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Mediators during a Multimodal intervention for stress-induced exhaustion disorder
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.ORCID iD: 0000-0002-4000-2866
Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.ORCID iD: 0000-0001-9717-0935
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. (Clinical psychology)ORCID iD: 0000-0002-9734-0153
Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden.ORCID iD: 0000-0002-6355-660X
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2024 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 53, no 3, p. 235-253Article in journal (Refereed) Published
Abstract [en]

Our understanding of the underlying psychological processes of development, maintenance, and treatments for stress-induced exhaustion disorder (ED) remains limited. Therefore, the current study aimed to explore whether sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility mediate change in exhaustion symptoms during a Multimodal intervention for ED based on Cognitive behavioral therapy principles. Participants (N = 913) were assessed at three time points, and mediation was explored using a two-criteria analytical model with linear mixed-effects models (criterion one) and random intercepts cross-lagged panel modeling (criterion 2). Criterion one for mediation was successfully met, as the findings indicated significant associations between time in treatment, with all suggested mediators, and exhaustion symptoms (significant ab-products). However, criterion two was not satisfied as changes in the mediators did not precede changes in exhaustion symptoms. Therefore, mediation could not be established. Instead, changes in the suggested mediators appeared to result from changes in exhaustion symptoms. Consequently, sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility appear to improve in conjunction with exhaustion symptoms during treatment, where improvement in exhaustion is indicated as the main driving factor, based on this exploratory analysis. The implications of these findings are contextualized within a broader framework of process-based therapy.

Place, publisher, year, edition, pages
Routledge, 2024. Vol. 53, no 3, p. 235-253
Keywords [en]
Burnout, Exhaustion disorder, multimodal intervention, mediators, process of change
National Category
Psychology
Identifiers
URN: urn:nbn:se:uu:diva-519073DOI: 10.1080/16506073.2023.2295217ISI: 001129767600001PubMedID: 38130175OAI: oai:DiVA.org:uu-519073DiVA, id: diva2:1823655
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00154Available from: 2024-01-03 Created: 2024-01-03 Last updated: 2024-05-20Bibliographically 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, JakobMcCracken, Lance M.Buhrman, Monica

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