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Wednesday, February 9, 2011


Leventhal incorporated illness beliefs into a self-regulatory model of illness behaviour to examine the relationship between someone’s cognitive representation of his or her illness and their subsequent coping behaviour.The model is based on problem solving and suggests that we deal with illnesses and their symptoms in the same way as we deal with other problems. The assumption is that, given a problem or a change in the status quo, an individual will be motivated to solve the problem and re-establish his state of ‘normality’. In terms of health and illness, if healthiness is your normal state, then you will interpret any onset of illness as a problem, and you will be motivated to re-establish your state of health. Traditional models describe problem solving in three stages: interpretation – making sense of the problem; coping – dealing with the problem in order to regain a state of equilibrium; and appraisal – assessing how successful the coping stage has been. These three stages are said to continue until the coping strategies are deemed to be successful and a state of equilibrium has been attained. This process is regarded as self-regulatory because the three components of the model interrelate, in an ongoing and dynamic fashion, in order to maintain the status quo. In other words, they regulate the self. The three stages of Leventhal’s model can be applied to health as follows:
Stage 1 – Interpretation
An individual may be confronted with the problem of a potential illness through two channels – symptom perception and social messages. Symptom perception (‘I have a pain in my chest’) influences how an individual interprets the problem of illness. This is not a straightforward process, perception being in turn influenced by individual differences, mood and cognitions. The factors contributing to symptom perception are illustrated by a condition known as ‘medical students’ disease’, described by Mechanic (1962). A large component of the medical curriculum involves learning about the symptoms associated with a multitude of illnesses. More than two thirds of medical students incorrectly report at some time that they have the symptoms they are learning about. This phenomenon might be explained in terms of mood (i.e. medical students becoming quite anxious due to their work load), cognition (the students are thinking about symptoms as part of their course) and social context (once one student starts to perceive symptoms, others may model themselves on this behaviour). Information about illness also comes from other people, perhaps as a formal diagnosis from a health professional or a positive test result from a routine health check. But we also often access such information via our ‘lay referral system’ (i.e. seeking informationand advice from multiple sources, such as colleagues, friends or family). For example, coughing in front of one friend may result in the advice to speak to another friend who had a similar cough, or a suggestion to take a favoured home remedy. Or it may result in a lay diagnosis or a suggestion to seek professional help from a doctor. Social messages like this will influence how we interpret the ‘problem’ of illness. Once we have received information about the possibility of illness through these channels we become aware that something has deviated from the norm and that there has been a change in our health status. According to this framework we are then motivated to return to a state of ‘problem free’ normality. This involves assigning meaning to the problem. According to Leventhal, we may do this by accessing our illness beliefs. So the notion is that the symptoms and social messages contribute towards the development of illness beliefs, which will be constructed according to the five dimensions mentioned earlier. These cognitive representations of the problem will give the problem meaning and enable us to develop and consider suitable coping strategies.
According to Leventhal, the identification of the problem of illness will result in changes in emotional state as well as in our cognitive representation. For example, perceiving a) the symptom of pain and receiving b) the social message that this pain may be related to coronary heart disease may result in deviation from the norm, and resultant anxiety. So any coping strategies have to relate to both our illness beliefs and our emotional state.

Stage 2 – Coping
Coping can take many forms, but two broad categories have been defined – approach coping (e.g. taking pills, going to the doctor, resting, talking to friends about emotions) and avoidance coping (e.g. denial, wishful thinking). When faced with the problem of illness, we develop coping strategies in an attempt to return to a state of healthy normality. In an alternative model of coping, Taylor and colleagues (e.g. Taylor, 1983; Taylor, Lichtman & Wood, 1984) looked at how we adjust to threatening events. In a series of interviews with rape victims and cardiac and cancer patients, they found that coping with threatening events (including illness) consists of three processes
1. a search for meaning – ‘Why did it happen to me?’
2. a search for mastery – ‘How can I prevent it from happening again?’
3. a process of self enhancement – ‘I am better off than a lot of people.’
Taylor and colleagues argued that these three processes are central to developing and maintaining ‘illusions’, and that these illusions constitute a process of cognitive adaptation.

Stage 3 – Appraisal
Appraisal is the final stage in Leventhal’s model. At this point people evaluate their coping strategy as either effective or ineffective. If it is appraised as effective then they will continue with it andthe same set of coping strategies will be pursued. If the coping strategies are appraised as ineffective then people are motivated to think of alternatives which will then be put into place. The appraisal stage clearly illustrates the self-regulatory nature of the model as the process of interpretation, coping and appraisal is not a linear pathway but dynamic and ongoing. Accordingly, the individual self-regulates by a constant ongoing process of appraisal, which assesses whether coping is effective and whether the individual is successfully managing to achieve a renewed sense of equilibrium.

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