Global practitioner assessment and management of mental fatigue and mental recovery in high-performance sport: A need for evidence-based best-practice guidelines.

BACKGROUND: Mental fatigue and mental recovery have gained scientific attention in relation to sporting performance, yet best practice assessment and management methods are lacking. A greater understanding of current knowledge and practices in high-performance sport are necessary. OBJECTIVE: To understand the contemporary knowledge, beliefs, monitoring processes, management strategies, perceived responsibility, sources of evidence, and challenges, when assessing the mental fatigue and mental recovery of athletes in high-performance sport. METHODS: A mixed-methods survey approach obtained information from 156 multi-disciplinary high-performance sport practitioners. Descriptive outputs were reported and potential differences between key concepts were detected using Wilcoxon-signed rank analysis. Thematic analysis interpreted open-text responses. RESULTS: Only 11.5% and 5.1% of respondents indicated they were "very" knowledgeable about mental fatigue and mental recovery, respectively. Knowledge (p < 0.001) and confidence in application (p = 0.001) were significantly greater for mental fatigue than mental recovery. Nearly all respondents perceived mental fatigue and mental recovery impacted training and competition performance, with a greater negative impact during competition (p < 0.001). A limited number of respondents reported deliberate assessment (31.1%) or management (51.2%) of mental fatigue and mental recovery. A combination of sources of evidence were used to inform practice, with common challenges to implementation including staff knowledge, athlete-buy in, time-availability, and a lack of evidence. Practitioners reported that assessing and managing mental fatigue and mental recovery was multi-disciplinary in nature. CONCLUSION: Practitioners reported that mental fatigue and mental recovery did impact performance, yet this was not reflected in the implementation of evidence-based assessment and management practices in high-performance sport.

Mindfulness-Based Interventions for the Recovery of Mental Fatigue: A Systematic Review.

Background: There is evidence that mindfulness-based interventions (MBI) can help one to recover from mental fatigue (MF). Although the strength model of self-control explains the processes underlying MF and the model of mindfulness and de-automatization explains how mindfulness training promotes adaptive self-regulation leading to the recovery of MF, a systematic overview detailing the effects of MBI on the recovery of MF is still lacking. Thus, this systematic review aims to discuss the influences of MBI on the recovery of MF. Methods: We used five databases, namely, PubMed, Web of Science, EBSCOhost, Scopus, and China National Knowledge Infrastructure (CNKI) for articles published up to 24 September 2021, using a combination of keywords related to MBI and MF. Results: Eight articles fulfilled all the eligibility criteria and were included in this review. The MBI directly attenuated MF and positively affected the recovery of psychology (attention, aggression and mind-wandering) and sports performance (handgrip, plank exercise and basketball free throw) under MF. However, the interaction did not reach statistical significance for the plank exercise. Therefore, the experience and duration of mindfulness are necessary factors for the success of MBI. Conclusions: mindfulness appears to be most related to a reduction in MF. Future research should focus on improving the methodological rigor of MBI to confirm these results and on identifying facets of mindfulness that are most effective for attenuating MF.

[Mental fatigue - possible explanations, diagnostic methods and possible treatments]. / Hjärntrötthet ­ ett osynligt gissel.

Mental fatigue or brain fatigue is a pathological and disabling symptom with diminished mental energy. It can be a long-lasting consequence after trauma or disease affecting the brain. The person can do most things in the moment and can be perceived as completely healthy, but the mental energy is insufficient over time and affects the ability to work and participate in social activities. After a conversation, for example, the person can be completely drained of energy and the recovery time is disproportionally long. Here we describe the phenomenon of mental fatigue, provide an explanatory model for how the condition can arise, point out diagnostic methods and possible treatments, which are currently in the research stage but may be implemented in healthcare within the foreseeable future.

Effect of Mindfulness Training on Fatigue and Recovery in Elite Volleyball Athletes: A Randomized Controlled Follow-Up Study.

Volleyball is a team sport with high physical and perceptual-cognitive demand, hence, increasing the perception of physical and mental fatigue during a competition. To alleviate fatigue (physical and mental), mindfulness and music have been proposed. The aim of this study was to analyze the effect of mindfulness-based mental versus music training on mental fatigue, physical fatigue, and recovery in elite competitive female volleyball athletes using a randomized two-controlled study with follow-up. Participants were 30 elite female Brazilian volleyball athletes. Athletes were randomly assigned to the following groups: 1) mindfulness-based mental training group (MBMT); 2) music-based training group (MBT); or 3) control group (CG). Three variables were evaluated as follows: 1) recovery based on total quality recovery; 2) mental fatigue visual analog scale; and 3) physical fatigue visual analog scale. Regarding recovery, there was no difference between the MBMT, MBT, and CG groups (p > 0.05). A difference in mental fatigue was noted between MBT and CG at follow-up [F(2,26) = 5.71, p = 0.009; large]. Regarding physical fatigue, there was no difference between the MBMT, MBT, and CG groups (p > 0.05). The mindfulness intervention effectively attenuated the mental fatigue caused by competition in volleyball athletes. These results will assist coaches and staff in providing fatigue management and reinforce the applicability of mental training in sports.

Comparing Relaxation Versus Mastery Microbreak Activity: A Within-Task Recovery Perspective.

Recovery from work is generally thought to occur outside of the workplace. However, employees may also have the opportunity to recover within the work day via microbreaks during demanding work tasks. Two major strategies for mitigating fatigue include psychological detachment (i.e., mentally disengaging) and replenishing motivational incentives via positive affect. This study examined whether 40-s "microbreaks" improve work recovery and to what extent different microbreak content (mastery vs. relaxation activities) boost performance. Using an experimental study, we randomly assigned individuals to receive a relaxation microbreak (n = 59), a mastery microbreak (n = 68), or no break (n = 72) in the middle of a monotonous work task and assessed work performance. Microbreaks improved task performance and within-task recovery, but only for psychological detachment (not positive affect). Mastery breaks also resulted in more psychological detachment than relaxation breaks, but this increased detachment did not explain performance differences between break types. These results build on existing recovery theories by further demonstrating within-task recovery and provide practical implications for organizations to consider the importance of microbreaks.

Effects of Rest-Break on Mental Fatigue Recovery Determined by a Novel Temporal Brain Network Analysis of Dynamic Functional Connectivity.

Mental fatigue is growingly considered to be associated with functional brain dysconnectivity. Although conventional wisdom suggests that rest break is an effective countermeasure, the underlying neural mechanisms and how they modulate fatigue-related brain dysconnectivity is largely unknown. Here, we introduce an empirical method to examine the reorganization of dynamic functional connectivity (FC) in a two-session experiment where one session including a mid-task break (Rest) compared to a successive task design in the other session (No-rest). Temporal brain networks were estimated from 20 participants and the spatiotemporal architecture was examined using our newly developed temporal efficiency analysis framework. We showed that taking a mid-task break leads to a restorative effect towards the end of experiment instead of immediate post-rest behaviour benefits. More importantly, we revealed a potential neural basis of our behaviour observation: the reduced spatiotemporal global integrity of temporal brain network in No-rest session was significantly improved with the break opportunity in the last task block of Rest session. Overall, we provided novel evidence to support beneficial effect of rest breaks in both behaviour performance and brain function. Moreover, these findings extended prior static FC studies of mental fatigue and highlight that altered dynamic FC may underlie cognitive fatigue.

Effectiveness of cognitive-behavioral therapy (CBT) in improving the quality of life and psychological fatigue in women with polycystic ovarian syndrome: a randomized controlled clinical trial.

Introduction: Given the increasing prevalence of complications caused by the polycystic ovarian syndrome (PCOS) such as medical and psychological problems and also the chronicity of this disease, patients with the PCOS tend to experience lower quality of life and greater psychological fatigue similar to other patients with chronic diseases. This study was conducted to determine the effects of cognitive-behavioral therapy (CBT) on the quality of life and psychological fatigue in women with the PCOS. Methods: This randomized controlled clinical trial study, conducted from 2016 to 2017, enrolled 74 women aged between 18 and 35 years from the Iranian city of Saqqez. The participants were assigned to a CBT group and a control group via block randomization. The intervention group received 8 weekly CBT sessions between 45 and 60 minutes each. The Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ) and the Fatigue Impact Scale (FIS) were completed by the patients before and after the intervention. Results: No significant differences were observed between the two groups before the intervention in terms of sociodemographic characteristics and the mean scores of quality of life and psychological fatigue. After the intervention, the mean (standard deviation [SD]) of the quality of life score was 60.2 (13.3) in the intervention group and 24.4 (15) in the control group, with the mean score of quality of life being significantly higher in the intervention group than in the control group (adjusted mean difference = 33.1). The mean (SD) score of psychological fatigue was 28.2 (13.9) in the intervention group and 78.2 (37.1) in the control group, with the mean score of psychological fatigue being significantly lower in the intervention group than in the control group (-54.8). Conclusions: The results showed that CBT was able to reduce fatigue and improve quality of life in our sample of women with the PCOS and ultimately boost their health.

The effects on mental fatigue and the cognitive function of mechanical massage and binaural beats (brain massage) provided by massage chairs.

OBJECTIVE: To verify whether the mechanical massage using massage chairs and binaural beats (brain massage) affect the mental fatigue recovery and cognitive enhancements. METHODS: 25 healthy adults used massage chairs that could provide mechanical massage and binaural beats (brain massage) for 20 min. Mental fatigue and cognitive function were assessed before and after receiving brain massage using electroencephalogram (EEG) and 5 prolonged cognitive tests. RESULTS: When a person received a brain massage on the massage chair, the decrease in mental fatigue was statistically significant compared to taking a rest or receiving a mechanical massage only on the massage chair. In addition, sustained attention, verbal short-term and long-term memory and non-verbal long-term memory were statistically significantly increased after using brain massage. CONCLUSION: Brain massage (mechanical massage and binaural beats) are effective in reducing mental fatigue and improving the cognitive function.

Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial.

BACKGROUND: Prolonged exposure to stress can lead to substantial suffering, impairment and societal costs. However, access to psychological treatment is limited. Internet-based cognitive behavioral therapy (ICBT) can be effective in reducing symptoms of stress, but little is known of its effects in clinical samples. The aim of this study was to investigate the efficacy of ICBT for patients suffering from chronic stress, operationalized as adjustment disorder (AD) and exhaustion disorder (ED). METHODS: A total of 100 adults diagnosed with AD or ED were randomly assigned to a 12-week ICBT (n = 50) or waitlist control condition (n = 50). Primary outcome was the level of perceived stress (PSS). Secondary outcomes included several mental health symptom domains as well as functional impairment and work ability. All outcomes were assessed at baseline, after treatment and at the 6-month follow-up. The study was preregistered at Clinicaltrials.gov: NCT02540317. RESULTS: Compared to the control condition, patients in the ICBT group made large and significant improvements on the PSS (d = 1.09) and moderate to large improvements in secondary symptom domains. Effects were maintained at the 6-month follow-up. There was no significant between-group effect on functional impairment or work ability. CONCLUSIONS: A relatively short ICBT is indicated to be effective in reducing stress-related symptoms in a clinical sample of patients with AD and ED, and has the potential to substantially increase treatment accessibility. Results must be replicated, and further research is needed to understand the relationship between symptom reduction, functional impairment and work ability.

Applying Attention Restoration Theory to Understand and Address Clergy's Need to Restore Cognitive Capacity.

Attention Restoration Theory is applied to explore the causes and consequences of mental fatigue in clergy and suggest practical interventions to restore cognitive wellbeing. Previous research has investigated the physical and emotional health and wellbeing of clergy, but has largely neglected clergy cognitive wellbeing. Due to the demanding nature of their work, clergy are particularly susceptible to mental fatigue and depletion of their capacity to maintain attention. Symptoms include inability to focus attention, inhibit distractions, make decisions or solve problems. Mental fatigue can be overcome, and cognitive capacity restored, by spending time in restorative environments that allow directed attention to rest.

Electrophysiological and behavioral effects of frontal transcranial direct current stimulation on cognitive fatigue in multiple sclerosis.

Fatigue is one of the most common and debilitating symptoms affecting patients with multiple sclerosis (MS). Sustained cognitive effort induces cognitive fatigue, operationalized as subjective exhaustion and fatigue-related objective alertness decrements with time-on-task. During prolonged cognitive testing, MS patients show increased simple reaction times (RT) accompanied by lower amplitudes and prolonged latencies of the P300 event-related potential. Previous studies suggested a major role of structural and functional abnormalities in the frontal cortex including a frontal hypo-activation in fatigue pathogenesis. In the present study we investigated the neuromodulatory effect of transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) on objective measures of fatigue-related decrements in cognitive performance in MS patients. P300 during an auditory oddball task and simple reaction times in an alertness test were recorded at baseline, during and after stimulation. Compared to sham, anodal tDCS caused an increase in P300 amplitude that persisted after the end of stimulation and eliminated the fatigue-related increase in RT over the course of a testing session. Our findings demonstrate that anodal tDCS over the left DLPFC can counteract performance decrements associated with fatigue thereby leading to an improvement in the patient's ability to cope with sustained cognitive demands. This provides causal evidence for the functional relevance of the left DLPFC in fatigue pathophysiology. The results indicate that tDCS-induced modulations of frontal activity can be an effective therapeutic option for the treatment of fatigue-related declines in cognitive performance in MS patients.

Magnetic stimulation at acupoints relieves mental fatigue: An Event Related Potential (P300) study.

BACKGROUND: Mental fatigue caused by continuous cognitive tasks represents one of the most worrying modern health problems. Event Related Potential (ERP) P300 is thought to be associated with cognitive function. OBJECTIVE: This study aimed at characterizing the neural activity correlated with the attentional processes and exploring a novelty method which combine the magnetic stimulation and acupoint to relieve mental fatigue caused by continuous cognitive tasks. METHODS: P300 (P3a and P3b) were extracted at three points: when subjects felt relaxed, at the point of mental fatigue, and after the subjects were stimulated at acupoints. The amplitudes and latencies of P3a and P3b were analyzed statistically. RESULTS: Among the four features (P3a amplitude, P3a latency, P3b amplitude, and P3b latency), only P3b amplitude was found to have a significant difference between the resting state and the mental fatigue state. And P3b amplitude significantly increased after magnetic stimulation at the acupoints. CONCLUSIONS: Subjects experiencing mental fatigue demonstrated a significant decrease in P3b amplitude in the parietal region, suggesting attenuation of resource allocation for selective attention. P3b amplitude significantly increased after magnetic stimulation at acupoints indicating that this strategy can be used to improve selective attention and relieve mental fatigue.

Assessment and treatment of mental fatigue after a traumatic brain injury.

Mental fatigue is a frequently occurring symptom after mild, moderate or severe traumatic brain injury (TBI). Such mental fatigue may become a long-lasting problem, irrespective of severity and even after recovery from other neurological or psychiatric symptoms. Two characteristics of this mental fatigue are that patients easily become exhausted and there is generally a long recovery time. There is a need to increase knowledge and awareness of mental fatigue as it interferes considerably with work, studies, and social activities. Assessment is difficult and few treatment studies have been carried out. For the purposes of assessment, the development of the Mental Fatigue Scale is described here, and we also summarise the few treatment studies found for fatigue after TBI. Symptom alleviation is reported through Mindfulness-Based Stress Reduction (MBSR), light therapy and for the psychostimulant methylphenidate and the dopamine stabiliser (-)-OSU6162. However, more knowledge of the origin of mental fatigue and its underlying mechanisms is needed for development of more efficient therapeutic methods. Prospective randomised trials focusing on long-term outcomes are warranted and should include both pharmacological and non-pharmacological treatments.

Effects of physical exercise during adjuvant breast cancer treatment on physical and psychosocial dimensions of cancer-related fatigue: A meta-analysis.

Cancer-related fatigue has a multidimensional nature and complaints typically increase during adjuvant treatment for breast cancer. Physical exercise might prevent or reduce cancer-related fatigue. So far, no meta-analysis has investigated the effects of physical exercise on different dimensions of fatigue. The aim of the present meta-analysis was to investigate the effects of physical exercise during adjuvant breast cancer treatment on physical and psychosocial dimensions of fatigue. We performed a systematic literature search in PubMed, Embase and the Cochrane Library in June 2015. Randomised controlled trials reporting the effects of physical exercise during adjuvant breast cancer treatment on different dimensions of fatigue were included. Pooled effects of 6 exercise programmes (including 784 patients) showed significant beneficial exercise effects on general fatigue (ES: -0.22, 95% CI -0.38; -0.05) and physical fatigue (ES: -0.35, 95% CI -0.49; -0.21). Effects on fatigue subscales 'reduced activity' (ES: -0.22, 95% CI -0.38; -0.05) and 'reduced motivation' (ES: -0.18, 95% CI -0.35; -0.01) were also in favour of physical exercise. No effects were found on cognitive and affective fatigue. Including only the supervised exercise programmes (n=4 studies), slightly larger pooled effect estimates were found on general fatigue (ES: -0.25, 95% CI -0.47; -0.04) and physical fatigue (-0.39, 95% CI -0.56; -0.23). In conclusion, physical exercise during adjuvant breast cancer treatment has beneficial effects on general fatigue, physical fatigue, 'reduced activity' and 'reduced motivation', but did not show effects on cognitive and affective fatigue. Largest effect sizes are found for physical fatigue, suggesting that this is the fatigue dimension most sensitive to physical exercise.

Changes in mental health in compliers and non-compliers with physical activity recommendations in patients with stress-related exhaustion.

BACKGROUND: There is a lack of research regarding the long-lasting effects of a more physically active lifestyle in patients with mental disorders. In the present study, clinical data were analysed to examine if initially physically inactive patients, clinically diagnosed with stress-related exhaustion, taking part in 12-month multimodal treatment (MMT), differ at the 18-month follow-up regarding mental health, depending on whether they did or did not comply with the physical activity (PA) recommendations resembling those of the American College of Sports Medicine. METHODS: The study population consisted of 69 patients (65% women) who were referred to a stress clinic due to stress-related exhaustion. All patients received MMT. A major goal was to increase patients' PA levels. The patients received general comprehensive instructions including personal advice regarding the positive effects of PA on mental health and could self-select for an 18-week coached exercise program. Changes in mental health symptoms over an 18-month period were compared between non-compliers (n = 26), mild compliers (n = 22) and strong compliers (n = 21) with the PA recommendations included in the MMT. RESULTS: Non-compliers, mild and strong compliers did not differ regarding burnout, depression and anxiety at baseline. Although substantial improvements occurred in all groups, mild and strong compliers reported significantly lower burnout and depression levels at the 18-month follow-up than the non-complying group (p < .05). The general pattern of findings was corroborated, if standard cut-off criteria for clinical burnout were used. CONCLUSIONS: Compliance with PA recommendations is associated with decreased levels of burnout and depression in patients with stress-related exhaustion. Thus, the promotion of a more active lifestyle among patients with stress-related exhaustion should be implemented as a part of MMT, to achieve a more sustainable decrease of symptoms of burnout and depression. TRIAL REGISTRATION: This is not a clinical trial.

Effects of a process-based cognitive training intervention for patients with stress-related exhaustion.

Stress-related exhaustion has been linked to a pattern of selective cognitive impairments, mainly affecting executive functioning, attention and episodic memory. Little is known about potential treatments of these cognitive deficits. The purpose of this study was to evaluate the effects of a process-based cognitive training intervention, designed to target the specific cognitive impairments associated with stress-related exhaustion. To this end, patients diagnosed with exhaustion disorder (ED) were randomized to either a multimodal stress rehabilitation program with the addition of a process-based cognitive training intervention (training group, n = 27) or a treatment-as-usual control condition, consisting of multimodal stress rehabilitation with no additional training (control group, n = 32). Treatment effects were evaluated through an extensive cognitive test battery, assessing both near and far transfer effects, as well as self-report forms regarding subjective cognitive complaints and burnout levels. Results showed pronounced training-related improvements on the criterion updating task (p < 0.001). Further, evidence was found of selective near transfer effects to updating (p = 0.01) and episodic memory (p = 0.04). Also, the trained group reported less subjective memory complaints (p = 0.02) and levels of burnout decreased for both groups, but more so for the trained group (p = 0.04), following the intervention. These findings suggest that process-based cognitive training may be a viable method to address the cognitive impairments associated with ED.

Tertiary prevention in cancer care: understanding and addressing the psychological dimensions of cancer during the active treatment period.

Tertiary prevention refers to care aimed at reducing morbidity and disability in people diagnosed with, and being treated for, disease. This article focuses on psychological aspects of tertiary prevention during the active phase of cancer treatment. Research in this area gained momentum in the 1970s, a time that coincides with changing public attitudes about discussing cancer and the origins of health psychology and behavioral medicine as fields of study. Over the past 40 years, much has been learned about the psychological impact of cancer and the beneficial effects of psychological interventions on patients' mental and physical well-being. The amount of research in this area necessitates a selective, rather than comprehensive, review approach. The focus here is on issues that affect a large proportion of people with cancer and for which research has generated an in-depth understanding. Accordingly, the article summarizes findings regarding the prevalence, etiology, and contributing factors, and the clinical management of, two of the most common psychological reactions to cancer diagnosis and treatment (i.e., depression and anxiety) and two of the most common physical symptoms related to cancer and its treatment (i.e., fatigue and pain). The review also summarizes emerging lines of research on psychological reactions to recurrent and second cancers, and on cancer diagnosis and treatment as a "teachable moment" for promoting health behavior change. Finally, important future directions are identified, including the need to adopt a team science approach to tertiary care and to better translate findings from intervention research into clinical practice.

Compassion fatigue in military healthcare teams.

Since the onset of the Iraq war and Afghanistan conflicts, military healthcare teams have had increasing exposure to the traumatic effects of caring for wounded warriors, leading to a phenomenon termed compassion fatigue. The purpose of this integrative review was to develop a proposed definition for compassion fatigue in support of these teams. There is no current standardized formal definition, and this lack of clarity can inhibit intervention. Seven main themes evolved from the literature review and were integrated with the core elements of the Bandura Social Cognitive Theory Model as the first step in developing a uniformed definition.