Thesis Psychological Treatment of Stress-Induced Disorder: Towards a Contextual Behavioral Approach, van de Lear, 2024

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.


Opponent
Chalder, Trudie, Professor


https://uu.diva-portal.org/smash/record.jsf?pid=diva2:1851259&dswid=-8252

 

The research news site forskning.se wrote an article about the thesis a few days ago. In Sweden burn out syndrome is called fatigue syndrome, but I think the BPS crowd is mixing it all together with ME and making this much more confusing than necessary:


Vila inte alltid bäst vid utmattningsyndrom

google translation: Rest is not always the best with fatigue syndrome

quote:
- There is a lack of established evidence-based models for the psychological treatment of exhaustion syndrome. The concepts of recovery and stress are so accepted in our time that it is difficult to critically examine them, says Jakob Clason van de Leur, who recently received his doctorate in psychology at Uppsala University.

"It is easy to think that fatigue patients should prioritize resting and taking it easy, but a too one-sided focus on recovery can lead to a passive existence that is easy to get stuck in and instead become harmful over time," he continues.

 

Makes the “Persistent Burnout Theory” of ME/CFS (courtesy of David Jameson), not even need to be proven if you start having the definition of ME/CFS being so large.

 

Reminds of those "forever soups". It's the same soup, they keep adding the same stuff. It's technically not the same soup as last year, but it's the same soup as last year, and the year before that, and the one before that, and so on.