This form of therapy can save enormous amounts of money by getting people with mental health problems back to work more quickly

A new treatment method that involves metacognitive therapy and job focus can save society three times as much as it costs by getting people with mental health problems back to work sooner.

Sick leave due to mental illness is becoming increasingly common in Norway. The accompanying burden for the individual is substantial. But sick leave also costs society enormous sums of money. An estimated 9 million person-days of work are lost every year.

If it’s possible to reduce absenteeism in a responsible way, that would provide great benefits, both for those with mental disorders, but also for the nation. Fortunately, there is hope.

“Metacognitve therapy as a treatment, along with a focus on the job, can help get people back to work faster," says Odin Hjemdal.

Hjemdal is a professor and specialist in psychology at the Norwegian University of Science and Technology's (NTNU) Department of Psychology

New research on this treatment and the results have been published in eClinicalMedicine. This is a journal in the Lancet family, so it’s pretty high-impact.

Already a lot saved

“If this treatment becomes more common, society can save a lot of money," Hjemdal said.

He is not exaggerating. A total of 236 people on sick leave participated in this study. Around half, 121 patients, received the treatment quickly, and that turned out to be a major advantage.

“We compared this with a waiting list group. That group had to wait 10 weeks before starting the same treatment. For the 121 patients who did not have to wait, the savings were approximately NOK 9.5 million in reduced costs for reduced sick leave,” says Hjemdal.

Forty-two per cent of those who received early treatment were back at work after 12 weeks. The same applied to only 18 per cent in the group that had to wait for treatment. But even those who had to wait got equally good results after having completed the treatment.

Huge savings possible

The savings, both in suffering and money, thus apply to a relatively small group compared to the potential total of suffering patients.

In 2017, there were 223,000 people on sick leave in Norway due to a mental disorder. By 2024, this number had increased to 327,000. The increase is close to 47 per cent. There is a lot to gain here.

But what exactly is metacognitive therapy and job focus?

Metacognitive therapy?

“Metacognitive therapy does not work that much with the content of your thoughts. Instead, it works on how you relate to your thoughts," Hjemdal said.

In short, job focus is about the fact that work is important for mental health.

According to this method thoughts themselves are not what cause problems. Instead, ruminating, worrying, and focusing your attention strategically to identify possible danger, while trying to control your thoughts and coping that backfires is what maintains mental disorders rather than solving them.

“Thoughts and feelings are spontaneous events that come and go without us having to regulate them. The goal is for you to learn to stop regulating your thoughts and feelings. You should rather let them come and go without getting involved," Hjemdal said.

This form of therapy, developed by Professor Adrian Wells, is short-term and structured. It has been shown to be effective for anxiety and depression. About 70 per cent recover after completing treatment and few relapse. For comparison, with other treatments,  50 per cent usually recover and of these, as many as 50 per cent can relapse.

Job focus?

The therapists in the project used job focus as an integral part of metacognitive therapy, and others have used it with short-term cognitive behavioural therapy.

“In short, job focus is about the fact that work is important for mental health. We examine the job situation, and any need for facilitation, and investigate obstacles to returning to work, such as bullying in the workplace," Hjemdal said.

Therapy that has a job focus is aimed at helping the person return to normal life as quickly as possible. Therapists might ask questions such as:

• What prevents you from returning to your job?
• How do thought and worry patterns affect you in relation to work?
• Are there alternative strategies to work better in the workplace?

Especially promising against anxiety and depression

It appears that the treatment provides particularly good results in treating anxiety and depression.

“In Norway, this is one of the subgroups where we see major challenges in terms of sick leave," Hjemdal said.

That makes it possible to both help patients quickly and efficiently, while at the same time saving money.

“Sick leave related to anxiety and depression costs approximately NOK 71 billion annually in Norway alone," says Hjemdal.

Reference:
Gjengedal, Ragne G.H., et al., Hjemdal. (2025) Metacognitive therapy and work-focus for patients with depression, anxiety or comorbid depression and anxiety on sick leave: a single-centre, open-label randomised controlled trial. eClinicalMedicine, Volume 89, 103613 DOI: 10.1016/j.eclinm.2025.103613