PSYCHOLOGICAL REACTIONS TO DISABILITY

Phase 1

Adjustment and Coping

Phase 2 Phase 3

Adjustment

Changing thought or actions to interact in more satisfying ways with ones physical, social and cultural environment. Generally conceived as learning to deal better with changes in life. Process of managing difficult circumstances which includes developing strategies to deal with stress and to expend effort in the most useful ways while postponing some tasks in order to accomplish the most pressing first the process of managing external and/or internal demands that are appraised as taxing or exceeding the resources of the person (Lazarus & Folkman, 1948)

Phase 4

Coping

customary methods of problem solving (Gerald Caplan) Phases Initial rise in tension from the impact of the stimulus calls forth habitual problem solving responses. Lack of success and continuation of stimulus is associated with increasing upset and ineffectuality Further rise in tension acts as a powerful internal stimulus and calls out emergency problem solving mechanisms - novel methods to attack the problem, trial and error, and attempts to define the problem in a new way. As tension mounts beyond a further threshold, its burden increases to breaking point. To avoid major disorganization the person employs methods to reduce anxiety and opens up maladaptive pathways. These can lead eventually to the development of various psychiatric syndromes.

Types of coping styles

Stage Theory The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity and an understanding of life that fills them with compassions, gentleness, and a deep loving concern. Beautiful people do not just happen. Elisabeth Kbler-Ross Denial In this stage, the world becomes meaningless and overwhelming. Life makes no sense. Clients are in a state of shock and denial. They try to find a way to simply get through each day. Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Guilt is often bargainings companion as clients seek to negotiate a compromise Feeling of sadness and regret, fear, uncertainty and mourning Indication that there is some emotional detachment and objectivity Appraisalfocused coping We solve the problem by understanding the posed threat; a logical cognitive process that entails assessment and mental practice, definition and reframing, and avoidance or denial Assess and mentally practice Define and reframe Deny or avoid We solve the problem by seeking information, changing our own behavior, or taking whatever action is necessary Collect information Build support Act We primarily do things to deal with our emotional distress, such as seeking support and sympathy or avoiding/denying the situation Control emotions Release emotions Accept and surrender

Approach Avoidance

The person aims to solve the problem head-on, devises plans to meet the challenge Fleeing/running away from the challenge

Types of coping strategies

Anger

Bargaining Depression Acceptance

Problemfocused coping

Emotionfocused coping

Crisis Theory Crisis Turning point for opportunity for personality growth or maturation or risk of adverse affect with increased vulnerability to subsequent stress Crisis as an upset in the steady state A crisis is provoked when an individual, faced with an obstacle to important life goals, finds that it is for the time being insurmountable through the utilization of

Coping strategies and styles

external support from friends, give voice to their emotions and worries, and prioritize their decision making. Provide the opportunity to talk about changes and losses.

Anshel et al.

Coping styles Approach Avoidance Apply a mental distraction

Counseling Listening an attending to clients, as well as verbal counseling approaches Enable the client to recognize and use their own coping resources Encourage clients to talk about memories, concerns and fears Constructive feedback Demonstrating patience Motivation Motivation From the Latin word MOVERE or to move Refers to prompting movement The process by which activities are started, directed, and continued so that physical or psychological needs or wants are met. Characteristi cs of a motivated person

Problemfocused Coping strategies Emotionfocused

Analyze reasons why errors were made and correct them

Use progressive Vent unpleasant relaxation to reduce emotions, cry stress

Psychosocial Adaptation Strategies Changing thoughts

Using challenge appraisals Threat vs Challenge appraisals Threat appraisal elicit negative emotions (fear, anxiety, depression) and raises stress levels and often leads to emotion-focused coping Substitute positive self-statements Negative vs Positive self-statements Negative self-statements elicit negative emotions (fear, anxiety, depression) and raise stress levels and often leads to emotionfocused coping

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Changing behavior From emotion-focused to problem-focused coping

You are energized to engage in some activity You direct your energies toward a specific goal You have differing intensities of feelings about reaching that goal

Changing physiological responses

Biofeedback: Voluntarily learning to control physiological responses, such as muscle activity, blood pressure, or temperature, by recording and displaying these responses Progressive relaxation: Practicing tensing and relaxing major muscle groups of the body until you are able to relax any groups of muscle at will Meditation: Assuming a comfortable position, closing ones eyes and repeating and concentrating on a sound to clear ones head of all thoughts

Biological needs

Physiological requirements that are critical to our survival and physical well-being. (food, water, oxygen, sleep, etc) Are needs that are acquired through learning and experience (need to excel, for social bonds, to nourish and protect others, for independence, for fun and relaxation, etc)

Social needs

Theories of Motivation Instinct Approaches Human beings are born with specific innate knowledge about how to survive. These innate tendencies are preprogrammed at birth.

