Effectiveness of an ACT-based rehabilitation program for the treatment of chronic fatigue: Results from a 12-months longitudinal study

Coping strategies in patients with good outcome but chronic fatigue after aneurysmal subarachnoid hemorrhage

BACKGROUND

Fatigue is a highly prevalent and debilitating symptom among patients in the chronic phase of aneurysmal subarachnoid haemorrhage (aSAH) with no identified effective treatment. Cognitive therapy has been shown to have moderate effects on fatigue. Delineating the coping strategies used by patients with post-aSAH fatigue and relating them to fatigue severity and emotional symptoms could be a step towards developing a behavioural therapy for post-aSAH fatigue.

METHODS

Ninety-six good outcome patients with chronic post-aSAH fatigue answered the questionnaires Brief COPE, (a questionnaire defining 14 coping strategies and three Coping Styles), the Fatigue Severity Scale (FSS), Mental Fatigue Scale (MFS), Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). The Brief COPE scores were compared with fatigue severity and emotional symptoms of the patients.

RESULTS

The prevailing coping strategies were "Acceptance", "Emotional Support", "Active Coping" and "Planning". "Acceptance" was the sole coping strategy that was significantly inversely related to levels of fatigue. Patients with the highest scores for mental fatigue and those with clinically significant emotional symptoms applied significantly more maladaptive avoidant strategies. Females and the youngest patients applied more "Problem-Focused" strategies.

CONCLUSION

A therapeutic behavioural model aiming at furthering "Acceptance" and reducing passivity and "Avoidant" strategies may contribute to alleviate post-aSAH fatigue in good outcome patients. Given the chronic nature of post-aSAH fatigue, neurosurgeons may encourage patients to accept their new situation so that they can start a process of positive reframing instead of being trapped in a spiral of futile loss of energy and secondary increased emotional burden and frustration.

Mental fatigue and negative emotion among nurses during the COVID-19 pandemic

COVID-19 is a major public health event affecting the people worldwide. Nurses are still under immense psychological pressure. This study aimed to explore the relationship between mental fatigue and negative emotions among frontline medical staff during the COVID-19 pandemic. The study was conducted in August 2020, which included 419 medical staff between 17 to 28 years. The Fatigue Scale, Multidimensional Mental Flexibility Questionnaire, Cognitive Fusion Scale, and Depression-Anxiety-Stress Brief Version Scale were used. During the data collection period, the pandemic was under control in China and continued worldwide. The results indicated that 27.7% of the medical staff experienced depression, and 32.3% of them feel stressed. Specifically, first, correlation analyses showed significant positive pairwise correlations between mental fatigue, psychological inflexibility, cognitive fusion, and negative emotions among nurses. Second, mediation model tests showed statistically significant mediating effects of psychological inflexibility and cognitive fusion between mental fatigue on nurses' negative emotions, and statistically, significant chain mediating effects of psychological inflexibility and cognitive fusion. Mental fatigue indirectly affects nurses' negative effects through the mediating effects of psychological inflexibility, cognitive fusion, and the chain mediating effects of psychological inflexibility and cognitive fusion, respectively. the negative effects of mental fatigue come from impairment of cognitive functioning, and interventions using acceptance and commitment therapy for mental fatigue and negative emotions are more effective since both psychological inflexibility and cognitive fusion are important components of the therapy.

Education of the primary health care staff based on acceptance and commitment therapy is associated with reduced sick leave in a prospective controlled trial

Background

The use of cognitive behavioral therapy (CBT) to cope with mental distress and pain issues has helped many patients in primary health care in Sweden. However, the effects of CBT to reduce sick leave has not been equally convincing. Acceptance and Commitment Therapy (ACT) is an evolution of traditional CBT and we aimed to study if education based on ACT of the staff rather than the patients could reduce sick leave in primary health care.

Methods

This was a prospective trial in 6 primary health care centers in Kalmar (total amount of registered subjects of 28,930) in which the staff (physicians, nurses and therapists) received group-based education according to ACT during 2018 and 2019. The effects were compared with 5 similarly sized control health care centers in the neighboring Region of Jönköping in which no such education took place. The main aim was to study changes in sick leave in the 6 primary care centers of Kalmar and to keep track of more general trends by studying sick leave also in Jönköping, letting sick leave in the year 2017 to be the reference period for both areas.

Results

The staff at the health care centers in Kalmar reported to having attended a mean of 5.2 ± 2 educational ACT-sessions with psychiatrist Kadowaki in Kalmar. Sick leave for ICD-10 F43 (reaction to severe stress and related adjustment-disorders) was reduced from a mean value of 28.7 ± 9.1ongoing sick leaves/month in 2017 to 22.6 ± 7.0 sick leaves/month in 2018 (-21%, p = 0.033) and to 18.1 ± 10 sick leaves/month in 2019 (-37%, p = 0.038). The corresponding sick leave for any diagnosis (total sick leave) was reduced from 132 ± 39 sick leaves/month in 2017 to 118 ± 38 sick leaves/month in 2018 (-11%, p = 0.056) and to 102 ± 37 sick leaves/month in 2019 (-21%, p = 0.021). The corresponding sick leave comparisons in the control health centers did not show any significant changes (all p-values ≥ 0.24).

Conclusions

Total monthly mean sick leave was reduced 21% in the health care centers in Kalmar during the second year of the educational ACT intervention of the staff while it was unchanged in Jönköping. This suggests a significant effect to induce a reduction in long-term sick leave for patients in primary health care in which the staff received education according to ACT. The results of this trial could serve as a basis for a randomized trial in order to ascertain causality.

Trial registration

Pre-registration November 9, 2018 on ClinicalTrials.gov with number NCT03737019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01526-5.