Module State of the Art
Research of Psycho-Social
Aspects of APA (part 2)
general introduction
Prof. H. Van Coppenolle,
co-ordinator
Psycho-Social Aspects are maybe
the most important ones in APA
and maybe as well
the most forgotten

Physical handicap
 what
are the benefits of participation in sports on
the psychological and social domain when I am
physically handicapped ? (blind, deaf, amputee,
heartdisease, etc.)
 excellent
visual tool: “the awarded film
( Medal of Peace of the United
Nations):” “I am not Disabled”
“The Winners”: “Everybody wins”
Psychological problems
What
are the benefits of
participation in APA and sports
(psychomotor therapy) when I
have psychological problems
(depression, anorexia nervosa,
schizophrenia) ?
Intellectual deficiency
What
are the positive
aspects in sports and APA for
persons with an intellectual
handicap?
These three groups of persons
with a handicap
will be the subjects of
research in this
psycho-social area

Research data are mostly based
on questionnaires
if I want to know what the meaning of a
handicapped person about
sportsparticipation is , then I have to ask
him
 so all data are based on meanings of the
persons themselves because there is no
other way
 but these impressions are the only
meaningful ones because nobody else can
speak for them

on the other hand questionnaires
have weak points
do the persons tell the truth?
do they understand the
questions?
are they motivated to fill out
the questionnaire in a serious
way?

