Improving health and productivity: An exploratory RCT of T-CBT delivery in an occupational setting

Publication Summary

Background: The impairments and productivity losses associated with mental health difficulties such as depression are high, yet many workers are inadequately treated. Innovative models that deliver psychological therapy directly into the workplace offer one potentially effective solution. The published evidence base reports the use of the telephone cognitive behavioural therapy (T-CBT) in a wide range of mental health disorders. To date however there remains a paucity of data examining the effects of T-CBT in the workplace setting.This randomized pilot study reports on a telephone CBT service for employed adults with mild/moderate mental health problems.Methods: Participants comprised BT employees working in either BT Retail or Openreach and on GP-authorised sickness absence of more than 8 days duration. Exclusion criteria were severe or complex disorders (i.e. psychosis, co-morbid personality disorder); degenerative cognitive disorders, substance misuse or active self harm. Consenting participants were randomized to 12 weeks of T-CBT or Usual Care. Self-reported outcomes comprised mental health symptoms (CORE-OM, HADS), functioning (WSAS) and work productivity (HPQ), assessed at baseline and 3-month follow-up. In line with the MRC Complex Interventions Framework,1 a qualitative study of treatment acceptability was conducted alongside the examination of its effectiveness.Results: Treatment uptake: 70 out of 591 (12%) identified employees consented to researcher contact, of whom 66 (94%) were eligible for the study and 53 (82%) completed baseline measures. The mean (SD) number of T-CBT sessions required was 4.5 (3.2) and mean (SD) session length was 28.32 (18.24) mins. Twenty three (88%) individuals in telephone CBT had at least one session and 19 (73%) attended all appointments. Loss to follow up: Twenty one patients (40%) failed to return primary outcome data at 3-months. Non-respondents were more likely to be male and of greater illness severity. Effectiveness: Direction of effect favoured T-CBT, which was associated with ?medium? to ?large? effects sizes on clinical and work productivity outcomes. A significantly greater proportion of the intervention group was occupationally productive at 3-month follow-up. Acceptability: T-CBT was perceived to fulfil a previously unmet need in service provision that arose from a lack of effective and acceptable healthcare resources and a prevailing sense of mistrust in more long standing occupational health initiatives. Telephone-administered CBT represented an acceptable intervention to the majority of service users, with high levels of perceived treatment confidentiality and therapeutic trust. It facilitated recovery through the provision of support, knowledge and behavioural intervention and may have a important role to play in relapse prevention. The potential role of managerial staff in facilitating service referrals was emphasised.Conclusions: The principles of telephone-based CBT translate well between the clinical and workplace setting with quantifiable and potentially significant organisational and individual benefits. Recommendations: Future research should the consider cost effectiveness alongside clinical effectiveness in a larger-scale trial designed maximize participant recruitment and retention rates