The stress/vulnerability/coping/competence model was proposed by two individuals who are well known in the field of psychiatric rehabilitation, William A. Anthony and Robert Paul Liberman (1986). An elaboration of the diathesis stress model described earlier, the stress/vulnerability/coping/competence model provides both a theory about the cause of severe mental illness and an explanatory framework for the impact that psychiatric rehabilitation and treatment interventions can have on the symptoms and functional level of people who have psychiatric disabilities. The model proposes the following: Individuals inherit or otherwise acquire a vulnerability (sometimes referred to as diathesis) to major mental illnesses such as schizophrenia, major depression, or bipolar disorder. This vulnerability results in abnormal development of brain structures and processes or an unusual type of stress reaction.
Fortunately, a number of protective factors can either prevent the onset of an acute episode of illness or lessen the impact of symptoms. These factors include coping skills, supportive resources, competence in relevant life activities, and psychotropic medications. According to this model, the severity and outcome of these disorders have a lot to do with whether or not these protective factors are in place when a stressful event occurs. If an individual does not have adequate coping skills or does not acquire resources or supports that enhance coping, he or she remains very vulnerable to the influence of future stressors and more vulnerable to frequent or prolonged relapses. Conversely, a person with well-developed coping skills and a reliable support system is likely to experience fewer acute episodes of mental illness, as well as episodes that are less severe and shorter in duration. Consider the following vignette:
Cheryl has been coping with schizophrenia for 10 years. For the last 2 years she has been relatively stable, experiencing some negative symptoms, but very few positive symptoms. She sees a psychiatrist once a month who prescribes a relatively low dose of antipsychotic medication for her. Sometimes Cheryl forgets to take her medication, or chooses to skip her morning dose because it makes her drowsy. She used to attend a peer support group regularly, but has gradually lost touch with the group. Cheryl has a part-time clerical job that she likes. She is not particularly close to friends or family, and when not at her job she prefers to keep to herself. Cheryl was doing well at her job until her supervisor, whom she liked and trusted, left to take another position. About a week later she began to hear disturbing voices. She also had difficulty sleeping and could not concentrate on her filing duties at work. She missed some days at work and was occasionally late. Her new supervisor criticized her performance and questioned her recent tardiness and absenteeism. Unable to face an increasingly stressful work environment, Cheryl quit her job.
While Cheryl's job history suggests that she had some coping skills and a certain level of vocational competence, she lacked the problem-solving skills and support system she needed to help her cope with a major change at work. The fact that she was not taking her medication regularly at the time she was exposed to psychosocial stress may also have affected her vulnerability to psychosis and the distressing results.
An important role of psychiatric rehabilitation is to aid the individual in the development of coping skills and competence (Anthony & Liberman, 1986). By enhancing coping ability and competence in social and vocational environments, the vulnerability to stress is reduced. Psychotropic medications are also an important protective factor, and PsyR practitioners can play an important role in helping consumers obtain the information and skills they need to utilize medications appropriately. For individuals who have mastered coping skills, future stressors, which everyone faces, will be much less devastating.
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