Medical care personnel in primary care in the Swedish county council Region Kalmar have been trained in a form of therapy known as ACT. This strengthens them in their professional role and enables them to make medical decisions on firmer grounds. The training has led to a 21% reduction in sick leave for their patients. The study has been led by researchers from Linköping University.
Acceptance and commitment therapy, ACT, is a form of behavioural therapy that has received much attention. The aim of the ACT training has been to give doctors and other medical care personnel tools that help them stand for their profession, and strengthen them in their ability to carry out medical assessments. They can in this way take a comprehensive view of the patient, rather than prescribing sick leave as treatment.
Approximately 60% of all sick leave in Sweden is now related to anxiety, depression, pain and various forms of stress-related diagnosis. Most patients with such problems are treated within the primary care system.
“Patients with mild to moderate depression, for example, require more than simply being prescribed sick leave. Today, normal crises and life events are turned into medical events by the use of sick leave. But it should rather be a case of learning to live with one’s emotions and managing them. This is why we in the medical care system must take back the possibility of using medicine, and take action that helps the patient”, says Åsa Kadowaki.
She is a psychiatrist and licensed CBT therapist working for Region Kalmar, and principal author of an article published in the scientific journal BMC Family Practice. The article describes how medical care personnel at five local healthcare centres in Region Kalmar have been given training in how to approach their patients, with the aid of ACT. The study included comparison with five local healthcare centres in Region Jönköping, where the personnel had not received ACT training or supervision. The results show that while patient sick leave was reduced by 21% in Kalmar, it did not change at all in Jönköping.
ACT comprises several techniques with the objective of promoting beneficial change for the user. One technique is conscious presence, while another is acceptance of uncomfortable emotions and thoughts. The ACT training given to medical care personnel consist of lectures on how the personnel can approach their patients and their symptoms, supervision, and cross-disciplinary meetings in which some cases were discussed.
“It’s important that it is not just the doctors, but also, for example, nurses, physiotherapists and occupational therapists at the local healthcare centre who are given the opportunity for training, such that all members of a team contribute and travel in the same direction. Our objective is to help people to take their own decisions about what needs to change in order for them to achieve sustainability in their lives. This can take place by, for example, motivational consultations”, Åsa Kadowaki says. She also teaches on the medical programme at Linköping University.
Fredrik Nyström is professor of internal medicine at Linköping University and has been scientific leader of the study.
“Åsa Kadowaki has carried out most of the training and supervised the medical care personnel. The results show that her ACT-based method works. No other mental health intervention has given such a large reduction in the amount of sick leave”, says Fredrik Nyström.
The study has been financed by Region Kalmar.
The article: “Education of the primary health care staff based on acceptance and commitment therapy is associated with reduced sick leave in a prospective controlled trial”, Åsa Kadowaki, Anna-Karin Alvunger, Hanna Israelsson Larsen, Anna Persdotter, Marta Stelmach Zak, Peter Johansson and Fredrik H. Nyström, (2021), BMC Family Practice, published online 9 September 2021
BMC Family Practice
Method of Research
Randomized controlled/clinical trial
Subject of Research
Education of the primary health care staff based on acceptance and commitment therapy is associated with reduced sick leave in a prospective controlled trial
Article Publication Date
The authors declare that there are no competing interests with regards to this report.