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Rehabilitation psychology. Overview and key concepts.

Rehabilitation is based on the biopsychosocial model, which includes attention to medical, psychological and social aspects of illness and recovery. As part of an interdisciplinary rehabilitation team, mental health professionals evaluate and treat common emotional, cognitive, and behavioral problems. They can promote a patient-centered and individualized approach to care. Current psychological interventions in rehabilitation include cognitive, behavioral, family-based, peer support and positive psychology models. Cognitive remediation techniques can be used to improve the function of people with brain dysfunction. In partnership with physicians and other rehabilitation professionals, rehabilitation psychologists play an integral role in improving functional, psychosocial and health outcomes in chronic illness and disability.

Persons with Disabilities↗

[Attention process training application within an intervention project on attentional processes in children with cancer].

INTRODUCTION: Childhood cancer treatments have made a spectacular advance in recent years, obtaining survival rates of about 70%. These survival rates have permitted many children to reach adulthood, but also involve the appearance of previously unknown neurocognitive sequelae because of high mortality. DEVELOPMENT: Neuropsychological evaluation allows the detection of these deficits and the design of intervention. In children, rather than a loss of function there is a loss of the capacities that should develop in comparison with his/her peers. To obtain a base line to determine the affected and altered areas, it is equally vital to assess the acute and long term effects so as to evaluate the success of the intervention program. Attention Process Training (APT) is an individualized application program of attentional exercises of varying complexity in sustained, selective, alternating and divided attention. This program combines methods and techniques of cerebral damage rehabilitation, as well as educational and clinical psychology. It is completed with a self instruction training which is applied in situations of daily life. CONCLUSIONS: Child cancer treatment continues to carry long term neurocognitive sequelae. Neuropsychological evaluation is basic for its detection, allowing relevant information to be offered to parents and teachers, so as to facilitate design of individualized rehabilitation procedures. Attention training is basic for this type of population with generalized damage related to white matter, and forms part of a wider rehabilitation process that enhance the ecological validity of the program.

Antineoplastic Agents↗

Normality and adolescence.

Diagnostic work with adolescents has always been difficult. The problem is to distinguish serious psychopathology from mild crisis. We can now say, however, that a severe identity crisis and emotional turmoil are just not part of normal growing up. Our belief is that we do not help adolescents who experience such crises or turmoil when we tell them not to worry about their problems because they are a normal part of adolescence and because they will "grow out of it." In summary, we have presented data on the self-image of a large number of adolescents. We have stressed three things. First, we used self-administered questionnaires to collect our data. Most important, our data are consistent, and they are congruent with results obtained from use of other psychologic instruments such as interviews or parents' evaluations of their children. Second, we found that the normal groups of adolescents we studied were characterized more by their similarities than by their differences. The continuity of values for all our samples over an 18-year period and across cultures was especially impressive. Third, we stressed the diversity of adolescents' view of their psychologic worlds. These youths define normal functioning and development. They reside in our communities, and before we can help their disturbed peers who need professional help, we need to know what the norm is. Only then can we correctly diagnose and successfully treat the adolescents who do seek our help.

Adaptation, Psychological↗

Interpersonal processes and psychopathology among expectant and nonexpectant adolescent couples.

This study examined the interpersonal and psychological functioning of expectant and nonexpectant adolescent couples. Interpersonal processes were assessed using the Structural Analysis of Social Behavior (L. S. Benjamin, 1974) and psychological functioning was assessed using the Diagnostic Interview for Children and Adolescents--Revised (W. Reich, 1991). Compared with their nonexpectant peers, expectant couples exhibited higher rates of negative interpersonal processes, including demand-withdraw behaviors and lower rates of positive interpersonal processes. Expectant males reported higher rates of behavior disorders, substance use disorders, and internalizing disorders than nonexpectant males. Higher rates of substance-use disorders mediated the effect of expectancy status on demand-withdraw behavior. Results help clarify the links between the psychological risks associated with adolescent pregnancy and the interpersonal functioning of young expectant couples.

Adolescent↗

The consequences of marijuana use on intrapersonal and interpersonal functioning in black and white adolescents.

We examined the effects of marijuana use on adolescent personality, attitudinal, and behavioral attributes, perceived parent-adolescent relations, and perceived peer factors. Volunteer high school students (292 Blacks, 401 Whites) of middle-class backgrounds filled out questionnaires in their classrooms first when they were in the 9th and 10th grades and again 2 years later when they were in the 11th and 12th grades. Results suggest that regular use of marijuana may lead to lower achievement, increased tolerance of deviance, and more deviant behavior, and greater rebelliousness. Regular use also appears to interfere with adolescents' relationships with their parents and to lead them to associate with more deviant and drug-using friends. The consequences of marijuana use for intrapersonal and interpersonal functioning were for the most part similar in the different sex and age groups, although there were some ethnic differences.

