The Psychology Behind Recovery

By O2X Mental Performance Specialist Stephanie Zavilla

It is a hard truth that injury is an ever-present entity within physically demanding jobs, so it is important to fully understand its scope, and even more important to hone in on what actions you can take to successfully navigate rehabilitation and return to work.

The biopsychosocial model (Weise-Bjornstal et al., 1998) is a helpful lens through which to view injury, and can provide insight into techniques and interventions that can help you successfully walk the road to recovery. Injury touches every aspect of psychological functioning in some way. For example, the way you perceive and think about your injury will affect your mood and motivation throughout the rehabilitation process, which will impact how you choose to spend your energy and attention, resulting in either a successful or unsuccessful outcome.

COGNITIVE

• Goal adjustment (“There go my plans to run that 10k”)

• Pressure (“I have to get back as soon as possible”)

• Perceptions of challenges (“My PT says that balancing on one foot is a huge step, but seriously? I still have so much farther to go”)

• Catastrophizing (“I’ll never get back to the level I was performing at before”)

EMOTIONAL

• Grief cycle (denial, depression, anger, etc.)
• Fear of reinjury/return (which can lead to cautiousness and/or favoring the “good limb” and putting it at more at risk for overuse/injury)
• Mood swings
• Emotional fatigue

BEHAVIORAL

• Social isolation
• Substance use
• Exercise dependence (or on the flip side, a lack of motivation to stick to PT)

OUTCOMES

• Reinjury
• Successful return
• Career shift/termination
• Chronic pain

So now what? How does knowing all of this help? Well, recognizing that the way you think and feel about your injury can impact your subsequent behaviors and resulting outcomes offers an opening for intervention.

Psychological Recovery Hacks

• Healing imagery: Just like you might imagine a movement or skill before you perform it to increase confidence and mentally “rehearse” what you’re about to do, studies show that healing imagery can be very helpful in the recovery process. Benefits include improved mood, decreased pain, decreased anxiety, improved immune response, etc. (Dworsky & Krane, 2018). HOW TO DO IT: Take a few deep breaths in a quiet, comfortable environment. Imagine swelling leaving the injured area, ligaments fusing strong as steel, bones healing, red pain being replaced with cooling green energy, etc.
• Breathing: Injury puts a lot of stress on the body, sending your system into “fight or flight,” with increased heart rate, muscle tension, etc. Diaphragmatic breathing is a self-regulation tool that will boost the immune system, reduce anxiety, enhance focus, and decrease stress (Moss & Shaffer, 2007). HOW TO DO IT: Place your hand on your belly, and slowly inhale, counting to 4 seconds. As you inhale, your belly should expand/rise. Pause for a moment at the top of the inhale, then slowly exhale, deflating the belly, and counting to 6. The longer exhale engages the parasympathetic nervous system, counteracting the “fight or flight” response.
• Meditation: If you find yourself ruminating on negative, unhelpful thoughts, train your focus through meditation. Meditation teaches the ability to refocus attention when the mind inevitably drifts. HOW TO DO IT: Apps like Headspace can guide you through specifically tailored meditations, with 1 minute refocus meditations to longer, deeper sessions. You can meditate anytime, anyplace, by simply choosing to put your focus and attention on something (i.e. sounds, your breath), and gently bringing your focus back whenever you find yourself distracted. How does this relate to injury? You’re doing PT, find yourself riddled with negative thinking, take a deep breath, and choose to refocus your attention on the task at hand.

No doubt, injury is a tough break. However, by focusing your attention on what you can do instead of what you cannot do will help you feel more in control of the recovery process, more motivated to put in the physical recovery work, and will increase your chances of a strong, confident, and healthy return.

References:

Biopsychosocial Model of Injury:

• Weise-Bjornstal DM, Smith AM, Shaffer SM, Morrey MA. An Integrated Model of Response to Sport Injury: Psychological and Sociological Dynamics. J Appl Sport Psychol. 1998;10(1):46-69.

Healing Imagery:

• Dworsky, D., & Krane, V. (2018). Using the Mind to Heal the Body: Imagery for Injury Rehabilitation. https://appliedsportpsych.org/resources/injury-rehabilitation/using-the-mind-to-heal-the-body-imagery-for-injury-rehabilitation/

Heart Rate Variability:

• Moss, D. & Shaffer, F. (2007). Psycholophysiology & General Health Heart Rate Variability.