Karolinska Institutet.
Karolinska Institutet.
Behav Ther. 2019 May;50(3):475-488. doi: 10.1016/j.beth.2018.08.005. Epub 2018 Aug 20.
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 [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CI [-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.
越来越多的证据支持认知行为疗法（CBT）对与压力相关的疾病的有效性，但对于其改变的机制知之甚少。本研究旨在使用一种积极的心理治疗作为对照，研究 CBT 对严重压力导致的临床倦怠的潜在中介因素。我们使用线性混合模型分析了一项随机对照试验中 82 名患有临床倦怠的患者的数据，这些患者接受了 CBT 或另一种心理治疗。在治疗期间每周评估潜在的中介因素（即睡眠质量、行为激活、感知能力和治疗联盟）和结果（即倦怠症状）。结果表明，CBT 对倦怠症状的积极治疗效果（组间估计 d = 0.93）受睡眠质量改善的中介作用，ab = -0.017，95%CI [-0.037，-0.002]，以及感知能力的提高，ab = -0.037，95%CI [-0.070，-0.010]。行为激活，ab = -0.004 [ - 0.016，0.007]，和治疗联盟，ab = 0.002 [ - 0.006，0.011]，并没有显著中介治疗效果之间的差异。因此，改善睡眠质量和提高感知能力可能是 CBT 治疗临床倦怠症以减轻症状的重要过程目标。
