Cognitive Therapy and Research

, Volume 16, Issue 2, pp 143–163 | Cite as

Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions

  • Howard Leventhal
  • Michael Diefenbach
  • Elaine A. Leventhal
Article

Abstract

We summarize basic empirical themes from studies of adherence to medical regimens and propose a self-regulatory model for conceptualizing the adherence process. The model posits that self-regulation is a function of the representation of health threats and the targets for ongoing coping (symptom reduction, temporal expectancies for change) set by the representation, the procedures to regulate these targets, and the appraisal of coping outcomes. The underlying cognitive mechanism is assumed to function at both a concrete (symptom-based schemata) and abstract level (disease labels), and individuals often engage in biased testing while attempting to establish a coherent representation of a health threat. It also is postulated that cognitive and emotional processes form partially independent processing systems. The coherence of the system, or the common-sense integration of its parts, is seen as crucial for the maintenance of behavioral change. The coherence concept is emphasized in examples applying the model to panic and hypochondriacal disorders.

Key words

illness cognition self-regulation system coherence common-sense models 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alonzo, A. A. (1980). Acute illness behavior: A conceptual exploration and specification.Social Science and Medicine, 14 515–526.Google Scholar
  2. Appels, A., & Mulder, P. (1988). Excess fatigue as a precursor of myocardial infarction.European Heart Journal, 2 758–764.Google Scholar
  3. Abramson, L. Y., Seligman, M. E. P., & Teasdale, J. D. (1978). Learned helplessness in humans: critique and reformation.Journal of Abnormal Psychology, 87 49–74.Google Scholar
  4. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change.Psychological Review, 84 191–215.Google Scholar
  5. Baumann, L. J., & Leventhal, H. (1985). “I can tell when my blood pressure is up, can't I?”Health Psychology, 4(3), 203–218.Google Scholar
  6. Baumann, L., Cameron, L. D., Zimmerman, R., & Leventhal, H. (1989). Illness representations and matching labels with symptoms.Health Psychology, 8 449–469.Google Scholar
  7. Beck, A. T. (1967).Depression: Clinical, experimental, and theoretical aspects. New York: Hoeber.Google Scholar
  8. Beck, A. T., Epstein, N., Grown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties.Journal of Consulting and Clinical Psychology, 56 893–897.Google Scholar
  9. Becker (1974). The health belief model and personal health behavior.Health Education Monograph, 2 324–473.Google Scholar
  10. Bishop, G. D. (1987). Lay conceptions of physical symptoms.Journal of Applied Social Psychology, 17 127–146.Google Scholar
  11. Brownlee, S., Leventhal, H., & Balaban, M. (1992).Autonomic correlates of illness imagery. Manuscript submitted for publication.Google Scholar
  12. Caccioppo, J. T., Andersen, B. L., Turnquist, D. C., & Petty, R. E. (1985). Psychophysiological comparison processes: Interpreting cancer symptoms. In B. L. Andersen (Ed.),Women with cancer: Psychological perspectives (pp. 141–171). New York: Springer-Verlag.Google Scholar
  13. Cameron, L., Leventhal, E. A., & Leventhal, H. (1992).Symptom representations and affect as determinants of care seeking. Manuscript submitted for publication.Google Scholar
  14. Cioffi, D. (1990). Beyond attentional strategies: A cognitive-perceptual model of somatic interpretation.Psychological Bulletin, 109 25–41.Google Scholar
  15. Contrada, R., Leventhal, H., & O'Leary, A. (1990). Personality and health. In L. Pervin (Ed.),Handbook of personality: Theory and research. New York: Guilford Press.Google Scholar
  16. Croyle, R. T. (1990). Biased appraisal of high blood pressure.Preventive Medicine, 19 40–44.Google Scholar
