Role of Illness Models

Clinical Psychology Review 23 (2003) 171 – 196
Review article
A review of the role of illness models in severe
mental illness
Fiona Lobban*, Christine Barrowclough, Steve Jones
University of Manchester, Manchester, UK
Received 5 October 2001; received in revised form 19 September 2002; accepted 30 September 2002
Abstract
The ways in which people think about illness experiences have been associated with a variety of
important behaviours and emotional responses in patients, carers, and professionals. Some of these
responses have been shown to be related to outcome. Explicit models such as the self-regulation model
(SRM) [Leventhal, H., Nerenz, D. R., & Steele, D. F. (1984). Illness representations and coping with
health threats. In A. Baum & J. Singer (Eds.), A handbook of psychology and health. Hillsdale, NJ:
Erlbaum, 219 – 252.] have been shown to be useful in highlighting key beliefs across a wide range of
different physical illnesses. The specific beliefs about mental illness that have been assessed have been
varied and largely without a common theoretical framework. This has resulted in a literature from
which it is difficult to draw firm conclusions. The central aim of this paper is to assess the applicability
of the SRM to mental illness. To this end, we review studies to date that have examined the beliefs that
people with a mental illness have about their experiences. In addition, we review studies that have
examined the beliefs of relatives of people with a mental illness and professionals who work with this
population. We assess to what extent these studies are consistent with the SRM before suggesting ways
in which the model could be further developed and tested. The SRM is presented as a useful
framework for more advanced investigations into the function of beliefs about mental illness and how
these can be modified in order to effect outcome. Developing psychological theories common to both
* Corresponding author. Academic Division of Clinical Psychology, School of Psychiatry and Behavioural
Sciences, 2nd Floor Education and Research Centre, Wythenshawe Hospital, Manchester M23 9LT, UK. Tel.:
+44-161-2915319.
E-mail address: fiona.a.lobban@man.ac.uk (F. Lobban).
0272-7358/03/$ – see front matter D 2003 Elsevier Science Ltd. All rights reserved.
PII: S 0 2 7 2 - 7 3 5 8 ( 0 2 ) 0 0 2 3 0 - 1
172 F. Lobban et al. / Clinical Psychology Review 23 (2003) 171–196
physical and mental health may eventually result in an integrated approach in which mental illness
becomes less stigmatised within the treatment setting.
D 2003 Elsevier Science Ltd. All rights reserved.
Keywords: Schizophrenia; Mental health; Illness models; Self-regulation model
1. Introduction
There is nothing either good or bad, but thinking makes it so. (Shakespeare, Hamlet, Act 2
Scene 2)
The way in which people think about events is important in determining their emotional
and behavioural responses. This is true for a wide range of events, including health problems.
The relationships between beliefs about illness and emotional and behavioural responses have
been extensively explored in both physical and mental illness, but largely from different
perspectives.
In trying to understand variation in physical health- and illness-related behaviours,
psychologists have focused primarily on social cognition models. These models attempt
to identify the key cognitions that mediate between extrinsic factors that have been
associated with health behaviours, such as demographics and social factors, and individual
behaviours. The models that have been most widely applied include the health belief model
(Becker, 1974; Becker & Maimon, 1983; Janz & Becker, 1984), health locus of control
(Seeman & Seeman, 1983; Wallston, Wallston, & DeVellis, 1978), protection motivation
theory (Maddux & Rogers, 1983; van der Velde & van der Pligt, 1991), theory of reasoned
action/planned behaviour (Ajzen, 1988, 1991; Ajzen & Fishbein, 1980), self-efficacy theory
(Bandura, 1982, 1991; Schwarzer, 1992), the transtheoretical model of change (Prochaska &
DiClemente, 1984; Prochaska, DiClemente, & Norcross, 1992), and self-regulation theory
(Leventhal, Nerenz, & Steele, 1984). All of these models assume that individuals are
rational beings whose health-related behaviour depends upon their understanding of relevant
information. They have all been widely applied to a range of physical illnesses and overall
have been able to account for a significant amount of variance in illness-related behaviours,
making the key cognitions in each model an important target for intervention (Connor &
Norman, 1995).
In trying to understand variation in health- and illness-related behaviours in severe mental
illness, there have been very few attempts to draw on any of the developments made by the
physical illness models. In mental illness, the study of beliefs has generally been focussed on
people’s interpretations of internal and external experiences and how these interpretations
contribute to the development and maintenance of psychotic symptoms. Examples of this area
include studies of: (1) beliefs about intrusive thoughts, which may predispose them to be
experienced as auditory hallucinations (Morrison, 1998); (2) information processing bias such
as jumping to conclusions that result in persecutory interpretations of innocuous events (Garety
& Hemsley, 1994); and (3) tendency to make external and personal attributions for negative
F. Lobban et al. / Clinical Psychology Review 23 (2003) 171–196 173
events (Kinderman & Bentall, 1997). There has been less exploration of other potentially
important beliefs, highlighted in the physical health literature, such as the possible causes of the
experience, beliefs about control or treatment, perceived consequences, and how long the
experience is likely to last for (though important exceptions to this are reviewed below).
Garety, Kuipers, Fowler, Freeman, and Bebbington (2001) have used the term ‘‘secondary
appraisals’’ to refer to evaluations of the experience of psychosis itself (such as what caused
it, and how an individual can control it, what are the consequences to the person’s life), as
opposed to primary appraisals of the meaning of anomalous experiences that may drive the
core symptoms (such as ‘‘people who are looking at me intend to do me harm’’). Some
distinction between different types of appraisal is potentially very useful, especially when the
individual is able to recognise that their primary appraisals are part of a mental illness. For
example, their secondary appraisal may include beliefs such as ‘‘these thoughts about people
wanting to hurt me are caused by stress’’ or ‘‘I can control these experiences by taking some
medication or reducing my stress.’’ However, the distinction between primary and secondary
appraisal becomes less clear when the individual does not recognise their experiences as
being part of a mental illness. Their causal explanation may be that their thoughts about
people wanting to harm them are due to the fact that people really are trying to harm them.
The primary and secondary appraisals are not easy to distinguish in this scenario and
therefore the model becomes less useful. In addition, the terms primary and secondary may be
confusing as they are already used in the related literature on coping and have specific and
somewhat different meanings in that context (Lazarus & Folkman, 1984).
It is our suggestion that attempts to develop an understanding of the role of beliefs in
mental illness would benefit from drawing on the extensive work that has been already done
in understanding the role of beliefs in physical illness and, in particular, the self-regulation
model (SRM) (Leventhal et al., 1984). This model is particularly useful for understanding
severe mental illness for the following reasons.
(1) The SRM emphasises the importance of emotional representations as well as cognitive
representations. This may be particularly important in mental illness where dysregulation
of emotion may be integral (Garety et al., 2001).
(2) The SRM is currently the most widely used model because of its reliability and validity in
exploring important patient beliefs across a range of physical illnesses, and the advances
this has made in understanding self-management (Hampson, Glasgow, & Foster, 1995;
Hampson, Glasgow, & Toobert, 1990), and recovery (Horne, James, Petrie, Weinman, &
Vincent, 2000; Petrie, Weinman, Sharpe, & Buckley, 1996). The wide applicability of the
model suggests it may also be appropriate for mental as well as physical illness.
(3) Much of the work that has been done in mental illness is consistent with this model. This
literature is reviewed below.
(4) Preliminary studies in mental illness indicate that the SRM explains considerable variance
in important outcome measures for both patients (Clifford, 1998) and relatives (Barrow-
clough, Lobban, Hatton, & Quinn, 2001).
(5) Finally, the SRM would have the added advantage of encouraging a wider exploration of
beliefs about mental illness within clinical practice and research.
