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  • 1.
    Eskilsson, Therese
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Slunga Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Malmberg Gavelin, Hanna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Stigsdotter Neely, Anna
    Boraxbekk, Carl-Johan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre.
    Aerobic training for improved memory in patients with stress-related exhaustion: a randomized controlled trial2017Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, nr 1, artikel-id 322Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Patients with stress-related exhaustion suffer from cognitive impairments, which often remain after psychological treatment or work place interventions. It is important to find effective treatments that can address this problem. Therefore, the aim of this study was to investigate the effects on cognitive performance and psychological variables of a 12-week aerobic training program performed at a moderate-vigorous intensity for patients with exhaustion disorder who participated in a multimodal rehabilitation program.

    METHODS: In this open-label, parallel, randomized and controlled trial, 88 patients diagnosed with exhaustion disorder participated in a 24-week multimodal rehabilitation program. After 12 weeks in the program the patients were randomized to either a 12-week aerobic training intervention or to a control group with no additional training. Primary outcome measure was cognitive function, and secondary outcome measures were psychological health variables and aerobic capacity.

    RESULTS: In total, 51% patients in the aerobic training group and 78% patients in the control group completed the intervention period. The aerobic training group significantly improved in maximal oxygen uptake and episodic memory performance. No additional improvement in burnout, depression or anxiety was observed in the aerobic group compared with controls.

    CONCLUSION: Aerobic training at a moderate-vigorous intensity within a multimodal rehabilitation program for patients with exhaustion disorder facilitated episodic memory. A future challenge would be the clinical implementation of aerobic training and methods to increase feasibility in this patient group.

    TRIAL REGISTRATION: ClinicalTrials.gov: NCT03073772 . Retrospectively registered 21 February 2017.

  • 2.
    Malmberg Gavelin, Hanna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Rehabilitation for improved cognition in stress-related exhaustion: cognitive, neural and clinical perspectives2019Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

  • 3.
    Malmberg Gavelin, Hanna
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Boraxbekk, Carl-Johan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Stenlund, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lisbeth, Slunga Järvholm
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stigsdotter Neely, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Karlstad University.
    Effects of a process-based cognitive training intervention for patients with stress-related exhaustion2015Ingår i: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 18, nr 5, s. 578-588Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Malmberg Gavelin, Hanna
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Boraxbekk, Carl-Johan
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Stenlund, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Slunga Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stigsdotter Neely, Anna
    Karlstad University.
    Effects of a process-based cognitive training intervention for patients with stress-related exhaustion: a randomized clinical trial2015Ingår i: International Convention of Psychological Science, Amsterdam, 2015Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    The present study evaluated whether a computerized process-based cognitive training program improves cognitive function in patients with stress-related exhaustion (n=59). Results showed training effects that were generalizable beyond the specific training tasks, suggesting that cognitive training may be a viable part of the rehabilitation of stress-related exhaustion.

  • 5.
    Malmberg Gavelin, Hanna
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Eskilsson, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Boraxbekk, Carl-Johan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark..
    Josefsson, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Stigsdotter Neely, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden..
    Slunga Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rehabilitation for improved cognition in patients with stress-related exhaustion disorder: RECO – a randomized clinical trial2018Ingår i: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 21, nr 4, s. 279-291Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Stress-related exhaustion has been associated with selective and enduring cognitive impairments. However, little is known about how to address cognitive deficits in stress rehabilitation and how this influences stress recovery over time. The aim of this open-label, parallel randomized controlled trial (ClinicalTrials.gov: NCT03073772) was to investigate the long-term effects of 12 weeks cognitive or aerobic training on cognitive function, psychological health and work ability for patients diagnosed with exhaustion disorder (ED). One-hundred-and-thirty-two patients (111 women) participating in multimodal stress rehabilitation were randomized to receive additional cognitive training (n = 44), additional aerobic training (n = 47) or no additional training (n = 41). Treatment effects were assessed before, immediately after and one-year post intervention. The primary outcome was global cognitive function. Secondary outcomes included domain-specific cognition, self-reported burnout, depression, anxiety, fatigue and work ability, aerobic capacity and sick-leave levels. Intention-to-treat analysis revealed a small but lasting improvement in global cognitive functioning for the cognitive training group, paralleled by a large improvement on a trained updating task. The aerobic training group showed improvements in aerobic capacity and episodic memory immediately after training, but no long-term benefits. General improvements in psychological health and work ability were observed, with no difference between interventional groups. Our findings suggest that cognitive training may be a viable method to address cognitive impairments for patients with ED, whereas the effects of aerobic exercise on cognition may be more limited when performed during a restricted time period. The implications for clinical practice in supporting patients with ED to adhere to treatment are discussed.

  • 6.
    Malmberg Gavelin, Hanna
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Stigsdotter Neely, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.
    Andersson, Micael
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi.
    Eskilsson, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Slunga Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Boraxbekk, Carl-Johan
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark.
    Neural activation in stress-related exhaustion: cross-sectional observations and interventional effects2017Ingår i: Psychiatry Research: Neuroimaging, ISSN 0925-4927, E-ISSN 1872-7506, Vol. 269, s. 17-25Artikel i tidskrift (Refereegranskat)
    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.

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