Task to do1: 200 words report as mentioned in the attached file2: Reply back to one of user - about 5 or 6 statement - i will provide the words once post the first one
To gain a deeper understanding of your own illness cognitions, write a 200 word statement in which you: 1. Think about the last time you were ill. 2. Using Leventhal's model consider and briefly describe the stages involved in your recovery. 3. Consider whether your cognitions in this instance were consistent with your general illness cognitions , or different. Why do you think this was the case? Utilize your textbook, lecture handouts and notes, and at least one (1) journal article for writing the statement. Reference needed Student_Health_Psych_Behaviour_2019_Illness_Cogs 1 Health Psychology & Behaviour ILLNESS – Psychological Responses Assistant Professor Judy Buchholz 2019 About me ● Microbiologist, College Teacher (Biology, Physics, Chemistry, Maths) ● Practicing Psychologist >20 years: ACT Health; Private practice ● Endorsement in ➢ Clinical Psychology ➢ Clinical Neuropsychology Teaching and research supervision in ➢ Honours Program ➢ Masters Program Areas of interest: Cognitive Function and Mental Health related to ➢ Pain, grief and trauma ➢ Aging, Psychopharmacology and Suicide ➢ Learning disability esp. dyslexia Today’s plan ● What is Illness? ● Illness Cognitions ● Self-Regulatory model of Illness Behaviour ● Interpretation ● Coping & Appraisal ● Cognitive Adaptation Theory & Adjustment ● Coherence ● Resilience versus Cognitive Growth ● Illness cognitions and Illness management 2 What is Illness? Dictionary Definition: ● The fact or experience of being ill. ● A disease or period of sickness affecting the body or mind. ● synonyms: sickness, disease, ailment, disorder, complaint, malady, affliction, attack, infection, contagion, disability, indisposition The Health Continuum Chronic Illness Moderate level of energy Free from aches and pains Lack of energy, inattention, minor aches and pains Optimal level of energy, feeling of well-being Responding to health threats – illness. Leventhal’s Self-regulatory model (SRM): continues until normal state of health is achieved Emotional Representation Cognitive Representation Coping AppraisalInterpretation 3 SRM Stage 1: Interpretation Self-assessment of health –symptom perception ➢ Internal/external focus ➢ Demographics ➢ Attachment style ➢ Mood ➢ Cognition ➢ Social Context - social message: information from others e.g., diagnosis. Discuss: Do you think each of these factors operates in isolation? SRM Stage 1: Cognitive Representation What are Illness Cognitions? Act as filter and interpretative schema for illness information (socio- cultural knowledge, social environment and personal experience) . ‘A patient’s common sense beliefs about their illness’. Provide a framework for ➢ coping with and understanding their illness ➢ knowing what to look for if becoming ill (Leventhal & Colleagues, 1980) Cognitive Dimensions Interactive beliefs about - ● Identity of Illness: Label and symptoms ● Perceived cause of Illness: factors responsible (think bio-psycho-social) ● Timeline of Illness: chronicity ● Consequences of Illness: Effects and outcomes ● Curability and controllability of Illness: coping and treatment effectiveness 4 SRM Stage 1: Emotional Representation ● Fear ● Distress ● Anxiety ● Low-mood ● What predicts psychological impact? –Social support (Morris & Shakespeare-Finch, 2011) –Cognitive appraisals (Parle, Jones & Maguire, 1996) –Rumination & worry (Morris & Shakespeare-Finch, 2011) –Coping strategies (Carver et al., 1993) –Self-compassion (Pinto-Gouveia et al., 2014) Brief Illness Perception Questionnaire (Broadbent, Petrie, Main & Weinman, 2006) Designed to assess cognitive and emotional representations of illness. 9 items, 0 - 10 response scale. 