‘It was all intertwined’: Illness representations and self-management in patients with cancer and anxiety/depression

Objective: Cancer and anxiety/depression frequently co-occur, leading to poorer outcomes for these illnesses. However, the majority of existing research investigates how participants view single illnesses alone. This study aimed to explore the content of individuals’ multimorbid representations and how these relate to their coping behaviours and self-management strategies for cancer and anxiety/depression.

Design: A semi-structured qualitative research design with theoretical thematic analysis.

Main Outcome Measures: Multimorbid illness representations, coping behaviours, and self-management strategies.

Results: In interviews with 21 participants multimorbid representations varied, three participants viewed cancer and anxiety/depression as unrelated, five participants were uncertain about the relationship between cancer and anxiety/depression, and the majority of participants perceived cancer and anxiety/depression as related. This third group of participants often described relationships as causal, with representations having both positive and negative influences on coping behaviours and self-management strategies. Representations were shown to change over the course of the cancer experience, with fear of cancer recurrence and the influence of participants’ most challenging illness also discussed.

Conclusions: People hold multimorbid illness representations that can influence self-management. An awareness of these representations by researchers, health professionals, and patients is important for the creation of future interventions that aim to improve and maintain patient wellbeing.     

Understanding the prevalence and correlates of implicit theories of weight in the United States: Insights from a nationally representative sample

Objectives: The primary aim of this research is to understand how mindsets about weight controllability in the United States relate to population health. We examined the distribution of people’s implicit theories of weight, from an incremental (controllable) to an entity (not controllable) mindset, in a nationally representative sample, as well as their relation to: sociodemographic factors, beliefs about behaviour and genetics as causes of obesity and engagement in weight management-relevant behaviours.

Methods: We report data from the National Cancer Institute’s Health Information National Trends Survey 4.

Results: A majority of respondents endorsed an incremental mindset of body weight, but endorsement of this mindset was stronger among younger, white respondents, and those with a higher income and more educational attainment. A stronger incremental mindset was related to stronger behaviour and weaker genetic causal beliefs about obesity, as well as a tendency to report increased engagement in weight management-relevant behaviours.

Conclusions: Our research provides evidence that although incremental mindsets are more common overall and associated with engagement in health behaviours that can contribute to or detract from population health, incremental mindsets are less common among individuals from more marginalised groups.     

Medication beliefs and structural barriers to treatment adherence among people living with HIV infection

Background: People living in poverty face multiple structural challenges to medication adherence including lack of transportation, inadequate housing and food insecurity. The degree to which individuals’ motivations to remain adherent may overcome structural barriers has received limited attention.

Purpose: To examine whether medication necessity and concerns beliefs predict antiretroviral therapy (ART) adherence over and above structural adherence barriers associated with poverty.

Methods: People living with HIV in a southern US city (N = 942) completed computerised interviews, an objective measure of adherence and HIV viral suppression obtained from medical records. Hierarchical logistic regression models were constructed to examine demographic and illness characteristics, structural barriers, mental health, substance use and medication necessity and concerns beliefs as predictors of ART adherence.

Results: In multivariable models, current drug use and medication necessity and concerns beliefs predicted treatment adherence over and above demographic, health, mental health and structural factors.

Conclusions: Medication beliefs are proximal and powerful motivating factors that predict adherence. Adherence interventions should directly address medication beliefs in developing strategies to manage barriers facing people with HIV living in poverty.     

The perceptions of the causes of cardiac diseases: a taxonomy

Objective: This study verifies whether the open-ended question of the B-IPQ can collect causal attributions of patients with cardiac diseases, define the more frequent causal attributions reported, classify them and describe the relation between the classification of the causes and patients’ characteristics.

Design: A group of 2011 patients with cardiac diseases was recruited during the first week of cardiac rehabilitation.

Primary outcome measures: Every participant filled in the B-IPQ and the HADS. The qualitative and quantitative analyses of the text using T-LAB identified the most frequent causal attributions and their co-occurrences.

Results: Among the patients, 26% did not recognise any causal attribution. The likelihood that the patients did not provide an answer was increased in older patients, females, patients with lower levels of education and higher levels of depression. Smoking and stress emerged as the most important attributions, followed by genetics, metabolic syndrome, work and nutrition. Four thematic clusters were identified: ‘work and stress’, ‘metabolic syndrome and hypertension’, ‘displeasures and body care’ and ‘heredity and other related diseases’.

