Stress-related conditions such as adjustment disorder and clinical burnout can be effectively treated with a 12-week cognitive-behavioral programme, both when delivered as a face-to-face treatment and when delivered via the internet, according to a new doctoral thesis from Karolinska Institutet.

Stress-related ill-health is a widespread problem around the world. Prolonged exposure to stress without sufficient recovery is associated with mental and physical disorders, functional impairment, and high societal costs due to reduced productivity and sick leave. In primary healthcare settings, diagnoses indicative of chronic stress, such as adjustment disorders and clinical burnout, are highly prevalent. To date, however, there are no evidence-based treatments for these conditions.

Cognitive behavioural therapy (CBT) has been shown to effectively reduce symptoms of stress in non-diagnosed individuals with mixed symptoms, but access to CBT is generally limited and only a few studies have examined the effect of CBT for patients diagnosed with chronic stress-related conditions.

Can be delivered via the internet
“Our studies suggest that even patients with severe symptoms of chronic stress can benefit greatly from a relatively short CBT programme, even when it is delivered via the internet with less than 10 minutes therapist time per patient each week,” says Elin Lindsäter, psychologist at Gustavsberg’s primary care clinic outside of Stockholm and a doctoral student at the Department of Clinical Neuroscience, Karolinska Institutet.

In her thesis, she has studied the effects of a new CBT programme for people suffering from chronic stress-related conditions. The thesis comprises two randomised clinical trials, one in which the CBT programme was evaluated as face-to-face treatment, and the other in which the same treatment was evaluated as a therapist-guided internet-based treatment (ICBT).

Increased quality of life
Results from both studies indicate that the 12-week treatment can be highly efficacious in reducing overall symptom burden and enhancing quality of life. Symptomatic improvements were sustained to the 6- and 12-month follow-ups, but the treatment was not superior to control conditions on outcomes measuring sick leave or workability.

The overall results from the studies contribute with valuable information regarding how suffering can be alleviated in the common and disabling conditions of adjustment disorder and clinical burnout in primary care, where most patients first seek help. A health-economic evaluation showed that ICBT can be a cost-effective treatment compared with letting patients wait for treatment for 12 weeks.

No increased societal costs
“The CBT examined is relatively short and simple to administer,” says Elin Lindsäter. “If it were to be implemented as an internet-based treatment in primary care, it would greatly increase treatment accessibility and potentiate treatment at an early stage of symptom development without leading to increased societal costs.”

The research was conducted with the support of/in collaboration with the Doctoral School in Health Care Sciences, the Swedish Social Insurance Agency, Vinnova (the Swedish governmental agency for innovation systems), the Stress Research Institute at Stockholm University, and the Stockholm Stress Center. Details of specific collaborations and financing are given in each publication included in the thesis.