Evaluation of a transdiagnostic psychodynamic online intervention to support return to work: A randomized controlled trial

Abstract

Objectives: Given their flexibility, online interventions may be useful as an outpatient treatment option to support vocational reintegration after inpatient rehabilitation. To that purpose we devised a transdiagnostic psychodynamic online intervention to facilitate return to work, focusing on interpersonal conflicts at the workplace often responsible for work-related stress.

Research design and methods: In a randomized controlled trial, we included employed patients from cardiologic, psychosomatic and orthopedic rehabilitation with work-related stress or need for support at intake to inpatient rehabilitation after they had given written consent to take part in the study. Following discharge, maladaptive interpersonal interactions at the workplace were identified via weekly blogs and processed by written therapeutic comments over 12 weeks in the intervention group (IG). The control group (CG) received an augmented treatment as usual condition. The main outcome, subjective prognosis of gainful employment (SPE), and secondary outcomes (psychological complaints) were assessed by means of online questionnaires before, at the end of aftercare (3 months) and at follow-up (12 months). We used ITT analyses controlling for baseline scores and medical group.

Results: N = 319 patients were enrolled into IG and N = 345 into CG. 77% of the IG logged in to the webpage (CG 74%) and 65% of the IG wrote blogs. Compared to the CG, the IG reported a significantly more positive SPE at follow-up. Measures of depression, anxiety and psychosocial stressors decreased from baseline to follow-up, whereas the corresponding scores increased in the CG. Correspondingly, somatization and psychological quality of life improved in the IG.

Conclusions: Psychodynamic online aftercare was effective to enhance subjective prognosis of future employment and improved psychological complaints across a variety of chronic physical and psychological conditions, albeit with small effect sizes.

Fig 1. Participant flow after allocation and dropout throughout the study.

Fig 2. Primary outcome subjective prognosis of work ability over the course of time.

SPE scale with a range of 0–3 (a higher score indicates a higher risk for work disability or early retirement); ANCOVA with SPE score at baseline (start aftercare) and indication as covariate at the end of aftercare (1) and at follow-up (2); (1) F_[1,606] = 2.38, p = .12, d = 0.11; (2) F_[1,606] = 4.8, p = .03, d = 0.18.