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Rehabilitation Psychology RS2270: BSc (Hon) OT Year 2, BA (Hon) Applied Psychology & Minor in
Rehabilitation Psychology
RS2270: BSc (Hon) OT Year 2, BA (Hon) Applied
Psychology & Minor in Psychology
RS5305: MOT
Dr. Andrew Siu
Dr. Andrew Siu
What is Rehabilitation Psychology?  Science and treatment of disabling and chronic health conditions. 
What is Rehabilitation Psychology?
What is Rehabilitation Psychology?

Science and treatment of disabling and chronic health conditions.

Encompass knowledge from several branches of

psychology, including:

Social psychology,

Counseling,

Clinical psychology

Health psychology.

What you would learn … Interviewing persons with disabilities (6-8) Theories of Psychological Adjustment &

What you would learn …

Interviewing persons with disabilities (6-8) Theories of Psychological Adjustment & Application Mental Health
Interviewing
persons with
disabilities
(6-8)
Theories of
Psychological
Adjustment &
Application
Mental Health
Social Aspects of
rehabilitation
(1-5,9)
Issues in
Rehabilitation
(10,11,14)
(12)
What you would learn … 1. Psychological adjustment to disability and chronic health conditions. 
What you would learn …
What you would learn …

1. Psychological adjustment to disability and chronic health conditions.

Theories of adjustment, assessment of adjustment, principles and strategies in promoting adjustment.

2. Social aspects of rehabilitation.

Family issues, social support, employment, sexuality.

3. Therapeutic relationship and basic interviewing

skills.

4. Mental health issues in rehabilitation.

Teaching-learning Strategies  Lectures: required readings for every week  Videos: for illustration of lecture

Teaching-learning Strategies

Lectures: required readings for every week

Videos: for illustration of lecture contents, demonstrations, reflection

Tutorials: case discussion, experiential activities, role play.

Seminar: interview a person with disability/illness

& present your analysis of the person’s

psychological adjustment & adaptation in society.

Assessment  Written Assignment (30%): case analysis; written exercises in interviewing skills.  Seminar (30%):

Assessment

Written Assignment (30%): case analysis; written exercises in interviewing skills.

Seminar (30%): group presentations

Quiz (40%):

Around 100 MCQs

Based on lecture materials & readings.

Psychological Adjustment to Illness & Disability: an Overview RS2270, RS5305 Rehabilitation Psychology Dr. Andrew Siu

Psychological Adjustment to Illness & Disability: an Overview

Psychological Adjustment to Illness & Disability: an Overview RS2270, RS5305 Rehabilitation Psychology Dr. Andrew Siu

RS2270, RS5305 Rehabilitation Psychology

Dr. Andrew Siu

Content  Psychosocial Impact of Chronic Illness or Disability ( CID )  Definition and

Content

Psychosocial Impact of Chronic Illness or Disability (CID)

Definition and Indicators of Adjustment &

Adaptation

Health-related Coping Model

Facilitating Coping and Adaptation

PSYCHOSOCIAL IMPACT OF CHRONIC ILLNESS & DISABILITY

PSYCHOSOCIAL IMPACT OF CHRONIC ILLNESS & DISABILITY

Impact of Disability and Illness Impairment F u n c t i o n &

Impairment

Function &

Limitation

Role Assignment & Restriction

Body Function

& Structure

Activities

Participation

Body Function & Structure Activities Participation Assessment Intervention D i a g n o s i
Body Function & Structure Activities Participation Assessment Intervention D i a g n o s i
Body Function & Structure Activities Participation Assessment Intervention D i a g n o s i
Body Function & Structure Activities Participation Assessment Intervention D i a g n o s i

Assessment

Intervention

Diagnosis

Medical & Restorative Therapies

Functional

Performance Adaptive & Therapeutic Relearning

Role

Performance

Social & Community Support

International Classification of Functioning, Disability and Health ( ICF )

International Classification of Functioning,

Disability and Health (ICF)

International Classification of Functioning, Disability and Health ( ICF )
ICF analysis

ICF analysis

ICF analysis
Psychological Impact of Disability & Illness  Impairment:  Structural changes in anatomical,

Psychological Impact of

Disability & Illness

Impairment:

Structural changes in anatomical, neurophysiological mechanisms of the body

Disability:

Loss of bodily function, functional independence; the need to relearn function and living skills.

