Advertisement

Cognitively Oriented Behavioral Rehabilitation in Combination with Qigong for Patients on Long-Term Sick Leave Because of Burnout: REST—A Randomized Clinical Trial

  • Therese StenlundEmail author
  • Christina Ahlgren
  • Bernt Lindahl
  • Gunilla Burell
  • Katarina Steinholtz
  • Curt Edlund
  • Leif Nilsson
  • Anders Knutsson
  • Lisbeth Slunga Birgander
Article

Abstract

Background

Despite an increase in the occurrence of burnout, there is no agreement on what kind of rehabilitation these patients should be offered.

Purpose

Primary aim of this study was to evaluate effects on psychological variables and sick leave rates by two different group rehabilitation programs for patients on long-term sick leave because of burnout. Rehabilitation program A (Cognitively oriented Behavioral Rehabilitation (CBR) and Qigong) was compared with rehabilitation program B (Qigong only).

Method

In a randomized clinical trial, 96 women and 40 men with a mean age of 41.6 ± 7.4 years were allocated to one of the two rehabilitation programs.

Results

A per-protocol analysis showed no significant difference in treatment efficacy between the groups. Both groups improved significantly over time with reduced levels of burnout, self-rated stress behavior, fatigue, depression, anxiety, obsessive–compulsive symptoms, and sick leave rates. In an intention-to-treat analysis, patients in program A had fewer obsessive–compulsive symptoms and larger effect sizes in self-rated stress behavior and obsessive–compulsive symptoms compared to patients in program B.

Conclusion

This study showed no differences in effect between CBR and Qigong compared with Qigong only in a per-protocol analysis. Both rehabilitation programs showed positive effect for patients with burnout.

Keywords

Randomized controlled trials Burnout Cognitive therapy Sick leave 

Notes

Acknowledgements

This study was funded by the Swedish Council for Working Life and Social Research (dnr 2003-0761), the Västerbotten County Council, and the Swedish Social Insurance Agency.

