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Feasibility of a Novel Biopsychosocial Treatment 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
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

With the escalating prevalence of stress-related disorders in Western society, disorders such as Stress-Induced Exhaustion Disorder (ED) have garnered increased attention in contemporary scientific and clinical discourse. Despite various treatment studies, evidence-based treatments for ED and established clinical theories are lacking. This uncontrolled pilot study aimed to examine the feasibility, acceptance, and utility of a novel biopsychosocial treatment for ED based on a contextual behavioral approach. Twenty-six patients with ED were included in a 12-week digital multimodal intervention with the biopsychosocial treatment as the primary component. Self-rated questionnaires and independent clinical ratings were administered before and after treatment and at the three-month follow-up. Measures of exhaustion and psychological flexibility were also assessed weekly during treatment. Overall, participants reported significant improvements in symptoms of exhaustion, anxiety, and depression with large effect sizes (d = 0.75-1.10), which were maintained at follow-up. Independent clinical ratings indicated reduced clinical severity and functional disability. There were no dropouts and a high module completion ratio. Few negative effects were reported, and ratings on treatment credibility and client satisfaction were high. Finally, the mediation analysis indicated that increased psychological flexibility mediated improvements in exhaustion symptoms, which aligns with the contextual behavioral model underlying the treatment. These results provide preliminary support for the feasibility, acceptability, and utility of this novel biopsychosocial treatment for ED.  

Keywords [en]
Stress-Induced Exhaustion Disorder, Clinical Burnout, Cognitive Behavior Therapy, Internet, Contextual Behavior Science
National Category
Psychiatry Applied Psychology
Research subject
Psychology; Psychology
Identifiers
URN: urn:nbn:se:uu:diva-526360OAI: oai:DiVA.org:uu-526360DiVA, id: diva2:1850057
Available from: 2024-04-09 Created: 2024-04-09 Last updated: 2024-04-12
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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