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Interacción y Perspectiva Dep. Legal pp 201002Z43506
Revista de Trabajo Social ISSN 2244-808X
Vol. 13 N
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Julio-diciembre
ARTÍCULO DE INVESTIGACIÓN
El papel de la competencia de afrontamiento del individuo en la
aplicación del proceso de rehabilitación
DOI: 10.5281/zenodo.7812215
Elena Morozova *, Lyudmila Senkevich **, Galina Yulina ***, Valery Kartashev ****,
Anna Rybakova *****, Maria Tsygankova ******
Resumen
El objetivo fue examinar las características de compromiso con la rehabilitación y las
estrategias de afrontamiento de los pacientes. El estudio se realizó en la Oficina Federal
de Evaluación Médica y Social del Ministerio de Trabajo y Bienestar Social de la
Federación Rusa entre 2015 y 2018 y se basó en una muestra de pacientes (n = 510
personas) con la condición de discapacidad básica. El examen se realizó en diferentes
situaciones de la vida: inspección médica y curso de rehabilitación médico-social de
pacientes hospitalizados. Eran uniformes en cuanto a sus principales características
clínico-demográficas y sociales de los pacientes (sexo, edad, estado civil y educativo,
entidad nosológica, gravedad y duración de una enfermedad, salvo la discrepancia
estadísticamente fiable en la situación laboral). En el curso del estudio se utilizaron las
escalas del mecanismo de afrontamiento de Heim (L. Wassermann) y la Evaluación del
Compromiso de Rehabilitación (ARC) (E.V. Morozova). Los resultados obtenidos
caracterizan la especificidad del compromiso de rehabilitación y la competencia de
afrontamiento, siendo ambos la proactividad psicológica de los pacientes en los
diferentes grupos estudiados. El estudio de indicadores psicológicos en grupos de
personas con diferente actitud hacia el estado de discapacidad reveló mecanismos
psicológicos para distintos patrones de compromiso de rehabilitación. Por parte del grupo
de personas que no se identificaron como discapacitadas, el estudio reveló una
competencia de afrontamiento bien formada que implicaba principalmente el uso por
parte de los pacientes de estrategias de afrontamiento adaptativas sin ninguna respuesta
emocional negativa.
Palabras clave: Proactividad personal, Competencia de afrontamiento, Mecanismos de
afrontamiento, Compromiso de rehabilitación, Diagnóstico psicológico, Rehabilitación
psicológica.
Recibido: 1/03/2023 Aceptado:31/03/2023
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* Oficina Federal de Experiencia Médica y Social del Ministerio de Trabajo y Protección Social de la Federación
Rusa, Moscú, Rusia. ORCID ID: https://orcid.org/0000-0002-1897-5776. E-mail: elvamorozova@yandex.ru
