[2Y2T3S] [PT10110] [3] Psychosocial Adaptation: Chronic Illness and Disability

Two models of disabilities

1. Medical model

2. Social model

What model of disability is described below:

• Focused on curing the patient’s impairments

• Traditional view

Medical Model of Disability

What model of disability is described below:

• Focused on the people’s perception on disability

• Combatting discrimination

Society Model of Disability

Abnormalities of body structure and appearance and with organ or system function

Impairment

Loss or abnormality of psychological, physiological or anatomic structure or function

Impairment

Reflects the consequence of impairment in terms of functional performance and activity

Disability

Restriction in ability to perform a function that may result from an impairment

Disability

• Disadvantage which prevents from performing a role

• Reflect interaction and adaptation to the individual’s surroundings

Handicap

What level of disturbance is affected in an impairment?

Organ level

What level of disturbance is affected in disability?

Level of person

What level of disturbance is affected in handicap?

Societal level

Different stages of mourning (4)

1. Non-acceptance of the facts

2. Erupting emotions

3. Parting with the former

4. Finding a new self as well as new perspectives for one’s future

Factors that create a profound effect on the life of the individuals with CID (7)

1. Degree of functional limitations

2. Interference with ability to perform daily activities and life roles

3. Uncertain prognosis

4. Prolonged course of medical treatment and rehabilitation

5. Psychosocial stress associated with the incurred trauma or disease process itself

6. Impact on family and friends

7. Sustained financial losses

Dynamics to the Psychosocial Adaptation to CID (9)

1. Stress

2. Crisis

3. Loss and grief

4. Body image

5. Self-concept

6. Stigma

7. Uncertainty

8. Unpredictability

9. Quality of life

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

• Increased frequency and severity of stressful situations

• Need to cope with daily threats

Stress

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

• Sudden onset, life-threatening, loss of valued functions

• Although time limited, during its presence life is affected by disturbed psychological, behavioral, and social equilibrium

Crisis

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

Its consequences are long lasting and may evolve into pathological disorders

Crisis

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

• Triggers a mourning process for the lost body part or function

• Constant reminder of the permanency of the condition

Loss and grief

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

Daily triggering events act to remind of the permanent disparity between past and present or future situations

Loss and grief

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

• Unconscious mental representation or schema of one’s own body

• Evolves gradually and reflects interactive forces exerted by these factors:

  • Sensory

  • Interpersonal

  • Environmental

  • Temporal

Body image

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

True or False: CID alters and distorts the body image perception of other people towards the patient

False: CID alters and distorts own’s body image and self-concept

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

How does the successful psychosocial adaptation of body image to CID reflect?

Reflects the integration of physical and sensory changes into a transformed body image and self-perception

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

• Linked to body image and often seen as conscious, social derivatives of it

• Self-identity is privately owned and outwardly present

Self-concept

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

This may happen when self-identity is denied in social interactions with others who respond to the person as disabled first

Lost sense of real self

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

Negative set of beliefs about people with specific characteristics

Stigma

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

Increased life stress, reduced self-esteem and withdrawal from social encounters, including treatment and rehabilitation

Stigma

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

Three general types of stigma

1. Public stigma

2. Structural stigma

3. Self-stigma

TYPES OF STIGMA

Left out of social activities, circle may be more distant, people hesitant to make eye contact or start conversation

Social avoidance

TYPES OF STIGMA

Presumed helpless, unable to care for self, unable to make decisions

Stereotyping

TYPES OF STIGMA

Jobs, housing, opportunities

Discrimination

TYPES OF STIGMA

Coddled or over-protected due to perceptions of helplessness

Condescension

TYPES OF STIGMA

Accused of using disability for unfair gains

Blaming

TYPES OF STIGMA

Person himself feel ashamed or embarrassed

Internalization

Four ways how disability stigma can affect your relationship with patients

1. Concealment

2. Disability pride

3. Social integration

4. Need for respect

EFFECT OF DISABILITY STIGMA TO PATIENT RELATIONSHIP

Reluctant to use assistive device or disclose their diagnosis

Concealment

EFFECT OF DISABILITY STIGMA TO PATIENT RELATIONSHIP

• Some express pride and positive identity to counteract stigma

• Join groups with same disability

• May opt against medical treatment because they have developed an identity around the disability

Disability pride

EFFECT OF DISABILITY STIGMA TO PATIENT RELATIONSHIP

Choose to make a disability more evident to improve their options for social participation

• Ex. using a wheelchair instead of walker to travel with family without fatigue

Social integration

EFFECT OF DISABILITY STIGMA TO PATIENT RELATIONSHIP

Build a collaborative partnership with patient built on trust and respect communicates your support for the patient as a whole person

Need for respect

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

• Uncertainty, or inability to structure personal meaning

• Results if the individual is unable to form a cognitive schema of illness-associated events

Perceived uncertainty in illness

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

Examples of disabilities with stable or predictable perception (2)

1. Amputation

2. Cerebral palsy

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

Examples of disabilities with unstable and unpredictable perceptions (4)

1. Epilepsy

2. Cancer

3. DM

4. MS

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

• Successful restructuring of previously disrupted psychosocial homeostasis

• Attainment of an adaptive person-environment (reality) congruence

Quality of life

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

What domain of quality of life is referred to below:

• Health, perceptions of life satisfaction, feelings of well being

Intrapersonal

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

What domain of quality of life is referred to below:

• Family life, social activities

Interpersonal

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

What domain of quality of life is referred to below:

• Work activities, housing, schooling or learning and recreational

Extrapersonal

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

QOL is linked to ____ over CID (2)

QOL is linked to a more positive self-concept and body image, increased sense of control over CID

DYNAMICS TO THE PSYCHOSOCIAL ADAPTATION TO CID

QOL is negatively associated with (2)

