Gymnastik- och idrottshögskolan, GIH

Recovery from work stress is crucial for health and well-being. While research has strongly focused on recovery processes after the workday, there is increasing recognition of the importance of such processes during work. A challenge in investigating recovery processes at work has been the absence of validated measurement tools. This study developed and examined the psychometric properties of a work context-adapted version of the Swedish version of the Recovery Experience Questionnaire (REQ). Data were collected by means of an online survey, consisting of 481 employees at a large-sized company located in a medium-sized community in Sweden, in which the questionnaire was completed at two occasions (269 completed the questionnaire on the first or the second occasion, and 105 participants on both occasions). To determine the best-fitting model, we first conducted an exploratory factor analysis (EFA), followed by confirmatory factor analysis (CFA) to test the a priori model. Both the EFA and the CFA supported the proposed four-factor structure of the scale, consisting of the factors Control, Relaxation, Mastery, and Psychological detachment. High reliability estimates were demonstrated for both internal consistency of the total measure and of each subscale, and test-retest consistency. Furthermore, the measure proved to have good convergent validity and discriminant validity for all factors, except some concern regarding convergent validity for Mastery. Despite the limitations discussed, the findings provide support for the use of the Swedish version of the REQ-W and suggest the development and psychometric testing of translated versions of the REQ-W in other languages.

For decades, research on stress recovery has been neglected, as reflected in the underdevelopment of instruments measuring recovery processes. Nevertheless, a notable exception is the Recovery Experience Questionnaire (REQ) developed by Sonnentag and Fritz, which assesses work recovery experiences during leisure time. The REQ has demonstrated satisfactory reliability and validity across multiple languages. In this study, we used the Swedish version of the REQ to investigate whether a factor covering experiences of contrast between work time and non-work time could be incorporated as a fifth factor into the established four-factor model of the REQ, which currently includes the factors control, relaxation, mastery, and psychological detachment. Confirmatory factor analysis was conducted using a sample of 812 participants recruited through social media. Utilizing four questions as indicators of contrasting experiences, all fit indices suggested a satisfactory model fit, closely resembling those of the four-factor model. Moreover, indices of reliability and validity indicated good composite reliability, internal convergent validity, and discriminant validity for all five factors. Among the five recovery factors, experiences of contrast exhibited the weakest relationship with both burnout and vitality. In conclusion, despite certain limitations in the present study, further examination of experiences of contrast as a recovery factor and the inclusion of this factor in the initial Swedish version of the 5-factor REQ are warranted.

Background: Public and patient involvement and engagement (PPIE) is increasingly valued for improving the quality and relevance of health research. Patient research partners (PRPs) offer lived experience of a previous myocardial infarction and cardiac distress that can enhance study design and implementation. This protocol describes one out of four studies in a larger project aiming to adapt and evaluate a stress recovery intervention for adults (aged < 55) after myocardial infarction with cardiac distress.

Objective: The primary aim of this study is to explore PRPs' perceived impact on the design, implementation, and evaluation of the internet-delivered behavioral stress recovery intervention Balance in Everyday Life (iBEL), and to describe the process of their involvement in research activities. This study employs a PPIE approach to systematically involve PRP: s throughout all phases of the research project.

Methods: Five to eight PRPs with lived experiences of a previous myocardial infarction and cardiac distress will participate in a series of structured online workshops across all phases of the project. They provide feedback on intervention materials and study procedures. Data are collected using impact logs, semi-structured interviews, and questionnaires, and will be analyzed using thematic analysis.

Discussion: This study is expected to generate insights into how sustained PRP involvement can be integrated into behavioral intervention research. It will highlight how PRPs influence decision-making processes in real time, and how this aligns with scientific and practical considerations.

Conclusion: The present study provides insights into the perceived impact of PRPs on the design, implementation, and evaluation of the iBEL intervention, highlighting both effective aspects and challenges of patient involvement, and offering guidance for integrating PRP input in behavioral intervention research.

