Skip to main content

Effectiveness of Briefer Coping-Focused Psychotherapy for Common Mental Complaints on Work-Participation and Mental Health: A Pragmatic Randomized Trial with 2-Year Follow-Up

Journal of Occupational Rehabilitation volume 30, pages 22–39 (2020)Cite this article

Abstract

Purpose The aim of this study was to assess short and long-term effectiveness of brief coping-focused psychotherapy (Brief-PsT) compared with short-term psychotherapy (Short-PsT) on work-participation (WP) and mental health. Both treatments were preceded by group education. Methods All participants were on, or at risk of, sick leave due to common mental complaints. Patients were selected for inclusion in this study based on levels of self-reported symptoms (‘some’ or ‘seriously affected’) of anxiety and depression. They were randomized to Brief-PsT (n = 141) or Short-PsT with a more extended focus (n = 143). Primary outcome was the transition of WP-state from baseline to 3 months follow-up. In addition, WP at 12 and 24 months follow-up were assessed. The secondary outcome, clinical recovery rate (CR-rate) was obtained from the Beck Depression and Beck Anxiety Inventories, at 2-year follow-up. In addition, self-reported mental health symptom severity, self-efficacy, subjective health complaints and life satisfaction were assessed. Results At 3 months follow-up, the increase in WP was significantly greater in Brief-PsT than in Short-PsT (p = 0.039). At 3 months, 60% in Brief-PsT and 51% in Short-PsT was at work, partial or full. Thereafter, these differences diminished, 84% and 80% were at work at 2-year follow up. The 2-year follow-up of the secondary outcome measurements was completed by 53% in Brief-PsT and 57% in Short PsT. CR-rate was significantly greater in Brief-PsT compared with the Short-PsT (69% vs. 51%, p = 0.024). Furthermore, there was a greater reduction in the number of subjective health complaints in Brief-PsT (4.0 vs. 1.9 p = 0.012). All other measurements favoured Brief-PsT as well, but did not reach statistical significance. Conclusions Brief coping-focused psychotherapy added to group education for persons with depression or anxiety complaints seemed more effective in enhancing early work participation compared with additional short-term psychotherapy of standard duration with more extended focus. Clinical recovery rate and decline of comorbid subjective health complaints at 2-year follow-up were also in favour of the brief coping-focused program.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

Data Availability

The data-file that the current analyses are based on, is owned by Vestfold Hospital Trust and are kept on a secure research-data-server. Application for access to the data file must be send to the Data-privacy agent at Vestfold Hospital Trust by e-mail to Forskning@siv.no.

References

  1. Roelen CA, Hoedeman R, van Rhenen W, Groothoff JW, van der Klink JJ, Bultmann U. Mental health symptoms as prognostic risk markers of all-cause and psychiatric sickness absence in office workers. Eur J Public Health. 2014;24(1):101–105.

    PubMed  Google Scholar 

  2. Hensing G, Andersson L, Brage S. Increase in sickness absence with psychiatric diagnosis in Norway: a general population-based epidemiologic study of age, gender and regional distribution. BMC Medicine. 2006;4:19.

    PubMed  PubMed Central  Google Scholar 

  3. van der Noordt M, Ijzelenberg H, Droomers M, Proper KI. Health effects of employment: a systematic review of prospective studies. Occup Environ Med. 2014;71(10):730–736.

    PubMed  Google Scholar 

  4. Waddell G, Burton AK, Great Britain. Department for Work and Pensions. Is work good for your health and well-being?. London: The Stationery Office; 2006.

    Google Scholar 

  5. Modini M, Joyce S, Mykletun A, Christensen H, Bryant RA, Mitchell PB, et al. The mental health benefits of employment: results of a systematic meta-review. Australas Psychiatry. 2016;24(4):331–336.

    PubMed  Google Scholar 

  6. Layard R, Clark DM. Why more psychological therapy would cost nothing. Front Psychol. 2015;6:1713.

    PubMed  PubMed Central  Google Scholar 

  7. Alonso S, Marco JH, Andani J. Reducing the time until psychotherapy initiation reduces sick leave duration in participants diagnosed with anxiety and mood disorders. Clin Psychol Psychother. 2018;25(1):138–143.

