D12 Psychosocial Flashcards
Stages of Adjustment
- Trauma - Physical or Social when inability to perform skills or social stigma first realised.
- Shock/Denial - unable to think or feel, almost suspended in time. Looking for miracle.
- Succumb to depression - itemise perceived changes.
- Reassessment / Reaffirmation - accepting
- Coping and MObilisation
- Self acceptance, self-esteem.
Helps with
(1) experience getting through trauma before,
(2) sense of humour and problem solving
(3) good support network (formal, informal)
A partial or complete loss of vision can interfere with basic life functions and these disruptions can have a negative impact on a person’s self-concept and self-esteem.
Trauma-Physical or Social
Actual diagnosis/sudden onset of vision loss, can be seen as an overwhelming threat to self or the self-concept, may also be negative for family and friends. For congenitally blind, realisation may be more gradual, but trauma can also be experienced when inability to perform skills or other social stigma first realised.
Shock and denial
Experience a shock after onset of blindness and deny situation occurring or refuse to deal with it, a breakdown in congruence among feelings, thoughts and actions and beliefs. A person is unable to think or feel, almost suspended in time. A disbelief or a failure to admit that a trauma has occurred or an unrealistic expectation that a miracle from God, a medical procedure or a new scientific discovery will restore vision.
Mourning and withdrawal
grieving loss of vision and previous life situation, can take form of self-pity, egocentric, feelings of sadness or sorrow for perceived losses of adequacy, self-esteem, equality, or belonging. Temporary withdrawal natural, but prolonged can lead to isolation. Hostility/anger also common in this phase. Time for others to listen, acknowledge, and allow grieving for loss.
Succumbing to depression
thinking of impact of vision loss and becoming depressed/negative/frustrated/ more aware of the specific implications of the loss - person itemizes the perceived repercussions of the loss, whether realistic or not, may also manifest the “spread effect” by seeing even more losses than realistic, this phase is characterized by “I can’t” reaction. Temporary depression is a natural response to trauma, but some may progress to major depressive disorder needing intervention.
Reassessment and reaffirmation
start to reassess situation, the discouragement/anger/self-pity of the mourning phase begin to diminish. Starts the rebuilding process; individuals realise they are largely the same person, leads to reaffirmation of self and life. reassessment involves identifying one’s assets and limitations- including 1) perceived limits that are unrealistic as a result of the spread affect, 2) the temporary limitations that can be offset by learning to use aids 3) accepting the more permanent limitations. Reassessment is also reconsideration of goals/values and construction of new ones – can result in positive outlook
Coping and mobilisation
Emphasis is on what a person can do/participate, learning of new techniques restores competence, the person plays an active role in molding their life constructively. Mobilisation refers to acknowledgement of /need for/ and effective use of personal/interpersonal/institutional resources
Self-acceptance and self- esteem
acceptance of vision loss as part of identity - successfully meeting the demands of life does not necessarily result in self-acceptance or self-esteem, the acceptance of one’s blindness is a necessary prerequisite. If not, possibly won’t use what they’ve learned in training. Both psych support and training skills needed. Self-acceptance does not necessarily mean that a person likes the vision loss but has internalised it.
Study - 3 types of resources older adults helped to adjust positively; a) prior life experiences and successfully dealing with adversity, b) internal resources e.g. sense of humour/problem solving ability/determination to keep active and engaged c) external resources e.g. formal and informal supports, other VI role models, comparisons with less fortunate people.
There will be readjustment of balance between independence and dependence.
Self-efficacy & Cognitive Motivators
Judgement of capabilities.
Belief you’re up to task determines whether they will try, how hard they will try and they persist in face of difficulty.
Cognitive Motivators:
Past success (experience sequence is so important)
Realistic encouragement from others.
Attribution Theory (need to try more or not good enough)
- Positive Experience
- Well pitched task
- Compare well to others.
- Personality differences.
“Self-efficacy is defined as a person’s judgement of capabilities to organize & execute courses of action required to attain designated types of performance”
…the belief they are up to the task at hand – determines whether they will try, how hard they will try, and if they persist in the face of difficulty.
Bandura has demonstrated that a person’s perceived self-efficacy in relation to the task at hand plays a major role in performance difference.
