1. Roundtable on Coping with Chronic Illness and Disability (CID) Dr. Beatrice Wright Dr. Hanoch Livneh March 26 th, 2007 University of Memphis

2. 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.

3. 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).  Haan’s (1977) tripartite categorization of coping, defense mechanisms, and fragmentation

4. 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.

5. 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

6. 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)

7. 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)

8. 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)

10. 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 one’s mind or body. The following slides are quoted from p. 195 in Wright, B. A. (1983). Physical disability—a psychosocial approach (2nd ed.). New York: HarperCollins Publishers.

11. Coping…versus 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.

12. Coping…versus 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.

13. Coping…versus 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 person’s accomplishments are minimized by highlighting their shortcomings (comparative–status evaluation, usually measured in terms of “normal” standards).

14. Coping…versus succumbing 5. The negative aspects of the person’s 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 person’s life are recognized. 5. The negative aspects of a person’s 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).

15. Coping…versus 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.

16. Coping…versus succumbing 7. Managing difficulties also means living on satisfactory terms with one’s 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.

17. Coping…versus succumbing 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. 8. The person with a disability is pitied and his or her life essentially devaluated.

18. Invitation to tomorrow’s events 1) Tuesday, March 27th, 2007: You are invited to the experiment “Experiencing an Experience” from 11- 12:30 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.