PS370 Unit 5 Illness Perceptions Paper Example

The Stent Fixed It: A PS370 Unit 5 Chronic Illness and Illness Perceptions Paper

[Student Name]

Purdue University Global

PS370: Health Psychology

Unit 5 Chronic Illness and Illness Perceptions Paper

[Instructor Name]

[Date]

The captain, his scores and his care team are composite; the models, measures and studies cited are real.

An Acute Story About a Chronic Disease

At 51, Paul has run his own scallop boat out of the port of New Bedford for eighteen years. His heart attack came fourteen months ago, at sea, and ended with a stent in the main artery feeding the front of his heart. His cardiologist explained that coronary artery disease is chronic: the stent opened one blockage, but the process that caused it continues in his other arteries and will progress unless his risk factors change. Paul heard a different story. Asked by his rehabilitation nurse what had happened to him, he said that a pipe got clogged, the doctors put in a new piece, and now it is fixed.

That belief shaped what he did next. He attended five of the thirty-six cardiac rehabilitation sessions he was offered, then went back to sea. He takes his statin most days but often forgets it on trips. He quit smoking on land but not at sea. None of these choices looks irrational once his view of the illness is understood. Each is what a sensible person would do after an injury had been repaired.

The Common-Sense Model

Leventhal's common-sense model of self-regulation holds that people facing a health threat build their own representation of it, and that this representation, rather than the medical one, guides what they do (Leventhal et al., 2016). The representation has several parts: identity, meaning the label and the symptoms attached to it; cause; timeline, meaning how long the person expects it to last and whether it comes and goes; consequences; and control, both personal and through treatment. People also form an emotional representation alongside the cognitive one. They choose coping actions that fit the representation, appraise whether those actions are working, and update the picture over time.

The model predicts that people with an acute representation of a chronic illness will treat it like an injury that has healed. Paul's representation is built from his own experience. His symptom was chest pressure; it went away after the stent. His previous health problem, a herniated disc, was treated as an injury that healed. His father's heart attack was fatal, so Paul has no family experience of living with heart disease over years. Absent symptoms, his common sense tells him there is nothing left to treat.

A man who feels well after a stent is not ignoring his heart disease; his own picture of it says the disease is gone.

What His Scores Show

At his first rehabilitation visit Paul completed the Brief Illness Perception Questionnaire, which asks patients to rate eight dimensions of their illness on scales from 0 to 10 and to list the three most important causes (Broadbent et al., 2006). The questionnaire was designed to be quick enough for clinical use while capturing the main parts of the common-sense model.

His answers fit his acute story. He rated consequences at 3, meaning he expected little effect on his life, and timeline at 2, meaning he expected the illness to last a short time. Treatment control was high at 9; he trusted the stent. Personal control was low at 4; he did not see much role for himself. Identity, the number of symptoms he attributed to his heart, was 2. Concern was moderate at 5, and emotional response higher at 6. His three causes were his father's genes, bad luck and stress on the boat. Smoking, cholesterol and blood pressure did not appear.

Two features stand out. First, the combination of high treatment control and low personal control suggests he believes the doctors did the work and that nothing he does matters much. Second, his causal beliefs leave out every factor he could change. A man who believes his heart attack came from genes and bad luck has no reason to quit smoking at sea.

Mood After the Heart Attack

Paul's emotional representation also deserves attention. His intake PHQ-9 score was 11, in the moderate range, and he described broken sleep, tiredness by midafternoon and no appetite for the evenings he used to spend at his brother's house. Writing for the American Heart Association, a panel of twelve researchers weighed the cohort evidence and concluded that depressed patients die and suffer new cardiac events at higher rates after an acute coronary syndrome, and recommended treating depression as a prognostic risk factor in its own right (Lichtman et al., 2014). Depression can also make it harder to attend rehabilitation, take medication and change habits.

His moderate score and his emotional response rating suggest that his acute story may also be protective. Believing the illness is over lets him avoid thinking about the father who died at 58. Any attempt to change his perceptions will need to account for the anxiety the medical picture might bring.

Can Illness Perceptions Be Changed?

Petrie et al. (2002) tested a brief hospital-based intervention for patients after a first heart attack. A psychologist met with each patient for three sessions of about thirty to forty minutes, explored their beliefs about causes, timeline and control, and worked to change inaccurate ones while building a written plan. Against a usual-care comparison group, the patients who received the sessions changed their perceptions of the illness, reported feeling better prepared to leave the hospital, returned to work sooner and reported fewer angina symptoms at three months.

The study suggests that perceptions are not fixed and that brief work can shift them. For Paul, the target is clear. His timeline needs to change from acute to chronic, his causes need to include what he can control, and his personal control needs to rise. A cardiac psychologist or a rehabilitation nurse trained in the approach could start with his own words, the pipe that was fixed, and offer a more accurate metaphor: the pipe was cleared, but the water that clogged it is still running through every other pipe. A written plan could connect each habit to his own stated goal, which is to fish until he is 65 and watch his daughter finish her nursing degree.

Fitting Treatment to His Life

Paul's schedule means that a standard rehabilitation schedule, built on regular weekly visits to a hospital gym for three months, will not work.

Conclusion

Paul's choices after his heart attack follow from a coherent but inaccurate picture of his illness. The common-sense model explains how that picture formed, his Brief IPQ scores show its shape, and evidence from early intervention trials suggests it can change. Treating his heart disease as chronic means first helping him see it as chronic.

References

Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The Brief Illness Perception Questionnaire. Journal of Psychosomatic Research, 60(6), 631-637. https://doi.org/10.1016/j.jpsychores.2005.10.020

Leventhal, H., Phillips, L. A., & Burns, E. (2016). The common-sense model of self-regulation (CSM): A dynamic framework for understanding illness self-management. Journal of Behavioral Medicine, 39(6), 935-946. https://doi.org/10.1007/s10865-016-9782-2

Lichtman, J. H., Froelicher, E. S., Blumenthal, J. A., Carney, R. M., Doering, L. V., Frasure-Smith, N., Freedland, K. E., Jaffe, A. S., Leifheit-Limson, E. C., Sheps, D. S., Vaccarino, V., & Wulsin, L. (2014). Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: Systematic review and recommendations: A scientific statement from the American Heart Association. Circulation, 129(12), 1350-1369. https://doi.org/10.1161/CIR.0000000000000019

Petrie, K. J., Cameron, L. D., Ellis, C. J., Buick, D., & Weinman, J. (2002). Changing illness perceptions after myocardial infarction: An early intervention randomized controlled trial. Psychosomatic Medicine, 64(4), 580-586. https://doi.org/10.1097/00006842-200207000-00007