Strategies
Performance accomplishments – nothing is more effective in convincing a person that they can handle a challenge than past success at doing so, nor is there anything more motivating for the future. Success raise efficacy judgements, and repeated failures lower them, especially if the failures occur in the early course of event or adverse external circumstances. This supports the importance placed by O&M sp on appropriate sequence of lessons and challenges providing a pattern of successful experiences.
Vicarious experiences – The observation of other performing the same behaviour. Seeing other people adequately perform a behaviour envourages the observer to feel that they can too. Vicarious experience also works the other way. Seeing someone being unable to perform a task can decrease an observer’s belief in his own ability. This confirms the value of having beginning mobility students associate with other students who are also beginning or who are slightly ahead of them in their training.
Verbal persuasion – Encouragement from others. When encouragement is realistic, it can give the effect of encouraging the person to mobilise greater sustained effort to succeed. However the raising of unrealistic beliefs of personal competence invites failure that will discredit the persuaders and undermine the recipent’s perceived self-eficacy. The O&M frequently encourages the student and helps them gather the courage to try skills in new situations with less supervision.
Monitoring of one’s own physiological states – Most people are aware of and influenced by their state of arousal as they approach new or threatening tasks. They are sensitive to the arousal signals from their autonomic nervous system, which may include a rapid heart rate, changes in breathing, sweating, muscle tension, and any number of idiosyncratic mannerisms. O&M frequently uses this insight by attending to behavioural manifestations of nervousness or fear and may choose to restructure a lesion, alter the level of difficulty or make some other adjustment that keeps the level of challenge appropriate without overwhelming the student.
Cognitive Motivators…
Attribution Theory – People who attribute past failures to not working hard enough are likely to strive harder. People who believed they failed in the past because they lack the necessary ability are likely to decrease their efforts and become discouraged. Changing causal attributes can temporarily raise motivations, but the improvement will not last for long in the absence of true efficacy-enhancing accomplishments.
Expectancy value theory – Perceived personal efficacy refers to a person’s judgement of how well they can perform a particular behaviour. Outcome expectations refer to the person’s assessment of how likely a particular behaviour is to produce a particular outcome. Both are important to understand motivation. Outcome expectations take 3 forms,
Positive and negative effects physical effects that accompany behaviour
Positive and negative social reactions to behaviour
Positive and negative self-evaluation, a cognitive notion.
Four determinants of the strength of outcome expectancies,
Outcome feedback
Task difficulty
Social comparison information
Personality differences.
Goal Theory – the ability to challenge oneself by setting a certain standard and evaluating one’s own performance against that goal. To enhance performance goals need to be specific, difficult, challenging and promimal.
Learned Helplessness – The belief that events in one’s environment are uncontrollable. The effects on self-helplessness can lead to three kinds of functional deficits,
Motivational deficits – resulting in the person showing an unwillingness to try new behaviours to solve problems or achieve certain outcomes.
Cognitive deficits – resulting in a person’s having a difficult time learning that a response can have an impact on outcomes in the future.
Affective deficits – leading to depressive reactions when it becomes clear that there is nothing that the person can do to control or predict their situation.
Passing
Trying to hide something obvious to avoid societal reactions.
Strains learner - having to be alert and explain when finally exposed.
This is behaviour designed to conceal a salient aspect of one’s identity. The person may progress through the stages of pass for the “fun of it”, and even being able to entirely conceal the disability portion of their identity. Allows for avoidance of societal reactions towards blindness.
Impact is strain on learner – having to be alert to keep up with details of situation, and then explaining when eventually being exposed. Challenge is to find balance between necessary help and unnecessary risk.
Family
Pitching correct… not expecting too much or too little
Practical supports and skills for helping.
Push or Limit too much. Establishing self-esteem constantly feeds from reaction of significant others. Important family are involved with journey and supportive of goals and supports.
Guessing…
Shock. Anger/Self Blame. Depression. Look Options. Start Supports. New Concepts. (have to focus on strengths)
The parents of a child with VI may not feel comfortable with their child learning to become more independent. The development of this skill may activate new fears and worries in the parents or may threaten their roles in the child’s life. These feelings can be conveyed to the child in direct or subtle ways that complicate the child’s motivation for learning these skills, similarly, patronizing or uninformed attitudes of people in the street can influence feelings of confidence during the learning process or afterward.
The child incorporates the attitudes of the parents. If the parents allow the wide and rich experiences of the environment, if they stress abilities, and help the child to deal realistically with limitations, a good self-concept is developed.
