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Psychosocial Adaptation to Chronic Illness and Disability: A Conceptual Framework

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Hanoch Livneh at Portland State University
Hanoch Livneh
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Abstract

This article reviews the fundamental components inherent in the process of psychosocial adaptation to chronic illness and disability (CID). It is proposed that investigation of the process of adaptation to CID should consider three distinct classes of interacting variables. First, antecedents or triggering events (causes and contextual variables) present during origination of condition are listed. Second, the dynamic process of adaptation itself (experienced reactions following the onset of CID), as anchored within the existing context of both internally and externally associated groups of variables, is discussed. Third, psychosocial outcome categories that reflect differing views of adaptation to CID are overviewed. Such outcomes correspond to specific or global indicators of quality of life and may be categorized according to their functional domains, content areas, technologies or methods of assessment, and sources of measurement data. This article concludes with discussion of the three-class model's potential implications to rehabilitation practitioners and researchers.
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Copyright © 2001. All rights reserved.
Copyright © 2001. All rights reserved.
Copyright © 2001. All rights reserved.
Copyright © 2001. All rights reserved.
Copyright © 2001. All rights reserved.
Copyright © 2001. All rights reserved.
Copyright © 2001. All rights reserved.
Copyright © 2001. All rights reserved.
Copyright © 2001. All rights reserved.
Copyright © 2001. All rights reserved.
... In other words, disability acceptance means acceptance of loss (S. Jeong, 2014;Livneh, 2001;Wright, 1983). Disability acceptance occurs continuously throughout life (Smart, 2001), and studies indicate that high disability acceptance correlates with high physical, psychological, and social independence (Nam et al., 2013). ...
... To recruit study participants, three selection criteria were considered: (1) individuals who were drafted under the Military Service Act and suffered injuries, either as combat casualties or in servicerelated accidents, while performing their duties (Constitution of the Republic of Korea, 1987); (2) those registered as persons with disabilities under Article 32 of the Act on Welfare of Persons with Disabilities and its Enforcement Decree (Act on welfare of persons with disabilities, 2023); and (3) those who have acknowledged and accepted the limitations and inconveniences caused by their disabilities and have opted to live with them based on the concept of disability acceptance, as proposed by earlier studies (S. Jeong, 2014;Li & Moore, 1998;Lindemann, 1981;Lindowski & Dunn, 1974;Livneh, 2001;Smart, 2001). In the case of participant selection criteria (3), it was asked whether it fell under (3) to confirm whether or not to accept disability, and those who answered "yes" were selected as study participants. ...
... The progression of disability acceptance of the participating soldiers was marked by the presence of distinct phases: initial turmoil, denial, resentment, feelings of despair and depression, the subsequent discovery of hope, and the eventual acceptance of the disability. This progression is consistent with earlier research findings (M. S. Kim & Seo, 2019;Livneh, 2001;Shin & Kim, 2017), as well. However, unlike certain studies, this study did not derive "gratitude for being alive" as a stage of the disability acceptance journey. ...
Qualitative case study on the disability acceptance experiences of soldiers with disabilities
Article
Full-text available
  • May 2024
Purpose This study comprehensively examines the disability acceptance experience of individuals who become disabled following accidents in the military after enlistment. Methods In-depth interviews and participative observation of two soldiers with disabilities are conducted. Data sources encompass the transcripts from these interviews, relevant news videos, and articles on the participants. A qualitative case study approach is applied to conduct both “within-case” and “cross-case” analyses. Results Although the two participants survived a crippling accidents, their military units did not actively attempt to resolve the accident. They grappled with despair and found it challenging to accept their new status as individuals with disability. Over time, they noticed changes in their personal relationships and started considering themselves burdens on their caregivers. However, despite encountering psychological challenges, which were marked by repeated setbacks and disappointments, the soldiers consistently made determined efforts to realize their objectives. Moreover, they strove to lead purposeful lives despite suffering the adversities caused by their disabilities. Conclusions This study is the first in-depth examination of the disability acceptance experiences of soldiers with disability. The insights gleaned from our in-depth interviews will help formulate psychological and physical support systems for such individuals.
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... În 2001 Livneh a prezentat un model conceptual care a căutat să integreze cunoștințele existente despre diferitele componente, structuri și procese care stau la baza adaptarii psihosociale [5]. În 2021, Livneh [4] a venit cu o revizuire a modelului. Cele mai pertinente modificări ale modelului anterior au fost realizate în procesul de adaptare. ...