    PubMed  Google Scholar 

  8. Blank L, Peters J, Pickvance S, Wilford J, Macdonald E. A systematic review of the factors which predict return to work for people suffering episodes of poor mental health. J Occup Rehabil. 2008;18(1):27–34.

    PubMed  Google Scholar 

  9. Brouwers EP, Terluin B, Tiemens BG, Verhaak PF. Predicting return to work in employees sick-listed due to minor mental disorders. J Occup Rehabil. 2009;19(4):323–332.

    PubMed  PubMed Central  Google Scholar 

  10. Churchill R, Hunot V, Corney R, Knapp M, McGuire H, Tylee A, et al. A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression. Health Technol Assess. 2001;5(35):1–173.

    CAS  PubMed  Google Scholar 

  11. Nieuwsma JA, Trivedi RB, McDuffie J, Kronish I, Benjamin D, Williams JW. Brief psychotherapy for depression: a systematic review and meta-analysis. Int J Psychiatry Med. 2012;43(2):129–151.

    PubMed  PubMed Central  Google Scholar 

  12. Cape J, Whittington C, Buszewicz M, Wallace P, Underwood L. Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Medicine. 2010;8:38.

    PubMed  PubMed Central  Google Scholar 

  13. Parikh SV, Quilty LC, Ravitz P, Rosenbluth M, Pavlova B, Grigoriadis S, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 2. Psychological treatments. Can J Psychiatry. 2016;61(9):524–539.

    PubMed  PubMed Central  Google Scholar 

  14. Gyani A, Shafran R, Layard R, Clark DM. Enhancing recovery rates: lessons from year one of IAPT. Behav Res Ther. 2013;51(9):597–606.

    PubMed  PubMed Central  Google Scholar 

  15. Moll LT, Jensen OK, Schiottz-Christensen B, Stapelfeldt CM, Christiansen DH, Nielsen CV, et al. Return to work in employees on sick leave due to neck or shoulder pain: a randomized clinical trial comparing multidisciplinary and brief intervention with one-year register-based follow-up. J Occup Rehabil. 2018;28(2):346–356.

    PubMed  Google Scholar 

  16. Hunsley J, Elliott K, Therrien Z. The efficacy and effectiveness of psychological treatments. Ottawa: Canadian Psychological Association; 2013.

    Google Scholar 

  17. Shapiro DA, Barkham M, Rees A, Hardy GE, Reynolds S, Startup M. Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy. J Consult Clin Psychol. 1994;62(3):522–534.

    CAS  PubMed  Google Scholar 

  18. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433–2445.

    Google Scholar 

  19. Bair MJ, Robinson RL, Eckert GJ, Stang PE, Croghan TW, Kroenke K. Impact of pain on depression treatment response in primary care. Psychosom Med. 2004;66(1):17–22.

    PubMed  Google Scholar 

  20. Shapiro DA, Rees A, Barkham M, Hardy G, Reynolds S, Startup M. Effects of treatment duration and severity of depression on the maintenance of gains after cognitive-behavioral and psychodynamic-interpersonal psychotherapy. J Consult Clin Psychol. 1995;63(3):378–387.

    CAS  PubMed  Google Scholar 

  21. Karjalainen K, Malmivaara A, Pohjolainen T, Hurri H, Mutanen P, Rissanen A. Mini-intervention for subacute low back pain: a randomized controlled trial. Spine. 2003;28:533–541.

    PubMed  Google Scholar 

  22. Harris A, Moe TF, Eriksen HR, Tangen T, Lie SA, Tveito TH, et al. Brief intervention, physical exercise and cognitive behavioural group therapy for patients with chronic low back pain (The CINS trial). Eur J Pain. 2017;21(8):1397–1407.

    CAS  PubMed  Google Scholar 

  23. Reme SE, Tveito TH, Harris A, Lie SA, Grasdal A, Indahl A, et al. Cognitive interventions and nutritional supplements (the CINS trial): a randomized controlled, multicenter trial comparing a brief intervention with additional cognitive behavioral therapy, seal oil, and soy oil for sick-listed low back pain patients. Spine (Phila Pa 1976). 2016;41(20):1557–1564.

