The Self-Regulation of Health and Illness Behaviour

Linda Cameron, Howard Leventhal, Linda Cameron, Howard Leventhal

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136617317
• Edition: 1
• Topic: Medizin
• Subtopic: Medizinische Theorie, Praxis & Referenz

Self-regulation theory focuses on the ways in which individuals direct and monitor their activities and emotions in order to attain their goals. It plays an increasingly important role in health psychology research.
The Self-regulation of Health and Illness Behaviour presents an up-to-date account of the latest developments in the field. Individual contributions cover a wide range of issues including representational beliefs about chronic illness, cultural influences on illness representations, the role of anxiety and defensive denial in health-related experiences and behaviours, the contribution of personality, and the social dynamics underlying gender differences in adaptation to illness. Particular attention is given to the implications for designing effective health interventions and messages. Integrating theoretical and empirical developments, this text provides both researchers and professionals with a comprehensive review of self-regulation and health.

1 Self-regulation, health, and illness

An overview

Linda D. Cameron and Howard Leventhal¹

The overall goal of this volume is to foster an integrated understanding of a self-regulation perspective of health and illness behavior. Recent years have witnessed a burgeoning interest in self-regulation within health psychology as well as in other fields, including social cognition, personality, education, and organizational psychology. We have sensed the need for a book that reviews current theory and research on self-regulation and health, not only to provide a synthesis of ideas and findings but also to orient and guide further research in this field. This volume is not designed to be a comprehensive overview of self-regulation theory and health research, but instead to provide selective reviews of principles and findings in order to familiarize readers with this area of study and stimulate new research ideas.

What is self-regulation in health and illness?

The growing popularity of self-regulation theory in psychological science has prompted the development and application of an array of self-regulation models for the study of health-related behaviors. Although there are some ambiguities and discrepancies across models regarding various principles of self-regulation, these models share some basic properties.

Virtually all models construe self-regulation as a systematic process involving conscious efforts to modulate thoughts, emotions, and behaviors in order to achieve goals within a changing environment (Zeidner et al., 2000). It is a dynamic motivational system of setting goals, developing and enacting strategies to achieve those goals, appraising progress, and revising goals and strategies. Feedback loops play an integral role in these models, in which goals serve as reference values for appraising the relative success of efforts. Particularly central to this systems perspective is the principle of the TOTE (test, operate, text, exit) unit, which represents the mechanism involved in detecting and evaluating discrepancies between input (perceptions of a present state) and a reference value, generating behavior aimed at reducing the discrepancy, and appraising outcomes of that behavior in the subsequent self-regulatory cycle (Miller et al., 1960).

Fundamental to many self-regulation theories is the delineation of a system of emotional processes that are integrally linked with cognitive mechanisms (Carver and Scheier, 1998; Epstein, 1994; Kuhl, 2000; Leventhal, et al., 2001; Maes and Gebhardt, 2000; Miller et al., 1996; Mischel and Shoda, 1999). Emotional responses are crucial elements of the motivational system – as direct responses to appraisals of goal-related progress, as experiences to be regulated, and as influences on cognitions and behaviors (see Chapter 8). Self-regulation models typically describe the parallel processing of problem-focused and emotion-focused goals, with cognitive and behavioral processes simultaneously dedicated to controlling the objective health problem and regulating emotional distress. Parallel processing of problem-focused goals and emotion-focused goals are explicitly identified, for example, by Lazarus and Folkman’s (1984) stress-coping model, Maes and Gebhardt’s Health Behavior Goal Model (Maes and Gebhardt, 2000), and Leventhal’s Common-Sense Model (CSM; Leventhal et al., 1980).

Beyond these common themes, self-regulation models diverge in their contents and processes. In the following sections, we introduce some of the primary themes that have received particular attention in self-regulation theory and research within the health domain.

Hierarchical goal structure

One important theme that receives particular emphasis in Carver and Scheier’s (1998) model is the hierarchical organization of goals within the self-regulation system. Goals are arranged in a linked hierarchy whereby higher-level, more abstract goals (e.g., stay healthy) set the reference values for lower-level goals (e.g., take vitamins, keep cholesterol levels low, use sunscreen). This principle is useful for identifying the interconnectedness among various goals as well as capturing the general consistency among goals and, in turn, the coherence in actions and motivations displayed by an individual. Moreover, it provides a general framework for understanding how a particular action can serve multiple goals (see Chapter 2).

