Illness cognition and cognitive behavioral approches
1. Illness Cognitions And Cognitive-
Behavioral Approaches To Change
Behavior
By
Misha Riaz L1`F16BSSY0064
Iqra Khan L1F16BSSY0058
2. Contents
What does it mean to be ill?
Illness cognitions
Cognitive dimensions of illness cognitions
Self-regulatory model of illness
Stages of self-regulatory model
Why model is called self-regulatory?
Using the self-regulatory model topredict outcomes
Adjusting to Physical Illness
The Theory of Cognitive Adaptation
Cognitive-Behavioral Approaches To Change Behavior
Cognitive Behavioral Therapy
The Transtheoretica;l Model
3. What does it mean to be ill?
Dimensions of illness
Not feeling normal → ‘I don’t feel right’
Specific symptoms → physiological/psychological
Consequences of illness →‘I can’t do what I usually do’
Time line → how long the symptoms last
The absence of health → not being healthy
4. Illness cognitions
“A patient’s own implicit common sense beliefs about their illness"
Illness cognitions provide patients with a framework for:
Coping with their illness
Understanding their illness
What to look out for if they are becoming ill
5. Cognitive Dimensions Of Illness Cognitions
Given by Leventhal, for understanding and coping with illness
Identity → label given to the illness (the medical diagnosis) and the
symptoms experienced
The perceived cause of the illness → biological (virus) or
psychosocial (stress)
Time line → how long the illness will last (acute, chronic)
Consequences → the possible effects of the illness on life (physical,
emotional)
Curability and controllability → the illness can be treated and cured and the
outcome of illness is controllable
6. Self-regulatory model of illnesscognitions
Stage 1:
Interpretation
• Symptom perception
• Social messages
Representation of
health threat
• Identity
• Cause
• Consequences
• Time line
• Cure/control
Emotional
response to health
threat
• Fear
• Anxiety
• depression
Stage 2: Coping
• Approach coping
• Avoidance coping
Stage 3:
Appraisal
• Was my coping
strategy effective?
7. Self-regulatory model of illnesscognitions
The model:
is based on approaches to problem solving
suggests that illnesses are dealt with in the same way as other
problems
8. Self-regulatory model of illnesscognitions
Stage 1: Interpretation
Confronting with the problem of a potential illness through two channels:
symptom perception (‘I have a pain in my chest’)
individual differences: internally/externally focused
influenced by mood, cognitions, environment
social messages (‘the doctor has diagnosed this pain as angina’)
health professional →formal diagnosis or a positive test result
lay individuals → advices from colleagues, friends or family
9. Self-regulatory model of illnesscognitions
Representation of health threat
Illness cognitions are constructed according to 5 dimensions:
identity
cause
consequences
time line
cure/control
Give the problem meaning and enable the individual to develop coping
strategies.
10. Self-regulatory model of illnesscognitions
Emotional response to health threat
Identification of the problem of illness will also result in changes in emotional state:
fear
anxiety
Depression
Coping strategies also relate to the emotional
state of the individual.
11. Self-regulatory model of illnesscognitions
Stage 2: coping
Approaches to coping with illness:
Coping with a diagnosis
Coping with the crisis of illness
Adjustment to physical illness.
Broad categories of coping strategies:
Approach coping (e.g. taking pills, going to the doctor)
Avoidance coping (e.g. denial, wishful thinking)
12. Self-regulatory model of illnesscognitions
Stage 3: Appraisal
Individuals evaluating:
the effectiveness of the coping strategy
determining whether to continue with this strategy or whether to opt
for an alternative one
13. Why is the model called self-regulatory
The 3 components of the model (interpretation, coping, appraisal) interrelate
in order to maintain the status quo (i.e. They regulate the self)
If the individual’s health is disrupted by illness the individual is
motivated to return the balance back to normality
Self-regulation involves the 3 processes interrelating in an ongoing and
dynamic fashion
14. Using the self-regulatory model topredict
outcomes
Predicting adherence to treatment
Predicting recovery from stroke
Predicting recovery from myocardial infarction
15. Adjusting to Physical Illness
Adjustment is a process that begins at the presentation of symptoms and
continues throughout the course of the illness and responds to changes in
illness status.
Physical illness can be conceptualized as a stressor, the demands of which
depend upon the characteristics and severity of the illness
The prevalence of psychological disorders is generally found to be
considerably higher amongst those with a variety of health problems.
Nonetheless, a considerable number of patients who experience even the
most devastating of illnesses seem able to adjust to illness without
experiencing clinically significant psychological problems.
The processes by which these people are able to adjust and, in many
cases, find positive meaning in their experiences, are important to
understand.
16. A Theory of Cognitive Adaptation
Shelly Taylor (1983), a leader in the field of health psychology research and
practice,
Research on 78 women diagnosed with breast cancer
During extensive interviews, women described changes that had occurred in
their lives since their breast cancer diagnosis
When asked to indicate if changes in their lives were positive or negative since
cancer diagnosis
7% reported negative changes
53% reported positive changes
17. A Theory of Cognitive Adaptation
Originally relying on responses from 78 women diagnosed with breast
cancer and their family members, she theorized that adjusting to life-
threatening events usually entails three processes:
searching for meaning
regaining mastery
restoring self-esteem
18. Cont.…
Search for Meaning
involves attempts at understanding why the event happened
what it means to the present.
For example, 95% of the women interviewed offered some explanation for why
their breast cancer had occurred, such as a stressful divorce or an injury to
their breast.
In addition, over half the women reported that the having cancer had caused
them to reevaluate their lives.
19. Cont.….
Gaining A Sense Of Mastery
Usually involves personal beliefs that a person can control the illness
Keep it from occurring again.
For example, many of the breast cancer patients' efforts at control were entirely mental.
The most common belief reported was that a positive attitude would keep the cancer from
coming back.
Women attempted to control their cancer by using meditation, imaging, self-hypnosis, and
positive thinking.
Women also reported that they made dietary changes and eliminated medications like birth
control pills.
Attempting to control side effects of treatment was another attempt at mastery reported by
these women.
20. Cont.…
Restoring Self-esteem
As managed directly by doing things like taking a cruise or making a major
purchase,
Indirectly by making social comparisons.
Social comparisons means comparing one's personal circumstances with those
of others for purposes of self-evaluation.
Virtually all of these women thought they were doing as well as or somewhat
better than other women coping with the same crisis.
Even the women who were in the worst condition comforted themselves by the
fact that they were not actively dying or were not in pain.
21. Cognitive-Behavioral Approaches
Focus on the target behavior itself
-Conditions that elicit and maintain it
-Factors that enforce it
Focus on beliefs about health habits
-Goal to modify internal monologues interfering with behavior change.
Involves the patient as a "cotherapist"
-E.g., through self-monitoring, applying techniques
22. Advantages Of
Cognitive-Behavioral Approaches
Multimodal approach- combine techniques to target all aspects of
problem
Can individually tailor intervention plans
Can target several health habits simultaneously
23. Cognitive behaviour therapy (CBT)
An effective treatment approach for a range of mental and emotional health
issues, including anxiety, depression, health related problems, addiction etc.
CBT aims to help you identify and challenge unhelpful thoughts and to learn
practical self-help strategies.
These strategies are designed to bring about immediate positive changes in
your quality of life.
CBT can be good for anyone who needs support to challenge unhelpful
thoughts that are preventing them from reaching their goals or living the life
they want to live.
CBT aims to show you how your thinking affects your mood. It teaches you to
think in a less negative way about yourself and your life. It is based on the
understanding that thinking negatively is a habit that, like any other habit, can
be broken.
24. When CBT is useful
CBT is used to treat a range of psychological problems including:
anxiety
anxiety disorders
depression
low self-esteem
irrational fears
hypochondria
substance misuse, such as smoking, drinking or other drug use
problem gambling
eating disorders
insomnia
marriage or relationship problems
certain emotional or behavioural problems in children or teenagers.
25. CBT and Thoughts, Feelings and Behaviours
The main focus of CBT is that thoughts, feelings and behaviours
combine to influence a person’s quality of life
CBT aims to teach people that it is possible to have control over
their thoughts, feelings and behaviours.
CBT helps the person to challenge and overcome automatic beliefs,
and use practical strategies to change or modify their behaviour.
The result is more positive feelings, which in turn lead to more
positive thoughts and behaviours.
26. CBT for Health Problems
CBT interventions can increase coping with difficult disorders, reduce negative
emotions that exacerbate medical problems. A large body of research supports
the use of CBT for chronic pain, heart disease, gastrointestinal problems, and
high blood pressure
CBT for health problems addresses the mind-body connection by suggesting a
role for the mind in the cause as well as the treatment of illness.