    Google Scholar 

  24. Jensen C, Jensen OK, Nielsen CV. Sustainability of return to work in sick-listed employees with low-back pain. Two-year follow-up in a randomized clinical trial comparing multidisciplinary and brief intervention. BMC Musculoskelet Disord. 2012;13:156.

    PubMed  PubMed Central  Google Scholar 

  25. Sørensen PH, Bendix T, Manniche C, Korsholm L, Lemvigh D, Indahl A. An educational approach based on a non-injury model compared with individual symptom-based physical training in chronic LBP. A pragmatic, randomised trial with a one-year follow-up. BMC Musculoskelet Disord. 2010;11:212.

    PubMed  PubMed Central  Google Scholar 

  26. Trepper TS, Papay HE. Psychotherapy abbreviation: a practical guide. Routledge: Taylor and Francis; 2016.

    Google Scholar 

  27. Eriksen HR, Ihlebaek C, Ursin H. A scoring system for subjective health complaints (SHC). Scand J Public Health. 1999;27(1):63–72.

    CAS  PubMed  Google Scholar 

  28. Reme SE, Lie SA, Eriksen HR. Are 2 questions enough to screen for depression and anxiety in patients with chronic low back pain? Spine (Phila Pa 1976). 2014;39(7):E455–E462.

    Google Scholar 

  29. Beck AT, Steer RA. Internal consistencies of the original and revised Beck Depression Inventory. J Clin Psychol. 1984;40(6):1365–1367.

    CAS  PubMed  Google Scholar 

  30. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–897.

    CAS  PubMed  Google Scholar 

  31. Derogati L, Lipman RS, Rickels K, Uhlenhut E, Covi L. Hopkins Symptom Checklist (Hscl)—self-report symptom inventory. Behav Sci. 1974;19(1):1–15.

    Google Scholar 

  32. Beck AT, Steer RA. Manual for the Beck Anxiety Inventory. San Antonio: Psychological Corporation; 1996.

    Google Scholar 

  33. Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthr Care Res. 2011;63(Suppl 11):S467–S472.

    Google Scholar 

  34. Schwarzer R, Jerusalem M. Generalized self-efficacy scale. In: Weinman J, Wright S, Johnston M, editors. Measures in health psychology: a user’s portfolio causal and control beliefs. Windsor: NFER-NELSON; 1995.

    Google Scholar 

  35. Fugl-Meyer AR, Bränholm IB, Fugl-Meyer KS. Happiness and domain-specific life satisfaction in adult northern Swedes. Clin Rehabil. 1991;5:25–33.

    Google Scholar 

  36. Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4(863):12.

    Google Scholar 

  37. Joseph R, Sim J, Ogollah R, Lewis M. A systematic review finds variable use of the intention-to-treat principle in musculoskeletal randomized controlled trials with missing data. J Clin Epidemiol. 2015;68(1):15–24.

    PubMed  Google Scholar 

  38. Baldwin ML, Johnson WG, Butler RJ. The error of using returns-to-work to measure the outcomes of health care. Am J Ind Med. 1996;29(6):632–641.

    CAS  PubMed  Google Scholar 

  39. Hellstrom L, Madsen T, Nordentoft M, Bech P, Eplov LF. Trajectories of return to work among people on sick leave with mood or anxiety disorders: secondary analysis from a randomized controlled trial. J Occup Rehabil. 2018;28(4):666–677.

    PubMed  Google Scholar 

  40. Oyeflaten I, Lie SA, Ihlebaek CM, Eriksen HR. Multiple transitions in sick leave, disability benefits, and return to work. A 4-year follow-up of patients participating in a work-related rehabilitation program. BMC Public Health. 2012;12:748.

    PubMed  PubMed Central  Google Scholar 

  41. Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, et al. Interventions to improve return to work in depressed people. Cochrane Database Syst Rev. 2014;12:CD006237.

    Google Scholar 

  42. Nigatu YT, Liu Y, Uppal M, McKinney S, Rao S, Gillis K, et al. Interventions for enhancing return to work in individuals with a common mental illness: systematic review and meta-analysis of randomized controlled trials. Psychol Med. 2016;46(16):3263–3274.

