Work-focused cognitive–behavioural therapy and individual job support to increase work participation in common mental disorders: a randomised controlled multicentre trial
Open accessAbstract
OBJECTIVES: Common mental disorders (CMDs) are a major cause of rising disability benefit expenditures. We urgently need evidence on programmes that can increase work participation in CMDs. The aim of this study was to evaluate the effectiveness of work-focused cognitive-behavioural therapy (CBT) and individual job support for people struggling with work participation due to CMDs. METHODS: A randomised controlled multicentre trial (RCT) including 1193 participants was conducted. Participants were on sick leave, at risk of going on sick leave or on long-term benefits. The intervention integrated work-focused CBT with individual job support. The control group received usual care. The main outcome was objectively ascertained work participation at 12 months follow-up, with changes in mental health and health-related quality of life as secondary outcomes. RESULTS: A larger proportion of participants in the intervention group had increased or maintained their work participation at follow-up compared to the control group (44.2% vs 37.2%, p=0.015). The difference remained significant after 18 months (difference 7.8%, p=0.018), and was even stronger for those on long-term benefits (difference 12.2%, p=0.007). The intervention also reduced depression (t=3.23, p≤0.001) and anxiety symptoms (t=2.52, p=0.012) and increased health-related quality of life (t=2.24, p=0.026) more than usual care. CONCLUSIONS: A work-focused CBT and individual job support was more effective than usual care in increasing or maintaining work participation for people with CMDs. The effects were profound for people on long-term benefits. This is the first large-scale RCT to demonstrate an effect of a behavioural intervention on work participation for the large group of workers with CMDs. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, registration number: NCT01146730.
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Later trials where cognitive behaviour therapy is integrated with a work focus and more comprehensive return to work programmes have been effective in reducing symptoms and enhancing return to work for patients on long-term sick leave.
“Later trials where, for example, cognitive behaviour therapy is integrated with a work focus and more comprehensive return to work programmes have been effective in both reducing symptoms and enhancing return to work for patients on long-term sick leave [31].”
From Comparing the efficacy of multidisciplinary assessment and treatment, or acceptance and commitment therapy, with treatment as usual on health outcomes in women on long-term sick leave—a randomised controlled trial (2021) · cites this paper as [31]
The Abstract Results report improved work participation and reduced depression and anxiety symptoms for the trial overall. The Methods Procedure says participants on long-term benefits were primarily people who had been on sick leave for more than 12 months, and the Results Primary outcome measure reports a stronger work-participation effect in that subgroup. The paper does not establish that symptom reduction occurred specifically among patients on long-term sick leave. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA recent study showed that work-focused cognitive behavioral therapy for individuals on sick leave with common mental disorders was more effective than usual care in reducing depression and anxiety symptoms, increasing health-related quality of life, and increasing or maintaining work participation.
“However, a recent study showed that work-focused cognitive behavioral therapy for individuals on sick leave with common mental disorders was more effective than usual care in reducing depression and anxiety symptoms, increasing health-related quality of life, as well as increasing or maintaining work participation [11].”
From Effects of Inpatient Multicomponent Occupational Rehabilitation versus Less Comprehensive Outpatient Rehabilitation on Somatic and Mental Health: Secondary Outcomes of a Randomized Clinical Trial. (2017) · cites this paper as [11]
The Abstract Results report better work participation, depression and anxiety symptoms, and health-related quality of life than usual care. But the intervention combined work-focused CBT with individual job support, and the trial included people at risk of sick leave and on long-term benefits as well as those on sick leave. The Results (Primary outcome measure) report no statistically significant work-participation effect in the sick-leave subgroup specifically. (LLM, conf=0.90)
Experimental — accuracy not yet measuredMost occupational rehabilitation programs described in the scientific literature use some sort of cognitive behavioral therapy approach.
“Most occupational rehabilitation programs described in the scientific literature use some sort of cognitive behavioral therapy approach [6, 11].”
From Effects of Inpatient Multicomponent Occupational Rehabilitation versus Less Comprehensive Outpatient Rehabilitation on Somatic and Mental Health: Secondary Outcomes of a Randomized Clinical Trial. (2017) · cites this paper as [11]
The Methods (Interventions) describe this trial’s occupational rehabilitation programme as combining CBT with job support, and the Discussion (Strengths and limitations) discusses several earlier work-related CBT interventions. Neither passage establishes that most occupational rehabilitation programmes in the scientific literature use CBT. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIndividual Placement and Support (IPS) is a promising intervention offered as a supplement in the treatment of both mild and severe mental disorders.
“Another promising intervention is Individual Placement and Support (IPS), which is offered as a supplement in the treatment of both mild and severe mental disorders [30, 31]”
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References 41 · Cited by 132
Research works printed but not linked: 1
- [26]Berkowitz M Measuring the effects of public programs. Cost and benefits in vocational rehabilitation. Philadelphia: Temple University Press, 1988.
- Authors
- Reme, S. E., Grasdal, A. L., Løvvik, C., Lie, S. A., & Øverland, S.
- Affiliations
- University of Bergen (NO)
- Uni Research (Norway) (NO)
- Norwegian Institute of Public Health (NO)
- Venue
- Occupational and Environmental Medicine
- Publisher
- BMJ
- Published
- 2015-08-06
- Volume
- 72
- Issue
- 10
- Pages
- 745-752
- ISSN
- 0007-1072 (ISSN-L)
- 1351-0711
- 1470-7926
- PMC
- PMC4602235
- OpenAlex
- W2167890993
- Cited by
- 132
- References
- 41
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 14 · 2023: 6 · 2022: 11 · 2021: 21 · 2020: 12 · 2019: 11 · 2018: 20 · 2017: 18 · 2016: 4 · 2015: 1 · 2014: 1
- FWCI
- 26.15
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Occupational and Environmental Medicine (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- BIBSYS Brage (BIBSYS (Norway)) (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Topics
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Keywords
- work participation, common mental disorders, depression, anxiety, health-related quality of life, sick leave, return to work, behavioral interventions
- MeSH terms
- Adult, Age Factors, Mental Disorders, Female, Humans, Male, Middle Aged, Norway, Sex Factors, Program Evaluation, Cognitive Behavioral Therapy, Multivariate Analysis, Logistic Models, Employment, Supported, Treatment Outcome, Sickness Impact Profile, Risk Assessment, Sick Leave, Young Adult
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