Arielle M. Silverman

Resilience Predicts Functional Outcomes in People Aging With Disability: A Longitudinal Investigation

OBJECTIVES To investigate the links between resilience and depressive symptoms, social functioning, and physical functioning in people aging with disability and to investigate the effects of resilience on change in functional outcomes over time. DESIGN Longitudinal postal survey. SETTING Surveys were mailed to a community sample of individuals with 1 of 4 diagnoses: multiple sclerosis, muscular dystrophy, postpoliomyelitis syndrome, or spinal cord injury. The survey response rate was 91% at baseline and 86% at follow-up. PARTICIPANTS A convenience sample of community-dwelling individuals (N=1594; age range, 20-94y) with multiple sclerosis, muscular dystrophy, postpoliomyelitis syndrome, or spinal cord injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient Health Questionnaire-9 (to assess depressive symptoms) and Patient Reported Outcomes Measurement Information System (to assess social role satisfaction and physical functioning). RESULTS At baseline, resilience was negatively correlated with depressive symptoms (r=-.55) and positively correlated with social and physical functioning (r=.49 and r=.17, respectively). Controlling for baseline outcomes, greater baseline resilience predicted a decrease in depressive symptoms (partial r=-.12) and an increase in social functioning (partial r=.12) 3 years later. CONCLUSIONS The findings are consistent with a view of resilience as a protective factor that supports optimal functioning in people aging with disability.

Stumbling in Their Shoes Disability Simulations Reduce Judged Capabilities of Disabled People

Simulating other people’s difficulties often improves attitudes toward those people. In the case of physical disabilities, however, such experience simulations can backfire. By highlighting the initial challenges of becoming disabled, experience simulations decrease the perceived adaptability of being disabled and reduce the judged capabilities of disabled people. In two experiments, participants engaged in a challenging blindness simulation and afterward judged blind people as less capable of work and independent living than did participants after simulating a different impairment (Experiment 1), no impairment (Experiments 1 and 2), or after merely watching someone else simulate blindness (Experiment 2). Blindness simulators forecast that they would be less capable themselves if blind and that they would adapt to blindness more slowly (Experiment 2), highlighting the self-centered nature of judged capabilities of disabled people. The findings demonstrate that experience simulation can sometimes harm rather than help attitudes toward other people’s difficulties.

Stereotypes as Stumbling-Blocks How Coping With Stereotype Threat Affects Life Outcomes for People With Physical Disabilities

Stereotype threat, the concern about being judged in light of negative stereotypes, causes underperformance in evaluative situations. However, less is known about how coping with stereotypes can aggravate underperformance over time. We propose a model in which ongoing stereotype threat experiences threaten a person’s sense of self-integrity, which in turn prompts defensive avoidance of stereotype-relevant situations, impeding growth, achievement, and well-being. We test this model in an important but understudied population: the physically disabled. In Study 1, blind adults reporting higher levels of stereotype threat reported lower self-integrity and well-being and were more likely to be unemployed and to report avoiding stereotype-threatening situations. In Study 2’s field experiment, blind students in a compensatory skill-training program made more progress if they had completed a values-affirmation, an exercise that bolsters self-integrity. The findings suggest that stereotype threat poses a chronic threat to self-integrity and undermines life outcomes for people with disabilities.

Bouncing back again, and again: a qualitative study of resilience in people with multiple sclerosis.

Abstract Purpose The purpose of this study was to describe the meaning of resilience, factors facilitating resilience and barriers to resilience, from the perspective of persons with multiple sclerosis (MS), their care partners and community stakeholders. Method We conducted four focus groups: two with middle-aged (36–62 years) individuals with MS [one with men (n = 6) and one with women (n = 6)], one for partners of individuals with MS (n = 11) and one with community stakeholders serving people with MS (n = 9). We asked participants to describe what resilience means to them, what factors facilitate resilience and what barriers to resilience they perceive. We analyzed the focus group transcripts for emerging themes and sub-themes. Results Participants found it difficult to generate a concise definition of resilience, but they generated evocative descriptions of the concept. Psychological adaptation, social connection, life meaning, planning and physical wellness emerged as facilitators of resilience. Resilience depletion, negative thoughts and feelings, social limitations, social stigma and physical fatigue emerged as barriers to resilience. Conclusion The unpredictable nature of MS can present unique challenges to resilient adjustment, especially during middle age. However, several factors can contribute to resilience and quality of life, and these factors are amenable to intervention. Implications for Rehabilitation Resilience is the capacity to bounce back and thrive when faced with challenges. People with MS develop resilience through psychological adaptation, social connection, life meaning, planning ahead and physical wellness. Barriers to resilience with MS include burnout, negative thoughts and feelings, social difficulties, stigma and fatigue. Interventions should address both individual and social factors that support resilience, such as promoting positive thinking, planning and engagement in meaningful activities.

