-off scores differentiate clearly when tested against the 11 variables used to test criterion validity in the study. The results showed that the Swedish version of the NAQ-R, including the SNAQ, is a valid measure of workplace bullying. To our knowledge, this study is the first study presenting statistical cut-offs for the NAQ-R subscales as well as investigating both the NAQ-R and the SNAQ simultaneously. The present study also provides some criticism against and suggestions for improving the NAQ-R, aiming to capture even more of the overall experience of exposure, ability to defend oneself, overall duration, and on- and offline exposure.

Witnessing workplace bullying - protocol for a systematic review and meta-analysis of individual health and well-being outcomes.

BACKGROUND: Most research on workplace bullying has examined the impact of the mistreatment on those exposed. Although bullying also is assumed to have significant ripple effects on bystanders, the empirical evidence for this line of research is highly fragmented and inconclusive. The overarching aim of this planned systematic review and meta-analysis is therefore to determine whether witnessing bullying of others at the workplace is associated with health problems and lower well-being among the observers. To achieve this aim, the review includes an assessment of which theoretical frameworks and methodological designs used in research so far and shed light on which confounders, mediators, and moderators that have been accounted for. METHODS: A systematic review and meta-analysis will be conducted. Electronic databases will be searched using pre-defined search terms to identify relevant studies. Eligible studies should report empirical findings on any individual outcome variable assessed among witnesses to workplace harassment and bullying or any overlapping concept. Primary observational studies with cross-sectional or prospective research design, case-control studies, and studies with experimental designs will be included. Qualitative interviews and case studies will be excluded. The methodological quality of the included studies will be assessed with a previously established checklist for studies on workplace bullying. The quality of evidence for an association between witnessing bullying and potential outcomes will be evaluated in accordance with the GRADE system. A random effects meta-analysis will be conducted with the Comprehensive Meta-Analysis software, version 3. DISCUSSION: We expect that findings on outcomes of bystanding to workplace bullying will provide practitioners with an understanding of the effects workplace bullying may have also on non-targets and the workplace as a whole. Such information is important regarding the development and implementation of effective measures and interventions against bullying. In addition, the review will increase our understanding of existing research gaps and enable us to make recommendations to address them. Our work aligns with the sustainable development agenda to protect workers and reduce inequalities at the workplace. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 342006.

When the Going Gets Tough and the Environment Is Rough: The Role of Departmental Level Hostile Work Climate in the Relationships between Job Stressors and Workplace Bullying.

In line with the work environment hypothesis, the present study investigates whether department-level perceptions of hostile work climate moderate the relationship between psychosocial predictors of workplace bullying (i.e., role conflicts and workload) and exposure to bullying behaviours in the workplace. The data were collected among all employees in a Belgian university and constitutes of 1354 employees across 134 departments. As hypothesized, analyses showed positive main effects of role conflict and workload on exposure to bullying behaviours. In addition, the hypothesized strengthening effect of department-level hostile work climate on the relationship between individual-level job demands and individual exposure to bullying behaviours was significant for role conflict. Specifically, the positive relationship between role conflict and exposure to bullying behaviours was stronger among employees working in departments characterized by a pronounced hostile work climate. In contrast to our predictions, a positive relationship existed between workload and exposure to bullying behaviours, yet only among individuals in departments with low hostile work climate. These findings contribute to the bullying research field by showing that hostile work climate may strengthen the impact of role stress on bullying behaviours, most likely by posing as an additional distal stressor, which may fuel a bullying process. These findings have important theoretical as well as applied implications.

Mapping of pituitary stress-induced gene regulation connects Nrcam to negative emotions.

Environmental stressors such as repeated social defeat may initiate powerful activation of subconscious parts of the brain. Here, we examine the consequences of such stress (induced by resident-intruder paradigm) on the pituitary gland. In male stressed vs. control rats, by RNA- and bisulfite DNA sequencing, we found regulation of genes involved in neuron morphogenesis and communication. Among these, Neuronal cell adhesion molecule (Nrcam) showed reduced transcription and reduced DNA methylation in a region corresponding to intron 1 in human NRCAM. Also, genetic variability in this area was associated with altered stress response in male humans exposed to repeated social defeat in the form of abusive supervision. Thus, our data show that the pituitary gene expression may be affected by social stress and that genetic variability in NRCAM intron 1 region influences stress-induced negative emotions. We hope our shared datasets will facilitate further exploration of the motions triggered by social stressors.

