PTSD Series Part 4: Case Study

PTSD Series Part 4: Case Study

Occupational Therapists’ unique occupational lens and focus on empowerment and promotion of health and well-being makes them ideally placed to work with persons with Post-Traumatic Stress Disorder (PTSD) as they work to regain control over their lives. A proper Occupational Therapy assessment can assist the employer and employee in discussing suitable adjustments to the work and safety in return to work. An Occupational Therapist can also develop a suitable plan with your workplace stakeholders and healthcare team to ensure that the employee is safe and productive and the plan is well monitored.

Below is a case study written by one of our Occupational Therapists who has extensive experience working with employees with PTSD and creating return to work plans. Note that names and other personal identifiers have been changed to protect employee health confidentiality.

The Client

Client: David is a 36-year-old man who has been off work since 2016 suffering from Post-Traumatic Stress Disorder (PTSD) following a traumatic assault incident while on the job that significantly threatened his safety.

Role: Public Transit Bus Driver

Presentation at Intake

Three years following the incident, David was finally referred to Occupational Therapy. At the time of referral, he had been resistant to treatment and initially was trying to manage his own exposure therapy treatments under the guidance of a psychotherapist. It was thought that David had reached his maximum psychological recovery at the time of the referral to Gowan Consulting. The hope was that Occupational Therapist would bring about more substantial functional gains and restore some quality of life for David. The referral source and the assigned Occupational Therapist were not anticipating that return to work was a realistic goal.

At the time of referral, David was meeting weekly with his psychotherapist and had been doing so for three years. He was engaged in some driving exposure between two large urban centers that involved highway driving. He was spending time at home doing outdoor yard work and taking his children to their activities. He was assisting his wife with some indoor housework. He spent a majority of his time in the safety and comfort of his own home.

Barriers to Return to Work

The barriers to David’s return to work initially included the following:

  • Difficulty coping with stress, anxiety, avoidant behaviours to triggers including being in busy crowds, driving in busy congested areas, being around transit buses.
  • Difficulty concentrating
  • Lack of assertive communication and interpersonal communication skills
  • Sleep difficulties, fatigue, low energy
  • COVID-19 pandemic restrictions, which impact treatment and exposure goals in the community
  • Family stress, including being the primary caregiver to his partner who was experiencing health issues

Focus of Sessions

Phase 1

Based on a thorough initial assessment, it was determined that realistic Occupational Therapy goals in Phase I of the program needed to be focused on recovery and reactivation. Reactivation OT Goals included improving David’s sleep and nutrition and increasing his engagement in social and physical fitness activities. With Occupational Therapy education, problem-solving, and strategizing, David eventually established a healthy sleep wake routine, began eating healthier meals, initiated walking more, and began socializing more with friends and family. He also started volunteering two days per week at his children’s school. The Occupational Therapist was able to achieve these successes with David by using Cognitive Behavior Therapy Strategies and Dialectical Behavior Therapy Skills training as well as solution-focused goal setting and problem solving.

Phase 2

Phase 2 of David’s rehabilitation was focused on work exposure activities, including driving to/from a transit location in the city he had been working in. The exposure began with simply touching and boarding buses. He was introduced to watching transit training videos. A big part of his Occupational Therapy homework was engaging in imaginal exposure, which involved recording and reading back details of the incident that occurred at work.

As part of his work exposure, David wrote a letter to the CEO of the transit organization asking for his assistance in accommodating him back to work. David’s insurer had, to that point, been unsuccessful in finding an accommodated role that was a good job fit. David’s letter to the CEO was well received and successful; he was offered a new, work-from-home accommodation job that allowed for a graduated return to work. The new position was a great job fit and met his documented functional and medical restrictions. David’s new position even paid better than his transit driver position!

David’s determination to overcome his PTSD and willingness to implement therapeutic strategies and skills taught by the Occupational Therapist empowered him to take a difficult step and submit a direct request to senior management at his place of work. The combined factors of David’s newfound assertiveness and resilience, an Occupational Therapist who recognized his potential and was willing to think outside the box, along with a supportive employer, resulted in a significant return to work success after an extended period of time off work and a poor to guarded prognosis.


The following Occupational Therapy strategies implemented were highly successful:

  • Strategically and successfully collaborating with the insurer and employer, allowing the Occupational Therapist and employee to access to the workplace for exposure therapy
  • Employee was highly engaged and committed to improving his skills
  • Psychoeducation using distress tolerance skills and other DBT skills
  • Collaboration and support from the treating psychologist
  • Patient and persistent graded approach to Occupational Therapy treatment

Next Steps

To date, David and the Occupational Therapist have completed 77 sessions and continue to meet once weekly to ensure success during the return to work phase of intervention. David is now in Phase 3 of his recovery and rehabilitation. The focus of Occupational Therapy intervention is supporting the employee back to his new accommodated role and assisting him with making his return to work successful and sustainable.

How Can Gowan Consulting Help Your Employees?

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 for upcoming sessions and webinars.

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