New Therapy For Depression and Anxiety May Speed ​​Up Return To Work

Researchers tested a psychological therapy that combines treatment for depression and anxiety with practical strategies to help patients return to work. In a study of 236 people absent from work due to mental health problems, almost twice as many patients who received treatment immediately were able to return to work compared to those who waited on a waiting list. Furthermore, participants showed a significant reduction in emotional symptoms. This approach could represent a new way to reduce prolonged sick leave and its costs to society.

Depression and anxiety are among the most common mental health problems in the world. In addition to causing emotional distress, these disorders can profoundly affect people's daily lives, hindering basic activities, social relationships, and work performance.

When symptoms become more intense, many people need to temporarily step away from their professional activities. This affects not only individuals but also the economy: it is estimated that mental health problems cause global productivity losses of around one trillion dollars per year.

One of the challenges is that prolonged absence from work can further worsen the situation. Work, when performed under suitable conditions, usually offers routine, purpose, and social contact, factors that help protect mental health. When a person is away from work for too long, a difficult cycle can develop: symptoms make returning to work difficult, and absence from work contributes to maintaining or worsening the symptoms.

Although various forms of psychotherapy exist to treat depression and anxiety, many have limited effectiveness when the goal is to help people return to work. In many cases, only about half of patients experience significant symptom improvement, and returning to professional activities remains a challenge.

Therefore, researchers have been trying to develop treatments that not only reduce emotional symptoms but also directly aid in reintegration into the workplace.

In this study, scientists tested an approach called work-focused metacognitive therapy. Metacognitive therapy seeks to help people change how they deal with their own thoughts. Instead of trying to modify the content of negative thoughts, the therapy teaches strategies to avoid cycles of excessive worry, rumination, and self-criticism, mental patterns that often maintain anxiety and depression.

In the study, this approach was combined with specific return-to-work sessions, in which patients analyzed their professional situation, identified difficulties, and planned a gradual return to work.

To assess whether the treatment worked, the researchers conducted a clinical study with 236 adults in Norway who were on leave from work due to depression or anxiety. Participants were randomly divided into two groups. One group began therapy immediately.

The other group had to wait between eight and twelve weeks before starting treatment, serving as a comparison group. During this period, the researchers monitored the participants through questionnaires about symptoms of anxiety and depression and also analyzed official medical leave records to verify who had returned to work.

After twelve weeks, the results showed clear differences between the groups. Approximately 39% of those who received therapy immediately had already returned to work, while only 20% of those who waited for treatment managed to return within the same period. Furthermore, patients who participated in therapy showed significantly greater reductions in symptoms of depression and anxiety. No serious side effects were reported during the study.

The results suggest that integrating psychological treatment with specific return-to-work strategies may be an effective way to help people with depression and anxiety recover. If this approach is applied on a large scale, it could not only improve patients' quality of life but also significantly reduce the social and economic costs associated with prolonged absence from work.

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Metacognitive therapy and work-focus for patients with depression, anxiety or comorbid depression and anxiety on sick leave: a single-centre, open-label randomised controlled trial 

Ragne G.H. Gjengedal, Marit Hannisdal, Kåre Osnes, Silje E. Reme, Adrian Wells, Roland Blonk, Hilde D. Lending, Sverre U. Johnson, Suzanne E. Lagerveld, Frederick Anyan, Hans M. Nordahl, Romée B.T.W. Gerritsen, Marianne T. Bjørndal, Danielle Wright, Kenneth Sandin, Kjersti S. Bjøntegård, Jørund Schwach, and Odin Hjemdal

eClinicalMedicine. Volume 89103613. November 2025

DOI: 10.1016/j.eclinm.2025.103613

Abstract:

Employment is a key determinant of health, but mental health treatments have limited success on return-to-work (RTW) in depression and anxiety. We investigated the effectiveness of metacognitive therapy combined with work-focused components (MCT + WF) to improve RTW and reduce anxiety and depression in patients on sick leave. This single-centre, open-label, randomised controlled trial was conducted at an outpatient clinic (Diakonhjemmet Hospital) in Norway. Eligible patients were adults on sick leave with depression and/or anxiety. Patients with severe mental disorder or substance abuse were excluded. Participants were randomly assigned using computer-generated block randomisation, stratified by gender and percentage of sick leave, to receive either immediate MCT + WF or delayed MCT + WF after 8–12 weeks on a waitlist. Outcome assessors were blinded. Primary outcomes were depression (BDI-II), anxiety (BAI), and RTW at 12 weeks. Sick leave data were obtained from a national registry and self-report; symptoms were self-reported. Analyses followed the intention-to-treat principle, including all randomised participants. This trial was registered with ClinicalTrials.gov, NCT03301922. Between Sept 11, 2017, and Nov 17, 2020, 236 patients were enrolled and randomly assigned to immediate MCT + WF (n = 121) or waitlist (n = 115). At 12 weeks, logistic regression of registry data showed significantly higher RTW in the immediate MCT + WF group (39%; 47/121) than in the waitlist group (20%; 23/115; OR = 2.39, 95% CI 1.32–4.32; p = 0.0040), consistent with self-reported RTW (42% (51/121) versus 18% (20/114); OR = 3.44, 95% CI: [1.87, 6.35], p < 0.0001). Multilevel models revealed greater reductions in anxiety (time × group interaction coefficient = −8.35, 95% CI –10.61 to −6.09; p < 0.0001) and depression (−10.84, 95% CI –13.25 to −8.44; p < 0.0001) for immediate MCT + WF versus waiting. No serious adverse events were reported during the study. Immediate MCT + WF significantly improved RTW and reduced symptoms of depression and anxiety compared with waiting. Generalisability may be constrained by Norway's welfare system; strengths include registry data and naturalistic outpatient setting. The favourable outcomes suggest that MCT + WF could be integrated into mental health care. The study was funded by the South-Eastern Norway Regional Health Authority and DAM foundation-Mental Health, Diakonhjemmet Hospital.