** Universidad Social Estatal Rusa, Moscú, Rusia. ORCID ID: https://orcid.org/0000-0001-8147-7692. E-mail:
elvamorozova@yandex.ru
*** K.G. Razumovsky Universidad Estatal de Tecnologías y Gestión de Moscú, Moscú, Rusia. ORCID ID:
https://orcid.org/0000-0003-1920-4786. E-mail: 89151479832@mail.ru
**** Universidad Social Estatal Rusa, Moscú, Rusia. ORCID ID: https://orcid.org/0000-0002-5810-8124. E-
mail: 89151479832@mail.ru
***** Instituto de Física y Tecnología de Moscú, Dolgoprudny, Región de Moscú, Rusia. ORCID ID:
https://orcid.org/0000-0002-7816-8407. E-mail: elvamorozova@yandex.ru
****** Universidad Nacional Rusa de Investigación Médica que lleva el nombre de N.I. Pirogov, Moscú, Rusia.
ORCID ID: https://orcid.org/0000-0003-1120-0684. E-mail: m9055095445@yandex.ru
Abstract
The role of coping competence of the individual in the implementation of the
rehabilitation process
The aim was to examine psychological characteristics of a person suffering from disabling
conditions (including characteristics of commitment to rehabilitation and patients’ coping
strategies). One of the crucial resources ensuring a person’s psychological proactivity is
a so-called coping competence, i.e. a person’s conscious ability by adaptive ways to deal
with tough life situations. The study was conducted in the Federal Bureau of the Medical
and Social Assessment of the Ministry of Labour and Social Welfare of the Russian
Federation in 2015-2018 and was based on a sample of patients (n = 510 persons) with
the basic disabling condition. The examination was conducted in different life situations:
medical inspection and in-patient medico-social rehabilitation course. They were uniform
in terms of their main clinic-demographic and social characteristics of patients (gender,
age, marital and educational status, nosological entity, the severity and duration of a
disease, except for the statistically reliable discrepancy in the employment status). The
Heim's coping mechanism scales (L. Wassermann) and Assessment of the Rehabilitation
Commitment (ARC) (E.V. Morozova) were used in the course of the study. The results
obtained characterize the specificity of rehabilitation commitment and coping
competence, both being patients’ psychological proactivity in different groups studied.
The study of psychological indicators in groups of persons of different attitude towards
disability status revealed psychological mechanisms for different patterns of
rehabilitation commitment. On the part of the group of persons not identifying
themselves as being disabled the study revealed a well-formed coping-competence
involving primarily patients’ use of adaptive coping-strategies without any negative
emotional responses.
Key words: Personal proactivity, Coping-competence, Coping-mechanisms,
Rehabilitation commitment, Psychological diagnostics, Psychological rehabilitation.
Introduction
Morozova, Senkevich et al / El papel de la competencia de afrontamiento del individuo en la aplicación del
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At present, the international community highlights a higher rate of disability in a
population and emphasizes particular importance of related social challenges regarding
the improving of the approaches to the rehabilitation process implementation. The World
Report on Disability of the World Health Organization notes that over a billion people,
i.e. 15 per cent of the world population, in comparison with the previously reported by
the WHO level of 10 per cent, live with some form of disability. The international
community’s great concern is the prevalence of disability due to diseases such as
malignant neoplasms; circulatory system diseases; bone and muscular disorders and
connective tissue disorders. This triad constitutes the disability structure in the Russian
Federation.
At present, as estimated by the Federal Public information system “Disabled Persons
Registry”, there are 11,8 million persons with disabilities certified in accordance with the
procedure established under legislation of the Russian Federation, which constitutes
approximately 9,5% of the total population of the country. Of these, circulatory system
diseases constitute 35,5%, bone and muscular disorders and connective tissue disorders
– 22,6%; malignant neoplasms – 11,8%.
The abovementioned diseases cause serious limitations in the performance of daily
activities, including impairment of working capacity, which requires measures of social
and psychological protection such as a comprehensive rehabilitation approach.
While not denying the pivotal role of medical rehabilitation aimed at restoration of
functional deficiencies of the body and prevention of the onset or aggravation of
disability, the international community highlights that the rehabilitation and habilitation
of persons with disabilities cannot be limited exclusively or primarily to medical
measures.
The persistent nature of health conditions of persons with disabilities makes it
necessary to implement consistent measures, including rehabilitation measures aimed
directly at rehabilitation of a person, the objective of which is to ensure social
rehabilitation and social integration (Spiridonov et al., 2018; Wondergem et al., 2022).
Rehabilitation is always planned on the basis of medical data which practically allows
to assess rehabilitation capacity and prognosis, to define objectives and relevant
methodological approaches to the implementation of the rehabilitation process.
With regard to psychological rehabilitation of patients, it is essential to take their
functional and personal components into account. The functional component of
psychological rehabilitation capacity implies interventions (the improvement of the
attention function, memory, thinking abilities, mental capacity in general, etc.), allowing
for operational resource and actual human functioning. However, not only may higher
mental functions allow a person to function normally. Indeed, while retaining mental
capacity as well as memory, attention, sensory capacities which function within normal
parameters, a person might not be personally proactive and might stay reluctant to the
rehabilitation process, which requires psychological intervention for activation of
personal resources aimed at effective fulfilment of the wide range of rehabilitation
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objectives (Scholten et al., 2018; Ministry of Labor of Russia, 2019; Mol et al., 2021;
Fisenbeck et al., 2022; de Graaf et al., 2022).
