Psychological Stress Management Research Articles

Effect of a nonpharmacological psychological stress management intervention on major cardiovascular events and mortality in patients with coronary artery disease: A systematic review and meta-analysis of randomized clinical trials.

Effect of a nonpharmacological psychological stress management intervention on major cardiovascular events and mortality in patients with coronary artery disease: A systematic review and meta-analysis of randomized clinical trials.

Supplemental Material for Effect of a Nonpharmacological Psychological Stress Management Intervention on Major Cardiovascular Events and Mortality in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Supplemental Material for Effect of a Nonpharmacological Psychological Stress Management Intervention on Major Cardiovascular Events and Mortality in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

N-Acetylcysteine and a Specialized Preventive Intervention for Individuals at High Risk for Psychosis: A Randomized Double-Blind Multicenter Trial

Abstract Background and Hypothesis Clinical high risk for psychosis (CHR-P) offers a window of opportunity for early intervention and recent trials have shown promising results for the use of N-acetylcysteine (NAC) in schizophrenia. Moreover, integrated preventive psychological intervention (IPPI), applies social-cognitive remediation to aid in preventing the transition to the psychosis of CHR-P patients. Study Design In this double-blind, randomized, controlled multicenter trial, a 2 × 2 factorial design was applied to investigate the effects of NAC compared to placebo (PLC) and IPPI compared to psychological stress management (PSM). The primary endpoint was the transition to psychosis or deterioration of CHR-P symptoms after 18 months. Study Results While insufficient recruitment led to early trial termination, a total of 48 participants were included in the study. Patients receiving NAC showed numerically higher estimates of event-free survival probability (IPPI + NAC: 72.7 ± 13.4%, PSM + NAC: 72.7 ± 13.4%) as compared to patients receiving PLC (IPPI + PLC: 56.1 ± 15.3%, PSM + PLC: 39.0 ± 17.4%). However, a log-rank chi-square test in Kaplan–Meier analysis revealed no significant difference of survival probability for NAC vs control (point hazard ratio: 0.879, 95% CI 0.281–2.756) or IPPI vs control (point hazard ratio: 0.827, 95% CI 0.295–2.314). The number of adverse events (AE) did not differ significantly between the four groups. Conclusions The superiority of NAC or IPPI in preventing psychosis in patients with CHR-P compared to controls could not be statistically validated in this trial. However, results indicate a consistent pattern that warrants further testing of NAC as a promising and well-tolerated intervention for CHR patients in future trials with adequate statistical power.

A Study on the Cultivation of Psychological Stress Management Ability of Medical Personnel Based on Case Teaching

Medical work is often accompanied by high-intensity pressure and emotional load, and the impact of psychological stress on medical personnel cannot be ignored. In such a background, case teaching, as a teaching method with strong practicability and high interactivity, provides an effective way to cultivate the psychological stress-handling ability of medical personnel. This paper discusses the application of case teaching around the cultivation of the psychological stress-handling ability of medical personnel. The importance of psychological stress in medical personnel as well as its purpose and significance are introduced, as well as the advantages of case teaching in the cultivation of psychological stress handling ability and the limitations and challenges faced by case teaching. This is followed by a brief overview of the key steps of identifying training objectives and needs, collecting and screening suitable cases, designing case teaching activities, implementing case teaching, and assessment and feedback. Effective psychological stress management skills can help medical staff better cope with stress and challenges at work, enhance their psychological resilience and adaptability, and thus improve work effectiveness and provide better patient care.

Correlation between trait emotional intelligence and prefrontal activation during a verbal fluency task: A functional near-infrared spectroscopy study.

