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Toglia J, Goverover Y. Revisiting the dynamic comprehensive model of self-awareness: a scoping review and thematic analysis of its impact 20 years later. Neuropsychol Rehabil 2022; 32:1676-1725. [PMID: 35583377 DOI: 10.1080/09602011.2022.2075017] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to (1) describe the scope of research related to the Dynamic Comprehensive Model of Awareness (DCMA) (Toglia & Kirk, 2000); (2) identify themes and support for key model postulates; and (3) suggest future research directions related to this model. Using PRISMA scoping guidelines, 366 articles were reviewed, and 54 articles met our inclusion criteria. Selected studies were clustered into three themes: (1) the relationship between general and online self-awareness (50%); (2) interventions based on the model (41%); and (3) factors contributing to self-awareness (9%). Most studies were conducted with participants with acquired brain injury (BI) and traumatic BI (68%), most used a cross-sectional design (50%), and most intervention studies utilized a single-subject design (18%), followed by an experimental design (9%). This review provides evidence for the wide application of the DCMA across varying ages and populations. The need for a multidimensional assessment approach is recognized; however, stronger evidence that supports a uniform assessment of online self-awareness is needed. The intervention studies frequently described the importance of direct experience in developing self-awareness; however, few studies compared how intervention methods to influence general versus online self-awareness, or how cognitive capacity, self-efficacy, psychological factors, and context, influence the development of self-awareness.
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Affiliation(s)
- Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Yael Goverover
- Department of Occupational Therapy, New York University, New York, NY, United States
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Brown L, Fish J, Mograbi DC, Bellesi G, Ashkan K, Morris R. Awareness of deficit following traumatic brain injury: A systematic review of current methods of assessment. Neuropsychol Rehabil 2021; 31:154-188. [PMID: 31642719 DOI: 10.1080/09602011.2019.1680393] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
Background: Awareness of deficit plays an important role in adjustment following a brain injury and has been noted to impact on engagement with and outcome of rehabilitation. However, there are challenges associated with the assessment of awareness. Aim: To systematically review all instruments used to assess intellectual awareness of deficits following Traumatic Brain Injury (TBI) in adults, and evaluate instrument characteristics (e.g., the format and focus of measures of awareness) and assessment methods adopted. Results: Thirty-four studies, all rated as fair to good quality, were identified and within these twenty-three different assessment tools were adopted. The most common method of assessment was patient-proxy discrepancy, with three frequently used instruments employed in a total of 22 of the 34 studies. Across studies, variability was noted regarding the type of assessment method dependent on various sample demographics (e.g., age of sample) and injury characteristics (e.g., time post injury). Conclusions: There is no consensus on the preferred instrument to assess intellectual awareness of deficits after TBI. Continued instrument development should attempt to incorporate multiple perspectives and assessment should take into account demographic and injury-related factors. An insightful avenue for future research would be to determine which factors are likely to impact awareness measurement.
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Affiliation(s)
- Laura Brown
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Jessica Fish
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Daniel C Mograbi
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janerio, Brazil
| | - Giulia Bellesi
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | | | - Robin Morris
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Hütter BO, Huffmann B, Gilsbach JM. Coping and Health-Related Quality of Life after Closed Head Injury. Clin Neurol Neurosurg 2020; 197:106194. [DOI: 10.1016/j.clineuro.2020.106194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shibayama T, Tanha S, Abe Y, Haginoya H, Rajab A, Hidaka K. The role of illness schemata in self-care behaviors and glycemic control among patients with type 2 diabetes in Iran. Prim Care Diabetes 2019; 13:474-480. [PMID: 30926384 DOI: 10.1016/j.pcd.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 11/22/2022]
Abstract
AIMS The diabetes illness perception domains outlined by Leventhal's common-sense model may be weakly associated with hemoglobin A1c (HbA1c) and adherence to diabetes self-care behaviors. However, type 2 diabetes patients' illness schemata identified by clustering the illness perception domains remain to be explained. This study aimed to describe type 2 diabetes patients' illness schemata and to examine their association with self-care behaviors and glycemic control in Iran. METHODS A cross-sectional survey was conducted with 200 patients (mean age 59.5±10.3; 70% female) who attended self-management classes at the Iranian Diabetes Society in Tehran. Illness perceptions and self-care behaviors were assessed using the Persian version of the Illness Perception Questionnaire Revised and the Summary of Diabetes Self-Care Activity. RESULTS Three clusters of diabetes illness beliefs were identified: "empowered," "self-condemned," and "powerless." "Empowered" participants adhered most rigorously to general diet, fruit and vegetable intake, and exercise, and had the best glycemic control (HbA1c=7.2%, SD=0.2), followed by "self-condemned" and then "powerless" participants, who had the lowest adherence and the worst glycemic control (p<0.0001). CONCLUSIONS The clustering method for identifying type 2 diabetes patients' illness schemata is useful for selecting patients who need further care and assistance with adhering to self-care behaviors and glycemic control.
