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Cognitive Behavioural Therapy and individual Job Support

REME, S. E., GRASDAL, A. L., LØVVIK, C., LIE, S. A. & ØVERLAND, S. 2015. Work-focused cognitive–behavioural therapy and individual job support to increase work participation in common mental disorders: a randomised controlled multicentre trial. Occupational and Environmental Medicine. Epub.

This is a, recently published, open access paper that describes a multisite Randomised Controlled Trial of a Cognitive Behavioural Therapy (CBT) based intervention for helping people with common mental disorders to return or stay in work. More specifically the study intervention was called At Work and Coping (AWaC) and consisted of work focussed CBT and job support. The study was commissioned by the Norwegian Ministry of Health and Ministry of Labour in order to find out if AWaC increased work participation at 12 months post intervention. In addition, the study measured changes in symptomatology and quality of life. Finally, the project examined the cost effectiveness of AWaC and explored the efficacy of the intervention for different subgroups.

The paper included n=626 participants in the intervention arm and n=549 participants in the control arm to the study. Of the total, ~130 in each arm were considered to be on long term sick leave (>12 months). The findings were that the AWaC group faired significantly better across all measures. Interestingly, the most marked improvement was amongst those people whom had previously been claiming long-term health benefits (>12 months sick leave). With 30% increasing or maintaining work participation at 18 months compared to only 11% in the control group. In addition, this appeared to be a cost effective intervention for this specific sub group. However, this did not appear to be a cost effective intervention when compared to treatment as usual for other groups such as those not receiving any health benefits or on part sick leave/part employment.

The idea that a combined approach of work focussed CBT and job support can make a large difference to the number of people on long-term sick leave who return to work shows promise. Interestingly, the attrition rate for AWaC was very low (~5%) and more importantly, all participants were volunteers who had indicated that they were motivated to improve their level of participation in the workplace. I find this last point particularly pertinent given the recent interest in reducing benefits provided to people who are obese or suffering from addiction problems and who refuse to engage with a recommended treatment plan.

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