Education of the primary health care staff based on acceptance and commitment therapy is associated with reduced sick leave in a prospective controlled trial
Open accessAbstract
Background: The use of cognitive behavioral therapy (CBT) to cope with mental distress and pain issues has helped many patients in primary health care in Sweden. However, the effects of CBT to reduce sick leave has not been equally convincing. Acceptance and Commitment Therapy (ACT) is an evolution of traditional CBT and we aimed to study if education based on ACT of the staff rather than the patients could reduce sick leave in primary health care. Methods: This was a prospective trial in 6 primary health care centers in Kalmar (total amount of registered subjects of 28,930) in which the staff (physicians, nurses and therapists) received group-based education according to ACT during 2018 and 2019. The effects were compared with 5 similarly sized control health care centers in the neighboring Region of Jönköping in which no such education took place. The main aim was to study changes in sick leave in the 6 primary care centers of Kalmar and to keep track of more general trends by studying sick leave also in Jönköping, letting sick leave in the year 2017 to be the reference period for both areas. Results: The staff at the health care centers in Kalmar reported to having attended a mean of 5.2 ± 2 educational ACT-sessions with psychiatrist Kadowaki in Kalmar. Sick leave for ICD-10 F43 (reaction to severe stress and related adjustment-disorders) was reduced from a mean value of 28.7 ± 9.1ongoing sick leaves/month in 2017 to 22.6 ± 7.0 sick leaves/month in 2018 (-21%, p = 0.033) and to 18.1 ± 10 sick leaves/month in 2019 (-37%, p = 0.038). The corresponding sick leave for any diagnosis (total sick leave) was reduced from 132 ± 39 sick leaves/month in 2017 to 118 ± 38 sick leaves/month in 2018 (-11%, p = 0.056) and to 102 ± 37 sick leaves/month in 2019 (-21%, p = 0.021). The corresponding sick leave comparisons in the control health centers did not show any significant changes (all p-values ≥ 0.24). Conclusions: Total monthly mean sick leave was reduced 21% in the health care centers in Kalmar during the second year of the educational ACT intervention of the staff while it was unchanged in Jönköping. This suggests a significant effect to induce a reduction in long-term sick leave for patients in primary health care in which the staff received education according to ACT. The results of this trial could serve as a basis for a randomized trial in order to ascertain causality. Trial registration: Pre-registration November 9, 2018 on ClinicalTrials.gov with number NCT03737019.
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ACT has increasingly been adapted for use in group settings with health care professionals to address mental health and burnout.
“ACT, a modern cognitive behavioral therapy (CBT), has increasingly been adapted for use in group settings with health care professionals to address mental health and burnout [13, 14].”
From Recruitment, retention and recouperation: lessons learned from a study aimed at assessing burnout mitigation in physician learners (2025) · cites this paper as [14]
The Introduction and Materials and Methods describe group-based ACT education for primary health care staff. But the paper presents staff-directed ACT as a new strategy, not an increasingly common adaptation, and studies patients’ sick leave rather than whether the intervention addresses health care professionals’ mental health or burnout. (LLM, conf=0.88)
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Pflaum-Carlson, J., Redding, A., Murphy, D., MacLean, L., Hamilton, J., & Santarossa, S. (2025) · BMC Research Notes · doi:10.1186/s13104-025-07435-5
“ACT, a modern cognitive behavioral therapy (CBT), has increasingly been adapted for use in group settings with health care professionals to address mental health and burn-out [13, 14].”
- Authors
- Kadowaki, Å., Alvunger, A.-K., Larsen, H. I., Persdotter, A., Zak, M. S., Johansson, P., & Nystrom, F. H.
- Affiliations
- Linköping University (SE)
- Venue
- BMC Family Practice
- Published
- 2021-09-08
- Volume
- 22
- Issue
- 1
- Pages
- 179-179
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC8428055
- OpenAlex
- W3196478809
- Cited by
- 7
- References
- 25
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 4
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DiVA (Linkoping University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Linköping University
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
- Keywords
- acceptance and commitment therapy, sick leave, primary care providers, employee training, cognitive behavioral therapy, stress-related disorders, occupational health, group training, Kalmar, Jönköping, Sweden, psychological distress, pain, adjustment disorder
- MeSH terms
- Mental Disorders, Humans, Primary Health Care, Prospective Studies, Sick Leave, Acceptance and Commitment Therapy
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