M2.3 — Becoming Culturally Competent Pt. 3

Diversity

Diversity

Concepts of stress, crisis, loss/grief, body image, self-concept, stigma, uncertainty and unpredictability, and quality of life.

Stress

Need to cope with threats.

Crisis

Sometimes psychosocial in nature; consequences may be long-lasting.

Loss and Grief

Occurs when

• Mourning for the lost body part or function.

• Mourning for the lost body of a loved one.

Psychosocial

Involves social environment and psychological state of being.

Adaptation or Adjustment

— Changes in life made continuously after illness and disability.
— Both a process and an outcome.
— Dynamic, not linear

Unique, Personal, and Complex

Emotional Response Pattern is…

1. Self-Reflection

2. Return to Work

3. Absence of Depression

4. Socializing Again and Resume Previous Roles

Adaptation as an outcome…

1. Cognitive

2. Behavioral

3. Emotional

4. Social

1. Despair and Hope

2. Helplessness, Powerlessness and Hopelessness

Typical reactions to illness and disability include…

Despair

Result of roller-coaster effects of illness.

Hope

Enables clients to avoid overwhelming despair.

Helplessness

No sense of control.

Powerlessness and Hopelessness

Prolonged, sustained helplessness.

• Disbelief

• Denial

• Fear

• Fear of losing control over one’s life

• Depression

• Anger

• Guilt

• Greiving

Other typical reactions to illness and disability include…

Chronic Sorrow

— Sadness without end
— Can be life-long (Episodic or Progressive)
— May be characterized by events that cause sorrow to occur.
— Grief from:

• Loss of milestones of life

• Loss of future plans

• Lifestyle adaptations based on restrictions

1. Control

2. Self-Image

3. Dependency

4. Stigma

5. Abandonment/Rejection

6. Anger

7. Isolation/Withdrawal

8. Fear of Dying

Factors affecting Response to Illness/Disability

Control

— Factors affecting Response to Illness/Disability
— Not knowing what the future will bring.
— Related to fears and uncertainty of outcome.

Shock, Unprepraed

Body image and self-concept with sudden onset of disability entails…

Adapting to changes over time, more satisfied with themselves

Body image and self-concept with chronic/progressive disability entails…

True

The greater body image dissatisfaction, the lower the psychosocial adjustment and lower level of physical functioning.

True or False.

1. Prior Loss

2. Nature of Content Loss

3. Prognosis of Treatment and Recovery

4. Patterns of Development

5. Family and Cultural Values, Beliefs, and Attitudes

6. Personal Control

7. Sin and Stigma

8. Social Support

9 Factors that influence a Person’s Response to Body Image Changes

Dependency

— Factors affecting Response to Illness/Disability
— Threats to independence: emotional, physical, financial
— May lead to depression and suicidal thoughts
— May be affected by age, gender, psychosocial development, etc.

Stigma

— Factors affecting Response to Illness/Disability
— Related to issue of self-acceptance
— Attitudes of other will have impact on the individual.

Abandonment/Rejection

— Factors affecting Response to Illness/Disability
— Ambivalent feelings about:
• Fear of abandonment but feel bad about becoming a burden.
• Need care of others but also aware of difficulty it poses on others.

Anger

— An offshoot of perceived loss of control.
— Normal response to frustration.

Isolation

— Factors affecting Response to Illness/Disability
— Individuals isolate themselves due to:
• Depression
• Hopelessness
• Despair
• Low Self-Esteem
• Unworthiness
— Inability to continue previous life activities.
— Cut off from friends and family.
— Not talking to others.
— Keeping to oneself.
— Social, Physical, Emotional

1. Kubler-Ross Process of Adaptation

2. Van Servellen Emotional Stages

3. Johnson Stages of Adjustment

What are the conceptual frameworks of stages of adaptation?

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

6. Meaning

Enumerate the Kubler-Ross Process of Adaptation.

1. Shock and Anxiety

2. Fear

3. Anger and Hostility

4. Depression

5. Clues of Depth and Intensity of Depression

6. Depression

7. Resolution & Acceptance

Enumerate the Van Servellen: Emotional Stages

1. Denial

2. Resistance to “Letting” Illness/Disability Control Life

3. Affirmation

4. Acceptance

5. Personal Growth

Enumerate the Johnson Stages of Adjustment

Shock

— May be short-lived following the onset of traumatic and sudden injury, diagnosis of life-threatening, chronic disease.
— Involves numbness, cognitive disorganization, dramatically decreased mobility and speech (~decrease, slow).

Anxiety

— Panic-like state
— Involves confused thinking, rapid heart rate, hyperventilation, excess perspiration, and irritable stomach (~increase, fast)

Fear

— Objective and subjective appraisals of illness.
— Circumscribed and specific.

Anger and Hostility

— Reaction to stress and a statement of protest.
— May be communicated in many ways.
— May go unnoticed or misunderstood.
— The people they rely on the most becomes the outlets of frustration and misery.
— Depends on the following factors:
• Outlook
• Culture
• Religion
• Previous history with stressful life events

Depression

— Some admit to feeling down or that they are contemplating suicide.
— Can be more intense if there is insufficient outlet for angry feelings, limited support and intense feelings of powerlessness and hopelessness.
— Intense, suppressed anger may be associated.
— Those suffering from this are likely to mask their real feelings, may say they’re okay, fine, or pretty good; may also smile and appear cheerful as a facade

• Lack of energy/feel tired often.

