Using intervention mapping to deconstruct cognitive work hardening: a return-to-work intervention for people with depression

Mental health claims in the workplace are rising, particularly those due to depression. Associated with this is an increase in disability costs for the employer and the disability insurer, but even more important is the human suffering that results. While treatments are available for the depression there is a gap in interventions that specifically target return-to-work preparation. This paper presents cognitive work hardening, a treatment intervention that can bridge this gap by addressing the unique functional issues inherent in depression with a view to increasing return-to-work success. Cognitive work hardening applies the proven principles of classical work hardening (which has typically been applied to people with physical injuries) to the mental health domain. This paper explains how the occupational therapy principle of occupation and the core competency, enablement, are utilized and applied in cognitive work hardening. Key skills of the occupational therapist are also discussed. In addition, the paper considers the relationship of cognitive work hardening to recovery and mental illness, and the role it plays among workplace-based return-to-work interventions in the current movement toward non-clinical return-to-work interventions.