Problem solving therapy may help people with adjustment disorders partially return to work, according to Cochrane


Work-related stress is everywhere these days. Obviously us elves are pretty much immune, but looking at the Bristol Stress and Health at Work Study (Smith 2000) I can see that more than 50% of human respondents reported being extremely, very or moderately stressed at work. You lovely people do suffer from lots of emotional and behavioural problems when stress levels are high and these can result in serious social and occupational disability.

The clinical term for this kind of stress response is adjustment disorders and this health condition is a major cause of sick leave worldwide, so there is considerable interest in what safe and effective treatments can be used to prevent and treat these symptoms of distress.

A new Cochrane systematic review looks at this very question; specifically investigating what treatments can help people return to work quickly following episodes of acute or chronic adjustment disorders.


The reviewers carried out the usual gold standard Cochrane search looking for randomised controlled trials (RCTs) that studied which were the best treatments to help people with adjustment disorders return to work. They searched for a wide range of treatments including drug interventions, talking treatments, exercise, relaxation techniques and employee assistance programmes.

They found only 9 RCTs to include in their review and meta-analysis, which covered 10 separate treatments (all psychological). Cognitive behavioural therapy (CBT) and Problem solving therapy (PST) were the two talking treatments represented in the research.


  • PST is effective at helping people with a partial return to work. Workers who have problem solving therapy start 17 days earlier with partial return to work compared to workers who receive no treatment or the usual treatment from their occupational therapist or GP
  • CBT or PST don’t help workers return to full-time work any quicker than workers who receive no treatment or the usual treatment from their occupational therapist or GP

The quality of the included trials was low-moderate, so there’s definitely room for improvement and more research will no doubt improve the certainty of these findings.


The reviewers concluded:

We found moderate-quality evidence that CBT did not significantly reduce time until partial return to work (RTW) and low-quality evidence that it did not significantly reduce time to full RTW compared with no treatment.

Moderate-quality evidence showed that PST significantly enhanced partial RTW at one-year follow-up compared to non-guideline based care but did not significantly enhance time to full RTW at one-year follow-up.

An important limitation was the small number of studies included in the meta-analyses and the small number of participants, which lowered the power of the analyses.

It’s notable that no randomised trials were found that looked into exercise programmes or employee assistance programmes, both of which would seem a logical area to explore in further detail.

As is often the case with Cochrane reviews, it’s great that a team have put in the effort to provide us with the best current knowledge on this topic. Now we need more primary research to add to the pool of data that can make this review more conclusive when it’s updated in years to come.


Arends I, Bruinvels DJ, Rebergen DS, Nieuwenhuijsen K, Madan I, Neumeyer-Gromen A, Bültmann U, Verbeek JH. Interventions to facilitate return to work in adults with adjustment disorders. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD006389. DOI: 10.1002/14651858.CD006389.pub2.

Smith A. The scale of perceived occupational stress. Occupational Medicine 2000;50(5):294-8. [PubMed abstract]

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