Academic journal article Journal of Cognitive Psychotherapy

Chronic Physical Disability and Secondary Control: Appraisals of an Undesirable Situation

Academic journal article Journal of Cognitive Psychotherapy

Chronic Physical Disability and Secondary Control: Appraisals of an Undesirable Situation

Article excerpt

"Secondary control" (accommodation to unchangeable, undesirable situations), rather than just "primary control" (choosing to leave or improve the situation) can help in adapting to a chronic physical disability. To identify instances of secondary control, semistructured interviews with 22 persons with chronic physical disabilities were conducted. This research examined the emotional valence of disability appraisals, and identified regularities in these appraisals. Results showed that the great majority of interviewees used secondary control in handling their disability, and that 95% of comments were non-negative in emotional tone. Regularities included mention that one learns much about the self and others, and comes to know more than able-bodied persons in some ways. It is concluded that secondary control processes are useful, and their training should be considered during cognitive therapy.

Acquiring a chronic physical disability-whether by illness or injury-often reduces control over one's life. The onset of the disability is sometimes instant; at other times, it is gradual and insidious. Serious health problems impose a great burden on numerous facets of life. It is suggested that peoples' cognitive appraisals of the disability are related to their psychological health.

This topic merits our attention because of the large number of people who experience a chronic physical disability. "Physical disability" is defined as a condition that impairs or substantially limits one or more major life activities (Americans with Disabilities Act, 1990). Chronic conditions are present in 14.3% of the population of the United States, or in more than one of seven people (Department of Health and Human Services, 1992, pp. 106-107). Chronic conditions occur in 22.2% of those between 45 to 65 years of age and in 37.9% of those over the age of 65.

The disability experience erodes controllability in ways that go far beyond the obvious physical limitations and symptoms. For example, losing one's ability to walk can lead to restrictions in job opportunities and/or the availability of accessible housing. Thus, the physical limitations are not only problematic in and of themselves as they erode actual physical control, but they also can lead to additional psychosocial difficulties in ways that disrupt one's previous life and one's belief in one's control.

The dominant subcultures of Western societies, as well as many studies of control, typically define control implicitly or explicitly as the perception that a given situation can possibly be changed (e.g., by buying an assistive device), avoided (e.g., fatigue can be avoided by purchasing the services of an aide or sometimes by ingesting a pill), and/or is subject to choice by the individual about their participation in the stressful situation. This form of control is called "primary control" by Rothbaum, Weisz, and Snyder (1982). It can be contrasted with "secondary control": the accommodation to a reality that cannot be changed given current medical capabilities.

A decay of primary control often rouses efforts to restore control. Indeed, Rothbaum et al. (1982) asserted that control is so highly valued that its pursuit is rarely abandoned; instead, people shift from one form of control (primary) to another form (secondary). They regard secondary control as intrinsically rewarding.

It should be noted that primary control is partially diminished in most cases of disability, but is rarely lost fully (e.g., a complete loss of primary control applies to the person who is in a coma). For example, primary control is present for persons with disabilities (PwDs) in the choice of personal aides and in decisions to marry or divorce.

There is often considerable overlap between primary and secondary control (e.g., obtaining a fairly sophisticated understanding of their illness, treated here as a secondary control technique, also may have a primary control function in evaluating the qualifications and procedures of potential health care providers)1. …

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