Mediators during a multimodal intervention for stress-induced exhaustion disorder

Stress-related disorders are on the rise in Western society, resulting in rising sick leave rates and declining productivity. Exhaustion due to persistent non-traumatic stress, often associated with burnout, has increasingly become a topic of public and academic concern. Yet, there is no universally accepted term for this condition. Clinical burnout, work-related depression, neurasthenia – a dear child has many names.  In Sweden, the diagnosis of “stress-induced Exhaustion disorder” (ED) is used. Characterized by debilitating exhaustion and cognitive impairments, ED is considered the end stage of severe burnout, requiring professional healthcare intervention. Despite numerous treatment studies, the understanding of effective treatment of ED is limited.

Much research on ED has emanated from a biological perspective, using studies on neuroimaging and biomarkers, with few conclusive results. Psychological change processes important in the treatment of ED have, on the other hand, been relatively unexplored.  Change processes are the specific factors that make a treatment affect a particular thing of interest, in this case, symptoms of exhaustion. In a scientific context, change processes are commonly referred to as mediators. The current study takes a closer look at potential psychological mediators, such as sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility, in a large sample of ED patients undergoing a broad multicomponent Multimodal intervention (MMI) based on various CBT principles. 

The findings were, however, somewhat limited. Sleep concerns partly emerged as a significant mediator, adding to previous research that sleep seems important in ED. Pathological worry, perfectionistic concerns, and psychological flexibility did not seem to drive changes in exhaustion symptoms. The lack of mediating effects may stem from the complexity of individual differences and bidirectional relationships between exhaustion symptoms and potential mediators. Therefore, this study calls for more theoretical exploration of the underlying change processes of ED. Such work should be complemented by clinical trials of more targeted interventions employing high-granularity measurements of how change in ED unfolds over time.

Read the full paper here: Clason van de Leur, J., Johansson, F., McCracken, L., Åhs, F., Brodda Jansen, G., & Buhrman, M. (2023). Mediators during a multimodal intervention for stress-induced exhaustion disorder. Cognitive Behaviour Therapy.

Featured photo: Jesper Sehested

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