CBT maintains that the mind and body interact
CBT suggests that illness can be caused by combination of biological,
psychological, and social factors. This more modern conceptualization is known
as the biopsychosocial model of health and illness.
27. Goals of CBT for Health Problems
Empowering the Patient
Empowering the Treatment
Taking Charge of Treatment
28. CBT for Depression
CBT can effectively treat people with depression, helping people learn skills to reverse
negative thinking habits.
Numerous studies have found Cognitive Behavioral Therapy (CBT) for depression to be
as effective as antidepressant medication in reducing depression symptoms, and more
effective than antidepressant medication in keeping depression symptoms from
reoccurring after the end of treatment
75% of individuals diagnosed with clinical depression experience a significant decrease
in symptoms after only 12- 20 sessions of CBT
85% of individuals who receive both CBT for depression and antidepressant medication
experience a significant decrease in depression symptoms and learn how to overcome
depression.
CBT helps people with depression restructure negative thought patterns, teaching
them to interpret their environment and interactions with others in a positive and
realistic way. It may also help you recognize other factors, such as maladaptive
behaviors, that may be making the depression worse.
29. CBT Treatment for depression can involve
Assessment and re-evaluation of problematic ways of thinking
Increasing behaviors that naturally promote pleasure and mastery
Assertiveness training
Treatment for insomnia
Mindfulness techniques
Social Skills Training
Problem Solving techniques
Treatment for underlying anxiety
Working effectively toward life goals
30. CBT for Quitting Smoking/ alcohol/ drug use
CBT treatment does not support the idea that addiction is a lifelong disease.
Instead, addictions are viewed as over-learned behaviors that serve important
functions.
The goal of Cognitive behavioral treatment is learning new more effective
behaviors to take the place of the addiction behaviors
Cognitive behavioral therapy for quitting smoking focuses on changing
people’s reactions to their urges to smoke.
This occurs through changing thoughts and behaviors.
Changing thoughts occurs by examining unhelpful thought patterns that lead
to smoking, and then learning more effective patterns.
Learning alternate behaviors involves identifying the functions that smoking
serves, and replacing the smoking with other behaviors that serve the same
function.
31. CBT for quitting smoking or alcohol and drug use may
include
Cognitive restructuring
Mindfulness training
Stimulus control
Self-monitoring
Functional analysis
Impulse tolerance training
Emotion regulation training
32. CBT for Eating Disorders
An eating disorder is a psychological problem that significantly interferes
with eating and/or overall nutrition. This can include
restricting one’s diet to small amounts of food
extreme overeating
engaging in unhealthy ways of regulating weight, such as over-exercise,
laxatives, or vomiting.
Eating disorders generally fall into three types
binge-eating disorder
Bulimia
anorexia nervosa
These disorders can become quite serious and have the potential to result
in lasting physical damage or death.
33. Cognitive Behavioral Therapy (CBT) has proven to be the most clinically
effective treatment for all eating disorders.
