Becoming ill - illness cognitions and coping

Question 1

How do you know if you/someone is ill?

Answer 1

• Shift in emotion and normal state
• Not feeling well/right
• Not feeling the same as you normally do
• Covers a range of different specific thing e.g. you feel different when you have a cold to when you have toothache

Question 2

What is the definition of health?

Answer 2

• WHO definition – ‘A state of complete physical, mental and social well- being and not merely the absence of disease and infirmity’ (WHO, 1948).
  o To be ‘complete’ health is rare. We don’t spend much time in this

Question 3

Who researched ‘what is healthy?’

Answer 3

Blaxter (1990)
o Study was given to 9000 individuals
o Describe someone that is healthy
o ‘What makes you call them healthy?’

Question 4

What did Blaxter (1990) find?

Answer 4

Found 5 categories of ‘what it means to be healthy’
 Health as not being ill.
 Health as physical fitness, having energy & vitality.
 Health as social relationships
 Health as ability to function
 Health as psychosocial well being
Health is more than just an absence of illness and there were positive connotations of what health is rather than what it is not

Question 5

What is an illness cognition?

Answer 5

• Ones own common sense belief about their illness
• E.g. “I always catch colds”
• Provide framework for coping and provide ideas of what to look for if feeling ill

Question 6

What did Leventhal identify regarding illness cognitions?

Answer 6

Identified 5 groups of illness cognitions:
1) Identity – label & symptoms
 E.g. I have a cold (diagnosis). Symp – runny nose
2) Perceived cause – biological or psychosocial
 E.g. cold caused by virus / cold caused by being run down
3) Time line – acute/chronic?
 Will it last long?
4) Consequences – impact on life
 Can be biological (pain) or psychological (reduced ability to socialise due to illness)
5) Curability / controllability – Can it be treated successfully?
 Who ‘controls’ illness?
 Does it require treatment by powerful others before it can be cured?

Question 7

What are the 5 groups of illness cognitions?

Answer 7

1) Identity - label & symptoms
2) Perceived cause - biological or psychosocial
3) Time line - acute/chronic?
4) Consequences - impact on life
5) Curability/controllability - can it be treated successfully?

Question 8

What evidence is there for illness cognitions?

Answer 8

• Evidence’ developed using both qualitative and quantitative approaches
• Not perfect. Is a theoretical framework which is changeable and is simply used by health psychologists as a framework

Question 9

What is the illness perception questionnaire?

Answer 9

Weinman et al., 1996
- Asks participants to rate a number of statements about illness
o E.g. ‘I have asthma’
- Rated: Strongly agree, agree, neither agree nor disagree, disagree, strongly disagree
- There is a brief version which has been designed for healthy people
- To understand people’s cognitions means that behavioural interventions can be designed to target changing behaviour as you then understand thought processes

Question 10

What broad framework is there regarding illness and treatment?

Answer 10

Necessity-concerns framework

Reality is complex interaction between illness and treatment.

Question 11

What 4 dimensions have been identified through factor analysis with beliefs about medicine?

Answer 11

Horne, 1997
o Specific beliefs about necessity for patient’s illness
o Specific beliefs about concerns of medication (side effects)
o General beliefs about all overuse of all medicines
o General beliefs about harm that medicines can do
Beliefs need to be targeted to understand behaviour and hence create/implement treatments

Question 12

What is Leventhal’s SRM?

Answer 12

• Leventhal and Nerenz (1985)
• Self-regulatory model
• Combines illness and treatment beliefs in a model of illness behaviour
• Consists of 3 main stages
• Framework for coping with and making sense of illness

Question 13

What is at the heart of the SRM?

Answer 13

Lay disease

• Lay disease representations are at the heart of the theory: ‘a patients own common sense beliefs about their illness’
• Dual processing model: thought & feeling
• Self-regulation happens through ‘balancing’ illness representations, coping & appraisal to return to a state the individual considers as normal
• Self-regulation back to our normal selves

Question 14

What are the 3 stages of the SRM?

Answer 14

1) Interpretation
2) Coping
3) Appraisal

Question 15

What are the two main ways that a person is made aware of symptoms?

Answer 15

Symptom perception and social messages (interaction)

• Once a person is made aware of a problem, this provides motivation to act
• Two main factors; illness cognitions and emotional state

Question 16

What factors have been shown to influence symptom perception (stage 1 SRM)?

Answer 16

• Internal/external focus (interoception)
• Gender
• Time of day/day of week
• Attachment style
• Mood
• Social context

Question 17

What are the 2 main types of coping (stage 2 SRM)?

Answer 17

• Avoidance (denial, ‘getting on with things’)

- Approach (medicating, visiting doctors, discussing with social groups)

Question 18

What does appraisal within the SRM mean (stage 3)?

Answer 18

• Evaluating the coping

- Deciding whether to continue or change

Question 19

What do we know about the SRM?

Answer 19

• Well researched
• Lots of early correlational studies
• studies to show that, at a baseline, beliefs predict outcomes

Question 20

What are illness representations like in certain contexts?

Answer 20

• Illness representations of patients and family members are similar
• Impact of social circle is important (esp cultural differences)

Question 21

What are the limitations of the SRM?

Answer 21

• Assumes that the way individuals react to illness is the same way as general problem solving
  o Assumes people react rationally
  o Illness is an emotional thing
• Does not take into account individual differences, culture, life stage, education, occupation, etc.
• Does not include the influence of professional treatment
  o Range of differences in treatments by doctors
• Limited in predicting how a given individual will react to illness

Question 22

What are the key aspects of managing long term conditions (LTCs)?

Answer 22

• Coping with the crisis of illness
• Adjustment to physical illness
• Benefit finding and post-traumatic growth

Question 23

What changes can physical illnesses present a crisis through?

Answer 23

• Identity
• Location
• Role
• Social support
• The future

Question 24

What processes constitute the coping process?

Answer 24

• Cognitive appraisal (e.g. SRM)
• Adaptive tasks
• Coping skills

Question 25

What 3 processes occur when coping with threatening events?

Answer 25

Cognitive Adaptation Theory

• Searching for meaning (‘why did it happen?’)
• Search for mastery (‘what can I do?’)
• Process of self-enhancement (social comparison theory)

Question 26

How can the SRM aid when coping with threatening events?

Answer 26

• Search for meaning
  o Casuality (why did it happen?)
  o Implications (what effect has it had on my life?)
• Search for mastery
  o Achieving a sense of control (prevention and also symptom management)
  o Taylor – positive attitude, medication, self-hypnosis, changing diet, managing side effects
• Self-enhancement
  o Make sense of the world by comparing it with others
  o People more likely to report ‘only positive’ changes to self-esteem than ‘only negative’

Question 27

What is useful about cognitive models and interventions?

Answer 27

They are useful frameworks which allow us to compare aspects of being ill and managing long term conditions with actual health outcomes