Adjustment, Coping, and Change from a Biopsychosocial Perspective - Term Paper Example

Adjustment, Coping, and Change from a Biopsychosocial Perspective Introduction Adjustment can be explained in terms of a process through which an individual comes to term with, makes sense of, and learns to adapt to the changes in the bodily function as a result of the onset of an illness or injury. People vary in the process of adjustment they undergo depending upon age, gender, biological factors, health status, and such other factors. One of the basic goals of rehabilitation is to promote the adjustment of patients to the impairments, role changes, and limitations of activity, and to facilitate their recovery (Wilson and Gracey, 2009). Changes caused by the onset of illness or injury also depend upon a host of biopsychosocial factors. For example, a disorder experienced during the childhood typically disrupts the developing skills or skills that the child has yet to develop whereas a disorder experienced in adulthood may cause a non-progressive or progressive loss of function (Kolb and Whishaw, 2003). Adjustment in the context of neurological disorders caused by brain injury during adulthood typically relates to activity restrictions, socioeconomic changes, and impaired function. People face chronic stressors as they have to cope with and adjust to the changes consistently. Psychological adjustment programs help patients with recovery and improve their quality of life (Cohen et al., 2004). Awareness of illness The adjustment process starts with the realization of a change in the cognitive, behavioral, or physical functioning. The change may occur because of conditions with episodic or intermittent symptomatology like multiple sclerosis, gradual onset caused by dementia or brain tumor, or a sudden onset such as the one caused by stroke or traumatic brain injury. Many people do not initially realize the changes caused because of the nature of these disorders e.g. damage to the neural systems (Ownsworth, Clare, and Morris, 2006). Therefore, many people are saved emotional distress initially, but this lack of awareness can further complicate the process of adjustment because of the delay caused in the commencement of appropriate medical interventions and treatment. Lack of awareness of the impairment may have either a psychological basis in terms of defensive coping and motivated denial, or a neurological aetiology like compromise of the self-reflective tendency caused by brain damage, or both (Fotopoulou, 2008). While poor self-awareness for rehabilitation may have negative implications on the individual’s tendency to adjust, successful adjustment may still be achieved without accurate awareness of a disorder’s effects. Many people make fewer functional gains because they have unrealistic expectations regarding their future and thus show hesitation to partake in the rehabilitation program. The focus of rehabilitation is also influenced by the concerns and views of the caregivers and health professionals in addition to the personal goals of the individual. Clinicians employ a variety of approaches to facilitate the awareness of the patients so that their tendency to participate in the rehabilitation and adjustment program is optimized. Appraisal: sense making Recognition of the changes to self leads the patients to undergo cognitive appraisal processes in an attempt to make sense of the changes and understand what they imply. Clinicians typically apply the Transactional Model of Stress and Coping (Lazarus and Folkman, 1984) in order to explain the process of adjustment to injury or illness including Alzheimer’s disease, multiple sclerosis, and traumatic brain injury to the patients (Godfrey, Knight, and Patridge, 1996). The primary appraisal in this model includes assessing the stressor’s personal significance in terms of changes in function and the challenges posed by it whereas in the secondary appraisal, people evaluate their coping resources’ adequacy to deal with these challenges. People experience more emotional distress when they perceive greater threat and inadequate support. Conversely, some people experience positive changes in psychology while they experience aversive circumstances (Folkman, 1997). This is one of the reasons why the traditional coping and adjustment models have been modified to address post-traumatic growth and other positive psychological changes. Coping and adaption Biopsychosocial chronic pain models imply that environmental and psychological factors play a role in an individual’s adjustment to chronic pain. Jensen et al. (2002) advocated the use of biopsychosocial perspective to study phantom limb pain because they found a statistically significant role of psychosocial predictors in the concurrent prediction of pain interference, depression, and average phantom limb pain at initial assessment, as well as psychosocial predictors’ role in the prediction of change in depression and pain interference subsequently over a period of 5 months. This suggests that a range of biopsychosocial factors including social support, resting as a response of coping, catastrophizing cognitions, and solicitous