Psychological Impact of Disability & Illness  Handicap:  Loss of roles , adoption of

Psychological Impact of

Disability & Illness

Handicap:

Loss of roles, adoption of sick role

Employment difficulties & self-support

Family and/or social support

Physical barriers in community

Social discrimination & self-stigma

Key Psychological Impact Body Image & Self- Concept Emotional Reactions Chronic Illness & Disability

Key Psychological Impact

Body Image & Self- Concept Emotional Reactions Chronic Illness & Disability Activation of Stress &
Body Image & Self-
Concept
Emotional Reactions
Chronic Illness &
Disability
Activation of
Stress & Coping
Psychological
Defense
Body Image  Particular important for visible disabilities, e.g. burns, amputation, spinal cord injury. 

Body Image

Particular important for visible disabilities, e.g. burns, amputation, spinal cord injury.

Process of adaptation:

Shutting out of existence or neglect of impaired body part

Search for illusory restoration of

body part or function

Avoid social contacts

Focus on non-impaired body parts

Gradual acceptance

of body part or function  Avoid social contacts  Focus on non-impaired body parts 
Loss, Grief, and Depression  Loss of body part or function  feelings of loss
Loss, Grief, and Depression  Loss of body part or function  feelings of loss

Loss, Grief, and Depression

Loss of body part or function feelings of loss and grief.

Mourning about loss depression

Prevalence of depression is at least twice in

people with disabilities, compared with non- disabled. Many studies showed that 30-50% of

hospitalized patients are depressed.

Prolonged and recurrent sorrow and sadness, or even suicidal

Defense Mobilization  Ego defenses are largely unconscious efforts to protect us from anxiety or
Defense Mobilization  Ego defenses are largely unconscious efforts to protect us from anxiety or

Defense Mobilization

Ego defenses are largely unconscious efforts to

protect us from anxiety or unpleasant emotions, and to maintain a consistent self-concept.

Examples: denial, rationalization, displacement,

projection, reaction formation.

Help us to hide from the truth (or facts) but could

eventually leads to a distorted view of self.

Stress & Coping  Having a serious illness or disability could be seen as a

Stress & Coping

Having a serious illness or disability could be seen as a major stress to the person.

The person may use a variety of coping

strategies to face the illness/disability.

Coping strategies (e.g. avoidance, problem

solving, diversion, etc.) could lead to very

different outcomes in adjustment and mental health

Definition and Indicators ADJUSTMENT & ADAPTATION

Definition and Indicators

ADJUSTMENT & ADAPTATION

Psychosocial Adaptation  Evolving, dynamic process through which a disabled person gradually approaches and optimal
Psychosocial Adaptation  Evolving, dynamic process through which a disabled person gradually approaches and optimal

Psychosocial Adaptation

Evolving, dynamic process through which a disabled person gradually approaches and optimal state of person-environment congruence.

Aspects of Adaptation, e.g.

Acknowledgement of abilities and limitations

Relearning of living skills

Enact role changes and social expectations

Acceptance of new body image

Re-establish a new self-concept

Indicators of Adaptation  Active participation in social, vocational, and leisure pursuits.  Successful

Indicators of Adaptation

Active participation in social, vocational, and leisure pursuits.

Successful negotiation of the physical

environment.

Awareness of remaining strength and assets,

as well as limitations.

Psychological Adjustment  Sometimes used synonymously with adaptation  Refer specifically to a particular phase

Psychological Adjustment

Sometimes used synonymously with adaptation

Refer specifically to a particular phase (i.e.

set of experience and reactions) of the adaptation process.

