Metacognitive therapy and work-focused interventions for patients on sick leave due to anxiety and depression: study protocol for a randomised controlled wait-list trial

Abstract

Background Common mental disorders such as depression and anxiety are major contributors to the global burden of disease. Affected individuals suffer reduced quality of life, impaired functioning and reduced capacity to work. Maintaining employment is an important determinant for health and wellbeing, and the economic impact of depression and anxiety is a significant societal expense. Treatments providing effective symptom reduction and helping patients return to work (RTW) would thus have substantial public health benefits. The present study will explore the effectiveness of metacognitive therapy (MCT) and work-focused interventions on reducing symptoms and increasing RTW rates for patients on sick leave due to depression and anxiety. Methods The study is a randomised controlled wait-list trial (RCT; N = 240). The intervention group will receive protocol-based MCT and work-focused interventions immediately after inclusion. The control condition is a wait-list control group. All patients will receive up to 12 weekly sessions. The study context is a Norwegian outpatient clinic part of a national programme aimed at reducing sick leave. The co-primary outcomes are change in RTW and symptoms of depression and anxiety at the end of treatment. In addition to self-report, sick leave will also be collected from national registries from 2 years prior to intervention to 4 years after intervention. Symptoms of scores will be collected by self-report at pre- and post-treatment and at 6 and 12 months follow-up after treatment. A cost-effectiveness analysis will use total cost and quality-adjusted life-years as the secondary outcomes. Discussion There is broad consensus on the importance of identifying treatment that effectively reduces depression and anxiety symptoms and aids RTW. This study is an important contribution to the field as it is the first RCT on MCT and work-focused interventions for patients on sick leave due to anxiety and depression. Trial registration ClinicalTrials.gov NCT03301922. Registered on October 4, 2017.

Work after mental-health-related absence: a qualitative study of perceived change after a combination of metacognitive therapy and work-focused interventions

“…Involvement of the workplace in regards to disclosure of information and possible adjustments were discussed in treatment and then it was up to the patients how they wanted to involve the workplace. Further detail about the RCT and the treatment can be found in the protocol by Sandin et al [ 20 ].…”

“…The treatment focused on challenging beliefs in the negative and positive metacognitions and reducing related CAS activity. The work interventions focused on collecting anamnestic information; exploring work function and potential barriers to RTW, such as bullying and conflicts; informing the patient about the advantages of work; designing an RTW plan; checking whether adjustments in the work situation were needed; and discussing a communication plan with the workplace [ 20 ].…”