ArticlePDF Available
Understanding
Psychosocial
Adjustment to
Chronic Illness
and Disability
A Handbook for
Evidence-Based
Practitioners in
Rehabilitation
Editors
Fong Chan, PhD
Elizabeth da Silva Cardoso, PhD
Julie A. Chronister, PhD
NEW YORK
Fong Chan, PhD , is a professor and director of clinical training
(PhD Program) in the Department of Rehabilitation Psychol-
ogy and Special Education, University of Wisconsin–Madison.
Dr. Chan is a licensed psychologist and a Certified Rehabilita-
tion Counselor. He is also a Fellow in the American Psycho-
logical Association and a National Institute on Disability and
Rehabilitation Research Distinguished Research Fellow. From
1995 to 1999, he also served as Director of Research for the
Foundation for Rehabilitation Education and Research, which
provides research support for the Commission on Rehabili-
tation Counselor Certification, the Certification of Disability
Management Specialists Commission, and the Commission
for Case Manager Certification. He is also the editor of two
textbooks, Case Management for Rehabilitation Health Profes-
sionals and Counseling Theories and Techniques for Rehabilita-
tion Health Professionals.
Elizabeth da Silva Cardoso, PhD ,received her doctorate
in Rehabilitation Counseling Psychology from University of
Wisconsin–Madison in 1997. She is an associate professor in
the Department of Educational Foundations and Counseling
Programs, Hunter College, City University of New York. She
is a licensed psychologist and completed a one-year predoc-
toral psychology internship at Harvard University’s McLean
Hospital and a postdoctoral psychology fellowship at Yale
University’s Yale Psychiatric Institute. She served as the
President of the New York State Rehabilitation Counseling
Association in 2002 and is currently on the executive board
of the National Council on Rehabilitation Education and on
the APA Committee on Disability Issues in Psychology.
Julie A. Chronister, PhD, is an assistant professor and reha-
bilitation counselor training program faculty member in the
Department of Counseling at San Francisco State University.
She received her PhD in Rehabilitation Psychology from the
University of Wisconsin–Madison. She is an editorial consul-
tant/reviewer for five rehabilitation and allied health peer-
review journals and served as the President of the New York
State Rehabilitation Counseling Association in 2005–2006.
Dr. Chronister has worked in the field of rehabilitation coun-
seling for over 15 years in a number of capacities including
rehabilitation counselor, community-based program director,
and rehabilitation counseling faculty.
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Ebook ISBN: 978-0-8261-2387-9
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Library of Congress Cataloging-in-Publication Data
Chan, Fong.
Understanding psychosocial adjustment to chronic illness and dis-
ability : a handbook for evidence-based practitioners in rehabilitation /
Fong Chan, Elizabeth da Silva Cardoso, Julie A. Chronister.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-8261-2386-2 (alk. paper)
1. People with disabilities—Psychology. 2. Chronic
diseases—Psychological aspects. 3. People with
disabilities—Rehabilitation. I. Cardoso, Elizabeth da Silva. II.
Chronister, Julie A. III. Title.
BF727.P57.C43 2009
362.4--dc22
2009015793
Printed in the United States of America by Hamilton Printing
The author and the publisher of this Work have made every effort to use sources
believed to be reliable to provide information that is accurate and compatible
with the standards generally accepted at the time of publication. The author and
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Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Part I: Introduction
Chapter 1 An Introduction to Evidence-Based Practice
Approach to Psychosocial Interventions
for People with Chronic Illness and Disability . . . . . . 3
Fong Chan, Julie Chronister,
and Elizabeth da Silva Cardoso
Evidence-Based Practice . . . . . . . . . . . . . . . . . . . . . . 5
Concluding Remarks . . . . . . . . . . . . . . . . . . . . . . . . . 16
Part II: Psychosocial Adjustment to Chronic Illness and
Disability: Concepts, Models, and Research
Chapter 2 The World Health Organization ICF Model
as a Conceptual Framework of Disability
. . . . . . . . . . 23
Fong Chan, Joy Sasson Gelman, Nicole Ditchman,
Jeong-Han Kim, and Chung-Yi Chiu
Models of Disability
. . . . . . . . . . . . . . . . . . . . . . . . . . 24
The World Health Organization ICF Model
of Disability
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Issues Related to Measuring Participation . . . . . . . 39
Implications for Rehabilitation . . . . . . . . . . . . . . . . 44
Concluding Remarks . . . . . . . . . . . . . . . . . . . . . . . . . 46
Contents
Chapter 3 Psychosocial Adaptation to Chronic Illness
and Disability: Models and Measurement . . . . . . . . . 51
Susan Miller Smedema, Shana K. Bakken-Gillen,
and Jacquelyn Dalton
Models of Adaptation
. . . . . . . . . . . . . . . . . . . . . . . . . 52
Empirical Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . 64
Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Chapter 4 Models, Research, and Treatment of Coexisting
Depression for People with Chronic Illness
and Disability
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Eun-Jeong Lee, Fong Chan, Julie Chronister,
Jacob Yui-Chung Chan, and Maria Romero
DSM-IV Criteria for Clinical Depression . . . . . . . . 77
Biological Mechanisms of Depression . . . . . . . . . . . 78
Cognitive Theories of Depression . . . . . . . . . . . . . . 80
Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Psychological Treatment of Depression . . . . . . . . . 92
Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Part III: Relevant Mediators and Moderators of
Psychosocial Adjustment to Chronic Illness
and Disability
Chapter 5 Coping and Rehabilitation: Theory, Research,
and Measurement
. . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Julie Chronister, Erica Johnson, and
Chen-Ping Lin
Theoretical Review . . . . . . . . . . . . . . . . . . . . . . . . . 113
Evidence Base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Application to Rehabilitation . . . . . . . . . . . . . . . . . 136
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Chapter 6 Social Support and Rehabilitation: Theory,
Research and Measurement
. . . . . . . . . . . . . . . . . . . . 149
Julie Chronister
Conceptual and Theoretical Review . . . . . . . . . . . 153
Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
vi Table of Contents
Table of Contents vii
Application to Rehabilitation Professionals . . . . . 170
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Chapter 7 Family and Adaptation to Chronic Illness
and Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
David A. Rosenthal, John Kosciulek, Gloria K. Lee,
Michael Frain, and Nicole Ditchman
Impact of Chronic Illness and Disability
on the Family
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Theoretical Frameworks of Family Adaptation
to Chronic Illness and Disability . . . . . . . . . . . . 188
Adaptation Phase of the Resiliency Model . . . . . . 190
Family Intervention Strategies . . . . . . . . . . . . . . . . 195
Concluding Remarks . . . . . . . . . . . . . . . . . . . . . . . . 200
Part IV: Intervention Strategies
Chapter 8 Positive Psychology and Psychosocial
Adjustment to Chronic Illness and Disability . . . . . 207
Chih Chin Chou, Eun-Jeong Lee, Denise Catalano,
Nicole Ditchman, and Lisa M. Wilson
Strength-Based Intervention
. . . . . . . . . . . . . . . . . 208
The Positive Psychology Movement . . . . . . . . . . . . 211
Related Positive Psychology Theories,
Models, and Constructs
. . . . . . . . . . . . . . . . . . . . 215
The Integration of the Strength Focus
of Rehabilitation Psychology
with Positive Psychology
. . . . . . . . . . . . . . . . . . . 220
Review of Selected Positive
Psychology Measurements
. . . . . . . . . . . . . . . . . . . 223
Review of Positive Psychology
Intervention Approaches
. . . . . . . . . . . . . . . . . . . 228
Empirical Research of Positive
Psychology in Rehabilitation
. . . . . . . . . . . . . . . . . 231
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Chapter 9 Application of Self-Efficacy Related Theories
in Psychosocial Interventions
. . . . . . . . . . . . . . . . . . 243
Chih Chin Chou, Nicole Ditchman, Steve R. Pruett,
Fong Chan, and Celeste Hunter
Social Cognitive Theory
. . . . . . . . . . . . . . . . . . . . . . 244
Stages of Change Model . . . . . . . . . . . . . . . . . . . . . 247
viii Table of Contents
Skills Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Motivational Interviewing . . . . . . . . . . . . . . . . . . . . 261
Concluding Remarks . . . . . . . . . . . . . . . . . . . . . . . . 268
Chapter 10 Wellness and Promotion of Health in
Chronic Illness and Disability: Theoretical
and Practical Models for Assessment
and Intervention
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Ruth Torkelson Lynch and Chung-Yi Chiu
Theoretical Constructs of Health Beliefs
and Health Promotion
. . . . . . . . . . . . . . . . . . . . . . . 281
Assessment of Health Beliefs, Health Behavior,
and Health Promotion Outcomes
. . . . . . . . . . . . 286
Health Promotion and Wellness
Interventions for Persons with Chronic
Illness and Disability
. . . . . . . . . . . . . . . . . . . . . . 297
Chapter 11 Psychopharmacology: A Review of Current
Treatment Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Susan Gallagher-Lepak, Janet Reilly, Alyce Keith,
and Suzanne Haines
Pharmacodynamics
. . . . . . . . . . . . . . . . . . . . . . . . . 308
Pharmacological Treatment of Depression . . . . . . 310
Pharmacological Treatment for Anxiety . . . . . . . . 314
Pharmacological Treatment of
Bipolar Disorder
. . . . . . . . . . . . . . . . . . . . . . . . . . 317
Pharmacological Treatment of
Psychotic Symptoms
. . . . . . . . . . . . . . . . . . . . . . 320
