UNWANTED EFFECTS WITHIN A COGNITIVE BEHAVIORAL THERAPY GROUP IN COMPARISON WITH A RECREATIONAL GROUP - A CLUSTER RANDOMIZED CONTROLLED TRIAL

Background: Group interventions can have negative effects for patients with anxiety disorders. Stimuli which provoke side effects may be the group setting, the content, or the interaction between the participants in the group. This study is the first to report negative effects from a cognitive behavioral group intervention, in comparison with an unspecific, recreational group for anxiety patients. Subjects and methods: 107 patients with work-related anxiety disorders were randomized to either a cognitive behavioral group therapy (work coping group WG) or an unspecific group encounter aimed at increasing recreational activities (recreational group RG). Patients completed the Unwanted Events in Group Therapy Scale (UE-G scale). Results: In the work-coping group, 41.9% of the patients reported at least one relevant side effect, as compared to 28.9% in the recreational group. These included an increase in the perception of anxiety and work-problems, feelings of exposure to criticism and the development of negative views on group therapy as such. Conclusions: This is the first randomized, controlled, therapy study in anxiety patients to systematically investigate side effects. Work-coping group interventions have, despite their useful main effects, specific negative effects, when compared with group encounters. Group psychotherapists or group moderators should be aware of the potential side effects in anxiety patients

Arbeitsfähigkeitsbeeinträchtigung und Aspekte der Arbeitsplatzwahrnehmung sind Prädiktoren für die Arbeitsunfähigkeitsdauer bei Menschen mit Arbeitsängsten

Persons with work-anxiety are on risk for long-term sick leave and cause high costs for society, companies and their own work biography. Understanding psychological return-to-work-predictors is important for early reintegration of these persons into the work context. This longitudinal study for the first time investigates the predictive value of workplace perception and objective work ability impairment for future sick leave duration in work-anxiety persons. The investigation was done in 103 persons with work-anxieties. These persons were in working age and confronted with return to work after somatic illness. Work ability impairment was assessed in a structured interview by a state-licensed socio-medical specialist using the established Mini-ICF-APP. Participants filled in a questionnaire on their workplace perception (KFZA). Degree of work ability impairment (Mini-ICF-APP) was predictive for longer sick-leave, as well as workplace perception (KFZA dimensions scope of action, social support, need for cooperation). Training and return-to-work-support in persons with work-anxiety should focus on both the work ability impairment, and on workplace perception.Menschen mit Arbeitsängsten haben ein ausgeprägtes Risiko für Langzeitarbeitsunfähigkeit und damit verbunden hohen Kosten für ihre Berufsbiographie und für Unternehmen. Diese Längsschnittstudie untersucht bei 103 Menschen mit Arbeitsängsten subjektive Arbeitsplatzwahrnehmung (KFZA) und objektive Arbeitsfähigkeitsbeeinträchtigung (sozialmedizinische Beobachterratings mittels Mini-ICF-APP) im Hinblick auf ihre prädiktive Wertigkeit für die Dauer der nachfolgenden Arbeitsunfähigkeit. Stärkere Arbeitsfähigkeitsbeeinträchtigung (Mini-ICF-APP) war vorhersagewertig für längere Arbeitsunfähigkeitsdauer innerhalb der nächsten sechs Monate. Darüber hinaus zeigte sich Arbeitswahrnehmung (KFZA) zusätzlich varianzaufklärend für die Arbeitsunfähigkeitsdauer. Training und Wiedereingliederungsbemühungen sollten sich bei Menschen mit Arbeitsängsten auf die Arbeitsfähigkeit konzentrieren, sowie die subjektive Wahrnehmung (v.a. Handlungsspielraum, sozialer Rückhalt, Kooperationsnotwendigkeit) der Arbeit mitberücksichtigen

Diagnostik „rund um die Arbeit“ bei psychischen Erkrankungen

Etwa 60% der Patienten in der psychosomatischen Rehabilitation kommen mit arbeitsplatzbezogenen Ängsten und Problemen. Aber auch in der ambulanten Praxis findet man unter Patienten mit chronischen psychischen Erkrankungen etwa 10%, die ihrem Arbeitsplatz mit phobischem Vermeidungsverhalten gegenüberstehen und häufig in einer Langzeitarbeitsunfähigkeit stecken (Muschalla & Linden 2013). Herauszufinden, was bei diesen Patienten das Problem ist, ist eine unabdingbare Voraussetzung um einen passenden Behandlungsansatz zu finden