Personality, Behaviour and Social
adjustment of persons with a handicap
R.
Shephard (“Fitness in
Special Populations”)
Human Kinetics, 1990,
pp.201-221)
Social Problems of the Disabled
The
disabled individual faces
many discouragement's during
daily life. Schooling is hampered,
employment prospects are poor,
and the person faces much
stigmatisation and stereotyping
Stigmatisation
a
physical handicap creates a visible stigma
that tends to be socially discrediting,
encouraging others to avoid the affected
person (Aufesser, 1982, Hunt, 1966)
 often the handicapped are regarded as
unproductive or socially deviant, and
civilisations have considered them to be
punished by the deity or a witch, or
possessed by the devil (Adedoja,1987,
Goffman, 1963)
unfortunately able bodied children seem to
develop negative stereotypes of the disabled
 in
general sensory disabilities are the least
stigmatised
 physical handicaps rank next, and those
with mental disorders are the most subject
to ostracism
 the cause of disability also influences
perceptions
 surprisingly the process can also occur
among the disabled themselves
Stereotyping
 the
most stereotypes are a perceived lack of
physical attractiveness, intelligence and
ability
 in many instances the entire stereotype is
inaccurate and inappropriate:
 the disabled are thus placed in special
schools, and sheltered workshops, when in
fact they are well able to cope with normal
education and employment opportunities
negative stereotypes have contributed to
conflicts over ownership of athletic contests
 some
able-bodied runners have wished to
exclude wheelchairathletes from events
such as the marathon
 such exclusion immediately has an adverse
impact on the majority of the handicapped
participants who wish to be judged on their
overall competitive performance rather than
as blind or paraplegic patients
Lifestyle and Disability
the
social problems faced by the
disabled often cause a reactive
depression and this can lead to an
adverse lifestyle (abuse of tobacco,
alcohol and drugs) (Nelipovich,
1983; Nelipovich §Parker, 1981)
Employment
 despite
negative stereotypes many
employers, many supposed “cripples” are
better motivated and more productive than
their able-bodied peers
 nevertheless employment prospects for the
average disabled person remain relatively
poor
Habitual Activity
following
spinal trauma the leisure
satisfaction of the injured
individual in general decreases
(Price, 1987)
participation in sports was likely to
decrease relative to the individual’s
pre-trauma situation
influence of the sportsorganisations
for the disabled
among
the various clinical types of
disability the least active group where
those affected by multiple sclerosis
(maybe because for this group no
special sportsorganisations exist)
smoking habits
 the
proportion of smokers among the
wheelchair disabled substantially exceeded
provincial norms
 the heavy smokers were predominantly
those with a type B personality on the
Rosemann scale: they intended to have an
external locus of control, there were also
trusting, shy and of below average
intelligence
alcohol consumption
 it
is very difficult to obtain accurate
information on alcohol consumption from
self-reports
 Kofsky a,d Shephard found that 68% of
their sample of paraplegics described
themselves as no more than occasional
drinkers
 only 12 % admitted taking more than six
alcohol drinks per week
Personality of the Disabled
 inevitably
the social problems tend to have
an adverse influence not only on the
lifestyle but also on the manifest
personality of the disabled person
 although some disabled athletes have as
high a level of selfactualisation as the ablebodied
disturbed personality
 many
disabled people show evidence of
maladjustment, retarded emotional
development, social alienation, feelings of
depression, etc.
 immediately following spinal injury , ego
strength is low and depression scores are
very high
 in subsequent months they have big
problems adjusting to their handicaps
physical activity may be of considerable
therapeutic and psychological benefit
 during
the early phase of rehabilitation
helping the patient develop a sense of selfefficacy
 and an awareness that is it not necessary to
accept a life of total inactivity and
dependency
 subsequent participation in sports
competition is also important to many
disabled people not only for the physical
gains
but because of the social respect,
approval and prestige that is gained
 involvement
in sports holds the prospect of
desinstitutionalization and reintegration into
able-bodied society
 Tucker found that the Cattell personality
test of physically handicapped persons
reflected greater intelligence, more
introversion,and less practical attitude than
able-bodied subjects
Harper used the Minnesota Multiphasic
Personality Inventory (MMPI)
 and
found that the disabled were particularly
prone to problems of social adjustment
 other studies involved standard psychological
tests, body image scales, locus of control tests, the
status of blind athletes with reference to anxiety
levels and mood states
 of course the results on these paper -and penciltests depend on the truthfulness of the subjects
because most of the studies were
cross-sectional in type
 there
is no proof as to whether an increase
of physical activity is responsible for the
favourable psychological characteristics of
groups such as wheelchairathletes
 or whether initially favourable
psychological characteristics have allowed
such subgroups to undertake more vigorous
activity subsequent to the onset of their
disability
Cattell Test Scores
 on
this personality test Goldberg and
Shephard didn’t find significant differences
of test scores relative to the general
population
 wheelchairathletes however were
distinguished from more sedentary
paraplegics on the factors intelligence,
venturesomeness and tough-mindedness
wheelchairathletes differed from the general
wheelchairpopulation on factor H (shy versus
venturesome)
 this
could imply that much of the
achievements that mark the disabled athlete
is due not to some peculiarity of
physiological endowment but rather to a
strength of personality
 and an achievement orientation that has
assured a willingness to undertake vigorous
training
Body Image
 Tests
of body image provide a numerical
expression of how the self is perceived both
physically and socially
 if the image is poor a substantial gap
develops between the ideal and the
perceived image
 early research suggested devaluation of self
in various types of disability
Harper (1978) found that paraplegics often had
problems of selfperception and poor body image
 although
no difference was found between
those with congenital and those with
traumatic lesions
 Brinkmann and Hoskins noted a poor selfconcept of hemiplegic patients
 after a period of training the researchers
reported significant gains on several
subscales on the Tennessee self-concept
scale
This subscales were: identity, physical
self, personal self and social self
 Patrick
applied acceptance- of- disability
scale and the Thennessee self concept scale
 5 months after their first competition
novice wheelchairathletes showed a
significant improvement on this scale
The Kenyon/Mc Pherson instrument is
one measure of body image
 It
develops scores for items such as “My
body is as I would like to be” and “ The real
me “ from a series of Likert scales,
spanning contrasting adjectives such as
beautiful and ugly
Goldberg and Shepard (1982)
found that
 the
gap between the perceived and desired
body image was larger in moderately
actively spinally injured than in those who
had achieved the status of wheelchair
athletes
Locus of Control
 the
locus of control scale examines the
extent to which an individual perceives an
ability to control her or his environment
 external locus of control is assumed when a
person perceives an event as unpredictable
or the result of luck, chance or fate
 internal locus of control is deduced if
events are seen as contingent upon personal
behaviour
The locus of control of wheelchairdisabled individuals is usually external
 the
average score is almost twice than that
described for young able-bodied people
 the locus of control of the spinally injured
person was uninfluenced by the level of the
lesion or by habitual physical activity
Self-Actualisation
 formal
measurements of self-actualisation
in elite ISOD competitors, using the
personal orientation inventory of Shostrom
demonstrated fairly high levels of
selfactualisation
 relative to non-elite competitors the
subjects scored higher
Anxiety
 many
disabled groups such as the blind
become acutely anxious following the onset
of disability
 they fear that they will be unable to support
themselves
 several reports suggest that the blind
competitors particularly prone to anxiety
during competition because of lack of
normal visual cues
Profile of Mood States (POMS)
 The
POMS test is a simple one page
questionnaire examining immediate mood
state
 disabled athletes demonstrated the “iceberg
profile”which is typical for an able-bodied
competitor
 a high score for vigour and low scores for
tension, depression, fatigue and confusion
Effects of training
 It
is logic that a favourable personality increases
the ability to undertake training
 and that an increased ability to perform daily
activities and live an independent life would have
a positive influence on the body image and
psychological profile
 in children with mental retardation participation in
competition (Special Olympics) had a very
positive impact on self-image and social
interactions
For the physically disabled
 Much
depends on the establishment of a
training program with realistic goals and
expectations
 trainers must take into account of inherent
shifts in mood state and avoid making
excessive physical or emotional demands
that could damage an already fragile selfimage
Exercise Motivation and Compliance
 Initial
recruitment to an activity class and
subsequent compliance are major problems
even with able-bodied subjects
 well-designed programs attract no more
than 20 to 30% of eligible adults
 and as many as half of those who are
recruited drop out of the organised activity
within 6 months
Attitudes toward physical Activity
 the
Kenyon instrument examines the
instrumental value to the individual of a
global concept of exercise in seven specific
domains
 a series of contrasting adjectives (e.g.
good/bad) rate the corresponding concepts
(e.g.,( good/ bad ) rate the corresponding
concepts (e.g. exercise as a means for
fitness and health)
Delforge ( 1973) found no differences between
handicapped and nonhandicapped students
 Goldberg
and Shephard 1982) found that
paraplegics perceive five of the seven
scales as did able-bodied individuals
 wheelchairathletes showed more interest
than the general population in exercise “as a
pursuit of vertigo” and “exercise as an
ascetic experience”
Perceived reasons for participation
 M.
Cooper (1986) used a paired comparison
test to rank the main perceived reasons why
the disabled individual participated in sport
 the first seven reasons were in order:
challenge of competition, fun and
enjoyment, love of sport, fitness and health,
knowledge and skills relating to sport ,
contribution to sport, and the team sport
atmosphere
These seven items were all ranked
significantly higher than items such as:
 liking
for other team members
 travel
 liking