Healing the wounds of workplace bullying: Evaluating mental health and workplace participation among victims seeking treatment for common mental disorders.

BACKGROUND: Victims of workplace bullying represent a group characterised by severe negative health complaints at risk of losing their foothold in working life. To date, very few studies have investigated the effect of psychological treatment of the health-related problems often facing victims of bullying. OBJECTIVE: The aim was to investigate if victims of workplace bullying suffering from common mental disorders (CMD) benefit from clinical treatment for their mental health problems at an outpatient clinic treating patients using Metacognitive or Cognitive Behavioural Therapy with work-focus. Criteria were symptom reduction and change in workplace participation. Comparisons were made between the victims of workplace bullying with CMD, a wait-list control group consisting of patients who had also been exposed to bullying yet now awaiting treatment, and other patients not exposed to bullying. METHODS: The sample comprised of 405 patients from an outpatient clinic in Norway. The study used a naturalistic observational design and data was collected pre-treatment and post-treatment. RESULTS: The results showed the treatment to be effective in symptom reduction for victims of bullying to a similar degree as patients otherwise not exposed to bullying. Even more, victims receiving treatment had a larger improvement compared to the wait-list control group (p < 0.001). Yet, among patients on sick leave pre-treatment, fewer victims of bullying were fully working by the end of treatment compared to the patients not exposed to workplace bullying. CONCLUSION: The findings provide ground for optimism for this treatment as an efficient way of dealing with the aftermath of workplace bullying.

Assessing Workplace Bullying and Its Outcomes: The Paradoxical Role of Perceived Power Imbalance Between Target and Perpetrator.

This study investigates the role of perceived power relation between target and perpetrator regarding victimization and turnover intent following exposure to bullying behavior at the workplace. We hypothesized that (1) targets of bullying behavior who self-label as victims experiences a larger power imbalance with the perpetrator compared to targets who do not self-label as victims, and (2) that the association between exposure to bullying behavior and intent to leave the job is stronger when there is power balance between target and perpetrator than when there is a power imbalance. The hypotheses were tested in a probability sample of employees working in the child welfare service in Oslo municipality, Norway, and that had been exposed to at least one instance of mistreatment from a colleague at their workplace (N = 374). Targets of bullying behavior whom self-labeled as victims reported a larger power imbalance with the perpetrator. Supporting the study hypothesis, and representing a reverse buffering effect, exposure to bullying behavior was most strongly associated with intent to leave among targets in power balance with the perpetrator. For targets in a perceived power imbalance, both low and high exposure to bullying behavior were associated with higher levels of intent to leave. These findings highlight the importance of implementing measures directed at preventing bullying and other forms of mistreatment, irrespective of the power relation between the two parties.

The influence of target personality in the development of workplace bullying.

The Victim Precipitation Theory states that people may exhibit certain characteristics or behaviors that may act as vulnerability factors for either being picked as a target or for provoking others, hence contributing to escalate an underlying conflict and then increase the risk of victimization from others. In line with this, previous research indicates that certain target personality characteristics may be risk factors for exposure to workplace bullying, particularly so trait-anxiety and trait-anger. The evidence is, however, mainly cross-sectional, and longitudinal studies are needed. In addition, previous research studied exposure to bullying behaviors rather than the development of workplace bullying. The aim of the present study was to investigate the role of personality in the development of workplace bullying, by looking at latent transitions across latent states of bullying exposure as a function of target trait-anxiety and target trait-anger. Data were collected in 2015-2016 among Romanian workers, at eight different measurement points over 6 months. Altogether, 300 respondents were included. Data were analyzed using a three-step latent Markov model. In the first step the statistical optimal number of latent classes or states were estimated, being "Not bullied," "Limited negative encounters," "Occasionally bullied," and "Severely bullied". In the second step, we modeled a latent class Markov model. In the third step, we added personality traits to the Markov chain and found that employees with trait-anxiety and trait-anger reported higher levels of bullying exposure at baseline, as hypothesized. Moreover, these personality traits were related to the subsequent development of bullying over time. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Workplace bullying increases the risk of anxiety through a stress-induced ß2-adrenergic receptor mechanism: a multisource study employing an animal model, cell culture experiments and human data.

