Principal Findings
anxiety, stress-related illness, stress-related disorders, insomnia, depression
RECRUITMENT, DISORDERS
To the best of our knowledge, this study is the first trial examining a work-focused intervention and a generic internet-based intervention in a clinical sample of employees with stress-related disorders. The results confirmed the primary hypothesis that both interventions were equally effective in reducing symptoms of perceived stress, burnout, exhaustion, depression, anxiety, and insomnia and in improving recovery from work and quality of life compared with a WLC group. Secondary explorative analyses indicated positive effects on work ability and a reduction in the number of days of SA in the work-focused group. No significant effects were found on outcomes for alcohol use, work experience, or net days on the benefits for long-term sick leave.The effects found on health-related outcomes were larger than those previously reported in a meta-analysis of internet-based stress management trials [Most of the participants (W-iCBT: 42/61, 69%; iCBT: 41/61, 67%) in the intervention groups fulfilled the criteria for clinically significant change in the primary outcome, SMBQ, and were maintained at the 6-month follow-up. The proportion of clinically significant changes was comparable with previous trials [As hypothesized, changes in health- and work-related outcomes remained stable in both intervention groups at the 12-month follow-up. The results were in line with the long-term effects found in a meta-analysis of internet-based stress management trials [Interestingly, the effects on work ability and SA were only seen between the W-iCBT and WLC groups. However, these effects were small but comparable with those found in a meta-analysis of psychological interventions for individuals in SA because of common mental disorders [Inspired by the recovery from work training by Hahn et al [This study has several limitations. First, although this study focused on recruiting participants who were on sick leave because of stress and burnout, only 51 (28%) of 182 received sickness benefits at T1 and T3, resulting in unsatisfactory power in the statistical analysis. It is possible that the use of an open recruitment strategy and the fact that the intervention was delivered from an external institution (the university) may have had an impact on the recruitment. Future studies could use another recruitment and delivery approach, for example, directly via primary and occupational health care, to include more participants who are on sick leave because of stress-related illness. Second, by using an open recruitment strategy, we cannot rule out the risk of potential selection bias, selecting those cases that are most motivated to participate and willing to change. For example, 92% (167/182) of the participants had a university-level educational background, compared with 28% in the general population [