One of the most overlooked aspects of successful recovery from a work-related injury is the injured worker’s mindset.
Nick was a friend of mine who played racquetball. Famously, he hated to lose. One day, he told me that he was scheduled for a back fusion. As a claims adjuster, I had seen the usual time for recovery of a low back fusion to exceed two months. He turned to me and asked, “How is your Friday three weeks from now?” I said I could play him then but did not expect him to show. To my surprise, he was there and played the entire hour. After the game, I asked him how he was doing. He smiled and said, “I just kicked your ass.” Nick expected to recover entirely and quickly and did exactly what he had expected. I suspect he had some pain after the first game, but he never complained.
General Self-Efficacy is the confidence one has in oneself to solve problems, manage adversity, and navigate difficult situations.
Much attention is paid to diagnosis, treatment, and claims processing in workers’ compensation. Still, too little is invested in understanding how psychological readiness—specifically General Self-Efficacy —can make or break a recovery. Engagement isn’t just about attending physical therapy or following a treatment plan; it’s about the injured worker owning their recovery. GSE is the key to that ownership.
Understanding General Self-Efficacy is not just about grasping a concept; it’s about unlocking a powerful tool for empowerment. GSE is the belief in one’s ability to succeed in specific situations or accomplish a task. It is not just optimism or hope—it is a measurable, research-backed psychological trait linked to motivation, resilience, and behavioral follow-through. This potential for empowerment of GSE should instill a sense of hope and optimism in the audience.
GSE is typically assessed using the General Self-Efficacy Scale (GSES), a ten-item questionnaire that evaluates confidence in problem-solving, perseverance, and managing adversity. A higher GSE score indicates a stronger belief in one’s capacity to navigate difficulties and achieve goals—even when setbacks occur.
Why GSE Matters in Workers’ Compensation
In the controlled and often opaque world of workers’ compensation, injured workers can feel sidelined, reduced to a case number, and overwhelmed by a process they don’t understand. This is where GSE becomes essential.
Workers with high GSE are more likely to:
- Participate actively in physical therapy and treatment
- Ask questions and seek clarity about their care
- Set and pursue recovery goals
- Return to work faster and more confidently
- Cope better with pain and setbacks
Conversely, low GSE is not just a trait; it’s a red flag. It’s associated with passivity, avoidance, and poor recovery outcomes. In many cases, a low-GSE worker may appear non-compliant or disinterested when, in fact, they lack belief in their ability to succeed. This is a problem that needs our attention. Low GSE can manifest as a lack of initiative, a tendency to avoid challenges, and a belief that one’s efforts will not lead to success. Recognizing these signs can help identify workers who may need additional support in their recovery journey.
High GSE in Action: Competitive Drive as the Opposite of Learned Helplessness
At the opposite end of the spectrum from low GSE are individuals who possess an extraordinary belief in their ability to overcome adversity—often accompanied by a fierce sense of personal drive and competition. Elite athletes like Michael Jordan and LeBron James exemplify this mindset. Their belief in their ability to succeed in nearly any circumstance defines high GSE in its most empowered form.
These individuals don’t just respond to challenges—they seek them out, believing that effort, discipline, and mindset will lead to success. In injury, this self-efficacy translates into exceptional compliance, ownership, and determination to return to peak function. While few injured workers may operate at this elite level, claims professionals and healthcare providers should aim to foster this same spirit of agency and belief in recovery.
Fortunately, GSE is not a fixed trait—it can be developed with the right support. Employers, providers, and claims administrators can adopt strategies that promote a worker’s self-efficacy. This effort must be collaborative and include a variety of stakeholders. Emphasizing each stakeholder’s role in fostering GSE helps ensure they feel both responsible for and integral to the recovery process.
- Claims Examiners: Can reinforce progress, provide timely authorizations, and demonstrate belief in the worker’s recovery capacity.
- Employers: Supervisors, especially, can show personal concern and set positive expectations around return to work.