family members’ responses may help an individual adjust to the phantom limb pain. In addition, the adjustment process is intertwined with the family support system. Particular family members assume the role of caregiver following the onset of illness, which results in drastic change in the dynamics of interactions and relationships. Family members also have to adjust to the caregiver strain (Marsh et al., 2002). Adjustment Programs Goal The Psychological Adjustment Program has twofold goal. Provide a highly structured and therapeutic self-contained setting for the clients experiencing problems in psychological adjustment because of emotional dysregulation. Provide the clients that display appropriate behavior with support and opportunities to integrate in the society. The Therapeutic Components This program is directed at providing the clients with psychological support so that they can integrate into the society with their emotional disabilities while acquiring the necessary social and self-regulatory skills. The program has three broad divisions, meant to cater for the needs of male clients, female clients, and children up to 14 years of age. The therapeutic components of the program are customized according to the needs of the clients depending primarily upon their gender and age. For example, since the principles of child development suggest that children are in need of feeling a sense of belongingness, competence, and safety, the therapeutic components of the program designed for them include: Structured program of behavior management with due focus on positive reinforcers to facilitate the children with adaptive behavior choices Counseling in small group setting where the client to counselor ratio is low Individual behavior contracts and interventions Interactive and structured process of problem solving Delivery of psychological services including crisis intervention and individual or group sessions Intensive case management Differentiated pattern of instruction Alternative methods of discipline Development of collaboration with the caregivers and practitioners Assuming most child clients will be students, they may be required to take leave from school if all other options have been ruled out. Therapeutic Goals The therapeutic components of the program have been designed to address the goals as follows: Assist the clients with development of insight Increase the ability of clients to deal with stress by acquiring and practicing adjustment strategies Increase the ability of clients to make appropriate behavior choices to serve their needs Assist the clients in developing emotional bonds with peers and adults appropriately Increase the engagement, and generic skills and competencies of the clients in their professions. The ultimate goal of the program is to assist the clients to the extent that they are able to achieve psychological adjustment and emotional stability in their respective settings without the need to get extensive support. Program Details The program will be conducted at a medical-care facility i.e. a hospital, clinic, or private establishment of similar kind. The center will be equipped with human resources including dieticians, physicians, yoga trainers and nurses; ergogenic aids including exercise machines and mechanical aids; and technological equipment including multimedia projectors. The program will have two courses, one long and the other short. The short course will be meant for clients that cannot attend the counseling sessions regularly or who cannot fit the counseling sessions into their busy routines. The short course will provide such clients with an efficient and quick guide to biological, psychological, and social adjustment and recovery. The long course will be of two types; one for the clients with significant impairment and the other for the clients with relatively less impairment and appropriate behavior. The two courses are illustrated in Table 1 as follows: Table 1: Program Details Length of time Areas addressed Treatments Rationale for each treatment Short: 1 week Vision: To provide the clients with an efficient and effective support system to optimize their tendency to adjust to the psychological, emotional, and physical changes following the onset of damage. Biological: medication, diet, and exercise 1 week dietary schedule, and exercise training. Giving the clients medicines at due times to make them used to the routinely intake. Since this is a quick and effective guide to biological adjustment, the clinicians can ensure that the clients have received the right medication, and propose dietary plans and exercise routines. Psychological: Yoga, meditation, and anti-depressants Quick and easy yoga exercise training. Training on meditation. Prescribing anti-depressants Certain yoga exercises and meditation practices are easy to learn, so they can be taught to start with. Anti-depressants and mood enhancers can be prescribed with clinicians’ advice. Social: Family support, recreation, and combined physical activity Deciding caregiver roles in family members, assigning duties and responsibilities, preparing plan for outing The clinicians can decide caregiver