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- Alme, Tomas Nordheim, et al.
(författare)
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Chronic fatigue syndromes: real illnesses that people can recover from
- 2023
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Ingår i: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 41:4, s. 372-376
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Tidskriftsartikel (refereegranskat)abstract
- The Oslo Chronic Fatigue Consortium consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brains response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them.
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| 2. |
- Clason van de Leur, Jakob
(författare)
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Psychological Treatment of Stress-Induced Exhaustion Disorder : Towards a Contextual Behavioral Approach
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Long-term sick leave due to stress-related disorders has been steadily increasing in Western society. A portion of these sick leave rates is attributed to severe symptoms of exhaustion, assumed to be the result of persistent work stress. In Sweden, this symptomatology is currently classified using the diagnosis of stress-induced exhaustion disorder (ED). There are, however, no evidence-based treatments for ED, nor are there any established theoretical models to guide clinical interventions. Most current treatments revolve around promoting recovery behaviors, as ED is assumed to result from depleted psychophysiological resources. This thesis discusses the merits of this assumption and whether it is compatible with contemporary theories of stress and a contextual behavioral treatment approach. Additionally, a contextual behavioral model of ED is introduced with an accompanying biopsychosocial treatment, aiming to bridge the gap between theories of stress, basic learning principles, and clinically useful methods. The model suggests that ED can be conceptualized as a crisis of engagement rather than a result of depleted psychophysiological resources.Complementing this theoretical work are empirical studies of different aspects of multimodal interventions (MMI) for ED with the overarching aim of fostering a more theoretically coherent ED treatment that can be made accessible to more patients. Study I was an open clinical trial tracking ED patients (N = 390) participating in a 24-week MMI based on cognitive behavior therapy (CBT). Study II explored sub-groups and predictors of improvements in a large cohort (N = 915) of ED patients participating in the same MMI as Study I. Study III explored mediators commonly suggested to be relevant within ED treatment in the same cohort as Study II: sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility. Study IV was an uncontrolled pilot trial (N = 26) of the biopsychosocial treatment for ED presented in this thesis, delivered within a 12-week online MMI. In summary, the results of this thesis indicate that ED patients participating in CBT-based MMI benefit from treatment and report few adverse effects. Moreover, high degrees of perfectionism and high treatment credibility were identified as predictors of improvement, indicating the importance of addressing perfectionistic behaviors and treatment credibility in ED treatment. With positive results similar to those of Study I, Study IV provides preliminary support that ED can be treated more effectively with fewer clinical resources than more extensive MMIs when a more focused and theoretically stringent approach is utilized.
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| 3. |
- Edwards, Victoria, et al.
(författare)
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Participant experiences of guided self-help Acceptance and Commitment Therapy for improving quality of life in muscle disease : a nested qualitative study within the ACTMus randomized controlled trial
- 2023
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Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: In adults, muscle disease (MD) is typically a chronic long-term condition that can lead to a reduced quality of life (QoL). Previous research suggests that a psychological intervention, in particular Acceptance and Commitment Therapy (ACT), may help improve QoL for individuals living with chronic conditions such as MD.Methods: This nested qualitative study was incorporated within a randomized controlled trial which evaluated a guided self-help ACT intervention for people living with MD to explore their experiences of the intervention. Semi-structured interviews (n = 20) were conducted with those who had received ACT. Data were analyzed via thematic analysis.Results: There were four overarching themes. (1) Views on whether therapy sessions would help with a medical condition: participants' expectations regarding ACT varied. Some participants were skeptical about mindfulness. (2) I was able to look at things in a different way: participants described increased meaningful activity, greater awareness of thoughts and emotions and acceptance or adaptation to mobility problems. Some described improvement in the quality of relationships and a sense of feeling free. (3) Treating the body and the mind together: following the intervention participants noted that a holistic approach to healthcare is beneficial. (4) Intervention delivery: The remote delivery was generally seen as helpful for practical reasons and allowed participants to speak openly. Participants voiced a need for follow-up sessions.Discussion: Overall, the intervention was experienced as acceptable. Suggested improvements included de-emphasizing the role of mindfulness and adding follow-up sessions.
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| 4. |
- Rose, Michael, et al.
(författare)
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A randomised controlled trial of acceptance and commitment therapy for improving quality of life in people with muscle diseases
- 2022
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 53:8, s. 3511-3524
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic muscle diseases (MD) are progressive and cause wasting and weakness in muscles and are associated with reduced quality of life (QoL). The ACTMuS trial examined whether Acceptance and Commitment Therapy (ACT) as an adjunct to usual care improved QoL for such patients as compared to usual care alone.Methods: This two-arm, randomised, multicentre, parallel design recruited 155 patients with MD (Hospital and Depression Scale ⩾ 8 for depression or ⩾ 8 for anxiety and Montreal Cognitive Assessment ⩾ 21/30). Participants were randomised, using random block sizes, to one of two groups: standard medical care (SMC) (n = 78) or to ACT in addition to SMC (n = 77), and were followed up to 9 weeks. The primary outcome was QoL, assessed by the Individualised Neuromuscular Quality of Life Questionnaire (INQoL), the average of five subscales, at 9-weeks. Trial registration was NCT02810028.Results: 138 people (89.0%) were followed up at 9-weeks. At all three time points, the adjusted group difference favoured the intervention group and was significant with moderate to large effect sizes. Secondary outcomes (mood, functional impairment, aspects of psychological flexibility) also showed significant differences between groups at week 9.Conclusions: ACT in addition to usual care was effective in improving QoL and other psychological and social outcomes in patients with MD. A 6 month follow up will determine the extent to which gains are maintained.
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