Resources for Professionals . . . . . . . . . . . . . . . . . . 324
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
Part V: Societal Attitudes Toward Disability
Chapter 12 Societal Attitudes Toward Disability: Concepts,
Measurements, and Interventions
. . . . . . . . . . . . . . . 333
Fong Chan, Hanoch Livneh, Steven R. Pruett,
Chia-Chiang Wang, and Lisa Xi Zheng
Attitudes Toward Disability
. . . . . . . . . . . . . . . . . . . 335
Measurement Issues . . . . . . . . . . . . . . . . . . . . . . . . 344
Attitude Change Strategies . . . . . . . . . . . . . . . . . . . 352
Concluding Remarks . . . . . . . . . . . . . . . . . . . . . . . . 360
Part VI: Special Issues
Chapter 13 Psychiatric Rehabilitation . . . . . . . . . . . . . . . . . . . . . 371
Molly K. Tschopp and Michael Frain
Psychiatric Rehabilitation
. . . . . . . . . . . . . . . . . . . . 375
Psychiatric Rehabilitation Goals
and Strategies
. . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Evidence-Based Psychiatric
Rehabilitation Practices
. . . . . . . . . . . . . . . . . . . . 385
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Chapter 14 Substance Abuse: Models, Assessment,
and Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Elizabeth da Silva Cardoso, Arnold W. Wolf,
and Steve L. West
Prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Terms and Definitions . . . . . . . . . . . . . . . . . . . . . . . 408
Conceptual Model of Abuse and Addiction . . . . . . 411
Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
Current Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432
Closing Statement . . . . . . . . . . . . . . . . . . . . . . . . . . 434
Chapter 15 Sexuality and Disability . . . . . . . . . . . . . . . . . . . . . . . 443
Maria Helena Juergens and Susan Miller Smedema
Sexuality and Disability . . . . . . . . . . . . . . . . . . . . . 447
Some Common Disabilities and Illnesses
that Affect Sexualities
. . . . . . . . . . . . . . . . . . . . . 455
Application to Rehabilitation . . . . . . . . . . . . . . . . . 463
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470
Chapter 16 Multiculturalism and Adjustment to Disability . . . . 479
Julie Chronister and Erica Johnson
Disability and Culture
. . . . . . . . . . . . . . . . . . . . . . . 483
Multicultural Concepts and Models . . . . . . . . . . . . 486
Adjustment to Disability Within a
Multiculturalism Framework
. . . . . . . . . . . . . . . 494
Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508
Table of Contents ix
xTable of Contents
Part VII: Outcome Measurements
Chapter 17 Quality of Life and Psychosocial
Adaptation to Chronic
Illness and Disability
. . . . . . . . . . . . . . . . . . . . . . . . . . 521
Malachy Bishop, Susan Miller Smedema,
and Eun-Jeong Lee
Psychosocial Adaptation and Quality of Life
. . . . 522
Historical Development and Evolution
of the Concept of Quality of Life
. . . . . . . . . . . . . 526
Distinguishing Quality of Life from
Related Constructs
. . . . . . . . . . . . . . . . . . . . . . . . 528
Quality of Life Models of Psychosocial
Adaptation
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 531
Issues in the Measurement
of Quality of Life
. . . . . . . . . . . . . . . . . . . . . . . . . . 539
Instruments for Assessing Quality of Life
in Psychosocial Adaptation
. . . . . . . . . . . . . . . . . 543
Conclusion and Future Research Directions . . . . 549
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .559
Shana K. Bakken-Gillen, PhD
Manager
Psychosocial Recovery Division
William S. Middleton Memorial
Veterans Hospital
Madison, WI
Malachy Bishop, PhD
Associate Professor and Coordinator
Rehabilitation Counseling Program
Department of Special Education
and Rehabilitation Counseling
University of Kentucky
Denise Catalano, PhD
Assistant Professor
Rehabilitation Counseling Program
Department of Rehabilitation,
Social Work, and Addictions
University of North Texas
Jacob Yui-Chung Chan
Assistant Professor
Rehabilitation Counseling Program
Department of Counseling
Psychology and Guidance Services
Ball State University
Chung-Yi Chiu, PhD(C)
Doctoral Candidate
Rehabilitation Psychology Program
Department of Rehabilitation
Psychology and Special Education
University of Wisconsin–Madison
Chih Chin Chou, PhD
Assistant Professor
Rehabilitation Counseling Program
Department of Special Education,
Rehabilitation, and School Psychology
University of Arizona
Jacquelyn Dalton, PhD
Assistant Professor
Rehabilitation Counseling Program
Department of Educational
Foundations and Counseling Programs
Hunter College
City University of New York
Nicole Ditchman, PhD(C)
Doctoral Candidate
Rehabilitation Psychology Program
Department of Rehabilitation
Psychology and Special Education
University of Wisconsin–Madison
Michael Frain, PhD
Assistant Professor
Rehabilitation Counseling Program
Department of Counselor Education
Florida Atlantic University
Suzanne Haines, RN, BSN
Clinical Advisor at Humana,
Green Bay and Adjunct Nursing
Clinical Instructor for Northeast
Wisconsin Technical College
Green Bay
Contributors
Celeste Hunter, PhD (C)
Doctoral Candidate
Rehabilitation Psychology Program
Department of Rehabilitation
Psychology and Special Education
University of Wisconsin–Madison
Erica K. Johnson, PhD
Lecturer
Graduate Program in Rehabilitation
Counseling
Western Washington University
Researcher
Health Promotion Research Center
University of Washington–Seattle
Maria Helena Juergens, PhD
Assistant Professor
Department of Psychology
Edgewood College
Madison, Wisconsin
Assistant Professor
Psychology
Madison Area Technical College
Alyce Keith, RNC
Clinical Director
Community Care-Marion, Iowa
Clinical Preceptor, Mental Health
University of Iowa
College of Nursing
Jeong-Han Kim, PhD
Assistant Professor
Rehabilitation Counseling Program
Department of Counseling
Psychology and Guidance Services
Ball State University
John Kosciulek, PhD
Associate Professor
Rehabilitation Counseling Program
Department of Counseling, Education
Psychology and Special Education
Michigan State University
Eun-Jeong Lee, PhD
Assistant Professor
Rehabilitation Psychology Program
Institute of Psychology
Illinois Institute of Technology
Gloria K. Lee, PhD
Associate Professor
Rehabilitation Counseling Program
Department of Counseling,
School and Educational Psychology
University at Buffalo,
State University of New York
Susan Gallagher-Lepak, RN, PhD
Assistant Professor
Professional Program in Nursing
University of Wisconsin–Green Bay
Chen-Ping Lin, PhD(C)
Doctoral Candidate
Rehabilitation Psychology Program
Department of Rehabilitation
Psychology and Special Education
University of Wisconsin–Madison
Hanoch Livneh, PhD
Professor
Rehabilitation Counseling Program
Department of Special and
Counselor Education
Portland State University
Ruth Torkelson Lynch, PhD
Professor
Rehabilitation Psychology Program
Department of Rehabilitation
Psychology and Special Education
University of Wisconsin–Madison
Steven R. Pruett, PhD
Postdoctoral Researcher
Department of Physical Medicine
and Rehabilitation
Ohio State University
xii Contributors
Janet Reilly, DNP, APNP-BC, RN
Assistant Professor
Professional Program in Nursing
Family Practice Nurse
Practitioner/Prescriber
University of Wisconsin–Green Bay
Maria Romero, PhD(C)
Doctoral Candidate
Rehabilitation Psychology Program
Department of Rehabilitation
Psychology and Special Education
University of Wisconsin–Madison
David Rosenthal, PhD
Associate Professor and Chair
Department of Rehabilitation
Psychology and Special Education
University of Wisconsin–Madison
Joy Sasson Gelman, PhD
Postdoctoral Fellow in Psychology
Integrated Health Psychology
Training Program
The Wright Institute, Berkeley, CA
Susan Miller Smedema, PhD
Assistant Professor
Rehabilitation Counseling Program
Department of Childhood Education,
Reading and Disability Services
Florida State University
Molly K. Tschopp, PhD
Associate Professor
Program Director, Rehabilitation
Counseling Program
Department of Counseling and
School Psychology
University of Massachusetts, Boston
Chia-Chiang Wang, MS
Doctoral Student
Department of Rehabilitation
Psychology and Special Education
University of Wisconsin–Madison
Steven L. West, PhD
Associate Professor
Rehabilitation Counseling Program
Department of Rehabilitation
Counseling
Virginia Commonwealth University
Lisa M. Wilson, PhD
Associate Professor and Coordinator
Rehabilitation Counseling Program
Pontifical Catholic University
Puerto Rico
Arnold Wolf, PhD
Professor and Coordinator
Rehabilitation Counseling Program
Department of Educational
Foundations and Counseling
Programs
Hunter College
City University of New York
Lisa Xi Zheng, PhD(C)
Doctoral Candidate
Rehabilitation Psychology Program
Department of Rehabilitation
Psychology and Special Education
University of Wisconsin–Madison
Contributors xiii
Preface
Rehabilitation researchers and scholars have long recognized
the need to understand the role of psychosocial factors in the
development of efficacious and effective clinical rehabilita-
tion practices. Therefore, the goal of this book is to provide
readers with a treatment of dominant theories, models and
techniques related to the psychosocial adjustment process
of persons with chronic illness and disability. In doing this,
we sought to provide in depth coverage of current theories
and models of disability and adjustment, major psychoso-
cial variables assessed in the adjustment to disability pro-
cess, and intervention strategies appropriate for use in the
adjustment process. In addition, this book includes chapters
that address important issues related to the adjustment pro-
cess (e.g., stigma, societal attitudes, and sexuality) as well as
chapters that address adjustment within the context of per-
sons with co-occurring psychiatric disabilities and alcohol
and other drug abuse issues. Finally, many of the chapters
include information on appropriate assessment tools and
interventions that can be used in clinical practice to address
and evaluate adjustment to disability related issues.
