adjustment & adaptation to illness & disability
TRANSCRIPT
Rehabilitation Psychology
RS2270: BSc (Hon) OT Year 2, BA (Hon) Applied
Psychology & Minor in Psychology
RS5305: MOT
Dr. Andrew Siu
What is Rehabilitation Psychology?
Science and treatment of disabling and chronic health conditions.
Encompass knowledge from several branches of psychology, including:
Social psychology,
Counseling,
Clinical psychology
Health psychology.
What you would learn …
Theories of Psychological Adjustment & Application
(1-5,9)
Interviewing persons with disabilities
(6-8)
Mental Health Issues in
Rehabilitation
(12)
Social Aspects of rehabilitation
(10,11,14)
1. Psychological adjustment to disability and chronic health conditions.
Theories of adjustment, assessment of adjustment, principles and strategies in promoting adjustment.
2. Social aspects of rehabilitation. Family issues, social support, employment, sexuality.
3. Therapeutic relationship and basic interviewing skills.
4. Mental health issues in rehabilitation.
What you would learn …
Teaching-learning Strategies
Lectures: required readings for every week
Videos: for illustration of lecture contents,
demonstrations, reflection
Tutorials: case discussion, experiential activities,
role play.
Seminar: interview a person with disability/illness
& present your analysis of the person’s
psychological adjustment & adaptation in society.
Assessment
Written Assignment (30%): case analysis;
written exercises in interviewing skills.
Seminar (30%): group presentations
Quiz (40%):
Around 100 MCQs
Based on lecture materials & readings.
Psychological Adjustment to
Illness & Disability: an Overview
RS2270, RS5305
Rehabilitation Psychology
Dr. Andrew Siu
Content
Psychosocial Impact of Chronic Illness or
Disability (CID)
Definition and Indicators of Adjustment &
Adaptation
Health-related Coping Model
Facilitating Coping and Adaptation
PSYCHOSOCIAL IMPACT OF
CHRONIC ILLNESS &
DISABILITY
Impact of Disability and Illness
Body Function
& StructureActivities Participation
Impairment Function &
Limitation
Role Assignment
& Restriction
Diagnosis Functional
Performance
Role
Performance
Medical &
Restorative
Therapies
Adaptive &
Therapeutic
Relearning
Social &
Community
Support
Assessment
Intervention
International Classification of Functioning,
Disability and Health (ICF)
ICF analysis
Psychological Impact of
Disability & Illness
Impairment:
Structural changes in anatomical,
neurophysiological mechanisms of the body
Disability:
Loss of bodily function, functional
independence; the need to relearn function
and living skills.
Psychological Impact of
Disability & Illness
Handicap:
Loss of roles, adoption of sick role
Employment difficulties & self-support
Family and/or social support
Physical barriers in community
Social discrimination & self-stigma
Key Psychological Impact
Body Image & Self-Concept
Emotional Reactions
Activation of Psychological Defense
Stress & Coping
Chronic Illness & Disability
Body Image Particular important for visible
disabilities, e.g. burns, amputation,
spinal cord injury.
Process of adaptation:
Shutting out of existence or
neglect of impaired body part
Search for illusory restoration of
body part or function
Avoid social contacts
Focus on non-impaired body parts
Gradual acceptance
Loss, Grief, and Depression
Loss of body part or function feelings of loss
and grief.
Mourning about loss depression
Prevalence of depression is at least twice in
people with disabilities, compared with non-
disabled. Many studies showed that 30-50% of
hospitalized patients are depressed.
Prolonged and recurrent sorrow and sadness, or
even suicidal
Defense Mobilization
Ego defenses are largely unconscious efforts to
protect us from anxiety or unpleasant emotions,
and to maintain a consistent self-concept.
Examples: denial, rationalization, displacement,
projection, reaction formation.
Help us to hide from the truth (or facts) but could
eventually leads to a distorted view of self.
Stress & Coping
Having a serious illness or disability could
be seen as a major stress to the person.
The person may use a variety of coping
strategies to face the illness/disability.
Coping strategies (e.g. avoidance, problem
solving, diversion, etc.) could lead to very
different outcomes in adjustment and
mental health
ADJUSTMENT & ADAPTATION
Definition and Indicators
Psychosocial Adaptation
Evolving, dynamic process through which a
disabled person gradually approaches and optimal
state of person-environment congruence.
Aspects of Adaptation, e.g.
Acknowledgement of abilities and limitations
Relearning of living skills
Enact role changes and social expectations
Acceptance of new body image
Re-establish a new self-concept
Indicators of Adaptation
Active participation in social, vocational,
and leisure pursuits.
Successful negotiation of the physical
environment.
Awareness of remaining strength and assets,
as well as limitations.
Psychological Adjustment
Sometimes used synonymously with
adaptation
Refer specifically to a particular phase (i.e.
set of experience and reactions) of the
adaptation process.
Indicators of Psychological
Adjustment
Reach and maintain psychosocial equilibrium.
Achieving a state of reintegration
Demonstrating positive self-esteem and self-concept
Positive attitudes towards oneself, others, and the disability.
Positively striving to reach life goals.