Background: Research has shown that younger patients who have had a myocardial infarction (MI) experience more emotional distress than their older counterparts. Objective: In this study, we aimed to compare emotional distress 2 months post-MI (follow-up 1) between younger (&lt;55) vs older (≥55) patients in Sweden, and investigate its impact on working status and 4 secondary preventive goals 1 year after MI (follow-up 2). Methods: Data (N = 50 213) from the SWEDEHEART National Quality Registers for Cardiac Care, which covers approximately 90% of all MIs in Sweden, were used. Results: After adjusting for confounders, logistic regression analyses showed that younger patients who had experienced an MI had higher odds of experiencing emotional distress than older patients at follow-up 1 (adjusted odds ratio [AOR], 1.59; 95% confidence interval [CI], 1.52–1.67) and follow-up 2 (AOR, 1.47; 95% CI, 1.40–1.55). Emotional distress at follow-up 1 was associated with lower odds of working (AOR, 0.60; 95% CI, 0.53–0.67) and achieving smoking and physical activity goals (AOR, 0.76; 95% CI, 0.67–0.86; AOR, 0.83; 95% CI, 0.76–0.91) at follow-up 2. However, emotional distress was not associated with achieving goals for low-density lipoproteins or systolic blood pressure at follow-up 2. Conclusions: Younger patients experienced emotional distress more often after a first-time MI than their older counterparts, and their distress predicted long-term lower levels of returning to work and achievement of smoking and physical activity goals. The results highlight the importance of identifying younger patients who have had an MI and are experiencing emotional distress, and offering them interventions targeting distress.

Teachers are particularly affected by stress and burnout. Recovery experiences are crucial to counteract the harmful continuation of everyday life stress reactions. There is a lack of knowledge regarding recovery experiences and its importance for burnout among compulsory school teachers. The aim of the present study was to investigate (1) the levels of burnout and different recovery experiences during leisure time among female compulsory school teachers in Sweden, and (2) to which extent different recovery experiences explain burnout. In a non-random sample of female compulsory school teachers (n = 570) and a random sample from a general female working population (n = 457/393), the participants self-rated their levels of burnout and their recovery experiences during leisure time via the brief version of the Shirom-Melamed Burnout Measure and the Recovery Experience Questionnaire, respectively. Independent t-tests showed that, compared to the general female working population, the female compulsory school teachers scored (1) significantly higher on burnout (with a high magnitude of effect, d = 0.87), and (2) significantly lower on recovery experiences (d = 0.38–1.23). In total, recovery experiences explained 37% of the variance in burnout. Among the four recovery experiences being investigated, Psychological detachment explained the highest variance in burnout (27%), with Mastery and Control also being significant predictors in the model. Surprisingly, the variance of Relaxation in explaining burnout was close to zero. The study suggests enhancing the circumstances that foster psychological detachment among female compulsory school teachers in Sweden and further investigation of recovery experiences among teachers.

The Shirom-Melamed Burnout Questionnaire/Measure (SMBQ/M) is one of the most commonly used measures of burnout. Using confirmatory factor analyses, the present study aimed to evaluate the model fit, composite reliability, and fac-torial (i.e. convergent and discriminant) validity of the new brief Swedish version of the scale-labeled SMBM-6. In addition, we used Cronbach’s α as an indicator of the internal consistency of the total scale. The SMBM-6 consists of two subscales: the emotional and physiological exhaustion subscale (three items) and the cognitive weariness subscale (three items). A total of 1251 teachers in Sweden were included in the study. The analyses showed that the Swedish version of the SMBM-6 has an excellent model fit and good convergent validity. The discriminant validity for the cognitive weariness subscale was good, but slightly inadequate for the physiological exhaustion subscale. Composite reliability and Cronbach’s α indicated high internal consistency for the subscales and the total scale, respectively. Multi-group invar-iance tests for age indicated no violation of invariance. These results are consistent with those of the study by Almén and Jansson (2021), in which the SMBM-6 was developed, and a subsequent psychometric study by Sundström et al. (2022). In conclusion, there is strong support for the Swedish version of the SMBM-6 as a reliable and valid scale for measuring burnout. Testing the scale in languages other than Swedish is warranted.

