Illness cognitions and health beliefs relate both directly and indirectly to recovery and can play a vital role in a patient’s progress. The relationship is not a simple one however but a complex and multifaceted interplay as this article will explain.

The effect that a patient’s illness beliefs have on their subsequent behaviour in dealing with disease is just one example of how illness cognitions relate to recovery. Illness beliefs are defined by Leventhal et al (1980) as ‘a patient’s own implicit common sense cognitive and emotional representations based on information received, symptom experience and previous knowledge’. These beliefs can have a negative or positive influence on their progress depending on the nature of these beliefs and the illness itself. For example; if a patient believes their condition to be serious they may be more inclined to take any medications and to follow the doctor’s advice. Conversely, should they decide they aren’t at any risk they might be more likely to ignore instructions and to continue unwise activities. In the US in 2000, 24% of 759.3 million patients didn’t follow their treatment (DiMatteo, 2004), a statistic that demonstrates the prevalence of the problem. Even this effect however is more complicated than it appears on the surface. For instance, the belief that an illness is serious can also have adverse affects by causing the patient to feel the situation is hopeless and so refuse medication for that reason, in a response almost like ‘learned helplessness’ (Hiroto & Seligman, 1975). Here we see the importance of individual differences among patients where those with an internal locus of control would react more adaptively than those with an external locus.

Some patients with strong internal loci of control might go beyond simply following advice and instead actively seek out information, asking lots of questions of the doctor and feeling anxious if they aren’t provided with enough information. Such individuals are referred to as ‘Monitors’ (Miller, 1987). On the other end of the spectrum are ‘Blunters’ who ask no questions of the doctor and tend to ‘zone out’ when being spoken to about their disease. By blocking out information they are able to ‘ignore’ the situation and so not become stressed by it. Denial of this nature can be adaptive initially (as it leads to a positive mood and distraction from symptoms) but can later become a problem as it prevents patients from monitoring their symptoms or diligently following advice. These examples outline the importance of a patient’s illness cognitions in regulating adaptive or maladaptive behavioral intentions.

Leventhal attempted to list the factors that make up an individual’s illness perceptions. In his list he included: identity – the label a patient gives their condition; consequences – such as time off work and/or disfigurement; timeline – whether the illness is long term, short term or terminal; causes – factors causing or contributing to the illness; and curability/control – whether and how recovery can be aided. These factors were later included in Leventhal’s ‘Self Regulatory Model of Illness Cognitions’ which applies models of problem solving to illness. Here the patient is motivated to re-establish normality and will thus go through three stages: interpretation – analyzing the symptoms and information available, coping – attempting to deal with the illness, and appraisal – assessing the success of the coping stage. In this model the coping strategies are mediated by the Leventhal’s illness perception factors as well as emotional aspects.

Mack LeMouse

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