... .4. Valorile medii în funcţie de factorul "starea de sănătate" pentru componentele. ...
Characteristics of the psychosocial adaptation of adolescents from the perspective of the state of health
Article
  • Jul 2023
The article presents some results of the research carried out on the subject of psychosocial adaptation of adolescents with physical disabilities. In this context, both the concept of psychosocial adaptation and the concept of disability are described. According to the research approach, psychometric instruments were used to identify the peculiarities of psychosocial adaptation of adolescents with physical disabilities. Moreover, for the study carried out, we considered it important to identify the relationship between the research variables such as general indices of psychosocial adaptation, hopelessness scale, affective problems, anxiety problems, somatic accusations, attention problems, oppositional behavior problems, conduct problems, the components of self-esteem and - the psychosocial factors related to the process of psychosocial adaptation of adolescents with physical disabilities. In this paper, we will only describe the relationship between the listed variables and the health status (with disability/without disability) of adolescents, but in general, the research carried out also refers to other factors: the environment of residence, the type of disability, the mode of studies
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... According to the psychosocial adaptation model of chronic illness and disability, individuals may undergo psychological adaptation to disability in complex and interactive ways (Livneh, 2001). Although psychological health issues, such as depressive symptoms, are influenced by various factors including family history (Tozzi et al., 2008) and substance abuse (Chinet et al., 2006), external factors like socioeconomic and environmental conditions also play a significant role in shaping one's experience of psychological adaptation to disease or illness (Livneh, 2022). ...
Estimating Anticipatory, Immediate, and Delayed Effects of Disability Registration on Depressive Symptoms
Article
Full-text available
  • Apr 2024
Purpose: This study examines (a) whether disability registration has anticipatory, immediate, and delayed effects on depressive symptoms and (b) how these effects differ by gender. Research Method/Design: Using data from the Korea Welfare Panel Study spanning over 16 waves between 2005 and 2020, this study employed the individual-level fixed effects models to estimate the trajectories of depressive symptoms before and after the registration of physical disability, for a cohort of 20,054 individuals. Furthermore, gender-stratified fixed effects models were used to examine gender differences. Results: Compared to the preregistration reference period (i.e., 4 or more years before disability registration), there was a sustained rise in depressive symptoms leading up to the year of registration, indicating the presence of anticipatory effects. After disability registration, depressive symptoms consistently remained at a statistically higher level than during the initial reference period, with a gradual return to the baseline level of depressive symptoms over time. These anticipatory, immediate, and delayed effects of disability registration were notably more pronounced among men than women. Conclusion/Implications: To develop more effective mental health interventions for people with disability, policymakers should consider gendered trajectories of depressive symptoms before and after disability registration.
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... Although SCCT constructs have demonstrated their impact on academic and career-related performance, their influence on the career decision-making process's psychosocial outcomes within this model has not been thoroughly explored. Career development factors have been emphasized, but the broader concept of QoL has been increasingly recognized as the primary goal in rehabilitation practice for individuals with disabilities (Bishop & Feist-Price, 2002;Livneh, 2001). Work is believed to contribute significantly to an individual's QoL (Peruniak, 2010). ...
Navigating the Career Development of Students With Disabilities in Science, Technology, Engineering, and Mathematics (STEM)
Article
Full-text available
  • Jan 2024
  • REHABIL COUNS BULL
In pursuit of the full inclusion of individuals with disabilities in science, technology, engineering, and mathematics (STEM) education and careers, it is essential to facilitate their successful academic and career development, while simultaneously implementing STEM pathways that mitigate barriers and improve retention. This study endeavors to explore the impact of career development activities, self-efficacy, outcome expectations, and goals on the quality of life (QoL) of college students with disabilities in STEM. Participants were 182 college students with disabilities attending 2-year and 4-year private/public universities in a Midwestern state. The findings of this research offer empirical evidence for a structural model that predicts the QoL of college students with disabilities in STEM. These results underscore the importance of strengthening support systems, nurturing partnerships, and enhancing access for students with disabilities engaged in STEM learning and career exploration. By shedding light on these dynamics, this research contributes to the creation of a more inclusive and supportive environment for individuals with disabilities who aspire to excel in STEM fields.