Adolescent↗

Risky parental behavior and adolescent sexual activity at first coitus.

Data from the National Longitudinal Study of Adolescent Health (Add Health) were used to examine the impact of parents' behavior on adolescents' sexual experience and contraceptive use. All else being equal, adolescents whose parents engage in risky behaviors are especially likely to be sexually active and to have had sex before age 15. These findings are only partly attributable to the link between parents' risky behaviors (smoking, drinking, driving without seatbelts) and adolescents' risky behaviors (smoking, drinking, delinquent activity, association with substance-using peers). Although parental behaviors are effective predictors of adolescents' sexual activity, they are not effective predictors of contraceptive use or of method choice at first coitus. Overall, parents with low levels of self-efficacy seem to be especially likely to have children at risk of engaging in problem behaviors.

Adolescent↗

Psychosocial aspects of adolescent cancer survival.

OBJECTIVE: The purpose of this research was to examine the psychosocial status of adolescent cancer survivors and compare them with healthy peers. It has been suggested in previous research that the majority of survivors display equivalent levels of psychosocial functioning post-treatment as compared with healthy controls. However, despite successful treatment, survivors may have to adjust to living with a chronic illness and its associated late effects interspersed across the lifespan (e.g. infertility, cognitive deficits, heart complications). Whilst young people appear to have similar levels of psychosocial functioning, avoidance strategies such as denial may result in previous research findings being confounded and in underestimating the true psychosocial status of survivors. It is important to understand the psychosocial status of survivors in order to optimise their quality of life. METHODOLOGY: Coping mechanisms, anxiety levels and self-concepts of 32 adolescent cancer survivors, predominantly Acute Lymphoblastic Leukaemia (ALL) were compared with 34 healthy adolescents (age range 12-17 years), via a mailout. RESULTS: Survivors' self-reports suggest no overt psychological dysfunctioning. Whilst the two groups shared similar coping strategies, survivors were found to be less anxious than peers, with a tendency to employ avoidance strategies to deal with problems faced in adolescence. Age, gender and specific illness variables, such as age at diagnosis and time since treatment, were strong predictors of psychological outcome. CONCLUSIONS: Results can be interpreted as suggesting that whilst cancer survivors have a similar psychosocial profile to healthy peers, they are more likely to utilise avoidance strategies to manage problems.

Adaptation, Psychological↗

Comments on Heller, Thompson, Trueba, Hogg, and Vlachos-Weber, "peer support telephone dyads for elderly women".

Comments on the support intervention study with elderly women by Heller et al. (1991). The study highlights the need to determine what aspects of social support are most effective for particular populations. I discuss what basic research on supportive functions suggests for this population, and what kinds of knowledge are needed to best translate epidemiologic findings into intervention research designs. Related research on the effects of family vs. peer support is discussed, and processes that may help or hinder family support are proposed. Finally, I note some implications for further research on social networks of elderly persons, and approaches to increasing social companionship and social integration.

Aged↗

Friendship expectations among immigrant adolescents and their host peers.

This study investigated differences in friendship expectations between immigrants in early and middle adolescence and their Israeli-born peers. Israeli newcomers from the former Soviet Union and their non-immigrant classmates were asked to rate behavioural characteristics of peers according to the extent of their importance for friendship, and also to assess the importance of these characteristics as friendship expectations of members of the other group. Results indicate that immigrants assign greater importance than their host counterparts to all aspects of friendship expectations (help and assistance, status, similarity, and avoidance of harm). Immigrants also tend to view their host peers as expecting more of their friendship in terms of status and similarity, whereas host adolescents perceive the help and avoidance functions of friendship to be a strong factor in the friendship expectations of their immigrant counterparts. Immigrants' friendship expectations were found to be correlated with social distress, especially among early adolescent girls. The results are discussed in terms of the functions of friendships and friendship expectations in the immigrants' adaptation process, and of institutional differences in allocation of immigrants to integrated or segregated classrooms.

Adolescent↗

[Determinant factors of functional status among the elderly].

OBJECTIVE: To investigate the impact of health-related demographic and socioeconomic factors, as well as the impact of factors associated to social activity and the subjective health evaluation on the functional status of elderly people. METHODS: A cross-sectional multicentric study was conducted in a representative population sample in the city of São Paulo, Brazil, in 1989. Functional status was evaluated using a scale of activities of personal and instrumental daily living. It was studied as a dichotomous variable: absence of dependency - disability/difficulty in none of the activities in contrast with moderate/severe dependency - disability/difficulty in 4 or more activities. Multiple regression analysis was applied to hierarchically clustered factors. RESULTS: Those with the following features were more associated to moderate/severe dependency: illiterate, retired, pensioner, house keeper, living in a rented home, age over 65 years, multigenerational family composition, hospitalization in the last 6 months, mental health screening case, no visiting friends, and having a pessimistic perception of his/her own health when compared to their peers. CONCLUSIONS: The identified features associated to moderate/severe dependency suggest a complex net of causes for the declining functional status. However, one can assume that preventive measures directed to specific factors can benefit these population by improving their well-being.

