Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout

Santoft, Fredrik; Salomonsson, Sigrid; Hesser, Hugo; Lindsäter, Elin; Ljótsson, Brjánn; Lekander, Mats; Kecklund, Göran; Öst, Lars‐Göran; Hedman‐Lagerlöf, Erik

doi:10.1016/j.beth.2018.08.005

Cited by 25 publications

(15 citation statements)

References 203 publications

(259 reference statements)

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“…Patients in the current study reported a decrease in insomnia with a large effects-size, which was maintained at the 12-month follow-up. This decrease is encouraging, given that improved sleep quality has been shown to play a vital role in the effective treatment of SED [ 6 , 48 , 55 ].…”

Section: Discussionmentioning

confidence: 97%

“…During the last two decades, long-term sick-leave due to stress-related ill-health has been increasing in several economically developed countries [ 1 – 4 ]. Long-term exposure to non-traumatic stressors (such as deficiencies in the work environment, high work-load, divorce, socioeconomic difficulties, and interpersonal conflicts) without sufficient recovery can lead to a debilitating state of exhaustion characterized by physical fatigue, cognitive impairments and sleep disturbances [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Standardized multimodal intervention for stress-induced exhaustion disorder: an open trial in a clinical setting

et al. 2020

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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. Trial registration This study was registered on Clinicaltrials.gov 2017.12.02 (Identifier: NCT03360136).

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Standardized multimodal intervention for stress-induced exhaustion disorder: an open trial in a clinical setting

et al. 2020

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“…Estimated means were calculated by using change trajectories. ES were investigated by subtracting estimated means from observed means at baseline, and finally dividing this number by SD of observed values at baseline (Santoft et al, 2019).…”

Section: Statistical Analysesmentioning

confidence: 99%

Psychological Flexibility in Depression Relapse Prevention: Processes of Change and Positive Mental Health in Group-Based ACT for Residual Symptoms

et al. 2020

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Relapse rates following a depressive episode are high, with limited treatments available aimed at reducing such risk. Acceptance and commitment therapy (ACT) is a cognitivebehavioral approach that has gained increased empirical support in treatment of depression, and thus represents an alternative in relapse prevention. Psychological flexibility (PF) plays an important role in mental health according to the model on which ACT is based. This study aimed to investigate the role of PF and its subprocesses in reducing residual symptoms of depression and in improving positive mental health following an 8-week group-based ACT treatment. Adult participants (75.7% female) with a history of depression, but currently exhibiting residual symptoms (N = 106) completed measures before and after intervention, and at 6 and 12-month follow-up. A growth curve model showed that positive mental health increased over 12-months. Multilevel mediation modeling revealed that PF significantly mediated these changes as well as the reduction of depressive symptoms, and that processes of acceptance, cognitive defusion, values and committed action, in turn, mediated increased PF.

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“…To date, we have limited knowledge regarding what factors mediate changes in CBT-based interventions for stress. Acceptance and psychological flexibility of undesirable thoughts and emotions (Bond & Bunce, 2000;Lloyd et al, 2013), emotion regulation , improved recovery (Ebert et al, 2015), insomnia severity (Lindsäter et al, 2020) and sleep quality (Querstret & Cropley, 2012;Santoft et al, 2019), have been indicated as potential mediators of change in outcomes of symptom reduction (e.g., perceived stress, burnout, exhaustion, insomnia) following stress interventions.…”

Section: Cognitive Behavioural Interventionsmentioning

confidence: 99%

Learning how to recover from stress-related disorders via internet-based interventions

Asplund

2021

Linköping Studies in Behavioural Science

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Gerhard Andersson, my main supervisor. We first met at Uppsala university in 1999-2000, when I was a student looking for a scientific project in psychology. From that day on, you have always shown such kindness and openness to new ideas. Your supervision has been very wise and gentle, pushing me when I need to, and generously and trustfully letting me explore and grow as a researcher. And thank you for all the laughs and mischievous pranks (mixing up signs, titles, roles, mugs etcetera). To my delight, I have also noticed that you have picked up some recovery activities during these years.Brjánn Ljótsson, my co-supervisor. I am very grateful for all your valuable support and encouragement during these years. You have really inspired me in testing and applying various statistical methods. And thank you for sharing your experiences and knowledge on becoming a PhD.George Vlaescu (a.k.a. G or Speedy), IT-System developer. Thank you for your quick, invaluable and sometimes crucial support regarding the IT-platform iterapy. Without your quick and methodical work, this research would not have been possible.Per Carlbring, professor and fellow grant applicant. Thank you for your enthusiastic, and super quick responses, and for your helpful and thorough comments on our studies.Master level psychology students and psychotherapy students. Without your commitment and hard work, this would never have been possible. I have enjoyed reading all the comments from grateful participants regarding the importance of your guidance in their treatment. Study I,

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Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout

Cited by 25 publications

References 203 publications

Standardized multimodal intervention for stress-induced exhaustion disorder: an open trial in a clinical setting

Standardized multimodal intervention for stress-induced exhaustion disorder: an open trial in a clinical setting

Psychological Flexibility in Depression Relapse Prevention: Processes of Change and Positive Mental Health in Group-Based ACT for Residual Symptoms

Learning how to recover from stress-related disorders via internet-based interventions

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