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Neural activation in stress-related exhaustion: cross-sectional observations and interventional effects
Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).ORCID iD: 0000-0003-3256-9018
Umeå University, Faculty of Social Sciences, Department of Psychology. Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.ORCID iD: 0000-0003-3450-8067
Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
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2017 (English)In: Psychiatry Research: Neuroimaging, ISSN 0925-4927, E-ISSN 1872-7506, Vol. 269, p. 17-25Article in journal (Refereed) Published
Abstract [en]

The primary purpose of this study was to investigate the association between burnout and neural activation during working memory processing in patients with stress-related exhaustion. Additionally, we investigated the neural effects of cognitive training as part of stress rehabilitation. Fifty-five patients with clinical diagnosis of exhaustion disorder were administered the n-back task during fMRI scanning at baseline. Ten patients completed a 12-week cognitive training intervention, as an addition to stress rehabilitation. Eleven patients served as a treatment-as-usual control group. At baseline, burnout level was positively associated with neural activation in the rostral prefrontal cortex, the posterior parietal cortex and the striatum, primarily in the 2-back condition. Following stress rehabilitation, the striatal activity decreased as a function of improved levels of burnout. No significant association between burnout level and working memory performance was found, however, our findings indicate that frontostriatal neural responses related to working memory were modulated by burnout severity. We suggest that patients with high levels of burnout need to recruit additional cognitive resources to uphold task performance. Following cognitive training, increased neural activation was observed during 3-back in working memory-related regions, including the striatum, however, low sample size limits any firm conclusions.

Place, publisher, year, edition, pages
Clare: Elsevier, 2017. Vol. 269, p. 17-25
Keywords [en]
Working memory fMRI, Burnout, Stress rehabilitation, Exhaustion disorder, Cognitive training
National Category
Neurosciences Applied Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:umu:diva-139932DOI: 10.1016/j.pscychresns.2017.08.008ISI: 000412461700003PubMedID: 28917154OAI: oai:DiVA.org:umu-139932DiVA, id: diva2:1148090
Available from: 2017-10-10 Created: 2017-10-10 Last updated: 2019-01-07Bibliographically approved
In thesis
1. Rehabilitation for improved cognition in stress-related exhaustion: cognitive, neural and clinical perspectives
Open this publication in new window or tab >>Rehabilitation for improved cognition in stress-related exhaustion: cognitive, neural and clinical perspectives
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Stress-related exhaustion disorder (ED) has been associated with concomitant cognitive impairment, perceived by patients to have large impact on everyday life. However, little is known about how to address cognition in stress rehabilitation and how this could influence stress recovery over time. The aim of this thesis was to evaluate the efficacy of additional cognitive and aerobic training for patients with ED who participated in a multimodal stress rehabilitation program. A further aim was to explore the neural correlates of ED. The main focus of this thesis was on cognitive training, the effects of which were studied from a cognitive, neural, and clinical perspective (Study I-III). The final part of this thesis (Study III) broadened the perspective and investigated the long-term effects of cognitive and aerobic training on cognitive and clinical outcomes.

Study I and II evaluated the effects of process-based cognitive training immediately following the intervention. The results from Study I showed that generalization of training effects following cognitive training was selective and restricted to tasks similar to those trained. The cognitive training group showed a greater reduction in burnout symptoms, and partial support was given for fewer subjective cognitive complaints compared to stress rehabilitation alone. Study II used functional neuroimaging to explore the neural effects of cognitive training, showing training-related activation increases at high working memory load; however, conclusions were restricted due to the small sample.

Study II additionally explored the neural correlates of ED by investigating within-group associations between burnout level and functional neural response during working memory updating. The results revealed that patients with higher levels of burnout showed greater recruitment of working memory-related regions during task execution, potentially reflecting a compensatory mechanism serving to uphold task performance.

Study III evaluated the clinical utility of addressing cognitive impairments in stress rehabilitation. Here, the effects of cognitive and aerobic training on several ED-related variables were investigated 1 year after the intervention. Cognitive training was associated with a small and lasting improvement in cognitive performance. Aerobic training yielded improvements in episodic memory immediately following the intervention, but no significant difference was found between the aerobic training group and the control group at 1-year follow-up. For psychological health and work ability, no additional benefits were seen for the added interventions relative to stress rehabilitation alone. However, a long-term improvement in burnout symptoms favouring cognitive training was observed when restricting the analysis to only include patients who had completed the intervention. This highlights the importance of supporting patients in adhering to added treatments.

In sum, the papers in this thesis provide initial evidence of neurocognitive plasticity in patients with ED and tentatively suggest that cognitive improvements following cognitive training may translate into alleviated clinical symptoms. These results support the argument that interventions targeting cognitive impairments holds a place in the effective rehabilitation of ED.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2019. p. 74
Keywords
stress rehabilitation, burnout, exhaustion disorder, cognitive training, aerobic training
National Category
Applied Psychology
Research subject
Clinical Psychology
Identifiers
urn:nbn:se:umu:diva-154965 (URN)978-91-7601-998-6 (ISBN)
Public defence
2019-01-31, S213, Samhällsvetarhuset, Umeå, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2019-01-10 Created: 2019-01-07 Last updated: 2019-01-10Bibliographically approved

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Malmberg Gavelin, HannaStigsdotter Neely, AnnaAndersson, MicaelEskilsson, ThereseSlunga Järvholm, LisbethBoraxbekk, Carl-Johan

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Malmberg Gavelin, HannaStigsdotter Neely, AnnaAndersson, MicaelEskilsson, ThereseSlunga Järvholm, LisbethBoraxbekk, Carl-Johan
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Department of PsychologyUmeå Centre for Functional Brain Imaging (UFBI)PhysiologyPhysiotherapyOccupational and Environmental MedicineCentre for Demographic and Ageing Research (CEDAR)
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