Stenlund T.1, Fjellman-Wiklund A.1, Slunga Järvholm L.2, Stigsdotter Neely A.3, Boraxbekk C.-J.4,5, Nordin M.6
1Umeå University, Community Medicine and Rehabilitation, Physiotherapy, Umeå, Sweden, 2Umeå University, Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå, Sweden, 3Karlstad University, Social and Psychological Studies, Karlstad, Sweden, 4Copenhagen University at Amager Hvidovre Hospital, Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen, Denmark, 5Umeå University, Center for Demographic and Aging Research (CEDAR), Umeå Centre for Functional Brain Imaging, Umeå, Sweden, 6Umeå University, Psychology, Umeå, Sweden
Background: Stress-related diseases and exhaustion disorder have increased lately and are common reasons for sick leave. Persons with exhaustion disorder often report cognitive impairments that affect work and everyday life.
Purpose: The objective was to examine perceived factors that influence memory and concentration ability in persons with exhaustion disorder. This was done in the context of a multimodal rehabilitation program (MMR). Moreover, gender aspects were highlighted.
Methods: Individual semi-structured interviews were conducted, with 12 women and two men, and analyzed according to Grounded Theory. All participants were diagnosed with exhaustion disorder and participated in a 24-week MMR. The MMR consisted of group-based cognitive behavioural therapy (CBT) and vocational measures. Moreover, an individual prescription of physical activity was performed by a physiotherapist. After 12 weeks of MMR a randomization was performed to one of three conditions;
a) additional aerobic exercise,
b) addition of a computerized process-based cognitive training,
c) no additional training.
Results: A core category, Work in progress, was constructed. Three categories of perceived factors that influenced the memory and concentration ability were identified: Confirmation of self-worth, Tools for structure and prioritization and Learning by doing. For the category Confirmation of self-worth, the interviewees reported the importance of not feeling lonely but being accepted as good enough and to be loved and cherished despite their perceived limitations. The category Tools for structure and prioritization, included sayings that the aerobic exercise provided an appreciated structure and the use of a pulse watch facilitated the adjustment of exercise intensity. Moreover, memory training routines and CBT in group that met regularly gave further structure and tools for continued recovery. The category Learning by doing included statements about practical exercises on accepting oneself.
The core category, Work in progress, showed that regaining memory and cognitive ability was a process of hard work based on a confirmation of self-worth, structured by certain tools for both physical and mental exercises, and practicing these exercises. This gives insights in the disease and increases acceptance of oneself that can influence memory and concentration.
In highlighting the gender perspective, the interviewed women prioritized their children, family and ill relatives. They did not want to show weakness in front of others and blamed themselves for being a burden while sick. However, the rehabilitation process increased awareness that prestige and being a good girl was not all that important. Instead acceptance of oneself and the current situation improved memory and health.
Conclusion(s): Regaining memory and concentration ability is hard work and needs confirmation, tools for structure and exercising, as well as practicing both acceptance and memory. The findings add to previous ones that exercise (both physical and mental) and acceptance are beneficial for health. However, a stereotypic female behavior may act as a barrier for acceptance which needs to be addressed in further therapies.
Implications: To provide support and structure is a working arena for physiotherapists in an MMR. Persons need support in the clinic by a physiotherapist to find the appropriate and recommended level of physical activity and intensity.
Funding acknowledgements: This study was founded by REHSAM and the Västerbotten County Council.
Topic: Mental health
Ethics approval: This study was approved by the Regional Ethic Review Board in Umeå, Sweden (Approval Nr. 2010-53-31).
All authors, affiliations and abstracts have been published as submitted.
