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The ultimate goal of PTSD (posttraumatic stress disorder) therapy is to get the person back at work and functioning normally. This will be successful only if each step is done correctly.

Return to work and normalcy

The first step is to expose the injured worker to the situations and sensations that trigger his fears. Determine the activities that cause anywhere from mild to severe symptoms such as getting dressed for work the day of the traumatic event, driving to the scene and walking into the building where the event occurred. Guide the injured worker to visualize each event multiple times and physically expose him to the activities. This exposure to uncontrolled situations must be overcome before the worker can return to function.

Once the worker and therapist determine the injured worker is ready, he will gradually assimilate into work and his normal routine. Returning to work and normalcy cannot be done without proper forethought. It is the final step in the PTSD therapy process.

Accommodations

Throwing an injured worker with moderate to severe PTSD symptoms back into his regular job can be counter-therapeutic. While he may be ready to go to the job and take on some of his regular tasks, he must be gradually assimilated into the activities that might trigger his PTSD. For example, if he experienced a store robbery, he may need time before he can again work around the public, or he should avoid working around cash for a while. In the interim, he can do other tasks with colleagues. A First Responder who experienced a tragedy might need to work with a partner for a while before he can work on his own.

Additional accommodations that should be considered may include:

  • Daytime hours only
  • Space for the worker to make support calls if necessary
  • Adjustments to the work station
  • Reducing the number of non-essential tasks
  • More flexible work schedule
  • More consistent work schedule
  • Noise-canceling devices

Employers, supervisors and colleagues should be apprised of and educated on the worker’s situation to the extent possible without violating privacy rules. Having an understanding of PTSD helps provide a work environment that is best for the injured worker. For example, some recovering PTSD workers may have cognitive challenges that require understanding and help. The worker may need extra time to finish certain tasks or may do better with assistance. Reducing distractions may help him concentrate. Making lists and creating small goal-oriented tasks can be helpful. Setting reminders on a computer can also benefit the worker.

The worker may be easily startled, so positioning his work station against the wall or providing a mirror might help him feel more in control. Offering positive feedback when warranted is also beneficial.

In addition to creating a positive, accommodating work environment, it is important to encourage the worker to get back to his normal activities outside of work. Shopping, driving, banking and cooking are some of the activities the worker may have been avoiding since the traumatic event occurred. Doing as many of these as possible will expedite his return to function.

Conclusion

A carefully controlled therapy plan will be successful if each step is done correctly. The injured worker needs a safe place to process the activities surrounding the traumatic event in order to fully recover and should not be exposed to uncontrolled situations too quickly.

IMCS is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.