1. The document discusses a task-based model for understanding psychosocial adaptation to chronic illness. It proposes that individuals adapt by accomplishing a non-linear series of adaptive tasks in different life domains, rather than moving through rigid stages. 2. The model has five components: the stressor (diagnosis), cognitive appraisal of the stressor, adaptive tasks in physical, psychological, social, spiritual and vocational domains, coping skills used to accomplish tasks, and the outcome of adaptation. 3. Adaptive tasks involve meeting medical needs, maintaining emotional balance and control, seeking social support, finding meaning, and vocational engagement. Coping skills help accomplish these tasks. Successful adaptation results in a new equilibrium

1. Dr. André Samson, PhD
& Noah M.P Spector, M.S.W.
Faculty of Education
University of Ottawa
Psychosocial adaptation to major chronic illness:
The Task Based Model

2. Introduction: Tracking a New Reality
The past
• Not so long ago a diagnosis of cancer, HIV/AIDS infection or a heart
condition could be perceived as a death sentence.
Present
context
• Indeed, a large number of illnesses, once considered terminal, are now treated
as chronic medical conditions, which is to say that they develop over the long
term.
An
example
• For example, until 1995, a Human Immunodeficiency Virus (HIV) diagnosis
was equivalent to a death sentence. Today, HIV infection is categorized as a
chronic illness
(Samson & Siam, 2008)

3. Introduction: Tracking a New Reality
In 1995 1493 people died as a result
of an HIV infection in Canada. In
comparison, 45 people died of the
same cause in 2008 ( Public Health
Agency of Canada, 2010)
Mortality due to all chronic illnesses
fell from 794 per 100 000 inhabitants
in 1984 to 622 for 100 000 in 2001
(Public Health Agency of Canada,
2004).
The rate of deaths per 100 000
inhabitants between 1984 and 2000
dropped from 358 to 177 for diseases
of the circulatory and 222-117 for
ischemic heart disease (Public Health
Agency of Canada, 2011).

4. Introduction: A call to adapt
individuals diagnosed with a major chronic
disease must learn how to adapt to their illness
over the long term.
A primary consequence of the decrease in mortality and the subsequent
increase in people living with a chronic illness is that:
rather than prepare to die,

5. Introduction: What is adaptation?
Therefore, .“to
adapt.” literally
means to move
towards a
suitable outcome
or resolution.
“ to adapt.” stems from
the Latin roots “ad”,
which means “towards.”,
and “aptus.”, which
signifies “apt,” in the
sense of something that
is suitable.
Successful adaptation
involves restoring a
sense of normalcy to
one’s everyday life,
“normalcy” is defined
by patients according to
their perceived needs and
situations.

6. 1. Competing Theoretical Models
The predominant theoretical models to describe
the adaptation to major life transitions in general
and to the onset of chronic illness in particular
can be grouped into two main paradigms:
The first paradigm proposes the notion that
individuals adapt by moving through a set of phases.
An example of this theoretical paradigm is Dr.
Kübler-Ross’ stage-based model which has had a
particularly important impact on the field of
palliative care.
The second paradigm revolves around the
notion that adaptation to change is achieved
by accomplishing a nonlinear series of
adaptive tasks.
Examples of this paradigm include the
work of Corr (2003), Moos and Tsu
(1997), Cohen and Lazurus (1984) and
Samson and Siam (2008).

7. 1. Competing Theoretical Models
1.1 Critiquing stage based approaches
Staged-based approaches have been critiqued because of their rigid
linearity. In other words, they are seen as imposing a prescriptive way to
adapt.
This normative aspect does not take the highly subjective and
individual nature of adaptation processes into consideration.
The use of stage-based approaches may therefore lead to the exclusion of
those patients who do not follow these predetermined stages, as well as to
the imposition of unfounded expectations on the medical personnel.

8. 1. Competing Theoretical Models
1.2 A Promising Alternative
The second paradigm revolves around the notion that adaptation to change is
achieved by accomplishing a non-linear series of adaptation tasks (Samson
2006; Corr et al, 2003; Corr, 1992; Cohen & Lazarus, 1979; Moos & Tsu,
1977).
This approach to adaptation appears to present a more effective alternative to
the process of psychosocial adaptation to chronic illness.

9. 1. Competing Theoretical Models
1.3 Task based model: core assumptions
• The process of adaptation to chronic illness is highly individual.
• The task-based model does not delineate an ideal way to adapt – the ideal manner being the
one that the patient chooses to follow.
Assumption # 1: Highly individual
• Essentially phenomenological and transactional in nature.
• Through cognitive appraisal, patients continually evaluate and re-evaluate the impact of
chronic illness on different aspects of their everyday lives.
• The importance given to cognitive appraisal underlies the highly individual nature of this
adaptive process.
Assumption # 2: Cognitive and transactional

10. 1. Competing Theoretical Models
1.3 Task based model: core assumptions
• Individuals possess an innate drive to achieve, and subsequently maintain,
social and psychological homeostasis with the objective of regaining a sense of
normalcy and satisfaction in life (Moos & Tsu, 1977).
Assumption # 3: Regaining a sense of normalcy
• The process of adaptation usually revolves around the reconstruction of aspects
of the patients’ lives that have been affected by the onset of chronic illness.
• Through this process of reconstruction, patients attempt to regain a sense of
control over their lives
Assumption # 4: Regaining a sense of control

11. • Patients reach a positive outcome when they successfully
reconstruct and reintegrate the aspects of their lives that
have been affected by the onset of chronic illness.
• Negative outcomes occur when patients are unable to
cognitively appraise their diagnosis as a challenge that can
be overcome.
Assumption # 5 : The outcomes
1. Competing Theoretical Models
1.3 Task based model: core assumptions

