Stress/exhaustion/fatigue

What is chronic stress, what is exhaustion and fatigue, and how are symptoms associated with different psychiatric and somatic conditions? 

Symptoms related to chronic stress are common and cause individual suffering and high societal cost. Yet, there is no international consensus regarding diagnostics and treatment. In Sweden, the diagnosis utmattningssyndrom (English: Exhaustion disorder) is frequently used and is one of the main reasons for receiving sick leave reimbursement in the country. Importantly, research on exhaustion disorder is still limited. Knowledge gaps include why people develop symptoms of exhaustion/fatigue, symptom specificity in relation to other psychiatric and somatic conditions, and evidence-based treatments. 

Elin Lindsäter and her team has set out to improve our understanding of chronic stress and the core symptoms of exhaustion/fatigue. The goal is to contribute to the development of evidence-based care processes from primary care to specialized care contexts. 

Elin et al have recently published:

On chronic stress and exhaustion disorder as a scientific construct

• A scoping review of all empirical studies of exhaustion disorder. The overview found that the limited number of studies, lack of replication of findings, and methodological limitations makes it difficult to draw firm conclusions about the diagnostic construct. It concluded that an international collaboration is needed regarding conceptualization of chronic stress and fatigue, to promote the growth of evidence.
• A qualitative survey study, interviewing patients with exhaustion disorder and healthcare professionals working with these patients, aiming to understand more about what the condition consists of. The study found many aspects of ED that matter to patients and clinicians. It also found that the condition has a multidimensional symptom presentation with associated functional disability that resembles international descriptions of persistent fatigue.

On ICBT aimed at redicing stress

• A metanalysis of internet-delivered cognitive behavioral therapy (ICBT) aimed at reducing stress, which concluded that ICBT reduce stress, anxiety, and depressive symptoms.
• A systematic review and metaanalysis of ICBT interventions to reduce elevated stress. The study concluded that more studies are needed to strengthen the evidence for ICBT.
• An RCT evaluating the effects of ICBT for chronic stress, comparing it with waitlist control. From this study, we can see that a short internet delivered intervention is effective in reducing stress-related symptoms.
• A cost effectiveness analysis of the RCT, suggesting that ICBT is a cost-effective treatment for patients suffering from adjustment disorder  and exhaustion disorder.
• A paper on the mediating role of insomnia on the effect of ICBT for chronic stress. Accordingly, reducing insomnia severity could be of importance for achieving successful treatment outcomes in ICBT for chronic stress.