Helping Employees Return to Work After Trauma

Adults with PTSD (Post-Traumatic Stress Disorder) may find themselves avoiding places, situations, objects, and people that remind them of the trauma or distress they experienced. They also might avoid thinking or talking about a certain topic. This can make it difficult for those experiencing PTSD to return to work, especially for those who experienced the trauma at work.

Unfortunately, avoidance just keeps the distress going and reinforces the notion that the trigger is dangerous. Exposure therapy is a recommended treatment strategy that healthcare professionals can provide employees to help them overcome this avoidance and re-engage with meaningful activity. Possible healthcare providers include psychologists or psychotherapists, who can assist with trauma processing, and Occupational Therapists, who can help with exposure therapy and return to work planning.

What Is Exposure Therapy?

Exposure therapy is an evidence-based intervention that is effective in reducing distress and anxiety and overcoming fears, as well as improving function and developing a sense of mastery and control. The goal is to master fears and tackle avoidance behaviors. It is typically done through graded exposure by grounding and habituation to reduce the association of the trigger and danger.

The Occupational Therapist or healthcare provider begins the process of exposure therapy by taking the following steps:

1. Build rapport with the employee to establish trust.
2. Educate the employee by introducing them to exposure therapy, the role of the Occupational Therapist, and the anxiety/avoidance cycle.
3. Develop coping skills and grounding techniques before exposure begins.
4. Generate a list of fears or anxiety-provoking situations, places, objects, and/or people.
5. Build a fear hierarchy by arranging the list from the least to most feared.
6. Exposure – face the fears.
7. Include the psychologist, if there is one, in the plan.

Considerations For Return to Work

When assisting employees with mental health issues, employers and Occupational Therapists should consider several factors that will influence return to work planning. The culture of the work environment must be considered. Workplace culture includes “the character, values, beliefs, traditions, attitudes, and behaviors of an organization, its leadership and its employees who contribute to the emotional environment, and how people interact in the workplace setting.”¹ Assessing how the worker fits into the culture is important in order to understand the impact on the individual and will influence the worker’s strategies to manage symptoms.

How the employee will be affected by stigma is also important to understand, as it is a huge issue for clients living with mental health issues. Sources of stigma may include co-workers, family, friends, and society as a whole. Self-stigma can also be a significant problem, leading to feelings of shame, hopelessness, isolation, and negative self-image. Stigma can prevent employees from reaching out for help or can hinder an individual’s progress in managing their mental health symptoms.

Another consideration to make is that in-person therapy in underserviced areas may not always be available. However, remote therapy is an effective and safe option. Virtual therapy can involve over the phone or video conferencing and is a method of therapy administered by clinicians widely and globally.

Stages of Treatment

Early Intervention: Allows the worker to return to healthy routine and regular self-care habits. The Occupational Therapist addresses the daily maladaptive behaviors (e.g., alcohol consumption) and introduces positive coping strategies to integrate into the home and work routine. In collaboration with the psychologist and family, a safety plan is set and a need for crisis intervention potentially averted.

Recovery and Re-Integration: The OT provides evidence-based psychotherapy with the goal to re-engage the individual in life roles and actively participate in household/family activities while using psychotherapeutic strategies to reduce distress and discomfort. The next phase may be to address reintegration into community life, including friends, family, and other daily activities. With a systematic, goal-oriented, and client-centered approach, the Occupational Therapist enables the client to identify meaningful activities that were of high value to him/her and improve feelings of self-worth and belonging.

Return to Work and Sustainability: In collaboration with the employee and employer, the Occupational Therapist assists in developing a gradual return to work plan. This plan builds on the employee’s strengths and resiliency while providing opportunity to develop confidence and work-based coping strategies.

What Can Employers Do?

• Take steps to prevent further onset of mental illness. Educate employees and employers through anti-stigma programs and resiliency training and implement policies and procedures to address mental health and wellness.
• Prepare for conversations with employees. Gather information about new changes in behaviour, consider the effects of the concern, and determine what assistance can be provided to the employee.
• Respond to employees in distress. Learn the signs of distress. Listen to the distressed employee with respect and patience, find out if the employee has a support system in place, and involve yourself only as far as you can go given the limits of your role.
• Maintain confidentiality. Recognize there is a stigma around mental illness and keep personal health records private and on a need-to-know basis.
• Offer support and assistance. Consider possible work adjustments, provide access to the EAP provider, and suggest that the individual contact their healthcare provider to seek assistance.
• Identify possible risks of suicide or harm. Encourage employees to reach out to distress lines for assistance and in critical situations, call 911. The Canada Suicide Prevention Service can be reached for help at 833-456-4566.
• Engage an Occupational Therapist to help. OTs can screen for decreased functioning with employees and assist with accommodations for affected individuals to continue meaningful work.

How Can Gowan Consulting Help?

Occupational Therapists provide interventions with a focus on functional assessment and restoration of physical, cognitive, behavioral, emotional, and social function in daily activities within the context of their environment and culture. Treatment may focus on facilitating an understanding of diagnosis and symptoms, integrating self-management strategies, as well as developing work-focused skills and strategies to optimize functional abilities of the individual within the workplace.  A primary focus of Occupational Therapy is the practical application of therapeutic strategies in daily activities to build skills for return to work or to support stay at work activities.

Gowan Consulting is committed to ensuring that workplaces are psychologically healthy. To learn more about how we can help with PTSD and other mental health concerns, please contact us. If you are ready to make a referral, please see our online referral portal. For mental health training for employers and employees, visit our website to see our current training opportunities.

References

[1] “OSOT Task Force on Mental Health and Return to Work,” Ontario Society of Occupational Therapists.

“Occupational Therapy: A Resource to Workplace Mental Health and First Responders,” Ontario Society of Occupational Therapists, July 2020.

“Prolonged Exposure Therapy for PTSD.” Foa, E, Hembree, E, Rothbaum, B Rauch, S. Oxford University Press 2019