A growing number of people are taking sick leave due to mental health conditions, creating both personal hardship and major economic costs. Researchers in Norway have tested a treatment approach that combines metacognitive therapy with a strong focus on returning to work.
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A therapy approach that changes how people relate to their thoughts may help address one of the fastest-growing drivers of sick leave.
A treatment approach that combines metacognitive therapy with a focus on employment may allow people with mental health conditions to return to work sooner. Researchers say the strategy could save society up to three times what it costs by shortening periods of sick leave.
Mental health-related sick leave has become increasingly common in Norway. The personal impact can be severe for those affected. At the same time, the financial consequences for society are significant. Each year, about 9 million person days of work are lost because of mental illness.
Finding responsible ways to reduce time away from work could benefit both individuals with mental disorders and the broader economy. Researchers believe this treatment model may offer a promising solution.
“Metacognitive therapy as a treatment, along with a focus on the job, can help get people back to work faster,” says Odin Hjemdal.
Hjemdal is a professor and specialist in psychology at the Norwegian University of Science and Technology’s (NTNU) Department of Psychology.
New findings on the treatment and its outcomes were published in eClinicalMedicine, a journal within the Lancet family.
Already a lot saved
“If this treatment becomes more common, society can save a lot of money,” Hjemdal said.
He is not exaggerating. The study included 236 individuals who were on sick leave because of mental health problems. About half of them, 121 patients, began treatment soon after enrolling in the study, while the remaining participants were placed on a waiting list.
“We compared this with a waiting list group. That group had to wait 10 weeks before starting the same treatment. For the 121 patients who did not have to wait, the savings were approximately NOK 9.5 million in reduced costs for reduced sick leave,” says Hjemdal.
The timing of treatment made a clear difference. After 12 weeks, 42 percent of participants who started therapy right away had returned to work. In comparison, only 18 percent of those who waited for treatment had returned to work during that same period.
However, once people in the waiting group completed the therapy, their results were just as positive as those who started earlier.
Huge savings possible
The economic and personal benefits observed in the study involve a relatively small group of participants. The potential impact becomes much larger when considering the broader population.
In 2017, about 223,000 people in Norway were on sick leave due to mental disorders. By 2024, that number had climbed to 327,000. This represents an increase of nearly 47 percent.
Given the scale of the problem, effective treatments that help people return to work sooner could produce substantial benefits.
But what exactly are metacognitive therapy and job-focused treatment?
Metacognitive therapy?
“Metacognitive therapy does not work that much with the content of your thoughts. Instead, it works on how you relate to your thoughts,” Hjemdal said.
In short, job focus is about the fact that work is important for mental health.
According to this method, thoughts themselves are not what cause problems. Instead, ruminating, worrying, and focusing your attention strategically to identify possible danger, while trying to control your thoughts and coping that backfires, is what maintains mental disorders rather than solving them.
“Thoughts and feelings are spontaneous events that come and go without us having to regulate them. The goal is for you to learn to stop regulating your thoughts and feelings. You should rather let them come and go without getting involved,” Hjemdal said.
The therapy was developed by Professor Adrian Wells. It follows a structured and relatively short treatment format. Studies show that it is effective for anxiety and depression.
About 70 percent of patients recover after completing the treatment, and relapse is uncommon. In contrast, many other treatments lead to recovery in about 50 percent of patients, and up to half of those individuals may experience a relapse.
Job focus?
The therapists in the project used job focus as an integral part of metacognitive therapy, and others have used it with short-term cognitive behavioral therapy.
“In short, job focus is about the fact that work is important for mental health. We examine the job situation, and any need for facilitation, and investigate obstacles to returning to work, such as bullying in the workplace,” Hjemdal said.
Therapy that has a job focus is aimed at helping the person return to normal life as quickly as possible. Therapists might ask questions such as:What prevents you from returning to your job?
How do thought and worry patterns affect you in relation to work?
Are there alternative strategies to work better in the workplace?
Especially promising against anxiety and depression
It appears that the treatment provides particularly good results in treating anxiety and depression.
“In Norway, this is one of the subgroups where we see major challenges in terms of sick leave,” Hjemdal said.
That makes it possible to both help patients quickly and efficiently, while at the same time, saving money.
“Sick leave related to anxiety and depression costs approximately NOK 71 billion annually in Norway alone,” says Hjemdal.
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