12. 2. The Task-Based Model: 5 components
1. Source of
Stress
2. Cognitive
Appraisal
3. Adaptive
tasks
4. Coping
Skills
5. Outcome

13. The Integrated Adaptive Model
Source of stress
Diagnosis
Background and personal characteristics
Primary cognitive appraisal
Evaluation of the significance of an event: event seen as threat
Secondary cognitive appraisal
Evaluation of resources: event seen as challenge
Adaptive Tasks
Coping Skills
Information seeking, goal-setting, denying, taking action, minimizing, cognitive processes, requesting support, etc…
Outcome
Positive Outcome
New state of psycho-social equilibrium
Negative Outcome
Psychological deterioration and decline
Physical
Meet requirements
as prescribed
Comply with various
treatment procedures
Relational
Seek social
support
Establish
meaningful
relationships
Vocational
Reintegrate into
work environment
Vocational
rehabilitation or
volunteer work
Spiritual
Find meaning
Develop a sense of
hope
Psychological
Re-establish
emotional balance
Positive
self-image
Sense
of control
- Click on
each task to
see details

14. 2. The Task Based Model
2.1 Component 1: Source of Stress (The diagnosis)
• When an individual is given the news that they have been diagnosed with a
major chronic illness (source of stress) this diagnosis often provokes a crisis.
• Following this diagnosis, the initial process of adapting to a chronic illness
relies on how the stressor (i.e. the diagnosis) is perceived.
• Therefore, the same diagnosis can be appraised in different ways depending on
the circumstances of a particular individual.
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15. 2. The Task Based Model
2.2 Component 2: Cognitive Appraisal
Cognitive appraisal regarding a diagnosis of chronic illness can be classified
into two categories: (a) primary appraisal and (b) secondary appraisal.
Secondary appraisal marks an
evolution in cognitive appraisal;
the diagnosis is now perceived
as a challenge that requires
adaptive efforts.
Primary appraisal encompasses
initial psychological reactions
such as denial, fear, resentment
anxiety or even anger

16. 2. The Task Based Model
2.2 Component 2: Cognitive Appraisal
• Cognitive assessment of the diagnosis determines the trajectory of the
whole process of adaptation (Cohen & Lazarus, 1979).
• As the diagnosis and its consequences become part of everyday life, the
initial shock fades.
• Secondary cognitive appraisal emerges from this evolution in which the
chronic illness is increasingly perceived as a challenge to overcome.
• The individual then begins to reconstruct their life through adaptive tasks.
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17. 2. The Task Based Model
2.3 Component 3: Adaptive Tasks
Adaptive tasks encompass the principal aspects of human functioning that
allow the process of adaptation to occur.
The adaptive tasks are of a physical, psychological, social, spiritual and
vocational nature.
The person gradually accomplishes these adaptive tasks and can perform
either one task or several at a time.
The accomplishment of these five adaptive tasks can be achieved
simultaneously or in succession, with the accomplishment of a specific
task potentially facilitating that of another.
This process may vary from one individual to the next, depending on their
appraisal of the illness, their personal situation and overall coping skills.
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18. 2. The Task Based Model
2.3 Component 3: Adaptive Tasks
2.3.1 The Physical Task
Meeting
medical
requirements
Compliance
to various
treatment
procedures
Seeking
information
about the
illness
Maintaining
a healthy
lifestyle
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19. 2. The Task Based Model
2.3 Component 3: Adaptive Tasks
2.3.2 The Psychological Task
Therefore the psychological task implies maintaining satisfactory emotional equilibrium
and regaining a sense of control over one’’s life.
Consequently, living with a chronic illness can negatively effect a patient’s perception of
themself.
Persons living with a chronic illness may face a certain degree of uncertainty, anxiety and a
change in their physical appearance/ abilities.
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20. 2. The Task Based Model
2.3 Component 3: Adaptive Tasks
2.3.3 The Social Task
• Chronic illness may
trigger stigmatization
and social isolation
• In this context, the
social task means
gaining effective
support from
significant others.
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21. 2. The Task Based Model
2.3 Component 3: Adaptive Tasks
2.3.4 The Spiritual Task
The onset of
chronic illness
may confront
patients
prematurely with
their own
finitude.
Seeking meaning
may become a
necessity.
The completion
of the spiritual
task can play a
role in the
process of
adaptation to
chronic illness.
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22. 2. The Task Based Model
2.3 Component 3: Adaptive Tasks
2.3.5 The Vocational Task
Given the advancements in medical knowledge, patients living with
chronic illness are increasingly capable of maintaining an active
lifestyle and engaging in meaningful activities.
Career, or different life roles, whether paid or unpaid, remains for
most people a preferred way of expressing themselves and
integrating into society.
Through the vocational task, which includes work that is both paid
and unpaid, patients may resume their professional occupations,
give a new orientation to their career or get involved in volunteer
work.
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23. If adaptive tasks are seen as the general domains of adjustment, then coping
skills may be understood as the specific means to accomplish these tasks.
These skills embody both cognitive and behavioural components.
Some examples of coping skills:
Denying or minimizing
the seriousness of a crisis,
seeking relevant
information,
learning specific illness
related procedures.
2. The integrated model
2.4 Coping Skills
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24. Positive Outcome:
A new state of
psychological
equilibrium.
Negative Outcome:
Psychological
deterioration and
decline.
2. The integrated model
2.5 Outcome

25. Conclusion
• Adaptation to major chronic illness is a highly individual process.
• The task-based model takes into account the fact that each individual
cognitively appraises the onset of illness in a unique manner.
• Consequently, individuals adapt in unique ways depending on the
psychosocial contexts of their lives.