Stress is inevitable in humans and stress changes our physical and mental states. Stress has been studied epidemiologically, biologically, and psychologically. First defined in 1990, emotional intelligence (EI) affects psychological stress management. In contrast, the prefrontal cortex (PFC) is suggested to play a vital role in stress management. Human PFC activity can be inferred from the balance of oxygenated and deoxygenated hemoglobin in cerebral blood flow, which can be measured and calculated using functional near-infrared spectroscopy (fNIRS). An important cognitive activation task to activate the PFC is the verbal fluency task (VFT). Therefore, if the PFC is activated by the VFT and monitored by fNIRS, and the activity correlates with EI, fNIRS can be used to measure EI. In this study, Psychological tests using the self-rating depression scale, state-trait anxiety inventory (STAI), and trait emotional intelligence questionnaire-short form (TEIQue-SF) were conducted to evaluate the correlation with VFT performance. Relative oxygenated and deoxygenated hemoglobin concentrations were measured using an fNIRS device, and their correlation with VFT performance was tested. Spearman correlation coefficient was used to determine correlations. Results were as follows. Although VFT performance did not correlate with the oxygenated hemoglobin concentration ([Oxy-Hb]) changes, [Oxy-Hb] was elevated in all channels. VFT performance was significantly negatively correlated with the Zung self-rating depression scale (ρ = 0.063, P = .759), trait anxiety or anxiety level as a personal characteristic of STAI (ρ = 0.243, P = .232), and state anxiety or anxiety about an event of STAI (ρ = -0.138, P = .500), whereas no correlation was found with the TEIQue-SF (ρ = 0.303, P = .132). Healthy individuals PFC activity is not severely affected by their mental state and cognitive activation successfully activates the PFC, supporting the hypothesis that EI is correlated with frontal cortical activation during the VFT in a nonclinical population. EI may play a vital role in reducing stress associated with depression and anxiety in our social lives. Although we failed to show a statistical correlation between TEIQue-SF and [Oxy-Hb] due to a sample size shortage, our preliminary study was the first to attempt to show the PFC activity of EI through a hemodynamic response. Future research may elucidate the role of EI in reducing psychological stress in social life.

Emotions Management And Its Relationship To Psychological Stress Among Preparatory School Students

Emotions Management And Its Relationship To Psychological Stress Among Preparatory School Students Assist. Dr. Falah Hasan Ramadhan College of Basic Education / University of Mosul Falahhasan19811981@uomousl.edu.iq Abstract The aim of the current research is to identify the level of emotions and psychological stress management and its relationship to psychological stress among preparatory school students. The research sample consisted of (205) preparatory school students who were deliberately chosen from (14) schools from the right and left coasts of Mosul City (males and females), and for literature and scientific disciplines. The researcher used (Saleh, 2019) scale to measure the emotions management and (Shah, 2015) scale to measure psychological stress and after extracting the face validity and stability by presenting them to the experts by the test and retest method. The two scales were applied to the research sample and students’ answers were corrected. The data were treated statistically using Pearson correlation coefficient and the one-sample t-test and the test for significant significance correlation coefficient. The researcher reached the following results: - Preparatory school students have a good level of emotions management. - Students suffer from a high level of psychological stress. - There is an inverse correlation relationship between emotions management and psychological stress among preparatory students. In light of these results, the researcher identified a number of recommendations and suggestions, including: - Enhancing the level of emotions management among preparatory school students by educational counselors through group counseling sessions and demonstrating the importance of managing emotions in all of their lives.

Relationship between Psychological Stress Determined by Voice Analysis and Periodontal Status: A Cohort Study.

In modern society, evaluation and management of psychological stress may be important for the prevention of periodontal disease. The purpose of this study was to examine the relationship between psychological stress (vitality and mental activity) evaluated by Mind Monitoring System (MIMOSYS) and periodontal status. Forty students of Okayama University underwent the oral examination and self-reported questionnaire on the first day (baseline) and the 14th day (follow-up). Voice recording was performed every day with the MIMOSYS app during the whole study period. The participants completed the Patient Health Questionnaire (PHQ)-9 and Beck Depression Inventory (BDI) at baseline and at follow-up. Spearman’s rank correlation coefficient was used to determine the significance of correlations among variables. The PHQ-9 and BDI scores were negatively correlated with vitality in the morning. Change in vitality in the morning was significantly correlated with changes in periodontal inflammation. Mental activity was significantly correlated with change in mean probing pocket depth. This result shows that measurement of psychological stress using a voice-based tool to assess mental health may contribute to the early detection of periodontal disease.

Association between generalized anxiety symptoms and semen quality in infertile men: A multicentre study in North China.

