Stress/exhaustion/fatigue

How might new insights into chronic stress and exhaustion disorder improve diagnostic accuracy and treatment approaches for these prevalent conditions?

Chronic stress, exhaustion, and fatigue are prevalent symptoms that contribute to significant individual suffering and incur high societal costs. Despite their impact, there is no international consensus on diagnostic criteria or treatment protocols. In Sweden, the diagnosis of utmattningssyndrom (English: Exhaustion Disorder) is commonly used and is a leading reason for sick leave reimbursement. However, research on exhaustion disorder remains limited, with notable gaps in understanding why individuals develop symptoms, how these symptoms relate to other psychiatric and somatic conditions, and what constitutes effective, evidence-based treatments.

Elin Lindsäter and her team has set out to advancing our understanding of chronic stress and the core symptoms of exhaustion and fatigue. Their goal is to contribute to the development of evidence-based care processes that span from primary care to specialized treatment settings.

Current project: Fatigue as a transdiagnostic symptom dimension – Novel approaches to assessment and treatment in primary healthcare

Elin and her team are currently trying out a transdiagnostic treatment approach to fatigue. Fatigue is a widespread and challenging symptom that affects many people dealing with various psychiatric and medical conditions, and it’s commonly seen in primary care settings. Traditionally, fatigue has been viewed as a symptom tied to specific disorders. However, recent research suggests that it’s more effective to see fatigue as a broad symptom that cuts across different diagnoses. While cognitive behavior therapy (CBT) has been shown to alleviate fatigue in various contexts, no transdiagnostic CBT approach specifically targeting fatigue has been tested until now. This project aims to fill that gap by developing and evaluating an accessible internet-based CBT program designed to address fatigue for patients in primary care.

In this large-scale, randomized controlled trial involving 500 patients, we will compare the effects of this new online CBT program to standard care alone. The study will measure fatigue severity as the main outcome and track progress with follow-ups at 1 and 2 years. We will also explore which factors influence treatment effectiveness, the mechanisms behind the treatment, and its cost-effectiveness. The goal is to create solid guidelines for assessing and treating fatigue in primary care, offering a potentially groundbreaking solution that could reduce long-term suffering and high costs for both individuals and society.

Lindsäter et al. have recently published:

On chronic stress and exhaustion disorder as a scientific construct

• A scoping review of empirical studies on exhaustion disorder revealed that the limited number of studies, lack of replication, and methodological limitations make it challenging to draw definitive conclusions about the diagnostic construct. The review highlights the need for international collaboration to refine the conceptualization of chronic stress and fatigue and to foster the development of a robust evidence base.
• A qualitative survey study, which interviewed patients with exhaustion disorder and healthcare professionals, aimed to elucidate the condition’s characteristics. The study identified numerous factors significant to both patients and clinicians and found that the condition presents with a multidimensional symptom profile and functional disability that aligns with international descriptions of persistent fatigue.

On ICBT Aimed at Reducing stress

• A meta-analysis of internet-delivered cognitive behavioral therapy (ICBT) for stress reduction concluded that ICBT reduces stress, anxiety, and depressive symptoms.
• A systematic review and meta-analysis of ICBT interventions for elevated stress found that while ICBT is beneficial, further research is needed to strengthen the evidence base.
• An RCT comparing ICBT for chronic stress to a waitlist control group demonstrated that a short, internet-delivered intervention is effective in alleviating stress-related symptoms.
• A cost-effectiveness analysis of this RCT suggested that ICBT is a cost-effective treatment for adjustment disorder and exhaustion disorder.
• A paper exploring the mediating role of insomnia in ICBT for chronic stress indicated that addressing insomnia severity may be crucial for achieving successful treatment outcomes in ICBT.

Group members involved in the project