MODELS OF ADAPTATION
TO DISABILITY
GURBIR DULLET
STUDENT, M.PHIL. C.P.
DCRPR
STAGE MODEL OF ADAPATATION TO
DISABILITY
People who experience disability for the first time undergo stress; cope
with life transitions, value changes, and experience disability issues
across their life spans. From a sociological perspective, people who
experience disability for the first time also have to deal with the role of
family, cross-cultural issues and adjustments, the consequences of
negative demeanor's towards people with disabilities as a whole, and
the roles of professionals who work to assist them with adjusting. Their
system of life and living has changed in many different ways, meaning
they must endure a process of adjustment and self-evaluation.
The experience of an injury that leads to a psychological or physical disability
is similar to enduring a mourning process and might be equated to the
loss of a loved one.
Example. The mourning process can involve adjustment to the disability the
person experiences and may be divided into a series of four stages or tasks -
shock, denial, anger/depression, and adjustment/acceptance.
• The stages are expected, yet are not orderly or neat.
• People with new forms of disabilities go through these stages at their own paces and might
skip whole stages entirely.
• A difficulty exists when the person has trouble with resolving one of the stages or becomes,
'stuck.’
• When this happens, further progress towards adjustment and acceptance is hindered.
Stages of Adjusting to a New Form of Disability
The stages of adjusting to a new form of disability include four
basic ones. Shock: Shock involves a state of both emotional and
physical numbness that can last from a few hours to several days.
Denial: Denial may last anywhere from three weeks to two
months and is a defense mechanism that allows the implications
of the new disability the person has experienced to be gradually
introduced.
Denial only becomes an issue when it interferes with the
person's life, forms of treatment, or rehabilitation efforts.
Anger/Depression: Anger and depression are reactions to loss and the
person's change in social treatment and status. The person may experience a
number of different emotions during this stage and grieve for the changes in
their body image, function, loss of future expectations, or former satisfaction
based upon any function that has been lost.
Adjustment/Acceptance: The stage of adjustment and acceptance does not
necessarily mean the person is happy about the disability they now
experience, although it does allow for the relinquishment of any false hopes,
as well as the successful adaptation of new roles based upon realistic
potentials and limitations.
The person might benefit from interactions with others who experience forms
of disabilities, and becomes comfortable with who they are.
Emotional aspects associated with a new form of disability are many times a
major factor in determining the person's outcome and the benefits related to
rehabilitative efforts. Effective psychological intervention is beneficial where
ensuring recovery from an injury that has caused a form of disability is
concerned.
Many people experience more than four stages of adjustment to a physical disability; in fact -
people might experience as many as twelve stages that include:
Shock
Anxiety
Bargaining
Denial
Mourning
Depression
Withdrawal
Internalized anger
Externalized aggression
Acknowledgment
Acceptance
Adjustment
The experience of a form of disability forces the issue of, 'finding one's self.'
Some people take pride in the things they learn about themselves through the
experience of a form of disability. They appreciate the way disability helps to
define their values.
A number of psychological adjustments have little to do with the disability a
person experiences; they are issues everyone does. As an example, a person
might be frustrated because they are having a hard time finding someone to love
and believe it is their form of disability that is the cause of the loneliness they
feel. The issue; however, is a part of many people's lives, whether they
experience a form of disability or not. It is important for people with disabilities to
avoid making disability a scapegoat for issues that might very well have
appeared in their lives anyway.
For the majority of people with disabilities, disability does not define who they are;
it is something they deal with when it becomes necessary to do so. One person
with a disability noted that the entire human race is essentially disabled because
we are unable to live together in peace, something that has always been so, and
will continue to be so in the future. The question then becomes, 'What is normal’?
A person's experience with a new form of disability may be marked by:
fatigue,
negative emotions,
a sense of powerlessness, or
confusion.
It is important to remember that there is also the chance to experience confidence and
hope as they witness new abilities to cope with what is often a challenging situation.
The majority of people who experience a new form of disability adjust in ways they never
believed possible. With positive social support from family members, friends, and society at
large the vast majority of people who experience a new form of disability do adjust.
LIVNEH’S VIEW
Livneh provides a summary and synthesis of more than 40
explicit and implicit stage models of adjustment, described
as a reaction to a sudden and unexpected permanent
physically disabling condition. Livneh cites several authors
regarding a number of shared assumptions or rules of thumb
applicable to these models. Several of the more pertinent
assumptions are:
(a) adjustment is not a static, but rather a dynamic ongoing process, despite the
concept that adaptation is considered to be the final outcoe.
