psychological adjustment was related to positive reinterpretation, seeking emotional
support, not using substances and not venting emotions.Conclusion
The results from this study provide support for the predicted association between cogni-
tive variables (illness representations and coping) and level of functioning (psychological
adjustment, well-being and dysfunction) in CFS. In addition, the results provide support
for Leventhal’s self-regulatory model as illness representations were related to coping and
a measure of outcome (level of functioning). However, because of the cross-sectional
nature of the design it is not possible to say whether illness representations cause
changes in either coping or outcome and as the authors conclude ‘only a prospective
design can clarify some of these issues’.Problems with assessment
This dynamic, self-regulatory process suggests a model of cognitions that is complex and
intuitively sensible, but poses problems for attempts at assessment and intervention. For
example:
1 If the different components of the self-regulatory model interact, should they be
measured separately? For example, is the belief that an illness has no serious
consequences an illness cognition or a coping strategy?
2 If the different components of the self-regulatory model interact, can individual com-
ponents be used to predict outcome or should the individual components be seen
as co-occurring? For example, is the appraisal that symptoms have been reduced a
successful outcome or is it a form of denial (a coping strategy)?The individual processes involved in the self-regulatory model will now be examined
in greater detail.STAGE 1: INTERPRETATION
Symptom perception
Individual differences in symptom perception
Symptoms such as a temperature, pain, a runny nose or the detection of a lump may
indicate to the individual the possibility of illness. However, symptom perception is not a
straightforward process (see Chapter 12 for details of pain perception). For example,
what might be a sore throat to one person could be another’s tonsillitis and whereas a
retired person might consider a cough a serious problem a working person might be
too busy to think about it. Pennebaker (1983) has argued that there are individual
differences in the amount of attention people pay to their internal states. Whereas some
individuals may sometimes be internally focused and more sensitive to symptoms, others58 HEALTH PSYCHOLOGY