  17. Croyle, R. T., & Jemmott, J. B., III. (1989). Psychological reactions to risk factor testing. In J. A. Skelton and R. T. Croyle (Eds.),Mental representation in health and illness (pp. 85–107). New York: Springer-Verlag.Google Scholar
  18. Croyle, R. T., & Sande, G. N. (1988). Denial and confirmatory search: Paradoxical consequences of medical diagnosis.Journal of Applied Social Psychology, 18 473–490.Google Scholar
  19. Fishbein, M., & Ajzen, I. (1975).Belief, attitude, intention, and behavior: An introduction to theory and research (pp. 4–77). Reading, MA: Addison-Wesley.Google Scholar
  20. Fox, R. C. (1977). The medicalization and demedicalization of American society. In J. H. Knowles (Ed.),Doing better and feeling worse: Health in the United States. New York: Norton.Google Scholar
  21. Goldfried, M., & D'Zurilla, T. (1969). A behavior-analytic model for assessing competence. In C. Spielberger (Ed.),Current topics in clinical and community psychology (pp. 151–196). New York: Academic Press.Google Scholar
  22. Gonder-Frederick, L. A., & Cox, D. J. (1991). Symptom perception, symptom beliefs, and blood glucose discrimination in the self-treatment of insulin-dependent diabetes. In J. A. Skelton and R. T. Croyle (Eds.),Mental representation in health and illness. New York: Springer-Verlag.Google Scholar
  23. Gortmacher, S., Eckenrode, J., & Gore, S. (1982). Stress and the utilization of health services: A time series and cross-sectional analysis.Journal of Health and Social Behavior, 23 25–38.Google Scholar
  24. Horwitz, M. (1985). Disasters and psychological responses to stress.Psychiatric Annals, 15 161–167.Google Scholar
  25. Kleinman, A. (1980).Healers and patients in the context of culture: The interface of anthropology, medicine, and psychiatry. Berkeley: University of California Press.Google Scholar
  26. Janz, N., & Becker, M. (1984). The health belief model: A decade later.Health Education Quarterly, 11 1–47.Google Scholar
  27. Lau, R. R., & Hartman, K. A. (1983). Common sense representations of common illnesses.Health Psychology, 2 197–185.Google Scholar
  28. Lazarus, R. S. (1966).Psychological stress and the coping process. New York: McGraw-Hill.Google Scholar
  29. Leventhal, H. (1970). Findings and theory in the study of fear communications.Advances in Experimental Social Psychology, 5 119–186.Google Scholar
  30. Leventhal, H. (1980). Toward a comprehensive theory of emotion.Advances in Experimental Social Psychology, 13 139–207.Google Scholar
  31. Leventhal, H. (1986). Symptom reporting: A focus on process. In S. McHugh & T. M. Vallis (Eds.),Illness behavior: A multidisciplinary model (pp. 219–237). New York: Plenum Press.Google Scholar
  32. Leventhal, H., & Everhart, D. (1979). Emotion, pain, and physical illness. In C. E. Izard (Ed.),Emotions and psychopathology (pp. 263–299). New York: Plenum Press.Google Scholar
  33. Leventhal, H. (1984). A perceptual-motor theory of emotion.Advances in Experimental Social Psychology, 17 117–182.Google Scholar
  34. Leventhal, H., Baker, T., Brandon, T., & Fleming, R. (1989). Intervening and preventing cigarette smoking. In T. Ney & A. Gale (Eds.),Smoking and human behavior (pp. 313–336). Oxford, England: John Wiley & Sons.Google Scholar
  35. Leventhal, H., Brown, D., Schacham, S., & Engquist, G. (1979). Effects of preparatory information about sensations, threat of pain, and attention on cold pressor distress.Journal of Personality and Social Psychology, 37 688–714.Google Scholar
  36. Leventhal, H., Easterling, D. V., Coons, H., Luchterhand, C., & Love, R. R. (1986). Adaptation to chemotherapy treatments. In B. Andersen (Ed.).Women with cancer (pp. 172–203). New York: Springer-Verlag.Google Scholar
  37. Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common sense representation of illness danger. In S. Rachman (Ed.),Medical psychology (Vol. II, pp. 7–30), New York: Pergamon Press.Google Scholar
  38. Lewin, K. (1935).A dynamic theory of personality. New York: McGraw-Hill.Google Scholar
