Short answer: A frontline healthcare worker on long-term disability (LTD) with severe anxiety, who could not leave home, started a new job within 12 weeks of referral to Creative Therapy Consultants. Occupational therapy began online, moved to the clinic, then added graded exposure, a change of vocational direction agreed with the LTD insurer, and hands-on job search support.
The short version
- Who: a frontline healthcare worker in BC with anxiety linked to long-term exposure to the drug toxicity crisis at work.
- Starting point: unable to leave home, with a return to their previous job not feasible.
- Approach: virtual OT, self-management strategies, graded exposure, vocational assessment and job search support, in partnership with the LTD insurer.
- Outcome: a new job within 12 weeks of referral.
Identifying details have been left out to protect the client's privacy.
Background
A worker in a frontline healthcare role in British Columbia developed significant anxiety linked to long-term exposure at work to the drug toxicity crisis and its effects on the healthcare environment.
Their distress and functional limits grew to the point where they couldn't leave home or take part in normal community activities. At referral, going back to their previous job was not considered realistic.
Their long-term disability (LTD) insurer referred them to Creative Therapy Consultants for occupational therapy. The goals were to improve day-to-day function, reduce avoidance and explore a pathway toward work.
Occupational therapy assessment and intervention
The OT built a progressive, individualized program to restore daily function, rebuild confidence and support a sustainable return to work.
1. Starting online
Because the worker couldn't leave home, therapy started virtually.
Early sessions focused on building rapport, understanding the barriers to daily function and finding a manageable starting point.
The OT set small, achievable daily goals to gradually increase activity, build a routine and restore confidence with everyday tasks. The emphasis was on steady progress, not on pushing the worker into the community too soon.
2. Functional restoration and self-management
As confidence and activity tolerance grew, sessions moved in person to the clinic.
The OT helped the worker build a practical self-management toolkit: strategies to recognize and manage anxiety, regulate distress and handle difficult environments.
Step by step, the worker became more confident leaving home, getting to appointments and doing things outside their comfort zone.
3. Graded exposure and getting back into the community
A structured desensitization program targeted the environments linked to the worker's experiences at work.
This included graded exposure to the downtown core, where visible drug use and related cues were major sources of anxiety.
Exposure was stepped up in line with the worker's tolerance, with a focus on practical coping strategies and reducing avoidance. Over time, the worker regained confidence moving through community spaces and doing things that had felt out of reach.
4. Vocational assessment and return-to-work planning
As rehabilitation progressed, the OT assessed the worker's readiness for work.
Functional assessment and a discussion of job demands made it clear that returning to the previous frontline healthcare role was not an appropriate or sustainable goal at that stage of recovery.
The OT shared these findings with the LTD insurer and recommended exploring other employment instead. The insurer agreed to support a change of vocational direction and help identify alternative work.
5. Job search and vocational rehabilitation
The OT then supported the practical side of moving into new work, including:
- Updating the resume.
- Identifying transferable skills and strengths.
- Exploring suitable alternative jobs.
- Interview preparation and confidence building.
- Strategies to manage anxiety during the job search and interviews.
The OT helped turn the worker's healthcare experience into a vocational profile that could support work outside frontline care.
Outcome
Within 12 weeks of referral to Creative Therapy Consultants, the worker started a new job.
They went from being unable to leave home to taking part in community activities on their own, preparing for work and securing alternative employment. Key outcomes:
- Able to leave home and take part in community activities.
- Practical anxiety management and self-regulation strategies.
- More tolerance for places they had been avoiding.
- A more appropriate and sustainable vocational direction.
- New employment within 12 weeks of referral.
The result was a significant functional and vocational improvement, and it shows why LTD rehabilitation needs to address both psychological barriers and practical employment needs.
What the evidence says
The approach is consistent with research supporting integrated, work-focused rehabilitation for people whose anxiety or other mental health conditions keep them out of work.
- A 2024 systematic review of work-directed interventions for people on sick leave with depression, anxiety and stress-related conditions found that work-focused CBT and team-based support could improve return to work compared with standard care, although the certainty of the evidence was low [1].
- A randomized trial of 631 people on sick leave with depression or anxiety found that integrating vocational rehabilitation with mental healthcare led to more people in work at 12 months (56% compared with about 44 to 45%) than mental healthcare alone or usual services. It did not speed up the return to work, and the advantage over usual services had faded by the 24-month follow-up [2].
Together, these findings support an integrated approach that addresses daily function, community participation, readiness for work and realistic job options. They also support recognizing when a return to the previous job isn't the right goal.
Why this case matters
This case shows how occupational therapy can bridge psychological recovery and getting back to work.
For people with significant anxiety and a long time off work, rehabilitation may need to start with basic daily function and build gradually toward the community and then employment.
Successful rehabilitation doesn't always mean going back to the same job. Sometimes the most sustainable outcome is finding a better-fitting direction and supporting the move into new work.
Through individualized rehabilitation, graded exposure, functional goal setting and close work with the LTD insurer, Creative Therapy Consultants helped this worker go from being largely housebound to a new job within 12 weeks of referral. See insurers and long-term disability, vocational rehabilitation and counselling and mental health, or make a referral.
References
- Björk Brämberg E, Åhsberg E, Fahlström G, Furberg E, Gornitzki C, Ringborg A, Skogman Thoursie P. Effects of work-directed interventions on return-to-work in people on sick-leave for common mental disorders: a systematic review. International Archives of Occupational and Environmental Health. 2024. doi:10.1007/s00420-024-02068-w
- Hoff A, Poulsen RM, Fisker J, Hjorthøj C, Rosenberg N, Nordentoft M, Bojesen AB, Eplov LF. Integrating vocational rehabilitation and mental healthcare to improve the return-to-work process for people on sick leave with depression or anxiety: results from a three-arm, parallel randomised trial. Occupational and Environmental Medicine. 2022;79(2):134-142. doi:10.1136/oemed-2021-107894