Clinical and medical expert practice of different medical specialists validates the
truism that the severity of the disorder a person suffers does not always correspond to
the rehabilitation outcome. Indeed, some persons, though having significant functional
deficiencies, are able to accumulate their psychological resources to directly combat a
disease, overcoming life limitations attributable to the disease by means of medical and
social rehabilitation. However, unfortunately, in certain cases there were no positive
rehabilitation outcomes (despite there being minor functional disorders) both in terms
of medical and social rehabilitation, because a person was not eager to recover
(Raspopova et al., 2018; Van Diemen et al., 2018; Keramat Kar et al., 2019; Scholten
et al., 2020; Ying et al., 2022).
Consequently, apart from operational characteristics, the crucial psychological
mechanism of the implementation of the rehabilitation process is personal proactivity
based on different psychological characteristics of a person. In any case, the opposite
attitude of a person leads to the lack (or deterioration) of rehabilitation impact amid
psychological and social maladjustment (Morozova et al., 2018; Mikhailov et al., 2020;
Welten et al., 2022).
In this regard, measures aimed at detection and prompt personal risk correction
should be a priority for psychologists from the onset of the disease and periodically
carried out at all its stages.
The International Classification of Functioning Disability and Health (ICF) presents a
functioning human model that comprehensively reflects the interrelationships of its main
components: including the functional factor (directly reflecting health indicators); the
environmental factor (reflecting barrier or supporting environmental factors), as well as
the personal trait factor (reflecting the activity characteristics of the individual such as
activity and participation) (Shostka et al., 2003; Ministry of Labor of Russia, 2019).
Personal "activity and participation" can be considered related to the functioning of
an individual in periods of illness as a resource that provides psychological self-regulation
of the subject's activities to solve relevant medical and social problems during this
period. One of the most important resources that ensure the psychological activity of
the individual is the so-called coping competence, i.e., the conscious ability of an
individual to consciously adapt to various difficult life situations (Nabiullina & Tukhtarova,
2003; Scholten et al., 2018).
A disabling disease is definitely a difficult life situation that requires a person to
activate personal resources. The system of coping mechanisms is one of the most
important psychological resources of an individual implemented by a person through
emotional, cognitive and behavioral strategies, which are divided into adaptive, relatively
adaptive, and maladaptive strategies (Nartova-Bochaver, 1997; Nabiullina &
Tukhtarova, 2003). Mastering the adaptive repertoire of coping strategies and their
adequate situational application is the key to socio-psychological adaptation.
Morozova, Senkevich et al / El papel de la competencia de afrontamiento del individuo en la aplicación del
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260
Materials and methods
The study was conducted in the Federal State Budgetary Institution “The Federal
Bureau of the Medical and Social Assessment” of the Ministry of Labour and Social
Welfare of the Russian Federation (FSBI FB MSA of the Ministry of Labour and Social
Welfare of the Russian Federation) in 2015-2021 and was based on a sample of patients
(n = 510 persons) with the basic disabling condition. The study used certified, valid and
well-proven techniques.
The examination was conducted in different life situations: medical inspection and
in-patient medico-social rehabilitation course. They are uniform in terms of their main
clinico-demographic and social characteristics of patients (gender, age, marital and
educational status, nosological entity, the severity and duration of a disease, except for
the statistically reliable discrepancy in the employment status). Patients with malignant
neoplasms – 102 people (20%), patients with circulatory system diseases – 102 people
(20%), patients with bone and muscular disorders and connective tissue disorders - 102
people (20%), patients with endocrine and metabolic disorders (chronic endocrine
disease), of whom patients with type 1 diabetes - 102 people (20%) and with type 2
diabetes - 102 people (20%) (Morozova et al., 2018).
The presented results reflect the specifics of rehabilitation adherence and coping
competence as the psychological activity of people in various groups studied using the
following methods: Coping mechanisms’ diagnostics by E. Heim (L. Wasserman)
(Nabiullina & Tukhtarova, 2003); Assessment of rehabilitation adherence (ARC) by E.V.
Morozova (2020).
