Interventions
adjustment disorder, Work-focused, stress-related disorders, health-promoting behaviors, work-related stressors
The generic iCBT program, represented in the iCBT and W-iCBT groups, was based on contemporary CBT techniques adapted for stress-related disorders and recovery from work training inspired by Hahn et al [In the first module (introduction), the participants received information about the outline of the program and defined their individual treatment goals (eg, “I would like to be more assertive”). The first week also contained information and exercises on stress physiology; consequences of long-term stress, exhaustion, and burnout; and how to manage stressors (eg, workload, pace, and social support). During the second week (balance), the participants were introduced to different recovery techniques [The W-iCBT consisted of generic treatment for stress-related disorders (iCBT), plus components focusing on work and RTW. The W-iCBT aimed to facilitate RTW among those participants who were on sick leave and increase work functioning among those participants who were experiencing an adjustment disorder but not disabled from work. Work-focused CBT is built on the same conceptual framework as regular CBT. For example, CBT principles are used to change the appraisal of work stressors (eg, “it is ok although the task is not 100% complete or perfect”), change dysfunctional behavior (eg, working late close to bedtime and accepting more work despite heavy workload), or increase health-promoting behaviors (eg, recreational activities, assertive behavior, and RTW activities). The CBT principle of exposure has received special attention. Gradual exposure can help individuals develop more effective coping skills when dealing with work-related stressors (eg, assertiveness) and stimulate a gradual RTW setting for individuals on long-term sick leave [In the first 4 modules, a work-related perspective on the symptoms of chronic stress was provided, and an analysis of the work situation was made (including job content, job conditions, work relations, and work satisfaction). In module 5, participants who were on sick leave made the first draft of a gradual (stepwise) RTW plan, and participants who were working made an elaborative work adjustment plan. Participants were encouraged to communicate their problem analysis, RTW, and work adjustment plans through dialogue with their employer (eg, manager and human resource professionals). These plans were continually updated by the participants throughout the remaining modules. In modules 6 to 10, participants were taught how to become involved in health-promoting behaviors at work, including (1) effort, appreciation, and reward; (2) control, responsibility, and autonomy; (3) social, instrumental, emotional, and informative support; and (4) recovery in the workplace. In the last module, 10, an integrated summary and prevention plan was drafted for both the work-focused and generic CBT programs.Cognitive behavioral therapy (CBT) and work-focused content.