Self-expectations and expectations of others in family need to be realistic. The parent who makes excessive demands of visually impaired child fosters a feeling of uncertainty because they cannot meet expectations, and in turn develops a concept of being a failure.
Family members have to focus on strengths rather than limitations.
Sheltered or overprotective treatment results in distorted or over-inflated estimates of one’s personal attributes.
The attitudes & behaviors of family members impact O&M instruction by motivation, self-reliance, and emotional support
If family members understand the practical aspects of travel without vision, and if they are confident in the students ability to handle it, they can be a strong positive force in support of the process
time spent informing family members and encourages their observation of mobility lessons is a good investment - in contrast family that manifest a lot of anxiety and scepticism about the students skills can become formidable barriers to mobility training and independent travel
support of the family plays an important role during the reassessment and reaffirmation phase of adjustment
if the family members treat the blind person with equal dignity and worth, she is more likely to see herself in a similar manner
Family attitudes can ‘complicate” child’s motivation
Family attitudes toward blindness affect how the learner sees themselves and their potential to achieve O&M skills by influencing self-concept and expectations of capability
-The blind person’s internal process of establishing self-esteem interacts continuously with the judgments of significant others. The emergence of blind person’s goals and aspirations has an influence on the tasks and activities he chooses to accomplish.
-It is important for the student’s family to be aware of every stage of training and to actively participate through periodic observations of the student and discussions with the student and instructor.
-It is important that the family members have a clear understanding of the goals of the instruction. They should know what to expect at each level of the training and what represents a positive reinforcement.
Strategies
Consider impact of adjustment phases and timing of O&M instruction. Both family and individual benefit from going through grieving process together.
Implications for O&M is to structure sessions for success, to develop self-efficacy e.g. ensure program is appropriate sequence of lessons/challenges providing success experiences. Provide tasks that have appropriate amount of difficulty and provide appropriate level of support (performance accomplishments).
Have students & family observe others in training at similar level of skill or slightly ahead (vicarious experience).
Build relationship with student based on genuine caring and accurate, concrete feedback, realistic encouragement
O&M should accept the student and his feelings, communicate genuine caring for him, and speak the truth, especially in regard to the student’s actual ability and potential for independent travel. The O&M must be open and honest. Share openly with student where you will be during a lesson and whether or not you’ll be in a position to intervene to prevent injury or embarrassment. Communicate positive acceptance of the student, regardless of success or failure, and a respect for the student’s right to be involved in planning and decision making about his own program.
Regardless of the task or skill addressed by a lesson, the O&M has to encourage a belief in the student that she can accomplish it. The powerful impact on a person’ sense of self-efficacy is the experience of actually doing it herself. Structure a lesson so that the result is success and an enhancement to the person’s self-confidence. The extent to which a student changes her perceived sef-efficacy through performance will be influenced by the difficulty of the task, the amount of effort expanded, the amount of external aid received, the circumstances under which the student performed and the temporal pattern of her success and failures.
Public
Contribution
Self-esteem influenced by society… not catering, unwanted sympathy or over reaction to every day task completion, inappropriate curiosity, reexplain things, pity, awkwardness.
A person’s sense of competency or self-esteem can be affected by her perception of the effectiveness of her own actions, her perceived freedom to select from a number of possible actions, her sense of similarity with others, and the communications she receives about her competence from others. When a person with a visual disability has the option of travelling independently to accomplish her goals, this can contribute to her sense of competence and self-esteem, as can the positive feedback the person receives from members of the community. Offers of help from the public, whether unsolicited and necessary, or those that are solicited can each have a different effect on the student depending on how they are copy with their identity as a person with a disability. Expressions of sympathy or inappropriate curiosity can produce anxiety and frustration if the visually impaired person is unprepared. It may be helpful for the student to regard these interactions as opportunities to education the public about the truth about disabilities and their effects.
interactions with the public impact independent travel by increasing awareness of VI people as advocates for the capabilities of the demographic. When a person with a visual impairment has the option of travelling independently to accomplish their goals, this can contribute to their sense of competence and self-esteem, as can the positive feedback the person receives from members of the community. Being able to do it independently and successfully has an impact on the attitudes of others who observe this person’s behaviour. It increases the respect for the blind person from the public.
Negative impacts; blindness may elicit pity or fear by the public, so may increase feelings of helplessness or extreme dependence. Public may persist with inappropriate curiosity/sympathy.