Conclusions: This study suggests a classification of the causal attributions in patients with cardiac diseases and identifies thematic patterns and unknown attributions. The themes identified can serve as categories for future closed-ended questions.     

Social-class indicators differentially predict engagement in prevention vs. detection behaviours

Objective: Few systematic studies have examined the contexts in which social-class variables will predict engagement in health-relevant behaviours. The current research examined whether the impact of social-class on health behaviours depends upon how social-class is assessed and the category of health behaviour under consideration.

Method: Our sample was drawn from the Health Information National Trends Survey in 2012 (N = 3959). Participants reported their income and education as well as their engagement in a variety of prevention and detection behaviours.

Results: Consistent with our hypothesised framework, we found that income predicted engagement in a variety of detection behaviours above and beyond education, whereas education predicted engagement in a variety of prevention behaviours above and beyond income.

Conclusions: Our findings suggest that income and education operate on health behaviours via different pathways and have implications for public health policy and intervention.     

Stomaching rejection: Self-compassion and self-esteem moderate the impact of daily social rejection on restrictive eating behaviours among college women

Objective: The present study examined whether having high self-esteem or a self-compassionate perspective help mitigate the impact of daily social rejection on negative affect and restrictive eating behaviours.

Design: Following a baseline survey assessing self-esteem and self-compassion, 121 college women completed online daily diaries for one week.

Main Outcome Measures: Negative affect and restrictive eating behaviours.

Results: On days when women reported more rejection, they also reported higher restrictive eating behaviours and greater negative affect. Effects were moderated by self-esteem and self-compassion, such that the lower participants were in self-esteem or self-compassion, the stronger the positive relation between rejection and negative affect and restrictive eating. However, only the common humanity/isolation dimension of self-compassion significantly moderated daily effects of rejection when controlling for self-esteem. Mediated moderation results reveal different mechanisms by which self-esteem and self-compassion buffer against rejections’ effects on affect and restrictive eating.

Conclusion: Self-compassion and self-esteem influence the complex impact that social rejection has on affect and restrictive eating. More than other dimensions of self-compassion or self-esteem, remembering one’s common humanity can result in a healthier response to social rejection.     

Book reviews and books received

Helping interventions John Heron: Helping the Client: a Creative Practical Guide. London: Sage, 1990. £9.95.

A person-centred perspective on school counselling John McGuiness: A Whole School Approach to Pastoral Care. London: Kogan Page, 1989. £8.95.

How to relate effectively Richard Nelson-Jones: Human Relationship Skills (2nd edition). London: Cassell, 1990. £11.95.

Ripe for research? Dave Mearns and Windy Dryden: Experiences of Counselling in Action. London: Sage, 1989. £9.95.

Issues in action Windy Dryden (ed.): Key Issues for Counselling in Action. London: Sage, 1989. £7.95.

The meaning of death Rosemary Dinnage: The Ruffian on the Stair: Reflections on Death. London: Viking, 1990. £14.99.

The empty cradle Irving G. Leon: When a Baby Dies: Psychotherapy for Pregnancy and Newborn Loss. London: Yale University Press, 1990. £20.

Children against themselves Israel Orbach: Children Who Don't Want to Live: Understanding and Treating the Suicidal Child. San Francisco: Jossey-Bass, 1988. £17.95.     

The effectiveness of narrative versus informational smoking education on smoking beliefs,attitudes and intentions of low-educated adolescents

Objective: This study tests the effectiveness of narrative versus informational smoking education on smoking beliefs, attitudes and intentions of low-educated adolescents.

Design: A field experiment with three waves of data collection was conducted. Participants (N = 256) were students who attend lower secondary education. At the first and third waves, they completed a questionnaire. At the second wave, 50.8% of the participants read a smoking education booklet in narrative form and 49.2% read a booklet in informational form. After reading, all participants also completed a questionnaire at wave 2.

Main outcome measures: Beliefs about negative consequences of smoking, attitudes towards smoking and intentions to smoke were measured.

