Death, Dying, and Bereavement

Question 1

Name and outline the main stage theory of adjustment.

Answer 1

Kubler-Ross’ theory of adjustment 
DABDA 
1. Denial 
2. Anger 
3. Bargaining 
4. Depression 
5. Acceptance

Question 2

State some factors that show lack of evidence for these stages. (in the theory of adjustment)

Answer 2

Doesn’t account for variability in response
Places the patients in a passive role
Fail to consider social or cultural factors
Focus on emotional responses and neglect cognitions and behaviour
Pathologise people who do not pass through these stages

Question 3

State five myths about coping with loss as described by Wortman and Silver.

Answer 3

Distress or depression is inevitable
Distress is necessary, and failure to express distress is indicative of pathology
The importance of ‘working through’ loss
Expectations of recovery
Reaching a state of resolution

Question 4

Define illness representations

Answer 4

A patients own implicit, common sense beliefs about their illness (can be tested by illness perceptions questionnaires)

Question 5

Describe the 5 dimensions to illness representation (Leventhal)

Answer 5

• Identity = label of the illness and symptoms
• Cause = what might have caused the problem
• Consequence = expected effect from the illness and view about the outcome
• Time line = how long will the problem last (acute/chronic/episodic)
• Curability/controllability =expectations about recovery or control of the illness

Question 6

Describe the self-regulatory model by Leventhal

Answer 6

It makes us think about how individuals interpret (stage 1), respond/cope with (stage 2), and evaluate (stage 3) their effectiveness at coping with illness. This revolves around the illness representation and the emotional response to illness. This model is not linear as stages interact with each other and individuals will progress differently
NOTE: Model is not ideal for terminal illness patients

Question 7

How might illness representation affect a patient’s emotional response to illness/health threat

Answer 7

If it is something mild like a common cold they might not have an emotional response at all but if it something more serious their emotional response will be significantly different. E.g. If they have a terminal illness they might experience significant fear or anxiety. An illness with a poor prognosis may even experience significant feelings of depressoin (e.g. hopelessness)