References

  1. 1.
    Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory manual. Third ed. Palo Alto, California: Consulting Psychologists; 1996.Google Scholar
  2. 2.
    Shirom A. Burnout in work organizations. International Review of Industrial and Organizational Psychology. New York: Wiley; 1989. p. 25–48.Google Scholar
  3. 3.
    Schaufeli W, Enzmann D. The burnout companion to study & practice: a critical analysis.London: Taylor & Francis; 1998.Google Scholar
  4. 4.
    Ekstedt M, Fagerberg I. Lived experiences of the time preceding burnout. J Adv Nurs. 2005;49(1):59–67.PubMedCrossRefGoogle Scholar
  5. 5.
    Kushnir T, Melamed S. The Gulf War and its impact on burnout and well-being of working civilians. Psychol Med. 1992;22:987–95.PubMedCrossRefGoogle Scholar
  6. 6.
    Pines A. Marriage burnout: a new conceptual framework for working with couples. Psychother Priv Pract. 1987;5:31–44.CrossRefGoogle Scholar
  7. 7.
    Stenlund T, Ahlgren C, Lindahl B, Burell G, Knutsson A, Stegmayr B, Slunga Birgander L. Patients with burnout in relation to gender and a general population. Scand J Public Health. 2007;35:516–23.PubMedCrossRefGoogle Scholar
  8. 8.
    Hallsten L, Bellaagh K, Gustafsson K. Utbränning i Sverige-en populationsstudie. (Burnout in Sweden—a population study). Arbete & Hälsa, 6. Stockholm: National Institute for Working Life; 2002. (in Swedish).Google Scholar
  9. 9.
    Lindblom KM, Linton SJ, Fedeli C, Bryngelsson IL. Burnout in the working population: relations to psychosocial work factors. Int J Behav Med. 2006;13(1):51–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Soares J, Grossi G, Sundin Ö. Burnout among women: associations with demographic/socio-economic, work, life-style and health factors. Arch Womens Ment Health. 2007;10:61–71.PubMedCrossRefGoogle Scholar
  11. 11.
    Cohen-Katz J, Wiley S, Capuano T, Baker D, Shapiro S. The effects of mindfulness-based stress reduction on nurse stress and burnout, part II. Holist Nurs Pract. 2005;19(1):26–35.PubMedGoogle Scholar
  12. 12.
    Granath J, Ingvarsson S, Von Thiele U, Lundberg U. Stress management: a randomized study of cognitive behavioural therapy and yoga. Cogn Behav Ther. 2006;35(1):3–10.PubMedCrossRefGoogle Scholar
  13. 13.
    Hasson D, Anderberg UM, Theorell T, Arnetz B. Psychophysiological effects of a web-based stress management system: a prospective, randomized controlled intervention study of IT and media workers. BMC Public Health. 2005;5(78):1–14.Google Scholar
  14. 14.
    Rowe M. Skills training in the long-term management of stress and occupational burnout. Curr Psychol. 2000;19(3):215–28.CrossRefGoogle Scholar
  15. 15.
    Van Rhenen W, Blonk R, Van Der Klink J, Van Dijk F, Schaufeli W. The effect of a cognitive and physical stress-reducing programme on psychological complaints. Int Arch Occup Environ Health. 2005;78:139–48.PubMedCrossRefGoogle Scholar
  16. 16.
    Blonk R, Brenninkmeijer V, Lagerveld S, Houtman I. Return to work: a comparison of two cognitive behavioural interventions in cases of work-related psychological complaints among the self-employed. Work Stress. 2006;20(2):129–44.CrossRefGoogle Scholar
  17. 17.
    Brattberg G. Internet-based rehabilitation for individuals with chronic pain and burnout: a randomized trial. Int J Rehabil Res. 2006a;29:221–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Heiden M, Lyskov E, Nakata M, Sahlin K, Sahlin T, Barnekow-Bergkvist M. Evaluation of cognitive behavioural training and physical activity for patients with stress-related illness: a randomized controlled study. J Rehabil Med. 2007;39:366–73.PubMedCrossRefGoogle Scholar
  19. 19.
    Brattberg G. Internet-based rehabilitation for individuals with chronic pain and burnout II: a long-term follow-up. Int J Rehabil Res. 2007;30:231–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Michie S, Williams S. Reducing work related psychological ill health and sickness absence: a systematic literature review. Occup Environ Med. 2003;60:3–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Mimura C, Griffiths P. The effectiveness of current approaches to workplace stress management in the nursing profession: an evidence based literature review. Occup Environ Med. 2003;60:10–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Van Der Klink J, Blonk R, Schene A, Van Dijk F. The benefits of interventions for work-related stress. Am J Public Health. 2001;91(2):270–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Sancier K. Medical applications of Qigong. Altern Ther Health Med. 1996;2(1):40–6.PubMedGoogle Scholar
  24. 24.
