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Problem solving reduces pain and speeds up re-entry into the workforce

At a glance:
Two weeks of cognitive behavioural therapy
Cognitive Behavioural Therapy
a therapy used to modify behaviour by changing a person's assumptions, beliefs and approach to a problem
 reduced stress and anxiety in people seeking employment after recovering from work-related injury. This therapy discussed:

Different ways to communicate
Positive and negative thinking
Stress and relaxation
The importance of planning pleasant activities.

People who had cognitive
cognitive
relating to the mental processes of perception, memory, judgment, and reasoning
 behavioural therapy and job search training:

Felt they had increased physical ability
Returned to work earlier than people who only had standard job search training.
Perspectives:
Employee
When people are out of work due to a work related condition, they not only have to contend with their physical condition and uncertainty, they may also need to find another job. The situation may be even more difficult if the person applying has no experience in that position. Rejection of job applications is often taken personally and people can then feel more negative about themselves.

This study shows that taking a course that teaches you different thinking strategies can help you have a more positive self-image. This can improve your beliefs about your ability to function and help you find a job earlier.
Employer
Having a work injury and being off work is difficult. This study shows that helping people to learn think about the situation and their condition in a more positive way reduces distress
distress
Severe suffering, pain, anxiety or sorrow
 and improves outcomes.

While this study discusses a formal program, simple, everyday things can help people think more positively. A discussion of available options, understanding the compensation system, and encouraging them to take responsibility for their situation can assist. When people have useful and productive ways of communicating they are more able to deal positively with their medical condition and workplace relationships.
Treater
Cognitive behaviour therapy has been shown to work in a variety of clinical conditions. A broad range of studies indicate that an individual's beliefs about their problems have a significant impact on outcomes. Encouraging people to understand their medical condition, and take a positive and proactive approach to making decisions can help them return to work earlier.

Cognitive behaviour therapy is undertaken informally in many consultations. However we can get caught up with patient's negative beliefs and their level of distress and do not take the important step of addressing the consequences of these beliefs.

Treatment may be concentrated on pain relief and short term measures to ‘protect' the person from the immediate level of worry or distress. While these issues are important, confronting and challenging negative and incorrect beliefs may be required for longer term change. People's livelihood and emotional well being are influenced by their approach, and in turn the approach taken by their treating practitioners
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 affects the outcome
Insurer
This simple approach found that shifting people's beliefs about their situation improved outcomes. Further, it helped lessen their anxiety and distress, and improved their perception of their own abilities.

The participants in this study were a group of people looking for work with a new employer. The same principle applies, however, when the person is returning to work at the same workplace. Supporting the individual to think constructively and develop positive beliefs about their situation makes a difference.
Original Article, Authors & Publication Details:
C. Della-Posta1, P. D. Drummond1 (2006).

Cognitive behavioural therapy increases re-employment of job seeking worker's compensation clients. Journal of Occupational Rehabilitation; 16:223-230

1School of Psychology, Murdoch University, Perth 6150, Western Australia
Background, Study Objectives, How It Was Done:
People who are injured at work receive treatment for their physical condition to enable them to return to their job. If they are unable to return to their job they are counselled to re-train for a different, less physically demanding job. Those with the physical ability and skills to find work are given assistance with job seeking. However, in Western Australia, only 70% of people return to the workforce after suffering a workplace injury.

A person's ability to return to work is affected by:

Their physical condition
Being away from the workplace
Low expectations about returning to work
Low levels of confidence about their ability to return to the workforce
Low levels of confidence about their ability to find another job

To help injured workers there should be attention to their physical problem. As well, there should be attention to the psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 aspects of the situation. Previous research has shown that learning coping skills can help people become ready to return to work.

The authors wanted to see if cognitive behavioural therapy could:

Reduce anxiety and stress
Improve self-confidence, and
Improve expectations about returning to work in people who were unemployed and receiving worker's compensation.

The study followed 28 men and 11 women (aged 19-60) who participated in a rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 program at WorkFocus Australia. All participants had the physical ability and skills to find work, were looking for a new job, and had been referred for a Job Search Program as part of their rehabilitation. 29 of the participants had physically demanding jobs prior to their injury (e.g. labourers, storemen), while 10 had non-physically demanding jobs (e.g. administration, customer service).

The study participants were allocated to one of two treatment groups. The allocation into the groups was done randomly, to ensure the study was done according to sound scientific principles.

1. Group one - received standard job search training (four two-hour sessions in the first two weeks and four two-hour sessions in the second two weeks) which taught:

Goal setting,
Resume and application preparation,
How to look for employment, and
Telephone and interview techniques.

2. Group two - received the standard job search training provided to Group one.

As well as the job search training they were given cognitive behavioural therapy (four two-hour sessions in the second two weeks), including information on:

Stress and relaxation,
Different ways to communicate
Positive and negative thinking
The importance of planning pleasant activities
Simple ways to manage stress.

The study results were evaluated through:

I. Two questionnaires used to assess the outcome of the treatments. The study participants completed both questionnaires before and after the treatment.

The Depression Anxiety Stress Scale has 42 questions about anxiety, depression
depression
A symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection. Major depression is likely to interfere significantly with everyday activity, with symptoms including insomnia, irritability, weight loss, and a lack of interest in outside events. The disorder may last several months or longer and may recur, but it is generally reversible in the short run.
 and stress.
The Work Potential Profile rates aspects of employment readiness such as motivation, ability to cope with work pressures and physical ability.

II. The participants reported their work status before and after the treatment, and then again four and ten weeks later (via telephone), and their work status was confirmed by WorkFocus.
Study Findings:
The two treatment groups were similar in age, sex, years of education and time since injury. The cognitive behavioural therapy group had higher scores for anxiety than the job search training group before the treatment, but other questionnaire responses were similar between the two groups.

After treatment:

Anxiety and depression scores:

Decreased in the cognitive behavioural therapy group.
Remained the same in the job search training group.

Physical ability scores:

Increased in the cognitive behavioural therapy group.
Remained the same in the job search training group.

The group which received cognitive behavioural therapy scored better for anxiety, stress, and physical ability, but no difference could be identified in depression scores.

After treatment the cognitive behavioural therapy group found work more quickly (after 7 weeks on average) than the job search training group (after 8 weeks on average).

Patients who were pursuing legal action in this study (6 of the participants) did not find work by 4 weeks after the treatment, and only found work by 10 weeks if their court cases had been settled (3 participants).
Conclusions:
Cognitive behavioural therapy is an approach that helps people look at issues in a constructive way.

Cognitive behavioural therapy considers that a person's core beliefs (often formed in childhood) contribute to 'automatic thoughts' that pop up in response to everyday situations. Cognitive behavioural therapy helps the person find new, more positive ways of dealing with situations.

This study showed that cognitive behaviour therapy reduced stress and anxiety in people seeking employment after recovering from work-related injury. This was accompanied by a more positive perception of their physical ability. Return to work occurred earlier in those who received the cognitive behaviour therapy approach than people who had standard job search training.
References:
PubMed Abstract
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