This study was conducted to investigate the generalized anxiety levels and its association with semen quality in infertile men. We recruited male patients who visited the infertility outpatient departments of three teaching hospitals in North China and evaluated their generalized anxiety symptoms using the self-administered 7-item generalized anxiety disorder (GAD-7) scale. Seminal analysis was performed as per WHO guidelines. A total of 378 infertile men (average age: 31.43 ± 5.85 years) were classified into the normal group (n=174, 46%) and the anxiety group (n=204, 54%) according to their GAD-7 scale score. The proportion of patients with hyperlipidaemia in the normal group was significantly higher than that in the anxiety group (14.9% vs. 5.9%, p=0.004). The other demographic characteristics were not statistically different between both groups. Patients with abnormal GAD-7 scale scores had a significantly lower sperm count (202.48 vs. 166.80 million per ejaculate, p=0.023), sperm concentration (54.75 vs. 46.54 million/ml, p=0.033), and progressive motility (40.25 vs. 37.16, p=0.020) than those with normal GAD-7 scale scores. Multivariate linear regression models revealed that anxiety was significantly negatively associated with sperm concentration (percent change=-9.79, 95%CI: -12.38 to -7.12, p < 0.001), total sperm count (percent change=-13.07, 95%CI: -16.05 to -9.84, p < 0.001), progressive motility (β=-1.41, 95%CI: -1.86 to -0.96, p < 0.001), total sperm motility (β=-1.73, 95%CI: -2.38 to -1.08, p < 0.001), and normal sperm morphology (β=-0.16, 95%CI: -0.28 to -0.04, p=0.009), respectively. Taken together, generalized anxiety disorder could significantly influence the clinical semen quality in infertile men in North China, and psychological stress management might be helpful.

Deciphering the role of physical activity in stress management during a global pandemic in older adult populations: a systematic review protocol

BackgroundThe world has changed dramatically since the beginning of 2020 due to COVID-19. As a result of the pandemic, many older adults are now experiencing an increased and unprecedented amount of psychological stress. Physical activity has been found to be an evidence-based means of combating stress among older adults to promote their quality of life. Studies have demonstrated that those who are physically active experience fewer issues in regard to their mental health, specifically depression and anxiety disorders. Engagement in physical activity may exert a protective influence over stress inducing events and future mental health outcomes. Due to exercise being inexpensive, non-invasive, and effective even via incremental increases in activity level, physical activity interventions should be investigated as a therapy for reducing stress for older adults during the current pandemic.MethodsFour electronic databases (PubMed, PsycInfo, Web of Science, and SportDiscus) will be searched to identify randomized controlled trials that evaluate the effectiveness of physical activity or exercise programs as a psychological stress management tool in adults 50 years of age or older. Only peer-reviewed and published journal articles will be reviewed. Post-intervention psychological stress measures in comparison to baseline stress will be the primary outcome of interest. All studies will be assessed for bias using Cochrane’s risk of bias tool. A random effects meta-analysis will be investigated if sufficient evidence of homogenous research exists and the heterogeneity of effect sizes will be tabulated.DiscussionThis review will determine the effectiveness of various physical activity interventions for the treatment of psychological stress among the older adult population. This knowledge will help inform care aides, clinicians, family members, and older adults themselves of the most effective physical activity interventions in dealing with stress which is relevant to the ongoing pandemic.Systematic review registrationPROSPERO CRD42020192546

Psychological Stress Management in Primary Care

Psychological Stress Management in Primary Care

Effective Stress Management and Employee Productivity in the Nigerian Public Institutions; A Study of National Galary of Arts, Abuja, Nigeria

The objective of this study was to evaluate the effect of stress management on employee productivity in the Nigerian public institutions with particular emphasis on National Gallery of Arts, Abuja. The study is a survey research and the population of the study consists of employees of the institution with sample size of 171 determined using Taro Yamane’s formula. Primary data was used through the administration of questionnaire, and the formulated hypotheses tested by regression method. The findings revealed that there is a significant impact of physical stress management on employee productivity. Furthermore, the results also revealed that there is an insignificant impact of psychological stress management on the employee productivity. Equally there is a significant impact of emotional stress management; environmental stress management and economic stress management on employee productivity. The study concluded that effective stress management can mitigate the negative factors that distressed employees which also have a negative effect on their productivity; and recommended among others that adequate stress management should be incorporated into the fabric of Nigerian public institutions to improve the health of workers and intrapersonal relationships; ergonomic factor that reduces physical stress on a worker's body should be taken into consideration to which in turn can improve productivity; in addition, equity in compensation, feeling of been in control and meaningful task in the setting may help to reduce psychological and emotional stress to improve productivity, also providing some form of financial assistance especially in times of economic distress.