Results: Repeated measures analyses with time as a within-subjects factor and condition as a between-subjects factor showed that beliefs about smoking were more negative at Wave 2 compared to Wave 1, irrespective of condition. However, attitudes towards smoking were more positive at Wave 3 compared to Wave 1 when participants had read the narrative version.

Conclusion: These results show that narrative smoking education is not more effective than informational smoking education for low-educated adolescents and can even have an unintended effect for this target group by making attitudes towards smoking more positive.     

Sex,germs, and health: pathogen-avoidance motives and health-protective behaviour

Objective: Recent work suggests that the psychology of pathogen-avoidance has wide-reaching effects on how people interact with the world. These processes – part of what has been referred to as the behavioural immune system – are, in a way, our ‘evolved’ health psychology. However, scholars have scarcely investigated how the behavioural immune system relates to health-protective behaviours. The current research attempts to fill this gap.

Design: Across two cross-sectional studies (N = 386 and 470, respectively), we examined the relationship between pathogen-avoidance motives and health-protective behaviour.

Outcome Measures: The studies used self-reported measures of attitude and intention as indicators of health-protective behaviour.

Results: Data collected in Study 1 revealed that pathogen-avoidance motivation related to participants’ attitude and intention towards sexually transmitted infections screening. High levels of pathogen-avoidance motivation were also related to having had fewer sexual partners, which partially mediated the effect of pathogen-avoidance variables on testing motivation. Study 2 extended these findings by showing moderate associations between pathogen-avoidance motivation and a broad range of health-protective behaviours, including but not limited to pathogen-related health concerns.

Conclusion: We argue that understanding and targeting pathogen-avoidance psychology can add novel and important understanding of health-protective behaviour.     

Book reviews and books received

Practical help for family therapists John Carpenter and Andy Treacher: Marital and Family Therapy. Oxford: Blackwell, 1989. €29.50 (hardback); €9.95 (paperback).

Survival for the guidance teacher W.P. Gothard and E. Goodhew: Guidance and the Changing Curriculum. London: Croom Helm, 1987. €22.50.

Second-class male Michael S. Kimmel (ed.): Changing Men: New Directions in Research on Men and Masculinity. London: Sage, 1987. €35 (hardback); €14.50 (paperback).

Analysing the analyst Rosemary Dinnage: One to One: Experiences of Psychotherapy. London: Viking, 1988. €12.95.

Practical counselling skills revisited Richard Nelson-Jones: Practical Counselling and Helping Skills. London: Cassell, 1988. €7.95.

Snakes and pyramids Jocelyn Chaplin: Feminist Counselling in Action. London: Sage, 1988. €7.95.

The person-centred approach: a key text Dave Mearns and Brian Thome: Person-Centred Counselling in Action. London: Sage, 1988. €7.95.     

Book reviews

So you thought you had sorted out a Code of Ethics? Gavin Fairbairn and Susan Fairbaim: Ethical Issues in Caring. Aldershot: Avebury, 1988. £22.50.

The myth of positivism Celia Kitzinger: The Social Construction of Lesbianism. London: Sage, 1987. £8.95.

A family approach to art psychotherapy H. B. Landgarten: Family Art Psychotherapy: a Clinical Guide and Casebook. New York: Brunner/Mazel, 1987. $27.50.

Simple psychodynamics Michael Jacobs: Psychodynamic Counselling in Action. London: Sage, 1988.

Optimistic assumptions T. Haberle: Counselling and Curing. London: SPCK, 1987. £3.50.     

An illness-specific version of the Revised Illness Perception Questionnaire in patients with atrial fibrillation (AF IPQ-R): Unpacking beliefs about treatment control,personal control and symptom triggers

Objective: This study modified the Revised Illness Perception Questionnaire (IPQ-R) in patients with persistent atrial fibrillation (AF).

Design: Qualitative interviews and think-aloud techniques informed modification of the IPQ-R to be specific to AF patients. Confirmatory Factor Analysis (CFA) (n = 198) examined the validity of the modified IPQ-R (AF-IPQ-R). Exploratory factor analysis (EFA) examined the new AF-triggers scale. Construct validity examined associations between the AF-IPQ-R, quality of life (QoL) and beliefs about medicines. Test–retest and internal reliability were examined.

