CBT with return-to-work planning built in was linked to fuller return after sickness absence

Design

Systematic review and multilevel meta-analysis of randomised and non-randomised studies

Population

3279 working-age adults on sickness absence for common mental disorders (24 studies)

Primary outcome

Psychiatric symptoms and return to work

Effect

Small significant between-group symptom benefit; 56% returned post-treatment, 87% at follow-up; higher likelihood of full return vs control

This meta-analysis pooled 24 studies (26 treatment arms, 3279 working-age adults) of cognitive behavioural therapy that integrated return-to-work planning — graded return, workplace problem-solving, contact with the employer — for people off sick with depression, anxiety or stress-related disorders.

Symptoms improved substantially within groups and stayed improved at follow-up; the difference compared with controls was statistically significant but small. On work, 56% had returned by the end of treatment and 87% at follow-up, and full return was more likely with work-focused CBT than with control. More CBT content, a stronger work focus and more sessions were associated with larger symptom gains.

The review is candid about a weakness: many primary studies analysed return to work with methods that assume normally distributed data, when days off work are skewed and bounded, so the size of the work effect is uncertain. Even so, the pooled likelihood of full return favoured work-focused CBT despite substantial heterogeneity, and the step costs nothing to add. Treating symptoms and expecting work to follow on its own is the default the evidence argues against. Set a work goal from the first session.

• Ask at the first appointment whether the patient is off work, for how long, and what they fear about going back.
• Set a return-to-work goal as an explicit part of the treatment plan, not something to discuss once symptoms settle.
• Plan a graded return — reduced hours or duties — and write a fitness note that supports it.
• With the patient's consent, contact the employer or occupational health about adjustments.
• Review work status at each follow-up alongside symptom scores.

Why it matters

Symptom relief alone does not reliably get people back to work, and prolonged absence itself worsens outcomes.

Don't overread it

Between-group symptom effects were small and many studies analysed return to work poorly, so the size of the work benefit is uncertain.

The statistics, in plain English

Within-group improvement compares patients with themselves before treatment, which also captures natural recovery; the between-group difference against controls is the fairer measure, and here it was small. The 56% and 87% return figures describe treated patients, not the extra benefit over control.

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