Theories of Psychological
Adjustment
Theories of Adjustment
Stress & Coping
Phase Theory of Emotional Reactions
Counseling or Change theories:
Cognitive Behavior Therapy
Self-efficacy Theory
Person-centered
Stage of Change
HEALTH-RELATED STRESS &
COPING MODEL
General Model of
Stress & Coping
(Cox & MacKay,
1976)
Model of Stress & Coping
1. Stress: internal expectations or external demands.
2. Cognitive Appraisal Primary: if the stress is beneficial, relevant
harmful, or threatening.
Secondary: Judgment of coping resources.
Re-appraisal: alter one’s perception and judgment of stress situation and coping resources.
3. Responses to Stress – cognitive, affective, & behavioral coping
Ways to Manage Stress &
Increase Adaptation
Modify expectations for self
Examine person-environment fit
Learn or strengthen coping strategies
Mobilize personal or social resources for
coping
Encourage cognitive re-appraisal of stress
and coping resources needed
Examples of (Psychological)
Coping Strategies
Behavioral
• Avoidance, diversion
• Relaxation
• Disengagement
Cognitive
• Planning
• Problem-solving
Spiritual
• Turning to religion
• Seek meaning
Emotional
• Denial
• Blame or criticize
oneself
• Rationalization
• Bargaining or
negotiation
• Ventilation, Seek social
support
• Acceptance
HEALTH-RELATED COPING
MODEL
Health-related Coping Model
I. Personal Resources
Religious beliefs
Prior health-related and coping responses
Demographic background
Personality characteristics: e.g. self-
efficacy, extroversion, optimism, internal
control, problem-solving ability and style.
II. Health-Related Factors
Onset, stage, progression of health
condition
Symptoms: pain, fatigue/energy, etc.
Disability: type & loss of function
Health care environment and treatment
procedures: invasive procedures,
examination by strangers, technical
equipment.
III. Social & Physical Context
Social:
Relationship, support, and expectations of
people in network
Physical:
Physical aspects of home, workplace,
shopping, etc. can influence person’s access,
mobility, and autonomy
Personal space, privacy, aesthetic qualities of
surroundings, etc.
IV. Cognitive Appraisal
Is the stressor (e.g. chronic illness)
expected and is the person prepared for it.
Is the problem is regarded as
Challenge or threat?
Controllable or not?
Caused by self or not? Am I responsible?
Outcome of this appraisal greatly affects
coping efforts and strategies
V. Adaptive Tasks
1. Managing symptoms
2. Managing treatment
3. Forming relationships with health care providers
4. Managing emotions
5. Maintaining a positive self-image
6. Relating to family members and friends
7. Preparing for a uncertain future
VI. Categories of Coping Skills
Coping Skills
Logical analysis & search for meaning
Taking problem solving action
Cognitive avoidance or Denial
Acceptance &
resignation
Seeking alternative
rewards
Emotional discharge
Seeking guidance
and support
Positive appraisal
VII. Health-related Outcomes
Effects of coping strategies
Stress reduction or relief
Emotions: Anxiety, depression, anger; happiness,
satisfaction.
Acceptance of new body image, having illness
Self-esteem
Growth: e.g. resilience, EQ
Social relationship: e.g. closer or alienated
FACILITATING COPING &
ADAPTATION
Promote Adaptation
Person
Environment
Transition
PhysicalSocial
Information
Values
Coping
Reappraise
roles &
functions
Facilitating Coping &
Adaptation in Persons with CID
Intervention on Physical
Environment
Promote mobility and access within client’s
life space as far as possible, e.g. home,
work, leisure contexts.
Modification of home or work environment
if necessary and feasible.
Use of technology and additional
equipment.
Work simplification and energy
conservation.
Intervention on Social
Environment
Map the social support network and assess client’s needs for various types of support (emotional, tangible, information & guidance, need for companion)
Address the issues of caregiver burden.
Encourage client to provide support to others as well, or mutual help.
Encourage social participation
Monitor ongoing changes in social support.
Intervention on the Person
Commitment and values.
Re-organization of one’s life commitment & life roles
Identify values and beliefs of the client which may promote adaptation.
Cognitive restructuring of irrational thoughts.
Find facts: Information seeking
e.g. Seek advice, knowledge, guidance, sharing of experience from others.
Facilitate Coping Responses
Find meaning: Re-appraisal
e.g. find new meaning in situation, develop
emotional competence, ongoing self-reflection.
Manage stress: Inhibition
e.g. emotional discharge, stress management,
diversion or selective ignoring.
Intervention on Transition
Cannot change the nature of transition.
Prevent the development of sick role.
Explore changes in role expectations.
Assist client to re-appraise (acknowledge,
accept, and enact) one’s changing roles and
functions.
Required Reading
Livneh, H. (1997). Psychosocial adaptation to
chronic illness and disability. Gaithersburg, MD:
Aspen Publication. Chapter 1.
Martz, E, & Livheh, H. (Eds.). (2007). Coping
with chronic illness and disability: Theoretical,
empirical, and clinical aspects. New York:
Springer. Chapter 6.
Video
《共渡經濟漩渦》香港電台電視部,2002 (Call No: 18656 VCD)
TVB Pearl (2009). Bangkok Biding. (Call
No.: 26655DVD)