Block II

Stress and Coping Styles

BLOCK II STRESS AND COPING STYLES
Unit 6 focuses on concept of stress with reference to disability. Symptoms of stress
and types based on key dimensions such as frequency, intensity, and duration were
also described. Although there are various models that describe the functioning of
stress in the body some lay importance on the physiology such as the GAS model
other models describe stress as a result of transactions between individual and
environment resulting in stress. There are various specific sources of stress in persons
with disability
Unit 7 offers a comprehensive understanding to the concept and definition of coping,
various factors that have an effect on coping of the individuals with disability. Coping
style and strategies however vary from individual to individual and from situation to
situation but have been summarized by various theorists using which individuals cope
with the stress of disability and while adjusting and adapting to the environment. Defense
mechanisms are used by individuals with disability in order to overcome grief, loss,
guilt and fear.
 Stress in Disability
UNIT 6 STRESS IN DISABILITY*
Structure

6.1 Learning Objectives

6.2 Introduction
6.3 Concept of Stress
6.3.1 Types and Symptoms of Stress

6.4 Models &Theories of Stress

6.5 Sources of Stress in Persons with Disabilities
6.6 Let Us Sum Up
6.7 Key Words
6.8 Answers to Self AssessmentQuestions
6.9 Unit End Questions
6.10 References
6.11 Suggested Readings

6.1 LEARNING OBJECTIVES

After you go through this Unit, you will be able to:
 Explain the concept of Stress;
 Understand symptom and types of stress;
 Know the sources of stress in persons with disability; and
 Discuss the stressors related to different types of disabilities.

6.2 INTRODUCTION
Leena and Aman were happy to have their first baby. But all their excitement
turned into sadness when their child was diagnosed with cerebral palsy. They
felt frustration, guilt as well as anger as to why they had to face this. They had
to make multiple visits to the doctor, special educator, and also faith healers
with the hope that some miracle might happen and their child will become
healthy. All these created much stress in their relationship and also in taking
care of their child. As a result of this, they were often irritable, felt exhausted,
blamed each other, and their mental well-being was affected.

Stress is a common occurrence in everyone’s life. However, it gets more in

situations of disability, deprivation or disadvantage. Hence, it is important to
know and understand stress so that one is able to deal with it adequately.
________________
*Prof. Ritu Sharma, Faculty of Psychology, School of Social Sciences, IGNOU, New Delhi 131
Stress and An understanding of stress requires one to know the nature and symptoms of
Coping Styles
stress. This enables an individual to identify resources using which one can
mange stress in a more effective manner. In the present unit, you will learn
about the types and symptoms of stress. Further, you will learn about the
sources of stress in persons with disability and the various stressors related to
different types of disabilities.

6.3 CONCEPT OF STRESS

Many people view stress as an external event, either harmful or motivating.
Others perceive it as the internal physiological, psychological, and
behavioural response triggered by such events.

Stress in its essence, is our body’s inherent mechanism of responding to the

ever-changing demands of our environment. Change and demands are life’s
constants, but how we interpret them, both consciously and unconsciously,
significantly impact our stress levels. This intricate interplay between external
events and our internal appraisal is fundamental to understanding stress. When
confronted with a situation, we instinctively assess it: Is this a threat? How
can I manage it? What resources do I possess? If the demands seem to
outweigh our capabilities, the situation becomes “stressful,” triggering the
“fight-or-flight” response. Conversely, if we believe our coping mechanisms
are adequate, the situation may not be perceived as stressful. As a
consequence, not all individuals experience the same events as stressful. What
one person finds stressful might be innocuous to another, and vice versa.
Therefore, stress is an internal state triggered by physical demands on the
body or by emotionaland social situations that we perceive as potentially
harmful, uncontrollable, or exceeding our coping abilities.

Stress can be described as a rush of energy as the body seeks to counter the
perceived threat, which is appraised as negative or threatening. Stress can be
positive or negative, which means stress can be useful in terms of keeping you
motivated towards your work; or negative, which can drain your energy so
much that you find it difficult to focus and work on anything. Let’s take an
example for this, when you have to study for an exam you might feel stressed
but this stress keeps you on your toes and makes you prepare for the exam
properly. However, the same exam might be perceived as difficult to deal
with and thus a very stressful event for another student.

Biological aspect of Stress

Have you ever experienced a very frightening event, such as a near accident or
another emergency? Have you ever felt our heart beat racing rapidly and
forcefully, or your body trembling heavily during a stressful situation? These
are just a glimpse into how our bodies react to stress on a physiological level.
When we face a threat, our body automatically springs into action. This
“fight-or-flight” response, as coined by Walter Cannon, prepares us to either
confront the danger or escape it swiftly. The sympathetic nervous system
takes the lead, directly stimulating the heart and prompting the adrenal glands
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to release epinephrine (adrenaline). This surge of adrenaline acts like a fuel Stress in Disability
injection for our body, accelerating our heartbeat, sharpening our focus, and
increasing muscle tension – all to enhance our immediate response. However,
this heightened state is temporary. Ideally, once the threat passes, the body
gracefully returns to a calm baseline.

Psychosocial aspect of Stress

Psychosocial stress, encompassing social and emotional challenges, has a

profound and lasting impact on individuals across their lifespan. Early life
experiences, particularly those involving significant stress like abuse or
parental loss, can cast a long shadow. Research by Looze et al., 2024 and
Chen et al., 2024 suggests these events can influence cognitive abilities and
both physical and mental health decades later in adulthood.

Similarly, stressful events in adulthood, such as separation, bereavement, or

financial strain, are major risk factors for coronary heart disease (Gao et al.
(2024)). Studies like Roos et al. (2018) further show a correlation between
such events and heightened cortisol reactivity, a key stress hormone.

The timing of stress exposure also plays a crucial role. Stressful events during
periods of rapid brain development, such as childhood, can have a more
significant impact on brain structure compared to times of relative stability.
For instance, neglect and low socio-economic status in childhood have been
linked to reduced brain volumes, particularly in the hippocampus, a region
critical for memory (yu et al., 2018). These reductions persist even into
adulthood, highlighting the enduring influence of early life stress (Frodl et al.,
2010).

Stressful experiences in adulthood are also associated with lower hippocampal

volumes (Woon et al., 2010; Schoenfeld & Gould, 2012). Importantly, the
effects of stress likely differ by sex, with variations observed in both
hippocampal function (Yagi & Galea, 2019) and hormonal responses (Oyola
& Handa, 2017) between men and women.

Brain regions like the hippocampus and amygdala, which are heavily
implicated in memory and emotional processing, have a high concentration of
receptors for stress hormones. This explains the established link between
acute stress and poorer cognitive performance, including problems with
divided attention and working memory (LeBlanc, 2009). Furthermore, high
perceived stress levels predict an increased frequency of everyday cognitive
failures (Boals & Banks, 2012), underlining the real-world impact of stress on
our ability to think clearly.

6.3.1 Types and Symptoms of Stress

There are various types of stress depending on the nature and severity of
stressors. Stress can be daily or routine stress, and sudden/major stress events
that can disrupt one’s life to a great extent. Severity of stress experience is
influenced by various key dimensions: frequency, intensity, and duration of
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Stress and stressors (Sarafino& Ewing, 1999). This notion is well-supported by research
Coping Styles
demonstrating a direct correlation between stressor strength and
physiological strain (Steptoe et al., 2000).

Here we will discuss about acute vs chronic stress, and distress vs eustress.

 Acute stress is the type of stress, which is short-term and does not sustain
for long. For example, when you have to give a presentation in front of the
audience, or when you are stuck in a traffic and you have to reach on time,
your pulse rate increases, your breathing quickens, and you start to
perspire when under stress. These sensations pass quickly, and the body
quickly heals (Lakshmi, 2022).

 Chronic Stress: When you experience stress for a long period of time,
which negatively affects your physical and mental health is called chronic
stress. Examples of chronic stress are facing financial hardships, conflicts
with friends or family, etc. The frequent or prolonged exposure to
stressors (e.g., recurring thoughts about a trauma) – is particularly
detrimental as it lasts longer and causes significant damage to individual’s
health. Studies have shown that chronic stress weakens the immune
system, making individuals more susceptible to illnesses like the common
cold (Cohen et al., 2002).

 Distress: The most well-known form of stress is distress. When you get
into a fight with your friend or when you score less marks in your exams
than expected, that stress is commonly referred to as distress. It is a type of
negative stress that results in anxiety, fear, or concern. Generally speaking,
distress is brought on by unpleasant events and circumstances.

 Eustress: Eustress, on the other hand, is popularly known as positive

stress. For instance, when you got a new job, or getting married or there is
a family function etc. Such instances of stress are welcome by you and
leads to positive outcomes and new learning.

Symptoms of Stress

The following are some of the major symptoms that we experience when we
are in a stressful situation:

Physical symptoms: rapid breathing, increased pulse and heart rate, sweating,
tiredness, headache, tension in muscles etc.