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... However, despite them ftting diagnostically, most models have excluded cancer diagnoses from consideration [4]. One model that considers cancer and may be useful in identifying unmet needs in such a population is the Psychosocial Adaption to Chronic Illness and Disability (PACID) model [6,7]. Te PACID model comprises three components: antecedents (medical and contextual factors prior to diagnosis); processes (psychological reactions, coping, and appraisals); and outcomes (assessment of functioning and quality of life following illness onset). ...
Exploring the Psychosocial Needs of Adults with Haematological Cancer under Watch-and-Wait: A Qualitative Study
Article
Full-text available
Objective. Research reporting the unmet needs of individuals with haematological cancers under watch-and-wait is scarce, despite reports of elevated levels of psychological distress. This qualitative study aimed to explore the psychosocial needs of these individuals, and when these were met, if so at all. Methods. A longitudinal design using semistructured interviews was used. Individuals with a diagnosis of haematological cancer living under watch-and-wait were recruited through online support groups. Participants were each invited to two semistructured interviews, six months apart. Interviews took place in March 2022 and September 2022 and were therefore in the context of the COVID-19 pandemic. All interviews were recorded and transcribed verbatim. Reflexive thematic analysis and pattern-oriented longitudinal analysis were used to analyse the data. Results. Of the fifteen participants interviewed initially, twelve attended a second interview. The sample was predominantly White and female. Across participants and time points, a theme was generated that individuals experienced a “Psychological battle of watch-and-wait.” Under this overarching theme, four themes were constructed: “Understanding the impossible: Cancer that does not require treatment;” “Sense of abandonment under watch and wait;” “The importance of peer connection;” and “Trying to live after COVID-19.” The themes were understood to predominantly represent needs for information, communication, peer support, and emotional support and were most often met when individuals engaged with relevant charities. Conclusion. People living with haematological cancer under watch-and-wait may be at risk of having unmet needs across domains, and without support, these needs will likely remain unmet over time. The findings add to the growing literature base how Oncology and Haematology services can holistically support individuals with indolent cancers to live well alongside their diagnosis.
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Disability acceptance and depressive symptoms: the moderating role of social support
Article
Purpose: This study aims to estimate (a) the relationship between disability acceptance and depressive symptoms, and (b) how the quality and quantity of social support might moderate the link between disability acceptance and depressive symptoms.Materials and methods: The data for this study included information from 5165 individuals with disability who participated in 3 waves of the Disability and Life Dynamic Panel spanning years 2018 to 2020. This study employed fixed effects models to estimate the association between disability acceptance and depressive symptoms. Interaction models were used to assess the moderating effects of both the quantity and quality of social support.Results: A lower acceptance of disability was positively associated with depressive symptoms. Moreover, both the quantity and quality of social support were associated with a decrease in depressive symptoms. Only the quality of social support played a significant role in moderating the relationship between disability acceptance and depressive symptoms.Conclusion: A lower acceptance of disability increases depressive symptoms in individuals with disabilities. This study underscores the need for interventions to focus on enhancing the quality of social support to mitigate the link between disability acceptance and depressive symptoms.
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Disability Adjustment Counseling: Experiences and Perspectives of Certified Rehabilitation Counselors
Article
Full-text available
  • Jan 2024
Background Disability adjustment counseling (DAC) focuses on the diverse process of adjusting to chronic illness or disability, including responding to the initial diagnosis or the onset and adjusting to changes and barriers that arise from living with a disability. Although DAC is a primary role and function of rehabilitation counselors, there have been limited efforts to explore the use of DAC in the field. Objective The purpose of this study was to survey certified rehabilitation counselors (CRCs) about the extent of DAC utilization and its focus, the theoretical basis for DAC, and professional preparation. Methods A cross-sectional survey was completed with 109 CRCs recruited through the Commission on Rehabilitation Counselor Certification (CRCC). The research team developed a 35-item survey questionnaire for this study. Most respondents identified as white women with master’s degrees (mean age = 51.41 years). Results Approximately two-thirds of the respondents (67.78%) reported engaging in DAC for approximately a third (31.15%) of their professional time. Many respondents reported wanting to spend more of their professional time providing DAC. Most respondents (75%) indicated they do not operate from a specific model of psychosocial adjustment to chronic illness or disability. Nearly half (48.6%) of the respondents reported that there were not adequate options for DAC counseling. Conclusions The survey results confirm that DAC is an important role and function for rehabilitation counselors. Although the sample was too small to permit broad generalizations, the results imply that further exploration of the research questions among a larger sample is warranted.