OBJECTIVES: Several studies show that severe social stressors, e.g., in the form of exposure to workplace bullying in humans, is associated with negative mental health effects such as depression and anxiety among those targeted. However, the understanding of the underlying biological mechanisms that may explain the relationship between exposure to bullying and such negative health outcomes is scarce. The analyses presented here focus on understanding the role of the ß2-adrenergic receptors (ADRB2) on this association. METHODS: First, a resident-intruder paradigm was used to investigate changes in circulating norepinephrine (NE) in rat serum induced by repeated social defeat and its relationship with subsequent social behavior. Second, the direct effects of the stress-hormones NE and cortisol, i.e., synthetic dexamethasone (DEX), on the ADRB2 expression (qPCR) and monocyte chemoattractant protein-1 (MCP-1) release (immunoassay) was examined in cultured EL-1 cells. Third, in a probability sample of 1052 Norwegian employees, the 9-item short version of the Negative Acts Questionnaire-Revised (S-NAQ) inventory, Hopkins Symptom Checklist and genotyping (SNP TaqMan assay) were used to examine the association between social stress in the form of workplace bullying and anxiety moderated by the ADRB2 genotype (rs1042714) in humans. RESULTS: The present study showed a clear association between reduced social interaction and increased level of circulating NE in rats previously exposed to repeated social defeat. Parallel cell culture work, which was performed to examine the direct effects of NE and DEX on ADRB2, demonstrated ADRB2 downregulation and MCP-1 upregulation in cultured EL-1 cells. Genotyping with regard to the ADRB2 genotype; rs1042714 CC vs CG/GG, on human saliva samples, showed that individuals with CC reported more anxiety following exposure to bullying behaviors as compared to the G carriers. CONCLUSION: We conclude that workplace bullying promotes anxiety and threaten well-being through an ADRB2 associated mechanism.

Associations between exposure to workplace bullying and insomnia: a cross-lagged prospective study of causal directions.

OBJECTIVE: Workplace bullying has been established as a significant correlate of sleep problems. However, little is known regarding the causal direction between bullying and sleep. The aim of this study was to examine temporal relationships between bullying and symptoms of insomnia. METHODS: Reciprocal and prospective associations between exposure to workplace bullying and symptoms of insomnia were investigated in a national probability sample comprising 1149 Norwegian employees. Data stemmed from a two-wave full panel survey study with a 6-month time interval between the baseline and follow-up assessments. Models with stabilities, forward-, reverse-, and reciprocal associations were tested and compared using Structural Equation Modelling. Analyses were adjusted for age, gender, and the stability in the outcome variables over time. Workplace bullying was assessed with the nine-item Short Negative Acts Questionnaire. Insomnia was assessed with a previously validated three item scale reflecting problems with sleep onset, sleep maintenance, and early morning awakening. RESULTS: The forward association model, which showed that exposure to workplace bullying prospectively increased levels of insomnia (b = 0.08; p < 0.001), had best fit with the data [CFI = 0.94; TLI = 0.93; RMSEA = 0.049 (0.046-0.052)]. The reverse association model where insomnia influences risk of being subjected to bullying was not supported. CONCLUSION: Workplace bullying is a risk factor for later insomnia. There is a need for further studies on moderating and mediating variables that can explain how and when bullying influence sleep.

Killing two birds with one stone: how intervening when witnessing bullying at the workplace may help both target and the acting observer.

OBJECTIVE: This study examines under which conditions being an observer of bullying can be detrimental to health and well-being. It was hypothesized that health-related problems following observations of bullying are determined by (1) whether the observer has been exposed to bullying her/himself and (2) whether the observer have tried to intervene in the bullying situation that they witnessed. METHODS: The study was based on a longitudinal probability survey of the Swedish workforce, with an 18-month time lag between assessment points (N = 1096). RESULTS: Witnessing bullying at work were associated with an increase in subsequent levels of mental distress among the observers, although this association became insignificant when adjusting for the observers' own exposure to bullying. Intervening against bullying moderated the relationship between observations of bullying and mental health problems. Observers who did not try to intervene reported a significant increase in mental health problems at follow-up, whereas there were no significant changes in levels of mental health problems among those who did intervene. CONCLUSIONS: the findings suggest that observer interventions against bullying may be highly beneficial for both the targets and observers of bullying. Organizations should therefore invest in ways to increase constructive bystander behavior in negative social situations at the workplace.

Clinical Characteristics of Patients Seeking Treatment for Common Mental Disorders Presenting With Workplace Bullying Experiences.

BACKGROUND: Targets of workplace bullying tend to develop severe mental health complaints, having increased risk of sick leave and expulsion from the workplace. Hence, these individuals are likely to be overrepresented among patients seeking treatment for common mental disorders (CMD). This study investigated the prevalence of exposure to workplace bullying in a patient group seeking treatment for CMD. Further we explored if exposed and non-exposed patients differed on clinical and work-related characteristics. METHODS: The sample comprised of 675 patients from an outpatient clinic in Norway and consisted of 70% women and had a mean age of 39 (SD = 10.5) years. The study had a cross-sectional design and differences between the patient groups were analysed using chi-square, Mann-Whitney U-tests and independent sample t-tests. RESULTS: The prevalence of exposure to bullying was 25.8%. The patients exposed to bullying reported significantly more major depressive disorders (MDDs) measured with the MINI psychiatric interview, higher levels of depressive symptoms, anxiety symptoms, subjective health complaints, alcohol use, and lower resilience as measured with questionnaires. Twice as many were on full-time sick leave, reported lower work ability, lower return to work self-efficacy, and lower job satisfaction. A majority preferred another job than the one they have today over returning to their current employment. CONCLUSION: Victims of workplace bullying are a vulnerable group at risk of expulsion from working life, being overrepresented among patients seeking mental health treatment for CMD. One in four patients represented with such experience have higher levels of psychological symptoms and are more often diagnosed with depression as compared to other patients. Thus, this is a problem that should be addressed in clinical settings. If not addressed there is an increased risk of sick leave and permanent exclusion from working life.

Outcomes of a Proximal Workplace Intervention Against Workplace Bullying and Harassment: A Protocol for a Cluster Randomized Controlled Trial Among Norwegian Industrial Workers.

Background: Workplace bullying is an important and prevalent risk factors for health impairment, reduced workability and lowered efficiency among both targets and observers. Development and tests of effective organizational intervention strategies are therefore highly important. The present study describes the background, design, and protocol of a cluster randomized controlled trial evaluating the effectiveness of an organization-wide intervention on preventing workplace bullying with a focus on promoting active and constructive bystander behavior. The main overarching goal is to develop an easy to use and standardized organizational intervention based on theory and research in the role of bystanders in bullying situations with the potential of reducing the prevalence of workplace bullying. The theoretical framework of the study is theory of planned behavior (TPB; Ajzen, 1991).Methods/Design: Using a full randomized control trial (RCT) design, this project will empirically test the outcomes of an intervention program targeting bullying and harassment as the main distal outcomes and perceived behavioral control and helping behavior among bystanders as the main proximal outcome. A 1-year cluster randomized controlled design will be utilized, in which controls will also receive the intervention. About 1,500 workers from two different locations of a Norwegian industrial company will be randomized into one intervention group and two control groups with at least 400 workers in each group. A survey will be conducted electronically. With a total of three assessments over 10­12 months, the time interval between the measurement times will be 4 months. Thus, the data collection will take place at baseline, completion of the intervention and at 4 months follow-up.Discussion: This study primarily aims to develop, implement, and evaluate an intervention based on the abovementioned features with the ultimate aim of reducing the prevalence of workplace bullying, by awareness raising and training of bystanders. Manager involvement and involvement of the union representative and the elected health and safety representatives is an important feature of the program. Results of the intervention study will provide important information regarding the effectiveness of preventive interventions against workplace bullying when focusing on bystanders, particularly so regarding the role of bystander awareness, bystander self-efficacy, and bystander behavioral control on the one hand and the prevalence of bullying and harassment on the other.

Repeated social defeat promotes persistent inflammatory changes in splenic myeloid cells; decreased expression of ß-arrestin-2 (ARRB2) and increased expression of interleukin-6 (IL-6).