Cognitive symptoms: not able to think properly, overthinking, negative

thoughts, not able to concentrate, worrying, not able to make proper decisions
or judgments

Emotional symptoms: irritability, frustration, sadness, mood swings, etc.

Behavioural symptoms: staying alone, avoiding others, overeating or less

interested in eating, use of drugs and alcohol, difficulty in sleeping, not doing
or enjoying things which earlier the person was engaged in etc.
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Physiology of Stress Stress in Disability

Now, you must know the physiology of stress, to understand what and how
our body reacts during stress. The stress response is mostly mediated by two
interconnected systems. These are the hypothalamic-pituitary-adrenocortical
(HPA) axis and the sympathetic-adrenomedullary (SAM) system. (Taylor,
2020)

Sympathetic activation: One of the systems that mediates stress is the

sympathetic activation. The cerebral cortex in the brain recognises situations
as dangerous or threatening, and this recognition initiates a series of reactions
mediated by the above-mentioned assessments.

When you are in an unpleasant or stressful situation, the hypothalamus

receives information from the cortex and uses it to trigger sympathetic
nervous system arousal, one of the first reactions to stress. Sympathetic
arousal, thereby stimulates the medulla of adrenals glands which leads to
secretion of the epinephrine (EP) and norepinephrine (NE). These
consequences lead to the hyperbolic state we typically encounter under
stressful situations: elevated blood pressure, elevated heart rate, heightened
perspiration, and constriction of peripheral blood vessels, among other
modifications. (Taylor, 2020) Stress can also lead to dysregulation of
parasympathetic functions. (Sarafino& Smith, 2011)

Hypothalamic-pituitary-adrenal (HPA) axis: According to this system, when

we are in a stressful situation, the hypothalamic-pituitary-adrenal (HPA) axis
is also triggered. The pituitary gland secretes adrenocorticotropic hormone
(ACTH) in response to the production of corticotrophin-releasing hormone
(CRH) from the brain. This, in turn, stimulates the adrenal cortex to release
glucocorticoids. Among them, cortisol is particularly important. It works to
preserve glucose reserves and, in the event of an injury, lessens inflammation.
Additionally, after a stressful event, it aids the body’s restoration to
equilibrium. (Sarafino & Smith, 2011)

The multifaceted experience of stress arises from two primary sources: the
physical challenges we face and our unique interpretations of life
circumstances. Researchers have approached this multifaceted experience
through three distinct lenses (Dougall & Baum, 2001).

1) Environmental Stimulus: One perspective views stress as an objective

environmental force. Demanding jobs, chronic pain, or the loss of a loved
one act as stressors, external events that trigger the body’s stress response.

2) Internal Response (Strain): The second approach shifts focus to the

internal response to these stressors, often termed strain. Strain manifests as
a constellation of psychological and physiological symptoms. You might
experience a surge of anxious thoughts and heightened emotions,
alongside physical sensations like a racing heart, dry mouth, or sweating.

135
Stress and 3) Transactional Model: The third perspective, proposed by Lazarus and
Coping Styles
colleagues (Lazarus, 1999; Lazarus & Folkman, 1984), paints a more
nuanced picture. It emphasizes stress as a continuous process, a dynamic
dance between individuals and their environment. This ongoing exchange,
termed a transaction, underscores the reciprocal influence between us and
our surroundings.

Self AssessmentQuestions I
1) What is chronic stress?
...................................................................................................................
...................................................................................................................
...................................................................................................................

2) Which are the brain regions that play an active role in stress and
coping?
...................................................................................................................
...................................................................................................................

6.4 MODELS AND THEORIES OF STRESS

The Biopsychosocial Model of Stress emphasizes a dynamic interaction
between external stressors and internal responses, heavily influenced by an
individual’s cognitive processes. Building upon this framework, Lazarus and
colleagues (1984) introduced the Cognitive Appraisal Theory of Stress. This
theory emphasizes a dynamic transaction between the person and their
environment, where stress arises not simply from the event itself, but rather
from how we interpret and evaluate it.

The theory underscores the importance of meaning-making in the stress

experience. Our perception of a situation, rather than just the objective event,
determines whether we experience it as stressful. Lazarus (1999) differentiates
between the appraisal (the resulting conclusion) and the act of appraising
itself, the ongoing process of evaluation. He further proposes two key stages
of appraisal:

Primary Appraisal: This stage focuses on whether the event aligns with our
core values, goals, self-perception, and overall worldview. When these aspects
are threatened, stress is triggered. Primary appraisal can result in three types
of stress: harm/loss (actual damage incurred), threat (potential future harm), or
challenge (opportunity for growth). According to Lazarus (1999), three key
aspects influence primary appraisal:
 Goal relevance: How important is the goal being affected?
 Goal congruence: Does the event align with or hinder the goal?

136  Ego development: What are our coping resources and capacity?
Secondary appraisal: This stage involves evaluating our resources for coping Stress in Disability
with or managing the stress identified during the primary stage. Here, one
assesses the cause of the situation (harm, threat, challenge, or benefit) and
assign responsibility or credit to it. Importantly, primary and secondary
appraisal are not isolated processes; they interact dynamically, influencing
each other throughout the stressful experience (Lazarus, 1999).

(Bernard &Krupat, 1994) offers a comprehensive understanding of stress. It

identifies three key components:

1) External stressors: Environmental events that trigger the stress response.

These can be psychosocial (e.g., bereavement, job insecurity) or physical
(e.g., illness, injury). Common stressors often fall into personal,
social/familial, work, and environmental categories. Chronic stressors, in
particular, pose a significant health risk due to their prolonged activation
of the body's stress response.

2) Internal stress response: The physiological and neurological reactions to

stress. Hans Selye proposed the general adaptation syndrome (GAS) as a
framework for understanding the body’s non-specific response to stress
and its potential link to chronic illness (Selye, 1978). This concept
highlights the staged physiological reactions that unfold in the face of a
stressor.

 Alarm Stage: Mobilization for Action

The initial stage of GAS mirrors the fight-or-flight response, a rapid

mobilization of resources for immediate action. The sympathetic
nervous system takes center stage, directly activating organs like the
adrenal glands. These glands release epinephrine and norepinephrine,
further amplifying the body’s arousal. Selye placed particular
emphasis on the hypothalamus-pituitary-adrenal (HPA) axis, a slower-
acting but crucial component of the stress response. The
hypothalamus, a central control center, stimulates the pituitary gland to
release ACTH, which in turn triggers the adrenal glands to secrete
cortisol. This hormonal cascade further enhances the body's
mobilization for dealing with the stressor.

 Resistance Stage: Adaptation and Vulnerability

If the stressor persists, the physiological response transitions to the

resistance stage. The initial, intense reactions of the sympathetic
nervous system subside, and the HPA axis takes over. Here, the body
attempts to adapt to the stressor. While physiological arousal remains
elevated compared to baseline, the body replenishes its hormonal
reserves. Despite this ongoing response, outward signs of stress might
be minimal. However, the ability to handle new stressors may become
compromised. Selye theorized that this vulnerability could eventually
lead to “diseases of adaptation,” such as ulcers, high blood pressure,
asthma, or immune system dysfunction. 137
Stress and  Exhaustion Stage: The Cost of Chronic Stress
Coping Styles
The long-term or repeated activation of the stress response system
comes at a significant cost. Prolonged physiological arousal can
deplete energy reserves and weaken the immune system, leading to the
exhaustion stage. At this point, the body’s capacity to resist further
stress is severely limited. Continued exposure to the stressor
significantly increases the risk of illness, organ damage, and even
death.

3) Individual appraisal: The way a person perceives and interprets external

events significantly influences their stress response. Factors like
personality, coping mechanisms, and social support systems play a crucial
role in mediating the impact of stressors.

The Physiological Toughening Model, developed by Dienstbier, emphasizes

the duration of these stressors. Dienstbier (1989) proposes a three-category
classification of stressors:

 Acute Stressors: These are brief, often involving a clear and identifiable
threat. They elicit a fight-or-flight response, followed by a return to
baseline.

 Chronic Stressors: These stressors have a longer duration and are often
ambiguous or intangible, making them difficult to recognize and manage.
Because they become integrated into daily life, chronic stressors can pose
a significant health risk if left unchecked.

 Intermittent Stressors: This category occupies the middle ground, with

variable durations characterized by alternating periods of stress and calm.

The Physiological Toughening model posits that intermittent stressors, when

viewed as challenges, can actually enhance physiological resilience. The
repeated, periodic activation of the sympathetic nervous system (SNS)
triggered by intermittent stressors serves as a form of training, conditioning
the body to better handle subsequent stressors. This aligns with research
demonstrating that experienced individuals (e.g., astronauts) who have well-
rehearsed response plans and problem-solving strategies for emergencies
exhibit minimal negative physiological effects during stressful situations.
Emergencies, through preparation and training, become transformed into
routine situations, reducing their perceived threat and mitigating the stress
response (Mandler, 1982).

