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Effects of a process-based cognitive training intervention for patients with stress-related exhaustion
Umeå University, Faculty of Social Sciences, Department of Psychology.ORCID iD: 0000-0003-3256-9018
Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).ORCID iD: 0000-0002-4458-6475
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.ORCID iD: 0000-0002-2402-562X
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
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2015 (English)In: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 18, no 5, p. 578-588Article in journal (Refereed) Published
Abstract [en]

Stress-related exhaustion has been linked to a pattern of selective cognitive impairments, mainly affecting executive functioning, attention and episodic memory. Little is known about potential treatments of these cognitive deficits. The purpose of the present study was to evaluate the effects of a process-based cognitive training intervention, designed to target the specific cognitive impairments associated with stress-related exhaustion. To this end, patients diagnosed with exhaustion disorder (ED) were randomized to either a multimodal stress rehabilitation program with the addition of a process-based cognitive training intervention (training group, n = 27) or a treatment-as-usual control condition, consisting of multimodal stress rehabilitation with no additional training (control group, n = 32). Treatment effects were evaluated through an extensive cognitive test battery, assessing both near- and far transfer effects, as well as self-report forms regarding subjective cognitive complaints and burnout levels. Results showed pronounced training-related improvements on the criterion updating task (p < 0.001). Further, evidence was found of selective near transfer effects to updating (p = 0.01) and episodic memory (p = 0.04). Also, the trained group reported less subjective memory complaints (p = 0.02) and levels of burnout decreased for both groups, but more so for the trained group (p = 0.04), following the intervention. These findings suggest that process-based cognitive training may be a viable method to address the cognitive impairments associated with ED.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2015. Vol. 18, no 5, p. 578-588
Keywords [en]
burnout, cognition, executive function, exhaustion disorder, stress rehabilitation, working memory training
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:umu:diva-111130DOI: 10.3109/10253890.2015.1064892ISI: 000369888600011PubMedID: 26305186OAI: oai:DiVA.org:umu-111130DiVA, id: diva2:867717
Available from: 2015-11-06 Created: 2015-11-06 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, HannaBoraxbekk, Carl-JohanStenlund, ThereseLisbeth, Slunga JärvholmStigsdotter Neely, Anna

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Malmberg Gavelin, HannaBoraxbekk, Carl-JohanStenlund, ThereseLisbeth, Slunga JärvholmStigsdotter Neely, Anna
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