status
for the coach and
Socialisation into and via Sport
 disabled
individuals generally show poor
social relationships and a limited
integration into their immediate society
 potential expressions of maladjustment
include shyness, timidity, fearful behaviour
and other forms of withdrawal,
concealment, refusal to recognise the
reality, and actual delusions
Involvement in sport can sometimes
help the process of integration
but
whether it is effective,
particularly in the long term
depends not only on the attitude of
the disabled individual
but also on the reaction of physical
education majors and society as a
whole
the primary perceived stimuli to sports involvement
of a group of disabled athletes were
1.
the initiative of the individual
participant (29%)
2. encouragement of disabled
friends (27%)
3. of Able-bodied friends (27%)
4. or the family (9%)
Hopper (1986) suggested
however that:
other
factors such as career and
domestic happiness may have had
a larger impact upon self-esteem
than did success in
wheelchaircompetition
Psychomotor Therapy for
Psychiatric Patients
– is a form of treatment that has been
systematically used in Belgium (Flanders) since
1965
– in that year a post-graduate course was started
at the KU Leuven
– this form of treatment attempts to act
systematically on the body perception and the
behaviour in order to achieve therapeutic
objectives
Observation Scales in
Psychomotor Therapy
the Leuven Observation Scales
for Objectives in Psychomotor
Therapy
 Adapted Physical Activity
Quarterly, 1989, 6, 145-153
originally
psychomotor therapy goals were
imposed or set by general therapy
theories such as:
 psychoanalysis
 phenomenology
 behaviour therapy, etc.

but this approach was not
individualised
towards the patient
 and moreover was quite
speculative
 because most theories on which
this approach was based are quite
speculative and unscientific as well

therefore
 the
therapeutic objectives are no longer
based on these general theories
 but on a specific observation method
during movement situations
 because everyone moves according his
personality
 and this movement behaviour can offer
useful indications for PMT
development of the scales
 an
observation method should only give
information about those aspects that are
directly related to the goals
 213 therapeutic goals for PMT were
derived from literature
 and named in 9 categories of goals who are
important for psychiatric patients
the 9 groups of therapeutic
objectives
improving:
 1. emotional relations
 2. self-confidence
 3. activity
 4. relaxation
 5. movement control
 6. focusing on the situation
other therapeutic objectives
7. movement expressivity
 8. verbal communication
 9. social regulation ability

in a second phase these
objectives were made
operational as
observation items
by the following steps
a
definition of each item
 for each item a 7 point scale was
established from -3 to + 3
 the disturbed behaviour can present itself as
an excess or as a lack
 the zero score corresponds with non
disturbed behaviour
to operationalize further
general descriptions of the -2 and the
+ 2 scores were developed on the basis
of adjectives
 for example: underemotional relations
are revealed in contact that is apathic,
inhibited, detached, refusing,
inaccessible, too formal

more specific descriptions
 more
specific descriptions were developed
on the basis of very specific descriptions of
behaviour for the - 2 and + 2 scores
 for example: emotional underrelating can
be revealed in the following descriptions
 the patient does not react and shows no
interest in contact if he is contacted by
others
reliability of the observation
scales (inter and intra)
was for the general LOFOPT
ranging from 0.74-1.00
 for the specific LOFOPT:
0.70-0.98

