Running Head: PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

Psychological Effects Associated with Disability and Their Influence on

Rehabilitation
Alyssa R Harrison
Engineering Capstone Waxahachie Global High School
December 9, 2014

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

Table of Contents
Abstract..
..3
Introduction
.4
Addressing Emotional
Issues
5
Methods
.....5
Experimentation
.6
Other Theories........
.7
Conclusion
...8
Appendix
.10
Background.
...10
Experimentation.
....10
Table 1. Factor analysis results for the PSRFS.......10
Table 2. Factor analysis results for the AIPAS.......11
Results...
11
References
.12

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

Abstract
Physical disabilities from sudden injuries cause physical, psychological and
emotional issues. (Engel, 1995). Some psychological effects include
depression, isolation, fear, anger, and a sense of loss after a debilitating
injury. These reactions are inflicted by the dramatic changes in the injured
persons life, both socially and functionally (Kbler-Ross, 2005). In order to
gain back the most physical function possible, a patient must first address
and cope with the psychological aspects of suddenly obtaining a disability. If
a patient does not overcome each psychological stage that accompanies
their disability, it is unlikely that they will regain the same level of function
(Buckelew, 1991). It is critical that a patient, as well as the people around
them, accepts their disability.
Keywords: disability, psychology, injury, trauma, rehabilitation

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

Introduction
When a person experiences a catastrophe that causes a long-term
disability, it can be hard for them to cope with the fact that they cannot do
many activities they could before, or that they cannot do them as well as
they could before. The nature of the catastrophe affects the extent to which
function can be restored as well as the method of treatment which should be
used to do so. There are distinct differences between the psychological
processes of a person who knows they will have a disability in the future,
such as progressive hearing loss, than that of a person who suddenly
experiences an injury which causes disability (Engel, 1995).
Debilitating injures cause many physical limitations and needs for
rehabilitation, but they also seriously affect the emotional, cognitive, and
overall well-being of the mind, which plays a major role in the restoration of
the persons function (Tatsumi, 2014). The extent to which functional ability
is regained depends on the nature of the catastrophe, the character of the
person affected, the work they do and the extent to which they have an
object in life which would be impossible to achieve unless he makes the
necessary extra effort. Success is proportionate to his confidence in himself
and in others, in his personality, and, perhaps, his faith. (Pinsent, 1973).
Not only does a debilitating injury causes not only a lack of traditional
functionality among patients, but it also inflicts a sense of negativity in the
mind. Sudden revelations regarding a patients abilities can induce feelings
of stress, anxiety, depression, grief, fear, and isolation (Engel, 1995). Some

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

experience fear of pain or lack of motivation to participate in daily activities,

which lead to very limited use of the body, which in turn decrease the
possible the level of functionality, thus inhibiting rehabilitation. The severity
of these emotions can be incredibly difficult to measure and can seriously
complicate the rehabilitation process. There is an increased need for a
holistic approach, which accounts for the importance of patients
psychosocial condition in the field of psychological rehabilitation. Renowned
psychiatrist, George Engel, determined that the mind must have time to heal
before physical progress can be made, meaning a patient must overcome
the stages of grief that accompany a disability before becoming completely
functional again (Engel, 1995). Various forms of rehabilitation have since
adopted the Kbler-Ross model, which was originally created by Elisabeth
Kbler-Ross to explore the emotional process of those experiencing death.
This model described the phases of recovery and explained the importance
of psychological intervention (Kbler-Ross, 2005).
Addressing Emotional Issues
Methods
Psychological intervention has been approached in two different ways:
a psychodynamic approach and a behavioral approach. The first was formed
from the theories of loss and grief, while the second is based on the
psychological theory of stress. The stage model was the first model used in
the field of athletic rehabilitation and is linked with the theories of loss and
grief, meaning the patient feels as if they have lost an important part of their

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

life through the injury (Tatsumi, 2014). The ideal psychological condition for
full recovery is one in which the injured knows of the difficulties but controls
their emotions in order to determine what is necessary for recovery (Tatsumi,
1998). According to Britton W. Brewer, the stage model was lacking in
predictive value, and he proposed a cognitive appraisal model as a
replacement. The cognitive appraisal model was formed from the theory of
cognitive appraisal for stress and coping the work of Richard Lazarus and
Susan Folkman. In this model, the injured persons assessment of the injury
determines their emotional reaction along with their behavioral reaction,
meaning how well they will respond to rehabilitation efforts. This model is
based on cognitive behavioral therapy, and was designed to change the
patients negative views about their injuries as well as educate and
encourage them about their options in recovery. It became a common
method of speeding up the process of rehabilitation among athletes (Tatsumi
2014). The stages of this model denial, anger, bargaining, depression, and
acceptance can occur in any order. It is crucial that they occur, and the lack
of these emotions can be a sign of a potential problem (Petitpas, 1995).
Combined with grief therapy, the stage model elicits grief to promote
acceptance and true mental recovery. In a sense, the stage model was very
effective. However, the model which states that injured athletes must
overcome the grief stage in order to make progress in acceptance leaves
certain aspects of the response stage unclear. For this reason, the
establishment of an alternative model is necessary.