    CAS  PubMed  Google Scholar 

  43. van Vilsteren M, van Oostrom SH, ve Vet HC, Franche RL, Boot CR, Anema JR. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database Syst Rev. 2015;10:CD006955.

    Google Scholar 

  44. Finnes A, Enebrink P, Ghaderi A, Dahl J, Nager A, Ost LG. Psychological treatments for return to work in individuals on sickness absence due to common mental disorders or musculoskeletal disorders: a systematic review and meta-analysis of randomized-controlled trials. Int Arch Occup Environ Health. 2019;92(3):273–293.

    PubMed  Google Scholar 

  45. Smith OR, Alves DE, Knapstad M. Prompt mental health care: evaluation of the first 12 pilot sites in Norway. Oslo, Norway: Norwegian Institute of Public Health; 2016 (In Norwegian).

    Google Scholar 

  46. Chan SW, Adams M. Service use, drop-out rate and clinical outcomes: a comparison between high and low intensity treatments in an IAPT service. Behav Cogn Psychother. 2014;42(6):747–759.

    PubMed  Google Scholar 

  47. Aasdahl L, Pape K, Vasseljen O, Johnsen R, Gismervik S, Halsteinli V, et al. Effect of inpatient multicomponent occupational rehabilitation versus less comprehensive outpatient rehabilitation on sickness absence in persons with musculoskeletal- or mental health disorders: a randomized clinical trial. J Occup Rehabil. 2018;28(1):170–179.

    PubMed  Google Scholar 

  48. Jarvholm B. How should methods for return to work be evaluated? Scand J Work Environ Health. 2012;38(2):89–91.

    PubMed  Google Scholar 

  49. Koopmans PC, Bultmann U, Roelen CA, Hoedeman R, van der Klink JJ, Groothoff JW. Recurrence of sickness absence due to common mental disorders. Int Arch Occup Environ Health. 2011;84(2):193–201.

    PubMed  Google Scholar 

  50. Cuijpers P, Huibers M, Ebert DD, Koole SL, Andersson G. How much psychotherapy is needed to treat depression? A metaregression analysis. J Affect Disord. 2013;149(1–3):1–13.

    PubMed  Google Scholar 

  51. Loerinc AG, Meuret AE, Twohig MP, Rosenfield D, Bluett EJ, Craske MG. Response rates for CBT for anxiety disorders: need for standardized criteria. Clin Psychol Rev. 2015;42:72–82.

    PubMed  Google Scholar 

  52. Stulz N, Lutz W, Kopta SM, Minami T, Saunders SM. Dose-effect relationship in routine outpatient psychotherapy: Does treatment duration matter? J Couns Psychol. 2013;60(4):593–600.

    PubMed  Google Scholar 

  53. Barkham M, Rees A, Stiles WB, Shapiro DA, Hardy GE, Reynolds S. Dose-effect relations in time-limited psychotherapy for depression. J Consult Clin Psychol. 1996;64(5):927–935.

    CAS  PubMed  Google Scholar 

  54. Reynolds S, Stiles WB, Barkham M, Shapiro DA. Acceleration of changes in session impact during contrasting time-limited psychotherapies. J Consult Clin Psychol. 1996;64(3):577–586.

    CAS  PubMed  Google Scholar 

  55. Eckert PA. Acceleration of change: catalysts in brief therapy. Clin Psychol Rev. 1993;13(3):241–253.

    Google Scholar 

  56. Dekker J, Molenaar PJ, Kool S, Van Aalst G, Peen J, de Jonghe F. Dose-effect relations in time-limited combined psycho-pharmacological treatment for depression. Psychol Med. 2005;35(1):47–58.

    CAS  PubMed  Google Scholar 

  57. Wright T, Simpson-Young V, Lennings C. Therapeutic process in the context of third party determined time limits. Clin Psychol. 2012;16(2):82–92.

    Google Scholar 

  58. Springer KS, Levy HC, Tolin DF. Remission in CBT for adult anxiety disorders: a meta-analysis. Clin Psychol Rev. 2018;61:1–8.

    PubMed  Google Scholar 

  59. Hansen NB, Lambert MJ. An evaluation of the dose-response relationship in naturalistic treatment settings using survival analysis. Ment Health Serv Res. 2003;5(1):1–12.