All chapters in this book are written from an evidence-
based practice (EBP) perspective, emphasizing the empiri-
cal basis of the models and interventions explained, and
their effectiveness with rehabilitation-related populations.
Indeed, in today’s era of accountability and research utili-
zation, the EBP movement in medicine has permeated and
affected a wide array of health and allied health care disci-
plines, and the field of rehabilitation is no exception. Further,
it is our strong belief that rehabilitation and allied health
professionals should have an interest in delivering the most
effective services to people with chronic illness and dis-
ability, based whenever possible on the research evidence.
The utilization of EBP also promotes ethical practice among
rehabilitation health professionals by facilitating treatment
standards and care protocols that protect clients from
harm (nonmaleficence), improve the efficient use of scarce
resources (justice), and provide people with disabilities and
chronic illness the opportunity to exercise knowledgeable
self-determination and informed choice (autonomy).
We believe this book fills a significant gap that exists
within the academic and practice realm of psychosocial
aspects of disability and chronic illness. At present, there is
no textbook that provides comprehensive coverage of the
major psychosocial theories, models and interventions from
an evidenced-based practice perspective; it is this gap in par-
ticular that this book attempts to fulfill. Finally, this book is
intended to reach a broad scope of disciplines. Although the
chapters are written from a rehabilitation perspective, the
book is intended to be useful not only for rehabilitation prac-
titioners and students (upper level undergraduate and gradu-
ate students in rehabilitation counseling and psychology), but
also for professionals from allied health-related disciplines
such as nursing, occupational therapy, physical therapy,
speech and language therapy, recreation, and social work.
We are pleased to be part of this particular project for
several reasons. First, this book gave us an opportunity to
work with rehabilitation health professionals and research-
ers from around the United States who have diverse exper-
tise in the area of psychosocial adjustment. We are proud
that many of the contributing authors of this book are gradu-
ates of the University of Wisconsin–Madison, while others
have been professional associates of ours for years through
scholarly projects and professional associations. Finally, we
are extremely pleased to have contributions from those of
whom we have had limited opportunity to work with in the
past but have substantial background and work in the area of
adjustment to disability.
Another reason for undertaking this project stems from
our love for and commitment to psychosocial research. For us,
helping people cope with psychosocial adjustment to chronic
illness or disability is at the core of the rehabilitation process,
and has therefore been a major focus of our research careers.
In this book, we hope to bring together the broad scope of
psychosocial adjustment literature in a manner that inte-
grates theory, research, and practice with the ultimate goal
of improving the quality and effectiveness of rehabilitation
xvi Preface
health practices and the lives of people with chronic illness
and disability. We sincerely hope that this book will not only
excite and inform readers about the value of evidence-based
rehabilitation practice related to psychosocial adjustment
and disability, but ultimately benefit the clients with whom
our readers will serve.
Fong Chan
Madison, Wisconsin
Elizabeth da Silva Cardoso
New York City, New York
Julie A. Chronister
San Francisco, California
Preface xvii
Introduction
I
3
In today’s managed care era, the evidence-based practice
(EBP) movement in medicine has affected a wide array of
health and allied health care disciplines including reha-
bilitation health professions (Chronister, Chan, Cardoso,
Lynch, & Rosenthal, 2008). The philosophical underpin-
nings of EBP espouse that all health care professionals
should provide their clients with the most effective clini-
cal services based on sound research evidence (Chan,
Tarvydas, Blalock, Strauser, & Atkins, 2009; Chronister et
al., 2008). With regard to rehabilitation, the EBP movement
underscores the importance of incorporating research-
based knowledge into clinical rehabilitation practice to
ensure that people with chronic illness and disability
receive the most effective services. In addition, EBP pro-
1
An Introduction
to Evidence-
Based Practice
Approach to
Psychosocial
Interventions
for People with
Chronic Illness
and Disability
Fong Chan
Julie Chronister
Elizabeth da Silva Cardoso
4Part I: Introduction
motes ethical rehabilitation practice by better protecting
clients from harmful services (nonmaleficence), improv-
ing the efficiency of how scarce rehabilitation resources
are used (justice), and allowing people with disabilities
and chronic illness the opportunity to exercise self-deter-
mination and informed choice (autonomy) based on the
provision of knowledge regarding rehabilitation services
and care (Chan et al., 2009).
While the EBP movement is a relatively recent health
care phenomenon, aspects of this approach to service
delivery have been part of the rehabilitation philosophy
for years. For example, our field’s commitment to empow-
erment and consumerism has resulted in an emphasis
on client involvement, program evaluation, and the use
of empirical research in practice (Corthell & VanBoskirk,
1988; Emener, 1991; Houser, Hampton & Carriker, 2000;
McAlees & Menz, 1992; Rubin & Roessler, 1995). Nonethe-
less, our field’s commitment to using research in practice
has yet to be realized, and according to Law (2002), the
field’s current state of clinical practice may be more accu-
rately characterized as experience-based, eminence-based,
or habit-based. To enact an evidence-based approach in
rehabilitation, Dunn and Elliott (2008) proposed that we
need to first embrace a comprehensive theory-driven
research agenda; second, validate effective interventions
based on this research agenda; and finally, facilitate the
provision of empirically supported interventions based on
the evidence. In addition, we need to advance our train-
ing curriculum to include coursework that extends beyond
the traditional research methods knowledge areas that
specifically addresses the training and application of EBP
techniques.
Without a doubt, rehabilitation health professionals
will be increasingly asked to integrate research evidence
in their clinical decision-making process (Chan, Miller,
Pruett, Lee, & Chou, 2003; Chwalisz, 2003; Schlosser, 2006).
In light of the present and rapidly growing EBP movement
in health care and its implication for rehabilitation health
professionals, the purpose of this chapter is to provide
readers with an overview of EBP and related concepts,
discuss the need for a comprehensive theory- or model-
driven research agenda, and describe how this model-
driven culturally sensitive evidence-based practice forms
Chapter 1: Evidence-Based Practice 5
the foundation for organizing the contents and presenta-
tion of psychosocial theories, research, and techniques in
this textbook.