Independent or ungrateful? Consequences of confronting patronizing help for people with disabilities

People with disabilities routinely face a dilemma in dealing with patronizing help: While accepting unsolicited assistance may be harmful for its recipients, confronting the helper can lead to negative interpersonal repercussions. Across two studies, participants were presented with a scenario depicting an interaction between a blind target and a sighted pedestrian and asked to evaluate the behaviors of the characters involved. Study 1 showed that, whereas blind participants considered both patronizing and hostile treatment as inappropriate responses to the blind target’s request for information, sighted participants saw patronizing help as significantly more appropriate than openly hostile treatment. Study 2 further demonstrated that, among sighted participants, blind targets were viewed as less warm and more rude when confronting benevolent versus hostile discrimination. These findings highlighted the difficulty of confronting patronizing treatment and have important implications for people with disabilities as well as other patronized minorities more generally.

Fostering Positive Narratives: Social-Psychological Interventions to Maximize Motivation in the Classroom and Beyond

Abstract Purpose Achievement motivation is not a fixed quantity. Rather, it depends, in part, on one’s subjective construal of the learning environment and their place within it – their narrative. In this paper, we describe how brief interventions can maximize student motivation by changing the students’ narratives. Approach We review the recent field experiments testing the efficacy of social-psychological interventions in classroom settings. We focus our review on four types of interventions: ones that change students’ interpretations of setbacks, that reframe the learning environment as fair and nonthreatening, that remind students of their personal adequacy, or that clarify students’ purpose for learning. Findings Such interventions can have long-lasting benefits if changes in students’ narratives lead to initial achievement gains, which further propagate positive narratives, in a positive feedback loop. Yet social-psychological interventions are not magical panaceas for poor achievement. Rather, they must be targeted to specific populations, timed appropriately, and given in a context in which students have opportunities to act upon the messages they contain. Originality/value Social-psychological interventions can help many students realize their achievement potential if they are integrated within a supportive learning context.

Instilling positive beliefs about disabilities: pilot testing a novel experiential learning activity for rehabilitation students

Abstract Purpose: To develop and test a novel impairment simulation activity to teach beginning rehabilitation students how people adapt to physical impairments. Methods: Masters of Occupational Therapy students (n = 14) and Doctor of Physical Therapy students (n = 18) completed the study during the first month of their program. Students were randomized to the experimental or control learning activity. Experimental students learned to perform simple tasks while simulating paraplegia and hemiplegia. Control students viewed videos of others completing tasks with these impairments. Before and after the learning activities, all students estimated average self-perceived health, life satisfaction, and depression ratings among people with paraplegia and hemiplegia. Results: Experimental students increased their estimates of self-perceived health, and decreased their estimates of depression rates, among people with paraplegia and hemiplegia after the learning activity. The control activity had no effect on these estimates. Conclusions: Impairment simulation can be an effective way to teach rehabilitation students about the adaptations that people make to physical impairments. Positive impairment simulations should allow students to experience success in completing activities of daily living with impairments. Impairment simulation is complementary to other pedagogical methods, such as simulated clinical encounters using standardized patients. Implication of Rehabilitation It is important for rehabilitation students to learn how people live well with disabilities. Impairment simulations can improve students’ assessments of quality of life with disabilities. To be beneficial, impairment simulations must include guided exposure to effective methods for completing daily tasks with disabilities.

Solace in solidarity: Disability friendship networks buffer well-being.

Purpose/Objective: To determine whether having friends who share one’s disability experiences is associated with higher well-being, and whether these friendships buffer well-being from disability-related stressors. Research Method/Design: In 2 cross-sectional studies, adults with long-term physical disabilities identified close friends who shared their diagnosis. We assessed well-being as a function of the number of friends that participants identified in each group. Study 1 included 71 adults with legal blindness living in the United States, while Study 2 included 1,453 adults in the United States with either muscular dystrophy (MD), multiple sclerosis (MS), post-polio syndrome (PPS), or spinal cord injury (SCI). Results: In Study 1, having more friends sharing a blindness diagnosis was associated with higher life satisfaction, even controlling for the number of friends who were not blind. In Study 2, Participants with more friends sharing their diagnosis reported higher quality of life and satisfaction with social role participation. Participants with more friends sharing their diagnosis also showed and attenuated associations between the severity of their functional impairment and their quality of life and social role satisfaction, suggesting that their friendships buffered the impact of their functional impairment on well-being. Participants reporting more friends with any physical disability showed similar benefits. Conclusions/Implications: Friends with disabilities can offer uniquely important informational and emotional support resources that buffer the impact of a functional impairment on well-being. Psychosocial interventions should help people with long-term disabilities build their peer support networks.

Healing the Blind: Perspectives of Blind Persons on Methods to Restore Sight

According to the American Foundation for the Blind, there are approximately ten million visually impaired persons in the United States. Approximately 1.3 million (five per 1,000 Americans) are legally blind, meaning that they have a visual acuity of 20/200 or worse in the better eye with correction, or a visual field of 20° or less. Of these, 80% reported having some useful vision, while the remaining 20% have light perception or less. Half of all visually impaired Americans are over the age of 65 (American Foundation for the Blind 2007). Due to the aging of the population and improvements in technology to preserve the lives of premature infants, the prevalence of blindness and visual impairment has increased in recent decades and is likely to continue increasing.