The Transactional Model of Stress and Coping: Transactional Model of

Stress and Coping, as proposed by Kilickaya and Karakas (2017) and Lazarus
(2000), provides an insight into how the living environment affects the lives
of individuals with physical disabilities. According to this approach, stressful
events need to be understood in the context of interactions between people and
their surroundings. The influence of outside stressors, personal resources
138
(both actual and perceived), influential qualities of people in the household, Stress in Disability
and whether or not one lives alone or with others all affect the interactions.
(Jones, J. E. 2017)

According to Gibson et al. (2012), some attributes are required to establish an

atmosphere that supports dignity, such as the ability to manage and adapt
daily routines and the availability of chances for self-expression and self-
identity affirmations. People with physical disabilities are more likely to
perceive their lives as unpredictable, unmanageable, and overburdened if they
do not have access to chances that promote dignity (Hughes et al., 2005;
Livneh & Wilson, 2003; Pearlin, 2009; as cited in Jones, J. E. 2017).

Self Assessment Questions II

1) What are the key aspects that influence primary appraisal of stress?
...................................................................................................................
...................................................................................................................
...................................................................................................................

2) Highlight the theoretical basis of transactional model of stress and

coping.
...................................................................................................................
...................................................................................................................

Stress Proliferation Theory: According to this view, stress in other spheres

of life can arise from the initial stressor, which was a physical impairment.
For instance, the physical impairment can have been the initial source of
stress, but poverty impacts are added when the impairment keeps the person
from working. (Jones, J. E. (2017) Lack of access to dependable
transportation is a common consequence of poverty, which makes people put
off or avoid getting medical care and other components of their treatment
regimens (Reichard et al., 2017 as cited by Jones, J. E.,2017). Unchecked
stressors will multiply and seep into other aspects of life if appropriate coping
mechanisms aren’t employed (Celeiro et al., 2017; Groce, Kett, Lang, &
Trani, 2011 as cited in Jones, J. E. 2017).

Minority Stress Theory: The minority stress model’s main goal is to explain
why the majority and marginalised minority groups have different health
outcomes. (Meyer 2003, as cited in Botha & Frost, 2018). According to
research, marginalised minority groups experience more stressful living
circumstances and have fewer means to deal with them as a result of their
lower social status.

The minority stress model is based upon four concepts. That not all
differences are discrepancies is the first premise. The law of averages and
average effects serve as the foundation for the theory, according to the second 139
Stress and assumption. The social stress hypothesis applies causally to general health
Coping Styles
rather than particular illnesses, according to the third assumption. The fourth
assumption states that, rather than focusing on any particular group, social
stress theory is particularly concerned with the sociological category of
disadvantage created by restrictive social hierarchies (Schwartz and Meyer
2010; as cited in Botha & Frost, 2018). According to the minority model of
disability, which holds that disability (and concomitant psychiatric effects)
result from an inflexible society that prefers people without disabilities, the
social group is essentially devalued based on cultural norms. (Smart 2006; as
cited in Botha & Frost, 2018)

Traditional stigma ideas and theories claim that people with disabilities could
experience mistreatment and devaluation from others. Any human
characteristic that is "deeply discrediting" to those who possess it is
considered stigma, according to Goffman (1963:3). Examples of such
characteristics are "blemishes of individual character," "abominations of the
body," and "tribal stigmata." (Namkung & Carr, 2020)

Another relevant model is the Person-Environment Fit Model (P-E Fit)

proposed by French et al.,(1982). This model emphasizes the importance of
individual needs and abilities in relation to their environment. Stress occurs
when there's a mismatch between the demands of the environment and an
individual's resources to cope. Imagine an employee with a visual impairment
struggling to use a computer program lacking proper accessibility features.
The high environmental demand (using the program) clashes with the limited
resources available (lack of accessibility), creating a stressful situation.

6.5 SOURCES OF STRESS IN PERSONS WITH

DISABILITIES
The global prevalence of disabilities highlights the need to address stress as a
multifaceted issue reaching beyond its physiological roots. As reported by the
World Health Organization (WHO, 2011), in their World Report on Disability
that over a billion people, roughly 15% of the global population, live with
some form of disability. A disability simply refers to challenges faced by
some individuals in performing everyday activities. These challenges can be
physical, sensory, cognitive, or mental, often arising from a combination of
factors and can significantly impact daily activities. From mobility and
communication to social interactions and employment opportunities, living
with a disability presents unique obstacles.

Despite the fact that people with disabilities are a thriving and diverse
community, research suggests they face a unique combination of stressors
compared to the non-disabled population, contributing to poorer mental health
(Cree, 2020). These stressors include poverty, limited social connections, and
the constant struggle to manage existing health conditions, trouble accessing
healthcare (Boyle et al., 2020). Additionally, physical limitations, social

140
stigma, financial strain, emotional burdens, limited job opportunities and Stress in Disability
secure essential support services further exacerbate these challenges.

Disability is a multifaceted experience that includes many stressors related to

negotiating societal attitudes, accessibility challenges, and the day-to-day
obligations of maintaining one's health in addition to the functional limits
imposed by the illness. A person's physical, mental, and social well-being can
be greatly impacted by the particular difficulties that come with having a
disability.

Living with a disability presents special difficulties that go beyond physical

constraints. People with disabilities frequently deal with a range of pressures
that might negatively affect their wellbeing.

A qualitative study (I wasaki & Mactavish, 2005) on individuals with

disabilities reported two theme clusters as sources of stress. These are: (1) the
individual theme cluster, which includes (a) disability (i.e., added demands in
daily living and the issues and challenges related to disability and aging), (b)
health, (c) interpersonal relationships, and (d) the inability to meet
expectations; and (2) the systemic/environmental cluster, which includes four
sources of stress such as (a) exclusionary social systems/ structures, (b)
physical accessibility, (c) employment accessibility, and (d) economic
marginality.

Various specific sources of stress encountered by people with disabilities

are discussed below in detail:

Individuals with disabilities often encounter unique stressors that impact their
mental and physical health. Among these stressors, marginalization, body
image concerns, and threats to life and wellbeing are particularly significant.

Marginalization

Marginalization refers to the process by which certain groups are pushed to

the periphery of society, limiting their access to resources, opportunities, and
rights that are readily available to others. For individuals with disabilities,
marginalization manifests in multiple forms, including social isolation,
economic disadvantage, and political underrepresentation.

Social Marginalization

The primary source of disadvantage is not the impairment itself, but rather
society’s responses to people who are considered disabled. When a
community allows physical, architectural, transportation, and other barriers to
persist, it creates handicaps that oppress individuals with disabilities.
Conversely, by removing these barriers, communities empower people with
disabilities to function at much higher levels (Baffoe, 2013). Social
marginalization of individuals with disabilities often begins early in life and
continues across the lifespan. It is characterized by limited social interactions,
exclusion from community activities, and pervasive stigma.
141
Stress and 1) Social Isolation: Individuals with disabilities are disproportionately
Coping Styles
affected by social isolation. This can be attributed to a combination of
factors, including physical barriers that limit mobility, a lack of accessible
transportation options, and negative societal attitudes that create a sense of
exclusion. The cumulative impact of this isolation can be significant,
leading to feelings of loneliness, depression, and a poor quality of life
(Emersonet al., 2021; Macdonald et al., 2018).

2) Dependency on Others: While needing help with daily tasks is essential

for many people with disabilities to live a full life, it can also be a source
of stress. The support from caregivers and services is invaluable, but the
feeling of relying on others can be complex. People might worry about
becoming a burden on their loved ones, leading to feelings of guilt and
anxiety. Additionally, the loss of independence that comes with needing
help can be a major source of stress.

3) Stigma and Discrimination: The stigma associated with disability

presents a significant hurdle to achieving social inclusion. Negative
stereotypes and prejudices can add fuel to the discriminatory practices that
permeate various settings, from schools and workplaces to healthcare
facilities. This pervasive discrimination creates a vicious cycle, reinforcing
social exclusion and perpetuating the marginalization of people with
disabilities. (Barbareschi et al., 2021).

4) Educational Barriers: Many individuals with disabilities face significant

barriers to accessing inclusive education. Segregated educational settings,
often lacking adequate support services, hinder their academic and social
development. On the other hand, inclusive education is critical for
reducing marginalization and fostering social integration, allowing
individuals with disabilities to reach their full potential alongside their
peers. (Taneja-Johansson, 2021).

Economic Marginalization

Economic marginalization refers to the systemic exclusion of individuals with

disabilities from economic opportunities, resulting in poverty and financial
instability.

1) Employment Discrimination: Individuals with disabilities face a

significant employment gap compared to their non-disabled counterparts.
This disparity is rooted in various factors, including discriminatory hiring
practices, inaccessible workplaces that fail to consider diverse physical
needs, and a lack of reasonable accommodations for employees with
disabilities. These barriers create a significant hurdle for individuals
seeking economic independence, a critical factor in reducing
marginalization and fostering social inclusion. (Kwon & Archer, 2022).

