Work Comp Today

Providing biopsychosocial care in a therapeutic community for those who need it most.

In this issue:

Accelerating Recovery Through Social Support

The Loss of Socialization Post-Injury

The Surgeon General has declared that we are living in an “epidemic of loneliness” (15). Injured workers know loneliness and isolation all too well, as isolation can quickly take a toll. Some studies find that loneliness and isolation can have adverse impacts within hours to weeks on multiple body systems, including cardiovascular, neuroendocrine, and immune systems (17,20).

Injured workers may experience isolation for various reasons related to their injury. When patients fail to recover within the typical timeframe for their type and severity of injury, they enter a state called chronicity (16). Injured workers may withdraw from activities they once enjoyed, spend less time with family and friends, and experience strained relationships, all of which increase stress. This creates a vicious cycle, as a lack of social support further entangles workers in what Bruns and Disorbio (2009) described as the biopsychosocial vortex—a spiral where physical, psychological, and social factors feed into one another, deepening the challenges of recovery. Chronicity, therefore, is worsened by social isolation.

Actual or perceived physical limitations, job insecurity, and lack of support from peers and family can intensify isolation and alter self-identity, leading injured workers to feel disconnected from their social circles. Workplace detachment and stigma surrounding their injury can magnify feelings of loneliness and alienation, delaying recovery and complicating rehabilitation efforts.

How Social Isolation Impacts Recovery and Workers' Compensation Claims

Social isolation has a profound impact on injured workers’ recovery and their workers’ compensation claims. Numerous studies also suggest that individuals with conditions like traumatic brain injuries and chronic pain tend to have poorer outcomes when they lack social connections (1,5,12,14). Such injuries, often associated with high levels of pain catastrophizing, can, when paired with feelings of hopelessness or frustration, lead to poor adherence to rehabilitation programs and diminished motivation to engage in recovery.

This lack of participation can slow the healing process and extend absences from work. For workers’ compensation, these delays and complications can lead to longer claim durations and increased costs. Socially isolated workers often face prolonged recovery periods, resulting in higher medical expenses, ongoing wage replacement benefits, and poorer long-term outcomes. Isolation may also worsen feelings of detachment from the workplace, making reintegration challenging once they return.

Cut off from workplace communities, friends, and family, injured workers may feel increasingly lonely. Pain, fear, worry, and depression can all weigh on them. They may lose their home connection as well as their work connection by (a) unintentionally lashing out at family or friends due to pain and fear or (b) self-isolating to shield others from the physical and psychological impacts of their injury. The loss of workplace identity can deepen isolation over time.

Additionally, barriers to receiving care are significant contributors to isolation and loneliness, as workers may feel unsupported in their recovery. For first responders, organizational betrayal—the perception that their institution has failed to support them—can compound these feelings of isolation, making recovery even more challenging.

Sarah Creighton
Institutes of Health, Director of Law Enforcement Services

Research consistently highlights that isolation is a common factor in delayed recovery and is associated with increased stress, depression, and even chronic pain (14,18,21). Workers with few coping skills for addressing physical or psychological challenges are more likely to experience setbacks, prolonging their recovery (3).

Addressing the negative social factors that perpetuate chronicity requires providing opportunities for interpersonal connection. Workers who incorporate social engagement into their rehabilitation are more likely to succeed in returning to work or pursuing educational goals (3,7).

The Biopsychosocial Model of Care

The biopsychosocial model of care (2) emphasizes the interconnectedness of biological, psychological, and social domains in achieving optimal health. In approximately 10-20% of workers’ compensation cases, recovery does not follow the expected timeline, and injured workers face obstacles that impede their progress. Engel’s model highlights that the social domain is crucial for fostering recovery by addressing isolation and promoting healing.

Improved Self-Efficacy and Engagement

Social support is vital for enhancing self-efficacy during recovery, helping individuals manage pain, adhere to rehabilitation programs, and navigate recovery challenges (6). Self-efficacy, which is closely tied to motivation, refers to an individual’s belief in their ability to complete specific tasks or overcome challenges (2). Workers with high self-efficacy are more motivated to engage in recovery activities, address obstacles, and persevere despite setbacks. This motivation, driven by confidence, helps them take active steps toward healing and returning to work sooner.

