Aimee Peters, LCSW, Chief Clinical Innovation Officer at Ascellus
When an employee suffers a work-related injury, the top priority is return to functioning and return to work. According to the Centers for Disease Control and Prevention, long-term disability is correlated with negative health and social consequences related to quality of life, socioeconomic status and even premature death. For obvious reasons, all stakeholders (the worker, the family, the employer, the third-party payor and more) benefit from an efficient resolution to injury claims. Studies have revealed that the statistical probability of returning to work diminishes dramatically the longer a worker remains off from work.
What is cognitive behavioral therapy?
A type of psychotherapy that challenges negative thought patterns about the self and the world to transform unsuccessful behavior patterns and/or treat mood disorders such as anxiety.
A review of the effectiveness of return-to-work treatments emphasizes the benefits of cognitive behavioral therapy for injured workers’ outcomes. After analyzing the results of 18 randomized controlled trials conducted primarily in Europe, researchers found significantly improved outcomes using psychosocial interventions for injured workers who experienced musculoskeletal or pain-related injuries accompanied by mental health issues. The most effective interventions were acceptance and commitment therapy (ACT) and work-focused, evidence-based cognitive behavioral therapy (CBT) that included psychoeducation and behavioral activation.
What is acceptance and commitment therapy (ACT)?
An empirically based psychological intervention encouranging psychological flexibility using acceptance and mindfulness strategies along with commitment to behavior change.
Researchers employed a method of systematic review established by the Institute for Work & Health, a Canadian not-for-profit research organization. Substantial evidence pointed to a marked reduction in lost work time and a decrease in workers’ compensation costs for patients who engaged in work-focused CBT.
In the review, researchers found three notable results concerning the effectiveness of including CBT in treating injured workers affected by musculoskeletal or pain-related injuries accompanied by mental health issues:
- Injured workers benefit from work-focused CBT. Return-to-work interventions help workers get back to work faster, with evidence indicating that workers who engage specifically in work-focused CBT have better RTW outcomes than customary care can provide.
- Moderate intensity interventions are preferred. Moderate-intensity interventions are more cost-effective and provide better results for injured workers than higher intensity interventions, which the study showed provided a negligible benefit. The study also noted that a particular CBT skill known as behavioral activation was effective in improving outcomes for injured workers who face these types of health issues and adds value when integrated with low-to-moderate intensity RTW interventions.
- The most effective RTW interventions include several attributes. Among the many interventions observed, the use of three characteristics prevailed as being vital to ensuring favorable RTW program outcomes: Work-focused CBT, Behavioral Activation, and Psychoeducation.
What is cognitive restructuring?
A guided imagery or socratic questioning psychotherpeutic technique which identifies and disputes irrational or maladaptive thoughts (also known as cognitive distortions such as overgeneralization, magnification or magical thinking.
The study referenced RTW guidelines from Compare, Safe Work Australia, CPT Insurance Regulator and Worksafe Tasmania. They recommend that evidence-based RTW interventions include early intervention and therapeutic CBT-based strategies, including psychoeducation, behavioral activation, problem-solving, goal setting and cognitive restructuring. Researchers believe that the latter three, while under-represented in the study, are beneficial for successful RTW interventions.
Researchers concluded that moderate RTW interventions that incorporate work-focused CBT, psychoeducation and behavioral activation exceed outcomes expected in customary care for injured workers experiencing musculoskeletal or pain-related injuries accompanied by mental health issues. For these reasons, researchers recommend incorporating work-focused CBT programs for these injured workers and using cognitive behavioral therapy for a time after these workers return to work to ensure continued improvement of on-the-job performance.
About Aimee Peters
Aimee Peters, LCSW, is the Chief Clinical Innovation Officer at Ascellus. Peters has nearly 25 years of clinical expertise, strategic acumen, product and program development and leadership in the behavioral health industry. She has pioneered virtual behavioral healthcare, increasing access and high quality behavioral healthcare to many of the US’s largest health insurers across all 50 states. Driven by a passion for promoting telehealth adoption, Aimee serves as an adjunct professor at Columbia University School of Social Work where she developed the University’s Telemental healthcare curriculum.
Ascellus is the leading behavioral health platform focused on helping injured workers restore their physical and mental wellbeing. By bringing people and technology together, Ascellus delivers customized treatment options through a national network of 1,500 licensed clinicians, reducing costs for workers’ compensation claims and empowering injured workers to return to work sooner.