142
2) Income Inequality: Individuals with disabilities often face a significant Stress in Disability
income gap compared to their non-disabled counterparts, even when they
are fortunate enough to secure employment. This disparity is compounded
by several factors, including limited access to high-paying jobs, a
prevalence of underemployment, and a higher likelihood of being
restricted to part-time work. The consequence of these challenges is a
heightened risk of poverty for people with disabilities (Jajtner et al., 2020).

3) Access to Financial Resources: Marginalization extends to crucial areas

like financial services, where individuals with disabilities often face
significant hurdles in accessing credit, loans, and other essential financial
products. This lack of financial inclusion creates a vicious cycle. Without
access to capital, people with disabilities are unable to invest in their
education, secure adequate housing, or obtain proper healthcare. These
limitations can significantly restrict their earning potential and trap them
in a cycle of poverty (Banks et al., 2017).

Body Image

Body image concerns add another significant layer of stress for individuals
with disabilities. These concerns stem from a complex interplay of factors.
Physical differences associated with the disability itself can lead to a sense of
disconnection from societal beauty standards and a perceived loss of one’s
pre-disability body. Additionally, the narrow definition of “ideal” bodies in
society often excludes those with disabilities, fostering feelings of inadequacy
and social rejection.

1) Self-Perception: People with disabilities often face challenges with their

self-image, particularly if their disability has a visible impact on their
physical appearance. This struggle is intensified by societal beauty
standards that frequently equate attractiveness with being able-bodied. The
resulting negative body image can have a significant impact on mental
health, potentially leading to conditions like anxiety and depression (Martí
et al., 2023).

2) Media Representation: The media landscape is often devoid of authentic

portrayals of people with disabilities. When they are included, the
representation frequently falls into stereotypical or negative depictions.
This lack of positive role models can significantly hinder individuals with
disabilities from seeing themselves reflected in the broader society. This
absence of relatable characters can further negatively impact their self-
esteem and body image. (Kasap & Gürçınar, 2017).

3) Peer Comparisons: The relentless pressure to conform to societal norms

of physical appearance can be particularly intense for individuals with
disabilities. They may find themselves constantly comparing their bodies
to those of their able-bodied peers, which can lead to a deep sense of
inadequacy and significant stress (O’Byrne & Muldoon, 2017) 143
Stress and
Coping Styles Self Assessment Questions III

1) What is P-E fit?

...................................................................................................................
...................................................................................................................

2) A disability simply refers to .......... faced by some individuals in

................. .

Threat to Life and Wellbeing

The constant threat to life and well-being is a profound source of stress for
people with disabilities. This threat manifests in various ways, encompassing
medical concerns, environmental barriers, and social inequalities.

1) Health Complications: Many disabilities are accompanied by associated

health complications, some of which can be life-threatening. The constant
burden of managing chronic pain, enduring frequent medical
interventions, and living with the uncertainty of future health can cause
significant stress for individuals with disabilities and lead to poor quality
of life (Williams & Egede, 2016).
2) Physical Stressors: like weariness, chronic pain, and mobility limits, are
frequently brought on by the functional limitations imposed by the
disability itself. Disabilities that directly affect a person’s body are
referred to as physical stressors. This covers discomfort and agony as well
as restrictions on movement or bodily functions. (Bekhet & Zauszniewski,
2012) These physical difficulties might make it difficult for the affected
person to carry out everyday tasks, and they may necessitate continuing
medical care and adaptive coping mechanisms in order to properly manage
symptoms (WHO, 2011).
3) Psychological Issues: The emotional and cognitive difficulties connected
to disability are referred to as psychological stresses. These could include
depressive, anxious, or poor self-esteem sentiments, as well as frustration
with the restrictions placed on by the impairment. Additionally,
disorientation, rage, anxiety, and inferior complex are frequently brought
on by their impairment. (Shafiq, H.,2014) Those with disabilities often
experience frustration, anxiety, and insecurity as a result of their
incapacity to do tasks effectively. (VT et al., 2021)
4) Functional Limitations: Functional limitations can be a constant source
of stress. Managing pain, medical conditions, and limitations in mobility
and self-care can be incredibly demanding. Tasks most people take for
granted can become daily hurdles for an individual with a disability. This
creates a significant burden, both physically and emotionally. On top of
that, inaccessible environments add another layer of difficulty. Imagine
the frustration of encountering stairs without ramps, buildings without
144
 elevators, or technology that’s unusable. These obstacles can make daily Stress in Disability
life incredibly challenging and contribute to feelings of isolation and
helplessness.
5) Accessibility Issues: The lack of access to essential healthcare services,
adaptive technologies, and even basic needs like transportation and
housing creates a significant threat to the well-being of individuals with
disabilities. These barriers can severely limit their ability to live
independently and safely, further adding to their stress. (Shandra, 2018).
6) Violence and Abuse: People with disabilities face a heightened risk of
experiencing violence and abuse, encompassing physical, emotional, and
sexual forms. The constant threat and the unfortunate reality of such
experiences become major sources of stress, negatively impacting their
mental and physical health in profound ways (Amborski et al., 2021).

Individuals with disabilities experience profound and multifaceted stress due

to marginalization, body image concerns, and constant threats to their life and
wellbeing. Addressing these challenges necessitates societal changes that
prioritize inclusion, representation, and accessibility. By actively fostering a
more inclusive and supportive environment, we can significantly mitigate the
stressors faced by individuals with disabilities, ultimately improving their
overall quality of life.

6.7 LET US SUM UP

In the present Unit, we learned about the concept of stress with reference to
disability. Symptoms of stress and types base don key dimensions such as
frequency, intensity, and duration were also described. Although there are
various models that describe the functioning of stress in the body some lay
importance on the physiology such as the GAS model other models describe
stress as a result of transactions between individual and environment resulting
in stress. There are various specific sources of stress in persons with disability
such as stigma, social isolation and discrimination and others were described
in the unit.

6.8 KEY WORDS

Biopsychosocial : It is a holistic approach which incorporates biological,
Approach psychological and social aspects into consideration.

Stress : Events that are experienced and perceived as

endangering one’s physical or psychological
wellbeing.

Stress Responses : Reaction or response in terms of flight or fight or

other reactions such as anxiety, anger or aggression;
to events which are perceived by the individual as
endangering to their wellbeing.
145
Stress and Distress : It is marked and defined by feelings of anxiety,
Coping Styles
aggression, or depression as a result of continuous
stress.

Flight or Fight : A bodily pattern of response that prepares and

response organism to deal with emergency situations.

6.9 ANSWERS TO SELF ASSESSMENT

QUESTIONS
Self Assessment Questions I

1) When you experience stress for a long period of time, which negatively
affects your physical and mental health is called chronic stress.

2) Brain regions such as hippocampus and amygdala have a high

concentration of receptors for stress hormones.

Self Assessment Questions II

1) The key aspects of primary appraisal are; Goal relevance: How important
is the goal being affected? ,Goal congruence: Does the event align with
or hinder the goal? Ego development: What are our coping resources and
capacity?

2) Transactional model if based on the approach that stressful events need to

be understood in the context of interactions between people and their
surroundings. The influence of outside stressors, personal resources (both
actual and perceived), influential qualities of people in the household, and
whether or not one lives alone or with others all affect the interactions.

Self Assessment Questions III

1) Person-Environment Fit Model (P-E Fit) proposed by French et al.,

(1982). This model emphasizes the importance of individual needs and
abilities in relation to their environment. Stress occurs when there is a
mismatch between the demands of the environment and an individual's
resources to cope.

2) A disability simply refers to challenges faced by some individuals in

performing everyday activities.

6.10 UNIT END QUESTIONS

1) Define stress and explain its types.

2) Discuss the symptoms of stress.

3) Enumerate and explain the sources of stress in persons with disability.

4) What are the stressors related to different types of disability.

146
5) Identify and discuss the various stressors that have a significant effect on Stress in Disability
the person with disability.

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 Coping Styles and
UNIT 7 COPING STYLES AND STRATEGIES* Strategies

Structure

7.1 Learning Objectives

7.2 Introduction
7.3 Concept of Coping
7.4 Coping Styles and Strategies
7.5 Coping and Disability
7.6 Stages of Adaptation and Adjustment
7.7 Factors Impeding Adjustment to Disability and Disabling Processes
7.8 Let Us Sum Up
7.9 Key Words
7.10 Answers to Self Assessment Questions
7.11 Unit End Questions
7.12 References
7.13 Suggested Readings

7.1 LEARNING OBJECTIVES

After you go through this Unit, you will be able to:
 Explain the concept of coping;
 Define coping styles and strategies;
 Understand defense mechanisms used to overcome grief, loss, guilt & fear;
 Know the aspects of coping in relation to disability;
 Discuss the various stages of adaptation and adjustment; and
 Explain factors impeding adjustment to disability and disabling processes.