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

Experimentation
Self-motivation and focus on the present are two influential aspects of
recovery, and they directly affect the patients level of dedication to recover.
Emotional stability, temporal perspective, or the extent of recovery
within a certain time period, and coping free of adhesion, or being able to
overcome the negative aspects of the disability an idea similar to the stage
method, are recognized to predict the quality of rehabilitation in patients.
(Tatsumi, 2014). Each of these factors affects the others, as displayed in a
study done by Tatsumi and Takenouchi:
When appraised, it was determined that self-motivation directly
correlated with the subscales rehabilitation participation, rehabilitation
completion, and rehabilitation effort, while focus on the present only
directly correlated with rehabilitation effort. Temporal perspective directly
correlated with rehabilitation effort and rehabilitation completion
(Tatsumi, 2014). If this data can be accurately applied inclusively, then
adequate emotional stability and a positive temporal perspective are both
not only fully necessary mental factors of physical rehabilitation, but they
also help make up the process of psychological acceptance. Tatsumi and
Takenouchi conducted a study of the causal model, a model in which
rehabilitation behavior is affected by the process of psychological
acceptance. (Tatsumi 2014). For background information about their
experiment, see appendix.

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

Other Possible Explanations

There is also a basic needs theory proposed by Richard Ryan and
Edward L. Deci in which competence, autonomy, and relatedness are the
three psychological needs that have to be met in order to enhance the level
of motivation and innate behavior. (Ryan 2002)
The fulfillment of these three needs results in emotional stability as it is
referred to by Tatsumi. Therefore, motivational needs directly affect the
process of psychological acceptance of athletic injuries. (Tatsumi, 2014)
Though these models are effective in general, they are still flawed. It is
impossible to correctly determine a patients mental state, as there is no
valid, tangible evidence. A patient may seem to be motivated enough and
devoted to rehabilitation, but perhaps still has not fully accepted the injury.
They may still be facing anxiety, denial, anger, impatience, etc. without
expressing such emotions. It is possible that these emotions could be the
genuine driving force behind recovery, and thus less effective than it would
be if the patient had accepted the injury. In certain cases, this emotional
state of the patient has been noted to cause further injury because it causes
the patient to incorrectly, hurriedly, or excessively do rehabilitation
exercises. This manner of exercise is counterproductive, and can cause major
issues in the treatment process especially during the beginning stages.
(Tatsumi 2014) Another issue that sometimes occurs in patients is fear of
movement which may cause re-injury or pain. When a patient fears the
movement will cause pain, they will typically avoid the movement necessary

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

for recovery. Before a patient suffering from pain-related fear can fully
recover, they must first overcome the fear. Experimental treatment has been
conducted by Joseph Wolpe in which the patients were systematically
desensitized from the pain-anxiety by being forced to confront it through
repeated intense movement over extended periods of time (Vlaeyen, 2002).
This was very effective, and most of the patients claimed to have
significantly more functional and enjoyable lives post-treatment.
Conclusion
Along with the patients own perception of the injury, it has been
demonstrated that physical therapists, coaches, and other peers can also
greatly affect the process of rehabilitation (Tatsumi, 2014). Though this could
potentially be a positive effect, it is often times yet another inhibitor instead.
This is mainly due to the fact that it has become a disgusting social norm to
assume that people who have disabilities are weak, inferior, or incompetent
in modern society, which causes many people to actuate outrageous social
behavioral differences between disabled and non-disabled people (Santi,
2013). There is an outstanding necessity for acceptance among people not
only the people who experience the effects of debilitating injuries but also
everyone they encounter in order for patients to gain back the most
possible function and carry out independent, pleasant lives.

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

10

Appendix
Expanded information on Tatsumi and Takenouchis Causal
relationships between the psychological acceptance process of athletic injury
and athletic rehabilitation behavior
Background
There were 189 subjects total, and 168 were considered valid and
therefore provided usable data. The subjects had an average age of 19.93
years old. (Tatsumi and Takenouchi, 2014).

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

Experimentation
Table 1. Factor analysis results for the PSRF-S

11

PSYCHOLOGICAL EFFECTS ASSOCIATED WITH DISABILITY

12

Table 2. Factor analysis results for the AIPA-S

Results
Emotional stability and temporal perspective showed statistically
significant positive standard partial regression coefficients for selfmotivation and focus on the presentFurthermore, temporal
perspective was confirmed to have a positive influence on
rehabilitation effort and have tendency of positive influence on
rehabilitation completionFurthermore, focus on the present of the
AIPA have tendency of positive influence on rehabilitation
effort.Temporal perspective also demonstrates a positive
influence on self-motivation. (Tatsumi, 2014 p.1253-4).

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13

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