Evidence-Based Practice
The evidence-based practice approach delineates both a
conceptual framework and a set of skills for clinical deci-
sion making (Walker, Seay, Solomon, & Spring, 2006). From
a conceptual perspective, there is a clear consensus that
EBP involves the “conscientious, explicit, and judicious use
of current best evidence in making decisions about the care
of individual patients” (Sackett, Rosenberg, Gray, Haynes, &
Richardson, 1996, p. 71). The complexities occur when schol-
ars discuss what constitutes best evidence. Questions regard-
ing what constitutes quality research, how to best apply
research evidence, and how to define effectiveness abound
in the literature (Tanenbaum, 2005). For example, within
the field of medicine, with its positivist scientific methods
tradition, the so-called gold standard for scientific evidence
is randomized clinical trials (RCTs), and best evidence
from this perspective is therefore derived from a series of
research study results based on RCTs that form an empirical
consensus regarding the effectiveness of a specific treatment
approach (Ottenbacher & Maas, 1999). Conversely, RCTs may
not be the best form of evidence for rehabilitation and other
allied disciplines because this type of experimental design
may not take into account the complexities of the real world
clinical populations and settings associated with behavioral
sciences (Chambless & Ollendick, 2001; Wampold, 1997, 2001,
2003). For these reasons, Tucker and Reed (2008) suggested
that we should embrace evidentiary pluralism as a strategy
for research and EBP in rehabilitation. Despite the debate
regarding what constitutes best evidence, a five-level hier-
archical framework was developed that offers health care
professionals a format for determining the strength of the
evidence based on the gradient of methodological rigor
(Holm, 2000; Nathan & Gorman, 1998). This hierarchy of
evidence is presented in Table 1.1.
Evidence gathered from Level 1 and Level 2 is consid-
ered empirically validated treatment in professional psy-
chology practice and reflects psychology’s long tradition of
6Part I: Introduction
using controlled experimental design to identify effective
treatments. Chambless and Hollon (1998) defined empirical-
ly validated interventions as psychological treatments that
are clearly shown to be efficacious in controlled research
studies with a delineated population. They further suggested
that best evidence for psychological and psychosocial treat-
ments should be evaluated in terms of efficacy (statistical
and clinical significance), effectiveness (clinical utility), and
efficiency (cost-effectiveness).
From a skills perspective, an evidence-based practitio-
ner in rehabilitation must be knowledgeable about specific
methods for locating research evidence and incorporating
this clinical information into treatment. DePalma (2002)
described EBP to include a process that begins with know-
ing what clinical questions to ask, how to find the best
practice, and how to critically appraise the evidence for
validity and applicability to the particular care situation.
Following this, the evidence must be considered within the
context of the client’s unique values and needs. The final
skill required in this process is evaluating the effective-
ness of care and the continual improvement of the pro-
cess. Walker et al. (2006) suggested following four specific
steps: (a) formulating well-defined, answerable questions;
(b) seeking the best evidence available to answer the ques-
tions; (c) critically appraising the evidence; and (d) apply-
ing the evidence to the individual patient. Following is a
detailed description of each step.
1.1
Level 1
: Strong evidence from at least one systematic review of multiple
well-designed randomized controlled trials.
Level 2
: Strong evidence from at least one properly designed randomized
controlled trials of appropriate size.
Level 3
: Evidence from well-designed trials without randomization, single group
pre-post, cohort, time series, or matched case-controlled studies.
Level 4
: Evidence from well-designed nonexperimental studies from more than
one center or research group.
Level 5
: Evidence from opinions of respected authorities, based on clinical
evidence, descriptive studies, or reports of expert committees.
Hierarchical Levels of Evidence
Chapter 1: Evidence-Based Practice 7
Step 1: Formulating Well-Defined,
Answerable Questions
This is likely the most important step of the EBP process
because it determines what evidence to look for and where
to search for the best evidence. Examples of general ques-
tions the rehabilitation health professional may ask at this
step include:
What processes/techniques make a specific rehabili-
tation intervention work?
For whom is the intervention most effective?
Are certain interventions/programs better for certain
persons?
Who should receive a specific intervention or program?
When? And for how long?
General questions are also known as background
questions. In EBP, background questions ask about a gen-
eral setting or context, whereas foreground questions ask
about a specific case within that context (Walker et al.,
2006). The following is a case illustration: A 52-year-old
man who is a Chinese immigrant sustained a work injury
and is unhappy with his physical therapy treatment. As
his physical therapist, you are treating his low back pain
with transcutaneous electrical nerve stimulation (TENS).
During treatment, he expresses an interest in trying acu-
puncture as an alternative therapy and asks you to help
him identify the best treatment approach for his low back
pain. In this case, background questions may include the
following examples:
What are the most effective treatments for low back
pain?
Is acupuncture an effective treatment for low back
pain?
Are there any significant risks associated with
acupuncture?
With regards to foreground questions, Walker et al.
(2006) recommend asking these questions using the fol-
lowing PICO format: Patient group (P), intervention (I),
comparison group (C), and outcome measures (O). The
8Part I: Introduction
following is an example of a foreground PICO question for
the above illustrative case: In middle-aged Chinese men
with chronic pain (P), is there any evidence that acupunc-
ture (I) is superior to sham treatment, biofeedback, relax-
ation training, and TENS (C) in reducing the frequency,
intensity, and/or duration of low back pain (O)? A set of
well-built background and foreground questions provide
direction for determining what evidence to look for and
where to search for the best evidence.
Step 2: Seeking the Best Evidence Available to
Answer the Questions
While Google searches are readily accessible and therefore
tempting, this search engine may provide outdated, unre-
liable, and inaccurate information. The most reliable and
scholarly approach to searching for best evidence is through
academic databases and/or scholarly Web sites. Appropriate
academic databases to use include Academic Search Elite
(a multi-disciplinary database that covers virtually every
area of academic study), CINAHL Plus with Full Text (the
world’s most comprehensive source of full text for nursing
& allied health journals), MEDLINE (the most authorita-
tive medical information database), and PsycINFO (the
most comprehensive database for psychological research).
The most useful Web sites for evidence-based medical
rehabilitation information include the Cochrane Collabo-
ration (http://www.cochrane.org), Agency for Healthcare
Research and Quality (http://www.ahrq.gov), and American
Congress of Rehabilitation Medicine (http://www.acrm.org/
consumer_professional/Evidence_Based_Practice.cfm).
Given the potential for a vast number of research arti-
cles with contradictory findings, the most efficient way to
find best evidence is to use the databases and/or specific
Web sites suggested above for systematic reviews (prefil-
tered evidence). Systematic reviews answer a specific clini-
cal question by using predetermined rules for capturing
the evidence, appraising it, and synthesizing it in a manner
that is easily accessible to clinicians. Systematic reviews are
based on work by scholars with expertise in a substantive
area who review and critique the available data in the field
(Schlosser, 2006). Strong evidence from at least one system-
Chapter 1: Evidence-Based Practice 9
atic review of multiple well-designed RCTs is considered
the highest level of best evidence and is frequently labeled
ameta-analytic review.
The most efficient way of searching for psychosocial and
rehabilitation treatment information is to search the above
databases and/or Web sites using keywords related to the
clinical problem coupled with the terms “systematic review”
or “meta-analysis.” To illustrate the efficiency of this, con-
sider the following with regards to our case scenario: Enter-
ing the terms systematic review, meta-analysis, acupuncture,
and chronic pain in Google resulted in 59,000 items; con-
versely, entering acupuncture, low back pain, and systematic
review using Academic Search Elite, CINAHL Plus with Full
Text, MEDLINE, and PsycINFO resulted in 12 entries When
just acupuncture was entered, 13,309 entries resulted; when
just low back pain was entered, 14,606 entries resulted; and
when acupuncture and low back pain were entered together,
264 entries resulted. Thus, entering just one term and enter-
ing all terms into these databases result in a much more
manageable number of entries than using Google. For this
search, the title of the two most current reviews are, “Com-
plementary and Alternative Medicine in the Treatment of
Low Back Pain: A Systematic Review” (published in 2006)
and “Acupuncture and Dry-Needling for Low Back Pain: An
Updated Systematic Review within the Framework of the
Cochrane Collaboration” (published in 2005). A review of
the two articles indicated that the Cochrane review (Furlan
et al., 2005) is more relevant for our illustrative case than the
first article. A summary of the Cochrane review is presented
below:
“For chronic low back pain, there is evidence of immedi-
ate and short-term pain relief and functional improve-
ment for acupuncture compared to no treatment or
sham therapy. There is also evidence that acupuncture,
added to other conventional therapies, relieves pain and
improves function better than the conventional therapies
alone. However, the effects are only small. Dry-needling
appears to be a useful adjunct to other therapies for
chronic low back pain. There is insufficient evidence to
support the effectiveness of acupuncture for acute low
back pain.