(b) the initial insult causes a psychological disequilibrium that typically restabilizes
over time.
(c)most individuals sequentially transition through time-limited stages by coming
to terms psychologically with whatever trauma has occurred to them.
(d) although most individuals experience most stages, others may not.
(e) not everyone transitions through all stages sequentially; some individuals skip stages,
some regress backwards to a previous stage, some can become stuck in a stage for long
periods, while others may never reach the final adjustment stage.
(f) experiencing different stages separately and sequentially does not
always occur, as some individuals may be observed to be in overlapping stages without
any particular timeline, and often fluctuate based on individual circumstances and coping
mechanisms.
(g)observations at each stage can be correlated with certain cognitions, emotions, and
behaviors.
(h) although stages are self-triggered, appropriate behavioral, psychosocial, and
environmental interventions (counseling) can positively affect coping strategies to
successfully transition toward adaptation.
SOMATOPSYCHOLOGY
• SOMATOPSYCHOLOGY IS THE STUDY OF THE PSYCHOLOGICAL IMPACT OF A DISEASE OR DISABILITY.
• Field theory postulated by kurt lewin (1935, 1936) centers around the belief that our self-concept
or self-worth can, and is, affected by the feedback we perceive from interacting with others in
our environment, referred to as our “life space.”
• The revised theory has been encompassed as follows: behavior (b) is a function (f) of
• Psychosocial variables such as self-esteem and coping skills (P), organic factors related to the
disability such as
• Paralysis or blindness (O), and
• environmental or physical access and attitudinal factors (E), comprising the Formula:
B = f(p × O × E) summarized by trieschmann (1988).
Somatopsychology Focuses on how physical & physiological processes influence
psychological function (totally opposite to psychosomatic theories)
Lewin's equation B = f(P,E)
Behaviour is a function of a person in their environment disability acceptance is
influenced by the personal meaning of the disability together with the value that the
disability holds for others in a person's life.
• Can do emphasis: Oriented to what a person with their disability can do
The life areas they can participate
The active role they play in their recovery
The idea that people with disability can lead meaningful and productive lives
• Somatopsychology interventions:
Gradual extension of new skills into real-life situations
Building self -concept of success in valued activities
Relevance of meaningful goals with graded sub-goals to support achievement and,
in turn, psychological state
New situations (Role playing to prepare)
Peer supported learning
• Acceptance model:
societal meaning of CID + personal values
coping vs succumbingsense of self
body image
physiological state
DISABILITY CENTRALITY MODEL
The most recent adaptation model to CID has shown to have great promise
theoretically, empirically, and with tangible clinical implications
Bishop proposes the DCM. He (2005) describes six tenets as the theoretical
underpinnings for DCM that factor in subjective and objective QOL satisfaction
and control over one’s medical and environmental circumstances.
THESE ARE SUMMARIZED AS FOLLOWS:
(A) The impact of a CID can be measured by a multidimensional subjective QOL
measure.
(B) QOL is an individual’s overall perceived subjective satisfaction of life
domains that are disproportional because of individual differences regarding
which domains are more important (central) to us.
(C) the onset of a CID results in an initial reduction in overall QOL and centrally
important satisfying activities, as well as feelings of personal control
(D) The degree of QOL reduced is dependent on how many central domains are
affected.
(E) Individuals seek to maintain and maximize overall QOL by minimizing gaps
(distress) caused by the CID.
(F) People strive to close these gaps by either changing their values and interests
commensurate with their disabled abilities, employ strategies to increase perceived
control over their health and environment, or alternatively do nothing to improve
control or change their values.
ECOLOGICAL MODEL
Chan et al. (2009) make the observation that even within the ecological models of
adjustment to disability, there is overlap representing the stage or phase theory of
adjustment including early reactions of shock, anxiety, and denial; intermediate
reactions of depression, internalized anger, and externalized anger; and later reactions
involving acknowledgment, acceptance, and adjustment. As we conclude later, all of
these proposed theories have overlapping and similar concepts.
Two theorists who summarize the complexity of ecological models best are arguably
Trieschmann (1988) and Vash and Crewe (2004). These models involve a foundation of
three major determining factors that consider:
(a) nature of the disability,
(b) characteristics of the person, and
(c) environmental influences.
Each of these determining factors require exploration by the counselor to assess what, if
any, bearing each of these factors have on psychosocial adjustment. It is important to
note that none of these factors may negatively influence poor adjustment; conversely,
any one of these factors, in and of themselves, if deemed important by the individual,
may delay or prolong adjustment.