Emotional and Practical Support Support from families and friends has an important impact on adaptation Health providers can offer suggestions to clients on how to organize their schedules, encourage and accept

INSTINCTS: innate tendencies or biological forces that determine behavior that exist in both people and animals

Does not explain WHY the person engages in a particular behavior Biologists who study animal behavior later redefined instincts as fixed action patterns FIXED ACTION PATTERN: innate biological force that predisposes an organism to behave in a fixed way in the presence of a specific environmental condition

Engaging in certain activities or behaviors because the behaviors themselves are personally rewarding or because engaging in these activities fulfils our beliefs or expectations Humanistic Approaches Human beings seek to satisfy successively 'higher needs' that occupy a set hierarchy.

Drive-reduction Approaches Behavior arises from physiological needs that cause internal drives to push the organism to satisfy the need and reduce tension and arousal

Maslow's Hierarchy of Needs is a theory in psychology that Abraham Maslow proposed in his 1943 paper, A Theory of Human Motivation. The Hierarchy of Needs was conceptualized by Maslows observation of monkeys. If monkeys were given a choice between play and food, they would most likely choose food. If monkeys were given a choice between food and water, they would most likely choose water.

NEED: biological state in which the organism lacks something essential for survival, such as food, water or oxygen DRIVE: state of tension that motivates the organism to act to reduce that tension HOMEOSTASIS: tendency of the body to return to, and remain in, a more balanced state A need results in a drive, which is a state of tension that motivates the organism to act to reduce the tension and return the body to homeostasis Drive motivates us to engage in a variety of behaviors to satisfy biological needs. Over a period of time, the strength of the drive would continually increase as long as it is not satisfied. Needs include deficiency needs (needs of the body) and growth needs (having friends, feeling good about oneself) Physiological Needs Consist of needs for oxygen, food, water, and a relatively constant body temperature The strongest needs that must be satisfied. Once the physiological needs are met in sufficient detail, people move on to address these more complex needs. Safety Needs Consist of needs for safe family environment (children) or economic stability (adults) Psychological in nature Adults have little awareness of their security needs except in times of emergency or periods of disorganization in the social structure Children often display the signs of insecurity and the need to be safe Belongingness and Love Needs Consist of need to belong on a social level, includes desire for a romantic partner and close friends For example: Children: approval from parents; Teens: acceptance in peer groups; Adults: desire to build relationships Maslow states that people seek to overcome feelings of loneliness and alienation This involves both giving and receiving love, affection and the sense of belonging Esteem Needs These involve needs for both self-esteem and for the esteem a person gets from others Humans have a need for a stable, firmly based, high level of self-respect, and respect from others When these needs are satisfied, the person feels self-confident and valuable as a person in the world

Incentive Approaches All creatures are motivated by gaining incentives.

INCENTIVES: environmental factors, such as external stimuli, reinforcers, or rewards, that motivate or behavior, things that attract or lure people into action Incentives pull us to obtain them, drives push us to reduce needs. This push-pull difference between drives and incentives explains some otherwise perplexing and seemingly unexplainable behaviors.

Cognitive Evaluation Theory Human beings are motivated intrinsically and extrinsically to satisfy needs.

Extrinsic Motivation results from external rewards Engaging in certain activities or behaviors that either reduce biological needs or help us obtain incentives orexternal rewards

Intrinsic Motivation comes from within the person

When these needs are frustrated, the person feels inferior, weak, helpless and worthless. Cognitive Needs These involve the need to know and understand the world Human beings are naturally curious Aesthetic Needs Human beings have the need to appreciate symmetry, order and beauty To be able to express oneself artistically in any way possible Self-actualization Maslow describes self-actualization as a person's need to be and do that which the person was "born to do Getting to know oneself, while being okay and unconditionally accepting of whatever it is that he or she discovers People who are self-actualizers are focused on what matters most in defining who they are A musician must make music, an artist must paint, and a poet must write." Transcendence To help others achieve self-actualization, reach their full potentials and capabilities as a human being

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Validate or shed accurate light on the clients beliefs Guide the clients in assessing their physical, emotional and interpersonal strengths and weaknesses Help the client perceive the positive growth opportunities from the situation Equip clients with accurate information and reassure them while they face their challenges and take responsibility for themselves Practice emphatic communication while helping people face what may lie ahead Help the client be optimistic and realistic Provide current information and indicate that newer treatments may be developed Help sustain hope by professing its values

Family Adaptation Family is a social network from which individuals derive identity and with whom they feel strong psychological bonds. The way in which families react and adapt to chronic illness and disability affects an individual's subsequent adjustment. o o Strong desire to be a normal family again What he or she might have been

Health providers must help clients with factbased reality Rehabilitation must aim to restore patients confidence in their bodies. This will not take place if everyone around continues to treat them as if they are made of Dresden china Markus et al, 1989, p.306 Hope The ability to invest our energy and vision in a reality beyond our sight in the present moment, the capacity to yearn for and expect a meaning deeper and outcome better than the circumstances seem to allow Phillips, 1989, p. 31