Delivery of cognitive behavioural therapy to workers: a systematic review

Cognitive behavioural therapy (CBT) is a key intervention, enabling workers on sick leave with common mental health problems to return to work. It can be delivered by a variety of methods including face-to-face therapy and the Internet. It is not known which is the optimal method of delivery.

To establish the optimum method of delivering CBT to workers with common mental health problems.

We undertook a systematic search of the OvidMEDLINE and EMBASE biomedical databases from the start of electronic records to 31 July 2013 for randomized trials comparing one method of delivering CBT with another for treatment of mild-to-moderate depression, anxiety and adjustment disorders. We included publications that assessed at least one of four outcomes: clinical or cost-effectiveness, accessibility and acceptability. A scoping search found no studies in the workplace. We therefore focussed on interventions in the 18-65 year age group.

We found six studies comparing methods of delivery of CBT for anxiety disorders but found no trials which compared methods of delivery for mild-to-moderate depression. All delivery methods led to an improvement in anxiety symptoms. Internet-delivered CBT with some input from a therapist was found to be as clinically effective as face-to-face CBT and more cost-effective.

Internet CBT should be made available in workplaces for workers with anxiety disorders as part of a stepped care plan.