roles with due consultation with the family members. Exercise and outing plans can be made for the client to follow. Long: 1 month Vision: To provide the clients with a highly structured and therapeutic self-contained setting top assist them with problems in adjustment to emotional, psychological, and physical dysregulation. Biological: Diet, exercise, preventive strategies Deciding diet particular to the disorders and illnesses. Adjusting exercise to match the needs of the client. Giving training on ways to prevent recurrence of the illness Clients need individualized dietary and exercise plans to match the needs as decided by their particular disorders and illnesses. The concerned clinicians and dieticians will be involved in training the clients on their respective plans. Psychological: Yoga, meditation, and behavioral counseling One-to-one session between counselor and clients 5 days a week. Detailed yoga One-to-one sessions will provide the clients with individualized care and attention particularly needed for quick adjustment and recovery. 1 month is sufficient to teach the clients more complicated and effective yoga exercises. Social: Community gatherings; sharing of stories, views, and opinions Displaying motivational documentaries on multimedia projectors, peer consultation and advice post-viewing Hearing about and watching documentaries of patients that have gone through the same struggle in the past and have successfully recovered and/or adjusted to the change is a potential way of motivating the clients. Having an opportunity to talk with other patients with similar diseases and recovery plans also lends psychological and emotional support to the clients. Additional treatments: Vision: To provide the clients that display appropriate behavior with support and opportunities to integrate in the society. Biological: Physical aids, ergogenic aids Training on the use of physical and ergogenic aids (e.g. treadmill) These patients display appropriate behavior. They can take good care of themselves, but need some guidance on the appropriate aids (physical and ergogenic) to ensure quick adjustment and recovery. Psychological: Continued exercise Yoga sessions Meditation In 1 month, detailed yoga exercises with higher complexity and that are known for effectiveness and longer lasting effects can be taught. Social: Reorganizing the life of clients by giving it a pattern Planning and scheduling Establishment of a routine is very essential for giving the life a structure and organization. 1 month is sufficiently long a period to take detailed insights from the clients and their caregivers to create such a plan. Conclusion People adjust to illnesses, injuries, and disorders through an ongoing process whereby they realize, make sense of, and take measures to cope with the impairment. The coping strategies and emotional well-being is influenced by the ways used to appraise the meaning of the impairment. The adjustment mechanism encompasses a complex interplay between a range of social and environmental factors, psychological characteristics of the patients, and the neuropathology of the disorder. Generally, the approaches of rehabilitation directed at the adjustment to brain injury may be more comprehensive milieu-oriented approaches or brief interventions. The needs for adjustment vary from one client to another depending upon their particular biopsychosocial details and the socio-cultural environment in which the support is provided. References: Cohen, L., et al. (2004). Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer. 100(10), 2253-2260. Folkman, S. (1997). Positive psychological states and coping with severe stress. Social Science and Medicine. 45, 1207–1221. Fotopoulou A. (2008). False-Selves in Neuropsychological Rehabilitation: The Challenge of Confabulation. Neuropsychological Rehabilitation. 18, 541-556. Godfrey, H. P. D, Knight, R. G., and Partridge, F. M. (1996). Emotional adjustment following traumatic brain injury: A stress-appraisal-coping formulation. Journal of Head Trauma and Rehabilitation. 11, 29-40. Jensen, M. P., Ehde, D. M., Hoffman, A. J., Patterson, D. R., Czerniecki, J. M., and Robinson, L. R. (2002). Cognitions, coping and social environment predict adjustment to phantom limb pain. Pain. 95(1-2), 133-142. Kolb, B., and Whishaw, I. Q. (2003). Fundamentals of human neuropsychology. 5th ed. New York: Worth Publishers. Lazarus, R. S., and Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer Publishing. Marsh NV, Kersel DA, Havill JH, Sleigh JW. 2002. Caregiver burden during the year following severe traumatic brain injury. Journal of Clinical and Experimental Neuropsychology. 24, 434-447. Ownsworth, T., Clare, L., and Morris, R. (2006). An integrated biopsychosocial approach for understanding awareness disorder in Alzheimers disease and brain injury. Neuropsychological Rehabilitation. 16, 415-438. Wilson, B. A., and Gracey, F. (2009). ‘Towards a comprehensive model of neuropsychological Rehabilitation’. In: Wilson BA, Gracey F, Evans JJ, Bateman A, editors. Neuropsychological rehabilitation: Theory, models, therapy and outcome. 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