It was found to be the briefest treatment, and CBT was found to be associated
with the lowest relapse rates. Rather than focusing on causes of the disorder
from the distant past, cognitive behavioral therapy focuses on immediate
conditions that maintain eating disorders. CBT for eating disorders varies by
disorder
CBT treatment for eating disorders involves several of the following components:
Cognitive restructuring
Behavioral chain analysis
Emotion regulation strategies
Distress tolerance training
Mindfulness
35. Self-Monitoring
Assessment of
Frequency of target behavior
What comes before/after behavior
Cognitions and emotions associated with behavior-
This is used as first step toward behavior change
Helps to get a sense of circumstances under which behavior occurs to inform
intervention planning
Increased awareness may produce behavior change in and of itself
36. Classical Conditioning
Pairing unconditioned response with new stimulus produces
conditioned effect
Used in alcoholism treatment
Drug Antabuse (unconditioned stimulus) produces nausea and
vomiting (unconditioned response) when taken with alcohol
Over time, alcohol associated with nausea/vomiting and elicits
same response (conditioned response) without drug
37. Operant Conditioning
Pairs voluntary behavior with systematic consequences
(reinforcement)
Positive reinforcement following behavior increases likelihood of
behavior occurring again
Withdrawing reinforcement or punishing behavior decreases
likelihood of behavior occurring
Interventions alter reinforcement maintaining poor health behavior,
or reinforce desired behavior
38. Self-Reinforcement
Individual systematically rewards/punishes self to increase/decrease occurrence of
target behavior
Self-reward
Positive self-reward- add desirable consequence to successful modification of
behavior
Negative self-reward- remove aversive factor in environment after successful
modification
Self-punishment
Positive self-punishment- administer unpleasant stimulus following undesirable
behavior
Negative self-punishment- withdraw positive reinforcers in environment following
undesirable behavior
39. Contingency Contracting
Form of self-reinforcement in which individual contracts with
another person regarding rewards/punishments contingent on
performance/nonperformance of target behavior
Example: person giving therapist money to give them for every
week of successful dieting
40. Cognitive Restructuring
Internal monologues: cognitions involving self-criticism/self -praise
Involves training to recognize and modify internal monologues associated
with health behavior
E.g. statements of self-efficacy when experiencing temptation; self-
reinforcing statements following resistance to temptation; self-criticism
following set-backs
Training involves:
Self-monitoring to identify monologues
Modification of monologues
41. Identify situations in which relapse likely and develop coping skills to
manage situations/events
Example: engage in constructive self-talk to resist temptation;
eliminate environmental cues
May involve exposure to such situations to practice use of coping
skills
Can increase self-efficacy
Relapse Prevention
42. The Transtheoretical Model
Developed by Prochaska and DiClemente in the late 1970s.
Research was being conducted on the experiences of smokers,
some who quit smoking on their own
some who had to seek treatment.
They wanted to understand why people quit on their own.
Research concluded that people quit smoking when they were ready
43. Stages
Pre-Contemplation
People do not intend to take action in the near future.
Completely unaware that their lifestyle is problematic and may produce
negative consequences.
Places more emphasis on the cons than the pros of changing behaviour.
Contemplation
The intention is there to start living a healthy behaviour in the foreseeable
future (in the next 6 months).
People are now made aware that their behaviour is unhealthy and can lead to
serious consequences.
A more thoughtful and equal approach is taken to the pros and cons however,
the person may be a bit reluctant to change their behaviour.
44. Cont…
Preparation
People are ready to take action within the next 30 days.
Small efforts are being made as they believe that it will lead to a
healthier life.
Action
People have changed their behaviour over the past six months and
intends to continue to maintain those changes.
Changes can be seen when people modify their problematic
behaviour or adapt to healthier behaviors.
45. Maintenance
People have changed and stuck to their new or modified behavioral
practices for the past six months and intend to continue.
They make every effort not to relapse into earlier stages.
Termination
People have no desire to return to their previous behaviour and are
sure they will not relapse.
Cont…
46. Process of Change
To progress through the stages of change, people apply cognitive, affective,
and evaluative processes. These processes result in strategies that help
people make and maintain change.
Consciousness Raising - Increasing awareness about the healthy
behavior.
Dramatic Relief - Emotional arousal about the health behavior, whether
positive or negative arousal.
Self-Reevaluation - Self reappraisal to realize the healthy behavior is part
of who they want to be.
Environmental Reevaluation - Social reappraisal to realize how their
unhealthy behavior affects others.
47. Cont…
Social Liberation - Environmental opportunities that exist to show society is
supportive of the healthy behavior
Self-Liberation - Commitment to change behavior based on the belief that
achievement of the healthy behavior is possible.
Helping Relationships - Finding supportive relationships that encourage the
desired change.
Counter-Conditioning - Substituting healthy behaviors and thoughts for
unhealthy behaviors and thoughts.
Reinforcement Management - Rewarding the positive behavior and reducing
the rewards that come from negative behavior.
Stimulus Control - Re-engineering the environment to have reminders and cues
that support and encourage the healthy behavior and remove those that
encourage the unhealthy behavior.
48. Limitations
Ignores the social context in which change occurs such as the socioeconomic
status (SES) and income.
The lines between the stages can be arbitrary with no set criteria of how to
determine a person's stage of change.
The questionnaires that have been developed to assign a person to a stage of
change are not always standardized or validated.
There is no clear sense for how much time is needed for each stage, or how
long a person can remain in a stage.
The model assumes that individuals make coherent and logical plans in their
decision-making process when this is not always true.