Patients were examined in periods of medical expert examination based on the
classifications and criteria of disability assessment in force in the Russian Federation
(Ministry of Labor of Russia, 2019) and the inpatient program of medical and social
rehabilitation in the Federal State Budgetary Institution Federal Bureau of Medical and
Social Expertise of the Ministry of Labor of Russia. The first group (n=360) is 70%, which
was in the period of medical and social expertise regarding challenging the disability
decision. Patients in this group either claimed to be considered disabled for the first time
or claimed to return the previously established disability group 2 after determining the
fact of partial rehabilitation, justifying a decrease in the severity of the disability from
group 2 to group 3, or appealed the decision to lose the status of "disabled" after
determining the fact of full rehabilitation.
The criterion for inclusion in this group was a negative decision of the Federal State
Budgetary Institution Federal Bureau of Medical and Social Expertise of the Ministry of
Labor of Russia regarding determining the status of "disabled" or aggravation of the
existing disability group. The psychological activity of the patients in this group was
characterized as maladaptive, since they categorically rejected the validity of the expert
decision, fixed on the idea of unfair loss or reduction of disability (or unfair decision of
doctors not to determine disability), showed pronounced negativism towards the expert
commission, often behavioral aggression, and protested the expert decision three times
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(at the district, regional and federal levels in the Federal State Budgetary Institution
Federal Bureau of Social and Medical Expertise of the Ministry of Labor of Russia). It can
be stated that the psychological activity of patients in this group is not aimed at active
social recovery activities, but at protest activity, rent behavior, sometimes aggressive
rent behavior due to emotional instability, frustration, and psychological alienation of
the fact of changing social status when being fixed on the "disabled" status (Morozova,
2020; Mol et al., 2022).
The second group consisted of patients with the same diseases as the patients in
medical expert examinations (n=150) is 30%. However, they did not consider
themselves to be disabled and were in the mode of an inpatient program of medical and
social rehabilitation in the clinic of the Federal State Budgetary Institution Federal Bureau
of Social and Medical Expertise of the Ministry of Labor of Russia. We emphasize that
the patients in this group did not differ in the main clinical, demographic, and social
indicators (gender, age, family and educational status, nosological entity, severity and
duration of the disease), and the main criterion to be included in this group was the
absence at this stage and earlier of the status of "disabled," as well as their lack of
intention to register disability in the near future.
Objective indicators of rehabilitation adherence characterized the psychological
activity of individuals in this group: in terms of systematic completion of medical and
social rehabilitation programs, active involvement in life activities despite a disabling
disease (including actual employment, by the indicator of which this group statistically
differs (p < 0,01) with the group of expert patients), and interest in participating in
various social rehabilitation activities (including attending psychologist sessions,
different rehabilitation actions), and an active life stance in general.
Differences in the social behavior of patients in these comparison groups along with
the uniformity of the main clinical, demographic and socio-environmental indicators are
also confirmed by the results of the "Assessment of Rehabilitation Adherence" method,
which characterizes the level of rehabilitation adherence of an individual (Morozova,
2020), which justifies the need to study the psychological mechanisms that determine
different rehabilitation adherence and adaptive psychological activity of an individual
suffering from a disabling disease.
Results
The results of the comparison of psychological indicators using the "Assessment of
Rehabilitation Adherence" method are presented in Table 1 (Morozova, 2020), which
studies the individual's adherence to rehabilitation not only in terms of patient behavioral
compliance but also their activity concerning the implementation of social recovery in
the leading spheres of life (see Table 1).
