Passive approach / low self esteem / poor self efficacy |
  
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Passive approach / low self esteem / poor self efficacy |
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A person with low levels of confidence is more likely to be passive in their approach. They are more likely to wait for others to take action and advise them of the next steps. People low on confidence are also less likely to believe they can deal with obstacles, overcome barriers, and sort things out themselves. They are less likely to look for ways to deal with problems that arise. This further diminishes the chance of success in difficult situations.
They are also more likely to internalise frustration and be distressed with their situation. In turn, this distress can inadvertently lead to increased treatment and delays in return to work.
People who are distressed convey their problems in a variety of ways. The language used in describing pain, for example, is more emotive. The pain may be described as terrible or dreadful. The individual is more worried about the future, about outcomes and often withdraws from common activities. This heightens their distress. They report more difficulties coping with life and press for remedies.
Treating practitioners aim to help people. Faced with heightened reports of pain, doctors feel compelled to 'do something'. People who are distressed are more likely to have an increased number of investigations and a greater amount of treatment. Treaters want to help, so they do what they are trained to do, attempt to identify the problems and sort things out.
Unfortunately medicine is relatively ineffective for many common musculoskeletal conditions. Investigations don't necessarily help and often leave the person more worried. Treatment can assist in some situations but quick fixes are uncommon.
Best evidence tells us many musculoskeletal conditions improve with time, but many take a year or two to resolve. More investigations and treatment raise expectations that a specific problems will be identified. And in turn that the condition will be resolved by a treatment.
Treatment without positive results causes increased worry, focuses the person's mind on the problem, and contributes to poorer outcomes.
The focus on identifying specific conditions and 'fixing' the problem through treatment commonly delays the focus on return to function and return to work. Making the problem better becomes the focus. The person is the passive recipient of treatment that hope to fix the condition. Whereas scientific research tells us that recovery is best achieved by advice and explanation, that supports the person with an understanding of their condition, while focusing on return to function.
Many people don't realise the potential consequences of delaying their return to function and work. It seems natural to them to expect treatment to sort out the problems, so they forget about work and focus on getting better. However the habits of getting up, of attending work, interacting with colleagues are lost within a matter of weeks. The downward spiral into isolation, despondency, and long term disability happens quickly without effective management.
Yellow flags: Predictors of chronicity
Beliefs:
| • | that there is major underlying pathology |
| • | that avoidance of activity will help recovery |
| • | that there is a need for passive physical treatments rather than active self-management |
Emotional response:
| • | depression, anger |
| • | blame, being a victim |
| • | frustration |
Other factors:
| • | perceived inconsistencies and ambiguities |
| • | family problems |
| • | other health problems |
