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Exposure-in-vivo containing interventions to improve work functioning of workers with anxiety disorder: a systematic review

BACKGROUND: Anxiety disorders are associated with functional disability, sickness absence, and decreased productivity. Effective treatments of anxiety disorders can result in remission of symptoms. However the effects on work related outcomes are largely unknown. Exposure in vivo is potentially well...

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Autores principales: Noordik, Erik, van der Klink, Jac JL, Klingen, Elmer F, Nieuwenhuijsen, Karen, van Dijk, Frank JH
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224747/
https://www.ncbi.nlm.nih.gov/pubmed/20937125
http://dx.doi.org/10.1186/1471-2458-10-598
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author Noordik, Erik
van der Klink, Jac JL
Klingen, Elmer F
Nieuwenhuijsen, Karen
van Dijk, Frank JH
author_facet Noordik, Erik
van der Klink, Jac JL
Klingen, Elmer F
Nieuwenhuijsen, Karen
van Dijk, Frank JH
author_sort Noordik, Erik
collection PubMed
description BACKGROUND: Anxiety disorders are associated with functional disability, sickness absence, and decreased productivity. Effective treatments of anxiety disorders can result in remission of symptoms. However the effects on work related outcomes are largely unknown. Exposure in vivo is potentially well fit to improve work-related outcomes. This study systematically reviews the effectiveness of exposure-in-vivo containing interventions in reducing work-related adverse outcomes in workers with anxiety disorders. METHODS: A systematic study search was conducted in Medline, Cinahl, Embase and Psycinfo. Two reviewers independently extracted data and from each study assessed the quality of evidence by using the GRADE approach. We performed a meta-analysis if data showed sufficient clinical homogeneity. RESULTS: Seven studies containing 11 exposure-in-vivo interventions were included. Four studies were focused on Obsessive Compulsive Disorder (OCD), two on Post Traumatic Stress Disorder (PTSD), and one on a mixed group of OCD and severe phobias. The studies were grouped according to type of anxiety disorder and subsequently according to type of comparisons. For OCD, exposure-in-vivo containing interventions can yield better work-related outcomes compared to medication (SSRIs) and relaxation but not better compared to response prevention. The results on anxiety outcomes were similar. The net contribution of exposure in vivo in two OCD intervention programs is also presented as a meta-analysis and shows significant positive results on work role limitations. The calculated pooled effect size with 95% confidence interval was 0.72 (0.28, 1.15). For PTSD, exposure-in-vivo containing interventions can yield better work-related and anxiety-related outcomes compared to a waiting-list but not better compared to imaginal exposure. CONCLUSIONS: Exposure in vivo as part of an anxiety treatment can reduce work-related adverse outcomes in workers with OCD and PTSD better than various other anxiety treatments or a waiting-list. We recommend that it should be studied how the results of these studies can be transferred to the practice of occupational health professionals and how clinicians can make better use of them to improve work-related outcomes. In future research, priority should be given to high-quality randomised controlled trials (RCTs) in which exposure-in-vivo containing interventions are applied to a variety of anxiety disorders and compared with other clinical anxiety treatments such as SSRIs. Work-related outcomes, in particular work functioning and sickness absence, need to be assessed with reliable and valid measures.
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spelling pubmed-32247472011-11-28 Exposure-in-vivo containing interventions to improve work functioning of workers with anxiety disorder: a systematic review Noordik, Erik van der Klink, Jac JL Klingen, Elmer F Nieuwenhuijsen, Karen van Dijk, Frank JH BMC Public Health Research Article BACKGROUND: Anxiety disorders are associated with functional disability, sickness absence, and decreased productivity. Effective treatments of anxiety disorders can result in remission of symptoms. However the effects on work related outcomes are largely unknown. Exposure in vivo is potentially well fit to improve work-related outcomes. This study systematically reviews the effectiveness of exposure-in-vivo containing interventions in reducing work-related adverse outcomes in workers with anxiety disorders. METHODS: A systematic study search was conducted in Medline, Cinahl, Embase and Psycinfo. Two reviewers independently extracted data and from each study assessed the quality of evidence by using the GRADE approach. We performed a meta-analysis if data showed sufficient clinical homogeneity. RESULTS: Seven studies containing 11 exposure-in-vivo interventions were included. Four studies were focused on Obsessive Compulsive Disorder (OCD), two on Post Traumatic Stress Disorder (PTSD), and one on a mixed group of OCD and severe phobias. The studies were grouped according to type of anxiety disorder and subsequently according to type of comparisons. For OCD, exposure-in-vivo containing interventions can yield better work-related outcomes compared to medication (SSRIs) and relaxation but not better compared to response prevention. The results on anxiety outcomes were similar. The net contribution of exposure in vivo in two OCD intervention programs is also presented as a meta-analysis and shows significant positive results on work role limitations. The calculated pooled effect size with 95% confidence interval was 0.72 (0.28, 1.15). For PTSD, exposure-in-vivo containing interventions can yield better work-related and anxiety-related outcomes compared to a waiting-list but not better compared to imaginal exposure. CONCLUSIONS: Exposure in vivo as part of an anxiety treatment can reduce work-related adverse outcomes in workers with OCD and PTSD better than various other anxiety treatments or a waiting-list. We recommend that it should be studied how the results of these studies can be transferred to the practice of occupational health professionals and how clinicians can make better use of them to improve work-related outcomes. In future research, priority should be given to high-quality randomised controlled trials (RCTs) in which exposure-in-vivo containing interventions are applied to a variety of anxiety disorders and compared with other clinical anxiety treatments such as SSRIs. Work-related outcomes, in particular work functioning and sickness absence, need to be assessed with reliable and valid measures. BioMed Central 2010-10-11 /pmc/articles/PMC3224747/ /pubmed/20937125 http://dx.doi.org/10.1186/1471-2458-10-598 Text en Copyright ©2010 Noordik et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Noordik, Erik
van der Klink, Jac JL
Klingen, Elmer F
Nieuwenhuijsen, Karen
van Dijk, Frank JH
Exposure-in-vivo containing interventions to improve work functioning of workers with anxiety disorder: a systematic review
title Exposure-in-vivo containing interventions to improve work functioning of workers with anxiety disorder: a systematic review
title_full Exposure-in-vivo containing interventions to improve work functioning of workers with anxiety disorder: a systematic review
title_fullStr Exposure-in-vivo containing interventions to improve work functioning of workers with anxiety disorder: a systematic review
title_full_unstemmed Exposure-in-vivo containing interventions to improve work functioning of workers with anxiety disorder: a systematic review
title_short Exposure-in-vivo containing interventions to improve work functioning of workers with anxiety disorder: a systematic review
title_sort exposure-in-vivo containing interventions to improve work functioning of workers with anxiety disorder: a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224747/
https://www.ncbi.nlm.nih.gov/pubmed/20937125
http://dx.doi.org/10.1186/1471-2458-10-598
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