Work-focused therapy for common mental disorders: A naturalistic study comparing an intervention group with a waitlist control group.

The comparison was not randomised. Patients were placed in the intervention or waitlist group according to waiting time and session attendance, so selection could explain part of the difference. Work status was measured by a single self-reported item after treatment, and changes in graded or full sick leave could not be analysed because of limited observations in each category. Therapists chose between CBT and MCT and tailored work-focused content without a session-to-session manual, and protocol adherence was not monitored. The study cannot show which part of the treatment produced the effect. Patients received only GP care during waiting, and medication was prescribed by GPs according to national guidelines, so usual care and medication were not controlled as separate factors. The sample excluded severe mental disorders, high suicide risk, substance abuse, unemployment and other non-sick-leave work situations, so it does not address those patients. Treatment duration and waiting time varied naturally, and follow-up was only after the waiting or treatment period, so longer-term return to work was not assessed. The study was done under Norwegian sick-leave rules, income coverage and dialogue meetings with NAV, employers and GPs. These conditions may not match other countries.

The authors declare no conflict of interest. No funding source or sponsor role is reported in the supplied text.

Do not conclude that the work-focused elements alone caused the return-to-work gain. The intervention combined either CBT or MCT with workplace analyses, return-to-work planning, psychoeducation, graded activity and adjustments, and workplace communication, while controls received GP care, with medication prescribed by GPs according to national guidelines; randomisation was not used and protocol adherence was not monitored, so the effect of any single component cannot be separated.