Indicators of Psychological Adjustment

Indicators of Psychological Adjustment  Reach and maintain psychosocial equilibrium .  Achieving a state of

Reach and maintain psychosocial equilibrium.

Achieving a state of reintegration

Demonstrating positive self-esteem and self-concept

Positive attitudes towards oneself, others, and the disability.

Positively striving to reach life goals.

Theories of Psychological Adjustment  Theories of Adjustment  Stress & Coping  Phase Theory

Theories of Psychological

Adjustment

Theories of Adjustment

Stress & Coping

Phase Theory of Emotional Reactions

Counseling or Change theories:

Cognitive Behavior Therapy

Self-efficacy Theory

Person-centered

Stage of Change

HEALTH-RELATED STRESS & COPING MODEL

HEALTH-RELATED STRESS & COPING MODEL

General Model of Stress & Coping (Cox & MacKay, 1976)

General Model of Stress & Coping (Cox & MacKay,

1976)

General Model of Stress & Coping (Cox & MacKay, 1976)
Model of Stress & Coping 1. Stress: internal expectations or external demands. 2. Cognitive Appraisal

Model of Stress & Coping

1. Stress: internal expectations or external demands.

2. Cognitive Appraisal

Primary: if the stress is beneficial, relevant

harmful, or threatening.

Secondary: Judgment of coping resources.

Re-appraisal: alter ones perception and judgment of stress situation and coping

resources.

3. Responses to Stress cognitive, affective, & behavioral coping

Ways to Manage Stress & Increase Adaptation  Modify expectations for self  Examine person-environment

Ways to Manage Stress &

Increase Adaptation

Modify expectations for self

Examine person-environment fit

Learn or strengthen coping strategies

Mobilize personal or social resources for coping

Encourage cognitive re-appraisal of stress

and coping resources needed

Examples of (Psychological) Coping Strategies Behavioral Emotional • Denial • Blame or criticize • Avoidance,

Examples of (Psychological) Coping Strategies

Behavioral

Emotional

Denial

Blame or criticize

Avoidance, diversion

Relaxation

Disengagement

oneself

Cognitive

Planning

Problem-solving Spiritual

Turning to religion

Seek meaning

Rationalization

Bargaining or negotiation

Ventilation, Seek social

support

Acceptance

HEALTH-RELATED COPING MODEL

HEALTH-RELATED COPING MODEL

Health-related Coping Model

Health-related Coping Model

Health-related Coping Model
I. Personal Resources  Religious beliefs  Prior health-related and coping responses  Demographic

I. Personal Resources

Religious beliefs

Prior health-related and coping responses

Demographic background

Personality characteristics: e.g. self- efficacy, extroversion, optimism, internal

control, problem-solving ability and style.

II. Health-Related Factors  Onset, stage, progression of health condition  Symptoms: pain, fatigue/energy, etc.

II. Health-Related Factors

Onset, stage, progression of health condition

Symptoms: pain, fatigue/energy, etc.

Disability: type & loss of function

Health care environment and treatment

procedures: invasive procedures,

examination by strangers, technical equipment.

III. Social & Physical Context  Social:  Relationship, support, and expectations of people in

III. Social & Physical Context

Social:

Relationship, support, and expectations of people in network

Physical:

Physical aspects of home, workplace, shopping, etc. can influence person’s access, mobility, and autonomy

Personal space, privacy, aesthetic qualities of surroundings, etc.

IV. Cognitive Appraisal  Is the stressor (e.g. chronic illness) expected and is the person

IV. Cognitive Appraisal

Is the stressor (e.g. chronic illness) expected and is the person prepared for it.

Is the problem is regarded as

Challenge or threat?

Controllable or not?

Caused by self or not? Am I responsible?