7.2 INTRODUCTION
Isha studying in class 11th wanted to pursue science and become a doctor. All
her dreams were shattered when all of a sudden in the 11th grade Isha
suddenly fell ill because of an unknown medical issue she became partially
blind. Isha could not understand the reason behind her illness and was unable
to cope with the same. She also became ambiguous about her future in academics.

________________
*Prof. Ritu Sharma, Faculty of Psychology, School of Social Sciences, IGNOU, New Delhi
153
Stress and Her parents were under equal stress and shock. She underwent a
Coping Styles
psychological counseling which was to help her and her parents cope with the
stress. She felt motivated and with a positive attitude she adopted new
methods of learning with the help of auditory aids. She took help of
government schemes which are to help individuals with disability. She
completed her studies and became a science teacher. Today as a teacher she
is helping others overcome disability and stay motivated by adopting healthy
coping strategies.

As you can see in the above example, Isha faced severe stress but with the use
of proper coping strategies she could deal with it effectively. Coping is an
important individual mechanism that is devised to overcome stress. Stress is
as a result of the perceived difference between expectation and reality. Stress
causes physical and psychological discomfort to the individual. To overcome
this discomfort people use coping mechanisms. Coping styles and strategies
can be healthy as well as unhealthy. It’s the individual who decides which
strategy fits well in the situation to be dealt based on their individual capacity
and possibility. Also, there are various factors that lay as a foundation to
development, selection or adoption of coping styles in individuals. This is due
to factors which also define individual differences. Psychological factors such
as cognition, perception, attitude, aptitude, intelligence, play an important role
in the coping of an individual. Apart from this, environmental factors, social
factors, and available resources also play a major role in coping.

In the present Unit, we will mainly discuss the concept of coping, develop an
understanding about various coping styles and strategies. Further, we will
discuss about coping in relation to disability. This unit will also cover stages
of adaptation, adjustment and the factors impeding adjustment to disability
and disabling processes.

7.3 CONCEPT OF COPING

A situation which is very stressful for you might not be as stressful for others.
The way a situation is cognitively appraised by an individual will decide the
level of stress experienced. Similarly not everyone uses a standard and
uniform coping style to overcome stress. Coping can be defined as strategies
using which an individual deals and adapts to the adversities experienced
which are leading to stress. Coping strategies or skills may be healthy or
unhealthy. If an individual adopts an unhealthy coping strategy or style (such
as smoking, consuming alcohol, or withdrawal behavior) then the person will
develop psychological issues in the long run. However, if the individual
adopts a healthy practice (such as meditation, or physical exercise) they will
be able to cope with stress in an effective manner without damaging their
mental or physical health and wellbeing.

Coping has been defined by various researchers and social scientists in many
ways. Some of the definitions are as under:

154
Roncaglia (2014) has defined coping as “the individual’s response to a Coping Styles and
Strategies
psychological stressor which is often related to negative event”.

Campus et al., (2001) has defined coping as, “Conscious volitional efforts to
regulate emotion, cognition, behavior, physiology, and the environment in
response to stressful events or circumstances”.

Bartram and Gardner (2008) have stated that “Coping is the process of
thoughts and behaviors that people use to manage the internal and external
demands of situations they appraise as being stressful or exceeding their own
resources. Coping efforts seek to manage, master, tolerate, reduce or minimize
the demands of a stressful environment”.

Managing stressful events, both internal and external, by the mobilization of

thoughts and behaviors is known as coping (Folkman S & Moskowitz JT,
2004). Basically, coping is the behavioural and cognitive efforts for dealing
with particular pressures, either internal or external, that are judged to be
inadequate for a person to handle or to be too stressful. (Isil, 2015)

However, looking at the definitions we can now conclude that coping is not a
singular response as it is responding or reacting to a situation. Rather it’s a
series of responses that an individual adopts in order to adjust to the situation
and after every adjustment the individual tends to reappraise the level of stress
or adversity whether it has been reduced or not. This reassessment and
reappraisal will decide the next course of action of that individual. For
example, in case of an acquired disability in an individual such as blindness;
the individual along with the stress of medical treatment and the loss
experienced will also be required to adjust to the environment in order to do
the daily chores. In such a situation that individual will not only adopt
methods to do the daily chores and manage ways to work on the daily routine
work but also will adopt coping strategies to overcome stress that has resulted
from this loss. Coping thus is a continuous transaction between the person and
the environment where both tend to influence each other and the entire
process is aimed at creating a balance (Folkman & Moskovitz, 2004).

A lot of individual factors act as the basis for deciding and choosing the
strategy or style that an individual adopts to overcome stress. The individual
differences while selecting a coping style or strategy depends upon the
individual’s own psychological factors (such as personality, cognitive
strategies, Intelligence, etc.), and factors related to family and social support.

Personality: Personality can be defined as an individual’s cognitive,

behavioural and affective tendency that are stable across situations.
Personality factors may lead to emotional distress or make an individual
resilient in situations of adversity and distress. Thus, personality of an
individual plays an important role in coping. Resilience is a combination of
three aspects of an individual’s personality, i.e. Self-esteem, personal Control,
and optimism (Major et al., 2013). Resilient individuals tend to cope with
adverse situations with a much positive strength and spirit.
155
Stress and Cognitive Strategies: individuals who use positive cognitive strategies such as
Coping Styles
telling themselves that “we will try to solve this problem”, “ I will be able to
manage the situation” and similar tend to use healthy coping strategies. While
those who use negative cognitive strategies such as “this is impossible a task”,
“I am the only one who gets to face these issues every time”, and so on tend to
find adversities and stress difficult to be dealt with and often use unhealthy
coping strategies to avoid stress. Cognitive strategies are used to modify
experiences. In fact many of the coping approaches use Cognitive strategies.
For instance in case of emotion-focused coping, the individual may use
cognitive strategy such as denial to unpleasant facts of the adversity.
Cognitive strategies are also used in treating chronic pain (Palermo et al.,
2010).

Culture: Cultural expectations also play a significant role as most of our stress
has been found to be as a result of our inability to meet the social norms and
expectations. As it is in the case of “disability”; it not only poses a demand of
physically managing to the society and daily chores but also to mentally adjust
ourselves to fulfill the social expectations managing the disability at the same
time. There exists cultural differences in perception and reaction to illness and
disability, while in some the display of distress and disability to pain is much
while in others its less (Young & Zane, 1995).

Self Assessment Questions I

1) Enlist the individual factors that have an effect on coping of an

individual.
2) Which of the following do not have an effect on coping of the
individual:
a) Personality
b) Cognitive strategies
c) Culture
d) Rote Learning

7.4 COPING STYLES AND STRATEGIES

Every individual adopts their own style and strategy to deal with stress and
adversities in life. However, researchers have identified various styles and
strategies which are used in common by individuals to cope with stress. For
instance people when faced with similar situations of stress tend to apply
coping strategies or styles which have worked positively for them in the past.
The strategies that they use for long term stress may be different from the ones
which are used to deal with short-term stress. Also, the method used in such a
condition can also be a mix of a new strategy and an old strategy leading to a
more refined one.
156
Coping styles or strategies are a collection of relatively consistent traits that Coping Styles and
Strategies
determine an individual’s behaviour in reaction to stress. They represent the
various ways in which individuals deal with stressors. These hold true over
time and in multiple settings. (de Boer, S. F., Buwalda, B., & Koolhaas, J. M.,
2017)

Proactive and Reactive coping: Coping can be broadly classified into two
categories: proactive coping and reactive coping. Proactive coping aims to
prevent future stresses; contrary to Reactive coping, which responds to the
stressor after it, occurs. Reactive people do better in a more varied setting,
whereas proactive people thrive in stable surroundings because they are less
reactive to stimuli, more rigid. (Coppens, C. M., de Boer, S. F., & Koolhaas, J.
M., 2010).

Approach-Avoidance model (Roth & Cohen, 1986). This model explains the
different approach that people adopt to cope with adversities. While some
individuals prefer to adopt an avoidant approach where they tend to avoid and
ignore the adversities experienced. On the other hand the individuals with
approaching style will take measures to confront and combat stress by taking
effective measures to reduce the stress.

Individuals with approach style of coping tend to find long term solutions to
their problems.

Transactional model (Lazarus & Folkman, 1984) Emotion- focused and

problem-focused are the two most well-known coping methods.