  39. Linz, D., Penrod, S., Siverhus, S., & Leventhal, H. (1982).The cognitive organization of disease and illness among lay persons. Unpublished manuscript, University of Wisconsin, Madison.Google Scholar
  40. Love, R. R., Leventhal, H., Easterling, D., & Nerenz, D. (1989). Side effects and emotional distress during cancer chemotherapy.Cancer, 63 604–612.Google Scholar
  41. Matthews, K. A., Siegel, J. M., Kuller, L. H., Thompson, M., & Vanat, M. (1983). Determinants of decision to seek medical treatment by patients with acute myocardial infarction symptoms.Journal of Personality and Social Psychology, 44 1144–1156.Google Scholar
  42. Melzack, R. (1973).The puzzle of pain. New York: Basic Books.Google Scholar
  43. Meyer, D., Leventhal, H., & Gutmann, M. (1985). Common-sense models of illness: The example of hypertension.Health Psychology, 4(2), 115–135.Google Scholar
  44. Miller, S. (1980). When is a little information a dangerous thing? Coping with stressful events by monitoring versus blunting. In S. Levine & H. Ursin (Eds.),Coping and Health: Proceedings of a NATO Conferences. New York: Plenum Press.Google Scholar
  45. Parson, T. (1975). The sick role and the role of the physician reconsidered.Millbank Memorial Fund Quarterly, Health and Society, 257–277.Google Scholar
  46. Pennebaker, J. W. (1982).The psychology of physical symptoms. New York: Springer-Verlag.Google Scholar
  47. Pilowsky, I. (1986). Abnormal illness behavior: A review of the concept and its implications. In S. Mchugh & T. M. Vallis (Eds.),Illness behavior: A multidisciplinary model. New York: Plenum Press.Google Scholar
  48. Prohaska, T. R., Keller, M. L., Leventhal, E. A., & Leventhal, H. (1987). Impact of symptoms and aging attribution on emotions and coping.Health Psychology, 6 495–514.Google Scholar
  49. Rachman, S. (1980). Emotional processing.Behavioral Research and Therapy, 18 51–60.Google Scholar
  50. Rachman, S., Levitt, K., & Lopatka, C. (1987). Panic: The links between cognitions and bodily symptoms—I.Behavioral Research and Therapy, 25 423–441.Google Scholar
  51. Roghman, K. J., & Haggerty, R. J. (1973). Daily stress and use of health services in young families.Pediatric Research, 7, 520.Google Scholar
  52. Rosenstock, I. M. (1974). Historical origins of the health belief model.Health Education Monographs, 2 328–335.Google Scholar
  53. Sackett, D. L., & Haynes, R. B. (1976).Compliance with therapeutic regimens. Baltimore: Johns Hopkins University Press.Google Scholar
  54. Safer, M. A., Tharps, Q. J., Jackson, T. C., & Leventhal, H. (1979). Determinants of three stages of delay in seeking care at a medical clinic.Medical Care, 12 11–29.Google Scholar
  55. Scheier, M. F., & Carver, C. S. (1987). Dispositional optimism and physical well being: The influence of generalized outcome expectancies on health.Journal of Personality, 55 169–210.Google Scholar
  56. Suchman, E. A. (1965). Stages of illness and medical care.Journal of Health Social Behavior, 6 114.Google Scholar
  57. Svarstad, B. (1976). Physician-patient communication and patient conformity with medical advice. In D. Mechanic (Ed.),The growth of bureaucratic medicine. New York: Wiley.Google Scholar
  58. Taylor, S. E., Lichtman, R. R., & Wood, J. V. (1984). Attributions, beliefs about control, and adjustment to breast cancer.Journal of Personality and Social Psychology, 46 489–502.Google Scholar
  59. Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the central role of negative affectivity.Psychological Review, 96 234–254.Google Scholar
  60. Weinstein, N. (1988). The precaution adoption process.Health Psychology, 7 355–386.Google Scholar
  61. Zola, I. K. (1973). Pathways to the doctor—from person to patient.Social Science and Medicine, 7 677–689.Google Scholar

Copyright information

© Plenum Publishing Corporation 1992

Authors and Affiliations

  • Howard Leventhal
    • 1
  • Michael Diefenbach
    • 1
  • Elaine A. Leventhal
    • 2
  1. 1.Institute For HealthRutgers UniversityNew BrunswickUSA
  2. 2.University of Medicine and Dentistry of New JerseyUSA

Personalised recommendations