DAWN STEWART BSC, MPA, PHD BRS 214 Introduction to Psychology Week 2-3 The relevance of psychology to the field of rehabilitation.

Introduction to Psychology Rehabilitation is the process of helping an individual achieve the highest level of independence and quality of life possible - physically, emotionally, socially, and spiritually. Rehabilitation does not reverse or undo the damage caused by a stroke, but rather helps restore the individual to optimal health, functioning, and well-being. Rehabilitate (from the Latin "habilitas") means "to make able again.

Introduction to Psychology Psychosocial rehabilitation is defined as a process that facilitates for individuals who are impaired, disabled or handicapped by a mental disorder to reach an optimal level of independent functioning in the community. To the extent that effective rehabilitation involves new learning on the part of the individual living with the impairment or disability, it would seem that behavioral psychologists especially should be centrally involved in the design, delivery and evaluation of services to those seriously injured or living with a chronic ill-health condition. Coping successfully with many of the situations faced by those living with disabilities requires

Introduction to Psychology Recent research has highlighted the importance of depression and anxiety as independent risk factors for mortality in cardiac patients. It is critical that clinically significant levels of distress are identified, both in-hospital and after discharge, to target patients who require specific psychological intervention, in addition to conventional cardiac rehabilitation.

Introduction to Psychology A disease, whether inborn or acquired through the years, and accidents, may cause a person’s disability. Temporary or permanent, however minor or serious, this can greatly affect the lives of the victim and those close to them. Persons would need constant reassurances, and plenty of love for them to find meaning in their lives again. This is where rehabilitation psychology comes in.

Introduction to Psychology When speaking of disability, it does not necessarily mean a total injury or impairment of the physical aspect. It can be anything from physical, sensory, cognitive, or emotional limitation of functions. However small this disability is, the impact in the lives of the person and their family is still there. It could affect their relationships with other people, their work, and learning ability. This is the reason rehabilitation psychology is necessary.

Introduction to Psychology There are many services rehabilitation psychology provides. There is health and behavior consultation. This allows one to learn about information on a particular health condition and how it can affect one’s life. Counseling and psychotherapy. This is geared towards influencing one’s attitudes and emotions with the need to change one’s behavior. Cognitive remediation is a service that helps an individual achieve cognitive abilities necessary with school or work, or their life in general, and is important in their practice of independence in the community as well.

Introduction to Psychology Rehabilitation Helps the Disabled Return to Functional Living. Rehabilitation psychology caters to an individual with emotional problems due to a disability. It aims to help the person and his family to cope and take control of their life again after a disability. It is directed to give hope and happiness in the lives of disability victims.

Introduction to Psychology Rehabilitation is an integrated program of interventions that empower individuals with disabilities and chronic health conditions to achieve “personally fulfilling, socially meaningful, and functionally effective interaction” in their daily contexts. Rehabilitation Psychology is a specialty area within psychology that focuses on the study and application of psychological knowledge and skills on behalf of individuals with disabilities and chronic health conditions in order to maximize health and welfare, independence and choice, functional abilities, and social role participation across the lifespan.

Introduction to Psychology Rehabilitation Psychologists’ work includes assessment and intervention regarding the range of physical, personal, psychosocial, cognitive, and behavioral factors that may be affected, such as neuro cognitive status, sensory difficulties, mood/emotions, desired level of independence and interdependence, mobility/freedom of movement, self-esteem and self- determination, behavioral control and coping skills, subjective view of capabilities and quality of life.

Introduction to Psychology Rehabilitation Psychologists consider the influences of culture, ethnicity, language, gender, age, developmental level, sexual orientation, social network, residence and geographic location, socioeconomic status, and relative visibility and/or assumption of disability on attitudes and available services.

Introduction to Psychology Although the process of rehabilitation has traditionally been viewed as ‘physical’ in nature, it is now considered a multi-faceted process involving not only the services of surgeons and physiotherapists but also exercise scientists, dieticians, athletic coaches and sport psychologists

Introduction to Psychology Over the last decade, researchers have become increasingly interested in the psychological impact of injury and how athletes react to being hurt.

Introduction to Psychology The grief reaction With serious injuries that are likely to result in a significant period of time out of the work or usual activities, persons will often experience emotional disturbances. Researchers suggest that persons often follow a five-stage process following injury: Denial Anger Bargaining Depression Acceptance Reorganisation.

Introduction to Psychology After the initial shock is over, many persons tend to play down the significance of the injury. As the injury becomes more apparent, shock is often replaced by anger directed internally toward themselves or externally towards other people. The responses can vary in intensity depending on situational and personal factors but can be especially strong in individuals whose self-concept and personal identity are based on being ‘an athlete’, ‘a nurse’, a mother’ etc. The loss of identity due to an inability to perform in their specific area can cause much distress.

Introduction to Psychology Following anger, the injured athlete might try bargaining/ rationalising to avoid the reality of the situation. A runner may promise herself to train extra hard or to be especially pleasant to those around her if she can recover quickly. By confronting reality, and cognitively realising the consequences of the injury, an athlete can become depressed at the uncertainty of the future. It must be noted, however, that depression is not inevitable and has not always been observed during the grief reaction in research studies.

Introduction to Psychology Finally, the person moves towards an acceptance of the injury and focus is directed to rehabilitation and a return to sports activity. This stage tends to mark the transition from an emotional to a problem-coping focus as the person realizes what needs to be done to aid recovery. The timescale for progression through these stages can vary considerably and setbacks during rehabilitation can lead to further emotional disturbance. In cases of very serious injury and ones in which the emotional reactions are prolonged, the skills of a clinical psychologist might be required.

Introduction to Psychology Researchers found evidence that fear of re-injury, anxiety, and questioning of their own abilities to recover were reported by a significant number of injured persons. More recent research, which investigated the subjective experiences of patients following reconstructions, highlighted fear of re-injury as having associations with those who did not adhere to the rehabilitation programme.

This fear may be linked to a reduction in self- motivation for such patients and avoidance rather than approach behaviours. what appears to be lack of motivation on the part of the injured athlete might actually be a symptom of emotional distress. Although these findings only represent qualitative data, there are implications for future researchers to establish if interventions to reduce this fear of re- injury might improve the adherence to rehabilitative programmes

Being able to detect those persons who are not adjusting to their injuries at an early stage can help to establish the necessary support. Poor adjustment can manifest itself in non- compliance or adherence to rehabilitation programmes, with some persons doing too little while others may push too hard. Physiotherapists have identified non-compliance as a significant problem preventing effective and efficient recovery from injury.

Introduction to Psychology One study identified a number of key characteristics in athletes who experienced difficulties in adjusting to their injuries. These included: Feelings of anger and confusion Obsession with the question of when one can return to sport Denial (considering the injury to be no big deal) Exaggerated bragging about accomplishments Rapid mood swings Withdrawal from significant others Fatalistic thinking (whatever I do, things are not going to improve) Dwelling on minor physical complaints.

Introduction to Psychology While psychosocial rehabilitation is an important part of the overall process of successful management of chronic mental illnesses, its importance has not been recognized in many developing countries, and its practice is still rare compared to the use of medicines to "cure" illnesses