Evaluation of a transdiagnostic psychodynamic online intervention to support return to work: A randomized controlled trial

Abstract

ObjectivesGiven their flexibility, online interventions may be useful as an outpatient treatment option to support vocational reintegration after inpatient rehabilitation. To that purpose we devised a transdiagnostic psychodynamic online intervention to facilitate return to work, focusing on interpersonal conflicts at the workplace often responsible for work-related stress.Research design and methodsIn a randomized controlled trial, we included employed patients from cardiologic, psychosomatic and orthopedic rehabilitation with work-related stress or need for support at intake to inpatient rehabilitation after they had given written consent to take part in the study. Following discharge, maladaptive interpersonal interactions at the workplace were identified via weekly blogs and processed by written therapeutic comments over 12 weeks in the intervention group (IG). The control group (CG) received an augmented treatment as usual condition. The main outcome, subjective prognosis of gainful employment (SPE), and secondary outcomes (psychological complaints) were assessed by means of online questionnaires before, at the end of aftercare (3 months) and at follow-up (12 months). We used ITT analyses controlling for baseline scores and medical group.ResultsN = 319 patients were enrolled into IG and N = 345 into CG. 77% of the IG logged in to the webpage (CG 74%) and 65% of the IG wrote blogs. Compared to the CG, the IG reported a significantly more positive SPE at follow-up. Measures of depression, anxiety and psychosocial stressors decreased from baseline to follow-up, whereas the corresponding scores increased in the CG. Correspondingly, somatization and psychological quality of life improved in the IG.ConclusionsPsychodynamic online aftercare was effective to enhance subjective prognosis of future employment and improved psychological complaints across a variety of chronic physical and psychological conditions, albeit with small effect sizes.

Internet- and mobile-based aftercare and relapse prevention in mental disorders: A systematic review and recommendations for future research

“…The majority of interventions ( n = 11) were based on principles of Cognitive Behavioral Therapy (CBT). One study ( Bischoff et al, 2013 ) was based on general psychotherapy ( Grawe, 1997 ), two studies on psychodynamic ( Zwerenz et al, 2017a ; Zwerenz et al, 2017b ) and one on mindfulness-based cognitive therapy (MBCT) ( Kraft et al, 2017 ) or focused on disease management ( Välimäki et al, 2017 ). Eleven IMIs were web- and 5 predominantly mobile-based.…”

“…Study dropout varied between 5.6% ( Fichter et al, 2012 ) and 64.2% ( Bischoff et al, 2013 ) with an average of 26.3%. About two third of the studies included passive CGs, one-third active CGs ( Bischoff et al, 2013 ; Holländare et al, 2011 ; Zwerenz et al, 2017a ; Zwerenz et al, 2017c ). The majority of studies ( n = 10) reported at least a medium follow-up period (6–12 months).…”

“…The search yield seven studies with a transdiagnostic approach ( Bischoff et al, 2013 ; Ebert et al, 2013 ; Norlund et al, 2018 ; Välimäki et al, 2017 ; Willems et al, 2017a ; Zwerenz et al, 2017a ; Zwerenz et al, 2017b ). Of these, three studies excluded individuals with acute suicidality, alcohol or drug addiction or psychiatric disorders ( Norlund et al, 2018 ; Ebert et al, 2013 ; Willems et al, 2017a ; Zwerenz et al, 2017b ) and another study excluding eating and personality disorders ( Bischoff et al, 2013 ).…”

Online Self-Help as an Add-On to Inpatient Psychotherapy: Efficacy of a New Blended Treatment Approach

“…Online programs have been used successfully to prevent relapse in patients with remitted depression [20,21,22] following outpatient or inpatient psychotherapy or rehabilitation in order to maintain treatment gains in recent trials [23,24]. However, we are not aware of a trial examining the efficacy of an online self-help program in addition to inpatient psychotherapy.…”

Chancen moderner Medien für psychotherapeutische Nachsorge und Rückfallprophylaxe

“…Eines der wenigen Online-Programme mit psychodynamischem Hintergrund ist das am Universitätsklinikum Mainz entwickelte "Gesundheitstraining Stressbewältigung am Arbeitsplatz-online" (GSA-online [9]). Das Programm basiert auf einem supportiv-expressiven, schreibtherapeutischen Ansatz und soll Patienten nach der stationären psychosomatischen Rehabilitation bei der beruflichen Wiedereingliederung unterstützen.…”