STRESS AND HEALTH ADAPTATION AND COPING
consciously perceived stimuli or by reflexive
STRESS
● Pattern of specific and non-specific responses
an organism makes to stimulus events that
disturb its equilibrium and exceeds its capacity
to cope
○ Restores what its used to niya before
● State of worry or mental tension caused by a
difficult situation; a human response that
prompts us to address challenges and threats
(WHO)
● Accounts for 60% of doctor visits
● Stressor - external demands of life
○ anything that can cause stress or difficulty in
an individual
○ Physical, mental or emotional
○ Acute or chronic
● Stress response - physical and emotional
effects to stressor
● A person's perception of a stressor dramatically
affects the physiologic responses
○ ie person is afraid of mouse, physiologic
response can be heightened compared to
who has no phobia
○ Same as those who has stress disorder
● Voluntary human behaviors can moderate or
aggravate the effects of these responses
PSYCHOSOCIAL ADAPTATION TO STRESS
● Physical or psychological stress = physiological
response is same
○ Before stresses of life are mainly physical,
now it is mainly psychological (ie work,
adjustments, emotional stress)
○ response to stress (whether physical or
psych), physiologic response is still the
same regardless of type of stress
● 2 responses: autonomic nervous system and
hypothalamic pituitary axis
ANS
● Sympathetic nervous system – activated by
unconsciousness response; norepinephrine;
stimulates our fight or flight response; stimulated
by either conscious or unconscious
○ ie of unconscious: you have a hidden
aggression towards SA; when you meet
them, it triggers a sympathetic response
○ Releases epinephrine and norepinephrine
● PNS – “the brake” that dampens the response;
dampens when the stress is already addressed
○ When addressed, it acts as a brake & tells
person to relax and everything will be okay
● If it activates, it increases HP, BP, CO, glycolysis
HPA
● Hypothalamus: releases CRH (stimulates
release of acth through ant pituitary) and AVP
(stimu release of cortisol and aldo)
● Anterior Pituitary – ACTH
● Adrenal cortex – cortisol and aldosterone
● There is increase of gluconeogenesis (thus
there is increase in energy), salt, and water
retention, BP, circulating volume thus there is
increase in energy
● In the event you have injury during fight or flight,
if you have enough volume, you have possibility
of having hypovolemic shock
● Before stresses of life are mainly physical, now it
is mainly psychological (ie work, adjustments,
emotional stress); response to stress (whether
physical or psych), physiologic response is still
the same regardless of type of stress
● Essential for Survival
● Self regulatory
○ Inc of such is essential for fight or flight &
self-regulatory
● Chronic activation impairs health
○ However, if it becomes chronic and not
regulated, it can cause disabilities and
health disturbances
ACUTE AND CHRONIC ACTIVATION OF STRESS
RESPONSE
● Cortisol reduces insulin release,
insulin-dependent growth factor and insulin
sensitivity:
○ When there is inc in cortisol, it induces
insulin release
○ + acutely it improves immediate energy →
glucose
 ○ - chronically contributes to development of
diabetes mellitus, obesity and dyslipidemia
● Cortisol and NE increases inflammatory
cytokines ie IL-6 and TNF-a and CRP
○ + acutely activate cellular immunity to fight
acute infection
■ imp for acute stage in case of pt getting
sick in that acute period
○ - chronically cause inflammation of the
arterial endothelium contributing to
development of atherosclerotic plaques
○ - chronically stimulate CRF release, thereby
perpetuating the stress response
■ Making it prone to stroke and MI
○ paulit ulit lahat and stress resp is heightened
● Norepinephrine and AVP constrict renal
arterioles and promote sodium retention
○ water always follow sodium so there is
sodium retention
○ + preserves circulating volume and reduces
the risk of hypovolemic shock in acute injury
or bleeding
○ - contributes to the development of
hypertension
■ However, when chronically elevated it
causes HTN
● How an individual conceptualizes stress
determines his response, adaptation, and coping
strategies
○ Perception of stress determines how they
will react to it
● Han Selye (1956)
○ Physiological response pattern
○ General Adaptation to Stress Model
○ 3 concepts:
1. Defense mechanism
2. Follows the 3 stages of: alarm,
resistance and exhaustion
3. If prolonged or severe, can result in
diseases of adaptation or even death
○ If stressor is chronic and severe, pt
condition may be pathologic
● When there is stress, pt will suddenly
decompensate wherein initiation of SNS
response kicks in (ALARM)
● Then pt will be able to adjust to stress and
initiates physiological systems with fight or flight
reaction to stressor, return to homeostasis,
reducing harm or accommodating stress
(RESISTANCE)
○ either resolved or cope with it
● if not resolved or chronic still there, exhaustion
and pathologic condition
● A significant life event or change that demands
response, adjustment or adaptation
1. Change is inherently stressful
● Stress as stimulus, any change that
happen within our lives
● By itself, change is already stressful
2. Life events demand the same levels of
adjustment across the population
● There is a certain level where people of
a population can cope
3. There is common threshold beyond which
illness will result
● Richard Lazarus
○ Transactional theory of stress and coping
■ If there is change in environment, kung
ano coping mechanism ni pt, pt will be
able to either cope or not depending on
support of environment they are in
○ Stress as a product of transaction between a
person (including cognitive, physiological,
affective, psychological and neurological)
and his complex environment
■ said that stress is interaction between
the person, holistically, and his
environment
COPING WITH STRESS Related Concepts to Stress Coping
● Strategies people can do: ● Locus of control (Rotter, 1966)
Cognitive Physical Environm Other
○ A person with internal locus of control
ental believes that their achievements and
outcomes are determined by their own
Therapy Artistic Music Conflict
Hobbies expression Nature resolution decisions and efforts. If they do not succeed,
Meditation Deep breathing Pets Prayer it is due to lack of effort.
Mindfulness Natural medicine Spa visits
Planning Physical exercise
■ they believe that they are the manager
Reading Relaxation of their lives and they have control over
Time Yoga their lives bc they have control of their
management
illness
○ A person with external locus of control
STRESS COPING believes that achievements and outcomes
● Process of cognitive appraisal to determine are determined by fate, luck or others. If a
whether an individual believes he or she has the person does not succeed, it is due to
resources to respond effectively to the uncontrollable external forces
challenges of a stressor or change ■ believe that achievements are
○ Think if you have the resources to respond secondary to belief or luck; ie god gave
to the stress and resolve it me this punishment; have lesser chance
○ Mentally, do i have the defense mechanism of coping
and coping strategies ● Sense of Coherence (Antonovsky, 1987)
○ Health, do i have a doctor, financial support, ○ Extent to which one has a pervasive,
1. Problem focused coping (active) enduring through dynamic feeling of
○ Has resources to manage the challenge confidence that:
○ "I try to analyze the problem in order to ■ is secondary to The stimuli deriving from
better understand; I'm making a plan of one's internal and external environments
action and follow-up" in the course of living are structured,
○ pt when they appraised themselves, they predictable and explicable
deemed that they have resources to address ■ The resources are available to one to
this problem & can do something meet the demands posed by the stimuli
○ Does problem solving and resolves the ● Stressor that is happening, you can
problem adjust and do something about it,
2. Emotion-focused coping (passive) and you can manage the stressor
○ Lack the capacity to respond to challenge ■ These demands are challenges worthy
■ Emotion focused coping and pass of investment and engagement
coping strategies ● Stressor is deemed as worthy
○ Feels a lack of control challenges in my life that i have to
○ Wishful thinking (I wish I could change what resolve
is happening or how I feel) ● Chances or opportunities of learning
○ Distancing (I'll try to forget the whole thing) and growing
■ ie No money to pay for her expenses, ● Self-efficacy (Bandura, 1997)
instead of actively working to resolve the ○ Belief in one's own ability to complete tasks
financial problem, they may distance and reach goals
themselves from the problem ○ Self-related growth or thriving
○ Emphasizing the positive (see the silver ■ Dispositional response to stress that
lining) enables the individual to see
■ i.e. “ay i have cancer, my relatives might opportunities for growth as opposed to
visit me and we would reconcile, but threat or debilitation
cancer would not be addressed ■ Psychological state in which individuals
experience both a sense of vitality and a
sense of learning at work
○ Same ng kanina
NEUROBIOLOGICAL CORRELATES OF
ADAPTATION AND COPING
● 2 primary emotions often associated with
medical adversity:
○ Fear
○ Sadness
● If pt is given a bad med prognosis, 2 main or
primary emotions associated are first fear then
sadness
● If persistent or prolonged, there will be
physiological and anatomical change within the
brain such as nasa table
● Atrophy of hippo no need to memo table
EFFECTS OF SOCIAL SUPPORT ON ADAPTATION
AND COPING
● Significantly aid both adapting to and coping
with major stressors alleviating much of the
associated burden and preventing additional
stress and negative consequences
○ If pt has good social support then pt has
better chances of adapting
● ACTIVE PARTICIPATION in and promotion and
maintenance of relationships in the individual's
immediate and larger social network are vital
4 Types of Social Support
● Instrumental support (eg. Offering direct
assistance) ie physical therapy, asdev
● Informational support (eg. Sharing information
about the illness) can also be done by you; info
should be accurate and reliable
● Appraisal support (eg. Aiding in assessing the
illness and/or decision-making)
● Emotional support (eg. Providing counseling)
Barriers to Seeking Social Support
● Marker of weakness and/or failure to
independently cope with stressors
● May wish to utilize professional services but
unable to afford
● Don't want to be deemed as helpless so they
don't seek support
ADAPTIVE METHODS OF ADAPTING AND COPING
WITH MEDICAL ADVERSITY
Cognitive Coping Strategies
● Normalizing: involves focusing thoughts,
attention, and behaviors on the normal aspects
of life and may be achieved through maintaining
rituals and routines that preexisted the stressor,
defining life as normal, participating in activities
that reflect the normalcy of the individual and/or
family, and minimizing attention to any negative
social effects of the stressor (e.g., stigma)
○ you continue with your daily life; integrate
what was delivered to you in your daily life;
you dont become dysfunctional and depress
○ You just continue with your daily life & still do
what you do
● Cognitive reframing and passive appraisal:
describes adjusting the meaning of a situation
and viewing stressors as something that will
care for themselves
○ become more positive on your view of
the stressor
● Joint problem solving: involves identifying and
communicating in an effort to isolate, select,
carry out, and monitor solutions based on
shared input from everyone involved in the
problem-solving process
○ friends, family, med practitioners in
making decisions for pt (collaborate with
pt)
● Becoming educated about medical adversity: is
an easy method for individuals to both increase
the feeling of control in uncertain situations and
better evaluate situations when making
decisions. It offers medical teams a means of
communication with patients and families and is
associated with effective coping and decreased
stress
○ everyone should be well informed
Effective Communication
● Sharing ideas and feelings, being honest and
clear, and using humor significantly effect coping
during medical adversity
○ communicate between pt and fam
MALADAPTIVE METHODS OF ADAPTING AND
COPING WITH MEDICAL ADVERSITY
Individual Methods
● Denial: is a defense mechanism that allows
individuals to disbelieve that a situation or some
aspect thereof exists
○ di naniniwalang may medical problem
 ● Emotional distancing: describes an inability to
cultivate close, emotional relationships and may
occur during periods of extreme stress
○ removing self from social support; rel
becomes dysfunctional
● Creation of myths: involves suspension of reality
by altering belief systems. Myths are produced
when wishes and expectations have not been
fulfilled and may serve as reflections of both
inner and outer states of an individual
○ kung ano anong beliefs and does not
follow med recc; they believe that they
can bre treated and cured by some
other nonmedical procedure
Group Methods
● Scapegoating: involves a group negatively
labeling, blaming, and displacing tensions,
hostilities, guilt, and stress on one member while
appearing to have achieved group harmony and
cohesiveness
● Triangling: gives the illusion of limiting and
diminishing group tensions by welcoming
additional members on whom the stress is
displaced
● Threats: involving permanent ostracism,
self-destructive acts of other members of the
group (e.g., suicide), and emotional withdrawal
may be posited when one group member
appears to display autonomy and independence
from the
● Dissolution and Addiction: During periods of
extreme stress, attempts to reduce tension may
result in separation from loved ones (e.g.,
divorce), addiction (e.g., gambling, substance
use), or violence
○ Most Common
○ Attention is shifted towards
● Increased family cohesion: may be achieved
through involvement in shared leisure-time
activities and rituals, especially when these
rituals maintain and foster shared identity and
world views among group members and
increase integration, cohesion, morale,
satisfaction, and resilience. Among families,
cohesion is characterized by emotional bonding
among family members and is considered to be
a central attribute to the family unit
○ they become closer
● Role flexibility: describes the ability for family
members to share and change roles during
times of stress. It is essential for maintaining the
equilibrium between stability and change and
thereby increases adaptive coping with
developmental, environmental, and life stressors
○ when someone in the fam gets bad med
dx, other members of fam will adjust and
take on role that sick pt has previously
taken in; ie father gets sick and got
stroke → disabled and nonfunctional,
mother can be the breadwinner of the
fam and eldest child takes othe rchildren