Psychological work capacity demands

Exploring psychological work demands is the basis for preventive or rehabilitative action, e.g. mental hazard analysis or work adjustment. Can descriptions from employees be useful to describe work demands? The latter requires that the work description is not confounded with an affective judgment on the workplace, e.g. work-anxiety. Based on an ICF-based work capacity concept which is standard in socio-medical work ability description, we did a study with 124 employees from diverse professions. They were investigated concerning their work demands and their mental health status in a structured interview by a state-licensed socio-medically trained psychotherapist. Additionally, participants filled in a capacity-oriented self-rating questionnaire on their work demands. For discriminant validity purposes, participants filled in the Short Questionnaire for Work Analysis, and a questionnaire on work-anxiety. Results show that different psychological work capacity demands are reported in different professional groups. The work capacity demands self-rating is able to differentiate capacity demands in different professional fields.Psychische Arbeitsanforderungen zu beschreiben ist eine Voraussetzung um präventive oder rehabilitative Maßnahmen in Organisationen umzusetzen, bspw. im Rahmen von betrieblichen Wiedereingliederungen oder Arbeitsplatzanpassungen. Eine wichtige Frage in diesem Kontext ist, auf welche Weise verlässliche Informationen zu Arbeitsanforderungen gewonnen werden können. Im Fall von Selbstberichten muss sichergestellt sein, dass die Arbeitsplatzbeschreibung nicht durch subjektives Befinden und arbeitsplatzbezogene Gefühle, bspw. Ängste, verzerrt wird. Die Arbeitsplatzbeschreibung soll die Tätigkeitsanforderungen beschreiben. Basierend auf einem ICF-orientierten Fähigkeitskonzept, das in der deutschsprachigen Sozialmedizin ein etabliertes Standardkonzept im Rahmen der Arbeitsfähigkeitsbeschreibung darstellt, wurde eine Untersuchung an 124 Personen verschiedenster Berufsfelder durchgeführt. Im strukturierten Interview durch eine sozialmedizinisch erfahrene Verhaltenstherapeutin wurden der psychische Gesundheitszustand und die Arbeitsplatzbeschreibung erhoben. Darüber hinaus füllten die Probanden einen ICF-basierten Selbstbeurteilungsfragebogen zur fähigkeitsorientierten Arbeitsplatzbeschreibung aus. Zu Validierungszwecken wurde zusätzlich eine Arbeitsbeschreibung mit dem Kurzfragebogen zur Arbeitsanalyse (KFZA) erhoben, sowie die Arbeitsangst. Im Ergebnis zeigt sich, dass von verschiedenen Berufsgruppen unterschiedliche Arbeitsanforderungsprofile berichtet werden. Der Selbstbeurteilungsfragebogen zur fähigkeitsorientierten Arbeitsplatzbeschreibung kann zwischen Arbeitsplatzbeschreibung und Arbeitsangst differenzieren. Psychologische Arbeitsanforderungen können als Fähigkeitsanforderungen exploriert werden und mittels Selbstauskunftsberichten der Arbeitsplatzinhaber unterstützt werden

Work-Anxieties and Their Treatment in Medical Rehabilitation – Hand Tools for Capacity Training and Psychotherapy

Arbeitsbezogene Ängste gehen oft mit Arbeitsplatzproblemen einher oder mit Langzeitarbeitsunfähigkeit. Psychopathologisch-differentialdiagnostisch können arbeitsbezogene Sorgenängste, phobische Ängste, Insuffizienzängste und krankheitsbezogene Ängste unterschieden werden. Eine Evaluation arbeitsorientierter Behandlungsansätze zeigte, dass die Beschäftigung mit dem Thema Arbeit während einer stationären Reha für den weiteren Verlauf günstig wirkt. In arbeitsbezogenen Fähigkeiten-Trainings oder einer verhaltenstherapeutischen Behandlung können typische Alltagsphänomene am Arbeitsplatz geübt werden (Selbstpräsentation, Soziale Spielregeln im Rudel, Arbeitsorganisation und Problemlösen, Umgang mit chronischer Erkrankung und Beeinträchtigung). Initiatives Verhalten und Kommunikation (dem Chef verständlich machen was das Problem ist) sind hilfreich, ebenso wie ggf. Erwartungskorrekturen und Normalisierung von alltäglichen Arbeitsproblemen (Alltagskonflikte und Anforderungen dürfen vorkommen und sind normal).Work-anxieties are often going along with workplace problems and long-term sick leave. Psychopathologically, different qualities of work anxiety can be distinguished: worrying, phobic anxiety, health-related anxiety, anxiety of insufficiency. An evaluation of a work-anxiety treatment showed that confronting patients with the topic work during medical rehabilitation leads to a better course. In work-oriented capacity trainings or behavior therapy groups, coping with everyday phenomena at work may be trained (self-presentation, social rules, work organization and problem solving, coping with chronic illness and impairment conditions). Active coping and communication (explaining impairment to the supervisor and occupational physician for making problem solving possible) are helpful. In some cases, correction of expectations must be done, and normalizing everyday work problems (conflicts and achievement requirements are normal at work, work does not make happy all the time)

Is it a case of “work-anxiety” when patients report bad workplace characteristics and low work ability?

