Purpose: The systematic review summarised the literature on the impact of patient illness perceptions on health outcomes and coping after an acute neurological event, guided by Leventhal’s Self-Regulatory Model (SRM). The empirical study investigated individuals’ lived experiences of emotionalism, a sudden onset neurological disorder characterised by involuntary laughter and crying. A further aim was to develop a questionnaire measuring beliefs about emotionalism based on patients’ perspectives. Method: The review identified seventeen articles through database searches using predefined inclusion criteria. In the empirical paper, eighteen individuals took part in a qualitative study to explore their experiences of emotionalism. Results: Findings provided support for the SRM in acute neurological populations. Negative illness perceptions were associated with a range of poor health outcomes and unhelpful coping behaviours. The empirical paper provided rich individual accounts of the social and personal impact of emotionalism. Four themes were identified and used to develop a questionnaire measuring beliefs about emotionalism. Conclusions: Both chapters emphasise the value of eliciting patient beliefs about their neurological condition and of providing support at the early stages of recovery. The clinical implications and directions for future research were discussed as was the need for further validation of the questionnaire.

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Psychological adjustment to chronic pain has been recently explored within three separate frameworks: a behaviour-focused account of chronic pain acceptance within the broader remit of Acceptance and Commitment Therapy; an emotion-focused approach with various research programs investigating the role of anger, fear, depression and also shame and positive emotions in chronic pain; and a cognitionfocused perspective more recently reframed in terms of illness perceptions as part of a wider model of response to health threats, the Self-Regulatory Model. Although these frameworks have broad areas of overlap, limited research has been directed at integrating acceptance, emotions and illness perceptions into a common, comprehensive account of psychological adjustment to chronic pain. Such an account would be beneficial both for providing a parsimonious approach that would guide further research and for developing pain management interventions that would take advantage of existing research from all three domains. The aim of the present thesis was to explore the possibility of integrating these separate areas by studying the relationships between the main concepts (acceptance, emotions, and illness perceptions) in the context of chronic pain. Based on a review of the relevant conceptual and methodological issues of each domain, a theoretical analysis of the similarities and differences between them was developed, with particular emphasis on the potential of existing models to support an integrative account. This analysis provided specific hypotheses regarding each domain and the interrelationships between them, which were investigated in a longitudinal study on a heterogeneous sample of 265 chronic pain patients using the services of the NHS Lothian Pain Clinic and several patient support organisations. Data were collected via postal and online questionnaires at 3 time points, at 41/2-month intervals (21% attrition rate). Validated questionnaires were used to measure the relevant constructs, with additional questions obtaining information regarding health status, medical history and demographics. The confirmatory analysis (employing a variety of statistical procedures, from correlation to multiple regression, factor analysis, cluster analysis and structural equation modeling) largely confirmed the expected relations within and between domains and was also informative regarding the most suitable data reduction methods. A detailed psychometric analysis of the questionnaires used offered a complementary view on the theoretical and methodological issues involved. An additional exploratory analysis focused on identifying the comparative characteristics of acceptance, emotions, and illness perceptions in predicting health status indicators, controlling for contextual factors such as medical history and demographics. Although no significant longitudinal changes were identified in most parameters (confirming the clinical observation of chronic pain as a stable condition), the longitudinal data allowed an analysis of the stability of the concepts and of the magnitude of their relationships in this patient sample. The analysis of intra- and interpersonal variation via hierarchical longitudinal modeling confirmed the stability of the data, highlighted the necessity of studying variation at both levels, and revealed interesting moderation effects, explained via the proposed concept of ‘discrimination ability’ and several alternative mechanisms. These results can be considered as first steps towards an integrative model of psychological adjustment to chronic pain. It is proposed that the behavioural, cognitive and emotional aspects need further conceptual clarification and these future efforts can be supported by the Cognitive-Affective Model of the Interruptive Function of Pain, within the wider framework of the Self-Regulatory Model.

Background and aims: Pain management programmes provide effective interventions for people with chronic pain, but effects are modest, and not all participants benefit. The current study aims to investigate the role of acceptance and cognitive representations i.e. beliefs about pain, in engagement, and outcome, of this kind of intervention. Design and participants: A quantitative design was used to investigate whether acceptance and cognitive representations of pain predict engagement and outcome of intervention, whether acceptance and cognitive representations change during intervention, and the relationship of acceptance with five dimensions of belief. Participants were 116 patients referred for assessment to a pain management programme. Measures Questionnaire measures of acceptance of pain, and cognitive representations of pain were used as predictor variables. Measures of distress, self-efficacy and physical function were used as outcome measures. Pain severity and waiting time were also measured as potentially confounding variables. Results: Measures of acceptance and cognitive representations of pain did not predict who would complete the intervention. Increases in acceptance, and decreases in perceived consequences of pain, and pain identity, occurred during the intervention. Lower acceptance was related to more serious perceived consequences and greater pain identity, but not with beliefs about cause or expected duration of pain, or beliefs in control and cure. Implications: Interventions aiming to increase acceptance by changing beliefs about perceived consequences of pain and pain identity may be useful. Further research is needed to explore the nature of acceptance, and the role of different dimensions of belief in affecting functioning, in chronic pain populations.

