the Web of
Reducing the Impact of Secondary Psychological Claims
Robert Aurbach
Principal Consultant
Uncommon Approach
Some people recover as
expected…some spiral
down into despair and
How can you impact the worker’s
What are “secondary psych”
Some claimants develop psychological “signs and
symptoms” in addition to their original condition
◦ Symptoms are what the worker reports
◦ “Signs” are the objective observations of a
trained medical professional and include the
results of objective testing
◦ The comparison of “signs” and “symptoms” for
consistency is an important part of claims
The secondary condition can be a more serious
blocker to return to work than the primary injury.
“Secondary Psych” claims are
 We
are addressing the
reason that some people
get better and some
people do not
Corporate perspective:
 Secondary
Psych is a
major cost driver
underlying most failure to
return to work and
extended incapacity
Personal Perspective:
 The
cases where there is an
unnecessary failure to
recover/resume normal life
make up the majority of the
20% of claims that cost about
80% of our time and resources
It’s helpful to understand
Secondary Psych better…
Without a model of what’s happening, all
you have is studies that show correlations
between various factors and disability.
 But
a model of how this happens
helps us to intervene effectively
We’ve learned a lot about how the brain
works in the last few years….
We learn almost every complex behaviour in
the same way
It’s been proven with experiments directly on
the brain
And proven by “miraculous” cures
– Stroke and head injuries
– Recovery from “phantom” pain
The brain has to make sense of a
 Everything
that is coming in at one
time is processed together
 The links between thoughts,
emotions, and sensations are links in
TIME, not in causation
First Law of Neuroplasticity
 Neurons
(brain cells) that fire
together, wire together” This is the
first law of neuroplasticity (don’t worry… there
are only two)
The brain cells that are linked together
are called a “neural network”
Neural Networks
 Have
you ever experienced a
song, a scent, or a picture that
brought up memories of another
time or place?
There is a change in the neural
connections with repetition
fire faster and more
Less “conscious thought” is involved
There is less opportunity for
examination of the reaction
Why “facilitated neural networks”
are critically important
When things are associated in facilitated
neural networks, the stimulation of one part
of the network fires all the things that are
linked into it
physical sensations (including chronic pain)
We learn almost everything this way
How to speak without thinking about how to
form the words
Playing music or sports
How to take the role of a “victim” or a
“disabled person”
How do we Learn?
“Practice Makes Perfect”
How much repetition is “enough”?
Changes in the brain begin to happen very quickly,
and more quickly when attention is focused
• “Mental rehearsing” is nearly as effective as physical
experience in creating and solidifying the neural
• This is the operational mechanism behind the
research on the impact of delay of return to work
(probability of return <50% after 12 weeks lost time)
The mental rehearsing turns out to be
the “most important” for
understanding disability
That’s where the opportunity to affect
the outcome is most often present
we call this
mental rehearsal
The “Web of Disability”
(fear of sleeplessness)
Loss of (work) Identity
Psychosocial factors
Economic Pressure
Anger, frustration,
worry, catastrophic
(fear of pain)
Environmental messages
Copyright 2012, Robert M. Aurbach
The “Simple” formula for Disability
 Negative
self-talk > ability to “overcome”
the negative messages = loss of control
 What
 Loss
does it feel like to be out of control?
of control is an intolerable state,
which requires a person to adopt a new
“identity” that is consistent with
“regaining control” under the
Our cultural
often suggests
the role of
Person” to the
If a new identity as a
disabled person is
resisted, then the strain
of living out of control
can be too much
That’s where we see the
development of secondary
psychological injury
There are two ways to prevent
adoption of the “Disabled” Mentality
or Secondary Psychological Injury
 Reduce
the negative inputs
(Interventions that influence how the
system impacts the worker)
 Change
the nature of the self-talk
(Interventions that look to bolstering the
workers’ “resilience”)
reducing the negative inputs
CAN have an
Fix things
before they get bad –
Early Intervention
“Fixing things” should be done
 Creation
of a “Web of Disability”
takes repetition
 Repetition takes time
 If the thought, emotion or sensation
is removed quickly enough, the new
“habit of thought” including it
doesn’t have time to become
Why Early Intervention Works
 Reduces
loss of work identity
 Reduces opportunity for specific
negative messages
 Reduces anger, frustration and
catastrophic thinking
 Reduces anxiety and sleeplessness
The “Second Law” of Neuroplasticity
The brain is wonderfully efficient and will
“recycle” resources that aren’t being used
“Use it or lose it”
Put someone back to work, and the habits
around staying home get replaced with
work routines and thought patterns
Why Return to Work is effective
 Reduces
loss of work
 Reduces economic
 Reduces anxiety and
Combination of
Early Intervention
(fear of sleeplessness)
Psychosocial factors
Loss of (work) Identity
Economic Pressure
Anger, frustration,
worry, catastrophic
(fear of pain)
Environmental messages
Copyright 2012, Robert M. Aurbach
Inadvertent actions in managing
the claim can
create needless disability
NONE of this is an issue of “fault” but most can
be reduced or prevented
◦ Delay
◦ Implied messages
◦ Driving the claimant into the hands of lawyers
◦ Failure to set positive expectations
◦ Failure to acknowledge and respond to what
they are experiencing
What can you do?
Be responsive and acknowledge
 Realise that no matter how many pending
files you have, his or her case is the only
one that is important to them
 Understand that your actions have a
massive impact on his or her retention or
loss of the critical sense of control over
his or her own life.
There’s a third line of
Changing the nature
of the self-talk
Research on Resilience
Data shows that people with high levels of
resilience were:
◦ Less likely to have time off following
◦ More likely to recover and return to work
◦ More emotionally and physically ready to
return to work
◦ Less likely to believe that someone else
was responsible for their injury/accident
What is “resilience”?
 The
literature has “defined” resilience by its
observed effects
 We
“foster” resilience by things like encouraging
people to “increase their self esteem” and
“promote good relationships“ and “be hopeful”
 This
circular approach hasn’t proven very
we call “Resilience” is really
the ability to resist negative self-talk
How does it work?
Repetition is necessary to make the
changes in the brain that are associated
with disability
 The repetition comes mostly from self-talk
 If we can build up the ability to quiet the
self-talk, the sense of loss of control
doesn’t get stimulated as much by the
claims environment
If the negative self-talk is
quieted, then it’s easier
to keep a sense of control
If people keep their sense of
control, they can “bounce
back” better from adversity
There appear to be four strategies
used (singly or in combination) by
resilient people in resisting negative
 Drown
out the negative messages (“Believer”)
 Change
the negative messages (“Reframer”)
 Make
the mind too busy to attend to negativity
 Create
separation of the sense of self from the
source of the negativity (“Distancer”)
We can tailor the
intervention to the
existing “resilience” style
By working with the injured
worker’s strengths, interventions
can empower -instead of creating
A “better” simple
Early Intervention/Return
to work + Maximizing
inherent resilience =
Substantially fewer
instances of unexpected
failure to recover
Thank you!
Robert Aurbach
[email protected]
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