Abstract
BACKGROUND: People diagnosed with stress-related exhaustion disorder report high levels of cognitive symptoms. This study aimed to explore how persons diagnosed with Exhaustion disorder (ED) experienced cognitive functioning and recovery 6-10 years after participating in a rehabilitation programme. Specifically, it investigated the experiences of current functioning, change over time, and what had been barriers or facilitators for cognitive recovery. METHODS: Semi-structured interviews were conducted for 38 persons previously diagnosed with ED (Mean age: 52; Females: 32) and explored using thematic analysis. RESULTS: The analysis resulted in four themes: "'It's different now': Remaining cognitive symptoms", "The bigger picture: Cognitive recovery in context", "Overcoming challenges: Strategies for coping with cognitive symptoms", and "The approach towards cognition matters". The participants' experiences varied but included descriptions on how cognitive functioning had become better with some remaining symptoms. These difficulties were reported across cognitive domains, yet often centred around upholding executive control. Cognitive recovery was seen in the context of overall well-being and recovery which differed between the participants. Facilitators and barriers thus varied between persons, and included both restorative and compensatory strategies, external conditions, the degree of worry, and development of a more acceptant or self-compassionate view on cognition and oneself. CONCLUSIONS: The results show that cognitive recovery in ED is multifaceted. 6-10 years after rehabilitation, experiences included improvement of everyday cognitive functioning, but also lingering challenges, often related to maintenance of executive control. Recovery was influenced by factors such as general well-being, restorative or compensatory strategies, worrying, or the adaptation of more accepting or self-compassionate perspectives. The findings indicate a need for tailored, person-centred approaches to supporting cognitive recovery. TRIAL REGISTRATION: Participants were recruited as part of the Rehabilitation for Improved Cognition (RECO) trial (ClinicalTrials.gov: NCT03073772, date of registration: 8 March, 2017). This study was preregistered on the Open Science Framework (osf.io: https://doi.org/10.17605/OSF.IO/S2W6X ).