Background: Juvenile idiopathic arthritis (JIA) is a long-term inflammatory arthritis which starts before the age of 16; 60% of those with JIA continue to have symptoms into adulthood. There are wide variations in experiences of adolescents with JIA, including the effects of the condition on social and intellectual development, self-management, psychological and physical functioning. Individual differences may be due to differences in how adolescents conceptualise JIA. Leventhal's Common Sense Self-regulatory Model (CS-SRM) has been used to theorise adults' experiences of illness, however, this has rarely been used with adolescents. The CS-SRM has three components, mental representations (component 1) that drive coping procedures and illness behaviours (component 2) which are then evaluated and appraised (component 3). A review of studies with adolescent cohorts that applied the CS-SRM found no evidence-base with which to justify application of an adult theory with children or adolescents. Thus the applicability of the theory and the use of the associated questionnaire, the Revised Illness Perceptions Questionnaire (IPQ-R), with adolescents are problematic. Aims: The aims of this PhD were first to assess the suitability of the CS-SRM for adolescents with JIA by investigating the three components of the model, and second, to develop a questionnaire for use with this population. Methods: To investigate the first two components of the CS-SRM, twenty-one participants aged between 11-16 years were recruited from a national cohort of JIA patients. Data collection was undertaken using cognitive interviewing. Framework analysis of the data was used to identify domains used by adolescents to conceptualise their JIA and content analysis to further investigate the suitability of the IPQ-R to assess beliefs. Transcripts were analysed identifying problems or inconsistencies with IPQ-R use. Adolescents' ways of coping with JIA were investigated using the somatic experience module of a computer-based interview, 'In My Shoes' (IMS). To evaluate the third component of the CS-SRM, quantitative data were used in a longitudinal mediation analysis to investigate the extent to which emotional representations and pain predicted physical behaviour (n= 50). To address the second aim of this PhD, Version 1 of the Pain Perception Questionnaire for Young People (PPQ-YP) was devised and sent to 18 healthy adolescents (11- 16) to assess linguistic validity and face validity of the items using a recent pain to answer items and provide feedback on language and length. The psychometric properties of a revised version were tested with 76 adolescents with JIA. Results: Adolescents' responses to having JIA were driven by their emotional and cognitive responses to symptoms (in this case pain) rather than illness beliefs per se. Thus, it is important to assess pain beliefs rather than broader illness representations. The need to preserve their social identity as 'normal' was a coping goal shared across the sample, however different strategies were identified, either to focus on maintaining normal activities or to attend to pain directly. Adolescents who focused on their pain held a more negative emotional representation, reported higher pain and lower functionality compared to adolescents who tried to maintain normality. Based on these results, longitudinal mediation models investigated the role of emotional representations and pain in predicting physical behaviour. Pain mediated 44% of the relationship between emotional representations and physical behaviour. Conclusions: Modifications to the model are recommended to take into account the role of social identity in the process of developing illness behaviours as well as the importance of a symptom driven conceptualisation of the condition.

This research project explored how mothers experiencing depression after childbirth perceived their mental illness. Illness perceptions were assessed across the dimensions outlined within the Self-Regulatory Model (SRM, Leventhal, Nerenz & Steele, 1984) via the use of the Revised Illness Perceptions Questionnaire (IPQ-R, Moss-Morris, Weinman, Petrie, Horne, Cameron & Buick, 2002). The psychometric properties of the IPQ-R within this clinical sample and relationships between illness perceptions, depression severity and maternal bonding were assessed. A literature review of the use of the IPQ and IPQ-R within mental health identified that these measures with modifications (in particular to the causal and identity subscales) were largely reliable and valid measures of assessing illness perceptions in mental health. The illness dimensions outlined within the SRM were largely endorsed within the clinical populations sampled, offering support of the applicability of the SRM within mental health. Mental illnesses were consistently viewed as chronic with serious negative consequences. Perceptions regarding mental illness consequences, chronicity and controllability were associated with coping strategies and help-seeking. Treatment adherence and attitudes towards taking medication were associated with illness controllability beliefs. The IPQ-R modified for depression after childbirth was shown to be a reliable measure for assessing illness perceptions within this clinical sample and was shown to be reliable over a four-week time period.Mothers experiencing depression after childbirth perceived their depression as having a moderate number of symptoms, a high number of negative consequences and responded to their depression with a number of emotions. Mothers perceived having a coherent understanding of their difficulties, believing that depression was amenable to treatment and personal control and that depression was cyclical in nature. Commonly reported symptoms experienced attributed to depression included depressed mood, difficulties concentrating, loss of interest/pleasure in activities, fatigue/loss of energy and sleep difficulties. Frequently endorsed causes of depression included stress or worry, hormonal changes, own emotional state, family problems, mental attitude and own behaviour. Interestingly, no significant difference was found between illness perceptions of mothers who previously experienced psychological problems and mothers who had not.Mothers who perceived having many symptoms and a high emotional response to depression were more likely to report higher depression severity. Whereas mothers who believed they had control over their depression were more likely to report lower depression severity. Illness identity and consequence beliefs were associated with maternal bonding difficulties. The project's findings were presented with reference to previous literature with implications for theory and clinical practice explored. Difficulties and limitations of the research and its related theory were discussed in addition to reflections upon the research project. Possible improvements to the research procedure and areas for future research were also identified.