10 Part I: Introduction
In another search seeking to determine the effective-
ness of TENs versus acupuncture, the terms acupuncture
and TENS were entered and six entries occurred. The lead
systematic review article indicated that the evidence for
the efficacy of TENS as an isolated intervention in the
management of chronic low back pain is limited and incon-
sistent. The authors stated that increased attention should
be given to the risks and benefits of the long-term use of
TENS and addressed the realities of managing chronic
low back pain. As such, there is evidence suggesting that
our illustrative client might be dissatisfied with his TENS
treatment. Moreover, acupuncture treatment may be more
effective within the context of his dominant culture as an
immigrant from China.
Step 3: Critically Appraising the Evidence
Rehabilitation professionals can save valuable time by learn-
ing how to glean evidence from systematic reviews as criti-
cally appraising evidence from a single properly designed
RCT article (i.e., Level 2 evidence) requires a relatively strong
background in research methods and a working knowledge of
concepts related to internal and external validity (Schlosser,
2006). To be able to read and understand systematic reviews,
rehabilitation professionals need to be familiar with several
concepts related to meta-analysis as described below:
1. Randomized clinical trials. RCTs possess three charac-
teristics: (a) an experimental group who receives the
experimental intervention or treatment; (b) a control
or comparison group who receives standard care or
a comparison intervention that is different from the
experimental treatment; and (c) random assignment
or randomization to experimental and control or com-
parison groups.
2. Meta-analysis. Meta-analysis is a subtype of systematic
review. A meta-analysis reviews the results of a collection
of empirical studies in a specific research domain through
statistical integration and analysis, and synthesizes the
results to determine the effectiveness of a given clinical
treatment (Durlak, 1995; Hunt, 1997). It is a mechanism
by which professionals can understand the effectiveness
of a practice/intervention domain in quantitative terms.
Chapter 1: Evidence-Based Practice 11
3. Effect size. Central to meta-analysis is the concept of effect
size. Similar to an individual experiment, a meta-analysis
contains both independent and dependent variables, with
the independent variables being such characteristics as
participants, interventions, and outcome measures, and the
dependent variable being the effect size (e.g., the d index),
or the outcome of the results of each study selected for
review, transformed into a common metric across studies.
In meta-analysis, the effect size of the individual RCT will
be reported as d and the aggregated effect size of a collec-
tion of RCTs will be reported as d+. For correlational stud-
ies, the effect size will be reported as r and for a Pearson
chi-square test, the effect size is reported as w. A typical
way to interpret the size is to use the standards established
by Cohen (1988) and presented here in Table 1.2.
To interpret the effect size in standardized mean differ-
ence research, the effect size d is identical to a z score. For
example, if the aggregate effect size for 40 acupuncture RCT
articles (e.g., acupuncture treatment vs. placebo) is equal to d
of 1.0 (i.e., z= 1.0), this means that clients with low back pain
who received acupuncture treatment are better off than 84%
(+1z score covers 84% of the normal curve) of the clients who
received placebo or sham treatments and therefore the dif-
ference between the treatment and control groups is large.
Step 4: Applying the Evidence to the
Individual Consumer
After locating, appraising, and synthesizing the research
evidence, the rehabilitation health professional must
incorporate the evidence into a client’s treatment plan by
1.2
Effect Size
PV
r
d
η
2 w
ƒ
2
Small effects .01 .10 .20 .01 .10 .02
Medium effects .10 .30 .50 .06 .30 .15
Large effects .25 .50 .80 .14 .50 .35
Effect Size Measures
12 Part I: Introduction
taking into account the significance of the evidence, his
or her own professional expertise and judgment, and the
client’s characteristics, values, and context. The American
Psychological Association (APA) defines best evidence as
“evidence based on systematic reviews, reasonable effect
sizes, statistical and clinical significance, and a body of
supporting evidence” (2005, p. 1). Professional judgment is
used to identify each client’s unique disability and health
status and to integrate the best evidence with the reha-
bilitation context. Client characteristics, values, and con-
text are the preferences, values, strengths, weaknesses,
personality, sociocultural factors, and expectations that
a consumer brings to the rehabilitation process. In EBP,
clinical decisions are made in collaboration with the cli-
ent. For example, in our illustrative case there are cultural
factors to consider such as the client being an older adult
who migrated to the United States from China. More spe-
cifically, not only does the evidence support acupuncture
over TENS, but the client may be more comfortable with
acupuncture given his cultural background.
Model-Driven Culturally Sensitive Evidence-Based Reha-
bilitation Practice .Dunn and Elliott (2008) argue for the
primacy of theory- or model-driven rehabilitation research.
Specifically, they advocate for the development of theory-
driven research programs that embrace a methodological
pluralism that advances theory and produces meaningful
research programs that inform rehabilitation practice. Of
particular importance to rehabilitation and allied health
fields is the need to consider conceptual models that con-
sider contextual and environmental factors in the devel-
opment of efficacious and effective rehabilitation practice
(cf. Wright, 1960, 1983). Helping people with chronic ill-
ness and disability cope with psychosocial and vocational
adjustment issues has been central to the clinical practice
of many rehabilitation health professions including reha-
bilitation counseling, rehabilitation psychology, nursing,
physical therapy, and occupational therapy. For example,
according to the APA’s Division of Rehabilitation Psychol-
ogy (APA, 2008), rehabilitation psychologists assess and
provide interventions for a range of physical, personal,
psychosocial, cognitive, and behavioral factors that may
be affected by chronic illness and disability. These factors
Chapter 1: Evidence-Based Practice 13
include neurocognitive status, sensory difficulties, mood
and emotions, desired level of independence and interde-
pendence, mobility and freedom of movement, self-esteem
and self-determination, behavioral control and coping
skills, subjective view of capabilities, and quality of life.
With regard to rehabilitation counseling, Maki and Rig-
gar (2003) defined the rehabilitation counseling discipline
as an integrated program of interventions that empowers
individuals with disabilities and chronic illness to achieve
“personally fulfilling, socially meaningful, and function-
ally effective interaction” (p. 1) in everyday life.
In light of our field’s role and emphasis on psychoso-
cial issues and their impact on rehabilitation outcomes, an
emerging research trend is to employ a biopsychosocial
model as a conceptual framework for empirically testing
rehabilitation interventions and providing empirical sup-
port for clinical practices (Dunn & Elliott, 2008; Gebbie,
Rosenstock, & Hernandez, 2003; Metcalfe & Moffett, 2005).
This approach is consistent with the 2003 Institute of
Medicine report that emphasizes the importance of under-
standing and utilizing an ecological approach to conducting
public health research based on individual level and group
level measures that include molecular/genetic, cellular,
organ systems, behavioral/psychological, social/environ-
mental, and cultural/political levels of analysis (Gebbie et
al., 2003). In addition, the National Institute on Disability
and Rehabilitation Research (NIDRR)’s conceptual frame-
work of disability embraces the use of a socioecological
approach to study psychosocial and vocational adjustment
of people with disabilities (Tate & Pledger, 2003).
The World Health Organization ICF Model
of Disability
Recently, the World Health Organization International
Classification of Functioning, Disability, and Health (ICF)
model gained worldwide acceptance among rehabilitation
health researchers and practitioners as a biopsychoso-
cial framework that can be used to support a systematic
approach for understanding chronic illness and disabil-
ity across diverse populations and cultures (Peterson &
Rosenthal, 2005). Specifically, the ICF paradigm is struc-
tured around the following broad components: (a) body
14 Part I: Introduction
functions and structure, (b) activities (related to tasks and
actions by an individual) and participation (involvement
in a life situation), and (c) environmental and personal
characteristic factors. Key constructs and how they inter-
act to affect full inclusion, health status, and quality of life
of people with chronic illness and disability, are depicted
in Figure 1.1.
Within the ICF framework, functioning and disability
are viewed as a complex interaction between the health
condition of the individual, the contextual factors of the
environment, as well as personal factors. In working with
clients with psychosocial adjustment issues related to the
onset of a chronic illness or disability, it is useful to consider
the importance of environmental (E) factors and personal
characteristic (P) factors and the significant the P × E inter-
action effect on the psychosocial and community adjust-
ment of people with chronic illness and disability in the
community. The ICF model enables rehabilitation health
professionals to conceptualize a client’s presenting prob-
lem and treatment solution from a holistic perspective and
enhances clinical decision-making based on the volumi-
nous research generated by ICF researchers from different
health care and rehabilitation disciplines.
