Models of adjustment to chronic illness: Using the example of rheumatoid arthritis
Introduction
Dubos (1961) identified the complex nature of health and adaptation to illness when he likened our perception of health to a receding mirage. He went on to explain that from a distance, health and adaptation to illness appear to be a clear concept, but as researchers and clinicians approach and attempt to define it, the substance disappears. In fact, there are three major paradigms that attempt to organize key components of health and adaptation to illness which include the following: the biomedical model which emphasizes disease; psychological models of adaptation to illness; and biopsychosocial models with the latter two emphasizing health, functioning, and well-being Greenfield & Nelson, 1992, Larson, 1999. These three paradigms were selected for review as they are currently the predominant models of explanation of how individuals adjust to chronic physical illness in both research and clinical practice. Each of these three major paradigms, including biomedical, psychosocial, and biopsychosocial frameworks, is discussed in turn, and the contributions and theoretical issues in terms of adjustment to chronic illness. Rheumatoid arthritis (RA) was selected as a focus of the paper because it is a serious chronic medical condition, and is among the most common causes of musculoskeletal pain, estimated in community studies to affect 0.5–1% of the population Arnett et al., 1988, Lawrence et al., 1998, Wolfe et al., 1990. As well, RA is a good exemplar of physical illness as it involves obvious pathophysiological factors and psychosocial issues, which enables a close inspection of the strengths and limitations of each model of adjustment to chronic physical conditions.
Section snippets
Biomedical models of adjustment to illness including RA
The first scientific paradigm for health originated with development of the machine model of the human body. Descartes (1596–1650) saw the body as a homologue of the machine. Descartes considered illness to be both natural and occurring on an individual basis, and further recommended that investigation of disease be divided into understandable components rather than a holistic approach Kelman, 1975, Larson, 1999. The methodologies that developed from this view continue to dominate the practice
Psychological models of adaptation to illness
The acceptance that psychological factors may play a role in the etiology and course of serious illnesses, including rheumatic conditions, has been acknowledged only for half a century with the skepticism of the medical profession expressed by the prominent physician Arnott (1954 as cited in Larson, 1999) who said: “So far as I can see, this hypothesis [i.e., the role of psychological factors, especially stress, in disease progression] has no scientific credible basis whatsoever—in fact most of
The biopsychosocial framework of adaptation to illness
As previously detailed, there is a growing body of literature that suggests that psychological variables may indeed influence disease activity, and related physical adjustment variables, such as pain and disability, via neuroendocrine and immune pathways in healthy individuals and those with RA Affleck et al., 1987, Affleck et al., 1992, Burckhardt et al., 1997, Cutolo et al., 1999, Harrington et al., 1993, Jacobs et al., 2001, Kiecolt-Glaser, 1999, Martin et al., 1996, Nicassio et al., 1999,
A proposed biopsychosocial model of adjustment to RA as an exemplar of chronic physical illness
Based on research conducted to date, albeit disparate research, an integrated biopsychosocial model is proposed of how stressors may impact on disease activity and related physical functioning outcomes in rheumatic conditions (Fig. 3). For the purposes of this research, Lazarus and Folkmann's (1984) stress and coping paradigm is the theoretical framework of the proposed model of psychosocial and physical adjustment to RA as an exemplifier of chronic physical illness. The stress and coping
References (167)
- et al.
The neuroendocrine immune basis of rheumatic diseases
Immunology Today
(1999) - et al.
Development of a questionnaire for the assessment of active and passive coping strategies in chronic pain patients
Pain
(1987) - et al.
Cytokines, glucocorticoids and neuroendocrine function
Pharmacological Research
(1994) Psychosocial factors and health status in women with rheumatoid arthritis: Predictive models
American Journal of Preventative Medicine
(1997)- et al.
Stress hormones, Th1/Th2 patterns, pro/anti-inflammatory cytokines and susceptibility to disease
Trends in Endocrinology and Metabolism
(1999) The conceptualisation of meaning in illness
Society, Science and Medicine
(1994)The measurement of meaning in illness
Society, Science and Medicine
(1995)Positive psychological states and coping with severe stress
Social Science & Medicine
(1997)Stress, personal relationships, and immune function: Health implications
Brain, Behavior, and Immunity
(1999)Learning to live with the pain: Acceptance of pain predicts adjustment in persons with chronic pain
Pain
(1998)
Coping strategies predict disability in patients with primary fibromyalgia
Pain
An interpersonally based model of chronic pain: An application of attachment theory
Clinical Psychology Review
Content validity in the assessment of health states
Health Values
Health psychology: Why do some people get sick and some stay well?