2. The SRM (Leventhal et al., 1984)
The SRM is based on the premise that patients are active problem solvers whose health-
related behaviours are attempts to close the perceived gap between their current health and a
future goal state. The coping strategies they select (for example, whether or not to take
medication) are guided by their interpretation and evaluation of their illness. The outcome of
these behaviours is then evaluated and fed back into their model of the illness, and/or used to
shape future coping responses. This dynamic aspect of the process is strongly emphasised in
the model. The key beliefs identified in the SRM refer to a specific illness episode, rather than
to intellectual beliefs about a possible illness occurrence. In applying the SRM to physical
illness, five specific components have been identified as being key to guiding individual
responses. These are the perceived identity of the illness (including a label and signs/
symptoms), the perceived consequences (physical, social, and behavioural), the likely causes
of the illness, and a likely timeline or sense of how long the illness will last for. A fifth belief
identified by Lau and Hartman (1983) about potential for control or cure of the illness has
also been added to the model. Validation for these beliefs is evident in the work of Kleinman
(1980, 1988) who identified similar key beliefs when examining explanatory models of
illness across different cultures.
In addition to a cognitive representation of illness, Leventhal proposed an emotional
representation, which he saw as existing in parallel. The emotional representation of illness
has been less well developed and consequently, the relationship between these two systems is
does not seem to have been fully elaborated (Fig. 1).
Although originally developed around physical illness, Leventhal, Diefenbach, and
Leventhal (1992) have briefly described how the model could be usefully applied to mental
illness. They use the example of hypochondriasis, and argue this originates when an
individual builds a model of illness in response to perceived bodily sensations. The
Fig. 1. Outline of the self-regulation model (Leventhal et al., 1984).

individual’s model is that they have a serious illness, but the medical investigations do not
confirm this and the medical practitioner’s model is that they are experiencing anxiety.
Repeated reassurance does not work in the long-term because it fails to provide the individual
with an alternative coherent model that explains why they experience the bodily sensations
that they do. Until this is done, re-experiencing of the bodily sensations will trigger the old
model of illness and the accompanying concern. This formulation is entirely consistent with
specific cognitive models of hypochondriasis (Salkovskis, 1989; Warwick & Salkovskis,
1990).
3. Assessing beliefs about illness/health
Since Leventhal originally proposed the SRM, there has been considerable support for
both the specific beliefs that constitute the way in which people think about physical illness,
and their utility in accounting for variation in outcome in a number of areas. A questionnaire
that assesses these dimensions; the Illness Perception Questionnaire (IPQ) (Weinman, Petrie,
Moss-Morris, & Horne, 1996) has been used with people with a wide range of health
problems. Using this and similar measures, and controlling for degree of disease severity,
associations have been demonstrated between illness perceptions and emotional adjustment
(e.g., Murphy, Dickens, Creed, & Berstein, 1999), overall functioning levels (e.g., Scharloo,
Kaptein, Weinman, Willems, & Rooijmans, 2000), coping and managing symptoms (e.g., de
Valle & Norman, 1992; Hampson, Glasgow, & Zeiss, 1994), adherence to health care
regimens (e.g., Wichowski & Kubsch, 1997), and cognitive processing of illness-related
information (e.g., Croyle & Ditto, 1990). The importance of relatives’/carers’ beliefs about
illness and/or treatment have also been investigated and shown to be associated with patient
outcome (Heijmans, de Ridder, & Bensing, 1999), and treatment adherence by the patient
(Heinzelman & Baguley, 1970). Relatives’ models are also likely to influence the patients’
own models, as evidence suggests that models can be influenced by information provided by
others, even strangers (e.g., Croyle, 1992).
The IPQ has recently been modified to include subscales assessing emotional repres-
entation and illness coherence (a sense of having a comprehensive understanding of the
illness). The dimensions of control/cure and timeline have also been subdivided to
differentiate personal and treatment control, and an acute/chronic and episodic timeline
(Moss-Morris et al., 2001). Although the IPQ has been extensively used in assessing illness
beliefs in physical illness, it has not been used to explore beliefs about mental illness,
except in one study described below, which found a version modified for relatives of people
with a diagnosis of schizophrenia to be a valid and reliable tool (Barrowclough et al.,
2001).
Before continuing to assess the reliability of the IPQ in measuring beliefs about mental
illness, more in-depth assessment of the validity of focusing on the beliefs highlighted in the
SRM is required. This requires a more open-ended methodology, such as semistructured
interviews, to establish whether or not the key constructs that people use about mental illness
are similar to those used to understand a range of physical illnesses, i.e., those described by the
SRM. It is important that such a methodology avoids suggesting attributes that fit the model to
be tested, but may not be those of concern to the patient (Leventhal & Nerenz, 1985).
