Psychosocial Factors That Can Delay Injured Worker Recovery

Many studies show that there is a correlation between behavioral health and physical health, which is an issue that often carries over into workers’ compensation claims. There are several other factors that play into a patient’s pain and disability besides the underlying medical diagnosis, often referred to as psychosocial issues. This term refers to a patient’s psychological and social issues that affect their recovery from the physical or biological effects of an injured worker.

“While many patients develop psychological problems as a result of their injury, others might have psychosocial issues from day one that interplay on their recovery,” said Mitch Neuhaus, Senior Vice President of Claims at Safety National. “These factors must be closely monitored and addressed when identified, otherwise they could adversely affect recovery. It is important to identify them early and address the appropriate factors to help employees regain their quality of life, heal, and return to work when possible.”

Identifying Psychosocial Factors

Psychosocial factors typically are not the exception to a workers’ compensation claim. They are prevalent in many cases, therefore it is important to screen for them in an attempt to identify the probability that injured workers might develop problems during their recovery process.

There are several screening tools and questionnaires that will help identify psychosocial factors like:

• Catastrophic thinking and low expectations of recovery. This can occur when the individual cannot stop seeing the worse in everything or constantly thinks about what has happened to them or their injury.
• Fear-avoidance beliefs that impact the behavioral response to pain and associated fear of re-injury. This materializes when movement hurts, so people stop moving.
• Perception of work, which often includes work dissatisfaction or fear that the employee will be reprimanded for their injury.
• Perceived injustice that something wrong was done to the individual.

Diminishing Psychosocial Factors

Carefully listening to understand what the employee is experiencing can help determine which approach to take. This could include:

• Uncovering which psychosocial conditions are driving the behavior. Is it depression, anger, fear of pain, unwillingness to consider light duty, poor compliance with therapy, or something else?
• Intervening proactively to increase the possibility of altering the injured worker’s thought process.
• Helping to adjust thought behavior. No one can convince people to heal. They must be shown by helping to create structure, planning activities, and creating consistency. Patients who are actively engaged in their recovery are proven to have measurably better outcomes.
• Focusing on positive expectations so that the employee believes in the program and is motivated to return to work.
• Helping the patient re-envision and re-engage with their behavioral life role. Their healing process depends on their perception of getting back to normal. Determine which activities can be worked into their treatment and healing process.

Treatment Options

Low- and moderate-risk individuals can usually be managed with proper education, but high-risk candidates might require additional resources to prevent them from becoming long-term chronic pain or disability patients.

The intent of the process is to identify and manage the cognitive, behavioral and psychosocial factors that interfere with recovery from the employee’s physical impairment.

One treatment protocol option that has shown to be effective is Cognitive Behavioral Therapy (CBT). This treatment focuses on techniques to change thinking patterns that might adversely affect the patient’s response to pain, such as getting the injured worker to change their view of an injury from overwhelming to manageable. It might also teach behavioral skills like relaxation or biofeedback in an effort to assist them to self-regulate psychosocial stimulation as well as pain.

These tools can teach injured workers to monitor maladaptive thoughts and substitute them with positive thoughts. Most importantly, this therapy can be used to convince the employee that treatment is relevant to their problem, and that they need to be actively engaged in the process. If they do not buy into the treatment regimen, then the results can be poor, regardless of the appropriateness.