Annual Review of Psychology
Attributional processes in rheumatoid arthritis patients
Arthritis and Rheumatism
Cognitive adaption to adversity: Insights from parents of medically fragile infants
Construing benefits from adversity: Adaptational significance and dispositional underpinnings
Journal of Personality
Neuroticism and the pain–mood relation in rheumatoid arthritis: Insights from a prospective daily study
Journal of Consulting and Clinical Psychology
Fibromyalgia and women's pursuit of personal goals: A daily process analysis
Health Psychology
Appraisals of control and predictability in adapting to a chronic disease
Journal of Personality and Social Psychology
Vulnerability and resilience to combat exposure: Can stress have lifelong effects?
Psychology and Aging
Positive psychosocial adjustment in potential bone marrow transplant recipients: Cancer as a psychosocial transition
Psycho-Oncology
Health, stress, and coping
Inhibition of the production and effects of interleukin-1 and tumor necrosis factor a in rheumatoid arthritis
Arthritis and Rheumatism
Central nervous system infections in the immunocompromised host
Infection
The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis
Arthritis and Rheumatism
The abuse of rest
Lancet
A stitch in time: Self-regulation and proactive coping
Psychological Bulletin
Sense of control and adjustment to breast cancer: The importance of balancing control coping styles
Journal of Behavioral Medicine
Psychological distress among adult patients being evaluated for bone marrow transplantation
Psychosomatics
Self efficacy mechanism in human agency
American Psychology
Ascribed meaning: A critical factor in coping and pain attenuation in patients with cancer related pain
Journal of Palliative Care
Anti-inflammatory actions of glucocorticoids: Molecular mechanisms
Clinical Science
Relationship of cognitive constructs to adjustment in rheumatoid arthritis
Cognitive Therapy and Research
Social roles, context and evolution in the origins of depression
Journal of Health and Social Behavior
Pain-coping strategies of women with fibromyalgia: Relationship to pain, fatigue, and quality of life
Journal of Musculoskeletal Pain
Families and health: The negative side of social ties
Annals of Behavioral Medicine
Structural equations modeling with AMOS: Basic concepts, applications, and programming
How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer
Journal of Personality and Social Psychology
Pituitary–adrenal axis responsiveness to ovine CRH in patients with rheumatoid arthritis treated with low-dose prednisone
Journal of Rheumatology
What does morbidity have to do with disability?
Disability and Rehabilitation
Attributional style and depression in rheumatoid arthritis: The moderating role of perceived illness control
Rehabilitation Psychology
Seminars in Medicine of the Beth Israel Hospital, Boston: The Hypothalamic-Pituitary-Adrenal Axis and Immune-Mediated Inflammation
New England Journal of Medicine
The concepts of stress and stress system disorders: Overview of physical and behavioral homeostasis
Journal of the American Medical Association
Beyond attentional strategies: A cognitive–perceptual model of somatic interpretation
Psychological Bulletin
A better world or a shattered vision? Changes in perspectives following victimization
Social Cognition
Informing patients: An assessment of the quality of patient information materials
Is stress a factor in the pathogenesis of autoimmune rheumatic diseases
Clinical and Experimental Rheumatology
Constructs and models in health psychology: The case of personality and illness reporting in diabetes mellitus
British Journal of Health Psychology
Hostile personality and risks of peripheral arterial disease in the general population
Psychosomatic Medicine
Cited by (65)
Predicting health-related quality of life in dialysis patients: Factors related to negative outcome expectancies and social support
2021, Patient Education and CounselingCitation Excerpt :Another potentially important predictor of HRQOL is the patient’s confidence in its ability to handle potential stressors, known as self-efficacy [20–23]. In addition to these cognitive-behavioral factors, social aspects have been found to affect HRQOL in patients with various chronic diseases [24]. Social support serves as a buffer to stressors and protects against unfavorable disease outcomes [14] and is associated with better HRQOL and decreased somatic symptoms and worrying [19,22,25–27].
Multimorbidity and quality of life: Systematic literature review and meta-analysis
2019, Ageing Research ReviewsCitation Excerpt :It could be that patients underreported their psychological problems having feared their social acceptance, as described by Fortin et al., 2006 (Fortin et al., 2006). Psychological adaptation of a patient to a health change (Walker et al., 2004), or potentially limitations of measurement tools to capture the change on psychological domain for multimorbid patients may also be a factor. A stronger inverse relationship between multimorbidity and physical QoL domains was previously noted (Fortin et al., 2004; Hodek et al., 2010).
The role of psychological factors in inflammatory rheumatic diseases: From burden to tailored treatment
2016, Best Practice and Research: Clinical RheumatologyCitation Excerpt :Within such models, both risk factors associated with worse outcomes and resilience factors that protect an individual from potential negative consequences are included. These models mostly consist of a combination of relatively stable personality characteristics, external stressors, and social aspects and a variety of cognitive, emotional, and behavioral risk and resilience factors, which influence the quality of life and disease outcome [3,24,25]. The risk and resilience factors included in the biopsychosocial models as depicted in Fig. 1 could influence the quality of life and disease outcome in inflammatory rheumatic diseases through different routes of possible mediating or moderating effects.
Influential Factors in Accepting Amputation by Trauma Patients: A qualitative study
2023, Research Square