The transactional model divides coping into two major groups based on its
functions. The first is referred to as an Emotion-focused coping approach,
and the second as a Problem-focused coping strategy. Problem-focused
coping refers to all proactive measures used to control stressful circumstances,
modify or remove the sources of stress through personal behaviour, and
improve a problematic person-environment connection. It is mostly predicated
on an individual's capacity to reason and modify the external event or
circumstance. (Schoenmakers, E. C., van Tilburg, T. G., & Fokkema, T.
(2015))

Utilizing problem-solving techniques, resolving interpersonal conflicts, asking

for advice, managing time, making goals, and learning more about what is
stressing one out are a few examples of this strategy at the cognitive level. On
the other hand, engaging in activities like following a particular diet plan,
joining a group therapy session are example of this strategy at behavior level.
(Sharma, Manoj, 2003)

Emotion-focused coping refers to all the restorative actions taken to lessen the
psychological consequences from stressful situations. (Schoenmakers, E. C.,
van Tilburg, T. G., & Fokkema, T., 2015) Here the emphasis is on changing
one’s inner thoughts and feelings about a circumstance or an occurrence.
Some examples of this approach at thought process level are denying the
presence of the stressful circumstance, expressing emotions openly, avoiding 157
Stress and the stressful scenario and indulging in activities like meditation, exercising,
Coping Styles
seeking for social support, etc. (Sharma, 2003)

Later, coping was conceptualized by Susan Roth and Lawrence Cohen as the
orientation of coping reactions with respect to the stressor or threat, which
was Approach-Avoidance coping.

Any behavioural, cognitive, or emotional response to a threat is known as

approach coping (like problem solving). This strategy offers the advantage of
enabling appropriate action to be performed during and after distress levels
have slightly decreased.

Any behavioural, cognitive, or emotional activity aimed at avoiding a threat is

known as avoidance (like withdrawal or denial). Distraction techniques are
examples of avoidance strategies that may help keep the distress level from
rising too high; these may be most useful in the early stages of a reaction to a
severe stressor. (Sharma, 2003)

Another model of coping was established by Bruce Compas and colleagues

which is known as the Responses to Stress model, that divides coping into
three basic dimensions. Each dimension is made up of more specific coping
subtypes. (Compas et al., 2001; E.F. Dubow et al., 2011)

Voluntary coping refers to coping strategies that need conscious effort, such
as problem resolution and cognitive restructuring, whereas involuntary
copingrefers to temperamentally based and conditioned reactions, such as
emotional numbing and intrusive thoughts. This is the first component of
coping.

The later incorporates reactions of engagement (i.e., responses oriented

toward a stressor or one's reaction to a stressor, e.g., problem solving) and
disengagement (i.e., responses directed away from a stressor or one's reaction
to a stressor, e.g., distraction). (Campus et al., 2001; E.F. Dubow et al., 2011)

Primary control coping strategies (i.e., strategies targeted at directly changing

objective conditions, such as problem solving, emotional expression) versus
secondary control coping strategies (i.e., strategies focused on adaptation to
the problem, such as acceptance, cognitive restructuring) are two further
dimensions along which voluntary coping responses are differentiated.
According to this paradigm, goal-directed attempts to preserve, strengthen, or
modify one's control over one's surroundings or self are considered voluntary
coping responses. (Campus 2001; E.F. Dubow. et. al., 2011)

Self Assessment Questions II

1. What are the major styles of coping?
...................................................................................................................
...................................................................................................................
158
 2. Describe the difference between voluntary coping and involuntary Coping Styles and
Strategies
coping.
...................................................................................................................
...................................................................................................................

7.5 COPING AND DISABILITY

There are many psychological reactions in the form of defense mechanisms
that individuals use in order to overcome the anxiety and stress that arises due
to adversities. The most commonly used among the defense mechanisms are
Denial, regression, compensation, rationalization, and emotional reaction
under situations of grief, loss, guilt and fear.

When an individual experiences grief that is emotional response following

loss or damage in one’s life or similar experiences under the situation of guilt
where the person is not able to forgive and compensate for the damage caused
by them; or in case of fear about the future events or present resulting from
their situation and actions leads to anxiety. In order to deal with the same
people often adopt defense mechanisms some of them have been explained in
this section.

Denial by an individual as a reaction to stressful situation is automatic refusal

to the stressful situation and disturbing elements of outer reality. For example,
an individual who is alcohol addict may say that he/she is a casual drinker and
not really an addict.

Regression has been described as resumption to an earlier stage of life

behaviour, returning to an earlier point of fixation of developmental stages
due to discomfort experienced in the present stage. This is when an individual
psychologically returns to an earlier stage of development to avoid anxiety
and distress caused by the present situation. For example, an individual might
be in a habit to put their hand or fingers in the mouth during the state of stress.
This is due to their fixation in the oral stage of development.

Compensation is wherein an individual overachieves or highlights their

achievements in one area to overcome or suppress the failure in another area
or field. For example, an individual who is not good in one field may perform
good in another field to compensate for their weakness.

Rationalization is one of the defense mechanisms where an individual

presents a justifiable rationale for unacceptable behavior. For example, stating
that your question paper was too tough as compared to the previous years to
be the reason of your low score despite the fact that you did not study is
rationalization.

Reaction formation is adopted by an individual to hide and avoid anxiety

provoking thoughts and feelings. This is where an individual adopts a 159
Stress and behaviour that is opposite to one’s true thoughts to avoid anxiety. For example
Coping Styles
a man who is attracted to a woman but cannot pursue the relationship and
closeness to the female will be more argumentative with her.

Coping with Acquired Disability

Anvi is a 25 year old female who recently met with a major car accident
which resulted in a major back injury also with other small injuries. Anvi is
unable to move due to severe pain in her spine. As she recovers from small
injuries she is able to do her task by sitting in the wheel chair. She is often
flooded with experiences of hopelessness, anxiety and depression as she is
unable to do her work the way she used to do it before her accident.

Her social relations have curtailed as she is unable to attend much of the
social gatherings without help and often experiences low self-esteem even if
she attends one. She is suggested by the doctors to meet a Psychologist so that
she can cope with her acquired disability.

Disability can be “inborn” or “acquired”. Acquired disability can be defined

as a disability that has developed as a result of illness or accident during the
lifetime of an individual. Inborn disability can be due to various physiological
and genetic reasons due to which the individual is born with disability.
However, if the disability is after the child is born or after then this will be
called as acquired disability. Acquired disability can be as a result of illness
such as Acquired Immune Deficiency syndrome (AIDS), multiple sclerosis,
Amyotrophic Lateral sclerosis (ALS), Guillain-Barre Syndrome, Parkinson’s
Disease, Brain-Stem stroke, to mention a few.

Individuals with disability tend to experience anxiety, depression, and

hopelessness. On the contrary individuals with acquired disability tend to
more often experience such feelings as they also thrive to overcome the stress
of acquired disability. An individual having lived without any disability when
acquires a disability due to any accident or illness tend to experience
hopelessness. Here the individual is not only required to work on livelihood
management but also make changes to his routine methods of dealing with
situations and tasks. The acquired disability not only has an effect on the
discomfort experienced by the individual but it also affects the social
relationships of the individual. Due to discomfort experienced the relation of
such individuals with family and friends also becomes strained. Acquired
disability is also an important factor that leads to stress in the family. If it’s the
bread-earner who has been affected then it will not only put social strain (as
the family’s time and freedom is altered) but also financial strain of managing
the illness/ disability and family both (Berg & Upchurch, 2007).

Behaviourism based therapy which is aimed at behavior modification using

techniques of classical and operant conditioning combining with cognitive
methods has been found to be effective in helping individuals with acquired
disability to cope with their disability. In a study by Turner (1982) training
was provided to enable patients with acquired disability to relax and think
160
differently about the pain in order to reduce pain. Such therapy sessions in Coping Styles and
Strategies
group or if taken individually tend to help individuals manage the morbidity.

Self Assessment Questions III

1) What is acquired disability?

.................................................................................................................
.................................................................................................................
2) Which of the following are the defense mechanisms used by
individual’s under stress situations.
a) Denial
b) Regression
c) Rationalization
d) All of the above

7.6 STAGES OF ADAPTATION AND

ADJUSTMENT
The intricate interplay between adaptation and adjustment has been integral to
the human experience since the inception of evolution, resonating with
Darwin’s foundational principle of survival of the fittest. Within the domain
of psychology, this dynamic relationship assumes a central role, particularly
when individuals confront the profound challenges associated with coping
with a disability.

The historical origins of adjustment trace back to Darwinian evolution,

specifically the principle of survival of the fittest. As a psychological
counterpart to biological adaptation, adjustment denotes a satisfactory
alignment with the evolving demands of daily life. It facilitates contentment
by enabling individuals to balance their needs with their capacity to fulfill
them, fostering resilience to effect necessary changes in their environment.
Adjustment is conceived as a dynamic, ongoing process, a reciprocal
interaction between an individual’s intrinsic characteristics and the demands
of their surroundings. This perpetual process, commencing at birth, sheds light
on how individuals cope with changing circumstances throughout their lives.
In essence, adjustment is both a product and a process of the continuous
adaptation required for navigating life's dynamic terrain.

Distinguishing Adaptation and Adjustment

While often used interchangeably, adaptation and adjustment carry distinct

meanings, particularly in the context of psychology. Adaptation, within the
perspective of psychology, entails a multifaceted process encompassing
cognitive, emotional, and behavioural modifications. It represents the
individual’s cognitive assimilation, emotional response, and behavioural
adjustments to effectively function amidst the flux of both external and 161
Stress and internal changes. In the specific context of disability, adaptation extends to
Coping Styles
acquiring novel skills, integrating assistive devices, and embracing coping
strategies, all of which collectively facilitate the navigation of daily life.