A number of other measures exist, which have been devised specifically to assess beliefs
about mental illness. These include the Beliefs about Voices Questionnaire (BAVQ: Chad-
wick & Birchwood, 1995), Personal Beliefs about Illness Questionnaire (PBIQ: Birchwood et
al., 1993), Short Explanatory Model Interview (SEMI: Lloyd et al., 1998), and the Family
Coping Questionnaire (Magliano et al., 1998). Some, such as the PBIQ, have been based on
theories drawn from other areas of psychology, but the validity of such theories in
understanding mental illness has not been previously established. Others, such as the BAVQ,
were devised from in-depth interviews with voice hearers. This more open-ended approach
would seem to be the most appropriate methodology at this early stage of understanding
(Leventhal & Nerenz, 1985).
4. Validity of the SRM in understanding mental illness
The central aim of this paper is to assess the applicability of the SRM to mental illness.
Studies are reviewed that have examined the beliefs that people with a mental illness hold
about their experiences. We will assess to what extent these studies are consistent with the
SRM before suggesting ways in which the model could be further developed and tested.
This review includes all studies in which a clear attempt has been made to explore a link
between beliefs about mental illness, and emotional or behavioural outcomes. In categorising
the studies, we have first divided them into those exploring beliefs about mental illness in
people who have experienced such problems, their close relatives, and professionals who
work directly with this population. Within each of these sections, we have further divided the
studies into those assessing each of the dimensions of the SRM. Some studies were pertinent
to more than one dimension, but have been described in the section considered most relevant.
Beliefs held by the lay population have not been included. Studies that described beliefs
without linking them to an outcome were also excluded.
The focus of the paper is on mental illness in general. Because many of the studies have
not specified in detail the diagnosis under investigation, we include here terms that imply
mental illness, such as ex-mental patient, psychosis, someone who has been hospitalised for a
mental health problem. Where researchers have been more specific, the most common
diagnosis has been schizophrenia. More specificity is required in future research in this area
as there is evidence to suggest that people do think differently about different specific
diagnoses (Crisp, Gelder, Rix, Meltzer, & Rowlands, 2000).
4.1. People who experience a mental illness
4.1.1. Identity
The identity dimension of the model assesses what the individual thinks their problem is.
This dimension has been divided into the signs/symptoms that the individual experiences, and
the label that they give to these.
4.1.1.1. Signs and symptoms. Most of the research about the role of cognitive factors in
mental illness, has focussed on the identity component, i.e., how individuals define their
experiences. Many studies support the idea of the role of an information processing bias,
including an externalising bias in people with paranoid delusions (Kinderman & Bentall,
1996), self-serving bias (Kaney & Bentall, 1989), attentional bias (Bentall & Kaney, 1989),
and recall bias (Kaney, Wolfenden, Dewey, & Bentall, 1992). In addition, there is
experimental evidence that people with delusional beliefs are more likely to jump to
conclusions (Huq, Garety, & Hemsley, 1988), and that voice hearers have higher levels of
private self-consciousness (Morrison & Haddock, 1997). These biases may explain why
internal events such as thoughts may be experienced as voices, or why harmless events
such as someone talking on a phone, may be experienced as a conspiracy to harm. Garety
et al. (2001) and Morrison (2001) attempt an integration of these processes into coherent
models.
The interpretations that are made about experiences have been clearly linked to beha-
vioural responses. Chadwick and Birchwood (1994), extending Beck’s cognitive model for
emotional disorders, proposed that beliefs about voices would be more important in
predicting emotional and behavioural responses, than their content per se. The beliefs that
they focused on were the omnipotence of the voice (how powerful it was) and whether it was
perceived as malevolent (wishing to do evil) or benevolent (wishing to do good). They found
that the individual actively engaged with voices perceived as benevolent, whereas those
perceived as malevolent were resisted. Beliefs about voices, rather than the content predicted
response. More recent work in this area has highlighted additional beliefs that may be
important including the control that the individual feels they have over the voice. These
studies are discussed below.