Aims: Work-anxiety may come along with a negative view of the workplace and is therefore an important factor of influence in work ability assessment. Work ability assessment requires to distinguish between descriptive workplace characteristics, work ability, and work-anxiety. This study explores the empirical relationships between patient-reported workplace characteristics, work-anxiety, and subjective and objective work ability measures. Methods: 125 patients in medical rehabilitation before vocational reintegration were interviewed concerning their vocational situation, and filled in a questionnaire on work-anxiety (WPS), subjective mental work ability (WAI) and perceived workplace characteristics (KFZA, JATS). Treating physicians gave independent socio-medical judgments concerning the patients´ work ability and impairment, and need for supportive means for vocational reintegration. Results: Patients with high work-anxiety reported workplace characteristics systematically more negative. Also low subjective work ability went along with reports of problematic workplace characteristics. When controlled for work-anxiety, subjective work ability remained related only with social workplace characteristics and with work achievement demands, but independent from situational or task characteristics. Sick leave duration and physicians´ judgment of work ability are not systematically related with patient-reported workplace characteristics. Conclusions: In socio-medical work ability assessment, patients with high work-anxiety must be expected to report more problematic workplace characteristics and lower work ability. For detecting potentially biased patient´s view on work characteristics and work ability, the patient must be explored concerning work-anxiety. Detecting work-anxiety is important in order to initiate early work-directed treatment, and avoid long-term sick leaves

Work anxiety and sick leave

Background: Mental work-ability decisions must be based on information on person´s symptom load, cognitive performance and workplace conditions. This investigation explores in which way these factors contribute to work ability in persons with common mental disorders CMD). Methods: 1570 CMD-patients underwent multimodal medical diagnostic. Participants filled in questionnaires on work-phobic-anxiety and general mental symptom load. They were also investigated concerning their cognitive performance. Sick leave duration, workplace problems and subjective work-ability were assessed. Physicians´ decision on the persons´ work-ability (fit or unfit for work) was given five weeks later. Results: Negative work-ability perception, long previous sick leave duration and high work phobic anxiety explained unfitness for work, whereas general symptom load and general cognitive performance did not. Conclusion: Work-directed diagnostics and interventions must address work-phobic anxiety and subjective work ability perception

Negative work perception not changed in a short work-anxiety-coping group therapy intervention

Background: Work-anxiety is disabling and often associated with long-term sick leave. Early intervention is therefore necessary. Work-anxieties are associated with a negative work perception. Therefore one aim in early intervention is a cognitive reframing of dysfunctional perceptions of workplace characteristics. Methods: A psychotherapeutic specialist conducted two group programs of four sessions each. One hundred twenty-three rehabilitation inpatients with work-anxieties were randomly assigned either to a work-anxiety-coping group or to a recreational group. The Short Questionnaire for Work Analysis (KFZA) was administered before and after the group treatment to measure perceptions of working conditions. Results: Participants from the work-anxiety-coping-group did not see their work in a significantly more positive light at the end of the intervention compared to participants from the recreational group (interaction of repeated measurement * intervention: p= .177 – .971, Cohen´s d for comparison of change from beginning to the end of rehabilitation = 0.00 – 0.23). Conclusions: A short work-anxiety-coping-group did not initiate a consistent positive re-appraisal of work in this study population. Employers and occupational physicians should not expect positive changes of work perception when an employee returns from short medical rehabilitation, even in cases in which work-directed treatment was completed. Additional support from the workplace must be considered, e.g. employer-physician-employee-conversation preceding return to work, or (temporary) work adjustment. The aim should be to overcome return to work-barriers in the form of negative work perception

A concept of psychological work capacity demands – first evaluation in rehabilitation patients with and without mental disorders.

BACKGROUND: Work capacity demands are a concept to describe which psychological capacities are required in a job. Assessing psychological work capacity demands is of specific importance when mental health problems at work endanger work ability. Exploring psychological work capacity demands is the basis for mental hazard analysis or rehabilitative action, e.g. in terms of work adjustment. OBJECTIVE: This is the first study investigating psychological work capacity demands in rehabilitation patients with and without mental disorders. METHODS: A structured interview on psychological work capacity demands (Mini-ICF-Work; Muschalla, 2015; Linden et al., 2015) was done with 166 rehabilitation patients of working age. All interviews were done by a state-licensed socio-medically trained psychotherapist. Inter-rater-reliability was assessed by determining agreement in independent co-rating in 65 interviews. For discriminant validity purposes, participants filled in the Short Questionnaire for Work Analysis (KFZA, Prümper et al.,1994). RESULTS: In different professional fields, different psychological work capacity demands were of importance. The Mini-ICF-Work capacity dimensions reflect different aspects than the KFZA. Patients with mental disorders were longer on sick leave and had worse work ability prognosis than patients without mental disorders, although both groups reported similar work capacity demands. CONCLUSIONS: Psychological work demands - which are highly relevant for work ability prognosis and work adjustment processes - can be explored and differentiated in terms of psychological capacity demands