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Reducing Psychological Injury
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Some people recover as expected…some with similar
injuries spiral down into despair and dependency
• Why can’t we seem to do anything about it?
We can do it the way we always have –but do we want those results?
• Why is it that RTW rates never improve?
• Why is it that 2ndary Psych complicates so many claims?
• The experience of injury is stressful (and we make it worse)*
• The sympathetic nervous system is stimulated
• Reactions
– Physiological changes
– Safety/Survival
– Black and white thinking
– Aggression/hostility
Once the recovering person is here, it’s hard to focus on regaining his/her life
There’s a Better Way
• Understand a little about how we learn and react
• Translate it into small & easy changes
We “wire” our own brains
To focus attention, we have to select from all the input
When we focus repeatedly, we change the way we process information
“Practice Makes Perfect” =
“Neurons that fire together, wire
together”
Touch one – touch them all
• Everything practiced at the same time becomes associated together
• Touching any one point will trigger the whole network
– Thoughts
– Emotions
– Sensations
LOSS OF
CONTROL
PAIN
(fear of pain)ANXIETY
Anger, grief, frustration,
worry, catastrophic
thinking, perceived injusticeEnvironmental messages
(both internal and external)
Economic Pressure Specific
negative
messages
Loss of (work) Identity
Sleeplessness(fear of sleeplessness)
Psychosocial factors
The “Web of Disability”
Copyright 2015, Robert M. Aurbach
Loss of Personal Control Feels Like Being Threatened/Attacked
• Fight or flight reactions– Disengagement– Distrust– “Fast” thinking
• When it gets to be too much to handle– Secondary psychological
overlay– Adoption of another
identity that is more consistent with the experience
Our cultural
environment
often suggests
the role of
“Disabled
Person” to the
injured
The claims that are costing you time, money and heartburn
• 20% cost you at least 80%
• Not just “risk based allocation of resources”
• Stopping unnecessary creation of harm
Improving injury management
• Distrust*
– Avoid unnecessary repetition, surprise, needless restrictions
– Share information and allow choice to build a enhanced sense of control
Your job is to “change the script”
• We ask them to repeat, over and over – and then expect them to change….*
– Minimise repetition
– “That’s what happened. Let’s look to the future”
Treating Stressed people like “Econs”
• We assume that people will act in their rational best interests*
• People in “fight or flight” don’t act that way
• If we can help him/her quiet the reaction, he/she will react more predictably
Engaging the Parasympathetic Nervous System
• SCARF– Status : does the
recovering person feel valued?
– Certainty : Can you help him/her get a sense of the future?
– Autonomy : How much control can he/she have?
– Relatedness : Does he/she feel like your aims are aligned?
– Fairness : Do you do what you say and answer questions openly?
David Rock (2008)
It’s not that hard…
• “The worst is over”
• “I’m really sorry that this happened to you”
• “We both want you to get better and resume your old life as much as possible”