Nature of disability : This factor explores aspects of the disability itself and the
implications of each. The first subfactor considers the time of onset regarding whether an
individual was born with a disability or acquires it sometime later in life.
Type of onset : Concerns whether or not the disability had a sudden impact (spinal cord
injury from a car accident) versus a prolonged onset (more gradual such as multiple
sclerosis), and the implications of each.
Functions impaired those persons who have lived and adapted to their disability
emphatically
disagree that it is the worst thing (bodily function) they could lose.
Severity of the disability essentially considers how severe the disability is, with the once
assumed belief that those with more severe disabilities were likely more maladjusted.
Visibility of the disability considers the reactions individuals with visible disabilities
sometimes experience (wheelchair users) such as discrimination, devaluation, and being
ignored.
Stability of the disability addresses whether the disability is stable and generally will
not become worse (spinal cord injury) versus those that have an uncertain prognosis, but
become progressively worse over time
Concept of pain deserves a category unto itself in addressing psychosocial adjustment. As
Vash and Crewe (2004) emphasized, unlike many of the other disabilities, chronic pain is
a primary or secondary debilitating condition that can have a significant negative impact
on an individual’s thoughts, emotions, and behaviors.
2) Personal Characteristics
These determining factors involve individualized traits or characteristics:
Gender largely considers gender differences in coping with disability, as well as societal expectations of
males and females .There are mixed findings regarding which gender adjusts to a disability better;
however, Western societal expectations of each gender are quite clear . Males and females with severe
disabilities may not be able to live up to some or any of these expectations, and may have difficulty
adjusting if they rely on external cues (societal expectations) for affirmation of their self-concept/self-
esteem.
Activities affected relates to the significance individuals place on their activities. A
hockey player who becomes paralyzed and is no longer able to play sports may
experience greater difficulty adjusting than a professor who has the same injury, but
can still perform academic activities.
Interests/values/goals pertain to the differing passions people have in their lives.
Those who proverbially “put all their eggs in one basket” or have few if any interests
and lose the ability to engage in them likely find adjustment more stressful than those
persons who have multiple interests and are still able to return to some of them
indicates that when people experience a loss and withdraw from engaging in what
were once pleasurable activities, there is a greater likelihood of lengthening or
exacerbating a reactive depression.
Remaining resources are described by Vash and Crewe (2004) as the abilities and
traits an individual retains regardless of his or her disability. These include
intelligence, motivation, sense of humor, extroversion, social poise, resilience,
emotional stability, and coping strategies, all of which have been implicated in
positive adjustment (see Livneh, 1991).
Spiritual and philosophical base refer to one’s spiritual or religious beliefs, particularly
as to whether some people believe their disability is a punishment from God or higher
power, with the assumption that those who believe they are being punished have a
more difficult time adjusting (Byrd, 1990; Gallagher, 1995; Graf, Marini, Baker, & Buck,
2007). Conversely, individuals who believe their disability to be a divine intervention or
calling for them to serve a higher purpose for God experience lesser adjustment
difficulties (Eareckson, 2001, Graf et al., 2007).
3) Environmental Influences
Environmental influences may have a significant impact on adaptation to disability
describe several contributing factors :
Family acceptance and support those families that have been shown to possess
positive coping strategies and support one another typically adapt well to the
disability.
Income plays an important role not so much as in overall happiness, but rather in
overall QOL a higher income and adequate health care positively impact one’s
ability to remain healthy, as well as purchase necessary accommodations and
equipment/devices (modified van, accessible home) for a better QOL.
Available community resources refers to support from local agencies, which could
include
Centers for Independent Living (CILs), Veterans Affairs services, Client Assistance
Programs (CAPs), access to modernized hospitals, and so forth.
Social support is also critical for positive adjustment and fostering self-esteem in most,
but not all, instances (Buunk & Verhoeven, 1991; Li & Moore, 1998). Schwarzer and
Leppin (1992) define functional support by differentiating between instrumental support
(offering financial aid), informational support (giving information and advice), and
emotional support (caring, empathy, and reassurance).
RECURRENT OR INTEGRATTED MODEL OF ADJUSTMENT :
Pertinent to this model are several key concepts. Beck’s (1967) cognitive theory defines
cognitive schema as our ingrained beliefs and assumptions regarding ourselves, others,
and how the environment works (beck & weishaar, 1989).
When a sudden and traumatic disability occurs, many individuals attempt to cling on to
the comfortable, old schemas because of an overwhelming anxiety and uncertainty that
the disability brings.
