User:Frl14/sandbox

Illness cognitions are a concept described in the Common-Sense Model of Self-Regulation (shortened to the CSM), a psychological theory first published in 1970, with most recent iterations published in 2016. Illness cognitions/perceptions/representations are used interchangeably in the literature and denote the same concept. Illness cognitions refer to cognitive responses to changes (or possible changes) in physiological (somatic) state, and these cognitions drive health-related action. Theoretical models of health-related behaviour aim to explain why people show differences in coping behaviours. The CSM approaches health behaviour from a self-regulatory perspective, viewing changes in somatic state as a threat to one’s regular state of being and thus are treated as a problem to be solved by individuals. Illness cognitions are a component by which individuals aim to solve the somatic change which is a threat to their health. The model's structure reflects a connected body-and-mind philosophy whereby mental processes such as cognitions are described to have a direct impact on physical health outcomes.

The Common-Sense Model of Self-Regulation
The CSM is a multi-component description of a process beginning with illness stimuli and resulting in illness outcomes. Illness stimuli is experienced either as the experienced onset of physical discomfort denoting illness or disease, or can be the suspicion or knowledge of an increased likelihood of illness onset. Thus, illness stimuli can either be physical experiences of illness or becoming aware that one might become ill (e.g. due to close contact with a contagious person). According to the model, these illness stimuli elicit cognitive and emotional illness representations. These cognitive and emotional representations inform individuals’ coping strategies as well as appraisals of these strategies. It is these strategies and appraisals of coping which lead to an individual’s emotional and physical illness outcomes. This process is cyclical, multi-directional and ongoing.

This model is self-regulatory because somatic changes – for example, beginning to feel that one has a headache – are treated as a problem to be solved via illness cognitions. One could recognise this feeling of pain as a headache (see illness cognition type - identity) and then choose the coping strategy of taking a painkiller such as paracetamol, which one may appraise as an appropriate and quick fix for the pain. In most cases, this results in positive illness outcomes whereby the headache disappears, and one eventually returns to their ‘normal’ state.

The CSM model can explain variances in health behaviours and coping strategies as it outlines covarying cognitive and emotional representations which interact and are subject to change throughout the experience of illness.

Types of illness cognitions
Illness cognitions relate to five different types of cognitions denoting beliefs about the experienced illness stimuli.


 * 1) Perceived cause. This cognition refers to why and how the individual believes they encountered their illness stimuli; for example, they might rationalise that they caught their cold from a close friend who they know was unwell with a cold last week.
 * 2) Consequences. These can be both real (for example, taking time off work) or imagined. For example, imagined consequences could be severe and extremely unlikely, and may be believed by someone with death anxiety.
 * 3) Control/cure. This refers to beliefs about the extent to which an individual is able to control and cure the change in somatic state, i.e. through attaining medication or resting.
 * 4) Identity. This is the ability or lack of ability to name the issue, e.g. labels are applied to experiences such as ‘headache’ or ‘cold’. These labels are not fixed: for example, if a cold persists and worsens, the label given by the individual could change to ‘flu’, thus changing its identity.
 * 5) Timeline. This cognition relates to the perceived onset and duration of the illness and the following recovery.

It follows that an individuals’ illness cognitions are dependent on one’s knowledge and education about illness types and their identities, typical timelines, and typical effects. It also follows that one’s emotional experiences can modulate any of the five illness cognitions, for example experiences of distress may distort certain cognitions.

Types of conditions
In the 2016 iteration of the Common-Sense Model, the authors distinguished between different types of conditions, describing three sub-types.


 * Acute conditions have a short duration, such as a headache.
 * Chronic conditions occur on a near constant basis, for example chronic pain.
 * Cyclical conditions occur on a regular and repeated basis but is not constant. For example, period pain or seasonal affective disorder.

Leventhal also emphasized that illnesses are both labelled in the abstract and ‘seen’ via concrete symptoms. Words used to describe a certain characterisation of illness – such as ‘flu’, ‘cancer’, etc, are abstract concepts. Symptoms which can objectively be seen and measured (such as coughing, or cancer tumours revealed by an fMRI scan) are concrete by comparison. Thus, individuals’ coping strategies exhibited illness may treat specifically the abstract label or the concrete symptoms they are experiencing, or both, and this is subject to change throughout the process of being unwell.

The Illness Perception Questionnaire
Based on the CSM, an illness-perception questionnaire (IPQ) was designed in order to measure people’s illness cognitions. It was first designed in 1996 and was revised in 2002, and then in 2006 a shortened version was created in order for the IPQ to be delivered quicker and more widely. This brief IPQ, containing 9 items, was assessed and determined to have good validity, exhibiting high correlation scores with the regular IPQ. These 9 items are provided as a Likert scale, asking respondents to rate how far they agree with a statement by circling a number between 0 and 10. Each statement addresses a different aspect of illness cognitions – for example, item 2 asks “how long do you think your illness will continue?” and thus corresponds with the ‘timeline’ illness cognition.

Research findings
The brief IPQ and revised IPQ (IPQ-R) have been given to patients suffering with a variety of conditions. Research using the IPQ to measure illness cognitions and the CSM as a model for health behaviours have found support for the idea that illness cognitions influence illness outcomes. This research has found similar evidence amongst stroke patients, heart attack patients, and chronic fatigue sufferers. They find that poor illness cognitions – inaccurate beliefs reflecting distress and a negative view on one’s illness outcomes – correlate highly with poor illness outcomes. The reverse is also seen whereby positive and realistic illness cognitions are much more likely to lead to better illness outcomes. Thus, interventions which focus on patients’ illness representations may be effective for a variety of conditions.

Theoretical significance
There are many different models for health behaviours in the field of psychology, but the most well-known examples include the health belief model and the theory of planned behaviour, both of which have contributed to psychological understandings of health behaviour change. The CSM differs from these theories as it is based on the psychological notion of self-regulation. It promotes holistic care of patients by highlighting the importance of mental states and psychological processes during experiences of illness and disease. Body and mind have historically been separated by theorists who argue in favour of mind-body dualism, a belief which dates back to Descartes in the 17th century who argued that the mind and body are separate entities which cannot influence one another. This body and mind connection – or lack of connection – has been disputed by psychologists, philosophers and physicians, and opposing models have emerged which argue in favour of mind and body connection. Supported by studies which use the IPQ as a measure of illness cognitions, the CSM aims to demonstrate that mindsets may influence how and when individuals recover from illness in the same way that medication can, thus supporting the idea that the mind and body have considerable influence on one another and are connected.