Abstract versus concrete-experiential processes

Another key theme of many self-regulation models is the distinction of abstract, conceptual processes from concrete-experiential processes (e.g., Epstein, 1994; Leventhal et al., 2001). Abstract processes involve conceptual, propositional knowledge and thought whereas concrete-experiential processes incorporate imagery and perceptual-affective memories. Cognitive schemata (representations) incorporate both sorts for information; for example, one’s representation of Parkinson’s Disease may include knowledge that it may have some genetic basis and that it is a degenerative disease as well as vivid images of Mohammad Ali’s trembling, yet controlled gestures and short, humorous verbal responses during interviews. These systems of memory and information processes have distinctive properties that differentially influence self-regulation. Conceptual-level processes tend to be more controlled and effortful, whereas concrete-experiential processes are automatic and emotionally evocative. Moreover, evidence suggests that concrete processes have a particularly strong influence on behavior (Brownlee et al., 2000).

Conscious versus nonconscious regulation processes

Our general definition of self-regulation focuses specifically on conscious efforts to direct and monitor thoughts, affect, and behavior. Yet these conscious dynamics are influenced in important ways by a variety of nonconscious processes. Both abstract and concrete material may be activated below the level of awareness, and their activation can influence information processing, affective experiences, and behaviors without the individual being mindful of such influences. Nonconscious goals can also activate processes that alter conscious self-regulation dynamics. For example, motivations to protect one’s self-concept or sense of safety can elicit defensive biases to process information in a manner that minimizes the threat to one’s sense of well-being (see Chapter 9). Of the multitude of psychophysiological regulation processes in virtually constant operation, the vast majority occur outside of awareness – for example, neuroendocrine regulation, cardiorespiratory dynamics, and unconscious processes involved in the down-regulation or reduction of negative emotion (Kuhl, 2000). Yet these psychophysiological currents can shape conscious self-regulation dynamics through somatic experiences, affect levels, and information processing effects.

General models versus health-specific models of self-regulation

A key factor that distinguishes between different self-regulation models used in health psychology is whether it represents a general model of behavior (e.g., the Scheier and Carver model and the Lazarus and Folkman stress-coping model) or whether it applies specifically to health and illness behavior (e.g., Leventhal’s CSM). Each type of model has its advantages. Health and illness are important life issues that critically influence goal selection and behavior in our daily activities. As such, general models of behavioral self-regulation must be able to account for health-related behavior. Health research generated by these models can usefully guide theoretical developments, and they can easily integrate evidence of self-regulation from other domains. In this manner, use of a general theory helps to integrate psychological science and promote cumulative knowledge about self-regulatory behavior.

On the other hand, health-specific models are able to capture critical aspects of health and illness that are unique to this life domain (e.g., the primary role of symptom experiences, the survival threat posed by many illnesses, and the complexities surrounding medication use and other medical treatments). As Leventhal et al. note in Chapter 3, there are important characteristics of the representational contents of illnesses and treatments that must be recognized in order to sufficiently understand health and illness behaviors and experiences.

Yet these two approaches to theory and research are not inconsistent, and the field will progress most effectively if we carefully attend to how the specific models of health self-regulation map onto the more general theories of self-regulation. These theories operate at different levels of specificity, and advances at one level can serve to refine and shape understanding at the other level. Moreover, the focus of general models on self-regulatory processes (as opposed to contents) can stimulate developments concerning generic systems procedures as more content-focused theories such as the CSM can advance our understanding of the schematic contents and attributes of illness and treatment representations, and how they operate within the self-regulation system. Greater attention to the fit between general and health-specific models will ensure that theoretical developments at both levels are on the right track. Such efforts will also enhance the flow of information between the fields of social cognition, personality, and health psychology (as well as other fields) so that health psychology research can effectively inform theory development in these fields and so that the fields develop in synchrony. The advantages of such efforts are demonstrated by Contrada and Coups (Chapter 4) in their presentation of a social-cognitive perspective of self-regulation that integrates key aspects of personality theory and research with health self-regulation research.

Goals of survival and coherence

It has been suggested that humans possess two inherent, overarching goals: survival and coherence (Carver and Scheier, 1996). We may not be consciously aware of them as we go about our daily activities, but these fundamental goals are the basis from which all other goals are generated. Illness experiences can threaten both survival and a sense of coherence in one’s sense of self and life goals, underscoring the critical importance of illness-related events and why adaptation to illness can present critical challenges in self-regulation. Consideration of survival and coherence goals seems crucial for understanding the cognitive, motivational, and behavioral patterns that evolve over the course of health threat experiences. In addition to Scheier and Carver’s general model, health-specific models such as the CSM (see Moss-Morris et al., 2002) and Myers’ Preventive Health Model (see Chapter 15) identify coherence as a critical attribute of representations and goals.