Body Experience and Body
Composition in Anorexia
Nervosa Patients
Issues in Special Education &
Rehabilitation. Vol.8, No. 2, 1993, pp.
35-39
Introduction: a disturbed body
experience is a central element in
the AN syndrome
 it
is one of the four diagnostic criteria in
DSM III Revised
 it has a perceptual and an affective
component
 nevertheless studies indicate no significant
over or underestimation of body measures
 no significant difference from estimates by
controls
these studies don’t refer to body
composition
which
is an important element because
it can affect body satisfaction and
perception
body experience has not been studied
before and after a therapeutic program
this was the reason of this study we
carried out with 43 AN patients
mean and range of age, height, weight,
percentage of fat mass and fat free mass
on admission
 age:(years):
22.8
 height (cm): 162.6
 weight:(kg) :39.7
 fat mass (%): 12.2
 FFM (kg):
34.922.
12.8-37.6
140.0-178.0
23.4-52.1
1.2-4.3
22.2- 43.3
method
the subject group was reevaluated after a therapeutic
program: 21 patients
 mean duration of
hospitalisation: 159 days (range
117-184)

procedure
body experience was evaluated by
the distortion technique
 and by a self report instrument:
the Body Attitude Questionnaire
which examine body image
satisfaction

the video distortion technique
a
video camera is linked to a color monitor
 using a potentiometer in the monitor: a
distortion (widening or narrowing) of max.
33% can be achieved
 the extent of the distortion is displayed by a
voltmeter
 a dummy was used as lifeless control
 the subject can turn a dial to widen or
narrow her image
4 tasks
 adjust
the thin or fat body image in full
frontal and profile positions until she
thought it represented her real image
 third task: estimate the dummy in order to
know whether the subject showed a more
general perceptual disturbance or poor
estimation abilities
 finally the subject was asked to adjust her
own frontal image to her ideal image
for each of these four tasks
 the
subjects were asked to perform six trials
ad random
 alternating between trials initially with a
thin image and trials initiating with a fat
image
 the composite score was the sum of the six
trials
the Body Attitude Test
consists
of 20 items which examine
body dissatisfaction
the maximum score is 100
the higher the score the more
dissatisfied the subject is with her
body
the items are scored on a 5 point scale
Body Composition
was measured with
densitometry techniques
which uses the underwater
weighing technique

the Psychomotor Program
 Tries
to influence the disturbance of the
body image
 through confrontation with and awareness
of the body it attempts to alter the negative
body experience in a more positive attitude
 the movement situations consist of relation
and confidence- improving techniques, nonverbal expression, body oriented sensory
awareness and social skill exercises
results: body experience
perception
significant
underestimation was found on
the four estimation tasks
but also the control dummy object was as
well significantly underestimated,
suggesting that a general perceptual
disturbance could be the basis of the
underestimation
body experience: ideal body
measures
the
ideal body measures correspond
with the actual thin body appearance
this indicates that prior to a
therapeutical program anorectic
patients are satisfied with their
emaciated bodies
body experience: dissatisfaction
the mean score on the BAQ was high:
46
 and differed significantly from the
control group of 103 students
 they are dissatisfied with their body

relation between body experience
and body composition
no significant relationship between
body composition and scores on the
body attitude questionnaire
 some significant correlations with
data from the videodistortion
technique:

significant relations
the higher the weight, fat and fat free
mass, the more the ideal images
measures were narrowed
 the less fat mass anorexics have the
more they underestimate their
measures this increases the perceptual
disturbance

body experience after therapy
a
decrease of the underestimation of body
measures was noticed in frontal, profile and
dummy estimations
 patients ideal image adjustments continue
to show significant underestimation
 this means that after a considerable weight
gain (39.3- 50.6) their basis wish to become
thinner has not changed
body satisfaction after therapy
the mean dissatisfaction score on the
BAQ decreases from 47.1 to 33.7
 this means that following the
therapeutical program the patients
were less dissatisfied with their body

EXAMPLES OF
GOOD PRACTICE
Different Films illustrating
the theory concerning
psychosocial aspects of APA
I am not disabled”
“Psychomotor observation and
therapy in a psychotherapeutic
community”
Psychomotor therapy with anorexia
nervosa patients”
“Fitnesstraining as psychomotor
therapy in depressive patients
“A real slice of the action”
“