The recovery perspective on stress management is new and few recovery intervention studies have been conducted. The aim of the study was to evaluate behavioral effects of a functionalistic stress recovery intervention, in which individuals perceiving high levels of stress were encouraged to pay attention to possibilities to perform potential recovery behaviors in everyday life and to choose behaviors that were predicted to lead to resource restoration. Seventy-three individuals were randomly allocated to either a 10-week intervention or a waiting-list control group. Three types of recovery behavior factors during leisure time were studied: perceived recovery opportunities (i.e., control), relaxational behaviors (i.e., relaxation), and positively challenging behaviors (i.e., mastery). In comparison with the control group, the intervention group significantly improved, showing high between-group effect sizes, regarding perceived recovery opportunities (p &lt; 0.001; d = 0.75) and relaxational behaviors (p &lt; 0.001; d = 0.80). Both groups normalized their levels of positively challenging behaviors between pre- and postassessment, and no statistically significant group difference was demonstrated. Analyses of reliable and clinically significant changes demonstrated results in favor of the intervention group regarding perceived recovery opportunities and relaxational behaviors but not positively challenging behaviors. The tested intervention warrants further research, for example, if a modified version of the intervention including components aiming at increasing postwork positively challenging behaviors would be beneficial for the improvement of the behavior and for health. 

Background. High levels of perceived stress and stress-related ill health, such as burnout, are common in many countries. Several theories postulate that stress behaviors promote adaption to environmental changes and if sustained they are potentially harmful for the body. In accordance, impaired stress recovery behaviors, i.e., psychophysiological deactivation after periods of stress behaviors, have been suggested to be a critical factor in explaining stress-related ill health. Whereas research shows that interventions targeting stress reactivity can have beneficial effects on stress-related variables, studies on interventions targeting stress recovery are surprisingly few. Also, the number of validated instruments for measuring behaviors important for stress recovery are few, in particular easily used self-rating scales. 

Aims. The primary aim of the thesis was to evaluate stress and health-related effects of an intervention targeting stress recovery behaviors in everyday life among people perceiving high levels of stress in life. A secondary aim was to validate a self-report scale measuring behaviors important for stress recovery in everyday life. 

Method. Three empirical studies were conducted to evaluate effects of the behavioral stress recovery intervention “balance in everyday life”, which solely aims at strengthening stress recovery behaviors in everyday life. First, a brief version of the intervention was investigated through a small pilot study in which a single-subject experimental design was used (study 1). After that, the intervention was exploratively tested in a group format in which a quasi-experimental design was used (study 2). Due to the positive results of these two studies, a larger scale study using a randomized controlled design was conducted in order to further investigate the effects of the intervention when delivered in a group format (study 3). To fulfill the secondary aim of the thesis, the Recovery Experience Questionnaire was translated into Swedish and analyzed using exploratory factor analysis and confirmatory factor analysis (study 4). 

Results. In study 1, data demonstrated immediate reduction of stress symptoms as a function of the intervention. The improvements were maintained at 1-year and 5-year follow-up assessments. In study 2, in comparison with a waiting-list-control group, the intervention yielded statistically significant improvements between pre- and postintervention assessment on eleven out of twelve stress and health-related variables. Medium to large between-groups effect sizes were demonstrated for the primary outcome measures covering (potential) recovery behaviors, perceived stress and rest and experiences of being recovered. In the third study, statistically significant improvements for all outcome measures at postintervention assessment and at the 3-month follow-up were demonstrated. The between-groups effect sizes for the primary measures - perceived stress, tension, and burnout - were medium-to-high at postintervention assessment and at follow-up. In addition, in all studies the intervention was associated with beneficial changes in levels of anxiety and depression. In the last study, support was found for the proposed four-factor structure of the Swedish version of the Recovery Experience Questionnaire. 

Conclusions. The results clearly indicate that the intervention “balance in everyday life” improves stress and health-related factors in a relatively satisfactory way among people perceiving high levels of stress in life. The empirical support is strongest for the reduction in tension, perceived stress, burnout, anxiety and depression, and to deliver the intervention in a group format. The studies demonstrated results that warrant further investigation of the effects of “balance in everyday life”, for example in different contexts, and to study other behavioral recovery interventions. To test (potential) recovery facilitating behaviors as mediators of intervention effects, such as reduction in burnout, the Swedish version of the Recovery Experience Questionnaire could be used.