Treating the aftermath of exposure to workplace bullying and preventing exclusion from working life : The effect of individual resilience, return to work self-efficacy, and work-focused metacognitive and cognitive treatment

Abstract

Workplace bullying is cemented in the literature as a severe social stressor that can lead to devastating consequences for the person involved. Decades of research have established a strong association with both psychological and physiological health complaints, as well as an increased risk of sick leave among those targeted. However, although the detrimental consequences of workplace bullying are well established in the literature, there has been limited research into the possibilities for psychological treatment for victims of workplace bullying presenting with mental health problems. Hence, the objective of the thesis was firstly to investigate the prevalence of workplace bullying experiences among patients suffering from common mental disorders (CMD) who are either currently on or at risk of sick leave, and to examine their clinical and work-related characteristics as compared to other patients. Additionally, it is of importance to explore whether individual characteristics and resources, such as resilience, have a protective effect when exposed to a severe stressor such as workplace bullying, in our case as a moderator in the relationship between exposure to bullying behaviours and return to work self-efficacy (RTW-SE). The literature has previously shown mixed results and identified reversed buffer effects for this vulnerable group of individuals. It is, therefore, of value to investigate this further in a group of patients that are victims of workplace bullying at risk of being excluded from work and working life. Lastly, we examined whether metacognitive therapy (MCT) or cognitive behavioural therapy (CBT) with work-focus can cause symptom reduction and an increase in workforce participation. We further examined whether such treatment may be as effective for victims of bullying as for other patients not exposed to bullying.

The first of three included studies investigated the clinical characteristics of patients seeking treatment for CMD presenting with experiences of workplace bullying. The aim was to investigate the prevalence of workplace bullying in a patient group seeking treatment for CMD. Additionally we examined whether these patients differed from other patients not exposed to bullying with regard to both clinical and work-related characteristics. The paper included a sample of 675 patients on sick leave or at risk of sick leave due to CMD, who had been referred to an outpatient clinic in Norway. There was a high prevalence of workplace bullying in this sample with one out of four being classified as victims of bullying. The findings indicated that the victims of bullying were more often diagnosed with major depressive disorder (MDD) and reported higher levels of psychological symptoms, and lower levels of resilience. In addition, the victims reported more frequent alcohol use than the other patients, although both groups scored within what is considered normal alcohol consumption. Furthermore, twice as many of the bullied patients were on full sick leave and they reported lower work ability, a lower RTW-SE and less job satisfaction, as compared to the other patients. Additionally, the majority of the victims of bullying reported that they would prefer another job over the one they currently had. This further indicates that these individuals represent a vulnerable group at risk of sick leave and that there is a high possibility that if these concerns are not addressed these individuals have an increased risk of losing their foothold in working life. Thus, there is a need for studies to investigate whether individual factors, such as resilience, acts as a buffer with regard to these severe symptoms and complaints, in addition to studies investigating whether these individuals could benefit from the same treatment as other patients with CMD, not exposed to bullying.

The second study was, therefore, designed to investigate the effect of resilience as a protective buffer in the expected and negative relationship between workplace bullying and RTW-SE, as there have been mixed results on the effect of such individual protective resources when faced with workplace bullying. Thus, the study aims to examine whether resilience will show a reversed buffering effect for the bullying – RTW-SE relationship. The same sample as in study one was used. The results showed a negative relationship between bullying and RTW-SE and a positive main effect for resilience, as patients with high resilience scored significantly higher on RTW-SE than patients with low resilience irrespective of levels of bullying. Furthermore, the results indicated that the resilience sub-dimension, personal resilience, moderated the bullying – RTW-SE relationship, while the sub-dimension, interpersonal resilience, did not. Thus, this suggests that patients with high personal resilience showed relatively lower RTW-SE scores when being exposed to bullying behaviours by comparison with those individuals with high personal resilience that were not subjected to bullying. This would indicate that also groups with high personal resilience are affected by a stressor as severe as workplace bullying.

The third study was therefore designed to investigate whether victims of workplace bullying benefit from MCT or CBT with work-focus, in terms of symptom reduction and change in workplace participation. The study used a sample of 423 patients from the same outpatient clinic in Norway and data were collected pre-treatment and post-treatment. Two comparisons were made in the analyses; firstly, we compared the victims of workplace bullying with patients not exposed to bullying, secondly, we divided the victims of workplace bullying into a treatment group and a waitlist control group. The results showed that the treatment was effective in terms of reducing symptoms of depression, anxiety, and subjective health complaints for the victims of workplace bullying to a similar degree as for patients not exposed to bullying. Furthermore, the victims of workplace bullying receiving treatment exhibited a significantly greater improvement compared to the waitlist control group. However, looking at patients who had been on sick leave pre-treatment, fewer of the victims of workplace bullying did return to full work post-treatment (45.7%), as compared to the other patients (66.0%).

Findings from this thesis have several important implications. Many patients seeking ordinary clinical treatment for CMD, will most likely have severe experiences with workplace bullying. They may even present with more severe health complaints than other patients. Personal resilience, although generally being an individual resource, seems to be relatively less of a resource for the more severely exposed victims. Yet, a general therapeutical procedure with MCT or CBT with work-focus seem to be as highly effective for victims of bullying as for other patients, at least in terms of symptom reduction. Yet, these patients may in addition need help in changing their employment or in handling a bullying situation at work.