{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T22:12:31Z","timestamp":1761948751086},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003945","name":"Link\u00f6ping University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003945","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Fam Pract"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The use of cognitive behavioral therapy (CBT) to cope with mental distress and pain issues has helped many patients in primary health care in Sweden. However, the effects of CBT to reduce sick leave has not been equally convincing. Acceptance and Commitment Therapy (ACT) is an evolution of traditional CBT and we aimed to study if education based on ACT of the staff rather than the patients could reduce sick leave in primary health care.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was a prospective trial in 6 primary health care centers in Kalmar (total amount of registered subjects of 28,930) in which the staff (physicians, nurses and therapists) received group-based education according to ACT during 2018 and 2019. The effects were compared with 5 similarly sized control health care centers in the neighboring Region of J\u00f6nk\u00f6ping in which no such education took place. The main aim was to study changes in sick leave in the 6 primary care centers of Kalmar and to keep track of more general trends by studying sick leave also in J\u00f6nk\u00f6ping, letting sick leave in the year 2017 to be the reference period for both areas.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The staff at the health care centers in Kalmar reported to having attended a mean of 5.2\u2009\u00b1\u20092 educational ACT-sessions with psychiatrist Kadowaki in Kalmar. Sick leave for ICD-10 F43 (reaction to severe stress and related adjustment-disorders) was reduced from a mean value of 28.7\u2009\u00b1\u20099.1ongoing sick leaves\/month in 2017 to 22.6\u2009\u00b1\u20097.0 sick leaves\/month in 2018 (-21%, p\u2009=\u20090.033) and to 18.1\u2009\u00b1\u200910 sick leaves\/month in 2019 (-37%, p\u2009=\u20090.038). The corresponding sick leave for any diagnosis (total sick leave) was reduced from 132\u2009\u00b1\u200939 sick leaves\/month in 2017 to 118\u2009\u00b1\u200938 sick leaves\/month in 2018 (-11%, p\u2009=\u20090.056) and to 102\u2009\u00b1\u200937 sick leaves\/month in 2019 (-21%, p\u2009=\u20090.021). The corresponding sick leave comparisons in the control health centers did not show any significant changes (all p-values\u2009\u2265\u20090.24).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Total monthly mean sick leave was reduced 21% in the health care centers in Kalmar during the second year of the educational ACT intervention of the staff while it was unchanged in J\u00f6nk\u00f6ping. This suggests a significant effect to induce a reduction in long-term sick leave for patients in primary health care in which the staff received education according to ACT. The results of this trial could serve as a basis for a randomized trial in order to ascertain causality.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>Pre-registration November 9, 2018 on ClinicalTrials.gov with number <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03737019\">NCT03737019<\/jats:ext-link>.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12875-021-01526-5","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T14:11:21Z","timestamp":1631110281000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Education of the primary health care staff based on acceptance and commitment therapy is associated with reduced sick leave in a prospective controlled trial"],"prefix":"10.1186","volume":"22","author":[{"given":"\u00c5sa","family":"Kadowaki","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna-Karin","family":"Alvunger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanna Israelsson","family":"Larsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Persdotter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta Stelmach","family":"Zak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Johansson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredrik H.","family":"Nystrom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,9,8]]},"reference":[{"key":"1526_CR1","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1186\/s12888-020-02749-z","volume":"20","author":"T Forslund","year":"2020","unstructured":"Forslund T, Kosidou K, Wicks S, Dalman C. Trends in psychiatric diagnoses, medications and psychological therapies in a large Swedish region: a population-based study. BMC Psychiatry. 2020;20:328.","journal-title":"BMC Psychiatry"},{"key":"1526_CR2","doi-asserted-by":"crossref","unstructured":"Carlsson L, Lannerstrom L, Wallman T, Holmstrom IK. General practitioners\u2019 perceptions of working with the certification of sickness absences following changes in the Swedish social security system: a qualitative focus-group study. BMC Fam Pract. 2015;16:21.","DOI":"10.1186\/s12875-015-0238-5"},{"key":"1526_CR3","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1111\/j.1600-0447.1998.tb10065.x","volume":"98","author":"M Posse","year":"1998","unstructured":"Posse M, Hallstrom T. Depressive disorders among somatizing patients in primary health care. Acta Psychiatr Scand. 