Is psychotherapy orientation important for depressive and anxiety disorder-related work disability outcomes? A...

Common mental disorders are a leading cause of work disability worldwide. While psychotherapies effectively treat these disorders, evidence of the effectiveness of different psychotherapy orientations mainly comes from clients in primary care and small-scale clinical studies focused on symptom change. This study assessed the association between various psychotherapy orientations and changes in work disability due to depressive or anxiety disorders among working-age individuals.

A nationally representative 33% random sample of the working-age population (18-64 years) in Finland was used. Data were drawn from national registers (Statistics Finland, Social Insurance Institution of Finland). The sample included individuals who initiated rehabilitative psychotherapy between 2014 and 2017 (N = 10,172) and were followed from 2011 to 2021. The dataset comprises individual-level psychotherapy episode data, focusing on different psychotherapy orientations: psychodynamic and psychoanalytic, solution-focused psychotherapy, cognitive, cognitive-analytic, crisis and trauma-focused, and integrative psychotherapy (91% of all rehabilitative psychotherapies). An interrupted time series (ITS) design was used to investigate the psychotherapy orientation-dependent changes in annual compensated sickness absence (SA) days related to depressive or anxiety disorders.

At the onset of psychotherapy, there were significant differences between the orientation groups in their level of SA, with those initiating crisis and trauma-focused or solution-focused therapy exhibiting the highest (42 and 41 days) and psychodynamic and psychoanalytic or integrative psychotherapy the lowest (30 days) level of SA. After the onset, the level and trend of SA showed a similar decrease (76-82%) across orientations. The psychotherapy orientation groups showed insignificant differences in their level of SA at the end of the follow-up.

Our register-based results, based on a considerably long follow-up period, align with the earlier findings that clients often experience similar improvements regardless of the psychotherapy orientation. Further examination of clients' pretreatment differences and treatment working mechanisms is needed to guide treatment choices.