Wright (1983) refers to this as “as if” behavior, whereby individuals attempt to minimize
anxiety by denying or distorting reality and pretending as if nothing (the disability) has
happened.
POSITIVE NEW SCHEMA ARE FORMED WHEN
INDIVIDUALS WITH TRAUMATIC DISABILITIES CAN
(a) Search and find meaning in the disability and in post disability life;
(b) learn to master or control their environment, the disability, and their future; and
(c) protect and enhance the self by incorporating the new disability identity (barnard,
1990; kendall & buys, 1998, p. 17).
Negative schema can also be formed about the disability, allowing stereotypical societal
expectations about disability (helpless, incapable) to influence one’s self-worth
(Charmaz, 1983; Stewart, 1996). Wright (1983) would describe those who develop
negative schema as otherwise having succumbed to their disability.
According to the theory of recurrent periods of sadness, even individuals who have
developed positive schema and have otherwise been successful in their lives still
experience sorrow or sadness from time to time (Kendall & Buys, 1998).
As some research has shown, it is quite likely that these periods of sorrow may be
facilitated from environmental influences such as a relationship rejection, job
rejection, or discrimination perceived by the individual because of his or her
disability (Graf et al., 2009; Li & Moore, 1998; Marini et al., 2009).
Overall, response to the disability varies for everyone depending on one’s coping
mechanisms
LEWIN’S CHANGE MODEL.
• The model describes three phases that people go through as they make changes in
their lives. These phases are unfreezing, changing, and refreezing.
• The three stages of this process include unfreezing (the person has an existing
state), moving or changing towards new ways of being, and then refreezing into a
new state altogether!
The first phase of the process involves everything required for someone to become
ready and willing to make a change. This state when they are not yet committed or
certain is called unfreezing. For example, it could involve anything from finding out
about a problem to receiving the go-ahead for action.
In the second phase, people actually make a change. This implies moving or changing,
and it’s usually not easy. People face a number of different challenges from being
uncomfortable to feeling uncertain about making changes.
Person might also feel as though they were losing something important by leaving their
old ways behind, which would fall under resistance during this period.
In the final phase, people are able to refreeze into a new state finally. This is when
they accept their changes and feel like it was worth all the energy that was channelled
into making them!
They may also feel more comfortable than ever about what’s going on in their lives
right now. When employees make positive changes at work, they begin to feel
motivated and committed!
If all three phases are completed successfully, it can be said that the
change management process has been successful!
PSYCHOSOCIAL MODEL
Tamara Dembo and Beatrice Wright, two of Lewin's students, are
recognized as pioneering figures in the history of rehabilitation
psychology. Wright authored two of the field's seminal texts, physical
disability: A psychological approach and the extensively revised
second edition, physical disability: A psychosocial approach. She also
proposed the somatopsychological model, which advocates for
interpreting disability within its social context
TRANSACTIONAL MODEL
CHAOS THEORY BY MOOS
Chaos as an indication of overwhelming anxiety. Psychic chaos, mostly equated with
debilitating anxiety, is also capable of triggering a mixture of related emotions that include
depression and anger (butz, 1997; chamberlain & butz, 1998; sabelli, 1989).
The experience of profound heightened anxiety, as of other pathological psychic
conditions, is likely to result in changes in the level of behavioral complexity
(dimensionality). A psyche confronted with overwhelming anxiety transforms into a series
of chaotic mental processes that serves both:
(a) the need to dissipate energy (i.E., Decrease levels of anxiety) arid
(b) the pursuit of adaptive forms of behavior and reconstructed self-organization
(chamberlain, 1998; conrad, 1986; perna, 1997).
CONTI….
The progression from the initial core anxiety state, through the chaotic turbulence,
to a renewed stable and adaptive functioning constitutes a phase transition “as the
original attractor becomes repellent and forces trajectories outward” (lewis &
junyk, 1997, p. 60).
Three components interact to play a dynamic role in the process of psychosocial
self-organization following the onset of CID. These include cognitive appraisals,
such as appraisals of loss; emotional experiences, such as experiences of anxiety and
sadness; and behavioral responses, such as retreat from social encounters.
Through the process of adaptation, these components interact with and activate each
other recursively, proceeding from less harmonious to more harmonious coexistence.
REFERENCES
• https://www.redorbit.com/news/science/267083/psychological_adaptation_to_
disability_perspectives_from_chaos_and_complexity_theory/
• https://www.ncbi.nlm.nih.gov/books/nbk233576/#!po=32.5397