1998;98:187\u201392.","journal-title":"Acta Psychiatr Scand"},{"key":"1526_CR4","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.jpsychores.2014.11.007","volume":"78","author":"E Bekhuis","year":"2015","unstructured":"Bekhuis E, Boschloo L, Rosmalen JG, Schoevers RA. Differential associations of specific depressive and anxiety disorders with somatic symptoms. J Psychosom Res. 2015;78:116\u201322.","journal-title":"J Psychosom Res"},{"key":"1526_CR5","doi-asserted-by":"publisher","first-page":"67","DOI":"10.3109\/02813432.2014.909163","volume":"32","author":"K Ejeby","year":"2014","unstructured":"Ejeby K, Savitskij R, Ost LG, Ekbom A, Brandt L, Ramnero J, et al. Symptom reduction due to psychosocial interventions is not accompanied by a reduction in sick leave: results from a randomized controlled trial in primary care. Scand J Prim Health Care. 2014;32:67\u201372.","journal-title":"Scand J Prim Health Care"},{"key":"1526_CR6","doi-asserted-by":"publisher","first-page":"1954","DOI":"10.1017\/S0033291718000065","volume":"48","author":"S Salomonsson","year":"2018","unstructured":"Salomonsson S, Hedman-Lagerlof E, Ost LG. Sickness absence: a systematic review and meta-analysis of psychological treatments for individuals on sick leave due to common mental disorders. Psychol Med. 2018;48:1954\u201365.","journal-title":"Psychol Med"},{"key":"1526_CR7","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1177\/2192568218765483","volume":"8","author":"CR Salathe","year":"2018","unstructured":"Salathe CR, Melloh M, Crawford R, Scherrer S, Boos N, Elfering A. Treatment Efficacy, Clinical Utility, and Cost-Effectiveness of Multidisciplinary Biopsychosocial Rehabilitation Treatments for Persistent Low Back Pain: A Systematic Review. Global Spine J. 2018;8:872\u201386.","journal-title":"Global Spine J"},{"key":"1526_CR8","doi-asserted-by":"publisher","first-page":"141","DOI":"10.3109\/02813432.2013.811943","volume":"31","author":"L Carlsson","year":"2013","unstructured":"Carlsson L, Englund L, Hallqvist J, Wallman T. Early multidisciplinary assessment was associated with longer periods of sick leave: a randomized controlled trial in a primary health care centre. Scand J Prim Health Care. 2013;31:141\u20136.","journal-title":"Scand J Prim Health Care"},{"key":"1526_CR9","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1111\/sjop.12590","volume":"61","author":"S Salomonsson","year":"2020","unstructured":"Salomonsson S, Santoft F, Lindsater E, Ejeby K, Ingvar M, Ljotsson B, et al. Effects of cognitive behavioural therapy and return-to-work intervention for patients on sick leave due to stress-related disorders: Results from a randomized trial. Scand J Psychol. 2020;61:281\u20139.","journal-title":"Scand J Psychol"},{"key":"1526_CR10","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1136\/oem.2010.057877","volume":"68","author":"MA Lexis","year":"2011","unstructured":"Lexis MA, Jansen NW, Huibers MJ, van Amelsvoort LG, Berkouwer A, Tjin ATG, et al. Prevention of long-term sickness absence and major depression in high-risk employees: a randomised controlled trial. Occup Environ Med. 2011;68:400\u20137.","journal-title":"Occup Environ Med"},{"key":"1526_CR11","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1002\/cpp.712","volume":"18","author":"M Linden","year":"2011","unstructured":"Linden M, Zubragel D, Bar T. Occupational functioning, sickness absence and medication utilization before and after cognitive-behaviour therapy for generalized anxiety disorders. Clin Psychol Psychother. 2011;18:218\u201324.","journal-title":"Clin Psychol Psychother"},{"key":"1526_CR12","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1001\/archpsyc.1992.01820100005001","volume":"49","author":"J Mintz","year":"1992","unstructured":"Mintz J, Mintz LI, Arruda MJ, Hwang SS. Treatments of depression and the functional capacity to work. Arch Gen Psychiatry. 1992;49:761\u20138.","journal-title":"Arch Gen Psychiatry"},{"key":"1526_CR13","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1037\/1076-8998.13.3.214","volume":"13","author":"W de Vente","year":"2008","unstructured":"de Vente W, Kamphuis JH, Emmelkamp PM, Blonk RW. Individual and group cognitive-behavioral treatment for work-related stress complaints and sickness absence: a randomized controlled trial. J Occup Health Psychol. 2008;13:214\u201331.","journal-title":"J Occup Health Psychol"},{"key":"1526_CR14","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.jad.2007.08.005","volume":"107","author":"P Knekt","year":"2008","unstructured":"Knekt P, Lindfors O, Laaksonen MA, Raitasalo R, Haaramo P, Jarvikoski A, et al. Effectiveness of short-term and long-term psychotherapy on work ability and functional capacity\u2013a randomized clinical trial on depressive and anxiety disorders. J Affect Disord. 2008;107:95\u2013106.","journal-title":"J Affect Disord"},{"key":"1526_CR15","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/BF03392677","volume":"17","author":"SC Hayes","year":"1994","unstructured":"Hayes SC, Wilson KG. Acceptance and commitment therapy: Altering the verbal support for experiential avoidance. Behav Anal. 1994;17:289\u2013303.","journal-title":"Behav Anal"},{"key":"1526_CR16","doi-asserted-by":"publisher","first-page":"364","DOI":"10.5271\/sjweh.3882","volume":"46","author":"SO Gismervik","year":"2020","unstructured":"Gismervik SO, Aasdahl L, Vasseljen O, Fors EA, Rise MB, Johnsen R, et al. Inpatient multimodal occupational rehabilitation reduces sickness absence among individuals with musculoskeletal and common mental health disorders: a randomized clinical trial. Scand J Work Environ Health. 