Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review

Abstract

Background Exhaustion due to persistent non-traumatic stress (ENTS) is a significant health problem with substantial personal, social, and economic impact. While there are increasing studies of ENTS, there is no international agreement on how it should be diagnosed and treated. This scoping review aimed to map definitions, diagnoses, treatments, outcome measures, and outcomes in psychological treatment studies of ENTS. A further aim was to assess the quality of the treatments and map what change processes are described within ENTS interventions. Methods A PRISMA-guided scoping review of psychological treatment studies delivered in a clinical setting for ENTS was conducted using the databases of PubMed, PsycINFO, and CINAHL. Results Of the 60 studies included, the majority (87%) stemmed from Europe. The most recurrent term for ENTS was burnout, and the diagnosis most often utilized was exhaustion disorder. Several treatments were reported, the most frequent being cognitive behavioral therapy (CBT) (68%). Statistically significant outcomes relevant to ENTS were reported in 65% (n = 39) of the studies, with effect sizes between 0.13 and 1.80. In addition, 28% of the treatments were rated as high quality. The most frequent change processes described were dysfunctional sleep, avoidance, behavioral activation, irrational thoughts and beliefs, worry, perceived competence/positive management, psychological flexibility, and recuperation. Conclusions While several treatments based on CBT show promising results for ENTS, there do not seem to be any uniformly established methods, theoretical models, or change processes. Instead of adopting a monocausal, syndromal, and potentially bio-reductionist perspective on ENTS, a process-based approach to treatment is encouraged.

A network analysis of exhaustion disorder symptoms throughout treatment

“…The costs of work-related stress to Western societies have been estimated to be as high as 187 billion dollars due to losses in productivity and medical expenses [ 5 ]. Patients with exhaustion due to persistent non-traumatic stress as their primary complaint report various somatic and psychiatric symptoms, and there is a lack of international consensus on how this heterogeneous condition should be diagnosed and understood [ 6 – 10 ]. In Sweden, the diagnostic criteria of stress-induced Exhaustion Disorder (ED) (SE-ICD-10; F43.8 A) are utilized to diagnose and guide the treatment of exhaustion due to persistent non-traumatic stress.…”

“…The prevalence of ED has increased rapidly since its introduction in 2005, and it is today one of the most common psychiatric disorders in Sweden, raising some concerns about the current diagnostic conceptualization of ED [ 12 , 13 ]. Regardless of the specific diagnostic construct of ED, there is an apparent need to increase the understanding of the symptoms that underlie this condition, in Sweden and globally [ 6 , 7 , 14 ].…”