Status and Factors of Menstrual Knowledge, Attitudes, Behaviors and Their Correlation with Psychological Stress in Adolescent Girls.

Adolescent girls perceive menstruation as a negative experience, which can affect adolescents' physical and mental health. The aims of this study were to describe the menstrual knowledge, attitudes, and behaviors of adolescent girls in China and to examine their association with psychological stress. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A cross-sectional study was conducted among 1349 adolescent girls aged 11-14years in Changsha, China. Participants anonymously completed questionnaires that assessed sociodemographic characteristics, menstrual knowledge and attitudes, dysmenorrhea self-care behaviors, and perceived stress. One-way analysis of variance and Pearson r correlation and multiple linear regression analyses were conducted to examine the differences and associations among variables. The mean age of menarche was 11.70 (±0.82) years. A total of 1053/1349 (78.1%) of girls had a knowledge of menstruation before menarche and their mothers were the main source 931/1349 (69.0%) of their knowledge. More than half (53.4%) of adolescent girls experienced different degrees of dysmenorrhea. The mother's education, family monthly income, family type, and the girls' age, grade, menstrual status, age at menarche, sanitary napkin change frequency, menstrual restrictions, and dysmenorrhea influenced menstrual knowledge, attitudes, and practice. Psychological stress was affected by age, grade, age at menarche, sanitary napkin change frequency, menstrual restrictions, dysmenorrhea, and menstrual knowledge, attitudes, and practices. Psychological stress management during menstruation should be a focus of health education programs for adolescent girls. During adolescence, health care providers should not only pay attention to the physical changes of adolescence girls, but also provide stress management skills to help them cope with menstrual-related concerns.

Research on the Method of Evaluating Psychological Stress by EEG

Stress is the source of all diseases, and the detection and management of psychological stress are very essential to everyone. In this paper, a stress evaluating system based on the EEG is designed for evaluating the state of psychological stress objectively. Firstly, the changes of EEG signals are obtained in real-time by using TGAM modules. Then the signal processing and wireless transmission are carried out by using Bluetooth technology to the computer. The pressure eigenvalues of EEG, which includes focal point, the edge spectrum, EEG pressure index and so on, are extracted. Finally, the results of the EEG analysis are to realize the automatic evaluation of stress state. At the same time, the experiment of pressure induction and evaluation is designed for verifying specific groups and combined with the VAS test. The results show that the EEG analysis can detect psychological stress more objectively, comprehensively and accurately.

Mental health treatment preferences and challenges of living with multimorbidity from the veteran perspective.

To explore middle-aged and older veterans' current disease-management practices, mental health treatment preferences, and challenges of living with multiple chronic health conditions (i.e., multimorbidity). Semi-structured qualitative interviews and self-report measures were collected from 28 middle-aged and older (50 years of age or older) veterans with multimorbidity. Our sample of veterans with multimorbidity was, on average, mildly depressed and anxious with elevated stress and disability. Veterans acknowledged the interaction of physical and emotional symptoms, which caused greater difficulty with health care management and daily functioning. Veterans had many concerns regarding their physical and emotional health conditions, such as continued disease progression and the addition of other emotional and physical health complications. Veterans also identified specific self-care approaches for disease management (e.g., medication, healthy lifestyle practices, and psychological stress management techniques), as well as barriers to engaging in care (e.g., money, transportation, and stigma). Participants preferred a combination of medication, psychotherapy, and healthy lifestyle practices for mental health treatment. The majority of participants (88.5%) agreed that these mental health treatments would be beneficial to integrate into disease management for older veterans with multimorbidity. Lastly, veterans provided an array of recommendations for improving Veteran's Administration services and reducing mental health stigma. These findings provide support for patient-centered approaches and integrated mental and physical health self-management in the Veteran's Administration for middle-aged and older veterans with multiple chronic conditions. Copyright © 2016 John Wiley & Sons, Ltd.