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Affiliation(s)
| | - Somayeh Tanha
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Yoshiki Abe
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | | | - Kikue Hidaka
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Aujla N, Walker M, Sprigg N, Vedhara K. Do individual versus illness belief schema differ in the prediction of post-stroke recovery? J Health Psychol 2018; 25:2118-2128. [DOI: 10.1177/1359105318785446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This longitudinal observational study examined how individual versus illness belief schema compare as predictors of post-stroke recovery. A total of 42 stroke survivors (mean age = 66.9 years/range = 29–96 years; 68% male) were involved. The primary outcome, Health-Related Quality of Life was measured using EQ-5D-5L, mood using Patient Health Questionnaire-9 and disability using Nottingham Extended Activities of Daily Living Scale. Stroke Illness Perception Questionnaire-Revised measured illness beliefs. Linear regressions showed that individual illness beliefs significantly explained more of the variance in 3-month post-stroke recovery than schema (7.4%–22.5% versus 1.9%–9.9%). Individual versus illness belief schema predict outcomes differently, but which approach predicts outcomes better remains unclear.
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Heruti I, Levy S, Avitsur R, Deutscher D, Gutvirtz M, Berkovitz T, Shiloh S. Development of the Injury Perceptions Questionnaire (InjPQ). Psychol Health 2017; 33:614-633. [PMID: 29022358 DOI: 10.1080/08870446.2017.1381957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Injuries are major causes of morbidity and mortality in the population. Given the central role of perceptions in self-regulation of health conditions, it is important to investigate how they are perceived. This article describes the development of the Injury Perceptions Questionnaire (InjPQ). METHODS A concurrent study in a diverse sample of injured individuals (n = 333). The internal structure and the reliability (Cronbach's α) of InjPQ sub-scales were explored by factor analyses. Relationships between injury perception dimensions and equivalent illness perception scales and outcome measures (self-assessed health; physical, emotional and social functioning; depression, anxiety and somatisation; satisfaction with life) were investigated. RESULTS The InjPQ was found to represent the following perception scales: injury identity composed of social and body part components, PTSD symptoms, Injury event, Injury specific emotions, Injured self-image, Positive consequences, Responsibility/guilt, Coping, Time distance, Dependency, Healthy self, External attributions and Injury risk factors. The reliability and construct validity of the scales were found adequate. CONCLUSIONS Injury perceptions can be reliably measured. While partly overlapping with equivalent illness perception scales, the InjPQ depicts cognitive dimensions unique to injury that add significantly to explaining variance in outcomes. The InjPQ is recommended for research and clinical use as a measure of injury perceptions.
