We often talk about identifying the risk factors and intervening with injured workers early to prevent or help those with delayed recoveries. Some of these issues are obvious; aging, having a weakened immune system, or a history of joint problems, for example. But others may not be quite as apparent or self-explanatory, yet they can have a major impact on the outcome.
Psychosocial risk factors cover a wide range of conditions, such as depression, traumatic stress, and childhood abuse. Among the most telling are catastrophic thinking, guarding behavior and perceived injustice. There are vast amounts of research from the past couple of years that point to these as major indicators of a poor outcome, possibly even more so than the medical factors associated with an injury.
The good news is that cognitive behavioral therapy can be instrumental in helping patients overcome these factors. Understanding exactly what these are can help workers’ compensation practitioners get appropriate care to affected injured workers as soon as possible.
Ruminating about irrational worst-case outcomes, exaggerating the threat value of pain sensations, and feeling helpless to deal with pain are included in definitions of catastrophic thinking. It’s essentially anxiety run amok.
People who catastrophize believe in negative outcomes. They greatly exaggerate potential danger, whether real or perceived. In terms of their health, they believe the worst about any physical ailment before any medical tests are even done. They assume any physical peculiarity will be devastating and that they won’t be able to cope with it, and they become almost obsessed with it.
This type of thinking can actually lead to the outcome the person fears, as it can become a self-perpetuating vicious cycle. It also causes a spike in the stress hormone cortisol and decreases a patient’s ability to react effectively.
The types of statements catastrophizers may think or say out loud are:
- The pain is terrible and won’t ever get any better.
- I can’t cope with the pain.
- I can’t get the pain out of my head.
- Something must be terribly wrong with me.
Unless someone points out to the person that he is catastrophizing, he thinks his thinking is rational and necessary. Those who catastrophize feel pain more intensely than those who don’t.