Cognitive behavioural therapy (CBT) works by training people to be aware of their (usually automatic negative) thoughts and behaviours when they are faced with daily life events and replace them with more realistic and helpful reactions. 

CBT is already the first-line treatment for many psychological illnesses and can be used to manage stress and burnout at work. But can it help people on sick leave return to work?

A review of the evidence found that the answer to this question is yes. 

About the study

The study looked at research published between 1990 and 2022 that compared workers on sick leave due to illness or injury and who received treatment that involved CBT to workers who received usual care or activities aimed at improving their health.

What the study found

It found that CBT:

• significantly boosts people’s chances of returning to work
• enhances their physical function 
• slashes the time they are on sick leave, and 
• alleviates symptoms of depression, stress and fatigue.

It also found that combining CBT as a work-focused intervention with ‘homework’ and other forms of rehab significantly reduced time off work compared to CBT-only interventions.

Why does CBT reduce sick leave?

There are probably several reasons for this.

Medical treatment alone may not be enough

The medical treatment of MSK pain and mental health disorders by itself may not be enough to reduce sick leave. 

Rehabilitation services are important because they provide education and physical training tailored to getting employees ready to return to work. But CBT complements this by helping to adjust how people think about work and how they manage the physical issues that keep them from being at work. 

Improving how patients think helps them cope better with why they're on sick leave in the first place. When people have more positive attitudes towards work they may be more eager to RTW. 

Also, CBT is effective in reducing stress and insomnia. The improvement of mental health due to CBT may lead to reduced sick leave because people are more likely to RTW faster if they are less stressed and fatigued. 

The CBT included homework assignments

Homework assignments in CBT play a crucial role in managing symptoms and honing new skills between therapy sessions. It gives people a chance to practice coping strategies on their own and keep up their skills when they go back to work. 

The takeaway message

CBT can help people boost workers’ mental health and can help get them back to work sooner.

Original research

Xu, H., Cai, J., Sawhney, R., Jiang, S., Buys, N., & Sun, J. (2024). The effectiveness of cognitive-behavioural therapy in helping people on sick leave to return to work: a systematic review and Meta-analysis. Journal of Occupational Rehabilitation, 34(1), 4-36.