An important next step for the self-regulation model is to demonstrate its utility for the development and empirical testing of educational and therapeutic interventions. These interventions should be based on the concepts defining illness representations and should incorporate ideas as to how representations shape coping procedures. The presentations should make use of concrete (i.e., perceptual) as well as abstract material in order to fully engage participants' underlying schemata of illness and procedural strategies and tactics. The material must be skillfully designed to appeal to these cognitive structures and to meld them with the ecological and biological realities of potential or actual health threats. The participant in self-management has to learn how to determine whether specific, somatic symptoms and declines in feelings of vigor or pleasure define the presence of illness, and they must learn when to seek professional assistance in clarifying their perceived cause and meaning. Kovatchev, Cox, Gonder-Frederick and Schlundt (1998) offered a path to interventions in their analysis of the transitions involved in diabetic's use of symptoms to achieve control over blood sugar levels. When in treatment, patients must learn how to share information and develop realistic expectations about the consequences of disease and specific treatments, and they must learn how to be sensitive to the meaning of “side effects” and the time lines for effective outcomes. Professional or self-care procedures for the management of disease threats may change subjective experience and lead to increasing differentiation of the representation of a disease, (as with the separation of the symptoms from the underlying disease by patients with rheumatoid arthritis), and the differentiation of the positive and negative effects of treatment. A critical question is whether the model can be used to help patients shape these changes to enhance their ability to minimize the destructive impact of disease on their physical, emotional, and social well being; that is, can people be helped to live with chronic disease rather than be overwhelmed by it? If the self-regulation model adds to our understanding of the processes involved in avoiding and adapting to health threats and assists us in facilitating effective adaptations, it will vindicate the effort and time spent in its development.
Preparation of this chapter was supported by grants AG 03501 and AG12072.
Abelson, R. P., Kinder, D. R., Peters, M. D., & Fiske, S. T. (1982). Affective and semantic components in political person perception. Journal of Personality and Social Psychology, 42(4), 619–630.
Affleck, G., Tennen, H., Pfeiffer, C., & Fifield, J. (1987). Appraisals of control and predictability in adapting to a chronic disease. Journal of Personality and Social Psychology, 53, 273–279.
Ajzen, I. (1988). Attitudes, personality, and behavior. Homewood, IL: Dorsey Press.
Alonzo, A. A. (1980). Acute illness behavior: A conceptual exploration and specification. Social Science and Medicine, 14, 515–526.
Andersen, B. L. (1999, August). Bio-behavioral aspects of cancer recurrence. In M. A. Andrykowski and A. Baum (Chairs), Presidential Mini-convention on Cancer-State of the art research programs in cancer. American Psychological Association Annual Meeting, Boston.
Anderson, J. L. (1983). The architecture of cognition. Cambridge, MA: Harvard University Press.
Anderson, J. L. (1993). The adaptive character of thought. Hillsdale, NJ: Lawrence Erlbaum Associates.
Andrykowski, M. A. (1990). The role of anxiety in the development of anticipatory nausea in cancer chemotherapy: A review and synthesis. Psychosomatic Medicine, 52, 458–475.
Aneshensel, C. S., Frerichs, R. R., & Huba, G. J. (1984). Depression and physical illness: A multiwave, nonrecursive causal model. Journal of Health and Social Behavior, 25, 350–371.
Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (pp. 1–34). New York: Cambridge University Press.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.
Barsky, A. J., Wyshak, G., & Klerman, G. L. (1986). Medical and psychiatric determinants of outpatient medical utilization. Medical Care, 24, 548–560.
Baumann, L., Cameron, L. D., Zimmerman, R., & Leventhal, H. (1989). Illness representations and matching labels with symptoms. Health Psychology, 8, 449–469.
Baumann, L. J., & Leventhal, H. (1985). “I can tell when my blood pressure is up, can't I?”. Health Psychology, 4, 203–218.
Becker, M. D., Haefner, D. P., Kasl, S. V., Kirscht, J. P., Maiman, L. A., & Rosenstock, I. M. (1977). Selected psychosocial models and correlates of individual health-related behaviors. Medical Care, 15(5), 27–46.
Becker, M. H. (1974). The health belief model and personal health behavior. Health Education Monographs, 2, 326–473.
Berkanovic, E., Hurwicz, M., & Landsverk, J. (1988). Psychological distress and the decision to seek medical care. Social Science & Medicine, 27(11), 1215–1221.
Berkanovic, E., Telesky, C., & Reeder, S. (1981). Structural and psychological factors in the decision to seek medical care for symptoms. Medical Care, 19, 693–709.
Bishop, G. D. (1991). Understanding the understanding of illness: Lay disease representations. In J. A. Skelton & R. T. Croyle (Eds.), Mental representation in health and illness. (pp. 32–59). New York: Springer-Verlag.
Bishop, G. D., & Converse, S. A. (1986). Illness representations: A prototype approach. Health Psychology, 5(2), 95–114.
Blumhagen, D. (1980). Hyper-tension: A folk illness with a medical name. Culture, Medicine, and Psychiatry, 4, 197–227.
Bovbjerg, D. H., Redd, W. H., Jacobsen, P. B., Manne, S. L., Taylor, K. L., Surbonem, A., Crown, J. P., Norton, L., Gilewski, T. A., & Hudis, C. A. (1992). An experimental analysis of classically conditioned nausea during cancer chemotherapy. Psychosomatic Medicine, 54, 623–637.
Bower, G. H. (1981). Mood and memory. American Psychologist, 36, 129–148.
Brody, E. M., & Kleban, M. H. (1983). Day-to-day mental and physical health symptoms of older people: A report on health logs. The Gerontologist, 23, 75–85.
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