Key factors that build self-efficacy include:

Mastery Experiences: Successes during rehabilitation enhance confidence, reinforcing belief in their recovery abilities.
Verbal Persuasion: Encouragement from peers, healthcare providers, and supervisors can boost motivation.
Vicarious Learning: Observing others recover from similar injuries offers a model for success.
Physiological and Affective States: Positive mood reduces anxiety and stress, fostering a stronger belief in one’s recovery ability.

Strong social connections also empower patients through collaborative rehabilitation goal-setting that aligns with returning to work. Such connections provide emotional support, enabling individuals to cope with the frustrations and negative emotions of injury, allowing for a corrective emotional experience. This fosters adaptive thinking, increased self-management, and reduced healthcare utilization.

The Benefits of Social Support in Recovery

A wealth of evidence underpins the notion that social support significantly improves recovery outcomes. Social factors—such as healthy relationships, community support, and social integration—profoundly affect physical and psychological health. Research consistently demonstrates that people with strong social ties often experience faster recovery from injuries (21). Findings show that those with strong social ties are 50% more likely to report faster recovery times than those lacking social connections (11). Social interactions provide a sense of belonging and purpose, which helps reduce stress, anxiety, and depression (5,14,21). Workers who report high levels of social connectedness are more likely to engage in their rehabilitation and adhere to treatment plans (1,18,19,21). In the realm of workers’ compensation, this translates into faster recovery times and a quicker return to work.

Some Benefits of Social Support During Recovery

Social Bonding: There is a reciprocal relationship between group physical activity and social bonding. As individuals participate in group exercises, they forge new connections, deepening relationships outside of the workplace. These strengthened social ties can positively impact work performance and general well-being.
Endorphin Boost: Physical activity increases the production of endorphins—often called “feel-good” hormones. This boost in endorphins helps with pain management and improves mood, helping injured workers cope with the emotional challenges of recovery.
Fun and Recreation: Participating in physical activities can be enjoyable, providing a much-needed way for workers to unwind, reduce stress, and break from the monotony of recovery. When rehabilitation becomes fun, it is easier to stay engaged.
Health Benefits: Regular physical activity improves physical and mental health, including reducing symptoms of depression and anxiety. These mental health benefits are crucial for injured workers, as they can mitigate the psychological toll of being out of work or facing long recovery periods.
Economic Benefits: Physical activity can boost productivity and reduce healthcare costs. Regular exercise is linked to reduced mortality rates, decreased instances of sick leave, and overall lowered healthcare expenses, benefiting both employees and employers in the long term.
Cognitive Development: Martial arts, in particular, have been shown to enhance cognitive development by stimulating brain structure changes and offering opportunities for social interaction. This dual benefit supports physical recovery and promotes mental sharpness, which can improve job performance.
Work Productivity: Employees who engage in regular physical activity are more likely to experience improvements in both health and work productivity. This benefit extends to workers recovering from injury, as social support and physical engagement from group activities help facilitate a quicker and more effective return to work.

Yvonne Guibert

Vice President, Education Strategy
Institutes of Health

Yvonne Guibert is Vice President of Education Strategy at Institutes of Health (IOH). With over 25 years of expertise in the workers' compensation industry, she is renowned for her innovative approach to education and communication. At IOH, Yvonne harnesses her deep industry knowledge and passion to develop impactful educational programs, through webinars, conference sessions, and more. Her work brings the world-class clinical expertise of IOH to the industry, helping to advance understanding and improve workers’ compensation practices. Her strategic vision and leadership in educational initiatives have solidified her reputation as a key influencer in advancing industry knowledge and best practices.

Dr. Shelby Moreira

Forensic and Neurocognitive Specialist

Shelby Moreira, Psy.D.

Dr. Shelby Moreira is a forensic and Behavioral Pain & Trauma Medicine Specialist who works at the intersection of the four epidemics in the workers’ compensation system: Chronic Pain, PTSD, Brain Injury and prescription drug abuse. As part of an advanced transdisciplinary clinical team, she works in an evidence-based space that focuses on systematically reversing the common disabling trajectories of medical syndromes that have been resistant to or failed prior medical care and which contributes to over 80% of the cost of the work comp system.

Dr. Katherine Turner

Director of IOH Academy
Behavioral Medicine | Neuropsychology

Katherine Turner, PhD

Dr. Katherine Turner is the director of the IOH Training Academy, a senior mentor, and works at the intersection of behavioral medicine and neuropsychology. In her clinical role, she specializes in the areas of chronic pain, brain injury, and Post-traumatic stress. Dr. Turner received her Ph.D. in Psychology from Stanford University and completed a postdoctoral fellowship in Brain Development Imaging at San Diego State University (SDSU) before moving into teaching and academic advising. Dr. Turner has taught at SDSU for 15 years and has won several awards during her tenure.