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Affiliation(s)
- Irit Heruti
- a School of Behavioral Sciences , Tel-Aviv Academic College , Israel
| | - Sigal Levy
- a School of Behavioral Sciences , Tel-Aviv Academic College , Israel
| | - Ronit Avitsur
- a School of Behavioral Sciences , Tel-Aviv Academic College , Israel
| | | | | | | | - Shoshana Shiloh
- c School of Psychological Sciences, the Gordon Faculty of Social Sciences , Tel Aviv University , Israel
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Belchev Z, Levy N, Berman I, Levinzon H, Hoofien D, Gilboa A. Psychological traits predict impaired awareness of deficits independently of neuropsychological factors in chronic traumatic brain injury. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 56:213-234. [PMID: 28467630 DOI: 10.1111/bjc.12134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 03/09/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To dissociate injury-related factors from psychological contributions to impaired awareness of deficits following traumatic brain injury (TBI); impaired awareness is theorized to partly reflect psychological factors (e.g., denial), but empirical evidence for this theory is scarce. DESIGN We examined how different factors predict awareness in patients undergoing rehabilitation (N = 43). Factors included (1) neurological (injury severity), (2) neuropsychological loss, (3) psychological (denial, projection, identification), and (4) personality (narcissism). METHODS/MAIN MEASURES The Patient Competency Rating Scale, comparing patient with clinician reports on different functional domains; the Thematic Apperception Test, an injury-independent measure of the propensity to mobilize specific defence mechanisms; and the Narcissism Personality Inventory. RESULTS Impaired awareness was not predicted by injury-related and neuropsychological scores but was significantly predicted by use of primitive defence mechanisms (denial and projection). Patients who underestimate their abilities also demonstrated high denial levels, but contrary to underestimators, this was positively related to depression and negatively to awareness. CONCLUSIONS Primitive defence mechanism use significantly contributes to impaired awareness independent of injury-related factors, particularly in domains associated with self-identity. Well-validated tests of defence mechanism mobilization are needed to support clinical interpretation of and intervention with impaired awareness. More research is needed to understand the psychology of hypersensitivity to deficits. PRACTITIONER POINTS This study provides an empirical demonstration of dissociable contributions of neurological and psychological factors to awareness of deficits in TBI. Trait proclivity to mobilize defence mechanisms in response to anxiety-provoking situations can be measured, and strongly predicts impaired awareness. Importantly, measures of psychological reactions were independent of responses to the neurological deficits themselves, discriminating between psychological and neurological contributions to impaired awareness. The importance of identifying psychological reactions to impaired awareness and hindering rehabilitation success is highlighted, and vital for clinicians to consider during the rehabilitation process. Psychological reactions to TBI can be identified using well-validated, quantitative measures of the use of psychological defences (e.g., Cramer's Thematic Apperception Test scoring system), and the authors suggest this is a critical step to properly characterize and manage awareness in patients during treatment. Although only TBI patients were examined, the results may inform impaired awareness that occur as a result of other disorders and illnesses. The patients in this study were in the chronic stages of the injury, and therefore, the results may not generalize to patients in more acute stages.
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Affiliation(s)
- Zorry Belchev
- Department of Psychology, University of Toronto, Ontario, Canada.,The Rotman Research Institute at Baycrest, Toronto, Ontario, Canada
| | - Neta Levy
- Department of Psychology, University of Haifa, Israel
| | - Itamar Berman
- Department of Psychology, University of Haifa, Israel
| | - Hila Levinzon
- Department of Psychology, University of Haifa, Israel
| | - Dan Hoofien
- Department of Psychology, Hebrew University of Jerusalem, Israel.,The National Institute for the Rehabilitation of the Brain Injured, Tel Aviv, Israel
| | - Asaf Gilboa
- Department of Psychology, University of Toronto, Ontario, Canada.,The Rotman Research Institute at Baycrest, Toronto, Ontario, Canada
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Shiloh S, Heruti I, Leichtentritt R. A common-sense model of injury perceptions. J Health Psychol 2016; 21:1516-26. [DOI: 10.1177/1359105314557876] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to clarify the difference between perceptions of injury and illness. A qualitative study using semi-structured interviews was conducted with 38 individuals who had been injured in the past, 8 medical psychologists, 62 graduate psychology students, and 19 health professionals treating injured patients. Data were analyzed by modified analytic induction and constant comparison methods. Common-sense perceptions of injury overlapped with some perceptions of illness, and 4 new themes were elicited. It was concluded that there are themes unique to injury perceptions that should be recognized in research as well as in clinical interventions.