Yes / Objective: There has been an increasing interest in establishing dementia friendly communities leading to the development and delivery of various dementia awareness initiatives. These initiatives have generally been aimed at adults, however to sustain dementia friendly communities, the involvement of young people is imperative. Very few dementia awareness initiatives exist for young people and none have been independently evaluated to establish their impact. This research aimed to design and develop a scale to measure adolescents’ attitudes towards dementia to allow such initiatives to be evaluated. Methods: The Adolescent Attitudes toward Dementia Scale (A-ADS) was developed in two stages. Firstly, cognitive interviews were conducted with 15 young people and secondly, a new scale (based on items from two existing scales) was piloted with 262 young people, recruited through schools. Results: A scale consisting of 23 items was developed. Exploratory factor analysis demonstrated that this captured three factors; perceptions of dementia, personal sacrifice and empathy with people living with dementia. The three sub-scales showed adequate internal consistency (>.60), correlated with the original scales (r = .79-.91, p <.001) and correlated with an existing measure of attitudes towards older people at a similar level to the original scales (r = .47, p < .001). Discussion: The scale will allow the evaluation of educational initiatives for young people and provide a validated and standardised measure to establish adolescents’ attitudes towards dementia.

Research on aging indicates that older adults do not, as a group, report decreased health-related quality of life (HRQOL) despite age-related declines in physical health status. Several cognitive adaptation strategies have been suggested to underlie HRQOL stability in this population. Studies of older cancer patients nevertheless show substantial variance in post-treatment HRQOL outcomes, although cognitive mechanisms for individual differences have received little attention. The current study expanded on a developmental adaptation of self-regulation theory in which aging influences both self-vulnerability and perceptions of disease. A model was tested in which older age was hypothesized to predict better HRQOL via less severe illness perceptions in men treated for localized (Stage I and II) PC. Results indicated that age was not directly associated with HRQOL. However, older age was indirectly associated with better HRQOL via less severe PC perceptions. Further, this indirection association helped account for the positive association between age and HRQOL that three risk factors (income, comorbid disease burden, and sexual function) were shown to suppress. Perceptions of PC may promote HRQOL stability by mitigating age-related declines in health and income status. Disease perceptions thus represent critical components of health assessments and interventions for PC survivors of all ages, but particularly for men facing difficulties adapting to complex health profiles or normative lifespan challenges.

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Includes vita. / Title from PDF of title page. / Document formatted into pages; contains 103 pages. / Thesis (Ph.D.)--University of South Florida, 2003. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT: The goal of this study was to examine differences in the psychological characteristics of patients admitted to the hospital for acute or chronic Myocardial Infarction (MI) or Unstable Angina (UA). Depression, anger, anxiety, curiosity, defensiveness, social support, and coping were evaluated for 165 patients (86 MI and 79 UA), who were tested on the Cardiology Stepdown Ward of Tampa General Hospital. The following psychological measures were administered to these patients: the Beck Depression Inventory (BDI), the State-Trait Anger Expression Inventory (STAXI-2), the Rationality/Emotional Defensiveness (R/ED) Scale, the Adult Form of the Coping Responses Inventory (CRI-Adult), the Interpersonal Support Evaluation List (ISEL), the Illness Perception Questionnaire (IPQ), the State-Trait Personality Inventory (STPI), and the Structured Clinical Interview (SCID-I) for the DSM - IV. Significantly more chronic patients than acute patients met criteria for depression as measured by the SCID following admission to the hospital, and more UA than MI patients also met these criteria. However, no differences were found between the acute and chronic MI and UA patients two weeks prior to admission. Results of this study also indicated that chronic patients and UA patients reported a greater frequency of illness symptoms and tended to cope with their heart disease through avoidant strategies. Chronic patients endorsed higher levels of state and trait anger compared with acute patients, and UA patients were less likely to believe that their illness could be cured or controlled (Control of Cure) than MI patients. Based on the results of this study, it appears that avoidance coping may be an insufficient strategy for addressing negative emotions of chronic patients and UA patients. In addition, perceived lack of control over the success of treatment may be related to depression for UA patients. These findings have important implications for the development and implementation of interventions designed to address perceived control over treatment effectiveness and coping skills for negative emotions in the treatment and rehabilitation of cardiac patients. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.