Getting down to business: an examination of occupational outcomes in cognitive behavioral therapy for depression

Cognitive-behavioral therapy (CBT) is an effective treatment for people with depression. Decades of research has found CBT reliably reduces symptoms of depression for many people (Strunk et al., 2017). However, reducing symptoms of depression is not the only goal clients have when starting a course of CBT. Many people in CBT are interested in finding a new job or improving their productivity at their current job. Research finds that people with depression are more likely to be unemployed, compared to people without depression (Lerner et al., 2004). People with depression are also more likely to have trouble concentrating at work, also known as presenteeism (Adler et al., 2006; Lerner et al., 2004). Even people who are no longer depressed still tend to be less productive than people who were never depressed (Adler et al., 2006). Therefore, it is important to consider what CBT can do to help people improve occupational outcomes (Layard & Clark, 2015).

Our study examined two occupational outcomes: employment status and presenteeism. Employment status refers to the type of employment a person has. It includes categories like having a part-time job, a full-time job, or being retired. We examined data in this study from people who were taking part in a course of CBT. We predicted employment status would improve (e.g., from not work to working, or working part-time to full-time) and presenteeism would be reduced over the course of CBT.

We were also interested in examining what therapeutic targets were related to changes in occupational outcomes. The first therapeutic target we examined was cognitive style. A negative cognitive style refers to maladaptive or pessimistic ways people interpret the negative events that happen to them. When those with a more negative cognitive style are asked about the causes they identified, they rate these causes as being related to many aspects of their lives rather than being event-specific. Similarly, they tend to characterize the causes they identified as having more negative consequences for their lives. We hypothesized these patterns of a negative cognitive style would be related to improvements in employment status and decreases in presenteeism. The second therapeutic target we examined was use of CBT skills. CBT skills include examining your thoughts to evaluate their accuracy. We predicted increases in CBT skill use would be related to improvements in employment status and decreases in presenteeism.

We found 41% of people seeking to improve their employment status were able to do so over the course of CBT. Among those working, presenteeism significantly decreased over the course of treatment. Neither negative cognitive style nor CBT skills were related to changes in employment status. However, patients who experienced a reduction in negative cognitive style also tended to experience reductions in presenteeism.

This study suggests people who take part in a course of CBT tend to see their occupational outcomes improve. Our findings raise the possibility that this may be partially due to CBT helping people think less negatively about negative events in their life. Future work should examine what therapists can do within CBT to help clients achieve positive occupational outcomes.

References

  • Adler, D. A., McLaughlin, T. J., Rogers, W. H., Chang, H., Lapitsky, L., & Lerner, D. (2006). Job performance deficits due to depression. American Journal of Psychiatry, 163, 1569-1576. https://doi.org/10.1176/appi.ajp.163.9.1569
  • Layard, R., & Clark, D. M. (2015). Thrive: How better mental health care transforms lives and saves money. Princeton University.
  • Lerner, D., Adler, D. A., Chang, H., Lapitsky, L., Hood, M. Y., Perissinotto, C., Reed, J., McLaughlin, T. J., Berndt., E. R., & Rogers, W. H. (2004). Unemployment, job retention, and productivity loss among employees with depression. Psychiatric Sertvices, 55, 1371-1378. https://doi.org/10.1176/appi.ps.55.12.1371
  • Strunk. D. R., Adler. A. D., & Hollon, S. D. (2017). Cognitive therapy of depression. In R. J. DeRubeis & D. R. Strunk (Eds.), Oxford Library of Psychology. The Oxford Handbook of Mood Disorders (pp. 411-422). Oxford University.

Read the full paper: Ezawa, I. D., Bartels, G. C., & Strunk, D. R. (in press). Getting down to business: an examination of occupational outcomes in cognitive behavioral therapy for depression. Cognitive Behaviour Therapy. doi:10.1080/16506073.2021.1875039

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