This is the Chapter 9 of the book Introduction to Health Psychology (Val Morrison_ Paul Bennett) 4th Edition. Which is content for the exam of the component Health Psychology of Module 5 (Health Psychology & Applied Technology) of the University of Twente, in the Netherlands. 

Ch.9: Symptoms experienced and interpreted

Sensation illness:

• Illness: changes in bodily sensations and functions, goes to the doctor. Includes changes in bodily functions (e.g. increased frequency of urination), emissions (such as blood in one’s ­ urine), sensations (e.g. numbness, loss of vison) and unpleasant sensations (e.g. fever, pain, nausea)
  • views about health --> prior experience of illness and their understanding of medical knowledge
• Disease: wrong organs, cells or tissues

Perception symptoms:

Sick recognition process: 1. Noticing, 2. Interpreting, 3. Planning/take action

• The attentional model of Pennebaker (1982): competition for attention between multiple internal or external cues or stimuli leads to the same physical sign or physiological change going unnoticed in some contexts but not in others.
• The cognitive–perceptual model of Cioffi (1991): processes of interpretation of physical signs and influences upon their attribution as symptoms while also acknowledging the role of selective attention

Bodily signs --> increased likelihood symptom perception:

• Bodily signs: are physical sensations that may or may not be symptoms of illness.
• Symptoms: defined as what is experienced and, as such, they are more subjective (unreliable indicators of the need for medical attention’)
  
  • Symptoms receiving attention:
    
    • Painful or disruptive: if a bodily sign has consequences for the person
    • Novel: (considered rare and serious) subjective estimates of prevalence significantly influence
      
      • (1) the perceived severity of a symptom
      • (2) whether the person will seek medical attention
    • Persistent: a bodily sign is more likely to be perceived as a symptom if it persists for longer than is considered usual
    • Pre-existing chronic disease: past or current illness experience has a strong influence upon somatisation (i.e. attention to bodily states) and increases the number of other symptoms perceived

Attentional states:

• Competition of Cues Theory: competition attention internal/external cues --> notice physical signs in some context, not notice in others
  • Stroop Task: demonstrated that previous experience with an illness can increase a person’s attentional bias --> anxiety is commonly implicated in enhanced attention to potential or actual health threats.
  • Placebo response: manifested by attentional processes --> demonstration of the power of expectation.
• Primary Attentional System (PAS): operate below the level of consciousness and acts on stored representations, such as illness schema which it automatically selects from.
  
  • Mass Psychogenic Illness: illustrates the powerful effect of anxiety on our perceptions and behaviour --> heightens a person’s attention to their own bodily signs and can produce the belief that they have contracted the illness.
  • Medical Student’s Disease: increased knowledge about disease-specific symptoms obtained during medical lectures increased the self-reported experience of exactly these symptoms
• Secondary Attentional System (SAS): attention here can be manipulated by conscious thoughts and cognitive processes, such as rational weighing up of likelihood. However, process is hampered if the PAS -->  if a ‘label’ has already been assigned to the symptoms, it can be difficult to shift
• Cognitive-perceptual model: focus processes interpretation physical signs and influences on attribution as symptoms, and role selective attention

Social Influences:

• Stereotypes who gets which disease --> change perception/response to symptoms (men associated with heart problems)
  • Context and time:
    • distracting environment, symptoms less likely detected
    • situations differ in the extent to which expect a person to either express or suppress the pain (at home pain may be expressed, such as moaning out loud
  • Social Display Rules: peer pressure influence willingness to express symptoms

Differences symptom perception:

• Gender:
  • women more attention symptoms --> physiological differences, more socially accepted
  • Pain Threshold: minimum amount pain required before it is detected --> contributes to physiological differences (menstruation)
• Age: older people more info own body
• Emotions: mood individual influences (good mood --> see themselves healthier)
  
  • Negative emotional states: increase symptom perception by means of its effect on attention, as well as by increasing rumination and recall of prior negative health events
  • Neuroticism: tendency experience negative emotional sensation
    
    • Negative affectivity (NA): interpret symptoms more negatively. Manifest itself either as a state (situation-specific) or a trait (generalised)

Cognitions/Coping style:

• Illness cognition: cognitive processes involved in a person’s perception or interpretation of symptoms or illness and how they represent it to themselves
  • Type A behaviour (TAB): impatience/competition/aggressiveness --> less likely notice symptoms (focused things should do, ignore signs of weakness)
  • Repression: supress feelings/thoughts associated aversive events, related to comparative optimism: (unrealistically optimistic) estimate their risk of experiencing a negative event compared with similar others
  • Monitors: pay attention symptoms, immediately try to do something about it, or blunters: ignore source of stress

Interpretation symptoms:

• Culture: influence the meanings and labels that individuals ascribe to symptoms
  • Variations in socialisation: ideas about what is acceptable pain to bear and express is shaped.
• Gender: women interpret physical signs as symptoms disease, more than men. Also, somatization disorder (significant focus symptoms, result major distress) more common in women
• Life stage: differ cognitive awareness disease. Research still needed
• Personality: neuroticism offer report symptoms --> moderate levels beneficial, visit doctor sooner
• Self-identity: interpretation dependent current social identity
  
  • Self-categorisation theory: influence symptom perception, and is dependent in social identity
• Disease experience: role previous experiences --> shape our disease prototypes
• Common-sense model: representation diseases formed by media, personal experience, friends experiences
  • Parallel processing components stimuli --> cognition symptom, emotional reaction

Illness/disease prototypes:

• What is it that leads a person to believe they are sick?
  • when the symptoms a person is experiencing ‘fit’ a model of illness retrieved from their memory
  • Salience symptom: symptoms will be ‘tagged’ to strong and emotive labels in our memory stores (e.g. heart attack), whereas others will be less so (e.g. menstrual cramp)

Disease representation:

• Illness Cognition: common-sense models of illness and illness representations, personal models, and illness perceptions
  • Common-sense Models of Illness: limited in the extent to which they develop our understanding of what lies within or behind the representations presented
• Self-regulatory Model of illness and illness Behaviour (Howard Leventhal and colleagues): ‘a patient’s own implicit common-sense beliefs about their illness’
  
  • Dual-processing model: considers in parallel objective components of stimuli (cognitive), and the subjective response to that stimulus (emotional)
  • ‘Self-regulatory’: feedback loops from coping to representations and back again -->  efforts to alter their responses in order to achieve a desired outcome
    
    • hangover, they are unlikely to be too worried --> if the symptoms persist, rethink their coping response (e.g. go to bed), or rethink their initial perception (e.g. maybe this isn’t a hangover)

Consistent themes in illness representation :

1. Identity: variables indicate presence/absence disease
2. Consequences: external influence disease
3. Cause: assumed cause (biological/psychological/emotional/genetic/environmental)
4. Timeframe: expectation acute (short) chronic (long)
5. Controllability/curability: extend think something can be done about disease

Representations influence course disease --> seek help depend extent someone things can be cured

Multidimensional Health Locus of Control Scale: perceived control over illness

Illness Perception Questionnaire (IRQ and IPQ-R):

Distinguishes convictions about personal control over outcome/ expected treatment control --> examines emotional response to illness/extent person feels they understand their condition

• Cross-sectional design: collects data from a sample one occasion only. Sample representative population under study

Fatigue:

• European Americans: referred more often to genetic causes, medicalised/somatised the condition more and considered it a chronic condition --> biomedical ‘disease’ model
• South Asians: temporary, caused by something transient and less needing of medical treatment --> socially oriented ‘depletion’ model

Representations/Outcomes:

Representation direct effects outcomes

• Perceived Controllability: associated with adaptive outcomes
• Perceptions of high symptom identity, chronicity and serious consequences: negatively associated with such outcomes
• --> However, many of the studies reviewed are cross-sectional and thus limited to providing evidence only of concurrent associations.

Respond to symptoms:

• Causal attributions: try and gain some sense of control --> self-preservation bias
  • lifestyle factors and stress were the most common attributions made
  • people with lung cancer, do not see smoking as possible cause --> defence mechanism
• Illness behaviour: behaviour of people with recognized symptoms, not yet seeking medical help à self-medication, or seek advice from lay referral system: informal network turned to for advice or information about symptoms and other health-related matters.
• Sick role behaviour: activities undertaken by a person diagnosed as sick in order to try to get well
  
  • Health Hardiness: extent person committed to and involved health-relevant activities, perceives control over their health and responds to health stressors as challenges or opportunities for growth.

Delay behaviour:

Delay in presenting symptoms for medical  attention --> related to outcomes of morbidity and

Mortality

• Model of Delay Behaviour (Safer et al., 1979): seek help, once 3 phases completed with positive answer
  • Appraisal delay: symptoms
  • Illness delay: seek medical assistance
  • Utilization delay: time between need help/actually visiting doctor

Factors determine seeking help behaviour:

• Social class/ Educational level
• Finances
• Symptom:
  • Type (visible yourself/others)
  • Effects (disrupt activities)
  • Location (some things are easier for people to discuss)
  • Observed prevalence
• Others --> take action if encouraged to do so by others
• Fear of diagnosis --> influence delay seeking help behaviour
• Treatment beliefs and delay behaviour (extension to Leventhal’s self-regulation model, by Horn and Weinman 1999): perceived benefits that an individual foresees of any treatments they may obtain as a result of seeking medical help are predictive delay behaviour