Date of Award
Doctor of Philosophy (PhD)
Illness behaviour is formulated within the context of the Disease Illness Distinction Model (Cott, 1987a, 1987b), a cognitive-behavioural model that is an extension or earlier disease/illness concepts. The thesis is comprised of two studies that focus on illness behaviour associated with chest discomfort and no significant cardiac disease. In the first study, the Retrospective Chest Pain Study, the incidence, nature and degree of illness behaviour were documented in 134 individuals with chest pain that was unlikely to be of cardiac origin. Results indicated a high level of disability that was attributed to chest pain, as measured by limitations on activities, changes in employment, cardiac medication intake, and visits to physicians. The nature of the disability was consistent with that reported in previous research investigating the degree of illness in individuals with chest pain and normal coronary arteries. Three conclusions were drawn from the results: Patient attributions for chest pain mediate illness behaviour and cognitions. Medication prescriptions and ingestion facilitate disease attributions and related illness behaviour. Physicians are often unaware of symptoms and related illness behaviour in their patients.
The second study, the Chest Discomfort Intervention Study, examined the utility of cognitive-behavioural interventions, based on the Disease Illness Distinction Model, in decreasing the degree of illness behaviour reported by individuals with chest discomfort and normal coronary arteries (n - 14) or mitral valve prolapse (n - 90). A second purpose was to examine the role of cognitions in illness behaviour. The cognitive-behavioural interventions were applied in both individual and group education formats, and were compared to self-monitoring attention control and wait list control groups. Results indicate that the cognitive-behavioural interventions were successful in reducing self- reported city attributed to chest discomfort and limitations on routine daily and exercise activities relative to control groups. The interventions were also more successful in shifting locus of control toward "internal," compared to controls. Fin3lly, the data indicate that while symptoms and illness behaviour appear to be related, improvements in symptoms are not necessary for reducing disability in these individuals. It was argued that the relationships identified between symptom measures and other measures of illness are medinted through cognitions regarding the significance of symptoms (e.g., "hurt" versus "harm"), rather than being the direct result of subjective characteristics of symptoms.
McCully, Jane Doran, "Illness Behaviour Associated with Chest Discomfort and No Significant Cardiac Disease: A Cognitive Behavioural Approach" (1990). Open Access Dissertations and Theses. Paper 3547.