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Affiliation(s)
| | - Irit Heruti
- Tel Aviv University, Israel
- Tel Aviv-Yaffo Academic College, Israel
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Wolters Gregório G, Ponds RW, Smeets SM, Jonker F, Pouwels CG, van Heugten CM. How Stable Is Coping in Patients with Neuropsychiatric Symptoms after Acquired Brain Injury? Changes in Coping Styles and Their Predictors in the Chronic Phase. J Neurotrauma 2016; 33:696-704. [DOI: 10.1089/neu.2015.3900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gisela Wolters Gregório
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Department Acquired Brain Injury Huize Padua, GGZ Oost Brabant, Boekel, the Netherlands
| | - Rudolf W.H.M. Ponds
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Adelante, Rehabilitation Centre, Hoensbroek, the Netherlands
| | - Sanne M.J. Smeets
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Frank Jonker
- Department Vesalius, Altrecht GGZ, Den Dolder, the Netherlands
| | - Climmy G.J.G. Pouwels
- Department Acquired Brain Injury Huize Padua, GGZ Oost Brabant, Boekel, the Netherlands
| | - Caroline M. van Heugten
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
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Aujla N, Walker M, Sprigg N, Abrams K, Massey A, Vedhara K. Can illness beliefs, from the common-sense model, prospectively predict adherence to self-management behaviours? A systematic review and meta-analysis. Psychol Health 2016; 31:931-58. [PMID: 26911306 DOI: 10.1080/08870446.2016.1153640] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine whether people's beliefs about their illness, conceptualised by the common sense model (CSM), can prospectively predict adherence to self-management behaviours (including, attendance, medication, diet and exercise) in adults with acute and chronic physical illnesses. DESIGN AND MAIN OUTCOME MEASURES Electronic databases were searched in September 2014, for papers specifying the use of the 'CSM' in relation to 'self-management', 'rehabilitation' and 'adherence' in the context of physical illness. Six hundred abstracts emerged. Data from 52 relevant studies were extracted. Twenty-one studies were meta-analysed, using correlation coefficients in random effects models. The remainder were descriptively synthesised. RESULTS The effect sizes for individual illness belief domains and adherence to self-management behaviours ranged from .04 to .13, indicating very weak, predictive relationships. Further analysis revealed that predictive relationships did not differ by the: type of self-management behaviour; acute or chronic illness; or duration of follow-up. CONCLUSION Individual illness belief domains, outlined by the CSM, did not predict adherence to self-management behaviours in adults with physical illnesses. Prospective relationships, controlling for past behaviour, also did not emerge. Other factors, including patients' treatment beliefs and inter-relationships between individual illness beliefs domains, may have influenced potential associations with adherence to self-management behaviours.
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Affiliation(s)
- N Aujla
- a Division of Primary Care, University of Nottingham , Nottingham , UK.,b Division of Rehabilitation and Ageing , University of Nottingham , Nottingham , UK.,d Division of Clinical Neurosciences, Stroke , University of Nottingham , Nottingham , UK
| | - M Walker
- b Division of Rehabilitation and Ageing , University of Nottingham , Nottingham , UK
| | - N Sprigg
- d Division of Clinical Neurosciences, Stroke , University of Nottingham , Nottingham , UK
| | - K Abrams
- e Department of Health Sciences , University of Leicester , Leicester , UK
| | - A Massey
- c School of Clinical Sciences , University of Nottingham , Nottingham , UK
| | - K Vedhara
- a Division of Primary Care, University of Nottingham , Nottingham , UK
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Snell DL, Surgenor LJ, Hay-Smith EJC, Williman J, Siegert RJ. The contribution of psychological factors to recovery after mild traumatic brain injury: Is cluster analysis a useful approach? Brain Inj 2014; 29:291-9. [DOI: 10.3109/02699052.2014.976594] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Changes in Self-Reported Pre- to Postinjury Coping Styles in the First 3 Years After Traumatic Brain Injury and the Effects on Psychosocial and Emotional Functioning and Quality of Life. J Head Trauma Rehabil 2014; 29:E43-53. [DOI: 10.1097/htr.0b013e318292fb00] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sasse N, Gibbons H, Wilson L, Martinez R, Sehmisch S, von Wild K, von Steinbüchel N. Coping strategies in individuals after traumatic brain injury: associations with health-related quality of life. Disabil Rehabil 2014; 36:2152-60. [DOI: 10.3109/09638288.2014.893029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Harrison S, Robertson N, Graham C, Williams J, Steiner M, Morgan M, Singh S. Can we identify patients with different illness schema following an acute exacerbation of COPD: A cluster analysis. Respir Med 2014; 108:319-28. [DOI: 10.1016/j.rmed.2013.10.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