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Table 1
Comparison of groups of patients who classify and do not classify themselves
as disabled, by rehabilitation adherence indicators
Psychological parameter
Social situation (claiming
disability "YES" / "NO")
Level
P
M ± S
(N=360)
Yes
M ± S
(N=150)
Not
Positive self-belief
2,66 ± 0,75
3,80 ± 0,40
<0,0001
Planning for the future
2,15 ± 0,80
3,41 ± 0,52
<0,0001
Will and responsibility for your health
2,17 ± 0,71
3,60 ± 0,52
<0,0001
Discipline in treatment
3,08 ± 0,46
3,78 ± 0,42
<0,0001
Focus on health-preserving activities
2,01 ± 0,88
3,71 ± 0,47
<0,0001
The total score characterizing the
locus of control and focus on health-
preserving activity
12,08 ± 2,53
18,30 ± 1,53
<0,0001
Professional / educational self-
realization
1,70 ± 0,94
3,58 ± 0,57
<0,0001
Creative self-realization
2,70 ± 0,62
3,84 ± 0,37
<0,0001
Sociocultural activity
2,08 ± 0,70
3,51 ± 0,54
<0,0001
Self-realization in interpersonal
relationships
2,71 ± 0,86
3,79 ± 0,42
<0,0001
Implementation of household living
arrangements
2,76 ± 0,79
3,97 ± 0,18
<0,0001
The total score, reflecting the activity
and participation in the
implementation of life
11,91 ± 2,43
18,69 ± 1,27
<0,0001
Overall cumulative indicator (Level of
adherence)
24,02 ± 4,30
36,99 ± 2,21
<0,0001
Source: Authors development
Table 2 below shows the results of comparing coping strategies studied using the
coping mechanisms’ diagnostics by E. Heim (Nabiullina & Tukhtarova, 2003) in groups
of patients who claim and do not claim disability (see Table 2).
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Table 2
Characteristics of individuals who classify and do not classify themselves as
disabled, according to coping strategies
Indicator
Social situation
(claiming disability
"YES" / "NO")
Level P
M ± S
(N=360)
Yes
M ± S
(N=150)
Not
Behavioral coping strategies
Abstraction
1,7 ± 1,3
3,6 ± 1,1
<0,0001
Altruism
2,2 ± 1,5
3,6 ± 1,1
<0,0001
Self-isolation
1,9 ± 1,6
1,0 ± 0,8
<0,0001
Compensation
1,0 ± 1,1
2,2 ± 1,4
<0,0001
Constructive activity
1,1 ± 1,1
3,2 ± 1,2
<0,0001
Avoidance, care
1,9 ± 1,5
0,1 ± 0,3
<0,0001
Appeal
1,7 ± 1,4
3,2 ± 1,2
<0,0001
Cooperation
1,5 ± 1,5
3,1 ± 1,3
<0,0001
Sum of behavioral coping strategies
Sum of behavioral coping strategies
13,0 ± 5,1
20,1 ± 3,9
<0,0001
Cognitive coping strategies
Humility
1,9 ± 1,3
2,9 ± 1,4
<0,0001
Ignoring reality
1,8 ± 1,4
3,0 ± 1,2
<0,0001
Maintaining composure
1,9 ± 1,5
3,0 ± 1,4
<0,0001
Problem analysis
2,0 ± 1,4
2,8 ± 1,5
<0,0001
Comparison
1,6 ± 1,4
2,9 ± 1,5
<0,0001
Religiosity
1,7 ± 1,2
1,7 ± 1,2
0,6901
Making sense
1,9 ± 1,4
2,6 ± 1,5
<0,0001
Setting your own value
1,7 ± 1,4
2,5 ± 1,5
<0,0001
Dissimilation, underestimation of
the problem
1,6 ± 1,6
2,7 ± 1,4
<0,0001
Confusion
2,7 ± 1,3
1,1 ± 1,1
<0,0001
The sum of cognitive coping
strategies
18,7 ± 5,4
25,1 ± 9,3
<0,0001
Emotional coping strategies
Protest
2,0 ± 1,5
1,0 ± 1,2
<0,0001
Despair
1,6 ± 1,6
1,0 ± 1,4
0,0035
Expressed aggressiveness
1,8 ± 1,6
0,4 ± 0,9
<0,0001
Suppression of feelings
2,4 ± 1,5
0,8 ± 1,2
<0,0001
Morozova, Senkevich et al / El papel de la competencia de afrontamiento del individuo en la aplicación del
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Optimism
1,6 ± 1,4
2,6 ± 1,6
<0,0001
Hopelessness
2,0 ± 1,5
0,8 ± 1,2
<0,0001
Self-blame
1,2 ± 1,4
0,5 ± 1,0
<0,0001
Passive collaboration
1,4 ± 1,4
1,8 ± 1,3
0,0027
The sum of emotional coping
strategies
13,0 ± 6,3
9,0 ± 5,0
<0,0001
Source: Authors development
The analysis of the research results on coping strategies revealed radically different
mechanisms of psychological activity of people in the compared groups.
