Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial

Abstract

Background: Prolonged exposure to stress can lead to substantial suffering, impairment and societal costs. However, access to psychological treatment is limited. Internet-based cognitive behavioral therapy (ICBT) can be effective in reducing symptoms of stress, but little is known of its effects in clinical samples. The aim of this study was to investigate the efficacy of ICBT for patients suffering from chronic stress, operationalized as adjustment disorder (AD) and exhaustion disorder (ED). Methods: A total of 100 adults diagnosed with AD or ED were randomly assigned to a 12-week ICBT (n = 50) or waitlist control condition (n = 50). Primary outcome was the level of perceived stress (PSS). Secondary outcomes included several mental health symptom domains as well as functional impairment and work ability. All outcomes were assessed at baseline, after treatment and at the 6-month follow-up. The study was preregistered at Clinicaltrials.gov: NCT02540317. Results: Compared to the control condition, patients in the ICBT group made large and significant improvements on the PSS (d = 1.09) and moderate to large improvements in secondary symptom domains. Effects were maintained at the 6-month follow-up. There was no significant between-group effect on functional impairment or work ability. Conclusions: A relatively short ICBT is indicated to be effective in reducing stress-related symptoms in a clinical sample of patients with AD and ED, and has the potential to substantially increase treatment accessibility. Results must be replicated, and further research is needed to understand the relationship between symptom reduction, functional impairment and work ability.

Effects of cognitive behavioural therapy and return‐to‐work intervention for patients on sick leave due to stress‐related disorders: Results from a randomized trial

“…As there are very few previously published randomized trials of psychological treatments for stress‐related disorders (Perski et al ., ), we view the results of this study regarding effects of CBT on symptom reduction as very promising. The present treatment, CBT for stress‐related disorders, has been further studied as Internet delivered CBT and effects on reduced symptoms were comparable (Lindsäter et al ., ). We therefore consider that this type of CBT for AD and ED could contribute to the evidence base for effective treatments of these disorders.…”

“…As no evidence‐based treatments exist for AD and ED, these disorders were treated with a CBT protocol that has been developed by our research group and tested in clinical practice since 2007. The treatment has been included in three randomized trials as face‐to‐face treatment (present study: Salomonsson et al ., ), stepped care with guided self‐help and face‐to‐face treatment (Salomonsson et al ., ), and as an Internet‐based treatment (Lindsäter et al ., ). The treatment is based on a model assuming that these disorders are maintained by a deficit of recuperation (Geurts & Sonnentag, ; Lisspers, Almén, & Sundin, ) that can be caused by for example difficulties to relax, extensive rumination, or aversive consequences of relaxing (e.g., a person may feel shame or guilt if taking a rest instead of working or helping friends or family).…”

“…The main components were psychoeducation regarding stress, practicing relaxation, scheduled recuperation, behavioural activation including valued living across a person’s different life areas, and exposure to break fear avoidance patterns. A detailed description of the treatment can be found in the main outcome study (Salomonsson et al ., ) and the trial of the Internet treatment (Lindsäter et al ., ).…”

“…A meta‐analysis has shown positive effects for CBT when treating occupational stress (Richardson & Rothstein, ). For patients with clinical levels of stress and exhaustion, meta‐analyses have shown no effect of treatments (Ahola, Toppinen‐Tanner, & Seppänen, ; Arends, Bruinvels, Rebergen et al ., ; Perski, Grossi, Perski, & Niemi, ), although some studies indicate positive effects (i.e., Lindsäter, Salomonsson, Santoft et al ., ; Persson Asplund, Dagöö, Fjellström et al ., ). The relatively limited knowledge of how to deal with stress‐related disorders stands in remarkable contrast to anxiety disorders, depression and insomnia, where there is strong empirical support for cognitive behavioural therapy (CBT) regarding symptom reduction (Hofmann, Asnaani, Vonk, Sawyer, & Fang, ).…”

Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout

“…However, meta-analyses of diagnosed samples have failed to find superior improvements of CBT compared to control conditions for both adjustment disorder 100 and exhaustion disorder 101 . Although recent randomized trials have found promising results of CBT for these disorders 102,103 , the effectiveness of CBT remains uncertain.…”