ADAPTIVE RELATIONAL METHODS OF ADAPTING

AND COPING WITH MEDICAL ADVERSITY

● Family group reliance: involves increased

structure and organization in the family and
home (e.g., chores, visits, mealtimes) and more
rigid time schedules and routines. It can lead to
increased integration, cohesion, strength, and
predictability, thereby leading to increased
coping with the stressor
○ Positive response of fam member is fam
to be united in dealing with med
adversity
 PSYCHOSOCIAL ADAPTATION TO PAIN chronic pain syndrome. Pain experiences is
intensified
BIOPSYCHOSOCIAL MODEL OF PAIN
EFFECTS OF PSYCHOSOCIAL CONSTRUCTS AND
PROCESSES ON PAIN-RELATED OUTCOMES

● Multidimensional, dynamic interaction among

physiological, psychological, and social factors
that reciprocally influence each other, resulting ● If there is chronic pain, it can become a disability
in chronic and complex pain syndromes bc they were not able to do work properly, higher
● Sensory and affective experience medical health cost, more doctor visits, etc
● Understand how pain works, assess patient and ● Other risk factors in
treat them wholistically
● Psych or affective factors
● Meaning whatever happens such as
pathophysiology of disease and pain, it is
correlated with pt’s response from previous
psychological status, defense mechanism,
coping mechanism, what are their view and what
is the social support and financial status of pt
● It also involves affective experience
● By knowing all of these factors, we cannot treat
these holistically; we also need to address the
psych factors