    PubMed  Google Scholar 

  60. Marks DF. IAPT under the microscope. J Health Psychol. 2018;23(9):1131–1135.

    PubMed  Google Scholar 

  61. Hollon SD, Stewart MO, Strunk D. Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annu Rev Psychol. 2006;57:285–315.

    PubMed  Google Scholar 

  62. Vittengl JR, Clark LA, Dunn TW, Jarrett RB. Reducing relapse and recurrence in unipolar depression: a comparative meta-analysis of cognitive-behavioral therapy’s effects. J Consult Clin Psychol. 2007;75(3):475–488.

    PubMed  PubMed Central  Google Scholar 

  63. Amos R, Morris L, Mansell W, Edge D. Clients’ experiences of one-to-one low-intensity interventions for common mental health problems: an interpretative phenomenological analysis. Psychol Psychother. 2018. https://doi.org/10.1111/papt.12200.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Verkuil B, Brosschot JF, Meerman EE, Thayer JF. Effects of momentary assessed stressful events and worry episodes on somatic health complaints. Psychol Health. 2012;27(2):141–158.

    PubMed  Google Scholar 

  65. Johnsen TL, Indahl A, Eriksen HR, Ihlebaek C, Tveito TH. Work and mental complaints: are response outcome expectancies more important than work conditions and number of subjective health complaints? J Occup Rehabil. 2017;27(2):218–227.

    PubMed  Google Scholar 

  66. Eriksen HR, Ursin H. Subjective health complaints: is coping more important than control? Work Stress. 1999;13(3):238–252.

    Google Scholar 

  67. McCracken LM, Eccleston C. Coping or acceptance: what to do about chronic pain? Pain. 2003;105(1–2):197–204.

    PubMed  Google Scholar 

  68. Stenberg U, Haaland-Overby M, Fredriksen K, Westermann KF, Kvisvik T. A scoping review of the literature on benefits and challenges of participating in patient education programs aimed at promoting self-management for people living with chronic illness. Patient Educ Couns. 2016;99(11):1759–1771.

    PubMed  Google Scholar 

  69. Stenberg U, Vagan A, Flink M, Lynggaard V, Fredriksen K, Westermann KF, et al. Health economic evaluations of patient education interventions a scoping review of the literature. Patient Educ Couns. 2018;101(6):1006–1035.

    PubMed  Google Scholar 

  70. White IR, Carpenter J, Horton NJ. Including all individuals is not enough: lessons for intention-to-treat analysis. Clin Trials. 2012;9(4):396–407.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We would like to thank the participants for taking part in the study, and all therapists involved for their inspiring and enthusiastic help and participation. Also, thanks to Clive Bachelor for carefully reading the manuscript and providing critical comments concerning English language use. The study was funded by Vestfold Hospital Trust and Rapid-RTW program, South-Eastern Norway Regional Health Authority.

Author information

Authors and Affiliations

  1. Division Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway

    M. E. A. Wormgoor & A. Indahl

  2. Division of Mental Health & Addiction, Vestfold Hospital Trust, Tønsberg, Norway

    E. Andersen & J. Egeland

  3. Department of Psychology, University of Oslo, Oslo, Norway

    J. Egeland

Authors
  1. M. E. A. Wormgoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Indahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Andersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Egeland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. E. A. Wormgoor.

Ethics declarations

Conflict of interest

Aage Indahl is currently employed at the outpatient clinic. Eivind Andersen and Marjon E.A. Wormgoor were previously employed at the outpatient clinic of the current study. Jens Egeland and Marjon E.A. Wormgoor are currently employed in the Divisions of Vestfold Hospital Trust that runs the outpatient clinic of the current study. None of the authors have been clinically involved in the patient population of this study.

Ethical Approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wormgoor, M.E.A., Indahl, A., Andersen, E. et al. Effectiveness of Briefer Coping-Focused Psychotherapy for Common Mental Complaints on Work-Participation and Mental Health: A Pragmatic Randomized Trial with 2-Year Follow-Up. J Occup Rehabil 30, 22–39 (2020). https://doi.org/10.1007/s10926-019-09841-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10926-019-09841-6

Keywords

  • Mental health
  • Return to work
  • Psychotherapy
  • Sick leave