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

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.

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Preparation of this manuscript was supported by grant AG 03501, and funds from The MacArthur Foundation Network on Health Promoting and Health Damaging Behavior. We would like to thank the Subcommittee on Risk and Worry, especially Daniel Kahneman, George Lowenstein, Jack Rachman, Judith Rodin, and Terry Wilson, of the MacArthur Health and Behavior Network for their stimulating discussion which contributed to the development of the ideas here presented.

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Leventhal, H., Diefenbach, M. & Leventhal, E.A. Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cogn Ther Res 16, 143–163 (1992). https://doi.org/10.1007/BF01173486

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Key words

  • illness cognition
  • self-regulation
  • system coherence
  • common-sense models