Research by Taylor et al. (2011), in plain language
What’s this paper about?
This paper discusses how people adjust to life after a stroke.
Why did they write this paper?
After a stroke, people can have different types of long-term difficulties, ranging from physical disabilities to problems with thinking. These difficulties can affect a person’s mental health, which in turn makes rehab more complicated. Adjusting to life after stroke is a journey – there’s no real end-point because things keep changing over time. So, instead of thinking about adjustment as something that has or hasn’t happened, it’s more helpful to look at it as a process. Researchers try to come up with explanations, or ‘models’, for this adjustment process to help clinicians support patients and to spot those who are struggling. This paper discusses a model called the Social Cognitive Transition Model for Stroke (SCoTS).
What did they discuss in this paper?
In the past, researchers have tried to explain post-stroke adjustment using the stages of grief, similar to what we go through when we lose a loved one. But, post-stroke adjustment is a bit different to the stages of grief. The stages of grief doesn’t take into account goals, which studies show is important to stroke survivors. It also doesn’t explain why some people “adjust” while others struggle. To explain post-stroke adjustment, we need a model that takes into account a person’s changed sense of self, their emotional struggles that can’t be seen, and changes in their relationships and how they interact with others socially. Instead of stages, we can think about post-stroke adjustment as a non-stop, back-and-forth process.
Our worldview
The SCoTS is a model that looks at post-stroke adjustment as a non-stop, back-and-forth process. It’s a model that can explain both good and bad experiences that people might have. The SCoTS takes into account a person’s surroundings and circumstances (their ‘social context’) as well as theories about how people cope with the stress of being sick. The SCoTS shows that what a person knows and how they view the world (their ‘worldview’) affects the way they adapt to their surroundings and circumstances.
We each have our own worldview. It’s based on all the things we’ve experienced and that are relevant in our own life, like the society and the culture we live in. Our worldview helps us think about and plan for the future. Based on our worldview, we expect and believe certain things in life. What we actually experience in life might fit with or go against what we expect and believe. When our experiences fit with what we expect and believe, our expectations and beliefs become more firm. But, when our experiences go against what we expect and believe, we feel uncomfortable and confused. We have to adjust our expectations and beliefs to form a new worldview that makes room for the new experiences. Being in denial or avoiding things might help us for a short while. It can dull our feelings of stress and help us gradually absorb changes that might be traumatic. We can refer to the time taken to adjust our worldview as the adjustment period.
There isn’t a set amount of time for the adjustment period, nor a right or wrong way to adjust. In most cases, a person’s worldview will be shaken up from having a stroke. They’ll most likely feel confused, sad, angry, and other uncomfortable feelings. Studies show that most people have a hard time accepting or adjusting to their long-term difficulties after stroke. This might be because they have very firm expectations and beliefs based on their worldview, which are hard to change and make room for post-stroke difficulties. On a deeper level, post-stroke difficulties might fit with a person’s negative expectations and beliefs about themselves, which would also cause uncomfortable feelings.
Things that make it harder to adjust
How hard it is for a person to change their worldview depends a bit on how bad the stroke was and how serious the long-term difficulties are. It would be harder for a person to make room for more serious post-stroke difficulties that cause big changes to things that meant a lot to them, like their job or their relationships. Another thing that would make it harder for a person to adjust is if they have problems with thinking, or ‘cognitive difficulties’. Cognitive difficulties make it hard for a person to fully understand their post-stroke difficulties and how they would affect them in their everyday life. For example, they might know that they have a certain physical disability, but not be able to see why it causes them trouble with chores at home. Cognitive difficulties tend to affect a person’s attention, language, memory, problem-solving and decision-making skills. It can make a person forget how they coped with their post-stroke difficulties. When this happens, the person might be stuck in a loop of having experiences that go against their expectations and beliefs, trying to adjust their expectations and beliefs, forgetting how they adjusted, then facing the same ‘new’ experiences again. Cognitive difficulties can even mean that a person doesn’t register when new experiences go against their expectations and beliefs. In this extreme case, a person actually has less trouble with adjustment. Emotional difficulties would also make it harder for a person to adjust. In fact, problems like depression can cause or worsen cognitive difficulties.
How we cope with stress
The uncomfortable feelings that come up when new experiences go against our expectations and beliefs can be called “stress”. We have ways of coping with stress within ourselves and based on our surroundings. Some of the ways we cope might be unhelpful and actually make us avoid new experiences so that we don’t have to change our worldview.
How we cope with stress within ourselves is related to how we think and how we feel. For a person after stroke, they might have to change the way they think about themselves, change the way they think about having long-term difficulties, or change the way they think about treatment. They might also have to work through feelings of denial, anxiety, anger, grief and acceptance. There can be positive feelings too, like relief that it could’ve been worse, and feeling stronger mentally having survived a stroke. How we cope with stress based on our surroundings is related to what we do and who we are in our everyday life. For a person after stroke, relationships, life roles, interactions with others, and experiences of healthcare all make a difference. It’s not one thing that affects how we cope with stress, it’s many different things overlapping and it also depends on what we’re dealing with in our surroundings and circumstances.
What’s the take home message?
The Social Cognitive Transition Model for Stroke explains how well, or not, a person might adjust to life after a stroke. A lot of it comes down to their expectations in life based on their worldview. Having new experiences, like long-term post-stroke difficulties, that go against their expectations is stressful. How stressful this is and how long the stress lasts depends on their coping responses, whether they have problems with thinking or emotions, and their surroundings and circumstances.
Where can I learn more?
This blog post is based on the following paper:
Taylor, G. H., Todman, J., & Broomfield, N. M. (2011). Post-stroke emotional adjustment: A modified social cognitive transition model. Neuropsychological Rehabilitation, 21(6), 808-824. doi:10.1080/09602011.2011.598403
You can read the original research paper here: