Employees who received this therapy and returned to work sooner did not suffer adverse effects and showed significant improvement in mental health over the course of one year.
The research is published online in the American Psychological Association’s Journal of Occupational Health Psychology.
“People with depression or anxiety may take a lot of sick leave to address their problems,” said the study’s lead author, Suzanne Lagerveld.
“However, focusing on how to return to work is not a standard part of therapy. This study shows that integrating return-to-work strategies into therapy leads to less time out of work with little to no compromise in people’s psychological well-being over the course of one year.”
The Dutch study followed 168 employees, of whom 60 percent were women, on sick leave due to psychological problems such as anxiety, adjustment disorder and minor depression.
Seventy-nine employees from a variety of jobs received standard, evidence-based cognitive-behavioral therapy (CBT), while the rest received CBT that included a focus on work and the process of returning to work.
The idea behind cognitive-behavioral therapy is that people’s thoughts, rather than external factors such as people, situations or events, cause feelings and behaviors.
Cognitive-behavioral therapists encourage their clients to change the way they think in order to feel better even if the situation does not change. Behavioral techniques such as gradual exposure to difficult situations are often used as part of CBT.
In the study, psychotherapists adapted the CBT strategy to address work issues in an early phase and used work and the workplace as mechanisms or context to improve the client’s mental health. For example, therapists consistently explained to their clients how work can offer structure and self-esteem, characteristics beneficial to clients’ recovery.
They also helped clients draft a detailed, gradual plan for returning to work, focusing on how the client would engage in specific tasks and activities.
Clients in both groups received treatment for about 12 sessions over an average of six months. The researchers checked in with them at three-month intervals for one year, shortly before treatment began.
Amazingly, individuals in the work-focused group fully returned to work on average 65 days earlier than the participants in the standard therapy group, and they started a partial return to work 12 days earlier.
Those in the work-focused therapy engaged in more steps to fully return to work, gradually increasing their hours and duties. Almost all the participants in the study – 99 percent – had at least partially returned to work at the one-year follow-up.
Most participants resumed work gradually, with only 7 percent going directly from full sick leave to full-time work.
All participants had fewer mental health problems over the course of treatment, no matter which type of therapy they received, with the most dramatic decrease in symptoms occurring in the first few months.
In the study researchers addressed the social aspects of being out of work – including the lost of daily social support an individual normally receives while working. Additionally, self-worth and self-esteem are often negatively impacted when an individual cannot work.
“Being out of work has a direct effect on people’s well-being. Those who are unable to participate in work lose a valuable source of social support and interpersonal contacts,” said Lagerveld.
“They might lose part of their income and consequently tend to develop even more psychological symptoms. We’ve demonstrated that employees on sick leave with mental disorders can benefit from interventions that enable them to return to work.”
The savings to an employer whose employee went back to work earlier was estimated at 20 percent, which amounted to about a $5,275 gain in U.S. dollars per employee, according to the article. This was based solely on wages paid during sick leave and did not include additional costs of productivity loss and hiring replacements.
Thus, a targeted CBT intervention can aid both the individual and the employer by improving mental health and expediting a return to work.