Back to Work or Not?

After just a few quick hours of procrastination, I start looking for materials for a new post. The first promising topic I find is a new intervention that helps short-term disability recipients get back to work. Coincidence? I’ll tell myself that it is.

Suzanne Lagerveld, Roland W. B. Blonk, et al, of Utrecht University dub their cognitive-behavioral therapy (CBT)-based intervention, “W-CBT”.  Besides treating mental health symptoms generally, it provides a module that focuses on work-related cognitions and returning to work in gradual steps. For their research just published in the Journal of Occupational Health Psychology, the authors enlisted employees on short-term disability for mild anxiety and depressive issues. They ruled out those with major depression, post-traumatic stress disorder or physical disabilities. One half of their sample received the new modality and regular CBT was provided to the rest. Per their findings, (PDF here, at least for now), W-CBT got clients back on the job significantly faster. After three months, 15% more W-CBT clients were back to work than clients from the standard CBT group. After six months, that gap increased to 18%. As the authors point out, mental-health absenteeism means lost productivity and profits.  The study’s faster return-to-work (RTW) rate provided a euros-and-cents benefit to Dutch employers, the Netherlands’ economy and society as a whole.

So why doesn’t it feel right?

What if he doesn't want to focus on returning to work ASAP?

Part of informed consent is the client’s freedom in choices about their therapy, including their choice of goals. The article doesn’t address who the client is in W-CBT. Is it the employer, who pays part of the insurance cost?  Or is the employee, who might not want to prioritize RTW? You could argue employees are morally obligated get back to work as fast as possible – if you were their clergyperson. Psychotherapists have a duty not to impose their views on clients, even such widely-held values as a work ethic.

The article states clients were not required to address RTW issues, but that the therapists were encouraged to say things such as, “You won’t recover from your symptoms just by sitting at home. It would probably even get worse.” Per this study, that isn’t necessarily true. According to Lagerveld and Blonk’s  findings, W-CBT and regular CBT had about the same effect on mental health symptoms. If it was once OK to imply symptoms grow worse if one doesn’t race back to the job site, it doesn’t appear ethical anymore.

The researchers are to be congratulated on producing a fascinating conundrum – W-CBT may be simultaneously effective, good, and, at least in some situations, ethically wrong.


Work-focused treatment of common mental disorders and return to work: A comparative outcome study. Lagerveld SE, Blonk RW, Brenninkmeijer V, Meij LW, Schaufeli WB. J Occup Health Psychol. 2012 Feb 6.

@ 2012 Jonathan Miller All Rights Reserved

1 Comment

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One response to “Back to Work or Not?

  1. My initial thought was that culturally this may work for their people, based on the work ethics and mentality in this country. As we know, this study will have to be replicated in other areas, other cultures. Than I recalled a position I held prior to getting my degree where I edited papers for psychologists who were paid by insurance companies. I had to leave the company because from reading all of these reports, I couldn’t help feeling as if the employees were being taken advantage of. I felt very sad for these people who were on disability because they were being tricked into going back to work. What was worse is that the people coming in did not speak English (or barely any English) as their first language and as it happens, neither did the doctors. The doctor and client spoke completely different languages too and used an interpreter. This also didn’t make sense to me because the interpreter was not a psychologist. It was good pay for a second job but ethically I didn’t feel I could continue there.

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