Coordinating Occupational Rehabilitation: The Role of Cognitive-Behavioral Therapy

Abstract

A revolution in rehabilitation is occurring as the twentieth century gives way to a new millennium. It involves a renaissance of the integration of knowledge and techniques from different disciplines where the whole is thought to be greater than the mere sum of the parts. It is driven by the vital need to provide high quality, effective occupational rehabilitation. This special issue is dedicated to examining what contribution psychology may make in this noble effort. The role of cognitive-behavioral therapy (CBT) in occupational rehabilitation and pain management is seldom questioned, and yet there is surprisingly little written about how these techniques are incorporated into a program (1). Programs, however, vary greatly. Some traditional programs provide little in the way of psychological intervention while others limit the use to therapy with individual patients. At the other end of the gamut are centers that integrate the various disciplines so that a cooperative treatment is provided where cognitive-behavioral therapy penetrates the entire program. Integrating different disciplines unique contributions to rehabilitation is not always easy, however, and this may be why there is such variation. Although cognitive-behavioral therapy has been shown to be effective for chronic pain, few studies have addressed the question of its specific contribution to occupational rehabilitation. Several reviews show that cognitive-behavioral approaches, usually in multidimensional pain clinic settings, are relatively effective in reducing pain, increasing activity levels and returning patients to work (2-6). However, there is a need to gain more knowledge about how these techniques are best applied in an occupational rehabilitation setting. Advancements in the application of cognitive-behavioral techniques might be enhanced by developing new applications and empirically testing the results. Only a handful of the techniques commonly used in CBT are regularly used in the area of pain. Moreover, as pointed out above, little research has actually examined the specific effect of these. A disappointingly low level of interest has been shown for