FEAR AVOIDANCE MODEL (FAM) of Pain

PSYCHOSOCIAL FACTORS INFLUENCING

PAIN-RELATED OUTCOMES
● Distress
○ Depression, anxiety, negative affect
■ Contribute to pain intensity, long term
outcomes such as physical disability,
health care cost, mortality and suicide
○ Premorbid psychological dysfunction
● Categorizes pain into 2: represents a risk for future development of
● Confrontation and Avoidance chronic pain conditions
● Confront: if they confront, they have better ■ If very anxious about surgery (ie
chances of recovery vc they have better amputatee are anxious and have yet to
chances of tx accept the need of surgery, they are at
● Avoidance: Negative affect; Prone to higher risk of developing pain)
depression, disability; Acute pain can becomes
 ○ Higher presurgical emotional distress were
associated with more post-surgical pain and
impairment
○ Emotional distress and psychosocial stress
have been shown to increase the likelihood
of transitioning from acute to chronic
musculoskeletal pain
○ Dispositional optimism improves pain
intensity through reducing pain
catastrophizing
When pt has depression or anxiety to pain, pain
becomes intensified → higher risk of mortality and
suicide
● Childhood traumatic experiences and PTSD
○ Childhood physical, sexual and
psychological abuse are reported to be risk
factors for adult development of pain
syndromes such as FM, irritable bowel
syndrome, chronic pelvic pain, TMJ
disorders
○ Presence of past trauma was associated
with 2-3 fold increase in subsequent
development of chronic widespread pain
○ Reports of child abuse conferred 97%
increase in risk for having painful somatic
syndrome
○ PTSD has been identified as a risk factor for
chronic pain, transition from acute to chronic
pain and elevated severity of pain and
disability in abuse victims
○ Those with past trauma are associated with
2-3 fold inc
○ For have child abuse have 97% risk of
having
○ Ptsd children are more at risk
● Social and interpersonal processes
○ More perceived social support is associated
with better outcome in those with SCI, MS
and acquired amputation
○ In patients with acquired amputation,
positive general social support were less
likely to develop persistent phantom limb
pain
○ Parental catastrophizing is strongly related
to the development of children's persistent
pain after a major surgery and is significantly
related to the child's disability
○ Parental attention to pain and solicitousness
behavior that encourage children to avoid
regular activities may provide specific
pathways by which parental catastrophizing
amplifies a child's pain experience and
behavior
● Those who have better social support, they have
better chances of recovery
● Those who have acquire amputation, it is found
as they have
● Child has painful condition, parents response to
that condition it'll affect child's response and
future
● Ie parent limits child’s activity to limit pain then
child will also have the same belief as parent
through time
● We should not be catastrophizing as parents
● Social and interpersonal processes
○ 2 crucial interpersonal factors for
psychotherapy process that we can do
as PTs:
1. Stimulating the patient's
expectations that treatment will help
2. Establishing a sound therapeutic
relationship
● 2 factors:
○ ie diabetic neuropathy → we do not tell
pt that they will have it forever, we say
that we can do this medication as it
helps a lot and give statistics and we will
see your response to the med and
manage it properly to the best that we
can
○ Transference and countertransference
→ pt has more trust with their medical
team = better chance of recovery
PAIN SPECIFIC PSYCHOSOCIAL CONSTRUCTS
● Pain coping
○ ✔ Active coping - strategies that control
pain or function despite pain; Pt actively
participates in controlling pain
○ Passive coping - relinquishing control of pain
to others
○ ✔ Problem-focused coping
○ Emotion-focused coping
● Catastrophizing - comprised of negative
cognitive emotional processes such as
helplessness, pessimism, rumination about pain
and magnification of pain reports
○ feeling niya bumagsak na mundo bc of their
disease → magnifying their pain = higher
cost, morbidity, mortality
○ Associated with pt’s affect towards the pain
 ○ when pt is depressed or anxious then there
is lesser chance of recovery and higher
chance of catastrophizing it, worsening
○ Positively correlates with negative affect
○ Risk for development of long term pain,
negative sequelae of pain such as
worsening physical disability, higher health
care cost and amplification of pain sensitivity
○ Treatment: cognitive behavioral therapy
■ We try to improve their view on painful
experience
● Self-efficacy - refers to an individual's belief that
his or her own ability to perform a certain
behavior to achieve a desired outcome
○ pt belief na he can do something sa
condition niya
● Expectations
○ Generalized positive outcome expectancy or
dispositional optimism is related to
increased feelings of control, use of more
active coping strategies and better functional
outcomes
■ Those who have good expectations or
optimistic of their tx has better outcome
■ Optimism and generalized positive view
of life
○ Both patient and provider expectations for
treatment success were strong predictors of
response
○ One of the core mechanisms of underlying
placebo mechanism
PSYCHOSOCIAL ADAPTATION: CHRONIC ILLNESS
& DISABILITY
THE MEDICAL MODEL OF DISABILITY
● Disability = disabled indiv is viewed as helpless,
need to be cared for always, and cannot be
independent → disabled indiv is the problem;