BACKGROUND: Previous studies suggest that persistent exposure to social stress in mammals may be associated with multiple physiological effects. Here, we examine the effects of social stress in rats, i.e. repeated social defeat, on behavior, hypothalamic-pituitary-adrenal (HPA)-axis and immune system. METHODS: A resident-intruder paradigm, where an intruder rat was exposed to social stress by a dominant resident rat for 1 hour each day for 7 consecutive days was used. The day after the last stress exposure in the paradigm the data were analyzed. Variation in social interaction was observed manually, whereas locomotion was analyzed off-line by a purpose-made software. Gene expression in the pituitary gland, adrenal gland and myeloid cells isolated from the spleen was measured by qPCR. RESULTS: The exposure to social stress induced decreased weight gain and increased locomotion. An increased nuclear receptor subfamily group C number 1 (NR3C1) expression in the pituitary gland was also shown. In myeloid cells harvested from the spleen, we observed decreased expression of the ß2-adrenergic receptor (ADRB2) and ß-arrestin-2 (ARRB2), but increased expression of interleukin-6 (IL-6). Subsequent analyses in the same cells showed that ARRB2 was negatively correlated with IL-6 following the stress exposure. CONCLUSION: Our results show that that the experience of social stress in the form of repeated social defeat in rats is a potent stressor that in myeloid cells in the spleen promotes persistent inflammatory changes. Future research is needed to examine whether similar inflammatory changes also can explain the impact of social stress, such as bullying and harassment, among humans.

Accumulated Long-Term Exposure to Workplace Bullying Impairs Psychological Hardiness: A Five-Year Longitudinal Study among Nurses.

Personality has been hypothesized to act as antecedent as well as an outcome of workplace bullying. Still, investigations on the longitudinal relationship between bullying and personality are scarce. We investigated the relationship between accumulated exposure to bullying at work and subsequent changes in psychological hardiness. Additionally, we examined whether hardiness predicted subsequent exposure to bullying. The data were based on the Survey of Shiftwork, Sleep, and Health (SUSSH), a cohort study with annual surveys among Norwegian nurses. The participants who completed standardized instruments measuring exposure to bullying behavior at T1 (2008/09) to T4 (2012) and psychological hardiness at T1 (2008/09) and T5 (2012) were included (n = 938). The results showed that accumulated exposure to bullying (sum of exposure from T1-T4) was associated with reduced psychological hardiness at T5, adjusted for age, sex, and hardiness at baseline (ß = -0.16, t = -5.70, p < 0.001). Accumulated exposure to bullying behaviors explained 2.3% of the change in hardiness. Less hardy individuals experienced higher levels of subsequent exposure to bullying behaviors, adjusted for age, sex, and bullying at baseline (ß = -0.04, t = -2.21 p < 0.05). Long-term accumulated exposure to bullying behaviors seemed to be a stronger predictor for changes in hardiness as compared to hardiness in predicting exposure to bullying.

Job Demands as Risk Factors of Exposure to Bullying at Work: The Moderating Role of Team-Level Conflict Management Climate.

Conflict management climate is an important organizational resource that is theorized to prevent interpersonal frustration from escalating into harsh interpersonal conflicts and even workplace bullying. The present study investigates whether team-level perceptions of conflict management climate moderate the relationship between previously investigated psychosocial predictors of workplace bullying (i.e., role conflicts, workload, cognitive demands) and perceived exposure to bullying behaviors in the workplace. We collected data from crews on ferries operating on the Norwegian coastline consisting of 462 employees across 147 teams. As hypothesized, multilevel analyses showed positive main effects of role conflict and cognitive demands (but not workload) on exposure to bullying behaviors. Also, the hypothesized moderation effect of team-level conflict management climate on the relationship between individual-level job demands and exposure to bullying behaviors was significant for role conflict and cognitive demands, but not for workload. Specifically, the positive relationships between the two job demands and exposure to bullying behaviors were stronger for employees working in teams with a weak (vs. a strong) conflict management climate. These findings contribute to the bullying research field by showing that conflict management climate may buffer the impact of stressors on bullying behaviors, most likely by preventing interpersonal frustration from escalating into bullying situations.

Exposure to Workplace Bullying, Distress, and Insomnia: The Moderating Role of the miR-146a Genotype.

Several lines of evidence show that systematic exposure to negative social acts at the workplace i.e., workplace bullying, results in symptoms of depression and anxiety among those targeted. However, little is known about the association between bullying, inflammatory genes and sleep problems. In the present study, we examined the indirect association between exposure to negative social acts and sleep through distress, as moderated by the miR-146a genotype. The study was based on a nationally representative survey of 1179 Norwegian employees drawn from the Norwegian Central Employee Register by Statistics Norway. Exposure to workplace bullying was measured with the 9-item version of Negative Acts Questionnaire - Revised (NAQ-R) inventory. Seventeen items from Hopkins Symptom Checklist (HSCL-25) was used to measure distress. Insomnia was assessed with three items reflecting problems with sleep onset, maintenance of sleep and early morning awakening. Genotyping with regard to miR-146a rs2910164, previously linked to inflammatory processes, was carried out using Taqman assay. The data revealed that individuals systematically exposed to negative social acts at the workplace reported higher levels of sleep problems than non-exposed individuals. Moreover, the relationship between distress induced by exposure to negative social acts and insomnia was significantly stronger for individuals with the miR-146a GG genotype. Thus, the miR-146a genotype moderated the association between distress and insomnia among individuals exposed to negative social acts. The present report support the hypothesis that inflammation could play a role in stress-induced insomnia among individuals exposed to workplace bullying.