Food as Medicine

See All Food as Medicine

Chef Denise Roa

Director, Clinical Nutrition Services
Institutes of Health

Denise Roa leads the culinary culture at Institutes of Health (IOH), focusing on lifestyle medicine, clinical nutrition, and farm-to-table concepts. Her work integrates healthy eating patterns with chronic condition management and health promotion. Before IOH, she was the Executive Chef at Rancho La Puerta Health & Fitness Resort, overseeing kitchens, menus, food production, and the Cooking School. Denise started her career at Johnson & Wales University's culinary arts program and worked at top San Diego restaurants, including her own, La Trattoria. Her recipes have been featured in major publications and media outlets, showcasing her expertise and passion for healthy eating.

A Full Spectrum of Whole Foods for Fall Health

Fall brings a colorful harvest of nutrient-rich fruits, vegetables, and plant-based foods that are perfect for the season. From pumpkins and sweet potatoes to antioxidant-packed cranberries, these fall favorites can boost your health while adding flavor to your meals. Chef Denise reviews the best seasonal foods to incorporate, along with suggestions for making the most of autumn’s freshest ingredients in your daily and holiday dishes!

Roasted Brussels Sprouts and Butternut Squash Medley

Check out our new featured recipe: Roasted Brussels Sprouts and Butternut Squash Medley. It includes many seasonal favorites in one dish and just a touch of Maple Syrup brings all those flavors together with warm and cozy vibes. It makes the perfect holiday side dish, and it is prep-ahead friendly!

Please consult your doctor if you have food allergies or other health-related concerns regarding your diet.

Did you know?

Science has proven that chronic, low-grade inflammation can turn into a silent killer that contributes to cardiovascular disease, cancer, type 2 diabetes, and other conditions. The culinary team at IOH provides simple tips to patients to fight inflammation, reduce chronic pain, and stay healthy. Click the link below to review more delicious, healthy & easy recipes for everyday life.

An integral component of IOH’s intensive biopsychosocial transdisciplinary programs is focused on nutrition. Chronic conditions are associated with changes in the microbiome, gut-brain, and HPA axis that increase systemic inflammation and negatively impact health and recovery. Education on clinical nutrition combined with an anti-inflammatory diet supports healthy neuroimmune function and lessens the effects of chronic pain. Patients learn how to shop for, prepare, and cook nutritious anti-inflammatory meals that help them feel better and restore function. They learn sustainable practices that promote self-management and improve their confidence in their ability to recover and maintain long-term wellness.

Movement Therapy

Lake Perris Outing

Recently, patients at our IOH Riverside clinic enjoyed a fun kayak outing at Lake Perris. Some patients mentioned they were nervous about trying the new activity, but eventually, they worked up to it and enjoyed themselves as you can see in the photos.

As with many outdoor activities, kayaking offers a holistic approach to fitness, providing a low-impact, full-body workout that strengthens muscles and improves cardiovascular health. Beyond physical benefits, it promotes mental well-being through stress reduction and a connection with nature.

Botanical Gardens Outing

IOH Riverside patients recently visited the nearby botanical gardens and enjoyed the spring blooms with a gentle walk, nature bingo, and paced respiration.

Walking outdoors in nature offers many health benefits, from reducing stress and improving mood to improving cardiovascular health and boosting vitamin D levels.

Did you know?

Incorporating movement into our daily lives profoundly benefits our physical and mental well-being. From enhancing flexibility and strength to boosting mood and cognitive function, increasing activity and staying active offers countless advantages. Creative approaches to movement, such as stretching to improve flexibility, walking to clear the mind, dancing for a fun cardiovascular workout, or engaging in aquatic exercises for low-impact resistance training, all ensure that staying active never becomes monotonous. Hiking in nature provides a scenic backdrop for exercise and connects us with the environment, enhancing our sense of peace and well-being. Activities can be tailored to individual preferences and fitness levels, making the journey toward health a personalized and enjoyable experience.

Exploring Creative Ways To Move More
IOH clinicians and technicians offer a variety of creative ways to help patients increase activity and mobility by exploring ways to move that are both enjoyable and beneficial.

