Stress-Recovery Management: A Pilot Study Using a Single-Subject Experimental Design

"Recovery activities are needed every step of the way"-exploring the process of long-term recovery in people previously diagnosed with exhaustion disorder

BACKGROUND

Sick-leave rates are high due to stress-related illnesses, but little is still known about the process of recovery from these conditions. The aim of this study was to explore the experiences of the recovery process, 6 to 10 years after treatment in people previously diagnosed with exhaustion disorder (ED), focusing on facilitators and barriers for the process of recovery from ED, and recovery activities experienced as helpful during the recovery process.

METHOD

Thirty-eight participants (average age: 52 years, 32 females) previously diagnosed with ED were interviewed with semi-structured interviews 6-10 years after undergoing treatment. The interviews were analyzed with thematic analysis.

RESULTS

Three themes resulted from the analysis. The first theme, "A long and rocky road", summarizes the fluctuating path to feeling better and emphasizes barriers and facilitators that affected the process of recovery, with a focus on external life events and the participants' own behaviors. Facilitators were changing workplace, receiving support, a reduction in stressors, and changed behaviors. Barriers were a poor work environment, caregiver responsibilities, negative life events and lack of support. The second theme "Recovery activities are needed every step of the way" describes how both the need for recovery activities and the types of activities experienced as helpful changed during the recovery process, from low-effort recovery activities for long periods of time to shorter and more active recovery activities. Recovery activities were described as important for self-care but hard to prioritize in everyday life. The last theme, "Reorienting to a new place", captures the struggle to cope with the remaining impact of ED, and how internal facilitators in terms of understanding and acceptance were important to reorient and adjust to a new way of functioning.

CONCLUSIONS

Recovering from ED is a long and ongoing process where recovery activities are needed every step of the way. Our results highlight the importance of supporting personal recovery and long-term behavioral change, addressing individual stressors that may perpetuate the condition, and adjusting recovery activities according to where the person is in the recovery process.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT0073772 . Registered on March 8, 2017. This study was pre-registered on Open Science Framework (osf.io).

A Functionalistic Stress Recovery Intervention Improves Perceived Recovery Opportunities and Relaxational Behaviors: A Secondary Analysis of a Randomized Controlled Trial

The recovery perspective on stress management is new and few recovery intervention studies have been conducted. The aim of the study was to evaluate behavioral effects of a functionalistic stress recovery intervention, in which individuals perceiving high levels of stress were encouraged to pay attention to possibilities to perform potential recovery behaviors in everyday life and to choose behaviors that were predicted to lead to resource restoration. Seventy-three individuals were randomly allocated to either a 10-week intervention or a waiting-list control group. Three types of recovery behavior factors during leisure time were studied: perceived recovery opportunities (i.e., control), relaxational behaviors (i.e., relaxation), and positively challenging behaviors (i.e., mastery). In comparison with the control group, the intervention group significantly improved, showing high between-group effect sizes, regarding perceived recovery opportunities (p < 0.001; d = 0.75) and relaxational behaviors (p < 0.001; d = 0.80). Both groups normalized their levels of positively challenging behaviors between pre- and postassessment, and no statistically significant group difference was demonstrated. Analyses of reliable and clinically significant changes demonstrated results in favor of the intervention group regarding perceived recovery opportunities and relaxational behaviors but not positively challenging behaviors. The tested intervention warrants further research, for example, if a modified version of the intervention including components aiming at increasing postwork positively challenging behaviors would be beneficial for the improvement of the behavior and for health.

A Cognitive Behavioral Model Proposing That Clinical Burnout May Maintain Itself

Burnout is common in many countries and is associated with several other problems such as depression, anxiety, insomnia, and memory deficits, and prospectively it predicts long-term sick-leave, cardiovascular disease, and death. Clinical burnout or its residual symptoms often last several years and a common assumption is that recovery takes a long time by nature, despite full time sick-leave and the absence of work stress. The literature suggests models that hypothetically explain the development, but not maintenance, of the syndrome. Based on cognitive and behavioral principles, stress research, and stress theories, this paper describes a theoretical model explaining how clinical burnout can develop and be maintained. While the development of clinical burnout is mainly explained by prolonged stress reactions and disturbed recovery processes due to work related stressors, maintenance of the syndrome is particularly explained by prolonged stress reactions and disturbed recovery processes due to the new context of experiencing burnout and being on sick-leave. Worry about acquired memory deficits, passivity and excessive sleep, shame, fear of stress reactions, and the perception of not being safe are examples of responses that can contribute to the maintenance. The model has important implications for research and how to intervene in clinical burnout. For example, it can offer support to professional care providers and patients in terms of focusing on, identifying, and changing current contextual factors and behaviors that maintain the individual’s clinical burnout symptoms and by that facilitate burnout recovery. Regarding research, the model provides a highly important reason for researchers to study contextual factors and behaviors that contribute to the maintenance of clinical burnout, which has been neglected in research.

Work/Family Conflict of More Importance than Psychosocial Working Conditions and Family Conditions for Mental Wellbeing

Studies have indicated the importance of family life and psychosocial working conditions for mental wellbeing. More recently, studies have highlighted that a good balance between work and family is crucial for good mental wellbeing. However, few studies compare the relative importance of these factors for mental wellbeing. The main aim of this study was to analyse the relative importance of psychosocial working conditions, family conditions and work/family conflict for mental wellbeing. The analyses are based on a Swedish data set, including questions regarding working life, family life and mental wellbeing. A total of 12,461 married/cohabiting individuals employed in Swedish organisations were included in the study. Results show that psychosocial working conditions, family conditions and work/family conflict all were related to mental wellbeing. In the final regression model, the strongest correlation was found between mental wellbeing and the variables work/family conflict, satisfaction with private life and partner relationship, with work/family conflict appearing to be of greatest importance. These findings highlight the necessity of including measurements of work/family conflict when studying the importance of work and family conditions for individual mental wellbeing. For workplace health promotion and improvement, it may be beneficial to consider not only psychosocial working conditions, but also family conditions, and particularly work/life conflict.