Discussion
The maladaptive orientation of patients in the group of expert subjects, both
concerning their inadequate "Internal Picture of Disability" and avoiding active social
interactions in the direction of protest behavior, is objectified by the results obtained
through the above methods. The rehabilitation adherence of patients in the studied
groups has significant differences in favor of a higher adherence of people who do not
consider themselves to be disabled.
All the psychological parameters studied by the "Assessment of Rehabilitation
Adherence" methodology reveal statistically significant differences in the indicators in
the groups, both on the Health-Saving Activity Scale and Activity and Participation of an
Individual in Life Activities Scale and, consequently, on the general indicator of
rehabilitation adherence.
It should be emphasized that the group of individuals who do not consider themselves
disabled and rehabilitate outside the status of "disabled" with the support of their own
resources has a high rehabilitation adherence, which orients an individual to activity and
participation in the rejuvenation and self-realization in the leading areas of social
relations.
The group of patients who repeatedly challenge the decisions of experts regarding
disability is significantly less focused on restoring social statuses, as well as less focused
on the ability to self-persuade positively, to plan for the future, has reduced willpower
and external locus of control, lower discipline in treatment with low cognitive activity and
interest in new medical and social technologies and opportunities for functional and social
recovery.
Also, a radically different structure of coping competence was revealed in the studied
groups.
We can see that behavioral and cognitive strategies dominate in the groups of people
who do not consider themselves disabled, while emotional strategies in the structure of
coping behavior mechanisms dominate in the group of expert patients who repeatedly
challenge expert decisions. This is due to the fact that in the emotional cluster only one
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strategy is adaptive such as Optimism, and for expert patients, as the study revealed,
this strategy is not typical and used by them much more rarely than in the group of
people who do not consider themselves disabled.
In the structure of coping behavior strategies, in the group of individuals who do not
claim to be disabled, constructive strategies of "distraction," "altruism," "constructive
activity," and "cooperation" prevail. In the group of individuals claiming disability, non-
constructive strategies are much more often used: "self-isolation" and "escapism,
withdrawal".
The comparison of values for cognitive coping strategies revealed that this cluster of
strategies is most typical for people who do not claim to be disabled. The exception is
the Religiousness strategy, the differences in the use frequency of which were not found
(p=0,6901), and the Confusion strategy, which is more often used by individuals
claiming to be disabled.
In general, the analysis of the results obtained for various clusters and coping
mechanisms reveals a greater coping competence of a group of individuals who do not
claim to be disabled. This is manifested in the use of adaptive strategies in all three
clusters (behavioral, cognitive, and emotional) by individuals who do not claim to be
disabled, which provide psycho-emotional regulation, cognitive self-action, and
productive social activity of an individual suffering from a disease that requires a
psychological resource to overcome a variety of emerging consequences. While the
group of people who repeatedly claim to be disabled is mainly characterized by the use
of emotional strategies of the maladaptive register "self-isolation," "escapism,
withdrawal," "confusion," "suppression of feelings," "protest," "hopelessness,"
"pronounced aggressiveness," etc.
Conclusion
As a result of the study, the following conclusions were made:
1. The activity of people who do not consider themselves to be disabled is more
adaptive and, in many ways, significantly differs from the activity of individuals claiming
to be disabled.
2. Individuals who do not claim to be disabled are characterized by greater social
activity, are more involved in the rehabilitation process, responsible for the treatment
and show interest in finding various new rehabilitation methods and technologies, are
socially active, and consciously use an adaptive repertoire of coping strategies against
the background of the absence of negativism.
3. In the group of expert patients, there is a low rehabilitation adherence, a low level
of coping competence, which serves as the basis for the inclusion of psychological
rehabilitation measures to correct these maladaptive personal manifestations.
4. Considering all psychological risks in the methodology and organization of
psychological rehabilitation measures is a condition for a successful rehabilitation
Morozova, Senkevich et al / El papel de la competencia de afrontamiento del individuo en la aplicación del
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outcome since it is obvious that an individual who has psyched himself up to recovery is
more likely to overcome the numerous difficulties caused by the disease (Scholten et al.,
2018).
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