September 26, 2022

A Primer on Behavioral Health Care in Workers’ Compensation

The Workers’ Compensation Research Institute (WCRI) published A Primer on Behavioral Health in Workers’ Comp, which addresses how behavioral health issues can delay a worker’s recovery and return to work, and increase medical costs.

This report utilizes interviews from stakeholders across the workers’ comp spectrum, as well as a review of occupational medical treatment guidelines, to examine behavioral health issues in workers’ comp, which range from psychosocial factors, psychological symptoms, and mental health diagnoses. The report also describes tools for early screenings for psychosocial factors and other mental health conditions, medical and non-medical interventions, and data needs.

According to the report, the most frequent behavioral health issue in workers’ comp are when psychosocial risk factors act as barriers to recovery following a physical injury, which can prolong disability and return to work. These factors include:

  • Poor recovery expectations
  • Fear of pain due to movement
  • Catastrophizing
  • Perceived injustice
  • Job dissatisfaction
  • Lack of family or community support systems

Interventions for psychosocial risk factors include early screenings for these risk factors, which can result in the patient being referred to a specialist that can help them focus on coping skills, stress management, and cognitive therapy. Job modifications, when applicable, can be of assistance, along with increased supervisor support.

Depressive disorders are reviewed as well, as stress resulting from chronic pain can be detrimental to patient wellbeing, with up to 85% of patients with chronic pain developing depression. Depressed patients often exhibit a poorer prognosis than non-depressed patients, which can increase disability and overall costs.

Among chronic pain patients, it is an overall recommendation by ACOEM and ODG that behavioral assessments and treatments be integrated into chronic pain management. Specific interventions can include cognitive behavioral therapy (CBT) – a group of psychotherapies that focus on modifying negative associations between how one thinks, feels, behaves, and physical symptoms – as it is the most researched behavioral treatment to show results in chronic pain patients.

Other treatment recommendations include:

  • Acceptance and commitment therapy
  • Biofeedback
  • Fear avoidance belief training
  • Interdisciplinary rehabilitation programs
  • The integration of antidepressants in combination with aforementioned psychotherapies

Post-traumatic stress disorder (PTSD), which is growing in prevalence in workers’ comp, can have long-lasting effects that can lower worker productivity and raise the risk of accidents even after return to work. PTSD can also increase the probability of developing costly chronic medical conditions such as hypertension, coronary heart disease, and metabolic syndromes.

Interventions for PTSD include:

  • Trauma-focused CBT
  • Eye movement desensitization and reprocessing, a form of psychotherapy that has the patient recall the specifics of a trauma while simultaneously focusing on external stimuli, such as therapist guided lateral eye movements
  • Medications in combination with psychotherapy and/or group therapy. This can include medications such as selective serotonin reuptake inhibitors (SSRIs) – such as sertraline (Zoloft®), paroxetine (Paxil®), and fluoxetine (Prozac®) – and serotonin-norepinephrine reuptake inhibitors (SNRIs) – such as venlafaxine (Effexor®)
  • Mind-body interventions such as mindfulness, yoga, and guided imagery

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