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Cited by 31Stress and Burnout ResearchPsychotherapy Techniques and ApplicationsHealthcare professionals’ stress and burnout

Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout

Santoft, Fredrik, Salomonsson, Sigrid, Hesser, Hugo, Lindsäter, Elin, Ljótsson, Brjánn, Lekander, Mats, Kecklund, Göran, Öst, Lars-Göran +1 more·2019·Behavior Therapy
DOI 10.1016/j.beth.2018.08.005
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Abstract

Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017, 95% CI asymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CI asymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.

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  • Positive changes in symptoms of exhaustion (measured with the Shirom Melamed Burnout Questionnaire) were partially mediated by improvements in insomnia and perceived competence.

    “Positive changes in symptoms of exhaustion (measured with the Shirom Melamed Burnout Questionnaire) were partially mediated by improvements in insomnia and perceived competence.”

    From Mediators during a Multimodal intervention for stress-induced exhaustion disorder (2024) · cites this paper as Santoft et al., 2019

  • These findings corroborate previous studies identifying insomnia as a potential mediator in ED treatment.

    “These findings corroborate previous studies identifying insomnia as a potential mediator in ED treatment (Lindsäter et al., 2021; Santoft et al., 2019).”

    From Mediators during a Multimodal intervention for stress-induced exhaustion disorder (2024) · cites this paper as Santoft et al., 2019

  • Of all secondary findings, only one was replicated across two studies: the effect of Internet-CBT on symptoms of stress and exhaustion was mediated by insomnia severity.

    “Of all secondary findings, only one was replicated across two studies, showing that the effect of Internet-CBT on symptoms of stress and exhaustion was mediated by insomnia severity [68, 80].”

    From Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review. (2024) · cites this paper as [80]

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Authors
Santoft, F., Salomonsson, S., Hesser, H., Lindsäter, E., Ljótsson, B., Lekander, M., Kecklund, G., Öst, L.-G., & Hedman-Lagerlöf, E.
Affiliations
  • Karolinska Institutet (SE)
  • Linköping University (SE)
  • Stockholm University (SE)
Corresponding author
Santoft, Fredrik
ORCID
Venue
Behavior Therapy
Publisher
Elsevier BV
Published
2019-05
Volume
50
Issue
3
Pages
475-488
ISSN
0005-7894 (ISSN-L)
DOI
10.1016/j.beth.2018.08.005
OpenAlex
W2888345551
Cited by
31
References
67
Citations by year
2025: 2 · 2024: 3 · 2023: 7 · 2022: 1 · 2021: 3 · 2020: 13 · 2019: 1 · 2018: 1
FWCI
6.11
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Behavior Therapy (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Karolinska Institutet
  • Stockholm County Council
Topics
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
Keywords
cognitive behavioral therapy, mechanisms of change, mediators, sleep quality, perceived competence, behavioral activation, therapeutic relationship, stress-related disorders, process goals
MeSH terms
Burnout, Psychological, Adult, Female, Humans, Male, Middle Aged, Cognitive Behavioral Therapy, Treatment Outcome, Self Report

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