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Pain and quality of life in persons with spinal cord injury: Mediating effects of mindfulness, self‐efficacy, social support, and functional independence
Article
Full-text available
  • Oct 2023
Objective To identify mediating roles of mindfulness, self‐efficacy, social support, and functional independence in the relationship between pain and quality of life (QOL) in persons with spinal cord injury (SCI). Methods A cross‐sectional descriptive study was conducted using a sample of 272 persons with SCI living in the United States. The participants completed self‐report standardized questionnaires on a Qualtrics survey. A parallel mediation analysis adjusting for covariates was performed to test the hypotheses. Results Findings showed significant direct effects of pain on functional independence, self‐efficacy, mindfulness, and social support. Self‐efficacy, mindfulness, and social support had significant direct effects on QOL. In the mediation analysis, mindfulness, self‐efficacy, and social support significantly mediated the relationship between pain and QOL, controlling for other variables in the model. Conclusions This study adds to the extant literature by providing evidence that mindfulness, self‐efficacy, and social support not only directly contribute to QOL but are likely to mitigate the negative effect of pain on QOL in persons with SCI. Identifying these potential factors that can assuage the adverse effects of pain on QOL is a first step toward active intervention to facilitate the adjustment of persons with SCI.
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Value Change and Cognitive Dissonance: A Conceptual Model for Psychosocial Adaptation to Disability and Chronic Illness
Article
  • Aug 2023
Background: Value change is critical for individuals’ psychosocial adaptation to chronic illness and disability. Although current value change theories facilitate our understanding of this process, limited interventions have been developed based on these theoretical frameworks. Objective: The purpose of the study is to examine the issues with current value change theories and propose a value change application model. Methods: A literature review approach was conducted in order to develop a value change application model by merging perspectives from rehabilitation psychology, cognitive dissonance theory, and schema theory. Findings: The Disability Inconsistency Model is proposed in the present study. Conclusion: The Disability Inconsistency Model views value from a dynamic perspective and identifies the catalyst to facilitate the psychosocial adaptation process. It also provides implications for the development of relevant interventions.
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A unified approach to existing models of adaptation to disability: I. A model adaptation.
Article
Full-text available
  • Mar 1986
Proposes a synthesis of various models dealing with the process of psychosocial adaptation to physical disability. A review of over 40 existing models suggests that they may be incorporated into a unified model consisting of 5 broad stages: (1) initial impact—shock anxiety; (2) defense mobilization—bargaining and denial; (3) initial realization—mourning, depression, and internalized anger; (4) retaliation—externalized aggression; and (5) reintegration—acknowledgement, acceptance, and final adjustment. Each of the suggested stages is described in terms of its identifying defense mechanisms; affective, cognitive, and behavioral correlates; and the direction assumed by the mastered energies. The present model is compared with several existing psychodynamic theories. (95 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Psychological intervention in a spinal cord injury center: An introduction
Article
Full-text available
  • Jan 1975
Discusses the psychological correlates of spinal cord injury and integrates the principles of learning theory and behavior change into a comprehensive applied approach to patient management and treatment. It is argued that the traditional treatment role of rehabilitation psychologists must be expanded to include not only emotional adjustment, but adaptation in the physical, social, and sexual spheres as well. Treatment must be individualized and geared toward specific developmental stages of the adjustment process. This introductory paper is followed by comments, opinions, evaluations, and amplifying material from 6 other writers, and by a final paper in which Dunn discusses these contributions. (59 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The Crisis of Physical Illness
Chapter
  • Jan 1984
An acute health crisis is often a key turning point in an individual’s life. The vivid confrontation with a severe physical illness or injury, prolonged treatment and uncertainty, and intense personal strains can have a profound and lasting impact. Most patients cope reasonably well with such a crisis and are able to recover and resume their prior level of functioning. Some individuals, however, are utterly demoralized and suffer serious psychological consequences, whereas others emerge with a more mature outlook and a richer appreciation of life. What factors affect the ultimate psychosocial outcome of a health crisis? Why do some patients continue to struggle under the most harrowing circumstances? What are the major adaptive tasks seriously ill patients encounter? What types of coping skills do they use to promote recovery? Are there common phases or stages through which individuals progress as they negotiate a health crisis? What stressors are encountered by health care professionals and how can they nourish the psychological healing process among patients and their families? We deal with these issues here by considering physical illness as a life crisis and by describing how patients and staff cope with the stress of illness and of treatment.
