Psychotherapy is an important part of rehabilitation treatment technology. The psychological characteristics and rules of the sick, injured and disabled, especially the disabled, are different from those of ordinary people and patients in the rehabilitation process. Therefore, during the rehabilitation treatment, psychotherapists and other professionals should implement psychotherapy according to the psychological characteristics of the sick, injured and disabled to ensure the comprehensive rehabilitation of the sick, injured and disabled. Rehabilitation physicians should also learn and master certain knowledge and skills of rehabilitation psychotherapy, and understand the psychological characteristics of the sick, injured, and disabled, in order to apply various rehabilitation treatment techniques including psychotherapy, so that the patient’s physical function and psychological behavior can be maximally rehabilitated.
Psychotherapy (psychotherapy). Also known as psychotherapy, it is the application of psychological principles and methods to heal the patient’s cognitive, emotional and behavioral problems through the interaction between the therapist and the therapee. It is a therapist who uses various verbal and non-verbal methods to change the patient’s cognition, beliefs, emotions, attitudes and behaviors through explanation, persuasion and support, in order to solve the problems, reduce the pain, and promote the patient to face life and live better and adapt to society.
I. Classification of psychosocial disabilities
1.Intellectual disability.
Intellectual disability is an irreversible intellectual deficit caused by serious organic damage to the brain or due to incomplete brain development. Intellectual disability is not just a disability of intelligence, but a comprehensive low level of various mental abilities, thus making it impossible to live, study and work like normal people, or even to adapt to normal social life. Intellectual disability can be divided into mental retardation and dementia.
Mental retardation is caused by genetic mutation, infection, poisoning, head injury, cranial malformation or endocrine abnormality and other harmful factors that cause the fetus or infant’s brain to fail to develop normally or to develop incompletely, so that the development of intellectual activity stays at a relatively low stage. Mental retardation can be divided into mild, moderate, severe and very severe, or into foolishness, dementia and idiocy. In dementia, the brain is damaged by physical, chemical and biological factors, causing serious damage to the original normal intelligence.
2.Behavioral and personality disability.
Behavioral and personality disability refers to the deviation or incongruity of stubborn behavior or personality development based on bad genetic qualities and under the influence of adverse socio-cultural environmental factors later in life, which is obviously different from normal people in terms of behavior patterns and emotional reactions. Therefore, it is difficult to adapt to the social life of normal people, often bringing not only losses to themselves, but also harm to others and society. Some of these people gradually relieve themselves due to the improvement of environmental conditions or through self-adjustment, while others may last a lifetime or even seriously lose their social functions.
3. Mental disability.
Mental disability is due to various mental illnesses, unable to recover to the original normal state, unable to maintain normal mental activities, and with irreversible damage becoming mental disability. People with mental disabilities are often unable to carry out normal social activities, unable to engage in normal work, and in severe cases, unable to take care of themselves.
Second, the psychological characteristics of the sick, injured and disabled
1. Cognitive characteristics.
Sick, injured and disabled people have different categories, that is, they have different defects, which will affect their cognitive style and cognitive ability. For example, blind people lack spatial concepts due to the loss of visual organ function, they do not have a complete picture of what is around them, and their image thinking is very underdeveloped. Although their sense of hearing and touch are very sensitive, they cannot compensate for the loss of vision. Since blind people do not have visual interference, they form the habit of thinking, and their abstract and logical thinking is more developed. Also because they have a more developed language and hearing ability and a better memory, the vocabulary they remember is richer, which also forms the characteristics of their strong language ability. In contrast, deaf people have very well developed figurative thinking, but their logical and abstract thinking is relatively affected. Patients with behavioral and personality deviations are emotionally unstable, and not only are their behaviors influenced by their emotions, but their cognitive style and cognitive abilities are also often affected by adverse emotions. Their cognitive characteristics are poor realism, easy to leave the actual to think about the problem, with a strong fantasy color, and paranoid tendency.
2. Emotional characteristics.
(1) loneliness and low self-esteem strong illness, injury, disability in the physical or psychological defects, often lead to loneliness and low self-esteem emotional reaction, more serious interpersonal barriers. Loneliness due to lack of understanding and low self-esteem due to frustration are the psychological problems that occur when people with illnesses, injuries and disabilities encounter difficulties and problems in life, study, work and social life without understanding, support and help.
