Stress, Coping and Emotional Well-Being

Spinal cord injuries are extreme and stressful life events that often leave individuals in a state of emotional instability. Following the trauma of a spinal cord injury (SCI), the experienced stress together with existing resources and strategies for coping with this stress play a large role in a patient’s overall emotional well-being.

Read more: General Introduction

Ingrid's Story

Ingrid lived a highly independent life. At 37 she had managed a career as a businesswoman, was involved in a relationship with her boyfriend and maintained an active social life. She belonged to a dancing group and took time out of her schedule to participate in the local volunteer fire department. Additionally, she enjoyed some athletic activities; one sport she recently began was mountain biking along trails outside the city.

Read more: Ingrid's Story

Assessment

Developing a Functioning Profile

To develop an accurate profile of Ingrid’s current functioning state, her health care team utilized the World Health Organization’s Comprehensive ICF Core Set for SCI in the early post-acute context.16 This provided the rehabilitation team with a comprehensive perspective of functioning and served as the basis for her assessment. As in each Rehab Cycle, this assessment covered body functions/structures, activities and participation, and the impact of her personal and environmental factors. All aspects of functioning were assessed through both the patient and health professional perspectives to provide a complete assessment on which the rest of the cycle would be based. The results of this Cycle’s assessment were integrated into the “ICF Categorical Profile” (Table 1) and the “ICF Assessment Sheet” (see Table 2).

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At the start of this Rehab Cycle, a psychologist was assigned to address Ingrid’s emotional and psychological needs, focusing primarily on One important component of the psychologist’s interventions at the beginning of this Rehab Cycle was the initiation of cognitive behavioural therapy (CBT) that took place two to three times weekly. CBT attempted to address a number of issues over the course of the Cycle, including improving emotional and personality functions, promoting relationships, carrying out a daily routine and handling stress.

Read more: Assignment and Intervention

As this Rehab Cycle ended, it concluded five complete months of rehabilitation since the accident. Ingrid showed little progress with regard to her emotional well-being. Besides coping with her injury, she had now needed to cope with the break-up of her relationship. Both of these stress factors led to increased difficulties with handling stress. This particularly affected her participation in the treatment sessions. As a consequence the health care team decided to reduce the intensity of her physical rehabilitation to support her emotional state during this Cycle.

As an overview of Ingrid’s functional improvement during this latest Cycle, her SCIM (Spinal Cord Independence Measure) score increased from 8 to 20. A modest improvement in a number or areas: self-care and indoor/outdoor mobility increased slightly; in-room mobility (including transferring) remained at 0, but wheelchair mobility increased to two; and respiration and sphincter management also increased from eight to ten.

Read more: Evaluation

The life changes and stresses that come with spinal cord injuries may contribute to increasing risks that patients may have problems with emotional well-being. Adapting and overcoming SCI-related challenges such as psycho-social and emotional problems is a time and energy-intensive process. Patients require varying degrees of time to develop sufficient coping strategies and resources that help to adequately confront these new and often times multiple stressors. During rehabilitation, health care providers need to be aware of signs and symptoms that might indicate anxiety and/or depression, as well as approaches, interventions and specific actions that could be undertaken to help mitigate these conditions.

Read more: Discussion