Results: Interviews indicated that patients viewed triggers of AF rather than initial causes of illness as more applicable. Patients believed specific behaviours such as rest could control AF. Treatment control beliefs related to pharmacological and procedural treatments. These data were used to modify the IPQ-R subscales and to develop a triggers of AF scale. CFA indicated good model fit. EFA of the triggers scale indicated three factors: emotional; health behaviours; and over-exertion triggers. Expected correlations were found between the AF-IPQ-R, QoL and treatment beliefs, evidencing good construct validity.

Conclusion: The AF-IPQ-R showed sound psychometric properties. It provides more detailed specification than the IPQ-R of beliefs that may help to understand poor QoL in AF patients, and guidance for future interventions in this area.     

Predicting jet lag in long-haul cabin crew: The role of illness cognitions and behaviour

Objective: Established risk factors for jet lag are mostly physiological including circadian preference, age, gender, the number of flight zones crossed and to some extent direction of travel. Some research has also highlighted a role for psychosocial factors including sleep, diet and ‘circadian’ health behaviours and illness cognitions although this remains relatively untested. The aim of this study was to evaluate the role of sleep, diet and illness cognitions in predicting perceived jet lag amongst long-haul crew.

Design: Sixty long-haul crew took part in a longitudinal study. Profile characteristics (including chronotype), preparation strategies (sleep, eating and ‘circadian’ behaviours) and illness cognitions were measured at baseline (before a trip).

Main outcome measures: Subjective jet lag (unidimensional and multidimensional) was measured on the crews’ second day off (post-trip).

Results: Hierarchical regression analyses showed that unidimensional jet lag was predicted by the belief in a cyclical timeline, whereas multidimensional jet lag was predicted by multidimensional jet lag at baseline and to a lesser extent by identity. No role was found for profile characteristics and preparation strategies.

Conclusion: Illness cognitions partly explain the experience of perceived jet lag in long-haul cabin crew indicating that jet lag is in part a psycho-social construct, not just a biological one.     

Structure and content of affective associations with health behaviours: Is the behaviour ‘good OR bad’ or ‘good AND bad’

Objective: The feelings and emotions individuals associate with health-related behaviours influence engagement in those behaviours. However, the structure and the content of these affective associations have not been examined. The studies reported here examined competing hypotheses about the structure (unidimensional or bidimensional) and content (generalised affect or specific emotions) of affective associations with two health-related behaviours: physical activity and fruit/vegetable consumption.

Design: For each behaviour, participants (fruit and vegetable consumption n = 149; physical activity n = 199) completed an assessment of the association of 40 positive and 51 negative affect concepts with the behaviour.

Main outcome measures: Ratings of affective associations with each behaviour.

Results: Confirmatory factor analyses comparing unidimensional and bidimensional affect structure models showed that the structure of individuals’ affective associations was bidimensional for both behaviours – positive and negative affective associations were shown to be separate and distinct constructs. Exploratory factor analyses supported a model of affective associations as generalised affect for both behaviours.

Conclusion: Affective associations with both physical activity and with fruit/vegetable consumption consist of separate positive and negative dimensions of generalised affect. These findings lead to recommendations for research and intervention development based on the implications for how affective associations might operate to influence behavioural decision-making.     

Book reviews and book received

The most practised, the least taught David S. Werman: The Practice of Supportive Psychotherapy. New York: Brunner/Mazel, 1984. $34.00.

Another load of research L.S. Greenberg and W.M. Pinsof (eds.): The Psychotherapeutic Process: a Research Handbook. New York: Guilford, 1986. £39.95.

Crisis of identity K. Yardley &; T. Honess (eds.): Self and Identity: Psychosocial Perspectives. Chichester: Wiley, 1987. £28.

A dig from the 'Rib' Sue O'Sullivan (ed.): Women's Health: a Spare Rib Reader. London: Pandora, 1987. £5.95.

'Weak on vision, hot on workshops' Zandy B. Leibowitz, Caela Farren and Beverley L. Kaye: Designing Career Development Systems. San Francisco: Jossey-Bass, 1986. £30.75.

Holland not neglected in Australia Jan J. Lokan and Keith F. Taylor (eds.): Holland in Australia: a Vocational Choice Theory in Research and Practice. Melbourne: Australian Council for Educational Research, 1986. $A24.95.

Need help getting a job? Elizabeth B. Yost and M. Anne Corbishley: Career Counseling: a Psychological Approach. San Francisco: Jossey-Bass, 1987. £24.

Children's health B. Mayall: Keeping Children Healthy. London: Allen &; Unwin, 1986. £6.95.

Educating about divorce Kathleen M. Cox and Martin Desforges: Divorce and the School. London: Methuen, 1987. £7.95.     

Book reviews

Laughing Gods, Weeping Virgins: Laughter in the History of Religion. Ingvild Sæud Gilhus, 1997 London, New York: Routledge 173 pp., £45.00 (hb) ISBN 0–415–16197–5

Questioning the Secular State: The Worldwide Resurgence of Religion in Politics. David Westerlund, ed., 1996 London: Hurst & Companyμ xii +428 pp., £14.95 ISBN 1–85065–241–4 (pb.)

Religion and Resistance Politics in South Africa. Lyn S. Graybill, 1996 Westport, Connecticut: Praeger/Greenwood Press 157 pp., £44.95 (hb) ISBN 0–275–95141–3

Engaged Buddhism: Buddhist Liberation Movements in Asia Christopher S. Queen & Sallie B. King, eds., 1996 Albany, NY: State University of New York Press 446 pp., US$24.95 ISBN 0–7914–2844–3

Religious Pluralism and Christian Truth. Joseph S. O'Leary, 1996 Edinburgh: Edinburgh University Press xiii + 269 pp., £45.00 ISBN 0–7486–0727–7

Church, State and Religious Minorities. Tariq Modood, ed., 1997 London: Policy Studies Institute 96 pp., £10.95 ISBN 0 85374 724 5

The Coming Deliverer: Millennial Themes in World Religions. Fiona Bowie, ed., 1997 Cardiff: University of Wales Press 264 pp., £9.95 (pb) ISBN 0–7083–1338–8

Zoroastrians in Britain. John R. Hinnells, 1996 Oxford, Clarendon Press xiv + 336 pp., £42.00 (hb) ISBN 0–19–826193–4

From the Holy Mountain: A Journey in the Shadow of Byzantium. William Dalrymple, 1997 London, Harper Collins 484 pp., illustrated, £18.00 ISBN 0–0025–5509–3

Jerusalem Today: What Future for the Peace Process?. Ghada Karmi, edv 1996 Reading: Ithaca Press xix +191 pp., £25.00 ISBN 0–86372–204–0

Judaism Since Gender. Miriam Peskowitz & Laura Levitt, eds., 1997 London: Routledge 229 pp., £14.99 (pb), £45.00 (hb) ISBN 0–415–91461–2 (pb), ISBN 0–415–91460–4 (hb)

Muslim Communities in the New Europe. Gerd Nonneman, Tim Niblock & Bogdan Szajkowski, eds., 1996 Reading: Ithaca Press 346 pp, £35.00 (hb) ISBN 0–86372–192–3

Congregation and Community. Nancy Tatom Ammerman, 1997 New Brunswick: Rutgers University Press xvi + 434 pp., US$55.00 (hb), US$24.00 (pb) ISBN 0–81352–334–6 (hb), ISBN 0–81352–335–4 (pb)

Against the Stream: The Adoption of Traditional Christian Faiths by Young Adults. Richard P. Cimino, 1997 Lanham, Maryland: University Press of America & Religion Watch 128 pp., US$46,00 (hb), US$26,00 (pb) ISBN 0–7618–0574–5 (hb), ISBN 0–7618–0575–3 (pb)

Polygamous Families in Contemporary Society. Irwin Altman & Joseph Ginat, 1996 Cambridge: Cambridge University Press xv + 512 pp., £55.00 (hb), £19.95 (pb) ISBN 0–521–56169–8 (hb), 0–521–56731–9 (pb)

Fertility, Class and Gender in Britain: 1860–1940. Simon Szreter, 1996 Cambridge: Cambridge University Press 710 pp., £50.00 ISBN 0–521–34343–7

Implicit Religion in Contemporary Society. Edward I. Bailey, 1997 Kampen, Netherlands: Kok Pharos Publishing House; Weinheim, Germany: Deutscher Studien Verlag 302 pp., Dfl.69.00, £23.00 ISBN (Kok) 90–390–0581–8; ISBN (DSV) 3–89271–694–3

