The Value of Work-Related Psychological Therapy

Title: Work-Focused Treatment of Common Mental Disorders and Return to Work: A Comparative Outcome Study (Fee or subscription required.)

Author: Suzanne E. Lagerveld (TNO Quality of Life/Work & Employment Hoofddorp), Roland W.B. Blonk (TNO Quality of Life/Work & Employment Hoofddorp and Utrecht University), and Veerle Brenninkmeijer, Leoniek Wijngaards-de Meij, and Wilmar B. Schaufeli (all Utrecht University)

Publisher: Journal of Occupational Health Psychology, vol. 17, no. 2

Date Published: February 2012

Employees who were on sick leave because of common mental health problems resumed work more quickly when their therapy focused on job-related issues, this paper found. The approach also proved a financial boon for employers, who saved about US$5,200 in sick pay per worker, on average.

Few studies have examined the effects of psychological counseling on getting employees to resume work. This study, which the authors say is the first to compare work-focused and regular cognitive–behavioral therapy, followed 168 employees in the Netherlands who were on sick leave because of stress, anxiety, burnout, or depression.

The participants worked in a wide range of jobs and at companies of various sizes. They were randomly assigned to two groups: The first, with 79 members, received standard cognitive–behavioral therapy, and the rest received cognitive–behavioral therapy that included a focus on returning to work.

The central idea behind cognitive–behavioral therapy is that a person’s perceptions of the world drive emotions and behavior — and that “errors” in thinking, such as overemphasizing negatives and minimizing positives, result in unrealistic perceptions and ultimately self-destructive behavior. Accordingly, cognitive–behavioral therapists urge their clients to reassess their thinking and to make it more realistic and practical; this should reduce their emotional distress and lead to changes in behavior, even if the outside world does not change.

In the work-focused group, therapists incorporated job issues early in the treatment, using the workplace as a context or mechanism for improving the person’s mental outlook. The therapists continually explained how work can offer structure and build self-esteem, and employees were encouraged to draw up a detailed plan for gradually getting back to the job.

Although treatment time for participants in this group could also be devoted to nonwork issues, therapists tried to relate the employees’ problems, at least partly, to work — for example, by asking how resuming work could help decrease excessive worrying about marital or money problems.

Participants in both groups received treatment in about a dozen sessions over the course of six months, on average. They completed questionnaires at three-month intervals for a year. The researchers tracked the number of days from the start of treatment to participants’ full return to work, defined as completing the number of hours in their job contract. Participants’ partial return, and the number of incremental increases on the clock before they made a full comeback, were also tracked.

To control for those with lesser or greater mental problems, the researchers coded each participant’s symptom (or multiple symptoms) using common psychological measurements. In their regression analysis, the authors also controlled for 32 variables, including demographics, marital status, and work conditions.

The analysis showed that people in the work-focused group spent an average of about 100 days away from work before returning fully, more than two months earlier than those in the standard treatment group, who were away for about 165 days. Those in the work-focused group also started a partial return to their jobs 12 days earlier than the others and took more small steps to make a complete comeback, slowly boosting their job duties and time on the clock.

An obvious concern is whether those who returned to work early might have done so prematurely, leading to increased relapses in sick leave. Although the authors note that participants receiving work-focused therapy did experience more relapses, the difference was not statistically significant and the relapses were not permanent, but rather “showed a wave-like pattern leading to full [return to work] within 1 year.”

Furthermore, those relapses had no adverse affects on mental health over the course of a year, which may mean participants in the work-focused group were simply being more experimental in their attempts to return, the authors write. No matter which type of therapy they received, all participants reported fewer mental health problems over the course of their treatment.

The job-related therapy group’s quicker return carried significant financial advantages for employers, the authors write. On average, employers in the standard treatment group paid $24,220 in wages per employee during the sick leave period. By contrast, employers in the work-focused group paid out $18,952, saving more than $5,200.

This implies a savings of more than 20 percent for employers whose workers receive job-related therapy, the authors note, without factoring in associated costs such as productivity loss and the hiring of replacements. Overall, the savings could be huge, given the prevalence of absenteeism related to psychological issues. (A 2007 report, for example, found that mental disorders account for 30 percent of the long-term sick leave in the Netherlands.)

The results of their work can be applied widely, the authors write, because of the variety of mental health complaints and range of jobs that were studied. In addition, they say, the focus on work can be integrated easily, and at relatively low cost, into conventional psychological therapy, providing “a fruitful approach with benefits for employees, employers, and care providers.”

Bottom Line:
Employees who are on sick leave because of mental health problems return to work more quickly if they receive therapy that includes a focus on work-related issues instead of standard treatment. The shorter time away produces significant savings for employers.