2020;46:364\u201372.","journal-title":"Scand J Work Environ Health"},{"key":"1526_CR17","unstructured":"Eilenberg T. Acceptance and Commitment Group Therapy (ACT-G) for health anxiety. Dan Med J. 2016;63(10):B5294. https:\/\/pubmed.ncbi.nlm.nih.gov\/27697138\/."},{"key":"1526_CR18","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1007\/s10926-017-9711-4","volume":"28","author":"KW Hara","year":"2018","unstructured":"Hara KW, Bjorngaard JH, Brage S, Borchgrevink PC, Halsteinli V, Stiles TC, et al. Randomized Controlled Trial of Adding Telephone Follow-Up to an Occupational Rehabilitation Program to Increase Work Participation. J Occup Rehabil. 2018;28:265\u201378.","journal-title":"J Occup Rehabil"},{"key":"1526_CR19","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1037\/ocp0000097","volume":"24","author":"A Finnes","year":"2019","unstructured":"Finnes A, Ghaderi A, Dahl J, Nager A, Enebrink P. Randomized controlled trial of acceptance and commitment therapy and a workplace intervention for sickness absence due to mental disorders. J Occup Health Psychol. 2019;24:198\u2013212.","journal-title":"J Occup Health Psychol"},{"key":"1526_CR20","doi-asserted-by":"crossref","unstructured":"Brugnera A, Nordstrand Jacobsen\u2009 T, Woodhouse A, Compare A, Borsting Jacobsen H. Effectiveness of an ACT-based rehabilitation program for the treatment of chronic fatigue: Results from a 12-months longitudinal study. Scand J Psychol. 2021;62:41\u201350.","DOI":"10.1111\/sjop.12672"},{"key":"1526_CR21","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1097\/SPC.0000000000000360","volume":"12","author":"NJ Hulbert-Williams","year":"2018","unstructured":"Hulbert-Williams NJ, Beatty L, Dhillon HM. Psychological support for patients with cancer: evidence review and suggestions for future directions. Curr Opin Support Palliat Care. 2018;12:276\u201392.","journal-title":"Curr Opin Support Palliat Care"},{"key":"1526_CR22","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1093\/alcalc\/agy089","volume":"54","author":"SP Byrne","year":"2019","unstructured":"Byrne SP, Haber P, Baillie A, Costa DSJ, Fogliati V, Morley K. Systematic Reviews of Mindfulness and Acceptance and Commitment Therapy for Alcohol Use Disorder: Should we be using Third Wave Therapies? Alcohol Alcohol. 2019;54:159\u201366.","journal-title":"Alcohol Alcohol"},{"key":"1526_CR23","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1186\/s12889-019-7185-3","volume":"19","author":"N Coupe","year":"2019","unstructured":"Coupe N, Peters S, Rhodes S, Cotterill S. The effect of commitment-making on weight loss and behaviour change in adults with obesity\/overweight; a systematic review. BMC Public Health. 2019;19:816.","journal-title":"BMC Public Health"},{"key":"1526_CR24","doi-asserted-by":"crossref","unstructured":"Haugmark T, Hagen KB, Smedslund G, Zangi HA. Mindfulness- and acceptance-based interventions for patients with fibromyalgia - A systematic review and meta-analyses. PloS one. 2019;14:e0221897.","DOI":"10.1371\/journal.pone.0221897"},{"key":"1526_CR25","doi-asserted-by":"crossref","unstructured":"Coto-Lesmes R, Fernandez-Rodriguez C, Gonzalez-Fernandez S. Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review. J Affect Disord. 2020;263:107\u201320.","DOI":"10.1016\/j.jad.2019.11.154"}],"container-title":["BMC Family Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01526-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-021-01526-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01526-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T14:14:41Z","timestamp":1631110481000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-021-01526-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,8]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1526"],"URL":"https:\/\/doi.org\/10.1186\/s12875-021-01526-5","relation":{},"ISSN":["1471-2296"],"issn-type":[{"value":"1471-2296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,8]]},"assertion":[{"value":"11 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The trial was approved by the Regional Ethics Committee of Link\u00f6ping with approval number 2018\/127\u201331. The study was pre-registered on the official registry ClinicalTrials.gov with identification number NCT03737019. This paper only presents data obtained from the registry Inera, see methods. No personal data from the questionnaires filled out by the staff was presented. Informed consent was obtained from the staff participants, data on sick leave was from official (and hence completely incognito) data from Inera, see Methods section. All methods were performed in accordance with relevant guidelines and regulations (Declaration of Helsinki).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"N\/A","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that there are no competing interests with regards to this report.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"179"}}