1.1
The World Health Organization ICF Model
Health Condition
(Disorder/Disease)
Body Function & Structure
(Impairment)
Activities
(Limitation)
Participation
(Restriction)
Environmental Factors Personal Factors
Chapter 1: Evidence-Based Practice 15
Mediators and Moderators in
Psychosocial Research
The ICF model can also be useful for studying mediators and
moderators in psychosocial theory, research, and practice
(Chan et al., 2008). The composition of the U.S. population is
expanding and becoming more diverse, with the European
American population projected to fall from 81% of the popu-
lation in 2000 to 52% of the population in 2050 and the pop-
ulation of people from Hispanic or Latino origin projected
to steadily increase from 12.6% in 2000 to 24.4% of the total
population by 2050. In addition, Asian Americans will also
experience a dramatic growth in population size from 3.8%
in 2000 to 8% of the population in 2050; the African Ameri-
can population will rise from 12.7% of the population in 2000
to 14.6% of the population in 2050; and the American Indi-
an, Eskimo, and Aleut will represent 1% of the population.
Indeed, the changing demographic makeup of the United
States has prompted many health care researchers to ques-
tion the traditional assumption that treatments that work for
European Americans will work for individuals from racial
and ethnic minority groups. For the rehabilitation commu-
nity, awareness of personal characteristics related to being
different from the majority population, how one sees oneself,
and how others see and react to an individual with a disabil-
ity or chronic illness have long been recognized as central
to the experience of having a disability or chronic illness.
Therefore, research that considers an individual’s culture
as well as other mediators and moderators of psychosocial
functioning is fundamental to explaining the full spectrum
of human experience.
Research questions involving moderators address when
or for whom a variable most strongly predicts or causes an
outcome variable, whereas mediators establish how or why
one variable predicts or causes an outcome variable (Frazier,
Tix, & Barron, 2004; Hoyt, Imel, & Chan, 2008). More specifi-
cally, a mediator provides information about the underlying
mechanisms for change, whereas a moderator effect is basi-
cally an interaction whereby the effect of an independent
variable (e.g., types of therapy) changes at different levels of
another independent variable (e.g., race). Similar to health
care research, the study of moderator effects in rehabilitation
research is particularly important for determining the effects
16 Part I: Introduction
of race, gender, disability type, resiliency (e.g., social support),
and vulnerability factors (e.g., stress) on adjustment to dis-
ability. For example, what works for European Americans with
disabilities may not work for clients from racial and ethnic
minority backgrounds; what works for men may not work for
women; and what works for European men with disabilities
may not work for African women with disabilities. Similarly,
moderators are extremely important in studying the role of
resiliency factors such as social support or determining dif-
ferences in relation to sudden onset versus chronic condi-
tions. For theory or model building, it is equally important to
study the mediator effect (i.e., the underlying mechanisms
of change) so that we can better design interventions that
work (Chan et al., 2009; Hoyt et al., 2008). Without question,
a renewed appreciation of model-driven research and an
increased awareness of the effect of mediator and moderator
variables on rehabilitation outcomes will help rehabilitation
professionals provide better and more effective psychosocial
interventions based on scientific advances.
Concluding Remarks
It is clear from this overview that not only have we made sig-
nificant progress in our understanding of the role of psycho-
social factors in the adaptation process related to chronic ill-
ness and disability, but we are embarking on new and exciting
directions in the study of psychosocial aspects of disabilities.
This book provides an overview of EBP, reviews the promi-
nent theoretical approaches to psychosocial adjustment to
chronic illness and disability, and includes some empirically
supported interventions that can be applied in rehabilitation
settings. In addition, the book covers other important issues
related to psychosocial adjustment such as stigma, societal
attitudes, diversity, and sexuality, and offer chapters that
explore psychosocial adjustment within the context of co-
occurring psychiatric disabilities and substance abuse issues.
The primary goal of this book is to provide readers with the
best research evidence available related to the topics we
consider important to the psychosocial adjustment of people
with chronic illness and disability. In addition, we sought to
garner the best evidence from literature bodies that are often
wrought with inconsistencies and contradictory findings.
Chapter 1: Evidence-Based Practice 17
In conclusion, we hope that the content of this book will
be helpful to practitioners and students of rehabilitation and
allied health professions in gaining a better understanding
of the complexities of psychosocial adjustment, the corre-
sponding evidence and best practices related to psychosocial
adjustment, and practical applications of psychosocial theo-
ries and techniques in rehabilitation settings.
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Chapter 1: Evidence-Based Practice 19
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... As a classification system, the ICF was established to provide a comprehensive system for conceptualizing health in a holistic manner. The ICF framework advances disability theory by incorporating elements of previous models of disability while also accounting for contextual (i.e., personal, environ-mental) factors (Chan, Cardoso, et al., 2009). The ICF model is consistent with the rehabilitation counseling philosophy of emphasizing the personal (P) and environmental (E) factors and the significance of the P X E interaction on the full integration of individuals with disabilities into the community. ...
... The ICF model is consistent with the rehabilitation counseling philosophy of emphasizing the personal (P) and environmental (E) factors and the significance of the P X E interaction on the full integration of individuals with disabilities into the community. Chan, Cardoso, et al. (2009) espouse the ICF as the most appropriate framework to study participation outcomes of people with CID. ...
... For individuals with PD and other chronic progressive illnesses, participation in valued life activities has been found to support the maintenance and improvement of both overall general health and QOL (Chan, Cardoso, et al., 2009;Kielhofner, 2008;Wilcock, 2006). However, the progression of PD motor and nonmotor symptoms and associated functional limitations increasingly restricts participation in activities of daily living, socialization, productivity, and employment, resulting in stark implications for health, psychosocial functioning, and quality of life (Abudi et al., 1997;Brod et al., 1998;Hartley et al., 2014;Lawrence et al., 2014;Schenkman et al., 2002;Scott et al., 2000). ...
Article
Objective The purpose of this study was to explore how the functional impact of Parkinson's disease affects participation and to evaluate whether positive psychological capital (PsyCap) mediates the relationship within the context of the World Health Organization International Classification of Functioning, Disability, and Health Model. Method Survey responses were analyzed from 144 adults with Parkinson's disease using a quantitative, correlational research design employing multiple regression and hierarchical regression analysis to examine hypothesized relationships. Results The results of the correlation analysis indicated that there was a statistically significant, moderate-to-strong positive correlation between functioning and PsyCap and participation. Hierarchical regression analysis revealed that functioning accounted for 65% of the variance in participation. Although PsyCap was associated with participation, no mediating effect was observed. Conclusions The results are consistent with traditional clinical judgment that physical functioning is positively correlated with participation. This study represents the first evaluation of the role of PsyCap in people with Parkinson's disease, and the results of the correlational analysis suggest that continued investigation of these relationships is warranted. Background Parkinson's disease results in a variety of motor and non-motor features that frequently result in reduced participation in valued life activities.
... When people are exposed to chronic work-related stressors that provoke their sense of death anxiety, their coping resources become strained (Chan et al., 2009), consequently increasing their risk of developing psychological disorders such as loss of meaning in life, psychological distress, and depression (Austin et al., 2017;Maxfield et al., 2014). Among nurses, such implications may detract from their professional engagement and functioning, the quality of services provided to patients, and the ability to feel and express empathy. ...
... Studies repeatedly show that the levels of stress among caregiving personnel increase when social support is limited (Bourbonnais et al., 2005;Eriksen et al., 2006). According to the stress buffering model (Chan et al., 2009;Cohen & Wills, 1985), social support might interact with stressful events or conditions to reduce the effect of stress by contributing to people's sense of belonging to the social environment, improving their sense of confidence and self-image as well as their belief in their ability to cope with difficulties. Accordingly, social support may reduce or prevent the emergence of psychological distress (e.g., Chan et al., 2009;Santini et al., 2015). ...
... According to the stress buffering model (Chan et al., 2009;Cohen & Wills, 1985), social support might interact with stressful events or conditions to reduce the effect of stress by contributing to people's sense of belonging to the social environment, improving their sense of confidence and self-image as well as their belief in their ability to cope with difficulties. Accordingly, social support may reduce or prevent the emergence of psychological distress (e.g., Chan et al., 2009;Santini et al., 2015). ...