1. How much does your illness affect your life? (Consequences) 2. How long do you think your illness will continue? (Timeline) 3. How much control do you feel you have over your illness? (Personal Control) 4. How much do you think your treatment can help your illness? (Treatment Control) 5. How much do you experience symptoms from your illness? (Identity) 6. How concerned are you about your illness? (Concern) 7. How well do you feel you understand your illness? (Understanding; Coherence) 8. How much does your illness affect you emotionally? (e.g. does it make you angry, scared, upset or depressed?) (Emotion) Brief Illness Perception Questionnaire (Broadbent, Petrie, Main & Weinman, 2006) Predictive validity: 3 month follow-up ➢ Myocardial infarct (MI) patients –Higher Consequences, Identity, Concern, and Emotional Response items predicted cardiac anxiety and poorer mental health –Higher Identity predicted poorer attendance at rehabilitation –Higher treatment control predicted slower return to work ➢Diabetes patients: ➢ Higher personal control related to better blood glucose control, higher treatment control related to poorer blood glucose control What beliefs do you think may be associated with the personal control and treatment control items? Why? 5 Brief Illness Perception Questionnaire (Broadbent, Petrie, Main & Weinman, 2006) Discriminant validity: comparison across people with diabetes, asthma, colds, MI patients and pre-diagnosis chest pain patients – Timeline: Longest for chronic illnesses: Asthma & Diabetes – Control: Highest for hospitalised, lowest for colds – Emotion: Lowest for colds, highest for diabetes How do you think the pre-diagnosis group scored for each of the following items. – Identity: – Understanding: – Treatment: – Emotion: ● Underestimation or overestimation of illness status can lead to inappropriate illness behaviour, such as overuse or avoidance of healthcare services. ➢ Health Anxiety SRM Stage 2: Coping/Adjustment Crisis Theory: Disruption on established personal and social identity is self-limiting Crisis of Illness: - characterised by changes in ● Identity, location, role, social support and the future – exacerbated by ● Unpredictability of illness ● Unclear information about the illness ● Need for quick decisions ● Ambiguous meanings, uncertainties ● Limited prior experience 6 SRM Stage 2: Coping/Adjustment Also thought of as adapting or adjusting ● Socioeconomic status ● Culture and ethnicity ● Gender-related processes ● Social resources and interpersonal support ● Personality attributes ● Cognitive appraisal processes ● Coping responses } focus Three appraisals Perceived threats to life goals Disease-specific expectancies Finding meaning • Illness impedes plans/activities with meaning • Loss of valued activities, social comparison, dissatisfaction, deterioration • View as acute versus chronic/cyclic ● Self-efficacy and control over management • Commitment to regime/behaviour change does not necessarily change outcome ● Meaning and finding benefit within the experience Cognitive Appraisal Processes The way we interpret and evaluate disease determines coping and adjustment (Lazarus and Folkman, 1984) Primary appraisal Secondary appraisal • Evaluates harm/benefit of situation • Goal relevance, congruence and personal meaning • Controllability of situation and coping resources Relevance Coping 7 Initial appraisal leads to ● The undertaking of adaptive tasks ● The use of coping skills (Moos & Shaefer, 1984) Adaptive Tasks Adaptive tasks involved in coping process (Moos & Shaefer,1984) Illness related tasks: ● Dealing with –Pain and symptoms –Hospital and treatment ● Developing and maintaining relationships with health professionals ●General tasks: ● Preserving –Emotional balance –Self image, competence and mastery ● Sustaining relationships with family and friends ● Preparing for an uncertain future Coping Skills Three forms (Moos & Shaefer,1984) Appraisal-focused: –Logical analysis and mental preparation –Cognitive re-definition –Cognitive avoidance or denial Problem-focused: –Seeking information and support –Taking problem-solving action –Identifying rewards Emotion-focused –Affective regulation –Emotional discharge –Resigned acceptance 8 Coping Responses Inventory (Rudolf, 1986) Please think about the most important or stressful situation you have experienced during the last 12 months and indicate which of the following you did in connection with that problem. 