(2) Sensitive, strong and unstable emotional reactions The impact of disability on the individual’s emotions is characterized by sensitivity, strong reactions and instability, and they may show more intense anger when their self-esteem is seriously hit, and may even take some retaliatory behavior. They are also more intense in the way they express their emotions, and are prone to extreme emotional reactions.
(3) Compassionate: mainly in the sick, injured, disabled people have a particularly deep compassion for their own kind, such as blind people to blind people, deaf people to deaf people with very good mutual feelings. This is because there is a common defect, the same way of communication, more willing to pour out their hearts together and exchange their feelings about life, learning and work.
3. Characteristic features.
As a special group of people, the sick, injured and disabled are not only special because of their physical disabilities, but their living environment also has certain special characteristics. Few interactions, simple social environment, and small social range, so that certain personality characteristics are formed, such as introversion, isolation, low self-esteem, etc.. In addition, each type of disease, injury, and disability has its own special personality characteristics. For example, blind people are more introverted, gentle and elegant, rarely outbursts; deaf people are more outgoing, brisk and straightforward; physically disabled people often show stubbornness and self-restraint, with strong endurance.
Third, the psychological adaptation process of the sick, injured and disabled
After suffering from disease or trauma causing disability, patients will undergo a series of psychological changes, first shock and denial, then depression or anxiety, anger or confrontation with independence, and finally psychological adaptation. The stages cannot be separated and may cross over. In the process of rehabilitation treatment, medical and nursing staff must correctly understand and grasp the psychological characteristics of the patient and the reactions of each stage in order to help and guide the patient to adapt to the change of disability as soon as possible and actively cooperate with the rehabilitation treatment.
1.Shock stage.
Shock is the patient’s immediate reaction to trauma and disease, a stage when the sudden and serious blow has not yet had time to be integrated. When an unexpected event occurs suddenly, the patient is often in physical shock and mental numbness, hazily realizing that “everything is over”, manifested in emotional stunned, numb, silent or no obvious reaction, and this stage lasts for several minutes to several days.
2. Denial stage.
As the shock of disability comes suddenly and violently, it is beyond the patient’s psychological capacity, so it is natural to adopt a psychological defense mechanism. The desire for survival is generally very strong when an accident occurs, and after being rescued from danger, people are often glad to be “back from the dead”, but they lack awareness of the terrible consequences of their possible lifelong disability and are not prepared for it, but believe that they can still fully recover and live happily as before. This is a natural psychological defense mechanism that completely denies the reality and prognosis of what has happened and is so sad. This stage can last from weeks to months.
3. Depression or anxiety reaction stage.
As medical treatment and rehabilitation proceed, patients gradually realize that they will have long-term or lifelong disabilities, such as hemiplegia, paraplegia, amputation, etc., and may have to spend their lives in wheelchairs; some people even have no control over urination and defecation, loss of fertility, speech and hearing impairment; in addition to physical disabilities, there are changes in social status and family roles, and deterioration of economic status. All this often makes the patient feel discouraged by becoming a “burden” to the family and society, and lose confidence in the future, showing extreme depressive reactions or typical anxiety reactions, and in some cases, suicidal thoughts and behaviors. This stage lasts for several weeks or months.
4. Anger or confrontation with independence stage.
After the patient realizes his or her disability, due to the increase of depression or anxiety, he or she often appears to be irritable, irritable, angry, or angry about trivial things, even dropping things, hitting people, refusing rehabilitation treatment, etc. Some patients appear to be psychologically and behaviorally regressive, showing excessive dependence on others, asking the escort or nurse to do what he or she can still do in life, not actively cooperating with rehabilitation treatment, etc. They do not cooperate with rehabilitation treatment, etc. Because they do not have the courage to face society independently with their disabilities. After being discharged from the hospital, they rely too much on their families and society, and lack the psychological and behavioral ability to earn a living independently.
5. Psychological adaptation stage.
After the above-mentioned stages, especially after giving certain rehabilitation treatment and two-way adaptation with family and social environment, patients gradually realize the reality of disability, gradually start to adapt from psychological to behavioral, depression and anxiety, pessimism and anger, confrontation with independence and other emotions improve or disappear, actively cooperate with rehabilitation treatment and training of daily living ability in action, have the idea to actively strive for self-care and return to society. They will try to participate in some or all of the family activities and resume some or all of their jobs.