Art and Creative Therapy

Observations on the Riverside Garden Mosaic project:

Decades of research demonstrate that art therapy is an efficacious intervention in the treatment of chronic pain and other debilitating chronic conditions such as traumatic brain injuries (TBI) and post traumatic stress injuries (PTSI). The mosaic garden art therapy project at IOH Riverside is an example of how that research can be applied towards successful rehabilitation outcomes and has been an enriching experience for both patients and program providers.

Art therapy is associated with decreased pain intensity, improvements in physical, emotional, and cognitive functioning, as well as improvement in overall quality of life for patients suffering with various chronic conditions (1, 2, 3, 4, 5, 6, 7). Our observations of patients working collaboratively on the mosaic art therapy project at Institutes of Health affirms that art therapy serves as a highly beneficial component in learning to manage and recover from chronic conditions.

More recent neuroscience research focused on artistic therapeutic interventions provides additional evidence that art therapy activates specific areas of the brain that support self-regulation, relaxation, and memory, thus contributing to restoration of functioning across cognitive, physical, and emotional domains (5, 6). Advanced imaging of the human brain taken during collaborative efforts amongst scientists and artists are beginning to untangle the complex nature of the relationship between art therapy and recovery from chronic conditions (5, 6).

Institutes of Health is actively applying the foundational principles of this evidence-based practice in transdisciplinary treatment of patients with chronic pain, TBI, and PTSI. The mosaic garden project at IOH is one example of the life-changing benefits of art therapy for our patients recovering from chronic conditions.

This creative outlet fosters socialization, as patients engage with one another, sharing ideas and techniques, thereby strengthening their sense of community. The process of designing and placing each mosaic piece ignites a creative spark, offering patients a constructive way to channel their emotions and thoughts, and as research has pointed out, engagement in artistic activities such as this activates important areas in the brain integral to the healing process (5, 6).

Through communal art therapy projects patients gain confidence, use fine and gross motor skills, engage in functional movements, enhance problem-solving skills, and experience emotional release, all pivotal to their overall recovery. The mosaic garden is a testament to what research has already provided evidence of, art therapy is a powerful tool in recovery and functional restoration.

This project is a wonderful accomplishment and underscores the importance of integrating creative practices in therapeutic settings. Furthermore, art is something that patients can continue to do independently long after they complete a functional restoration program, in that regard it is a coping mechanism that promotes long-term, independent self-management of symptoms thus potentially reducing future reliance on healthcare systems.

The small, precise movements in building this mosaic garden restore dexterity while inspiring creativity.

Concentration and executive planning promote teamwork in this project, building confidence in communication and cognitive ability.

Did you know?

Established and emerging research both suggest that engaging in creative arts like drawing and painting stimulates specific areas of the brain integral in healing and recovery. Art therapy provides a non-verbal outlet for processing emotions in individuals with brain injury, chronic pain, and PTSD. Art therapy reduces pain perception by shifting focus on the creative process and supports self-expression and emotional release. Participation in art therapy promotes post-traumatic growth, resilience, and hopefulness. These are all factors that have been associated with positive outcomes in research focusing on recovery from chronic conditions such as brain injuries, chronic pain, and post-traumatic stress injuries. Art therapy is an essential component of our comprehensive, evidence-based, transdisciplinary treatment approach at IOH.

What Our Patients Say

View More Patient Testimonials

We are proud to share this awesome 5-star review from one of our patients at IOH Riverside!

These words fuel our passion for providing the most advanced healthcare services for the Workers’ Compensation community. At Institutes Of Health, we strive to create a warm and welcoming environment from the very first step and deliver compassionate care to the patients we serve. Thank you for recognizing our commitment to excellence!

Community Engagement

IOH proudly participates in industry events where we connect and engage with colleagues, clients, potential clients, and industry friends in our workers’ compensation community. It has been a busy Summer and Fall, and we are fast approaching the holiday season! Here are some images from events we attended, including the Workers’ Compensation Institute Annual Conference in Orlando, the National Comp Conference in Las Vegas, our first annual Biopsychosocial Symposium at Sharp Healthcare in San Diego, Council of Self-Insured Public Agencies (COSIPA) in Costa Mesa, Employers Fraud Task Force Luncheon in Los Angeles and Decorate-A-Villa Day at Give Kids The World Village in Orlando: