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Henderson et al point out the increasing approval of counselling as an effective intervention to treat or prevent the effects of stress at work by British judges, although they could use expert advice on this matter.1 In reaction to this development, they pose the rhetorical question: where to find evidence on the effectiveness of counselling. In stead of answering this question they grasp the opportunity to criticise the report of the British Association for Counselling.2 I totally agree with their criticism of the report. It is of low quality and does not provide reliable evidence on the effectiveness of counselling. However, I was surprised by the fact that the authors did not present reliable evidence that does exist on the topic. The question cannot be left unanswered. We gave an answer to an almost similar question in our article on evidence based medicine. We showed the feasibility of searching for evidence in Medline for practitioners of occupational health.3 We elaborated an example of a teacher with symptoms of burnout who wanted to know the best treatment for his condition. Our search resulted in at least one good review and one meta-analysis.4,5 The meta-analysis by van der Klink et al firmly concludes: “stress management interventions are effective and cognitive-behavioural interventions are more effective than the other intervention types”. This is in line with the earlier findings of the review by Murphy that we found as well.
From the authors’ editorial it can be inferred that they favour interventions such as a reduction of working hours or increasing staff numbers, more than counselling. This does sound sympathetic to me as well and it is in line with the principle of hierarchy of controls, which states that primary prevention is to be preferred to, for example, personal protective equipment.6 However, in our case, there is not much evidence that supports such an approach. This is partly due to a lack of studies in the area of organisational interventions. The organisational intervention studies that have been done, however, do not yield a significant effect size.5 On the other hand, there seems to be enough evidence to conclude that cognitive behavioural interventions are effective in counterbalancing the effects of stress at work. So, even when only reliable evidence is used, there is still much to support counselling in the sense of cognitive behavioural treatment. In addition, there is a systematic review in the Cochrane Library on counselling in primary care, which concludes that it is associated with a modest improvement in short term outcome compared to “usual care” and not associated with more costs.7 Based on this evidence I would not simply reject counselling as ineffective.
This case illustrates that, in occupational health in general, there is a lack of awareness of the existence of evidence on effective interventions. That is the main reason why we are in the process of developing an Occupational Health Field within the Cochrane Collaboration. The Cochrane Collaboration is an international organisation, dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide. Have a look at www.cochrane.org for more details.
We hope that, in the near future, the Occupational Health Field will fulfil its promises and will simplify the finding of evidence on occupational health interventions like counselling.
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