Establishment of psychological rehabilitation system
1. Establishment of individual psychological adjustment mechanism.
The process of psychological rehabilitation is the process of allowing the sick, injured, and disabled to establish a psychological adjustment mechanism. Theoretically speaking, all sick, injured or disabled people or all sick, injured or disabled people receiving rehabilitation treatment should receive systematic and specialized psychological interventions, so that Li-Men can face various difficulties and, with the help of psychotherapists, form a positive psychological adjustment mechanism to gradually adapt to changes in life, study, family or work, in order to cope with various psychological problems that may arise and maintain psychological health. .
2.Establishment of assistance support system.
Sick, injured, disabled people live in a certain group, the attitude of the relevant people (colleagues or family members) has an important impact on their psychological state. In particular, family members and colleagues should understand the psychological problems caused by the disability, while the sick, injured or disabled person also brings psychological pressure to family or small group members. Therefore, psychological rehabilitation is not only to pay attention to the psychological changes of the sick, injured and disabled and give them timely psychological treatment, but also to pay attention to the psychological counseling work of those who are close to them like family members or colleagues, so as to create a good atmosphere for the psychological treatment of patients.
3, the establishment of expert assistance support system.
The psychological treatment of the sick, injured and disabled is a long-term adjustment process. To be guided and assisted by psychologists, psychotherapists and other professionals or experts, they must master the theory and methods of psychological counseling and psychotherapy, and have the skills and clinical experience to engage in psychotherapy. Through their treatment and guidance, the sick, injured and disabled people can gradually get rid of the negative psychological influence and establish positive life goals.
4.Establishment of community support system.
The rehabilitation process of disability is often a process that accompanies the sick, injured and disabled for the rest of their lives. When they return to their families and society, the community support system becomes very important. The role of relevant experts and related personnel in the community, such as community rehabilitation workers, community physicians, social workers and other personnel, should be brought into play to provide the necessary support and assistance at any time when the patient has psychological problems and to provide guarantees for psychological rehabilitation.
V. Psychological treatment methods commonly used in rehabilitation
There are many branches of psychotherapy and a variety of treatment methods. Here is a brief introduction of the commonly used methods.
1.Spiritual support therapy.
Spiritual support therapy is a widely used therapy at present. It is a psychologist (therapist) who reasonably uses communication methods such as persuasion, inspiration, encouragement, sympathy, support, evaluation, persuasion, elimination of doubts and provision of reassurance to help patients understand their problems, improve their state of mind and increase their confidence, thus promoting psychosomatic rehabilitation. It is particularly suitable for the psychological treatment of sick, injured and disabled people when they are depressed and anxious, negative and pessimistic. The process of implementing psychiatric support therapy is to first collect detailed information on various aspects, including living conditions, family situation, social background, interpersonal relationships and personality characteristics; secondly, to conduct the necessary examination or through the medical history to grasp the current state of the disease; then to select a quiet environment and have a cordial conversation in which the sick, injured or disabled person confesses his or her condition (especially his or her psychological condition), and the psychologist listens attentively and, if necessary, can Finally, the psychiatrist will analyze and treat the patient according to his or her complaints and the information available to him or her. Each treatment can only partially solve the problem.
2.Behavior therapy.
Behavior therapy (behavior therapy) 3L called conditioned reflex therapy, is guided by the theory of behavioral learning, according to certain treatment procedures to eliminate or correct people’s abnormal or undesirable behavior of a psychotherapy. The main theoretical basis of behavior therapy is Pavlov’s classical principle of conditioned reflexes. Behavior therapy emphasizes that a patient’s abnormal behaviors or physiological functions can be corrected or eliminated by means of conditioned reflexes, i.e., learning, or new healthy behaviors can be established to replace them. There are many kinds of behavioral therapies such as systematic desensitization therapy, shock therapy, aversion therapy, behavior shaping method, and token system therapy, etc. Two of them are briefly described below.