Expectancies, perceived competence, and self-efficacy

Self-regulation theories vary in the extent to which they identify the role of expectancies and competence beliefs in behavioral self-regulation. Models developed by Bandura (1999), Schwartzer (1992), and Maes and Gebhardt (2000) emphasize how beliefs about one’s ability to engage in a particular behavior (e.g., exercise) are crucial to the adoption of that behavior. Carver and Scheier’s model delineates the importance of more general expectancies regarding potential outcomes. Other models (e.g., Leventhal’s CSM) focus less explicitly on these beliefs – although ability, treatment efficacy, and expectations about disease course and treatment outcomes are seen as implicitly imbedded within illness and treatment representations. Self-efficacy and competence beliefs may be more important for complex health behaviors (e.g., exercise and dietary changes), yet less important for a substantial proportion of illness behaviors. For example, there may be relatively little variation in perceptions of one’s ability to take oral medication or to seek medical care for serious symptoms (practical access issues notwithstanding).

The role of the self in self-regulation

Self-regulation theories of health and illness behavior generally tend to focus on the psychological dynamics that are specific to selected episodes and illness experiences. Yet there is increasing recognition of the need to connect these self-regulation dynamics with the more general self-system (Contrada and Ashmore, 1999). The self has been defined as a multifaceted knowledge structure within which a web of self-representations and identities are connected with multiple sets of scripts and strategies for achieving related goals (Cantor and Kihlstrom, 1987). Illness challenges the integrity of the self, and managing illness requires the regulation of critical aspects of the self – in particular, emotional states and physical states. Social cognition theorists are making gains in clarifying the connections between self-constructs (e.g., self-efficacy and self-guides) and self-regulation, and Contrada and Coups (Chapter 4) identify a number of connections between these constructs and health-related self-regulation. As Kuhl (2000) notes, cognitive representations of goals and activities cannot energize behavior until they have personal meaning – that is, until they connect with the self. Once these connections are made, then cognitive representations of goals and activities may be translated into specific behavioral routines that can become dissociated from personal meaning over time. Scheier and Carver (Chapter 2) and Leventhal et al. (Chapter 3) discuss how the personal meaning of health-related goals and activities influence behavior, and how appraisals of health status and health-related activities shape the self-concept. Moreover, motivations to protect the self can bias health-related construals and cognitions, as discussed by Wiebe and Korbel (Chapter 9); the extent to which these effects can lead to the development of serious functional somatic syndromes is addressed by Moss-Morris and Wrapson (Chapter 6).

Self-regulation within the social and cultural systems

Although self-regulation theories tend to focus on internal processes and mechanisms, they must take into account that these processes occur in a sociocultural context and that knowledge structures of illnesses, health, and treatment methods reflect experiences within the family, neighborhood, community, and society at large (Jackson et al., 2000). Moreover, social and economic resources constrain or permit health-related behavior and critically influence cognitive and affective experiences when dealing with health threats. Indeed, sociocultural factors affect virtually every component of the self-regulation system: definitions of the self, construals of illness, development of desires and goals, identification of strategies for coping, reference values for appraising progress, and even emotional responses and use of emotion regulation strategies. Self-regulation theory offers a framework with which to systematically examine the interactions between persons and contexts – that is, how self-regulation is linked with social relationships and the cultural environment (see Chapter 12).

Health and illness self-regulation occurs within dynamic social contexts, and illness management is often a shared task involving family members and significant friends. As social experiences involving the sharing of ideas, treatment procedures, and emotional regulation with others, illness behavior is best understood within the social context and by considering the congruence and incongruence of self-regulation systems among those involved (see Chapters 10 and 11).

Are these models different from other models popular in the health domain?

The term ‘self-regulation’ has been used so widely in recent years that there is some speculation as to whether self-regulation models are really that different from other mo...

Table of contents

• Cover 
• Title
• Copyright
• Contents 
• List of illustrations
• List of contributors
• Acknowledgements
• 1 Self-regulation, health, and illness: an overview
• Part I Theoretical foundations
• Part II Representations of illnesses and health actions
• Part III Emotional processes
• Part IV The social and cultural context
• Part V Applications and interventions
• Index