Enabling Access Blog


Cognitive Work Hardening - Helping Clients with PTSD Get Back to the Job of Living

Work Hardening in the rehabilitation world has widely been used to assist people with regaining physical capabilities in efforts to return them back to work, following injury or illness. We are seeing more and more people suffering from mental health issues, either as a result of having to live with their physical disability or from injuring or ending someone else’s life.


Rehabilitative treatment for clients who are physically injured may involve Work Hardening in a clinic setting to improve strength, coordination, endurance and pain tolerance, with their simulated job tasks. Often clients make good improvements in this type of intensive treatment program. Unfortunately, once they complete the program some folks still have difficulty returning to work, due to their mental health status.


Symptoms of depression, anxiety and anger are common barriers to successful Return to Work experiences. In these cases, clients are usually sent for psychological consult, to determine if regular treatment sessions are warranted. After much time, many beneficial sessions and several attempts of returning to work, we still see these clients struggling to work at the capacity they did prior to their accidents.


Cognitive Work Hardening is like the physical Work Hardening we see in the clinic, but it is conducted by an occupational therapist who works closely with the client in their place of work. The goal of Cognitive Work Hardening is to walk with the client, through their daily tasks, evaluating potential challenges, barriers and triggers that may result in exacerbating their symptoms of depression, anxiety, anger or other emotional distress.


In Cognitive Work Hardening, we can assist our clients by providing strategies for managing work flow, simplifying processes, dealing with coworkers, providing recommendations for clustering  like-energy tasks,  incorporating mental breaks, thought blocking, self-talk, and much more. The common goal is to increase productivity, motivation, confidence and reduce emotional pain and non-productive thinking that stems from emotional distress.


Just because the accident or incident that caused the client to be off work is in the past, doesn’t mean it's not presently running through that client’s mind several times a day. It takes both Body and Mind to heal from injury or loss and we should make sure we are treating both in our rehabilitative programs.



Marnie Courage, OT Reg (MB)

Managing Director

Enabling Access




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