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Objectives: The majority of patients who seek help for stress and sleep problems do so in primary health care in Sweden. However, the resources for psychological treatment are limited. The aim of this study was to assess the effectiveness of a low-intensity student-led group interventions, applying cognitive behavioral therapy (CBT) with an indicated prevention approach in primary care for recovery and reducing symptoms of stress and sleep disturbance.

Methods: Using a quasi-experimental design, interventions were conducted for stress (n=274, mean age=38 years, 75% women) and sleep (n=106, mean age=44 years, 56% women) problems in consecutively recruited primary care patients. These were compared with a control group (n=221, mean age=45 years, 91% women) recruited via social media. The interventions were CBT-based psychoeducative group interventions that consisted of four 90-min sessions and led by psychology students. Assessment was completed at pre- and post-intervention and at 3-month follow-up. Main outcome measures were the 10-item Perceived Stress Scale and the Shirom-Melamed Burnout Questionnaire for the stress intervention, and the Karolinska Sleep Questionnaire for the sleep intervention. The Hospital Anxiety and Depression Scale and the 15-item Patient Health Questionnaire were used to assess anxiety, depression and somatization as secondary outcome measures for both interventions. Analysis of covariance (pre- vs post-intervention) and reliable change index (pre-intervention vs three-month follow-up) were applied.

Results: Statistically significant, but small effects of improved health in comparison to the control group were found on stress and burnout (η2=.021-.030) in the stress intervention, and on sleep (η2=.017) in the sleep intervention. The proportion of patients in the stress intervention with a reliable improvement at three-month follow-up was 28% for stress and 59% for burnout, and 0% and 33%, respectively, for the control group. Among those with a reliable improvement in burnout, 31% also met a recovery criterion (<4.0). In the sleep intervention, 25% of the patients showed a reliable improvement in sleep and 61% in burnout, and 6% and 33%, respectively, for the control group. The effects of the stress intervention were statistically significant, but small on anxiety and depression (η2=.021-.047), as were the effects of the sleep intervention on stress and burnout (η2=.017-.026). 

Conclusion: The results suggest that psychology students can effectively provide a low-intensity group-delivered CBT intervention for patients exhibiting symptoms of stress, burnout and sleep disturbance in routine general medical practice, offering promising opportunities for scalability expansion. Although the average treatment effects were small, a substantial proportion of the patients showed reliable improvement or recovery at 3-month follow-up. This suggests that the interventions decrease the prevalence of burnout and sleep disturbance or improve the well-being of individuals experiencing mental distress.