    Lee M, Ryu H, Chung H. Stress management by psychosomatic training: effects of ChunDoSunBup Qi-training on symptoms of stress: a cross-sectional study. Stress Med. 2000;16:161–6.CrossRefGoogle Scholar
  25. 25.
    Skoglund L, Jansson E. Qigong reduces stress in computer operators. Complement Ther Clin Pract. 2007;13:78–84.PubMedCrossRefGoogle Scholar
  26. 26.
    Lee M, Kang C, Lim H, Lee M. Effects of Qi-training on anxiety and plasma concentrations of cortisol, ACTH, and aldosterone: a randomized placebo-controlled pilot study. Stress Health. 2004;20:243–8.CrossRefGoogle Scholar
  27. 27.
    Tsang H, Fung K, Chan A, Lee G, Chan F. Effect of a Qigong exercise programme on elderly with depression. Int J Geriatr Psychiatry. 2006;21:890–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Stenlund T, Lindström B, Granlund M, Burell G. Cardiac rehabilitation for the elderly: Qi Gong and group discussions. Eur J Cardiovasc Prev Rehabil. 2005;12:5–11.PubMedCrossRefGoogle Scholar
  29. 29.
    Melamed S, Kushnir T, Shirom A. Burnout and risk factors for cardiovascular diseases. Behav Med. 1992;18:53–60.PubMedGoogle Scholar
  30. 30.
    Melamed S, Ugarten U, Shirom A, Kahana L, Lerman Y, Froom P. Chronic burnout, somatic arousal and elevated salivary cortisol levels. J Psychosom Res. 1999;46:591–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Burell G, Granlund B. Women’s hearts need special treatment. Int J Behav Med. 2002;9:228–42.PubMedCrossRefGoogle Scholar
  32. 32.
    Bergdahl J, Larsson A, Nilsson LG, Riklund Åhlström K, Nyberg L. Treatment of chronic stress in employees: subjective, cognitive and neural correlates. Scand J Psychol. 2005;46:395–402.PubMedCrossRefGoogle Scholar
  33. 33.
    Grossi G, Perski A, Evengård B, Blomkvist V, Orth-Gomér K. Physiological correlates of burnout among women. J Psychosom Res. 2003;55:309–16.PubMedCrossRefGoogle Scholar
  34. 34.
    Claesson M, Slunga Birgander L, Lindahl B, Nasic S, Åström M, Asplund K, Burell G. Women’s hearts–stress management for women with ischemic heart disease. J Cardiopulm Rehabil. 2005;25:93–102.PubMedCrossRefGoogle Scholar
  35. 35.
    Beurskens A, Bultmann U, Kant I, Vercoulen J, Bleijenberg G, Swaen G. Fatigue among working people: validity of a questionnaire measure. Occup Environ Med. 2000;57:353–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Mattila-Evenden M, Svanborg P, Gustavsson P, Åsberg M. Determinants of self-rating and expert rating concordance in psychiatric out-patients, using the affective subscales of the CPRS. Acta Psychiatr Scand. 1996;94:386–96.PubMedCrossRefGoogle Scholar
  37. 37.
    Svanborg P, Åsberg M. A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand. 1994;89:21–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Dawson-Saunders B, Trapp RG. Basic & clinical biostatistics. East Norwalk, Connecticut: Appleton & Lange; 1994.Google Scholar
  39. 39.
    Jensen IB, Bergström G, Ljungquist T, Bodin L, Nygren ÅL. A randomized controlled component analysis of a behavioral medicine rehabilitation program for chronic spinal pain: are the effects dependent on gender? Pain. 2001;91:65–78.PubMedCrossRefGoogle Scholar
  40. 40.
    Engström LG, Janson S. Stress-related sickness absence and return to labour market in Sweden. Disabil Rehabil. 2007;29(5):411–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Lund T, Kivimäki M, Labriola M, Villadsen E, Christensen KB. Using administrative sickness absence data as a marker of future disability pension: the prospective DREAM study of Danish private sector employees. Occup Environ Med. 2008;65:28–31.PubMedCrossRefGoogle Scholar
  42. 42.
    Brattberg G. PTSD and ADHD: underlying factors in many cases of burnout. Stress Health. 2006b;22:305–13.CrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2008

Authors and Affiliations

  • Therese Stenlund
    • 1
    Email author
  • Christina Ahlgren
    • 2
  • Bernt Lindahl
    • 3
  • Gunilla Burell
    • 4
  • Katarina Steinholtz
    • 1
  • Curt Edlund
    • 5
    • 6
  • Leif Nilsson
    • 1
  • Anders Knutsson
    • 6
  • Lisbeth Slunga Birgander
    • 1
  1. 1.Department of Public Health and Clinical Medicine, Occupational and Environmental MedicineUmeå UniversityUmeåSweden
  2. 2.Department of Community Medicine and Rehabilitation, PhysiotherapyUmeå UniversityUmeåSweden
  3. 3.Department of Public Health and Clinical Medicine, Behavioral MedicineUmeå UniversityUmeåSweden
  4. 4.Department of Public Health and Caring SciencesUniversity of UppsalaUppsalaSweden
  5. 5.Department of Public Health and Clinical Medicine, Epidemiology and Public Health SciencesUmeå UniversityUmeåSweden
  6. 6.Department of Health SciencesMid Sweden UniversitySundsvallSweden

Personalised recommendations