The reality of the sadness and frustration encountered by individuals after a traumatic brain injury (TBI) is quite evident when hearing testimonies of people who have personally dealt with TBIs. Something that deeply saddens me about TBIs is the fact that they are unpredictable and debilitating in their results. To go from fully functioning, to completely dependent on others is something that I cannot fathom the radical lifestyle change. Not only do TBIs tend to completely change the way life looks for the individual, but they also can produce mood and personality changes in the individual. Because TBIs vary considerably depending on the severity, where they occur in the brain, and even the functioning of the individual prior to the injury, effective treatment of TBIs can be difficult.
An idea emphasized through the work of Kendall & Terry (2008) emphasizes discrepancies among people in coping after a TBI. This study investigated the Goodness-of-Fit hypothesis and its ideals applied in the coping strategy of individuals with TBIs. This study investigated perceived emotional well-being and role functioning of individuals and caregivers. Coping has been described as falling into one of the three following categories: problem-focused, emotion-focused and perception-focused. Problem-focused is as it sounds where the individual attempts to figure out alternative ways of interacting with the environment. The difference between emotion and perception in this study is that emotion is more of an escape whereas perception focuses on diminishing the apparent issues. Coupled with these strategies, the model proposed that an individual's ability to cope also relates to the perceived controllability of the situation. It was assumed that if the situation appeared uncontrollable, either the emotion-focused or perception-focused strategies would be helpful. However, if the situation appeared controllable, then using the problem-solving approach would produce positive results. After an eight month longitudinal survey of the participants, the ideas emphasized in the Goodness-of-Fit model were not supported, and even in some cases were the opposite of reality. While problem-solving coping did show some positive effects, perceived control did not help emotional well-being. Especially in long-term, the emotional state of individuals decreased due to anxiety and depression when control and problem-focused coping were coupled. Emotional escapism was not indicated as being useful as well as the study's results indicated that understanding the discrepancies between what was perceived and the reality was more useful than escaping reality. Minimizing the client's situation and suppressing emotions also indicated negative results in the individuals who had experienced a TBI. While individuals with a TBI may appear fully functioning, minimizing their emotions indicated a lower emotional well-being in this study.
Although this study's findings should be further investigated, I think there are vast implications when it comes to occupational therapy. Often, we are taught to never give up because perseverance is what wins the race. While I do not want to discount the importance of hard work and pursuing goals, I also believe that the situations involving those who have experienced a TBI are intricate cases where a simple answer is not the reality. Some individuals post-TBI cannot solve the issue of their parking spot being taken, and I can see how the emphasis on problem-solving can become source of discomfort. While therapy should focus on readjusting and finding another spot to park, I also believe that this therapeutic strategy will not be universally useful for each individual client. Suppression of emotions is a tactic I have never agreed with whether you are talking about a person with or without a TBI. Something we as human beings have the incredible ability to do is to have emotional feelings. I have seen it in myself that being open about where I am allows others to understand my background and then we can move forward. I can only assume that this reality is even more important for those with a TBI. Dealing with the emotional sadness of living with a TBI is a hard reality. Effective OT should have transparency between the client and practitioner where there exists the emotional support and understanding that others accept you where you are. Admitting your emotions is one way of getting past them. Yes, I agree that if you dwell on an issue instead of focusing on the desired goal, attaining the goal will be difficult. But I also see the importance of showing your client that you understand tasks will not be as easy as they once were. You should meet your client where he is and work from there to attain goals.
Reference:
Kendall, E. & Terry, D., J. (2008). Understanding adjustment following traumatic brain injury: Is the Goodness-of-Fit coping hypothesis useful? Social Science & Medicine, 67, (1217-1224). Doi: 10.1016/j.socscimed.2008.05.033.
An idea emphasized through the work of Kendall & Terry (2008) emphasizes discrepancies among people in coping after a TBI. This study investigated the Goodness-of-Fit hypothesis and its ideals applied in the coping strategy of individuals with TBIs. This study investigated perceived emotional well-being and role functioning of individuals and caregivers. Coping has been described as falling into one of the three following categories: problem-focused, emotion-focused and perception-focused. Problem-focused is as it sounds where the individual attempts to figure out alternative ways of interacting with the environment. The difference between emotion and perception in this study is that emotion is more of an escape whereas perception focuses on diminishing the apparent issues. Coupled with these strategies, the model proposed that an individual's ability to cope also relates to the perceived controllability of the situation. It was assumed that if the situation appeared uncontrollable, either the emotion-focused or perception-focused strategies would be helpful. However, if the situation appeared controllable, then using the problem-solving approach would produce positive results. After an eight month longitudinal survey of the participants, the ideas emphasized in the Goodness-of-Fit model were not supported, and even in some cases were the opposite of reality. While problem-solving coping did show some positive effects, perceived control did not help emotional well-being. Especially in long-term, the emotional state of individuals decreased due to anxiety and depression when control and problem-focused coping were coupled. Emotional escapism was not indicated as being useful as well as the study's results indicated that understanding the discrepancies between what was perceived and the reality was more useful than escaping reality. Minimizing the client's situation and suppressing emotions also indicated negative results in the individuals who had experienced a TBI. While individuals with a TBI may appear fully functioning, minimizing their emotions indicated a lower emotional well-being in this study.
Although this study's findings should be further investigated, I think there are vast implications when it comes to occupational therapy. Often, we are taught to never give up because perseverance is what wins the race. While I do not want to discount the importance of hard work and pursuing goals, I also believe that the situations involving those who have experienced a TBI are intricate cases where a simple answer is not the reality. Some individuals post-TBI cannot solve the issue of their parking spot being taken, and I can see how the emphasis on problem-solving can become source of discomfort. While therapy should focus on readjusting and finding another spot to park, I also believe that this therapeutic strategy will not be universally useful for each individual client. Suppression of emotions is a tactic I have never agreed with whether you are talking about a person with or without a TBI. Something we as human beings have the incredible ability to do is to have emotional feelings. I have seen it in myself that being open about where I am allows others to understand my background and then we can move forward. I can only assume that this reality is even more important for those with a TBI. Dealing with the emotional sadness of living with a TBI is a hard reality. Effective OT should have transparency between the client and practitioner where there exists the emotional support and understanding that others accept you where you are. Admitting your emotions is one way of getting past them. Yes, I agree that if you dwell on an issue instead of focusing on the desired goal, attaining the goal will be difficult. But I also see the importance of showing your client that you understand tasks will not be as easy as they once were. You should meet your client where he is and work from there to attain goals.
Reference:
Kendall, E. & Terry, D., J. (2008). Understanding adjustment following traumatic brain injury: Is the Goodness-of-Fit coping hypothesis useful? Social Science & Medicine, 67, (1217-1224). Doi: 10.1016/j.socscimed.2008.05.033.
Fantastic post, Lauren! Very insightful and full of empathy. The OT-think here is unmistakable!
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