Roundtable on Coping with Chronic Illness and Disability CID

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Roundtable on Coping withChronic Illness and
Disability (CID)

• Dr. Beatrice Wright
• Dr. Hanoch Livneh
• March 26th, 2007
• University of Memphis

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Some basic philosophical concepts

• Person and context/environment
• Biopsychosocial model
• The following slides are taken from Livneh, H.
  Martz, E. (in press). An introduction to coping
  theory and research. In E. Martz and H. Livneh
  (Eds.), Coping with chronic illness and
  disability Theoretical, empirical, and clinical
  aspects. N.Y. Springer.

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Definitions of Coping

• Constantly changing cognitive and behavioral
  efforts to manage specific external and/or
  internal demands that are appraised as taxing or
  exceeding the resources of the person (Lazarus
  Folkman, 1984, p. 141).
• A stabilizing factor that can help individuals
  maintain psychosocial adaptation during stressful
  periods. It encompasses cognitive and behavioral
  efforts to reduce or eliminate stressful
  conditions and associated emotional distress
  (Holahan, Moos Schaefer, 1996, p. 25).
• Haans (1977) tripartite categorization of
  coping, defense mechanisms, and fragmentation

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Coping

• Coping efforts include a wide range of cognitive,
  emotional, and behavioral strategies directed at
  both external (i.e., environmental) stressors and
  internal demands and needs.
• Coping involves both stable personality
  characteristics and process-oriented aspects.

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Coping

• Two common categorizations of coping
  problem-solving and emotion-focused coping.
• Problem-focused efforts are often needed to
  manage stressful events (thus are adaptive), but
  can be detrimental under conditions in which the
  situation is unchangeable (Zeidner Saklofske,
  1996).
• Emotion-focused coping can be beneficial when it
  helps to maintain emotional balance under
  conditions that are beyond personal control or
  that may be unchangeable (Aldwin, 1994 Mattlin,
  Wethington Kessler, 1990 Taylor, 1999 Zeidner
  Saklofske, 1996). I

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Variables that influence/interact with coping
processes

• Note The following slides are additional
  thoughts from Dr. Livneh
• Chronological age
• Age of CID onset
• Duration of CID
• Functional limitations
• Level of pain or discomfort
• Nature of stressful event/situation (e.g.,
  controllability, changeability, course,
  familiarity)

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Issues associated with the definition and
operation of coping

• State (situation-specific) vs. Trait (durable
  dispositions)
• Global (coping as a macro-analytic concept high
  level of abstraction or aggregation) vs. Specific
  (coping as a micro-analytic concept low level of
  abstraction such as a distinct behavior)
• Temporality (preventive/proactive vs.
  present/ongoing vs. reactive/residual coping
  efforts)

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Issues associated with the definition and
operation of coping, continued

• Problem-focused (eliminating or reducing
  stressful events externally-oriented efforts)
  vs. Emotion-(or perception) focused (regulating
  or managing distressing emotions
  internally-oriented efforts)
• Conscious vs. unconscious processes
• Adaptive vs. Non-adaptive (degree of coping
  successfulness adaptiveness is judged in
  relation to the nature, duration,
  controllability, and changeability of the
  stressful event)

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Coping versus succumbing framework

• Coping world-view emphasizes positive aspects,
  qualities, and abilities inherent in an
  individual
• Succumbing world-view focuses on the
  impairment, pathology, or insufficiency in ones
  mind or body.
• The following slides are quoted from p. 195 in
  Wright, B. A. (1983). Physical disabilitya
  psychosocial approach (2nd ed.). New York
  HarperCollins Publishers.

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Copingversus succumbing

• 1. The emphasis is on what the person can do.
• 2. Areas of life in which the person can
  participate are seen as worthwhile.

• 1. The emphasis is on what a person cannot do.
• 2. Little weight is given to the areas of life in
  which the person can participate.

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Copingversus succumbing

• 3. The person is perceived as playing an active
  role in molding his or her life constructively.

• 3. The person is seen as passive, as a victim of
  misfortune.

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Copingversus succumbing

• 4. The accomplishments of the person are
  appreciated in terms of their benefits to the
  person and others (asset evaluation), and not
  evaluated because they fall short of some
  irrelevant standard.

• 4. The persons accomplishments are minimized by
  highlighting their shortcomings
  (comparativestatus evaluation, usually measured
  in terms of normal standards).

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Copingversus succumbing

• 5. The negative aspects of the persons life,
  such as the pain that is suffered or difficulties
  that exist, are felt to be manageable. They are
  limited because satisfactory aspects of the
  persons life are recognized.

• 5. The negative aspects of a persons life, such
  as the pain that is suffered or difficulties that
  exist, are kept in the forefront of attention.
  They are emphasized and exaggerated and even seen
  to usurp all of life (spread).

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Copingversus succumbing

• 6. Managing difficulties mean reducing
  limitations route changes in the social and
  physical environment as well as in the person.
  Examples are
• a. eliminating barriers
• b. environmental accommodations
• c. medical procedures
• d. prostheses and other assistive devices
• e. learning new skills

• 6. Prevention and cure are the only valid
  solutions to the problem of disability.

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Copingversus succumbing

• 7. Managing difficulties also means living on
  satisfactory terms with ones limitations
  (although the disability may be regarded as a
  nuisance and sometimes a burden). This involves
  an important value changes.

• 7. The only way to live with the disability is to
  resign oneself or to act as if the disability
  does not exist.

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Copingversus succumbing

• 8. The person with a disability is pitied and his
  or her life essentially devaluated.

• 8. The fact that individuals with disabilities
  can live meaningful lives is indicated by their
  participation in valued activities and by their
  sharing in the satisfactions of living.

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Invitation to tomorrows events

• 1) Tuesday, March 27th, 2007 You are invited to
  the experiment Experiencing an Experience from
  11-1230 pm (Ball Hall auditorium). Dr. Wright
  will lead this experiment that will examine
  concepts related to disability.
• 2) Tuesday, March 27th, 2007 2 pm- 3 pm
  Discussion of 20 value-laden beliefs in 205
  Ball Hall. You are invited to a discussion
  session that covers how our beliefs influence our
  professional practice/behaviors.