Academic journal article Journal of Allied Health

The Mediating Role of Secondary Beliefs: Enhancing the Understanding of Emotional Responses and Illness Perceptions in Arthritis

Academic journal article Journal of Allied Health

The Mediating Role of Secondary Beliefs: Enhancing the Understanding of Emotional Responses and Illness Perceptions in Arthritis

Article excerpt

Chronic illnesses are a significant issue across many health professional domains, becoming an increasing burden on limited and costly resources. The current study investigated the relationship between secondary beliefs and emotional responses, beyond the relationship accounted for by illness perceptions, using the framework of Rational Emotive Behavior Therapy. Sixty-five adults with arthritis participated in the questionnaire-based study. Multivariate analysis found that different emotional representations of the illness were significantly predicted by the individual's secondary belief, above and beyond that predicted by the cognitive representation of their illness alone. The study found that individuals who utilized an achievement secondary belief experienced feelings of worry, whereas individuals who used an approval orientation to understand their arthritis experienced emotions such as depression, being upset, anger, anxiety, and fear. No significant pattern emerged for individuals who used a comfort secondary belief to understand their arthritis. These findings are in line with the theory of secondary beliefs, as articulated by Rational Emotive Behavior Therapy. J Allied Health 2008; 37:30-37.

CHRONIC ILLNESS has been identified as a major concern, with the health-related costs representing 54% of the worldwide disease burden in 2001 and predicted to exceed 65% by 2020, due in part to the aging populations of many countries.1 Arthritis is a major chronic illness affecting approximately 3.4 million people in Australia and costing $19.25 billion in 2004.2 Due to the aging demographic of the Australian population, it is predicted that the incidence of arthritis will increase by 35% to 4.6 million (20% of the population) by 2020.2 It is believed that the financial burden of chronic illnesses such as arthritis will increase accordingly. This increase in the prevalence of chronic illness will also place an increasing burden on many allied health professional areas. Given this, research has focused on how individuals understand their illness. Such research has utilized the Self-Regulatory Model (SRM).

The SRM is a dynamic model that specifies how illness representations guide illness behavior.3-5 Within the model, the individual is understood to be an active problem solver trying to make sense of potential or existent changes in their somatic state and to act to avoid or control signs of illness or physical disorders.4-6 Fundamental to the model is that illness behavior is guided by a cognitive representation of the illness.3,5,7 This representation influences the choice and goals of illness behavior and sustains it until the goal is achieved.3 The integration of symptoms and illness labels with contextual information6,7 gives the illness an identity, a timeline, consequences, causes, and assumptions about controllability of the illness.5

While the theory of the SRM suggests that the individual develops an understanding of his or her illness through development of an illness representation, the individual is believed to also develop an emotional representation of their illness. Unfortunately, the theory articulating this relationship between the representations has received little attention from research focusing on the SRM. However, one area that has received extensive research in how emotional representations are formed is the theory behind Rational Emotive Behavior Therapy (REBT).

REBT, as postulated by Albert Ellis,8,9 represents a model postulating that humans have two superordinate goals of aliveness and happiness. Within the context of these, individuals have activating events (A), a belief regarding the event (B), and the behavioral and emotional consequence (C) of the event.9-15 Given this, REBT proposes that individuals are not disturbed by events (activating events) themselves but by the views they take of them.12,14

According to Ellis,13 beliefs contain a primary and a secondary component. …

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