Cognitive–behavioural therapy and return-to-work intervention for patients on sick leave due to common mental disorders: a randomised controlled trial

Salomonsson, Sigrid; Santoft, Fredrik; Lindsäter, Elin; Ejeby, Kersti; Ljótsson, Brjánn; Öst, Lars‐Göran; Ingvar, Martin; Lekander, Mats; Hedman‐Lagerlöf, Erik

doi:10.1136/oemed-2017-104342

Cited by 54 publications

(74 citation statements)

References 47 publications

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“…Larger sample sizes and longer follow-up periods are needed to establish potential effects of ICBT on functional impairment. Regarding work ability, results from the present study support previous findings that decreased symptoms are not necessarily related to perceived work ability or return to work after sick leave [4,23]. The lack of treatment effect could partly be understood by the fact that the treatment's primary focus was on mental health rather than on work-related difficulties.…”

Section: Discussionsupporting

confidence: 80%

“…The ICBT protocol was a 12-week treatment based on a CBT protocol for AD and ED that was developed in clinical practice and evaluated in 2 randomized clinical trials conducted by our research group [22,23]. A key assumption of the treatment was that stress is a natural and necessary part of life, but that negative health consequences result, in part, from maladaptive behaviors adopted in response to stressors.…”

Section: Interventionsmentioning

confidence: 99%

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

Lindsäter

Axelsson

Salomonsson

et al. 2018

Psychother Psychosom

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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.

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Section: Discussionsupporting

confidence: 80%

Section: Interventionsmentioning

confidence: 99%

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

Lindsäter

Axelsson

Salomonsson

et al. 2018

Psychother Psychosom

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“…The present study is a subgroup analysis based on data from a previously reported randomized clinical trial (Salomonsson et al ., ) where 211 patients on sick leave due to CMDs were randomized to CBT, RTW‐I or COMBO. For the purpose of the present study, the effects of the three interventions were analysed separately for the Stress subgroup (n = 152) and for the DepAnxIn subgroup (n = 59).…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have found that psychological interventions can reduce sick leave to some extent, but there may be disorder specific differences. Due to the limited knowledge of how to treat stress‐related disorders specifically, and how to aid patients with common mental disorders on sick leave in general to regain work ability and return to work, we conducted subgroup analysis based on a large scale RCT in which we compared CBT, a return‐to‐work intervention (RTW‐I) and a combination of the two (COMBO) for primary care patients on sick leave due to CMDs (Salomonsson, Santoft, Lindsäter et al ., ). In the previously published study, all treatments were associated with large within‐group effects on symptoms and sick leave.…”

Section: Introductionmentioning

confidence: 97%

Effects of cognitive behavioural therapy and return‐to‐work intervention for patients on sick leave due to stress‐related disorders: Results from a randomized trial

Salomonsson

Santoft

Lindsäter

et al. 2019

Scandinavian J Psychology

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The aim of this study was to evaluate specific effects for patients with adjustment or exhaustion disorder, the Stress subgroup (n = 152), regarding symptom severity and sick leave after CBT, a return‐to‐work intervention (RTW‐I), and a combination of them (COMBO), using data from a randomized trial. In the original study, primary care patients on sick leave (N = 211) were randomized to CBT (n = 64), RTW‐I (n = 67), or COMBO (n = 80). Blinded Clinician Severity Rating (CSR) of symptoms and sick leave registry data were primary outcomes. Subgroup analyses showed that for the Stress subgroup, CBT led to greater reduction of symptoms than RTW‐I posttreatment, but COMBO did not differ from CBT or RTW‐I. Regarding sick leave, there was no difference between treatments in the Stress subgroup. An exploratory analysis of the treatment effects in a subgroup of patients with depression, anxiety or insomnia indicates that RTW‐I reduced sick leave faster than CBT. We conclude that CBT may be promising as an effective treatment of stress and exhaustion disorder.

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“…We would like to connect these findings to some recent trials concerning RTW interventions for individuals with CMD. Some studies found no beneficial effects on work participation and mental health, such as an Individual Placement and Support intervention for individuals with mood and anxiety complaints [48], an RTW intervention for primary care patients on sick leave due to CMD [49], and an RTW program for employees without an employment contract, sick-listed due to CMD [50]. Other studies did find benefits in terms of employment and mental health, such as an individual enabling and support intervention for affective disorders [51], and a combined intervention for individuals struggling with work participation due to CMD [42].…”

Section: Theoretical and Practical Implicationsmentioning

confidence: 99%

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

et al. 2018

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Purpose This study examined who benefits most from a cognitive behavioural therapy (CBT)-based intervention that aims to enhance return to work (RTW) among employees who are absent due to common mental disorders (CMDs) (e.g., depression, anxiety, or adjustment disorder). We researched the influence of baseline work-related self-efficacy and mental health (depressive complaints and anxiety) on treatment outcomes of two psychotherapeutic interventions. Methods Using a quasiexperimental design, 12-month follow-up data of 168 employees were collected. Participants either received work-focused cognitive behavioural therapy (W-CBT) that integrated work aspects early into the treatment (n = 89) or regular cognitive behavioural therapy (R-CBT) without a focus on work (n = 79). Results Compared with R-CBT, W-CBT resulted in a faster partial RTW, irrespective of baseline self-efficacy. Among individuals with high self-efficacy, W-CBT also resulted in faster full RTW. The effectiveness of W-CBT on RTW did not depend on baseline depressive complaints or anxiety. The decline of mental health complaints did not differ between the two interventions, nor depended on baseline self-efficacy or mental health. Conclusions Considering the benefits of W-CBT for partial RTW, we recommend this intervention as a preferred method for employees with CMDs, irrespective of baseline self-efficacy, depression and anxiety. For individuals with high baseline self-efficacy, this intervention also results in higher full RTW. For those with low self-efficacy, extra exercises or components may be needed to promote full RTW.

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Cognitive–behavioural therapy and return-to-work intervention for patients on sick leave due to common mental disorders: a randomised controlled trial

Cited by 54 publications

References 47 publications

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

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

Effects of cognitive behavioural therapy and return‐to‐work intervention for patients on sick leave due to stress‐related disorders: Results from a randomized trial

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

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