focus is the tx of indiv itself however, we do
whatever we can do to alleviate but there are
some disease that continues throughout life
● i.e. SCI or paraplegic: we treat them pero not
back sa previous function
● Residual disability still seen as problem
THE SOCIAL MODEL OF DISABILITY
● Disabled person is not a problem
● The environment (ie attitudes, rules, and
policies, government) is the problem and are not
beneficial to them
○ Ie buildings lack of ramps, people who
have stereotypes of people
● As medical practitioners, we help them to adjust
to society and society as well
Impairment
● Concerned with abnormalities of body structure
and appearance and with organ or system
function
● Any loss or abnormality of psychological,
physiological or anatomic structure or function
● Disturbance at organ level
○ disturbance at level of organ (ie SCI =
impairment is loss of function of lower limbs)
● Paralysis of limbs due to
● SCI
Disability
● Reflects the consequence of impairment in
terms of functional performance and activity
○ ie consequence of paraplegia: inability to
walk and perform ADL
● Disturbance at the level of person
● Inability to walk and perform ADL
Handicap
● Handicap: at societal level; hindrance of
performing specific role;
○ ie tetraplegic pt = they become dependent
● Disadvantage which prevents from performing a
role
● Reflect interaction with and adaptation to the
individual's surroundings
● Societal level
● Immobility, dependence
● At the onset of disease, what we see is the signs
and symptoms which are the initial impairments
such as the loss or ..
● Disability and handicap are the consequences of
disease
● Handicap is restriction in fulfillment of role
STATISTICS ON CHRONIC ILLNESS AND DISABILITY
– WHO
● Estimated 1.3B. people experience significant
disability. (16% of world's population or 1 of 6)
○ Increasing in number due to increase in
noncommunicable disease and longer
lifespan
● Some persons with disability die up to 20 years
earlier than those without
● Persons with disabilities have twice the risk of
developing conditions such as depression,
asthma, diabetes, stroke, obesity or poor oral
health
● Face many health inequities (arise from unfair
conditions faced by persons with disability,
including stigma, discrimination, poverty
exclusion from education and employment and
barriers faced in the health system.
STATISTICS ON CHRONIC ILLNESS AND DISABILITY
● Approximately 54M Americans (1 in 5) have
physical, sensory, psychiatric or cognitive
abilities that interfere with daily living
 ● > 9M Americans with disabilities are unable to
work or attend school
● Costs of annual income support and medical
care provided by US government is about $60B
● Disabilities are higher among older people,
minorities and lower socioeconomic groups
● 8 of the 10 most common causes of death in US
are associated with chronic illness
● In 2021, 8/10
FACTOR THAT CREATE A PROFOUND EFFECT ON
THE LIFE OF THE INDIVIDUALS WITH CHRONIC
ILLNESS AND DISABILITY
● Degree of functional limitations
○ Things that the pt cannot do anymore.
● Interference with ability to perform daily activities
and life roles
○ How does this impairment interfere with ADL
and performance of his role as son,
husband, worker, etc?
● Uncertain prognosis
○ ie Cancer pt do not know if chemotherapy
will treat their condition, what are the
consequences of their tx; ie don’t know if
they will have remission or exacerbation
● Prolonged course of medical treatment and
rehabilitation
○ Financial burden on pt and his family
● Psychosocial stress associated with the incurred
trauma or disease process itself
● Impact on family and friends
○ Relational impact
● Sustained financial losses
DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION
TO CID
STRESS
● Increased frequency and severity of stressful
situations
○ Has more stress than those who are normal
or disabled and healthy bc simple things in
their life must be taken into consideration
● Need to cope with daily threats
○ One's life and well being
○ Body integrity
○ Independence and autonomy
■ Ie paraplegic pt: how will i change my
clothes, how will i brush my teeth
○ Fulfillment of familial, social and vocational
roles
○ Future goals and plans
○ Economic stability
CRISIS
● Crisis bc of its sudden onset and life-threatening
such as MI stroke, loss of valued functions such
as kidney dialysis
● Sudden onset, life-threatening, loss of valued
functions
○ Suddenness of having been dx is viewed as
crisis
● Although crisis is time limited, during its
presence life is affected by disturbed
psychological, behavioral and social equilibrium
○ Time limited but there is changes in all the
mains of his life
○ It is stressful to that person although short
lived, effects are short term
● Its consequences are long lasting and may
evolve into pathological disorders
○ Mas matagal → becomes pathological
LOSS OF GRIEF
● Triggers a mourning process for the lost body
part or function
○ Mainly about amputations
 ● Constant reminder of the permanency of the
condition
● Daily triggering events act to remind of the
permanent disparity between past and present
or future situations
○ Constantly reminded of the surgical removal
of their limb
Different Stages of Mourning
● Mainly due to loss of body part of image goes
through these stages
● Parang 5 stages of grief: Denial, anger,
bargaining, depression, acceptance
● Non-acc: this is not happening to me
● Erupting: crying, anger, depression
● Pqarting: part with former, gradually accept na
may change sa function
