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Similarly, for those with severe disabling conditions, access to personal assistance services may be required for participation in almost all activities, and such access is dependent on the availability of funding for such services through either direct payment or tax credits. A final example—one very germane to this report—of how public policy influences the extent to which people with disabling conditions will be able to function in everyday life is the level of public investment in research of all kinds, from discovering the mechanisms by which disabling pathologies arise through developing assistive technologies and finding out the best way of financing their distribution.
Thus, the potential mechanisms of public policy are diverse, ranging from the direct effects of funds from the public purse, to creating tax incentives so that private parties may finance efforts themselves, to the passage of civil rights legislation and providing adequate enforcement. The sum of the mechanisms used can and does have a profound impact on the functioning of people with disabling conditions. This section focuses on the impact of psychological factors on how disability and disabling conditions are perceived and experienced.
The argument in support of the influence of the psychological environment is.
Several constructs can be used to describe one's psychological environment, including personal resources, personality traits, and cognition. These constructs affect both the expression of disability and an individual's ability to adapt to and react to it. An exhaustive review of the literature on the impact of psychological factors on disability is beyond the scope of this chapter.
However, for illustrative purposes four psychological constructs will be briefly discussed: three cognitive processes self-efficacy beliefs, psychological control, and coping patterns and one personality disposition optimism. Each section provides examples illustrating the influence of these constructs on the experience of disability. Cognition consists of thoughts, feelings, beliefs, and ways of viewing the world, others, and ourselves.
Three interrelated cognitive processes have been selected to illustrate the direct and interactive effects of cognition on disability. These are self-efficacy beliefs, psychological control, and coping patterns.
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Self-Efficacy Beliefs Self-efficacy beliefs are concerned with whether or not a person believes that he or she can accomplish a desired outcome Bandura, , Beliefs about one's abilities affect what a person chooses to do, how much effort is put into a task, and how long an individual will endure when there are difficulties. Self-efficacy beliefs also affect the person's affective and emotional responses. Under conditions of high self-efficacy, a person's outlook and mental health status will remain positive even under stressful and aversive situations.
Under conditions of low self-efficacy, mental health may suffer even when environmental conditions are favorable. The findings from several studies provide evidence of improved behavioral and functional outcomes under efficacious conditions for individuals with and without disabling conditions Maddux, How do self-efficacy beliefs affect disability?
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Following a stroke, for example, an individual with high self-efficacy beliefs will be more likely to feel and subsequently exert effort toward reducing the disability that could accompany any stroke-related impairment or functional limitation. The highly self-efficacious individual would work harder at tasks i. These self-efficacy beliefs will thus mediate the relationship between impairment and disability such that the individual would experience better functional outcomes and less disability.
Psychological Control Psychological control, or control beliefs, are akin to self-efficacy beliefs in that they are thoughts, feelings, and beliefs regarding one's ability to exert control or change a situation. A voluminous amount of literature has been written on the beneficial aspects of control and the need that people have for control over their lives.
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The research suggests that self-generated feelings of control improve outcomes for diverse groups of individuals with physical disabilities and chronic illnesses Taylor et al. The onset of a disabling condition is often followed by a loss or a potential loss of control. What is most critical for adaptive functioning is how a person responds to this and what efforts the person puts forth to regain control.
Perceptions of control will influence whether a disabling condition is seen as stressful and consequently whether it becomes disabling. Individuals with disabling conditions who perceive that they have control over the management of their health, rehabilitation, and related outcomes will fare better.
Under conditions of perceived lack of control, people with disabling conditions are not likely to engage in behaviors e. Under these circumstances, the relationship between impairment and disability becomes circular. Once disability increases, so may the level of impairment and functional limitation as a result of not pursuing rehabilitation therapy.
Conversely, under conditions of perceived control, a person is likely to engage in behaviors that will subsequently reduce disability. Once disability is reduced, one's level of impairment may subsequently be reduced. Under conditions of perceived loss of control, the individual may actively cope to restore control through primary control efforts e. An example of primary control would be a person with decreased mobility moving from a building with no elevators to a building with elevators. An example of secondary control would be when this individual changed his or her beliefs about the importance of mobility.
