By Dr. Felicia Fraser, PhD
Individuals who acquire spinal cord injuries face major challenges that impact functioning in a variety of settings, including at home and in the community. Researchers estimate that the prevalence of psychiatric disorders among individuals with spinal cord injury ranges from approximately 25 to 30 percent, though some studies have found rates as low as 9 percent and as high as 60 percent. Psychiatric conditions following the onset of spinal cord injury include but are not limited to depression, anxiety, PTSD, suicidal ideation, and adjustment disorders.
In both the acute (while in the hospital) and chronic (long-term) phases, psychological responses to spinal cord injury may be influenced by a number of factors such as pain, bowel and bladder dysfunction, mobility, impairments, sensory loss, and isolation. Some individuals may present with sadness, depressed mood, despair, loneliness, guilt, helplessness, resentment, and feelings of inadequacy and worthlessness among other symptoms. Studies have shown that coping style, defined as the network of cognitive, emotional, and behavioral processes and strategies adopted to manage both external and internal stressful situations, is predictive of psychological adjustment (Livneh & Martz, 2011).
Coping styles can be classified as either adaptive/engaged or maladaptive/disengaged. Maladaptive or disengaged coping diverts from the stressor and the related emotions, whereas adaptive or engaged coping involves direct coping, thereby facing the stressor and related emotions (Dijkstra & Homan, 2016). Common forms of maladaptive/disengaged coping include social withdrawal, self-medicating with drugs or alcohol, avoidance, and escape. Use of adaptive/engaged coping, as opposed to maladaptive/disengaged coping, is associated with higher levels of psychosocial adjustment (Livneh & Martz, 2014).
While coping responses may change over time even without intervention or intent, learning to utilize adaptive coping techniques can support psychological adjustment to spinal cord injury. Researchers have adapted the Cognitive Model of Stress and Coping to adjustment and coping within the context of spinal cord injury. This model assumes that the initial appraisals an individual makes after experiencing a traumatic event influence coping strategies, thereby affecting psychological outcomes (Kennedy et al., 2013). Studies have shown that using Coping Effectiveness Training, an intervention aimed at utilizing adaptive coping strategies, is associated with reduced risk of anxiety and depression relative to non-psychotherapy-based activities (Kennedy et al., 2003).
Adaptive coping techniques encompassed in this intervention include normalizing stress, increasing awareness of one’s appraisals and habitual coping tendencies, and problem-solving strategies. Psychoeducation about associations and distinctions between thoughts, feelings, and behaviors; pleasant activity scheduling; and relaxation were other key components of this intervention. Coping Effectiveness Training and other interventions focused on adaptive/engaged coping are often incorporated into mental health treatment given the implications for psychological status and quality of life. Such interventions can also be self-administered, which improves accessibility and feasibility over time. In sum, use of adaptive/engaged coping techniques rather than maladaptive/disengaged coping techniques is recommended for individuals with spinal cord injury in order to support better long-term psychological outcome.