Article
Based on the stress-buffering model, the current study sought to examine the moderating role of perceived social support in the association between death anxiety and psychological distress among nurses. Select variables found in previous studies to correlate with psychological distress served in the current study as covariates to control for their relationship with psychological distress among nurses. These include gender, years of professional experience, self-rated health, self-efficacy, and self-defined burnout. Structured questionnaires were administered to a sample of 795 professionally active nurses in Israel. Psychological distress was assessed by the 6-item Kessler Psychological Distress Scale (K6), death anxiety was assessed by a single item scale designed by Abdel-Khalek, and perceived social support was assessed by the Multidimensional Scale of Perceived Social Support (MSPSS). The research findings show that higher levels of death anxiety were associated with higher levels of psychological distress only among nurses with lower levels of perceived social support. The study indicates that in order to reduce the level of distress experienced by nurses it is important to take action to reduce their death anxiety and enhance their social support mechanisms.
... In general, migraine patients with comorbid depression and anxiety had more neuroticism than patients without migraines and those with depression or anxiety without migraines [81,82]. As neuroticism is significantly related to symptoms of anxiety and depression [83,84], treatment for migraine might be more effective if it included interventions such as cognitive behavioral therapy (CBT) [85]-which is considered one of the most effective interventions for depression-together with the usual medical treatment [86]. Nevertheless, it is important to be cautious in assuming that depression and neuroticism are related to migraine through the same mechanism. ...
Article
Full-text available
Headache is the first cause of consultation in neurology, and one of the most frequent reasons for consultation in general medicine. Migraine is one of the most common, prevalent, and socioeconomically impactful disabling primary headache disorders. Neuroticism can be conceptualized as a disposition to suffer anxiety and emotional disorders in general. Neuroticism has been associated with various mental and physical disorders (e.g., chronic pain, depression), including migraine. With the aim to explore in depth the relationship between migraine and neuroticism, and contribute to the understanding of this relation in order to provide a better treatment for migraine patients based on a personalized and more comprehensive approach, a scoping review was performed using PubMed, Scopus, and Web of Science. Databases were searched independently by the two researchers, reaching a final set of 18 articles to be included. The search terms were: migraine and neuroticism. Neuroticism seems to be highly prevalent in migraine patients. Findings reveal that migraine patients with comorbid depression and anxiety showed higher levels of neuroticism. Depression has been associated with an increased risk of transformation from episodic to chronic migraine whereas neuroticism might be a mediator factor. Neuroticism also might be a mediator factor between childhood maltreatment and migraine. The revision conducted confirms that: (1) Migraine patients usually have a higher level of neuroticism and vulnerability to negative affect, compared to non-migraineurs and tension-type headache patients. (2) Neuroticism is associated with migraine. Nonetheless, more research is needed to clarify potential moderators of this relationship and the role of neuroticism itself in this disease. This knowledge might be useful in order to promote a better management of negative emotions as part of intervention programs in migraine.
... Social support is a good interpersonal relationship. It might interact with stressful events or conditions to reduce the effect of stress by contributing to people's sense of belonging to the social environment, improving their sense of confidence and self-image as well as their belief in their ability to cope with difficulties [19,20]. Accordingly, social support may reduce or prevent the emergence of psychological distress and some studies have found its alleviating effect on death anxiety [21,22]. ...
Article
Full-text available
Purpose This study aimed to investigate death anxiety in advanced cancer patients and identify associated factors in the context of Chinese culture. Methods Participants (N = 270) with advanced cancer in a tertiary cancer hospital completed anonymous questionnaire surveys. Measures included the Chinese version of a Likert-type Templer-Death Anxiety Scale, Rosenberg’s Self-esteem Scale, Medical Coping Modes Questionnaire, the Social Support Rating Scale, and Connor-Davidson Resilience Scale. Data were analyzed in SPSS using descriptive statistics, Student’s t test, Pearson correlation test, and linear regression. Results Respondents returned 252 (93.33%) of the 270 questionnaires. The total CL-TDAS score was 39.56 ± 10.20. The top three items were “I fear dying a painful death” (3.59 ± 1.41), “I often think about how shortly life really is” (3.11 ± 1.33), and “1 am not particularly afraid of getting cancer” (3.09 ± 1.35). Associated factors of death anxiety (R² = .333, F = 15.756, p < .001) were the medical coping mode (resignation, confronce), self-esteem, the participants’ adult children, the patient-primary caregivers’ relationship, resilience, and the level of activity of daily living. Conclusions Our results demonstrate high levels of death anxiety in advanced cancer patients. Generally, patients with adult children, high self-esteem and resilience had low death anxiety. Conversely, patients with low levels of activity of daily living and high coping mode (resignation, confrontation) reported high death anxiety. We determined that associated factors contributed to reduce death anxiety. Social interventions are recommended to improve the end-of-life transition for patients and caregivers.
... This cluster has been found to be independent of the first two in a number of studies (Amirkhan, 1990;Carver et al., 1989;Dunkel-Schetter et al., 1992;McColl et al., 1995). The use of seeking social support strategies has also been found to be linked to better PA among people with CID (Chronister, 2009;Livneh & Martz, 2012;Manne, 2003). The clinical unfolding and adaptation relevance of these three broad coping modes have been observed to be both mutability and controllability dependent on the nature of CID (Livneh & Martz, 2012;Penley et al., 2002;Stanton et al., 2007). ...
Article
Full-text available
The article revisits and updates an earlier model (Livneh, 2001) that examined the building blocks that constitute the dynamics of psychosocial adaptation to chronic illness and disability (CID). In the revised tripartite model, the author reconstructs and refines the earlier model based on recent theoretical formulations, clinical reviews and research findings. In the revised model, the author discusses three overarching components, namely, antecedents (causes of medical conditions, background variables), processes (the dynamically unfolding course of post-CID events), and outcomes (anticipated exit indicators that serve, as snapshot end products, to assess the individual’s experienced and reported quality of life following onset of CID). The article concludes with a brief review of the model’s practical and research implications.
... Sin embargo, es importante mencionar que después del diagnóstico médico de DM2 los diabéticos viven un proceso de adaptación a la enfermedad y necesidades del tratamiento, debido a que se enfrentan a nuevas demandas que desafían sus recursos personales y pasan por un proceso de adaptación psicosocial (13). De la exitosa elaboración de este proceso de adaptación dependerá el desarrollo de las conductas de AC necesarias para el adecuado manejo de la enfermedad (14). ...
Article
Mantener un adecuado control de la diabetes se relaciona a variables como autocuidado y sentido de coherencia que reducen las tasas de morbilidad y mortalidad. El objetivo fue evaluar el efecto mediador del sentido de coherencia en la relación entre autocuidado y niveles de glucosa en sangre de personas con diabetes. A 220 sujetos con diabetes mellitus tipo 2 se les aplicó un instrumento para autocuidado y otro para sentido de coherencia, mientras que la hemoglobina glucosilada se obtuvo del expediente médico, posterior se analizaron los datos por medio de un modelo de ecuaciones estructurales. Los resultados muestran que el tanto el autocuidado (c’ = −0.33; p < 0.05), como el sentido de coherencia (b = −0.34; p < 0.05) tienen un efecto directo sobre los niveles de glucosa, así como también un efecto indirecto significativo (−0.168; p < 0.05), el efecto total de AC sobre A1c corresponden a −0.498, en consecuencia, este modelo estimado corresponde a un modelo de mediación simple parcial. Los resultados confirman la hipótesis de que el sentido de coherencia en personas con diabetes media la relación entre AC y HbA1c. El enfoque salutogénico mejora la adherencia a las conductas de autocuidado lo que puede facilitar el control glucémico de la enfermedad.
... To acquire this altered self or state of adjustment it is required to explore the effective coping mechanism across male and female SCI patients [17]. Further it is described that adjustment in life long illness as recognition of one's remaining potentials and accept one's limitation and able to confer outside the environment [18]. A study concluded coping mechanism as predictor of social and physical adjustment among SCI patients and highlighted utilization of healthy copings in psycho social rehabilitation plan of these sufferers [19]. ...
Article
The present study aimed to examine the impact of coping strategies and psychological adjustment across male and female Spinal Cord Injured (SCI) patients. Purposive sampling technique was employed based on cross-sectional design. The data was collected through two questionnaires. The result revealed that psychological adjustment was significant correlated with Positive coping strategies (r =.36, p = .002) and Problem focused coping strategies (r = .45, p =.000). On the other hand psychological adjustment was significant negative correlation with Active avoidance (r =-.69, p = .000) and Religion & Denial coping strategies(r =-.38, p=.001).The result revealed that positive coping strategies were positively significant predicted psychological adjustment (B= 2.15, p= 0.01; B=-.20, p=n.s) for male rather than female respectively. The result also displayed that problem focused strategies were positively significant predicted psychological adjustment (B= 2.22, p=.05; B= .54, p= n.s) for female rather male respectively. The result shown that active avoidance coping strategies were negatively significant predicted psychological adjustment (B=-1.52, p= .05; B=-.67, p=n.s) for male and female respectively. The study suggested that the gender was significant moderator between coping strategies and psychological adjustment in Spinal Cord Injured patients. The study recommended that male patients are more vulnerable on problem focused coping strategies whereas females are more predisposed on positive and active avoidance coping strategies. This study would be helpful in clinical and rehabilitation settings for SCI patients.
