scholarly journals Multidisciplinary Intervention and Acceptance and Commitment Therapy for Return-to-Work and Increased Employability among Patients with Mental Illness and/or Chronic Pain: A Randomized Controlled Trial

2018 ◽  
Vol 15 (11) ◽  
pp. 2424 ◽  
Author(s):  
Erik Berglund ◽  
Ingrid Anderzén ◽  
Åsa Andersén ◽  
Lars Carlsson ◽  
Catharina Gustavsson ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Mental Illness ◽  
Sick Leave ◽  
Return To Work ◽  
Acceptance And Commitment Therapy ◽  
Multidisciplinary Team ◽  
Control Group ◽  
Randomized Controlled ◽  
Acceptance And Commitment

Background: People on long-term sick leave often have a long-lasting process back to work, where the individuals may be in multiple and recurrent states; i.e., receiving different social security benefits or working, and over time they may shift between these states. The purpose of this study was to evaluate the effects of two vocational rehabilitation programs, compared to a control, on return-to-work (RTW) or increased employability in patients on long-term sick leave due to mental illness and/or chronic pain. Methods: In this randomized controlled study, 427 women and men were allocated to either (1) multidisciplinary team management, i.e., multidisciplinary assessments and individual rehabilitation management, (2) acceptance and commitment therapy (ACT), or (3) control. A positive outcome was defined as RTW or increased employability. The outcome was considered negative if the (part-time) wage was reduced or ceased, or if there was an indication of decreased employability. The outcome was measured one year after entry in the project and analyzed using binary and multinomial logistic regressions. Results: Participants in the multidisciplinary team group reported having RTW odds ratio (OR) 3.31 (95% CI 1.39–7.87) compared to the control group in adjusted models. Participants in the ACT group reported having increased employability OR 3.22 (95% CI 1.13–9.15) compared to the control group in adjusted models. Conclusions: This study of vocational rehabilitation in mainly female patients on long-term sick leave due to mental illness and/or chronic pain suggests that multidisciplinary team assessments and individually adapted rehabilitation interventions increased RTW and employability. Solely receiving the ACT intervention also increased employability.

scholarly journals Comparing the Efficacy of Multidisciplinary Assessment and Treatment, or Acceptance and Commitment Therapy, with Treatment as Usual on Health Outcomes in Women on Long-Term Sick Leave—A Randomised Controlled Trial

2021 ◽  
Vol 18 (4) ◽  
pp. 1754
Author(s):  
Anna Finnes ◽  
Ingrid Anderzén ◽  
Ronnie Pingel ◽  
JoAnne Dahl ◽  
Linnea Molin ◽  
...  
Keyword(s):  
Sick Leave ◽  
Health Outcomes ◽  
Acceptance And Commitment Therapy ◽  
Significant Interaction ◽  
Treatment As Usual ◽  
Multidisciplinary Assessment ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Assessment And Treatment

Background: Chronic pain and mental disorders are common reasons for long term sick leave. The study objective was to evaluate the efficacy of a multidisciplinary assessment and treatment program including acceptance and commitment therapy (TEAM) and stand-alone acceptance and commitment therapy (ACT), compared with treatment as usual (Control) on health outcomes in women on long-term sick leave. Method: Participants (n = 308), women of working age on long term sick leave due to musculoskeletal pain and/or common mental disorders, were randomized to TEAM (n = 102), ACT (n = 102) or Control (n = 104). Participants in the multidisciplinary assessment treatment program received ACT, but also medical assessment, occupational therapy and social counselling. The second intervention included ACT only. Health outcomes were assessed over 12 months using adjusted linear mixed models. The results showed significant interaction effects for both ACT and TEAM compared with Control in anxiety (ACT [p < 0.05]; TEAM [p < 0.001]), depression (ACT [p < 0.001]; TEAM [p < 0.001]) and general well-being (ACT [p < 0.05]; TEAM [p < 0.001]). For self-rated pain, there was a significant interaction effect in favour of ACT (p < 0.05), and for satisfaction with life in favour of TEAM (p < 0.001). Conclusion: Both ACT alone and multidisciplinary assessment and treatment including ACT were superior to treatment as usual in clinical outcomes.

scholarly journals Neural Mechanisms of Acceptance and Commitment Therapy for Chronic Pain: A Network-Based fMRI Approach

2021 ◽  
Vol 15 ◽  
Author(s):  
Semra A. Aytur ◽  
Kimberly L. Ray ◽  
Sarah K. Meier ◽  
Jenna Campbell ◽  
Barry Gendron ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Behavioral Outcomes ◽  
Depression Scale ◽  
The United States ◽  
Functional Improvement ◽  
Pain Acceptance ◽  
Commitment Therapy ◽  
Acceptance And Commitment

Over 100 million Americans suffer from chronic pain (CP), which causes more disability than any other medical condition in the United States at a cost of $560–$635 billion per year (Institute of Medicine, 2011). Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy (CBT) can be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy (ACT) has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions (Gutierrez et al., 2004). However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women (n = 9) with chronic musculoskeletal pain. Functional magnetic resonance imaging (fMRI) data were collected pre- and post-ACT, and changes in functional connectivity (FC) were measured using Network-Based Statistics (NBS). Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire (AAQ-II), the Chronic Pain Acceptance Questionnaire (CPAQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the NIH Toolbox Neuro-QoLTM (Quality of Life in Neurological Disorders) scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection (default mode, DMN), emotion (salience, SN), and cognitive control (frontal parietal, FPN). These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies.

The effect on length of sickness absence by recognition of undetected psychiatric disorder in long-term sickness absence. A randomized controlled trial

2009 ◽  
Vol 37 (8) ◽  
pp. 864-871 ◽  
Author(s):  
Hans Jørgen Søgaard ◽  
Per Bech
Keyword(s):  
Randomized Controlled Trial ◽  
Mental Disorders ◽  
Return To Work ◽  
Sickness Absence ◽  
Controlled Trial ◽  
Intervention Group ◽  
Rate Of Return ◽  
Control Group ◽  
Randomized Controlled

Background: The burden caused by psychiatric disorders on the individual and society has resulted in more studies examining interventions aimed at reducing sickness absence. Aims: To examine if detection of undetected psychiatric disorders in long-term sickness absence (LSA) would improve the rate of return to work. Methods: Over one year all 2,414 incident persons on LSA in a well-defined population were within one week after eight weeks of continuous sickness absence posted the Common Mental Disorders Screening Questionnaire (CMD-SQ) to screen for mental disorders. In a randomized controlled trial (RCT), of 1,121 responding participants, persons with a minimum level of psychiatric symptoms 420 were allocated to the intervention group and 416 to the control group. The intervention was a psychiatric examination including diagnostics with Present State Examination and feedback regarding treatment and rehabilitation to the participants themselves, general practitioners and the social service taking care of the participants’ rehabilitation back to work. Of the 420 in the intervention group 329 (78.3%) participated in the intervention. The outcomes measure was in an intention treat analysis the rate of return to work. Results: The rate of return to work was non-significantly lower for the intervention group than for the control group, except for persons without a psychiatric sick-leave diagnosis who were sick-listed from full time work, who showed a significantly higher rate of return to work in the intervention group. Conclusions: The effect of interventions for return to work depends on socio-demographic characteristics. Further studies are needed regarding interventions to improve return to work.

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