● Finding: integrate and go back sa roles mo
BODY IMAGE
● Unconscious mental representation or schema
of one's own body
● Evolves gradually and reflects interactive forces
exerted by sensory (visual, auditory, kinesthetic),
interpersonal (attitudinal), environmental
(physical conditions) and temporal factors
○ Affected by sensory (what you see in the
mirror, what you hear about yourself)
● CID alters and distorts one's body image and
self-concept
○ Nagiiba yung tingin mo sa sarili mo
○ Ie CID have darker skin complexion
○ One of these would affect self’s body image
● Successful psychosocial adaptation to CID is
said to reflect the integration of physical and
sensory changes into a transformed body image
and self-perception
○ Success psychosocial adaptation:They must
integrate what they think or how they
perceive themselves to their environment.
SELF-CONCEPT
● Also known as conscious
● Linked to body image and often seen as
conscious, social derivatives of it
● Self-identity (sense of self) is privately owned
and outwardly presented
○ Only self can know about it
○ May be denied in social interactions with
others who respond to the person as
disabled first = lost sense of real self
○ Self-esteem gradually becomes eroded
and negative self-perceptions follow
● As med prac, we should educate the society
about disabled people
STIGMA
● Negative set of beliefs about people with specific
characteristics.
● Increased life stress, reduced self-esteem and
withdrawal from social encounter, including
treatment and rehabilitation.
● Disability always comes with the stigma which
adds stress to pt → reduced self esteem →
withdrawal including their tx (Ayaw nalang nila
makipag interact sa mga tao)
STIGMA
● Social avoidance
○ left out of social activities, circle may be
more distant, people hesitant to make eye
contact or start conversation
○ People tend to avoid interacting with CIDs
(ie lets not bring her anymore, it’s a bother
to wheelchair her) → social support is loss;
people around him avoids making eye
contact or conversing with them; treat them
as how you treat other people
● Stereotyping
○ Presumed helpless, unable to care for
self, unable to make decisions
○ Stereotyping: They are assumed na
helpless, presumed na need alagaan
like demented people. They are not
helpless, since they can be given proper
tools
● Discrimination
 ○ Jobs, housing, opportunities UNCERTAINTY AND UNPREDICTABILITY
○ Discrimination: employment, education ● Associated with diagnosis
● Condescension ● Stable or predictable - amputation, cerebral
○ Coddled or over-protected due to palsy
perceptions of helplessness ○ both are not manageable or curable but can
○ Condescension: binababy sila be treated with cont therapy etc
● Blaming ● Unstable and unpredictable - epilepsy, cancer,
○ Accused of using disability for unfair DM, MS
gains ○ they dont know what will happen in the
○ Blaming: used for unfair gains; ie using future
wheelchair because he wants use the ○ Exacerbation and remissions
elevator ○ Unpredictable complications
● Internalization ○ Experiences of pain and loss of
○ Person himself feel ashamed or consciousness
embarrassed ○ Alternating pace of gradual deterioration
○ Internalization: CID person himself feels ● Perceived uncertainty in illness (Mishel,
embarrassed 1981)
● Hate crimes and violence ○ uncertainty, or inability to structure personal
meaning, results if the individual is unable to
How Disability Stigma Affect Your Relationship with form a cognitive schema of
Patients? illness-associated events
○ Uncertainty of disease is more stressful to
Concealment Disability Social Need for
the patient
Pride Integration respect
QUALITY OF LIFE
Reluctant to use Some express Choose to Build a
assistive pride and make a collaborative ● Domains:
devices or positive identity disability more partnership with ○ Intrapersonal (health, perceptions of life
disclose their to counteract evident to patient built on
diagnosis. stigma improve their trust and
satisfaction, feelings of well being)
option for respect ○ Interpersonal (family life, social activities)
Concealment: Join groups social communicates ○ Extrapersonal (work activities, housing,
They try to with same participation your support for
conceal their disability (using wc the patient as a schooling or learning and recreational)
instead of whole person. ○ Successful restructuring of previously
disability and
May opt walker to travel
become against medical with family w/o Need: respect disrupted psychosocial homeostasis and
reluctant to use tx because they fatigue) their decision attainment of an adaptive
what they have and what they
should use bc developed an Social: more of person-environment (reality) congruence
want to
there is stigma; identity around getting special ○ QOL is linked to a more positive
the disability communicate to
they become tx
other people; self-concept and body image, increased
more prone to we help and sense of control over CID
Disability Pride:
falls, etc; don't treat them with
disclose their
Iniintegrate ○ QOL is negatively associated with perceived
yung disability their condition ;
disease stress and feelings of loss and grief
sa Ego nila. It form an alliance
is bad kasi they with them then
become proud gradually help CID TRIGGERED RESPONSES
of their them ● Shock (Early Response)
disability where
● Anxiety (Early Response)
they don't want
any medical ● Denial (Early Response)
treatment ● Depression (Intermediate Response)
● Anger/Hostility (Intermediate Response)
● Adjustment (reintegration, acceptance) - Late
reactions