Geography of Religions in Russia. Alexei D. Krindatch, 1996 Decatur, Georgia: Glenmary Research Center 72 pp., 47 maps, US$29.95 (Paper/Spiral Bound) ISBN 0–914422–25–1

Believing in Australia: A Cultural History of Religions". Hilary M. Carey, 1996 St Leonards, N.S.W.: Allen & Unwin xviii + 270p., £16.95 (pb) ISBN 1–86373–950–5

Icelandic Spiritualism: Mediumship and Modernity in Iceland. William H. Swatos, jr. & Loftur Reímar Gíssurarson, 1997 New Brunswick: Transaction Publishers 269 pp., US$32.95 (hb) ISBN 1–56000–273–5

The Channeling Zone: American Spirituality in an Anxious Age. Michael F. Brown, 1997 Cambridge, Massachusetts & London, England: Harvard University Press 214 pp., £14.50 (hb) ISBN 0–674–10882–5

Listening People, Speaking Earth: Contemporary Paganism. Graham Harvey, 1997 London: Hurst & Co. 250 pp., £27.50 (hb), £9.95 (pb) ISBN 1–85065–271–6 (hb), ISBN 1–85065–272–4 (pb)     

Influencing health decision-making: A study of colour and message framing

Objective: Previous research has provided evidence that colour associations and frame can influence behavioural intentions to engage in vaccination behaviours. In this study, the extension of these effects to sunscreen application behaviours was investigated. Additional colours and the manner in which colour primes were employed were also explored.

Design: Two hundred and eighty-six college students were primed with either short wavelength colours (blue/purple) or long wavelength colours (red/orange) as part of goal framed sunscreen information pamphlets.

Main outcome measures: Self-reported behavioural intentions to apply sunscreen, immediate affective reaction to stimuli material, anticipated affect towards sunscreen use, and perceived efficacy of preventing skin cancer were measured.

Results: Individuals with no prior intention to use sunscreen expressed greater behavioural intentions to do so after reading a positively framed sunscreen pamphlet that was designed using short wavelength colours. The negatively framed messages and those presented in long wavelength colours did not enhance persuasion.

Conclusions: In accordance with the Unification Theory of Framing, a match between the representations of the target behaviour, the colour prime, and the frame resulted in the greatest amount of persuasion. Creating communications with representations that match the target behaviour could be a powerful tool to increase compliance.     

Book reviews and books received

Counselling and spirituality Lyall, D. 1995 Counselling in the Pastoral and Spiritual Context Buckingham, Open University Press ISBN 0-335-19162-2 £10.99

Career counselling Seligman, L. 1994 Developmental Career Counseling and Assessment (2nd ed.) London, Sage ISBN 0-8039-5804-8 £19.95

Women's careers Walsh, W.B. &; Osipow, S.H. (Eds), 1994 Career Counseling for Women Hove, Erlbaum ISBN 0-8058-1035-8 £53.50

Crisis? what crisis? Dattilio, F.M. &; Freeman, A. (Eds), 1994 Cognitive-Behavioral Strategies in Crisis Intervention New York, Guilford ISBN 0-89862-221-2 £25.00

Guidance on research methods McLeod, J. 1994 Doing Counselling Research London, Sage ISBN 0 8039 7804 9 £10.95

Barker, C. Pistrang, N. &; Elliott, R. 1994 Research Methods in Clinical and Counselling Psychology Chichester, Wiley ISBN 0-471-93612-X £29.95

Research into creative therapies Gilroy, T. &; Lee, C. (Eds), 1995 Art and Music Therapy and Research London, Routledge ISBN 0-415-10045-3 £37.50 (hardback); £15.99 (paperback)

Treating stress Palmer, S. &; Dryden, W. 1995 Counselling for Stress Problems London, Sage ISBN 0-8039-8863-X £12.95

Breast cancer Batt, S. 1994 Patient No More: the Politics of Breast Cancer London, Scarlet Press ISBN 1-85727-167-3 £10.99

Supervision Feltham, C. &; Dryden, W. 1994 Developing Counsellor Supervision London, Sage ISBN 0-8039-8939-3 £9.95