Conversely, adjustment emerges as a more comprehensive term, enveloping a

spectrum of changes responsive to diverse life situations. These may
encompass shifts in environmental circumstances, personal experiences, or
alterations in social dynamics. Within this expansive framework, adjustment
becomes the umbrella term under which various adaptive responses unfold.
This may include profound alterations in attitudes, behaviours, and emotional
regulation.

Adjustment has been defined in the following ways:

According to L.F. Shaffer (1961): “Adjustment is the process by which living

organisms maintain a balance between their needs and the circumstances that
influence the satisfaction of these needs.”

According to Eysenck (1972) “adjustment is a state in which the needs of the

individual on the one hand and the claims of environment on the other hand
are fully satisfied or the process by which this harmonious relationship can be
attained.”

Theories of adjustment in relation to disability:

Ecological Models (Livneh&Antonak, 1997; Vash & Crewe, 2004): It

considers the broader environmental factors that shape the journey of
adjusting to disability. These models take into account a wide range of
influences, such as societal attitudes, support systems, and accessibility
considerations. The essential idea of ecological models is recognizing the
need for a profound understanding of how individuals with disabilities
navigate the intricate interplay between themselves and the broader social and
physical environments. This approach highlights the importance of
acknowledging and addressing the diverse elements that contribute to the
adaptive experiences of individuals facing the challenges of disabilities.

Recurrent or Integrated Model (Kendall & Buys, 1998): It suggests that

the adjustment to disability constitutes an enduring and cyclical process.
Individuals are likely to revisit specific stages, particularly in the face of
significant life changes or events, thereby initiating a continuous cycle of
adaptation. This model appreciates the dynamic and evolving character of
adjustment, emphasizing its non-linear nature — a succession of recurring
cycles rather than a straightforward progression.

Chaos Theory (Parker, Schaller, & Hansmann, 2003): It conceptualizes

adjustment to disability as a complex and non-linear process. It posits that
minor changes can yield substantial and unforeseeable impacts on an
individual’s adaptive journey. The theory underscores the significance of
comprehending the intricate interplay among various factors in the adjustment
process, recognizing that outcomes may exhibit sensitivity to initial
conditions. This perspective invites a nuanced understanding of the
162 unpredictable dynamics inherent in the adaptation to disability.
The Stages of Adjustment in Coping with Disability: Coping Styles and
Strategies
The journey of coping with a disability unfolds through distinct stages of
adjustment, each marked by unique psychological nuances. Nancy Kerr
(1977), a psychologist who herself navigated life as a paraplegic, outlines five
major stages in adjusting to permanent disability, including shock, expectancy
of recovery, mourning, defense, and adjustment. These stages are not discrete
categories but points on a continuum and these stages describe common, but
not inevitable, behavioral phases.

The aforementioned five major stages are discussed below in detail with their
respective characteristics:

1) Shock (First Stage):

a) Lack of Comprehension: Individuals find themselves in a state of
initial unawareness or incomplete understanding of their illness or
disability.

b) Minimal Anxiety: Initial responses are characterized by a subdued

level of emotional distress.

2) Expectancy of Recovery (Second Stage):

a) Realization of Existing Issue: Recognition dawns upon the individual
regarding the presence of a health concern.
b) Preoccupation with Improvement: A focused anticipation of recovery
is accompanied by a keen interest in witnessing an amelioration of the
disabling condition.
c) Lack of Motivation for Adaptation: The prospect of the disability
disappearing diminishes the motivation to proactively learn adaptive
strategies.

3) Mourning (Third Stage):

a) Absence of Recovery: Non-realization of the expected recovery leads
to a stage of mourning.
b) Acute Distress and Readiness to Give Up: Escalating emotions
manifest as acute distress and a profound sense of surrender.
c) Thoughts of Suicide: The distress may culminate in contemplations of
self-harm.
d) Hostility and Resignation: Self-pity may transform into hostility, with
some individuals resigning themselves to their fates indefinitely.

4) Defense (Fourth Stage):

Healthy defense which included:
 Coping Efforts: Progression to the defense stage involves active
coping mechanisms. 163
Stress and  Interest in Normalcy: Renewed interest surfaces in learning to
Coping Styles
embrace normalcy despite prevailing challenges.
 Acknowledgment of Barriers: Barriers are acknowledged and either
surmounted or tactically circumvented.
b) Neurotic Defence: In instances of neurotic defense, individuals
employ mechanisms to deny the existence of barriers.

5) Adjustment (Final Stage):

a) Overcoming Disability as a Barrier: Disabilities cease to be perceived
as insurmountable obstacles.
b) Satisfaction of Needs: Individuals discover ways to satisfy their needs
within the context of their abilities.
c) Perception of Adequacy: Those in the adjustment stage feel a sense of
personal adequacy, signifying the culmination of the adaptive process.

Furthermore, delving deeper into the multifaceted nature of adjustment,

Livneh and Hanoch (1980) conducted a systematic review which revealed
additional layers in the adjustment process, as posited by various researchers.
These supplementary stages encompass anxiety/fear, bargaining, denial,
depression, withdrawal, anger, hostility or aggression, acknowledgment, and
acceptance. Each of these stages signifies a cognitive and emotional
progression, serving as integral steps in the profound journey of
acknowledging the presence of a disability and adeptly adapting to a
perceived new reality.

Understanding these stages is not only pivotal for those undergoing this
intricate process but also holds immense significance for mental health
professionals providing support. The stages, ranging from shock and denial to
eventual acceptance and adjustment, delineate the emotional and
psychological terrain individual’s traverse. Embracing these stages is not
merely a process; it is a profound odyssey marked by self-discovery,
adaptation, and ultimately, the pursuit of a fulfilling life beyond the
constraints imposed by disability.

Self Assessment Questions IV

1) State the difference between adaptation and adjustment.

.................................................................................................................
.................................................................................................................
.................................................................................................................

2) Enumerate the stages of adjustment in coping with disability.

.................................................................................................................
.................................................................................................................
164
 Coping Styles and
7.7 FACTORS IMPEDING ADJUSTMENT TO Strategies
DISABILITY AND DISABLING PROCESSES
People will always have to go through a process of adjusting to their new life
situation, regardless of whether they were born with a disability or acquired
one through disease, accident, or another cause (Kriofske et al., 2019).
Writing on the impact of a physical handicap on an individual's functioning,
Beatrice Wright and her colleagues developed the theory of disability
acceptance (Dembo, Leviton & Wright, 1956). According to this theory, there
are four main adjustments that must be made to a person's value system in
order for their acceptance of impairment to be influenced overall. (a) The
enlargement of the scope values, (b) the subordination of physique, (c) the
containment of the spread of the handicap impact, and (d) the transformation
of comparative status values into asset values are examples of these value
modifications (Dembo et al., 1956; Wright 1983; as cited in Kriofske et al.,
2019).

The acceptance of areas unaffected by the circumstances and of values distinct

from the disability constitute an enlargement of the scope values. For instance,
someone with a physical impairment might concentrate on their brilliance,
inventiveness, or artistic tendencies. (Kriofske et al., 2019)

The shift in significance from the physical self to other sources of self, such
the personality, is known as subordination of the physique. An individual can
see that despite using a wheelchair to move about, he is still the same person
to his loved ones, thoughts like this can help in this value shift. (Kriofske et
al., 2019)

The value that is (often negatively) placed on disability itself is known as the
“spread effect.” Reducing or controlling the spread of disability involves
reframing it using new and positive ideas and preventing it from permeating
areas of one's life that are not related to the functional limitation itself.
(Kriofske et al., 2019)

Ultimately, the shift from comparative to asset values is the decision to stop
comparing oneself to other people and instead concentrate on one's own
advantages (Wright, 1983, as cited in Kriofske et al., 2019). Here, the factors
like resilience and persistence of an individual come into picture in order to
deal with an impairment or recently acquired impairment.

According to Livneh and Antonak (1997), adjusting to a disability is a

dynamic and ever-changing process that people go through in an effort to
eventually achieve the best possible person-environment congruence, as
demonstrated by: (1) engaging in social, professional, and recreational
activities; (2) navigating the physical environment with ease; and (3) being
aware of one's residual abilities and assets as well as current limitations.
Nonetheless, the authors defined adjustment to disability and chronic illness
as the last stage of this process, during which people are able to establish and
preserve psychosocial equilibrium, reach a state of reintegration, work 165
Stress and towards achieving their goals in life, show positive attitudes towards
Coping Styles
themselves, others, and their disability, and exhibit positive self-esteem, self-
concept, and self-regard. As a result, it is possible to think of disability
adjustment as a process that results from the start of incapacitating symptoms.
(Jadwisienczak, H., 2008)

Disability adjustment can be a difficult and complicated process, the

following are some factors that affect an individual with disability:

Physical barriers: Physical barriers are structural impediments that obstruct

access or mobility (the ability to move around in an environment) in both
natural and man-made situations. Physical barriers can take many different
forms, such as curbs and steps that prevent someone with limited mobility
from accessing a sidewalk or entering a building, mammography equipment
that requires a woman with limited mobility to stand, and lack of a
wheelchair-accessible weight scale or one suitable for people with limited
upper body strength.

