Work-focused treatment of common mental disorders and return to work: A comparative outcome study.

Abstract

The aim of this study was to compare the effectiveness of two individual-level psychotherapy interventions: (a) treatment as usual consisting of cognitive-behavioral therapy (CBT) and (b) work-focused CBT (W-CBT) that integrated work aspects early into the treatment. Both interventions were carried out by psychotherapists with employees on sick leave because of common mental disorders (depression, anxiety, or adjustment disorder). In a quasi-experimental design, 12-month follow-up data of 168 employees were collected. The CBT group consisted of 79 clients, the W-CBT group of 89. Outcome measures were duration until return to work (RTW), mental health problems, and costs to the employer. We found significant effects on duration until RTW in favor of the W-CBT group: full RTW occurred 65 days earlier. Partial RTW occurred 12 days earlier. A significant decrease in mental health problems was equally present in both conditions. The average financial advantage for the employer of an employee in the W-CBT group was estimated at $5,275 U.S. dollars compared with the CBT group. These results show that through focusing more and earlier on work-related aspects and RTW, functional recovery in work can be substantially speeded up within a regular psychotherapeutic setting. This result was achieved without negative side effects on psychological complaints over the course of 1 year. Integrating work-related aspects into CBT is, therefore, a fruitful approach with benefits for employees and employers alike.

Predicting the Effectiveness of Work-Focused CBT for Common Mental Disorders: The Influence of Baseline Self-Efficacy, Depression and Anxiety

“…To give more insight into the benefits of combining cognitive-behavioural and work-focused techniques [8,17], we conducted an earlier study in which we compared the effectiveness of two CBTbased psychotherapeutic interventions: treatment as usual consisting of R-CBT and W-CBT [9]. W-CBT consisted of R-CBT treatment plus a module focusing on work and RTW that was integrated in each session.…”

“…There were no a priori reasons to assume that departments would differ with respect to clients' socio-demographic background, the severity of their complaints, or any other variable. Randomization checks were performed for 32 variables including socio-demographic variables, therapeutic characteristics, and mental health and work characteristics at baseline (see also [9]). The two conditions did not differ on these variables, except for two variables (marital status and time on the waiting list, see also statistical analyses below).…”

“…Table 1 presents the baseline characteristics of the sample, including the duration of sickness absence at baseline, and the number of therapeutic sessions. More detailed information about the participants and procedure can be found in elsewhere [9].…”

“…Although there is limited evidence available concerning effective RTW interventions for employees with CMD [6,7], research suggests that interventions that combine cognitive-behavioural techniques with work-focused techniques constitute effective treatments [8]. In a recent study, we demonstrated that work-focused cognitive behavioural therapy (W-CBT), compared with regular cognitive behavioural therapy (R-CBT), indeed promoted full and partial RTW among employees who were sick-listed due to CMD [9].…”

“…Building upon our earlier study [9], we examined the influence of baseline RTW self-efficacy and mental health symptoms on the outcomes of W-CBT, compared with R-CBT, among employees with CMD. RTW self-efficacy is an overarching construct that relates to the multifactorial nature of RTW, taking into account both mental health symptoms and the work context, which is not only useful for understanding and facilitating the RTW process [13], but may also predict who will benefit most from interventions that aim to enhance RTW [14].…”