Interreality in the management of psychological stress: a clinical scenario.

The term "psychological stress" describes a situation in which a subject perceives that environmental demands tax or exceed his or her adaptive capacity. According to the Cochrane Database of Systematic Reviews, the best validated approach covering both stress management and stress treatment is the Cognitive Behavioral (CBT) approach. We aim to design, develop and test an advanced ICT based solution for the assessment and treatment of psychological stress that is able to improve the actual CBT approach. To reach this goal we will use the "interreality" paradigm integrating assessment and treatment within a hybrid environment, that creates a bridge between the physical and virtual worlds. Our claim is that bridging virtual experiences (fully controlled by the therapist, used to learn coping skills and emotional regulation) with real experiences (allowing both the identification of any critical stressors and the assessment of what has been learned) using advanced technologies (virtual worlds, advanced sensors and PDA/mobile phones) is the best way to address the above limitations. To illustrate the proposed concept, a clinical scenario is also presented and discussed: Paola, a 45 years old nurse, with a mother affected by progressive senile dementia.

Patient satisfaction and psychological well-being after internet-based cognitive behavioral stress management (IB-CBSM) for women with preterm labor: A randomized controlled trial

Objective and methodsDespite its value for the management of psychological burden, little is known about the efficacy of and patient satisfaction with internet-based cognitive behavioral stress management (IB-CBSM) for women with preterm labor. The present study sets out to analyze stress/anxiety reduction, patient satisfaction and patient's working alliance in a group of 58 women with preterm labor participating in an online psychological stress management project. As part of the project, women were randomly assigned to online stress management or a control condition. ResultsLevels of stress and anxiety decreased significantly in both conditions from pre- to post-treatment measure. Participants in IB-CBSM reported significant higher working alliance inventory (WAI) scores in the task and goal subscale (p<.001; p<.05) than women in the control condition. In Addition the IB-CBSM group showed significant correlations of the WAI subscale task and goal and the stress/anxiety outcome. Regarding patient satisfaction, women in the IB-CBSM reported significantly higher satisfaction scores (p<.001) than women in the control condition. WAI explained nearly 40% of the variance in patient satisfaction. Furthermore, WAI mediates, at least in part, the relationship between group condition and patient satisfaction. ConclusionThe current analysis indicated that participants in IB-CBSM had higher WAI scores and were more satisfied with the program. In addition only the IB-CBSM group showed significant correlations of the WAI with the stress/anxiety reduction outcome. Based on these findings, it can be presumed that measures of agreement with working alliance parameters, especially task and goal components, are substantially important for more effective and satisfactory therapeutic interventions.

Experiential virtual scenarios with real-time monitoring (interreality) for the management of psychological stress: a block randomized controlled trial.

BackgroundThe recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress.ObjectiveOur goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones).MethodsThe study was designed as a block randomized controlled trial involving 121 participants recruited from two different worker populations—teachers and nurses—that are highly exposed to psychological stress. Participants were a sample of teachers recruited in Milan (Block 1: n=61) and a sample of nurses recruited in Messina, Italy (Block 2: n=60). Participants within each block were randomly assigned to the (1) Experimental Group (EG): n=40; B1=20, B2=20, which received a 5-week treatment based on the Interreality paradigm; (2) Control Group (CG): n=42; B1=22, B2=20, which received a 5-week traditional stress management training based on cognitive behavioral therapy (CBT); and (3) the Wait-List group (WL): n=39, B1=19, B2=20, which was reassessed and compared with the two other groups 5 weeks after the initial evaluation.ResultsAlthough both treatments were able to significantly reduce perceived stress better than WL, only EG participants reported a significant reduction (EG=12% vs CG=0.5%) in chronic “trait” anxiety. A similar pattern was found for coping skills: both treatments were able to significantly increase most coping skills, but only EG participants reported a significant increase (EG=14% vs CG=0.3%) in the Emotional Support skill.ConclusionsOur findings provide initial evidence that the Interreality protocol yields better outcomes than the traditionally accepted gold standard for psychological stress treatment: CBT. Consequently, these findings constitute a sound foundation and rationale for the importance of continuing future research in technology-enhanced protocols for psychological stress management.Trial RegistrationClinicalTrials.gov: NCT01683617; http://clinicaltrials.gov/show/NCT01683617 (Archived by WebCite at http://www.webcitation.org/6QnziHv3h).