(1) Systemic desensitization therapy starts with an in-depth understanding of what kind of stimulus situations cause the patient’s abnormal behaviors (such as anxiety and fear), and arranges all the anxiety reactions into “anxiety hierarchies” in order from weak to strong. Then, the patient learns to relax, and the relaxed state and the anxiety state are arranged in a hierarchy from low anxiety to high anxiety, forming a reciprocal inhibition or confrontation situation, and eliminating them one by one from weak to strong (i.e. desensitization), and the abnormal behavior is overcome and the patient reestablishes normal behavior.
(2) Token system therapy is a behavior therapy in which patients are rewarded (tokens) immediately when they perform expected good behaviors through some kind of reward system, so that their good behaviors can be formed and consolidated, and their bad behaviors can be subdued. This is formed and refined on the basis of the operational conditioning theory, especially the principle of conditioned reinforcement. Tokens are used as positive reinforcers and can be expressed in the form of scorecards, chips, etc. Tokens can be exchanged for items or activities that the patient prefers. The tokens can also be withdrawn when the patient exhibits undesirable behaviors, and negative reinforcement can be applied. This method can be used in conjunction with exercise and occupational therapy for the sick, injured, and disabled.
3.Cognitive therapy.
Cognitive therapy is a general term for a class of psychotherapeutic methods that change the patient’s poor cognition through cognitive and behavioral techniques based on the theoretical assumption that cognitive processes influence emotion and behavior. The basic idea of cognitive therapy is that cognitive processes and their resulting misconceptions are the mediators of behavior and emotion, and that maladaptive behavior and emotion are related to maladaptive cognition. The psychologist works with the patient to identify these maladaptive cognitions and provides learning or training modalities to correct this knowledge and bring the patient’s cognition closer to reality and actuality. As the maladaptive cognitions are corrected, the patient’s psychological barriers are gradually removed. Cognitive therapy is generally divided into four treatment processes.
(1) Establishing the motivation to seek help The doctor and the patient agree on the cognitive interpretation of their problem, explain the maladaptive presentation and estimate the expected outcome of the correction.
(2) Correction of maladaptive cognitions, i.e., the patient develops new cognitions and behaviors to replace maladaptive ones.
(3) Counteracting the old cognition with new cognition allows the patient to practice applying the new cognitive model to social situations, replacing the old cognitive model.
(4) Changing perceptions about the self as a result of the new perceptions and training requires the patient to reevaluate self-efficacy and the role of the self in processing perceptions and situations.
Cognitive therapy can be used to treat depression and anxiety, emotional irritation, sexual dysfunction, social terror, chronic pain, etc. in sick, injured, and disabled people.
4.Biofeedback therapy:
Biofeedback therapy (biofeedback therapy) is in the electronic apparatus with the help of the body’s internal physiological processes, bioelectrical activity to be amplified, the amplified information in the form of visual or auditory presentation, so that the subject can understand their own body state, and learn to control and correct abnormal physiological changes to a certain extent at will. The types of biofeedback are brain wave feedback, electromyographic feedback, heart rate feedback, blood pressure feedback, electrical skin feedback, skin temperature feedback, etc. Psychological problems such as tension, anxiety, fear and most psychosomatic disorders can be treated and relieved by biofeedback. Patients are taught general relaxation exercises at the beginning of treatment, and are instructed to make observations of their own bodies during the exercises. Three types of sensory information should be learned to be grasped when learning to observe: the first is a clear physiological state, the second is an awareness of internal bodily sensory cues, and the third should be an understanding of the meaning of the feedback received from the apparatus. At the end of each training session, the patient should be asked to make a subjective rating to understand how many levels of tension the patient has reduced from after the training. From the second training session onwards, the patient should be asked to talk about the problems encountered since the training to provide a basis for determining new training goals. Biofeedback therapy can be used for the treatment of paralyzed patients or sick, injured or disabled people who are nervous, anxious, scared and other psychological states.
5.Morita therapy:
Morita therapy (morita therapy) is a psychotherapy for neurosis created by Japanese scholar Morita Masa. Morita believes that the basis of neurosis is neuroticism, so by ignoring the attitude of “staying as you are and listening to nature”, emotions can be relaxed. This allows all the bad feelings to disappear on their own until the disease is cured. Morita therapy is mostly used for adult patients who are mainly hospitalized, mainly for the treatment of obsessive-compulsive thinking, hypochondria, anxiety neurosis, and plant nerve disorders, but also for the treatment of certain psychosomatic diseases.