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Hunt AW, Turner GR, Polatajko H, Bottari C, Dawson DR. Executive function, self-regulation and attribution in acquired brain injury: A scoping review. Neuropsychol Rehabil 2013; 23:914-32. [DOI: 10.1080/09602011.2013.835739] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Postconcussive Complaints, Anxiety, and Depression Related to Vocational Outcome in Minor to Severe Traumatic Brain Injury. Arch Phys Med Rehabil 2013; 94:867-74. [DOI: 10.1016/j.apmr.2012.11.039] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 11/25/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022]
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Björkdahl A, Lundgren-Nilsson Å, Sunnerhagen KS. How Can We Tell Who Is Aware? Where Does the Veracity Lie? J Stroke Cerebrovasc Dis 2012; 21:812-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 12/08/2010] [Accepted: 04/15/2011] [Indexed: 11/30/2022] Open
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Lin F, Heidrich SM. Role of older adult's illness schemata in coping with mild cognitive impairment. J Psychosom Res 2012; 72:357-63. [PMID: 22469277 DOI: 10.1016/j.jpsychores.2012.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 12/14/2011] [Accepted: 01/09/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE 1) To describe the illness representations of older persons with Mild Cognitive Impairment (MCI); 2) to describe how older adults cope with MCI; 3) to examine the relationships between illness representations and coping. METHODS Sixty-three older adults with MCI completed questionnaires on demographic and health information, beliefs about MCI (Illness Perception Questionnaire-MCI), and coping with MCI (brief COPE and Self-care Behaviors Checklist). RESULTS Participants endorsed an average of 7 symptoms that they experienced and believed were related to MCI and an average of 7 potential causes of MCI. Participants tended to believe MCI was chronic, not cyclic, and controllable, but they differed in their beliefs about the consequences, understandability and emotional impact of MCI. Participants used many dementia prevention behaviors and memory aids, some problem-focused and emotion-focused coping strategies, and few dysfunctional coping strategies. Cluster analysis identified three clusters of beliefs about MCI: "few symptoms and positive beliefs," "moderate symptoms and positive beliefs," and "many symptoms and negative beliefs." Those in the "many symptoms and negative beliefs" cluster had significantly more negative beliefs about the consequences, unpredictability (cyclic timeline), and emotional impact of MCI than those in the other clusters. Participants in the "few symptoms and positive beliefs" cluster used significantly fewer memory aids, problem-focused coping strategies, emotion-focused coping strategies, and dysfunctional coping than those in the other two clusters. CONCLUSION As suggested by the Common Sense Model, older adults with MCI have beliefs about their MCI and these beliefs are associated with how older adults cope with MCI.
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Affiliation(s)
- Feng Lin
- School of Nursing, University of Rochester Medical Center, United States.
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Brands IMH, Wade DT, Stapert SZ, van Heugten CM. The adaptation process following acute onset disability: an interactive two-dimensional approach applied to acquired brain injury. Clin Rehabil 2012; 26:840-52. [DOI: 10.1177/0269215511432018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe a new model of the adaptation process following acquired brain injury, based on the patient’s goals, the patient’s abilities and the emotional response to the changes and the possible discrepancy between goals and achievements. Background: The process of adaptation after acquired brain injury is characterized by a continuous interaction of two processes: achieving maximal restoration of function and adjusting to the alterations and losses that occur in the various domains of functioning. Consequently, adaptation requires a balanced mix of restoration-oriented coping and loss-oriented coping. The commonly used framework to explain adaptation and coping, ‘The Theory of Stress and Coping’ of Lazarus and Folkman, does not capture this interactive duality. Relevant theories: This model additionally considers theories concerned with self-regulation of behaviour, self-awareness and self-efficacy, and with the setting and achievement of goals. The two-dimensional model: Our model proposes the simultaneous and continuous interaction of two pathways; goal pursuit (short term and long term) or revision as a result of success and failure in reducing distance between current state and expected future state and an affective response that is generated by the experienced goal-performance discrepancies. This affective response, in turn, influences the goals set. This two-dimensional representation covers the processes mentioned above: restoration of function and consideration of long-term limitations. We propose that adaptation centres on readjustment of long-term goals to new achievable but desired and important goals, and that this adjustment underlies re-establishing emotional stability. We discuss how the proposed model is related to actual rehabilitation practice.
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Affiliation(s)
- Ingrid MH Brands
- Blixembosch Rehabilitation Centre, Department of Neurorehabilitation, Eindhoven, The Netherlands
| | - Derick T Wade
- Department of Rehabilitation, School for Public Health and Primary Care, Maastricht University, The Netherlands
| | - Sven Z Stapert
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
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