Despite evidence suggesting that work-focused cognitive behavioural therapy (W-CBT) leads to better RTW outcomes than traditional CBT for people with mental health conditions, information about the implementation of this approach remains limited, especially in Australia. A new research project by Dylan Slater, PhD candidate at Flinders University, aims to understand why. And you can help.

The ‘why’ behind the research

Statistics from Safe Work Australia indicate that workers with mental health conditions take longer to return to work and have higher claim costs compared to those with other conditions. Also, across all claims in the 2021 data set, 37.1% of those who were not working were assessed as having a probable serious mental illness. These concerning statistics highlight the urgent need for more effective RTW strategies.

Slater hopes his research will lead to clearer guidelines and improve the implementation of work-focused CBT in the Australian context. ‘We know we can do better at returning people with mental health conditions to work’, he says. ‘Understanding how we can effectively implement work-focused CBT in our systems and funding models is an important step towards that’.

What is work-focused CBT?

While traditional CBT helps people identify and change unhelpful thoughts and behaviours, work-focused CBT specifically applies these techniques to workplace challenges. 

‘The key difference is that all CBT components are delivered within a work context’, explains Slater. ‘Whether you're doing psycho-education, behavioural activation, exposure therapy, problem-solving, cognitive restructuring or developing communication skills — everything is framed around work-related situations and returning to work’.

Slater’s systematic review, published in December 2023, helped clarify how work-focused CBT differs from other approaches. Unlike traditional CBT combined with separate occupational rehabilitation, work-focused CBT should be delivered as a standalone intervention by a single practitioner. This integration ensures that therapeutic strategies directly address workplace challenges, with RTW as the primary goal.

Current guidelines and implementation

The Royal Australian College of General Practitioners' clinical guidelines for the diagnosis and management of work-related mental health conditions in general practice were published in 2019. It recommends referring to existing guidelines while considering work factors for primary mental health conditions and suggests work-focused CBT for mental health conditions secondary to musculoskeletal injury. However, there's still confusion about how to implement it.

The practice has been developed and researched in Scandinavian countries, the Netherlands, USA and Canada, but there has been little research in Australia. ‘In Norway, they actually have a subspecialty of work-focused psychology delivered within their universal healthcare system’, Slater notes. ‘But in Australia, the practice appears to be limited to a handful of companies, mainly in the employment services sector’.

Research goals and methodology

Slater’s research aims to bridge the gap between existing literature and real-world practices. The current phase involves interviewing both practitioners who provide work-focused CBT and people who have undergone the treatment. 

The study seeks to understand practitioners' attitudes and beliefs about work-focused CBT, how they deliver it, their training experiences and what they believe drives therapeutic change. For recipients, the research will explore their experiences, what they found helpful or challenging and what underpinned any changes they experienced.

A key focus is understanding how practitioners in Australia interpret and deliver work-focused CBT given the unique funding models and healthcare context of the country. 

The research will also compare Australian practices with international approaches, particularly in countries where work-focused CBT has been more widely adopted.

Recruitment challenges

Recruitment for the study has proven challenging. ‘The employment services companies have privacy concerns due to government scheme requirements, and it's been difficult to find practitioners who are delivering work-focused CBT as a standalone intervention’, Slater explains. ‘There's also the question of how this approach fits within workers' compensation schemes, where there's typically a separation between occupational rehabilitation and treatment providers’.

This is where you, reader, come in!

Call for participants

The research team is seeking to interview practitioners from both Australia and overseas who have provided work-focused CBT in the last 12 months, as well as Australian recipients who have received the treatment in the last 12 months. 

The study aims to conduct interviews across these groups until ‘thematic saturation’ is reached — the point where additional interviews stop revealing new insights or themes.

The potential impact of this research extends beyond individual therapy sessions to broader societal benefits, including improved workplace productivity and better outcomes for people struggling with mental health conditions.

How you can help

If you know practitioners who deliver work-focused CBT or are one, or if you know anyone who has received this therapy, you are encouraged to share information about this study. 

The research team has ethics approval for this ‘snowball’ approach to recruitment, where participants can help spread the word to other potential participants. 

Even if you haven't personally experienced work-focused CBT, sharing this research in your professional networks could help reach those who have. The more people who know about the study, the better chance of gathering diverse experiences that could help improve RTW outcomes for people with mental health conditions.
For more information about participating in the research, interested practitioners and recipients can access information statements through this link.