- Doctors and Physical Therapy Professionals: Can frame treatment as a path to empowerment, not a sign of impairment.
- Managed Care Nurses: Can coach and guide workers through challenges, celebrating milestones, such as completing a week of physical therapy, and addressing barriers, like providing resources for transportation to therapy sessions.
- Plethy Coaches: Provide personalized support and motivational feedback, reinforcing adherence and engagement.
- Family Members: Play a critical role in emotional support and reinforcing recovery goals at home.
Here are some practical strategies all these stakeholders
can use to build GSE:
- Set Achievable Goals: Break recovery into manageable milestones.
- Celebrate Small Wins: Recognize and reinforce progress.
- Use Shared Decision-Making: Involve the worker in choices about care.
- Provide Coaching and Education: Help them understand their role and empower them with knowledge.
- Model Positive Expectations: Express belief in their ability to recover.
These strategies send a powerful message: “You can do this—and we believe in you.”
GSE vs. Locus of Control: Clarifying the Distinction While closely related, GSE and Locus of Control (LoC) differ.
- Locus of Control refers to whether a person believes they have control over events in their life (internal) or whether outcomes are dictated by fate, luck, or others (external). In other words, it’s about who or what you believe is in control of your life and the events that happen to you.
- GSE reflects confidence in executing behaviors necessary to produce desired outcomes.
In other words, LoC is about who controls the outcome, while GSE is about your belief in your ability to act.
Injured workers with an external LoC may feel powerless, attributing delays or failures to the system or bad luck. Those with low GSE may feel they can’t influence the outcome, even if they are given tools or support. A truly engaged worker needs an internal locus of control and high self-efficacy.
The Role of Adverse Childhood Experiences (ACEs) Adverse Childhood Experiences (ACEs) refers to potentially traumatic events that occur in childhood (0–17 years), including physical or emotional abuse, neglect, caregiver mental illness, substance use, incarceration, domestic violence, or household dysfunction. ACEs have been shown to disrupt healthy brain development and impact emotional regulation, resilience, and coping mechanisms in adulthood.
Another essential factor that contributes to low GSE is a history of ACEs. Individuals with high ACE scores often develop poor coping mechanisms and are more vulnerable to stress and perceived helplessness.
In the workers’ compensation system, these individuals are especially at risk when they encounter doctors or attorneys who reinforce a disability mindset. When told, “You are disabled,” they may internalize that label. Instead of being supported to recover, they are subtly encouraged to adopt a passive, dependent role.
This is the exact opposite of GSE. Where GSE fosters empowerment, ACEs combined with negative messaging can lead to resignation and long-term disability. Recognizing these vulnerabilities is crucial to shaping the right clinical, legal, and claims-handling approach.
GSE and Informed Consent One overlooked but decisive moment to build GSE is during the informed consent process. Rather than simply handing over a form, use this time to explain options, clarify expectations, and encourage questions. This builds trust and reinforces the worker’s confidence in their ability to make decisions and participate in their care.
Conclusion: GSE as a Foundation for Recovery
Not many injured workers are like Nick. Few people possess the same internal drive, clear expectations, or competitive mindset that propels recovery forward without assistance. Most need support, guidance, and belief from those around them. That’s where we must step in as stakeholders in the workers’ compensation system.
Engaging injured workers isn’t just a best practice, it’s a business imperative. Disengaged workers stay out longer, cost more, and are far more likely to litigate. But engagement cannot happen without belief. We cannot expect people to participate actively in their recovery if they don’t believe they can succeed.
General Self-Efficacy is the foundation of that belief. By understanding, measuring, and nurturing GSE, we do more than manage claims—we foster recovery, rebuild lives, and promote resilience.
Empowered patients don’t just follow orders. They take ownership. They persevere. They heal. And ultimately, they return to work.
Recognizing what high GSE looks like is one step—now let’s explore how we can help build it in injured workers.
