Effectiveness of Briefer Coping-Focused Psychotherapy for Common Mental Complaints on Work-Participation and Mental Health: A Pragmatic Randomized Trial with 2-Year Follow-Up

Abstract

The aim of this study was to assess short and longterm effectiveness of brief coping-focused psychotherapy (Brief-PsT) compared with shortterm psychotherapy (Short-PsT) on workparticipation (WP) and mental health. Both treatments were preceded by group education. MethodsAll participants were on, or at risk of, sick leave due to common mental complaints. Patients were selected for inclusion in this study based on levels of self-reported symptoms ('some' or 'seriously affected') of anxiety and depression. They were randomized to Brief-PsT (n=141) or Short-PsT with a more extended focus (n=143). Primary outcome was the transition of WP-state from baseline to 3 month follow-up. In addition, WP at 12 and 24 months follow-up were assessed. The secondary outcome, clinical recovery rate (CR-rate) was obtained from the Beck Depression and Beck Anxiety Inventories, at 2-year follow-up. In addition, self-reported mental health symptom severity, self-efficacy, subjective health complaints and life satisfaction were assessed. ResultsAt 3 months follow-up, WP was significantly more increased in Brief-PsT compared with Short-PsT (p=.039). At 3 months, 60% in Brief-PsT and 51% in Short-PsT was at work, partial or full. Thereafter, these differences diminished, 84% and 80% were at work at 2-year follow up. The 2-year follow-up of the secondary outcome measurements was completed by 53% in Brief-PsT and 57% in Short PsT. CR-rate was significantly greater in Brief-PsT compared with the Short-PsT (69% vs. 51%, p=.024). Furthermore, there was a greater reduction in the number of subjective health complaints in Brief-PsT (4.0 vs. 1.9 p=.012). All other measurements favoured Brief-PsT as well, but did not reach statistical significance. ConclusionsBrief coping-focused psychotherapy added to group education for persons with depression or anxiety complaints seemed more effective in enhancing early work participation compared with additional short-term psychotherapy of standard duration with more extended focus. Clinical recovery rate and decline of comorbid subjective health complaints at 2-year follow-up were also in favour of the brief coping-focused program.

The impact of comorbid spinal pain in depression on work participation and clinical remission following brief or short psychotherapy. Secondary analysis of a randomized controlled trial with two-year follow-up

“…This study is a non-prespecified secondary analysis applying data from a pragmatic randomized controlled trial (RCT) with two-year follow-up. For more detailed description of methods and progress of the participants through the trial, see Wormgoor et al [ 27 ] and Fig 1 . The study was conducted at a transdiagnostic outpatient clinic for individuals with mental health or musculoskeletal complaints.…”

“… The initial screening procedure has been reported in a previous publication [ 27 ]; CSP-Comorbid Spinal Pain; BDI- Beck Depression Inventory-II. …”

“…The psychotherapy has been described elsewhere [ 27 ]. Summarized, the Brief-PsT psychotherapy aimed at up to 6 sessions, with focus on normalizing, accepting and coping with their present mental health complaints and their hindrance for WP.…”

“…With the exception of one omitted inventory (Hopkins Symptoms Checklist-10) giving information overlapping with the Beck-inventories and BIPQ that was added in these current analyses, the methods applied in the present study equals to those reported in Wormgoor [ 27 ]. The difference in methods being that we now look for prognostic and effect modifying impacts and divides the sample as to CSP or non-CSP.…”

“…Previous reviews showed that brief interventions may be effective with regard to clinical outcome, in participants with common mental health problems [ 21 – 24 ], as well as in LBP [ 25 , 26 ]. Even though many studies have favoured short term psychotherapies above brief psychotherapies for depression, we found in a recent pragmatic randomized controlled trial (RCT), that the briefest intervention was superior in enhancing early work participation and long term clinical remission [ 27 ]. In the brief psychotherapy, the focus was on normalizing, accepting and coping with present mental health complaints and hindrance for work participation.…”