0 = no; 1 = yes, once or twice; 2 = yes, sometimes; 3 = yes, fairly often Approach: ● Logical analysis (C) ➢ Think of different ways to deal with the problem? ➢ Try to step back from the problem and be more objective? ● Positive appraisal (C) ➢ Tell yourself things to make yourself feel better? ➢ Try to see the good side of the situation? ● Seeking support (B) ➢ Talk with a friend about the problem? ➢ Talk with a professional person? ● Problem-solving (B) ➢ Try at least two different ways to solve the problem? ➢ Take things a day at a time, one step at a time? Coping Responses Inventory (Rudolf, 1986) Please think about the most important or stressful situation you have experienced during the last 12 months and indicate which of the following you did in connection with that problem. 0 = no; 1 = yes, once or twice; 2 = yes, sometimes; 3 = yes, fairly often Avoidance: ● Cognitive avoidance(C) ➢ Try to forget the whole thing? ➢ Wish the problem would go away or be over with? ● Acceptance (C) ➢ Feel that time would make a difference, the only thing to do was wait? ➢ Realise that you had no control over the problem? ● Alternative rewards (B) ➢ Get involved in new activities? ➢ Spend more time in recreational activities? ● Emotional discharge (B) ➢ Take it out on other when you felt angry or depressed? ➢ Cry to let your feelings out? Add up your scores. What was your style of coping with the problem? (Highest scores) Would you say that this is how you generally respond to problems? Knowing how you respond, is there anything you would change? 9 SRM Stage 2: Coping Responses ● Effectiveness of coping responses depends on controllability of stressor. ● Approach strategies: – Information-seeking, problem-solving, social support, benefit in experience, emotional expression – generally helpful and adaptive for controllable stressors ● Avoidance strategies: – Denial and suppression, disengagement, emotional discharge – tend to be unhelpful SRM Stage 2: Coping Responses Internal Coping Resources – Behaviours and thoughts an individual engages in to deal with a stressful situation. For example: ➢ Reappraisal ➢ Acceptance ➢ Distraction ➢ Rumination Coping techniques can be ● adaptive (healthy), which increase our functioning, or ● maladaptive, which relieve symptoms temporarily but don't address the root cause of the problem and may lead to deterioration. Can you think of some maladaptive behaviours you have engaged in when responding to a problem? Is there any time that these behaviours would be adaptive? 10 Adjustment Conceptualisation Stanton et al., (2001) - interacts across interpersonal, cognitive, emotional, physical and behavioural domains Mastery of disease-related adaptive tasks Preservation of functional status Perceived QOL in several domains Absence of psychological disorder Low negative affect Theory of Cognitive Adaptation (Taylor, 1984) Illness A search for meaning Causality: Why? Implications: Effects Illusions Understanding: Cognitive Adaptation Self-enhancement Social comparisons: Self-esteem A search for mastery Control SRM Stage 3: Appraisal Ongoing Appraisal: Evaluating the effectiveness of the coping response and adjusting until reach desired outcome. 11 Q: What about health professional perceptions and beliefs? Heath professional’s cognitions Health professional’s behaviour Other influences: psychological, social, cultural Patient’s cognitions Patient’s health outcomes Medical procedures & treatment Behaviour Q: What about health professional perceptions and beliefs Interpretations by clients can differ significantly from health professionals. Clinical decision making: 1. Accessing information about the patient’s symptoms. 2. Developing hypotheses about causes - nature of clinical problems - probability estimate - Seriousness and treatability of the illness - Personal knowledge of patient - Health professional stereoptypes 3. Search for attributes to test hypothesis (careful – confirmation bias). 4. Making management decisions – diagnosis and treatment ●Variability: ●Information accessed ●Different hypotheses ●Search for different attributes ●Different degrees of bias ●Reach different management decisions Coherence • Beliefs about causes of illness are consistent with beliefs about treatment. •