Dr. Katy Kamkar: Psychological therapy can help distressed workers return to work faster
Published Monday, April 30, 2012 7:16AM EDT
Last Updated Monday, June 11, 2012 1:55PM EDT
Increased attention is being brought to mental health issues in the workplace, due in part to the annual health care cost of mental disorders in Canada, which are estimated at $51 billion. One third of that can be attributed to productivity losses.
Common mental health problems in the workplace include depression, anxiety and adjustment disorders, all of which are associated with decreased work performance and productivity, interpersonal conflicts, increased absenteeism, sick leave and disability.
Being away from work on sick leave often compounds the psychological distress because of a reduced sense of self confidence and wellbeing, loss of daily routine and structure, reduced income leading to financial strains and, at times, more stress and conflict at home.
When people are unable to work, they often report the desire to return to work and regain their productivity. Thus, interventions that include a return-to-work component can be very beneficial to employees on sick leave -- and also for employers.
Cognitive Behaviour Therapy (CBT) is an evidence-based psychological treatment shown to be effective through research for a wide range of mental health problems, including depression and anxiety disorders. CBT encompasses various components, including: education to better understand the problems, one’s reactions to problems and psychological symptoms (e.g., understanding symptoms of anxiety, functional versus dysfunctional anxiety; components of depression and symptoms of depression).
CBT is skill-based, in that it teaches various skills to better cope with the psychological symptoms, including: cognitive restructuring to identify distressing thought patterns and reduce negativity, put things into perspective and offer ways to develop healthier balanced thoughts; problem solving skills; anxiety management skills; communication and assertiveness skills, relaxation techniques.
“Behavioural activation” helps to increase activities and overall functioning. Exposure interventions help to gradually reduce any maladaptive behaviours, such as avoidance. It also can help with confronting feared but safe situations, places and activities. CBT is also goal-oriented, focusing on the “here and now.” It provides homework in between the sessions to help generalize the skills learned in sessions to everyday life, and focuses on maintenance of therapeutic gains and relapse prevention.
When Return to Work component is integrated within CBT, therapy also focuses on discussion about work and associated anxious thoughts and emotions; assess one’s perception of capacity to work; set up a gradual exposure to work setting; learn effective communication skills to improve interpersonal relationships and reduce conflict; reduce negative or unhelpful thoughts or negative appraisals/interpretations of work situations and focus on balanced thoughts that could help towards problem solving and productivity and reduce overall distress; focus on the benefits of work (e.g., increased activities and functioning, well being and sense of accomplishment and increased self confidence, daily structure and routine, reduced financial worries); and healthy coping techniques to better cope with work related stressors. At times, therapy can also help towards changing work aspects contributing to significant stress, such as change of work duties or placements.
A recent study published by the Journal of Occupational Health Psychology compared the effectiveness of individual CBT with work-focused CBT (W-CBT) that integrated work aspects early in treatment among employees on sick leave suffering from depression, anxiety or adjustment disorder. The CBT group encompassed 79 clients and the W-CBT group 89 clients, with 12-month follow-up data collected among the employees. The study looked at duration until return to work (RTW), mental health problems, and costs to the employer.
The study found that:
Clients who received the work-focused CBT returned to work earlier than those who received simple CBT.
Full return to work occurred 65 days earlier with W-CBT.
Clients with similar symptom levels were more often motivated to return to work within the W-CBT when compared with CBT.
A significant reduction in mental health problems occurred equally in both CBT and W-CBT.
The W-CBT was also more cost effective, so that the average financial advantage for the employer of an employee in the W-CBT group was estimated at US$5,275, compared with the CBT group.
The study concluded that:
Focusing more on work related issues and return to work in treatment as well as addressing those return to work aspects earlier on in treatment could help fasten occupational functioning.
The result was obtained without negative side effects on psychological complaints over the one year period.
Integrating work-related components into CBT is beneficial for both employees and employers.