Structural factors: People with disabilities encounter discrimination, stigma,

and ableism in all areas of life, which has an adverse effect on their emotional
and physical well-being. Laws and regulations may take away their autonomy
and permit a number of damaging health-related practises, including forced
sterilisation, forcible admission and treatment, and even institutionalisation.
(WHO)

Self-Efficacy: A person’s perception of control over their accomplishments

and ability to overcome obstacles and accomplish goals is referred to as self-
efficacy. According to Amtmann et al. (2012), self-efficacy is the conviction
that one can overcome one’s limitation and accomplish their objectives. Self-
efficacy beliefs influence behaviour in a variety of ways, including the choices
people make on what to do, since most people choose to do things that make
them feel competent and accomplished. Perseverance and perceived stress
levels are also impacted by these beliefs. (Amtmann and others, 2012) Higher
self-efficacy individuals frequently exhibit lower levels of anxiety and
despair, which can positively impact their outlook and ability to adjust to life
after diagnosis (Tan-Kristanto&Kiropoulos, 2015).

Locus of control:The locus of control of an individual affects how they

interpret life's occurrences. While those who have an internal locus of control
believe that their acts are the catalysts for events, those who have an external
locus of control assign events and consequences to factors outside of
themselves, such as other people's actions. (Christensen, N., 2023)

Social support: According to King et al. (2000), social support is linked to

increased emotional and psychological well-being, lower stress levels, and an
improved sense of achievement and satisfaction. Jensen et al. (2014)
discovered a relationship between people with physical limitations' subjective
well-being and their perception of social support. Physically disabled people
are more likely to report not feeling like they have enough social support since
their mobility may be limited, making it harder for them to interact with the
166 larger community. Individuals’ depression levels are influenced differently
depending on the kind of social support they receive, namely from friends, Coping Styles and
Strategies
family, or significant others. Jensen et al. (2014) found that friends provide
the most support.

Economic factors: People with disabilities face a lot of economic challenges

from feeling financial strain due to medical expenses or facing employment or
workplace discrimination. Whether a disease progresses to disability depends
on one's financial situation. Lack of resources can have a negative impact on a
person's capacity to manage a disabling illness.

In a similar vein, a person in need of personal support services or certain

physical adjustments may have fewer alternatives and capacities due to
financial constraints. Additionally, the person might not be able to pay for the
necessary rehabilitation treatments to lessen the extent of their prospective
handicap because they are unable to pay for the services outright or the cost of
specialised transportation services.

Individuals with disabilities encounter obstacles such as job rejection and

economic exclusion. They are thought of as incapable of contributing to
anything, dependent, and perpetually in need of assistance. (Jimmy 2013;
Uromi, S. M., & Mazagwa, M. I. , 2014). Psychological control is one of the
factors that play an important role apart from these external factors.

Self assessment Questions V

1) List the impediments to adjustment in disability.

.................................................................................................................
.................................................................................................................

2) Livneh and Antonak (1997) have described adjusting to a disability is

a ............ and ..................... process that people go through in an effort
to eventually achieve the best possible ............................ .

Psychological Control

Psychological control can be defined as the belief in one’s own ability to exert
control over the stressful events. This ability helps the individual to determine,
control and modify their behaviour when encountered with stressful situation
and adversities and bring out exhibit desired behaviors (Taylor, Helgeson,
Reed, & Skokan, 1991). A lot of factors related to “self” play an important
role in determining the strength of psychological control. It has been found
that self-efficacy which determines the capacity of an individual through self
appraisal is significantly and positively correlated to Psychological Control.

Research also indicates that psychological control need not be individual all
alone it can also be collective that is the perception that significant others have
an important role to play also fosters healthy coping in individuals (Hou &
Wan, 2012).
167
Stress and Psychological control helps in developing interventions to help individual
Coping Styles
with disability. It helps in promoting positive mental health by developing
healthy habits.

7.8 LET US SUM UP

In the present unit, we learnt about the concept and definition of coping,
various factors that have an effect on coping of the individuals with disability.
Coping style and strategies however vary from individual to individual and
from situation to situation but have been summarized by various theorists
using which individuals cope with the stress of disability and while adjusting
and adapting to the environment. Defense mechanisms are used by individuals
with disability in order to overcome grief, loss, guilt and fear. Disability can
be inborn or acquired. In both cases the process of overcoming the stress of
disability is similar and can be understood by understanding the stages of
adaptation and adjustment which enables these individual stop overcome
stress and adjust to their environment. Finally, there are factors such as
physical barriers, structural factors, locus of control, social support,
psychological control and economic factors that play and important role in the
adjustment and adaptation of disables individuals.

7.9 KEY WORDS

Locus of control : defines the degree of control over the situations or
event that an individual assumes to hold.
Defense mechanisms : refer to the methods adopted by individuals to
manage the conflict between Id and Superego.
Acquired disability : is defined as a disability that has developed as a
result of illness or accident during the lifetime of
an individual.
Coping : can be defined as strategies using which an
individual deals and adapts to the adversities
experienced which are leading to stress.

7.10 ANSWERS TO SELF ASSESSMENT

QUESTIONS
Self Assessment Questions I

1) Personality, Cognitive Strategies, Culture, family and Social Support

2) d) Rote Learning

Self Assessment Questions II

1) Major styles of coping are proactive/ reactive coping, emotional focused

coping/ problem focused coping and voluntary/ involuntary coping.
168
2) Voluntary coping can be defined as adoption of coping strategies that Coping Styles and
Strategies
need conscious effort, while involuntary coping is temperamentally based
and conditioned reactions.

Self Assessment Questions III

1) Acquired disability can be defined as a disability that has developed as a
result of illness or accident during the lifetime of an individual.
2) d. All of the Above.

Self Assessment Questions IV

1) Adaptation in context of disability extends to acquiring novel skills,
integrating assistive devices, and embracing coping strategies, all of
which collectively facilitate the navigation of daily life. While,
Adjustment is referred to as a process by which individuals try to
maintain a balance in the adverse situations of life.
2) Stage of adjustment in coping with disability are: Shock, Expectancy of
recovery, Mourning, Defense and Adjustment.

Self Assessment Questions V

1) The major Impediments to adjustment in disability are physical barriers
include structural impediments that obstruct access or mobility, structural
factors such as discrimination, stigma, and ableism; locus of control,
social support and economic factors include challenges from feeling
financial strain due to medical expenses or facing employment or
workplace discrimination.
2) Dynamic; ever-changing.

7.11 UNIT END QUESTIONS

1) Define Coping. Discuss the strategies and styles of coping.
2) Compare and contrast Adaptation and adjustment in the process of
coping.
3) Enumerate the impediments to adjustment in disability.
4) Define Psychological Control. Highlight its importance in coping.
5) Differentiate between disability and acquired disability and how is coping
different or similar in both.

7.12 REFERENCES
 Amtmann, D., Bamer, A. M., Cook, K. F., Askew, R. L., Noonan, V. K.,
& Brockway, J. A. (2012, October). University of Washington Self-
Efficacy Scale: A New Self-Efficacy Scale for People With Disabilities.
Archives of Physical Medicine and Rehabilitation, 93(10), 1757–1765.
[Link] 169
Stress and  Bartram, David & Gardner, Dianne. (2008). Coping with Stress. In
Coping Styles
Practice. 30. 228-231. 10.1136/inpract.30.4.228.

 Berg, C. A., & Upchurch, R. (2007). A developmental-contextual model

of couples coping with chronic illness across the adult life span.
Psychological Bulletin, 133(6), 920–954. [Link]
2909.133.6.920

 Disability and Health Disability Barriers | CDC. (2024, May 2). Centers
for Disease Control and Prevention. [Link]
disabilityandhealth/[Link]

 Christensen, N. (2023, May 10). Disability and Self: Critical Factors in

Positive Adjustment After the Onset of Disability in Emerging Adulthood.
Columbia Social Work Review, 21(1), 101–118. [Link]
10.52214/cswr.v21i1.11209

 Compas, B. E., Connor-Smith, J. K., Saltzman, H., Thomsen, A. H., &

Wadsworth, M. E. (2001). Coping with stress during childhood and
adolescence: Problems, progress, and potential in theory and research.
Psychological Bulletin, 127(1), 87–127. [Link]
2909.127.1.87

 Coppens, C. M., de Boer, S. F., & Koolhaas, J. M. (2010, December 27).

Coping styles and behavioural flexibility: towards underlying
mechanisms. Philosophical Transactions of the Royal Society B:
Biological Sciences, 365(1560), 4021–4028.
[Link]

 de Boer, S. F., Buwalda, B., & Koolhaas, J. M. (2017, March). Untangling

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