Comparing ACT, Recuperation, and ACT Plus Vocational Support for Clinical Burnout

Burnout Symptom Severity

This is one of two co-primary outcomes. Burnout symptoms will be assessed using the Shirom-Melamed Burnout Measure-12 (SMBM-12), a 12-item self-report scale measuring the core components of burnout: emotional and physical exhaustion (items 1-6) and cognitive/mental exhaustion (items 7-12). Each item is rated from 1 (almost never) to 7 (almost always). Items are averaged to produce a total mean score ranging from 1 (lowest level of burnout) to 7 (highest level of burnout). Higher scores indicate more severe burnout symptoms. Only the total mean score will be used as the primary outcome. Unit of Measure: SMBM-12 mean total score (1-7)

Net Sick-Leave Days

This is one of two co-primary outcomes. This outcome reflects the total number of registered sick-leave days during the 12-month period following treatment. Data will be obtained from the Swedish Social Insurance Agency. Part-time sick leave will be converted into net days (e.g., 50% sick leave = 0.5 net day). Higher values indicate worse functional outcome (i.e., more days of sick leave). Unit of Measure: Net sick-leave days (0 to no upper limit)

Perceived Stress

Perceived stress will be measured using the Perceived Stress Scale-10 (PSS-10), a 10-item self-report questionnaire assessing the degree to which situations in one's life are appraised as stressful. Items are rated on a 0-4 scale and summed to a total score ranging from 0 (lowest perceived stress) to 40 (highest perceived stress). Higher scores indicate greater perceived stress.

Anxiety Symptoms Severity

Anxiety severity will be measured using the Generalized Anxiety Disorder-7 (GAD-7), a 7-item self-report questionnaire. Each item is rated from 0 (not at all) to 3 (nearly every day). Items are summed to produce a total score ranging from 0 (no anxiety) to 21 (severe anxiety). Higher scores indicate greater anxiety severity. Unit of Measure: GAD-7 total score (0-21)

Depressive symptoms severity

Depressive Symptom Severity will be measured using the Patient Health Questionnaire-9 (PHQ-9), a 9-item self-report scale. Each item is rated from 0 (not at all) to 3 (nearly every day). Items are summed to produce a total score ranging from 0 (no depressive symptoms) to 27 (severe depressive symptoms). Higher scores indicate greater depressive symptom severity. Unit of Measure: PHQ-9 total score (0-27)

Insomnia severity

Sleep disturbance will be measured using the Insomnia Severity Index (ISI), a 7-item self-report scale assessing the severity and impact of insomnia symptoms. Each item is rated on a 0-4 scale, with response options reflecting increasing severity (e.g., from "no problem" to "very severe problem"). Item scores are summed to produce a total score ranging from 0 (no insomnia) to 28 (severe insomnia). Higher scores indicate greater sleep disturbance. Unit of Measure: ISI total score (0-28)

Treatment Credibility and Expectancy

Treatment credibility and outcome expectancy will be measured using the Credibility/Expectancy Questionnaire (CEQ), a 6-item self-report measure. Items 1-4 assess treatment credibility, and items 5-6 assess outcome expectancy. The CEQ uses two response formats (rating scales and percentage estimates), and subscale scores are calculated according to CEQ scoring guidelines. Higher scores indicate greater perceived credibility and expectancy. Unit of Measure: CEQ credibility and expectancy subscale scores (higher = greater credibility/expectancy)

Psychological Flexibility

Psychological flexibility will be assessed using the Psy-Flex scale, a 6-item self-report measure capturing core processes of psychological flexibility. Each item is rated from 1 (very inflexible) to 5 (very flexible). Items are summed to produce a total score ranging from 6 (lowest psychological flexibility) to 30 (highest psychological flexibility). Higher scores indicate greater psychological flexibility. Unit of Measure: Psy-Flex total score (6-30)

Recuperation Behaviors

Recuperation behaviors will be assessed using the Recuperation Behaviors Index (RPI-6), a formative process measure designed to capture multiple distinct aspects of recuperation. The index consists of six items representing complementary recuperation-related skills: detachment, relaxation, pacing, sleep protection, managing obligations, and prioritizing energy-restoring activities. Each item is rated from 1 (not at all true) to 7 (completely true), and items are summed to create a total score. Higher total scores indicate engagement in a broader set of recuperation behaviors. Content validity was established through expert ratings. The RPI-6 is included as a process measure to assess engagement in recuperation behaviors during treatment; full psychometric validation will be conducted in future research. Unit of Measure: RPI-6 total score

Return-to-Work Self-Efficacy

Description: Return-to-work self-efficacy will be assessed using a shortened version of the Self-Efficacy for Return to Work (SE-RTW) scale, originally developed by Lagerveld et al. (2010). The scale measures confidence in handling work demands, managing symptoms at work, and returning to or remaining in employment. Each item is rated on a 1-6 scale, from 1 = "strongly disagree" to 6 = "strongly agree." Items are summed to produce a total score, with higher scores indicating greater return-to-work self-efficacy. Unit of Measure: SE-RTW total score (higher = greater RTW self-efficacy)