• Reports of crying, sadness, and a sense of isolation

• Some may even start writing or preparing their last will and testament

What are clues of depth and intensity of depression?

Depression

Arises from the realization of permanency, magnitude, and future implications.

Resolution and Acceptance

— Sense of relief
— Vary from person to person.
— Thoughts of “too little time” or “too little time left”
— Regain/remain a sense of control and hope.

1. Behavioral

2. Cognitive

3. Decisional

What are the 3 Categories of Control?

Behavioral Control

Actions to direct environmental demands.

Cognitive Control

Way in which patient evaluates or interprets events.

Decisional Control

Ability to choose courses of action from alternatives.

Denial

— Johnson Stages of Adjustment
— Not wanting to accept and acknowledge illness/disability.
— Used as a defense mechanism to control anxiety and distress.

Denial of Facts

What is the first order use of denial?

Denial of Implication of Facts

What is the second order use of denial?

Denial of Ultimate Outcome

What is the third order use of denial?

Resistance to letting illness/disability control life

— Johnson Stages of Adjustment
— Action-based response.
— Unrealistic expected of personal control which may lead to depression.

Affirmation

— Johnson Stages of Adjustment
— Acknowledgement of illness/disability.
— Allows individual to open up, process, and develop/use resources.
— Facilitates re-evaluation of life’s priorities.

Acceptance

— Johnson Stages of Adjustment
— Realistic recognition of illness/disability.
— Coming to terms

Personal Growth

— Johnson Stages of Adjustment
— Responding with the attitude that with every experience, there is opportunity to grow and evolve in new ways.
— More appreciation for life and gratitude for the things that are right in one’s life.

Coping

— Supports people during stressful circumstances by diminishing or eliminating psychological distress and allowing them to function.
— Constantly changing cognitive and behavioral efforts to manage external/internal demands appraised as taxing or exceeding the resources of the person.
— Active, process-oriented.
— Wide range of strategies (not one size fits all)
— Situation and person specific.
— Influenced by personal factors and available resources.
— May increase risk for morbidity and mortality.

1. Locus of Control

2. Self-Efficiency

3. Self-Esteem

4. Social Support

What are the factors affecting motivation and coping?

1. Appraisal-Focused Coping

2. Problem-Focused Coping

3. Emotion-Focused Coping

What are the 3 coping orientations?

Appraisal-Focused Coping

— Deal with meaning associated with crisis.
— Cognitive process that entails…
• Assessment and Mental Practice
• Definition and Reframing
• Avoidance or Denial

Problem-Focused Coping

— Manage or alter the source of stress.
— Action-based
— Practical aspects of the situation.
— Collect info.
— Build support.
— Develop other measures of satisfaction or success.

Emotion-Focused Coping

— Regulate stress emotions
— Control emotions
— Release emotions.
— Accept and surrender.

1. Problem Solving

2. Problem Avoidance

3. Social Support

4. Social Withdrawal

5. Self-Criticism

6. Cognitive Restructuring

7. Express Emotions

8. Wishful Thinking

What are the 8 coping strategies?

Problem Solving

Behavioral and cognitive strategies to eliminate sources of stress by changing stressful situations.

Cognitive Restructuring

Cognitive strategies that alter the meaning of the stressful situation–examine its positive aspects, viewed from a new perspective.

Social Support

Seeking emotional support from people (family and friends).

Express Emotions

Releasing and expressing emotions.

Problem Avoidance

Denial of problems; avoidance of thoughts or action about the stressful event.

Wishful Thinking

Cognitive strategies that reflect an inability or reluctance to reframe or symbolically after the situation–hoping and wishing that things could be better.

Self-Criticism

Blaming oneself for the situation and criticizing self.

Social Withdrawal

Spending time alone; avoiding people.

1. Problem Solving + Cognitive Restructuring

2. Stressful Situation

What are the….

1. Stategies under PROBLEM-FOCUSED ENGAGEMENT

2. What is the focus of PROBLEM-FOCUSED ENGAGEMENT

1. Social Support + Express Emotions

2. Individual’s emotional reaction to the stressful situation.

What are the….

1. Stategies under EMOTION-FOCUSED ENGAGEMENT

2. What is the focus of EMOTION-FOCUSED ENGAGEMENT

What are the….

1. Stategies under PROBLEM-FOCUSED DISENGAGEMENT

2. What is the focus of PROBLEM-FOCUSED DISENGAGEMENT

1. Self-Criticism + Social Withdrawal

2. Shutting off oneself and feelings; criticizing/blaming self.

What are the….

1. Stategies under EMOTION-FOCUSED DISENGAGEMENT

2. What is the focus of EMOTION-FOCUSED DISENGAGEMENT

• Problem Solving

• Cognitive Restructuring

• Social Support

• Express Emotions

What are the strategies under engagement?

• Manage stressful situations

What is the focus of engagement tertiary subscale?

• Self-Criticism

• Social Withdrawal

• Wishful Thinking

• Problem Avoidance

What are the strategies under disengagement?

• Disengaging from a person/environmental situation.

What is the focus of disengagement tertiary subscale?

1. Difficulties with motivation

2. Participation in therapy

3. Adoption of compensatory strategies

What factors can have an impact on rehab outcome?

True

OT Values don’t necessarily include the cultural variation of values.

True or False.

Patience, Openness, and Sensitivity

In order to consider these variations, we must approach the new culture with….