Thesis
Full-text available
Disability is a common human experience, and thus clinicians will frequently encounter clients with disabilities. In order meet ethical expectations and practice competently, clinicians need to be prepared to work with persons with disabilities. Competency requires that clinicians develop awareness, knowledge, and skills regarding disability issues. Opportunities to develop competency within graduate training programs in psychology are limited, despite the call for such training and the fact that disability is considered a minority status and included within multicultural competencies. This project offers a one-day training program covering awareness, knowledge, and skills. The curriculum can be divided into three separate modules as well. The ultimate goal of the training is to provide the necessary elements for clinicians to develop a disability-aware practice.
Chapter
The purpose of this chapter is to (a) describe the impact that neurological disorders have on health, employment, and quality of life outcomes and (b) present strategies designed to aid people with neurological disorders in achieving their rehabilitation goals. We begin with an overview of neurological disorders in general, then present a conceptual framework for understanding the impact of neurological disorders in people’s lives. Following a discussion of the construct quality of life, we provide examples of three commonly occurring neurological disorders (multiple sclerosis, Parkinson’s disease, traumatic brain injury) and examine the quality of life implications of each condition.
Article
Full-text available
The health care environment of the past quarter century went through numerous evolutionary processes that affected how occupational therapy services were provided. The last iterations of these processes included requests for the evidence that supported what we were doing. This year's Eleanor Clarke Slagle Lecture (a) examines the strength of the evidence associated with occupational therapy interventions-what we do and how we do it-(b) raises dilemmas we face with our ethical principles when some of our practices are based an limited evidence, and (c) proposes a framework of continued competency to advance the evidence base of occupational therapy practice in the new millennium.
Article
Full-text available
National discussions of health-care delivery systems have renewed the effort to identify empirically validated psychotherapies. Although the logic of efficacy studies in psychotherapy, which are used to empirically establish the efficacy of psychotherapy, is relatively simple, the validity of inferences from these studies are ambiguous and the focus on outcome obscures other important aspects of psychotherapy. Problems related to (a) common versus specific confounds, (b) difficulties in disproving the uniform efficacy supposition, and (c) hazards in standardizing treatments are discussed. These problems make developing criteria for establishing empirically validated treatments difficult; a currently proposed set of criteria for proving treatment efficacy is critiqued.Die in den USA geführte Diskussion über das System der Gesundheitsversorgung hat zur Erneuerung von Bemühungen beigetragen, empirisch validierte Psychotherapien zu identifzieren. Obwohl die Logik von Effektivitätsstudien in der Psychotherapie, die dazu benutzt werden, die Effektivität von Behandlungen empirisch abzusichern, relativ emfach ist, ist die Validität von Schilussfolgerungen, die aus diesen Studien abgeleitet werden, durchaus zwiespältig. Die ausschliessliche Betrachtung des Therapieergebnisses beispielsweise verschleiert andere wichtige Aspekte der Psychotherapie. Wesentliche Probleme, die in diesem Beitrag diskutiert werden, beziehen sich auf (a) Konfundierungen allgemeiner vs. spezifischer Effekte, (b) Schwierigkeiten, die uniforme Annahme der Effektivität zu widerlegen und (c) die Gefahren standardisierter Behandlungen. Diese Probleme machen es schwierig, Kriterien fur empirisch validierte Behandlungen festzulegen. Die gegenwärtig vorgeschlagenen Kriterien zum Nachweis der Effektivität einer Behandlung werden kritisiert. (Wampold)Les discussions nationales du système de distribution des soins de santé ont ravivé les efforts concernant l'identification des psychothérapies validées empiriquement. Bien que la logique des études sur l'efficacité des psychothérapies soit relativement simple, la validité des inférences de ces études est ambiguë. De plus, le fait de se focaliser sur les résultats occulte d'autres aspects importants de la psychothérapie. Nous discutons dans cet article des problèmes relatifs:aux confusions communes versus spécifiquesaux difficultés dans la réfutation de l'efficacité uniforme supposéeet au hasard dans la standardisation des traitements.Ces problèmes nous poussent à développer des critères afin d'établir les difficultés de traitement validé empiriquement; nous discutons un ensemble de critères pour mettre à l'épreuve l'efficacité des traitements. (Wampold)
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The field of rehabilitation has attempted to identify theories which can be used in practice. Several recent examples of theories or concepts include normalization and empowerment. Most recently empowerment has been a major emphasis in the provision of rehabilitation services. This paper involved a review of the empowerment concept and a caution in the overgeneralization of the concept into practice. In order to interpret and apply empowerment most effectively it is suggested that rehabilitation counselors concurrently use Social Role Theory. We discuss the major components of Social Role Theory and how the theory and concepts can be applied with specific disability groups and rehabilitation programs. This is done to illustrate the relevance of interconnecting the theory and concept of empowerment and Social Role Theory.
Book
Much about this third edition of A Guide to Treatments That Work remains as it was in the first and second editions. Like its predecessors, this edition offers detailed evaluative reviews of current research on empirically supported treatments, written in most instances by clinical psychologists and psychiatrists who are major contributors to that literature. Similarly, the standards by which the authors were asked to evaluate the methodological rigor of the research on treatments have also remained the same. As before, they provide information on the quality of the research on treatment efficacy and effectiveness that is reviewed.
Article
The evidence-based practice (EBP) movement in medicine has permeated and affected a wide array of health and allied health care disciplines, and the field of rehabilitation is no exception. The purpose of this paper is to provide rehabilitation professionals up-to-date information about the defining characteristics and available resources of EBP for healthcare and rehabilitation practices, the critical issues that surround this movement, and the implications of this movement for the field of rehabilitation.
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Little or no research has been conducted to explore patients’ expectations of physiotherapy. This article investigates the relationship between patients’ expectations of benefit and other relevant variables prior to physiotherapy. A postal questionnaire survey was sent to 285 patients referred for musculoskeletal outpatient physiotherapy for a peripheral joint problem. The results showed that higher expectations of benefit were found if the patient: (1) was female; (2) had a traumatic condition; (3) had a shorter duration of condition; (4) had a higher locus of control; (5) had no previous experience of physiotherapy; and (6) had greater satisfaction with previous health care received.
Article
Rehabilitation counseling must embrace an evidence-based practice paradigm to remain a vital and respected member of the future community of professions in rehabilitation and mental health care and to fully discharge its responsibility to assist consumers in accessing effective rehabilitation interventions and exercising truly informed choice. The goals of this article are to (a) discuss the importance of using model-driven and culturally sensitive evidence-based rehabilitation counseling practices to enhance rehabilitation outcomes for people with disabilities, (b) highlight the needs for an integrative conceptual framework of disability that can be used to conduct systematic rehabilitation counseling research and to examine mediators and moderators affecting vocational rehabilitation outcomes, and (c) recommend changes in rehabilitation counseling practice, education, and research.
Article
In her advocacy of a model to train counseling psychologists as “evidence-based practitioners,” Chwalisz (2003 [this issue]) criticizes research based on positivism and advocates for methodological pluralism but ironically suggests the adoption of a medical model to influence the discourse on practice. In this comment, the author examines (a) issues raised by methodological pluralism and multiple sources of evidence and (b) dilemmas created by criticizing quantitative methods while at the same time adopting a medical model. Finally, the author suggests that methodological inclusiveness does not logically imply, and should not lead to, rejection of quantitative methods in counseling psychology.
Article
A consensus has long existed that the scientist-practitioner model has failed to reflect what was envisioned by the Boulder Conference participants and endorsed by counseling psychology at the Greyston and Georgia Conferences. Counseling psychology's commitment, however, to the scientist-practitioner model has not faltered. Furthermore, developments within the health care system (e.g., managed care, empirically validated treatments, treatment guidelines) demand from psychologists increasing levels of scientific knowledge and a wider range of research skills. Psychology's current commitment to positivist explanation, scientific knowledge characterized by law-governed causal processes, is at the core of the scientist-practitioner split. To integrate scientist-practitioner ideals into a comprehensive approach to counseling psychology training, research, and practice, counseling psychologists should embrace an identity as evidence- based practitioners. Inherent in this framework is a philosophical, scientific, political, and social shift toward an expanded view of what constitutes scientific evidence.