QOL is negatively associated with perceived stress and feelings of loss and grief

Early triggered responses of CID (3)

1. Shock

2. Anxiety

3. Denial

Intermediate triggered responses of CID (2)

1. Depression

2. Anger/hostility

Late triggered response of CID (1)

1. Adjustment (reintegration, acceptance)

CID TRIGGERED RESPONSES

• Short-lived reaction

• Marks the initial experience following the onset of a traumatic or sudden injury or diagnosis of a life threatening or chronic and debilitating disease

Shock

CID TRIGGERED RESPONSES

Manifested by:

• “Psychic numbness”, cognitive disorganization, and dramatically decreased or disrupted mobility and speech

Shock

CID TRIGGERED RESPONSES

Panic-like feature on initial sensing of the nature and magnitude of the traumatic event

Anxiety

CID TRIGGERED RESPONSES

Manifested by:

• Confused thinking, cognitive flooding, multitude of physiological symptoms (rapid heart rates, hyperventilation, excess perspiration and irritable stomach)

Anxiety

CID TRIGGERED RESPONSES

Defense mechanism mobilized to ward of anxiety and other threatening emotions

Denial

CID TRIGGERED RESPONSES

• 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

Denial

CID TRIGGERED RESPONSES

Manifested by:

• Wishful thinking, unrealistic expectations of recovery, or blatant neglect of medical advice and recommendations

Denial

CID TRIGGERED RESPONSES

Reflect the realization of the permanency, magnitude and future implications associated with loss of body integrity, chronicity of condition, or impending death

Depression

CID TRIGGERED RESPONSES

Manifested by:

• Feelings of despair, helplessness, hopelessness, isolation, and distress

Depression

CID TRIGGERED RESPONSES

Two types of anger

1. Internalized anger (self)

2. Externalized hostility

CID TRIGGERED RESPONSES

What type of anger is described below:

• Self-attributions of responsibility for the condition onset of failure to achieve successful outcomes

Internalized anger (self)

CID TRIGGERED RESPONSES

What type of anger is described below:

• Blame others for CID onset or unsuccessful treatment efforts or aspects of the external environment

Externalized hostility

CID TRIGGERED RESPONSES

Manifested by:

• Aggressive acts, abusive accusations, antagonism, passive-aggressive modes of obstructing treatment

Anger/hostility

CID TRIGGERED RESPONSES

Reorganization, reintegration, or reorientation

Adjustment

CID TRIGGERED RESPONSES

First component of adjustment

Earlier cognitive reconciliation of the condition, its impact, and its chronic or permanent nature

CID TRIGGERED RESPONSES

Second component of adjustment

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

CID TRIGGERED RESPONSES

Third component of adjustment

An active pursuit of personal, social, and/or vocational goals

CID TRIGGERED RESPONSES

Psychological strategy mobilized to decrease, modify, or diffuse the impact of stress-generating life events

Coping

CID TRIGGERED RESPONSES

Two types of coping strategies

1. Disengagement coping strategies

2. Engagement coping strategies

CID ASSOCIATED COPING STRATEGIES

• Seek to deal with stress events through passive, indirect, even avoidance-oriented activities

• Denial, wish-fulfilling fantasy, self and other blame, resorting to substance abused

• Associated with higher levels of psychological distress difficulties in accepting one’s condition and poor adaptation

Disengagement coping strategies

Three intervention strategies for People with CID

1. Theory-driven interventions

2. Psychosocial reaction-specific interventions

3. Global clinical interventions

INTERVENTION STRATEGIES FOR PEOPLE WITH CID

Supportive, affective-insightful or psychodynamic in nature are more useful in earlier phases of adaptaton

Psychosocial reaction-specific interventions

INTERVENTION STRATEGIES FOR PEOPLE WITH CID

Active-directive, goal-oriented or cognitive-behavioral in nature may be more beneficial during the later stages

Psychosocial reaction-specific interventions

INTERVENTION STRATEGIES FOR PEOPLE WITH CID

Provide patient and family with emotional, cognitive, and behavioral support

Global clinical interventions

INTERVENTION STRATEGIES FOR PEOPLE WITH CID

Equip the patient with adaptive coping skills that could be successfully adopted when facing stressful situations

Global clinical interventions

INTERVENTION STRATEGIES FOR PEOPLE WITH CID

Provisions done to patients in global clinical interventions (4)

1. Assisting clients to explore the personal meaning of the CID

2. Providing clients with relevant medical information

3. Providing clients with supportive family and group experiences

4. Teaching clients adaptive coping skills for successful community functioning

Three CORRECT ways in establishing respectful communication

1. Speak directly to your patient. Make eye contact

2. Use ordinary language.

3. Ask patients with speech impairments how they prefer to communicate

Two INCORRECT ways in establishing respectful communication

1. Interrupt or rush a patient who communicates slowly

2. Guess what a patient is trying to say

Four CORRECT ways of respecting patient privacy and autonomy

1. Provide written materials

2. Ensure your office and toilets are accessible and they can navigate the space independently

3. Office practice is accessible (layout, procedures)

4. Ask a patient the best way to provide physical assistance if it is needed

Two INCORRECT ways of respecting patient privacy and autonomy

1. Touch, pull or grab patient’s body without asking for consent

2. Handle patient’s mobility device without consent

Two CORRECT ways of respecting disability identity and culture

1. Respect a patient’s choice to downplay or highlight their disability in particular settings

2. Introduce your patient to support groups

Two INCORRECT ways of respecting disability identity and culture

1. Use negative words to describe disability (tragedy, suffering, confined to wheelchair)

2. “Golden rule thinking” – imagining how you would personally feel with a disability as a way to infer how your patients feel