Outcome of this appraisal greatly affects coping efforts and strategies

V. Adaptive Tasks 1. Managing symptoms 2. Managing treatment 3. Forming relationships with health care

V. Adaptive Tasks

1. Managing symptoms

2. Managing treatment

3. Forming relationships with health care providers

4. Managing emotions

5. Maintaining a positive self-image

6. Relating to family members and friends

7. Preparing for a uncertain future

VI. Categories of Coping Skills Logical analysis & search for meaning Coping Skills Seeking alternative

VI. Categories of Coping Skills

Logical analysis & search for meaning
Logical
analysis &
search for
meaning
Coping Skills
Coping
Skills
Seeking alternative rewards
Seeking
alternative
rewards
Positive appraisal Seeking guidance and support Emotional discharge
Positive
appraisal
Seeking
guidance
and support
Emotional
discharge
Taking problem solving action Cognitive avoidance or Denial Acceptance & resignation
Taking
problem
solving
action
Cognitive
avoidance
or Denial
Acceptance
&
resignation
VII. Health-related Outcomes  Effects of coping strategies  Stress reduction or relief  Emotions:

VII. Health-related Outcomes

Effects of coping strategies

Stress reduction or relief

Emotions: Anxiety, depression, anger; happiness, satisfaction.

Acceptance of new body image, having illness

Self-esteem

Growth: e.g. resilience, EQ

Social relationship: e.g. closer or alienated

FACILITATING COPING & ADAPTATION

FACILITATING COPING & ADAPTATION

Facilitating Coping & Adaptation in Persons with CID Reappraise roles & functions Transition Person Promote

Facilitating Coping & Adaptation in Persons with CID

Reappraise

roles &

functions

Transition
Transition

Person

Promote

Adaptation

Physical

Information

Values

Coping

Environment

Social

Intervention on Physical Environment  Promote mobility and access within client ’ s life space

Intervention on Physical

Environment

Promote mobility and access within clients life space as far as possible, e.g. home, work, leisure contexts.

Modification of home or work environment if necessary and feasible.

Use of technology and additional

equipment.

Work simplification and energy

conservation.

Intervention on Social Environment  Map the social support network and assess client ’ s

Intervention on Social

Environment

Map the social support network and assess clients needs for various types of support (emotional, tangible, information &

guidance, need for companion)

Address the issues of caregiver burden.

Encourage client to provide support to

others as well, or mutual help.

Encourage social participation

Monitor ongoing changes in social support.

Intervention on the Person  Commitment and values .  Re-organization of one ’ s

Intervention on the Person

Commitment and values.

Re-organization of ones life commitment & life roles Identify values and beliefs of the client which may promote adaptation.

Cognitive restructuring of irrational thoughts.

Find facts: Information seeking

e.g. Seek advice, knowledge, guidance, sharing of experience from others.

Facilitate Coping Responses  Find meaning: Re-appraisal  e.g. find new meaning in situation, develop

Facilitate Coping Responses

Find meaning: Re-appraisal

e.g. find new meaning in situation, develop emotional competence, ongoing self-reflection.

Manage stress: Inhibition

e.g. emotional discharge, stress management, diversion or selective ignoring.

Intervention on Transition  Cannot change the nature of transition.  Prevent the development of

Intervention on Transition

Cannot change the nature of transition.

Prevent the development of sick role.

Explore changes in role expectations.

Assist client to re-appraise (acknowledge, accept, and enact) ones changing roles and

functions.

Required Reading  Livneh, H. (1997). Psychosocial adaptation to chronic illness and disability . Gaithersburg,

Required Reading

Livneh, H. (1997). Psychosocial adaptation to chronic illness and disability. Gaithersburg, MD:

Aspen Publication. Chapter 1.

Martz, E, & Livheh, H. (Eds.). (2007). Coping

with chronic illness and disability: Theoretical, empirical, and clinical aspects. New York:

Springer. Chapter 6.

Video  《共渡經濟漩渦》 香港電台電視部, 2002 (Call No: 18656 VCD)  TVB Pearl (2009). Bangkok

Video

《共渡經濟漩渦》香港電台電視部, 2002 (Call No: 18656 VCD)

TVB Pearl (2009). Bangkok Biding. (Call

No.: 26655DVD)