Objectives, Background and Concepts
What is relevant in this case is not whether the individual has actual control but whether the person perceives that he or she has control. Coping Patterns Coping patterns refer to behavioral and cognitive efforts to manage specific internal or external demands that tax or exceed a person's resources to adjust Lazarus and Folkman, Generally, coping has been studied within the context of stress Young, ; Zautra and Manne, Having a disabling condition may create stress and demand additional efforts because of interpersonal or environmental conditions that are not supportive.
Several coping strategies may be used when a person confronts a stressful situation Stewart and Knight, ; Affleck et al. These strategies may include the following: seeking information, cognitive restructuring, emotional expression, catastrophizing, wish-fulfilling fantasizing, threat minimization, relaxation, distraction, and self-blame. The beneficial effects of certain coping efforts on adaptive and functional outcomes among individuals with disabling conditions have been demonstrated in several studies Revenson and Felton, ; Kleinke, ; Affleck et al.
In general, among people with disabling conditions, there is evidence that passive, avoidant, emotion-focused cognitive strategies e. An adaptive coping pattern would involve the use of primary and secondary control strategies, as discussed earlier. What seems useful is the flexibility to change strategies and to have several strategies available Stewart and Knight, ; Dunkel-Schetter et al.
In one study, Jarama investigated the role of active coping on mental health and vocational outcomes among people with diverse disabling conditions. The findings from that study indicated that active coping is a significant predictor of mental health and employment-related outcomes. Under conditions in which individuals with disabling conditions use active and problem-solving coping strategies to manage their life circumstances, there will be better functional outcomes across several dimensions e.
An important component in the coping process is appraisal. Appraisals involve beliefs about one's ability to deal with a situation Young, ; Zautra and Manne, Take, for example, two people with identical levels of impairment. The appraisal that the impairment is disabling will result in more disability than the appraisal that the impairment is not disabling, regardless of the objective type and level of impairment.
Appraisal is related to self-efficacy in the sense that one's thoughts and cog-. When a person feels that he or she can execute a desired outcome e. Similarly, under conditions in which an individual appraises his or her disabling conditions and other life circumstances as manageable, the person will use coping strategies that will lead to a manageable life i.
Optimism is a personality disposition that is included in this chapter as an example of a personality disposition or trait that can mediate how disabling conditions are experienced. Several other interrelated personality factors could be discussed e. Optimism in contrast to pessimism is used for illustrative purposes because it relates to many other personality traits. Optimism is the general tendency to view the world, others, and oneself favorably. People with an optimistic orientation rather than a pessimistic orientation fare better across several dimensions.
Optimists tend to have better self-esteem and less hostility toward others and tend to use more adaptive coping strategies than pessimists.
In a study of patients who underwent coronary artery bypass surgery, Scheier at al. Individuals with optimistic orientations had a faster rate of recovery during hospitalization and a faster rate of return to normal life activities after discharge. There was also a strong relationship between optimism and postsurgical quality of life 6 months later, with optimists doing better than pessimists.
Optimism may reduce symptoms and improve adjustment to illness, because it is associated with the use of effective coping strategies. This same analogy can be extended to impairment. Optimistic individuals are more likely to cope with an impairment by using the active adaptive coping strategies discussed earlier. These in turn will lead to reduced disability. Summary Four constructs of the psychological environment i.
These psychological constructs are interrelated and are influenced to a large extent by the external social and physical environments. The reason for the inclusion of the psychological environment in this report is to assert that just as the physical and social environments can be changed to support people with disabling conditions, so can the psychological environment.
In fact, voluminous empirical research sup-. However, relatively little research has been directed at understanding the process by which the psychological environment can be enhanced for people with disabilities. This research is needed. The family can be either an enabling or a disabling factor for a person with a disabling condition.
Although most people have a wide network of friends, the networks of people with disabilities are more likely to be dominated by family members Norris et al.