Dispositional Affect as a Moderator in the Relationship Between Role Conflict and Exposure to Bullying Behaviors.

Stressors in the work environment and individual dispositions among targets have been established separately as antecedents and risk factors of workplace bullying. However, few studies have examined these stressors in conjunction in order to determine personal dispositions among targets as possible moderators in the work stressor-bullying relationship. The aim of the present study was to examine multiple types of dispositional affect among targets as potential moderators in the relationship between role conflict and exposure to bullying behaviors, employing two independent cross-sectional samples. The first sample comprised 462 employees from a Norwegian sea transport organization, where trait anger and trait anxiety were included moderators. The second sample was a nationwide probability sample of the Norwegian working population and comprised 1,608 employees randomly drawn from The Norwegian Central Employee Register, where positive and negative affect were included moderators. The results showed that trait anger, trait anxiety, and negative affect strengthened the positive relationship between role conflict and reports of bullying behaviors. Positive affect did not moderate this relationship. We conclude that the association between role conflict and bullying is particularly strong for those scoring high on trait anger, trait anxiety, and negative affect.

Protocol for a systematic review and meta-analysis of research on the associations between workplace bullying and sleep.

BACKGROUND: Existing evidence on the association between exposure to bullying and sleep is limited and inconclusive. The aims of this planned systematic review and meta-analysis are therefore (1) to determine whether exposure to workplace bullying is related to changes in sleep function and (2) to establish mediating and moderating factors that govern the relationship between bullying and sleep. METHODS: A systematic review and meta-analysis will be conducted. Electronic databases will be searched using predefined search terms to identify relevant studies. Eligible studies should report empirical findings on the association between exposure to workplace bullying and at least one indicator of sleep. Primary observational studies with cross-sectional or prospective research design, case-control studies, and studies with experimental designs will be included. Qualitative interviews and case studies will be excluded. The methodological quality of the included studies will be assessed with a previously established checklist for studies on workplace bullying. The quality of evidence for an association between bullying and sleep problems will evaluated in accordance with the GRADE system. A random effects meta-analysis will be conducted with the Comprehensive Meta-Analysis software, version 3. DISCUSSION: This review and meta-analysis will be among the first to systematically explore and integrate the evidence available on the association between exposure to bullying and sleep, as well as on the mediating and moderating factors that can govern this associations. By gathering and summarizing information about potential factors that can explain when and how bullying is related to sleep, the findings from this study will provide directions for future research and provide practitioners and clinicians with an understanding about the nature and consequences of workplace bullying and point to directions for relevant interventions. SYSTEMATIC REVIEW REGISTRATION: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018082192 ).

Does Ability to Defend Moderate the Association between Exposure to Bullying and Symptoms of Anxiety?

In the context of workplace bullying, the ability to defend refers to whether or not a target feels able to deal with those negative behaviors that typically constitute bullying. The aim of this study was to determine whether the perceived ability to defend oneself moderates the association between exposure to bullying behaviors at work and symptoms of anxiety as predicted by the definition of workplace bullying. It was hypothesized that exposure to bullying behaviors would be more strongly related to symptoms of anxiety among targets feeling unable to defend oneself than among targets who do feel that they are able to defend themselves in the actual situation. This survey study was based on a probability sample of 1,608 Norwegian employees (response rate 32%). Only respondents exposed to at least one bullying behavior were included (N = 739). In contrast to hypothesis, the findings showed that ability to defend only had a protective effect on the relationship between exposure to bullying behaviors and anxiety in cases of low exposure. In cases of high exposure, there was a stronger increase in anxiety among employees able to defend themselves than among those who generally felt unable to defend. Hence, the ability to defend against exposure to bullying behaviors does not seem to protect high-exposed targets against symptoms of anxiety. Organization should therefore intervene against bullying in early stages rather than relying on the individual resilience of those exposed.