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Self-Efficacy and Quality of Life in People with Spinal Cord Injuries in China
Article
  • Dec 2000
The purpose of this study was to explore the relationship between self-efficacy beliefs and the quality of life (QOL) in Chinese individuals with spinal cord injuries (SCI) and to examine whether health status and demographic variables correlated with the QOL in this population. One hundred individuals with SCI in China participated in the study. The results indicated that self-efficacy beliefs accounted for a substantial variance in the QOL of the participants. Moreover, health status, income, educational level, and time spent on voluntary work were correlated with the QOL in this population. The results are discussed in line with the Chinese culture and its influences on psychosocial adjustment to SCI and rehabilitation services for people with disabilities in China.
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Psychosocial Adjustment Following Closed Head Injury: A Model for Understanding Individual Differences and Predicting Outcome
Article
  • Apr 1996
In addition to permanent physical and cognitive deficits, many individuals with closed head injury (CHI) experience poor psychosocial outcomes, such as interpersonal and family conflict, emotional distress, and behavioural disturbances. Although very little is known about the characteristics that predispose these individuals to psychosocial disruption following CHI, many researchers have suggested that neurological factors, such as the locus of the lesion, the severity of the injury or the level of cognitive impairment, offer the most parsimonious explanation. However, a number of studies have indicated that neurological factors are unable to account adequately for individual variation in psychosocial outcom e, and that there m ight be a significant role for non-neurological factors. Despite this evidence, there has been a lack of research that has system atically investigated the non-neurological determ inants of psychosocial adjustm ent am ong individuals w ith CHI. The present paper describes a m odel derived from the Lazarus and Folkman (1984) cognitive-phenomenological theory of stress and adjustment, which is proposed to be a heuristically useful framework for the exam ination of the non-neurological variables that might influence psychosocial w ell-being follow ing CHI. It is proposed that, with adequate research, this model will have utility for the identification of “at risk”; individuals and will provide a focus for rehabilitative eff orts.
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A Model for Analyzing Human Adaptation to Transition
Article
  • Jun 1981
  • COUNS PSYCHOL
Presents a theory that describes the complex reality that accompanies and defines the capacity of humans to cope with change in their lives. A model is presented that represents a framework in which transitions of all kinds—positive and negative, dramatic and ordinary—can be analyzed and possible interventions formulated. The model views adaptation to transition as a dynamic process, a movement through the various stages of a particular transition. Three sets of factors influence adaptation to transition: (1) the characteristics of the transition itself; (2) the characteristics of the pre- and posttransition supports, and physical setting; and (3) the characteristics of the individual. Preliminary data on the model that clarify its uses are presented. (63 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Rehabilitation Goals: Their Hierarchical and Multifaceted Nature
Article
  • Sep 1988
Presents a hierarchical approach to the ordering and classification of rehabilitation goals in which improvement in quality of life is progressively reduced to smaller goals by utilizing a multifaceted perspective. Included in this perspective are (1) the contexts, or environments, within which rehabilitation takes place; (2) the activity levels or systems defining human performance; and (3) the adjustment or functional levels achieved. 12 sets of goals are described, followed by a list of examples. The goals may assume the form of behaviorally anchored, individually targeted, situationally specific and numerically assessed objectives. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Research in Counseling: Methodological and Professional Issues
Article
  • Sep 1979
  • COUNS PSYCHOL
Part 1 examines salient methodological and technical issues in research on counseling and related processes: the state of the art of counseling research, research strategies, issues in criteria selection, and considerations in selecting samples and control groups. Discussion is guided by the "bubble hypothesis," a view of research recognizing the costs inherent in each solution offered for methodological problems. Part 2 examines issues surrounding the scientific productivity of counseling psychologists and their specialty. Assets and negative features of the scientist-practitioner model are examined, and 2 propositions are offered about the research/science training situation in counseling psychology: First, students enter training with deeply ambivalent attitudes as to the value and meaning of science in their careers and their ability to be effective as scholars. Second, training programs show little that is deliberate and systematic in attempting to foster positive motivation and attitudes. 10 ingredients of effective research training are discussed. (4 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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