Discussing psychosocial factors with patients requires a delicate touch. It’s crucial to frame these conversations positively, explaining that psychosocial factors influence everyone’s health outcomes. 

Here are some key principles to keep in mind: 

• use empathetic listening—show that you understand and validate the patient’s experiences 
• avoid judgement—present psychosocial factors as normal, modifiable aspects of the recovery process 
• be clear and concise—use simple language to explain complex concepts 
• encourage open dialogue—create a safe space for patients to express their concerns and ask questions
• focus on empowerment—highlight the patient’s role in their recovery and the modifiable nature of psychosocial barriers. 

Conversation toolkit 

Here are some tips for addressing psychosocial barriers. 

Addressing low self-efficacy 

‘Many people find it challenging to feel in control of their recovery. It’s actually quite common. 

How confident do you feel about managing your condition? Understanding this helps us work together more effectively.’ 

Discussing passive coping

‘There are different ways people handle their symptoms at home. 

Some approaches work better than others. 

What strategies have you been using? Let’s explore if there are active approaches we could add to your routine.’ 

Exploring workplace stress

‘Work can often be a source of stress, especially when you’re dealing with an injury. 

Have you noticed any changes in your work relationships or environment since your injury? 

Addressing any concerns can be crucial for a smooth return to work.’ 

Introducing the concept 

‘It is a surprise for some people but how you think about your condition affects your recovery as much as your body. 

It might seem unexpected but addressing these factors is important for the best approach to recovery.’ 

Addressing fear of movement 

‘It’s natural to be cautious about movement after an injury but too much caution can actually slow recovery. 

Have you noticed yourself avoiding certain movements? 

Understanding these concerns can help us address them effectively.’ '

Managing catastrophising 

‘It’s common for people to worry about their long-term recovery. These worries can sometimes feel overwhelming. 

What specific concerns do you have about your recovery? Identifying them can help us tackle them together.’ 

Tailored treatment approaches

Once you’ve identified psychosocial barriers through screening and discussion, it’s crucial to tailor your treatment approach
accordingly. Here’s a step-by-step guide to incorporating psychosocial factors into your treatment plan.

Step 1: discuss findings with the patient 

Explain how these factors might affect their recovery and why addressing them is important. This helps build trust and engagement in the treatment process. 

Step 2: adjust your treatment plan 

Incorporate exercises or techniques that specifically address identified psychosocial barriers. For example, if fear of movement is a key issue, consider a graded exposure approach to feared activities. 

Step 3: refer for additional support 

• Psychosocial counselling—for issues like anxiety, workplace barriers or low self-efficacy. 

• Pain management programs—for patients struggling with chronic pain. 

• Workplace rehabilitation provider—for assistance with workplace issues or return-to-work planning. 

• Case management support—for complex cases requiring additional coordination. 

Step 4: collaborate with other healthcare providers 

Organise case conferences with the treating doctor and other relevant professionals to ensure a cohesive, multidisciplinary approach. This can lead to better outcomes and more efficient care.

Step 5: set functional, work-specific goals 

Work with the patient to establish achievable milestones that relate directly to their job tasks. This helps maintain a focus on return to work and can improve motivation. 

Step 6: monitor progress closely

Regularly reassess psychosocial factors and adjust your approach as needed. This might involve readministering screening tools or having follow-up discussions about specific barriers. 

Step 7: consider workplace interventions 

If appropriate, suggest workplace visits or ergonomic assessments to address environmental factors. This can be particularly helpful in addressing workplace stress or fear of re-injury. 

Tailored interventions for specific barriers

Here are some specific strategies for common psychosocial barriers. 

Low self-efficacy 

• Set small, achievable goals to build confidence. 

• Provide positive reinforcement for progress. 

• Teach self-management strategies. 

Fear of movement 

• Implement graded exposure to feared movements. 

• Provide education on pain neuroscience. 

• Use cognitive behavioural techniques to address unhelpful beliefs. Workplace stress 

• Liaise with the GP to access psychosocial or psychological support. 

• Teach stress management techniques. 

• Consider gradual return-to-work programs. If there is a workplace rehabilitation provider involved, collaborate about strategies.  

Passive coping 

• Encourage active self-management strategies. 

• Set homework tasks to promote engagement outside of sessions. 

• Educate on the benefits of active versus passive approaches. 

Remember, if progress stalls despite these interventions, it may be time to consider referral to a specialist or back to the GP for reassessment. 

>>Dr Mary Wyatt is an occupational physician practising in Victoria. Significant contributions were made to this article
by members of the physiotherapy advisory group It Pays to Care: Rosemary Grant, Thomas Adler, Fleur Balmain, Wade Byrnes, Craig Elliott, David Elvish, Marcus Mancer and Des O’Shaughnessy.