Cognitive Behavioural Psychological risk factors

The psychological and behavioural risk factors for injury are not specific to overuse injuries, but can also be risk factors for acute injuries.

Health Anxiety and Cyberchondria

Health anxiety can cause injury because it can lead one unwittingly into the hands of either incompetent, misguided or careless interventions and because of undertaking health DIY (please follow this link because I think that this is such an important issue that I have devoted a whole page to it). Not getting the balance right between health under- and over-anxiety can be a potential source of injury, as I discuss below under the topic of complacency.

Inappropriate attitude towards risk

It is important to get the balance right between being too risk averse and not cautious enough. Often if we avoid one risk we expose ourselves to another risk because life is inherently full of risk. However not exercising due caution is also clearly not a good thing. This is a difficult area because if you don’t have the right information on which to base your decisions about whether to take a risk then it is hard to make a good decision. In terms of overuse injury is often difficult to get a diagnosis quickly. Sometimes when I have been faced with a decision about whether to take time off work because of an injury it has been difficult to make a decision because I’ve not had a diagnosis. I have responded to this pressure to work whilst being injured by going to work but trying to reduce the amount of stress on the affected area. This hasn’t always worked because I haven’t given myself enough time to sufficiently rest the injury so this kind of compromise when faced with a risk can sometimes result in an inadequate response.

Lack of Time

Rushing around whether on foot, in a car or on a bike is clearly risky. So many accidents happen simply because we don’t give ourselves enough time. In a broader sense taking a more gradual approach to things can often reduce stress.  Giving adequate time to rest after an injury is important, not just so that the tissues have enough time to heal but also to create some space for reflecting on what has happened, to make the necessary appointments and undertake your rehabilitation regime. This is where taking sick leave can be very important. Having time to think is vital so that one can make the right judgements about the issues one is facing.

A lack of time may be caused by not effectively managing the time that you’ve got. I think that there is probably a law of diminishing returns with a lot of activities which means that if you simply focus excessively on one thing you are neglecting other things. Sometimes it’s better to make sure that one is focusing on devoting some time to a range of different things so that important aspects do not become neglected, opportunities are not missed and risks are properly addressed.

Lack of Focus

i) Complacency. This is related to the above point about time, but is wider because it includes the lack of focus that can be caused by a range of factors including anxiety that diminishes one’s awareness of one’s physical environment and complacency.  It’s easy to get complacent if you get away with something. Every time you get into your car or onto your bike or if you are doing anything that is potentially dangerous you should be vigilant. Regarding overuse injuries, if you get over an injury it’s easy to become complacent. I recovered from RSI and may have fallen into this trap and have since learned that when injuries come back they are always worse than the first time. So the really is no room for complacency. However, becoming complacent is an integral part of the aetiology of an overuse injury because by their very nature there is a long buildup time when one is not experiencing any kind of discomfort or pain and so it’s easy to think that what one is doing is okay until one day injury suddenly hits hard and fast.

ii) Intuition. I read an interesting story about someone who managed to avoid the clutches of the infamous serial killers Ian Brady and Myra Hindley. The boy was lured into their house on the pretext being offered some food. When he was in the house he had a vague sense of unease, that something wasn’t quite right. He then made his escape and later discovered that Brady and Hindley were child killers and that he had narrowly missed such a fate.

Lack of Money

It’s important to spend money so that you have the right equipment that has been properly maintained when you are at work, undertaking a task or engaging in any kind of physical fitness training.

Over- and under- conscientiousness

Being too conscientious with work can make you push yourself too hard and then feel guilty about taking sick leave. Under-conscientiousness can encourage you to break rules, cut corners and not follow correct procedures around health and safety. You may even experience a mix of over-conscientiousness with the amount of work you are doing but under-conscientiousness in looking after your health and safety. This may be because the reasons behind health and safety rules have not been properly explained or because your low esteem means that you do not value yourself enough to look after yourself properly.

Low self esteem

Low self-esteem can manifest itself in different ways;

i) Firstly, lack of assertiveness. There are a number of ways in which a lack of assertiveness lead to injury. The most serious example is the case of violent assaults where you are more likely to be a victim if you have unassertive body language. I have sometimes been talked into lifting heavy objects where really I should have said no. Sometimes it is that simple you just need to say no and be direct. Another example is not taking sick leave at work when you have an injury. I think that this is about realising that you do have a right to take sick leave if you are unwell. In all these cases it’s about realising that you have power and rights just like everyone else and you can just say no and not let people bully you into things that are harmful to you or that you do not want to.

ii) Being competitive can be driven by a sense of low self esteem. It can lead to injury because it can encourage you to push yourself too far. A particular risky kind of competitiveness is wanting to appear macho. I guess the latter is is something that affects males more than females. It is dangerous because it can encourage you to take risks that put yourself in danger, whether through getting involved in an aggressive confrontation with somebody or wanting to prove your manliness by doing something that is beyond your limitations.

iii) Responding to inappropriate social pressure. This refers to how we can take risks because of feeling embarrassed or maybe not wanting to look different or weak in some way. An example is somebody who is about to have sex with someone but doesn’t want to suggest using a condom because they feel embarrassed about it.