Assessment of quality of life in patients with psoriasis: a study from Serbia.

Psoriasis has a substantial impact on patients' quality of life. The aims of this study were to assess the impact of the clinical severity of psoriasis on patients' quality of life and to determine the effects of psoriasis-related stress on patients' everyday life. The cross-sectional study was conducted at the Institute of Dermatovenereology, Clinical Center of Serbia, Belgrade. The study included 201 patients (124 men and 77 women), aged 18-70 with a diagnosis of psoriasis, hospitalized or treated as outpatients during 2009. For the assessment of patients' quality of life, the psoriasis disability index (PDI) was used. The stress related to psoriasis was measured with the psoriasis life stress inventory (PLSI) and disease severity with the psoriasis area and severity index (PASI). We found moderate correlation between PLSI and all PDI subscales and overall score (correlation coefficients ranged from 0.334 to 0.521). The correlation between PASI and PDI subscales was weak, while we failed to find any significant correlation between PASI and the PLSI. The results of multiple regression analysis indicated that stress, more severe disease, and lower educational level are significant determining factors of a poorer quality of life in patients with psoriasis. Our results support the importance of assessing the quality of life in psoriasis and effects of stress in patients' adjustment to their condition and may have important implications for a psychological stress management approach in the clinical management of psoriasis.

Professional psychological stress management in chronic renal failure patients

PURPOSE: Any patients with chronic diseases, and especially those with chronic renal failure, face not only the specific physical aspects of their own primary pathology but also the psychological distress when realizing the severity of the progression of this disease and its poor prognosis. The objective of this study was to reveal some psychological features of the patients on haemodialysis. MATERIAL AND METHODS: The investigation covered 70 patients, 43 males and 27 females with chronic renal failure treated in the Clinic of Dialysis of Varna and in the Dialysis Centre of Targovishte. The patients filled in anonymous questionnaires and underwent a psychological examination according to a modified anxiety scale. RESULTS: Recently, the number of emergency cases in both haemodialysis centres increased. In Varna, the emergency cases were 34 out of 37 while in Targovishte, these amounted to 8 out of 11. This hampered the provision of sufficient information about the disease to the patients. At the onset of treatment, social activity was preserved in 44% of the patients while after 12 months this persisted in 16% of them. More than 85% of the patients retired due to disability caused by the renal disease. The influence on the interpersonal relations of the disease-related stress and anxiety was very unfavourable. CONCLUSION: There is a necessity to apply individualized psychotherapeutic approach to the patients with chronic renal failure in order to improve their adjustment to this severe pathology and collaboration with the physician as well as to minimize their feeling of inevitability. Scripta Scientifica Medica 2013; 45(1): 40-42.

Can we enhance the ability to return to work among workers with stress-related disorders?

BackgroundStress-related disorders are widespread and responsible for high societal costs e.g. sick leave payment and reduced productivity. The aim of this study was to evaluate the effect of an intervention program on return to work or labour market.MethodsIn a controlled interventional study design we compared 72 emotionally distressed patients, who received support during 2006, with 89 control individuals who had also been sick listed for emotional distress. Intervention was provided by trained psychologists and social workers who were in continuous dialog with the patients, providing counselling e.g. on decisions concerning resumption of work, support to families, participation in meetings with the workplace. Basically, the controls and the intervention group share the same access to welfare benefits. The main outcome was time to return to labour market (TTR).ResultsThe baseline characteristics were similar in the two groups. There were no differences in the rate of resuming work between the two groups. About 80% in both groups had returned to the labour market after one year.ConclusionAn intervention program with psychological stress management and case management did not improve work capability compared to usual care. Work resumption as a single outcome probably is an insensitive parameter of intervention management quality, and should be supplemented by other data on different aspects of treatment.