SHOCK (Early Response)

● Short-lived reaction
 ● Marks the initial experience following the onset
of a traumatic or sudden injury or diagnosis of a
life threathening or chronic and debilitating
disease
● “Psychic Numbness”: cognitive disorganization
and dramatically decreased or disrupted mobility
and speech; seen in movies; di makaisip ng
maayos, there is schock
● like crisis
ANXIETY (Early Response)
● Characterized by panic-like feature on initial
sensing of the nature and magnitude of the
traumatic event
● Confused thinking, cognitive flooding, multitude
of physiological symptoms including rapid heart
rates, hyperventilation, excess perspiration and
irritable stomach
● Masyado na madami iniisip → panic → become
confused and hyperventilate
DENIAL (Early Response)
● Defense mechanism mobilized to ward of
anxiety and other threatening emotions
● Involves minimization and even complete
negation of the chronicity, extent and future
implications associated with the condition
● Involves selective attention to one's physical and
psychological environments
● Wishful thinking, unrealistic expectations of
recovery, or blatant neglect of medical advice
and recommendations, creation of myths
DEPRESSION (Intermediate Response)
● Reflect the realization of the permanency,
magnitude and future implications associated
with loss of body integrity, chronicity of condition,
or impending death
● Feelings of despair, helplessness,
hopelessness, isolation and distress
ANGER / HOSTILITY (Intermediate Response)
2 types:
● Internalized anger (self)
○ Self-attributions of responsibility
for the condition onset of failure
to achieve successful outcomes
○ attributes responsibility to
himself; whatever happens is
their fault
● Externalized hostility
○ Blame others for CID onset or
unsuccessful treatment efforts
or aspects of the external
environment
○ patient is angry towards oher
people such as practitioner,
family member, → we must
know that they are not really
angry at you and make sure
they are in a safe environment
where they will not harm
themselves and other people
● Aggressive acts, abusive accusations,
antagonism, passive aggressive modes
of obstructing treatment
ADJUSTMENT (late reactions)
● Reorganization, reintegration or reorientation
● Components:
1. Early creconciliation of the condition, its
impact, and its chronic or
2. An affective acceptance, or
internalization, of oneself as a person
with CID, including a new or restored
sense of self concept, renewed life
values and a continued search for new
meanings
3. An active pursuit of personal, social
and/or vocational goals
❖ 1 and 2 is acceptance of his/her
condition
➢ emotional acceptance; new life
goals, body self-concept,
❖ 3 is actively doing something to pursue
his goals, so positive
CID ASSOCIATED COPING STRATEGIES __________
COPING
● Psychological strategy mobilized to decrease,
modify or diffuse the impact of stress-generating
life events
● Disengagement coping strategies
● Engagement coping strategies
DISENGAGEMENT COPING STRATEGIES
● Seek to deal with stressful events through
passive, indirect, even avoidance-oriented
activities
● Denial, wish-fulfilling fantasy, self and other
blame, resorting to substance
 ● Associated with higher levels of psychological a. Vent feelings leading to
distress difficulties in accepting one's condition acceptance of condition
and poor adaptation permanency, altered body
image and realization of
ENGAGEMENT COPING STRATEGIES decreased functional capacity
● Efforts that defuse stressful situations through 2. Providing clients with relevant medical
active, direct and goal-oriented activities such as information
information seeking, problem solving, planning 3. Providing clients with supportive family
and seeking social support and group experiences
● Linked to higher levels of well-being, acceptance 4. Teaching clients adaptive coping skills
of condition and successful adaptation for successful community functioning
● Also same as active or problem focus coping a. Assertiveness, interpersonal
strategy relations, decision making,
problem solving, stigma
INTERVENTION STRATEGIES FOR PEOPLE WITH management and time
CID management skills
● We help them explore meaning of CID
Psychosocial Reaction-Specific interventions ● Change in identity, we help them integrate
● Supportive, affective-insightful or illness to identiity
psychodynamic in nature are more useful in ● We dont lie to the pt regarding their medical info
earlier phases of adaptation and give realistic, up to date information
○ Encouraging to vent feelings associated
with guilt, shame,, mourning for loss of QUALITY OF LIFE
function ● In rehabilitation:
○ Reinforcing social contacts and activities ○ Successful efforts to reestablish the
○ Practicing self-assertiveness, psychosocial homeostasis disrupted by
self-determination and independent the advent of the disability
living skills ○ Attainment of person-environment
● Active-directive, goal-oriented or congruence, where the person with CID
cognitive-behavioral in nature may be more is said to demonstrate better
beneficial during the later stages psychosocial adaptation
○ Practicing anger expression in socially ○ Intrapersonal - health and psychological
sanctioned forms well being
○ Behavior modification techniques to ○ Interpersonal - family and marital
reduce physically and verbally ○ Extrapersonal - work activities, housing
aggressive acts or living environments, recreational
● During early phases: if patient needs help, they activities and learning or schooling
should be able to ask for help and help them be activities
independent ● Three domains should be functional in all three
● During later stages of CIP, we do active-directive domains
etc. ● If there is balance and pt can function to the best
● To help them express their anger in a socially of his abilities, then we can say rehab is
accepted way successful
Global Clinical Interventions
● Provide patient and family with emotional, ESTABLISHING RESPECTFUL COMMUNICATION
cognitive and behavioral support ✔ speak directly to your patient. Make eye contact
● Equip the patient with adaptive coping skills that ✔ use ordinary language. "see you later" to a blind or
could be successfully adopted when facing "lets walk to the park" to nonambulatory
stressful situations ✔ Ask patients with speech impairments how they prefer
1. Assisting clients to explore the personal to communicate
meaning of the CID ✖ Interrupt or rush a patient who communicates slowly
✖ guess what a patient is trying to say
 ● Communication should be at par with pt’s
understanding; it ‘s not offensive to them
● Do they want it in writing, can they lipread,
trying to communicate slowly (we encourage
them to talk)
● We do not guess what they are trying to say

