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Standardized multimodal intervention for stress-induced exhaustion disorder: an open trial in a clinical setting
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.ORCID iD: 0000-0002-4000-2866
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.ORCID iD: 0000-0002-1722-3505
Mid Sweden Univ, Dept Psychol & Social Work, Kunskapens Väg 1, SE-83140 Östersund, Sweden.
Karolinska Inst, Dept Clin Neurosci, Tomtebodavägen 18A, SE-17176 Stockholm, Sweden.ORCID iD: 0000-0002-1019-0245
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2020 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 20, no 1, article id 526Article in journal (Refereed) Published
Abstract [en]

Background

Long-term sick-leave due to stress-related ill-health is increasing in several economically developed countries. Even though different forms of interventions are administered in regular care for stress-related disorders, such as Stress-induced Exhaustion disorder (SED), the scientific evidence for the effectiveness of such treatments is sparse. The objective of this study was to explore changes in SED-symptoms and return-to-work-rates in a large group of SED-patients participating in a standardized Multimodal intervention (MMI) in a clinical setting.

Method

This open clinical trial tracked 390 patients who fulfilled the criteria for SED undergoing a 24-week MMI, including return-to-work-strategies. Before inclusion, all patients underwent a multi-professional assessment by a team of licensed physicians, licensed psychologists, and licensed physiotherapists. Self-rated questionnaires were administered before treatment, at treatment-start, mid-treatment, post-treatment, and at 12-month follow-up. Within-group change was evaluated over time with mixed-effects models. Beyond different symptoms, working time, sick-leave compensation, and adverse effects were also measured.

Results

There were significant improvements in symptoms of SED, burnout, anxiety, depression, and insomnia, with large within-group effect sizes (d = 0.91–1.76), improvements that were maintained at 12-month follow-up. Furthermore, there was a significant increase in quality of life and large improvements in average working time and sick-leave compensation. Some adverse effects were reported, mainly concerning an increase in stress, anxiety, and worry.

Conclusion

SED-patients participating in this standardized MMI reported large symptom alleviation, increased working time and reduced sick-leave compensation, indicating a beneficial treatment. There were some adverse effects, but no more so than other psychological treatments. This study confirms previous findings that high levels of depression and anxiety decrease to sub-clinical levels during treatment, while symptoms of SED also decline, yet still persists above sub-clinical levels at 12-month follow-up. On the whole, this open clinical trial suggests that a standardized MMI, administered in a clinical setting, improves symptoms and return-to-work rates in a clinically representative SED-population.

Place, publisher, year, edition, pages
2020. Vol. 20, no 1, article id 526
Keywords [en]
Stress-induced exhaustion disorder, Burnout, Long-term stress, Rehabilitation, Multimodal intervention, Negative effects
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-426336DOI: 10.1186/s12888-020-02907-3ISI: 000586797900001PubMedID: 33153461OAI: oai:DiVA.org:uu-426336DiVA, id: diva2:1506575
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00154Available from: 2020-12-03 Created: 2020-12-03 Last updated: 2024-04-12Bibliographically approved
In thesis
1. Psychological Treatment of Stress-Induced Exhaustion Disorder: Towards a Contextual Behavioral Approach
Open this publication in new window or tab >>Psychological Treatment of Stress-Induced Exhaustion Disorder: Towards a Contextual Behavioral Approach
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Long-term sick leave due to stress-related disorders has been steadily increasing in Western society. A portion of these sick leave rates is attributed to severe symptoms of exhaustion, assumed to be the result of persistent work stress. In Sweden, this symptomatology is currently classified using the diagnosis of stress-induced exhaustion disorder (ED). There are, however, no evidence-based treatments for ED, nor are there any established theoretical models to guide clinical interventions. Most current treatments revolve around promoting recovery behaviors, as ED is assumed to result from depleted psychophysiological resources. This thesis discusses the merits of this assumption and whether it is compatible with contemporary theories of stress and a contextual behavioral treatment approach. Additionally, a contextual behavioral model of ED is introduced with an accompanying biopsychosocial treatment, aiming to bridge the gap between theories of stress, basic learning principles, and clinically useful methods. The model suggests that ED can be conceptualized as a crisis of engagement rather than a result of depleted psychophysiological resources.

Complementing this theoretical work are empirical studies of different aspects of multimodal interventions (MMI) for ED with the overarching aim of fostering a more theoretically coherent ED treatment that can be made accessible to more patients. Study I was an open clinical trial tracking ED patients (N = 390) participating in a 24-week MMI based on cognitive behavior therapy (CBT). Study II explored sub-groups and predictors of improvements in a large cohort (N = 915) of ED patients participating in the same MMI as Study I. Study III explored mediators commonly suggested to be relevant within ED treatment in the same cohort as Study II: sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility. Study IV was an uncontrolled pilot trial (N = 26) of the biopsychosocial treatment for ED presented in this thesis, delivered within a 12-week online MMI.  

In summary, the results of this thesis indicate that ED patients participating in CBT-based MMI benefit from treatment and report few adverse effects. Moreover, high degrees of perfectionism and high treatment credibility were identified as predictors of improvement, indicating the importance of addressing perfectionistic behaviors and treatment credibility in ED treatment. With positive results similar to those of Study I, Study IV provides preliminary support that ED can be treated more effectively with fewer clinical resources than more extensive MMIs when a more focused and theoretically stringent approach is utilized. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2024. p. 143
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 223
Keywords
Stress-Induced Exhaustion Disorder, Burnout, Cognitive Behavior Therapy, Contextual Behavior Science, Process-Based Therapy, Recovery
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-526606 (URN)978-91-513-2128-8 (ISBN)
Public defence
2024-06-13, Sal X, Universitetshuset, Biskopsgatan 3, Uppsala, 13:00 (English)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00154
Available from: 2024-05-23 Created: 2024-04-12 Last updated: 2024-05-23

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Clason van de Leur, JakobBuhrman, Monica

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