Activities of Daily Living↗

Cognitive coaching for nurse educators.

Major changes within the work setting may be required in order to meet the requisite conditions for a successful peer coaching program. A cadre of teachers and administrators who are committed to faculty professional development is fundamental to the implementation and success of this type of program. The peer coaching approach to faculty development allows for personal and professional growth through trust, openness, and curiosity. Learning is promoted as a never-ending, lifelong process. Additionally, discussion and critique of others' views are promoted. These aid in the refinement of individual thinking and enhance individual competencies. Peer cognitive coaching is a strategy that involves the use of human resources in an effort to enhance the education of both teachers and students. Cognitive coaching acknowledges nurse educators as professionals and encourages them to function as self-regulating learners.

Cognition↗

The practice of prevention in the New York City public schools.

Five prevention models based on arousal, coercion, and psychotherapeutic counseling are constructed. The models consist of arousal of anger and channeling the emotion to reverse passivity; arousal by self-discovery and reinforcer sampling without social risk, to attract adoption of a more productive role, coercion by peer group rule enforcement while newly learned resistance behaviors are established; coercion by parental rule enforcement while parents learn new skills and family functioning is repaired; and therapeutic counseling, wherein student internalizes new learning about personal significance by experiencing caring that survives conflict. The dynamics implied by choice of model for each student and engaged by its use will explain changes in student behavior. Examination of singular activities such as "peer influence" or "inoculation" must be done within the context of the model in order to comprehend the nature of its use and predict the outcome.

Adolescent↗

Perfectionism, low self-esteem, and family factors as predictors of bulimic behavior.

A previous study found that self-reported body dissatisfaction, depression, and peer pressure to maintain a thin body shape were significant predictors of bulimic behavior in college women, but that family functioning was not a significant predictor [Eat. Behav. 2 (2001) 323]. The current study examined whether perfectionism, low self-esteem, and a more specific family variable--perceived pressure from the family to be thin--predicted any additional variance in eating-disordered behavior after significant variables from the previous study had been taken into account. As in the previous study, self-reported body dissatisfaction, depression, and peer pressure to maintain a thin body shape were significant predictors of bulimic behavior. Perceived weight-related pressure from the family was also a significant predictor. In contrast, high parental expectations were found to predict lower levels of bulimic behavior and to moderate the effects of peer influence on bulimic behavior. The variables found in this study to be related to bulimic behavior may be useful targets for clinical intervention for women with disturbed eating patterns.

Adult↗

High school students who use crack and other drugs.

BACKGROUND: When it appeared in the 1980s, crack was thought to represent a completely new pathway of entry into drug use. Our objective was to identify the distinguishing characteristics of adolescents who have reached different stages of drug use, in particular the highest state represented by crack. METHODS: Adolescents (N = 7611) representative of students in grades 7 to 12 from 53 New York state schools were classified in the following six mutually exclusive, cumulative categories of drug use: nonusers; alcohol and/or cigarette users only; marijuana users only; users of illicit drugs other than marijuana but neither cocaine nor crack; cocaine but not crack users; and crack users. The groups were compared in level of psychosocial functioning. RESULTS: Students who use illicit drugs show deficits in school performance, quality of family relationships, and health and increased psychological symptoms. Compared with nonusers, they are more delinquent and more actively involved with their peers and live in social environments in which the perceived use of drugs by other adolescents and parents is more extensive. Delinquency and extent of perceived drug use consistently increase with each higher stage of use. Crack users exhibit the lowest level of psychosocial functioning of any drug-using group. CONCLUSIONS: There are stage-specific characteristics and common characteristics (delinquent participation, peer drug use) throughout the developmental sequence of drug use. Despite declines over the last two decades in the prevalence of the use of different drugs, young people who use drugs display characteristics over historical time similar to those of young drug users 20 years ago.

Adolescent↗

Psychosocial support for patients in pediatric oncology: the influences of parents, schools, peers, and technology.

The diagnosis and treatment of pediatric cancer can be associated with profound psychosocial changes in the life of young patients. Although nurses, physicians, and other health care professionals are important sources of support, psychosocial support is also available through parents, schools, and peers. This article presents a review of the literature on how parents, schools, and peers affect the coping and adjustment of young patients with cancer and critically reviews interventions directed at improving functioning in these areas. Special attention is paid to recent interventions that exploit technology such as video games, CD-ROMs, and the Internet to provide creative new forms of support for patients in pediatric oncology. Existing research on both technological and interpersonal forms of intervention and support shows promising results, and suggestions for further study are provided.

Adaptation, Psychological↗