RESPECTING PATIENT PRIVACY AND AUTONOMY

✔ provide written materials
✔ ensure your office and toilets are accessible and they
can navigate the space independently ● Actively listen to what they need help with and
✔ office practice is accessible (layout, procedures) respect them as an individual
✔ ask a patient the best way to provide physical
assistance if it is needed
✖ touch, pull or grab patient's body without asking for
consent
✖ handle patient's mobility device without consent
● Ensure w/c accessibility
● If they want to go to the toilet, we ask if they
need help or will they need any assistance;
● We do not touch pt without consent, we always
ask for permission
● Before we move them unless it is a danger to
them and other people; but if time allows, we
ask consent if you may move their w/c to the
side so people can move

RESPECT DISABILITY IDENTITY AND CULTURE

✔ respect a patient's choice to downplay or highlight
their disability in particular settings
✔ Introduce your patient to support groups
✖ use negative words to describe disability (tragedy,
suffering, confined to wheelchair)
✖ "golden rule thinking" - imagining how you would
personally feel with a disability as a way to infer how
your patients feel
● We do not humiliate or shame the pt
● We respect their decision
● We dont assume na if ako nagka SCI and the pt
cannot walk, useless na kaagad
● Proper mindset: i think i will be strong
emotionally to go through this challenge and go
to rehab
● We don't do “ay pag nawala ako, di ko hahayaan
mangyari sakin etc” because individual cope and
respond differently