Understanding individual beliefs about identity of voices may also be important in
preventing future harm. For example, Junginger (1990) found that people who experienced
command hallucinations were more likely to act on these if they recognised the identity of the
voice as someone familiar to them, and if they held delusions related to their voices. Acting
on commands was not associated with the dangerousness of the command.
Label. How the individual then summarises and labels these experiences may also have
an important impact on their responses. In particular, whether or not the individual labels
their experience as being disease-related. Within mental illness, how the individual labels
their experiences has been closely linked to insight. Traditionally, insight has been seen as
on all or nothing phenomenon and patient insight would be assessed by clinical
descriptions of patient free responses (Amador, Strauss, Yale, & Gorman, 1991). People
who show insight are more likely to be compliant with medication (Bartko, Herczeg, &
Zador, 1988; Nageotte, Sullivan, Duan, & Camp, 1997), and have a better treatment
outcome (McEvoy et al., 1989; McEvoy, Howe, & Hogarty, 1984). However, more
recently, there has been recognition of the construct of insight as complex, multidimen-
sional, and fluid over time (Amador & David, 1998). The need to understand the way in
which individual appraises his or her own experiences, and the function of this appraisal,
has been recognised. Moreover, the assumption that understanding psychotic symptoms
within a strict medical model is beneficial to the patient has been challenged. White,
Bebbington, Pearson, Johnson, and Ellis (2000) found a strong positive association between
‘‘insight’’ as measured by adherence to a medical model, and depression. Jackson et al.
(1998) found that people who integrated their experiences more fully, accepting that they
had experienced a psychotic episode, actually showed higher levels of depression, than
those who adopted a more ‘‘sealing over’’ approach. They argue that this may reflect the
individual becoming engulfed by the demoralization and stigma that they associate with
mental illness.
The link between medication adherence and insight is also more complex than initially
suggested. Overall, there is a positive association between traditionally measured insight, and
adherence to medication (Bartko et al., 1988). However, there are many individuals who do
not accept the assertion that they have a mental illness, and yet are adherent to treatment. This
suggests that the relationship between insight and adherence is influenced by other factors. A
recent review of nonadherence in affective disorders highlights the importance of attitudes
and beliefs about medication, and argues for more research to identify specific targets for
intervention (Scott & Pope, 2002).
Finally, the way in which individuals label their experiences has been associated with
perceived quality of life. Mechanic, McAlpine, Rosenfield, and Davis (1994) found that
people who attributed their mental illness to a physical/medical/biological problem as
opposed to a psychological problems, scored higher on a perceived quality of life measure,
and reported less personal stigma and greater self-esteem. However, the results of this study
need to be interpreted in light of the fact that the participants were recruited via membership
of an organisation that promotes a disease model of schizophrenia.
These studies suggest that the way in which an individual identifies their experiences is
associated with their emotional response, and important behaviours such as taking medica-
tion. However, to fully understand these responses, the pattern of beliefs across a number of
dimensions is important. The signs/symptoms described or the label used is not sufficient on
its own.
4.1.2. Cause
This dimension of the model assesses what the individual thinks has caused their illness.
This dimension has mainly been explored in relation to depressed mood. It is likely that
beliefs about cause are important in many areas, especially adherence to treatment, but no
studies were identified that explicitly assessed this.
Postpsychotic Depressive Disorder of Schizophrenia was listed in the Diagnostic and
Statistical Manual of Mental Disorders—4th ed. (DSM IV; American Psychiatric Association,
1994) as a possible diagnostic category requiring further research. Roughly one third of
patients with a diagnosis of schizophrenia, also have full depressive syndromes, and over a 7-
year period, nearly half will experience significant depression (Sands & Harrow, 1999). A
large number of factors have been suggested to account for why some individuals develop
depression, including genetic factors or family history (e.g., Galdi, 1983; Galdi, Reider,
Silber, & Bonato, 1981), the use of neuroleptics (e.g., Van Putten & May, 1978), personality
(e.g., Liddle, Barnes, Curson, & Patel, 1993), and substance abuse (e.g., Bartels & Drake,
1989). More recently, the suggestion that post psychotic depression is associated with the
individual’s secondary appraisal of their experiences has been made. Birchwood, Iqbal,
Chadwick, and Trower (2000a, 2000b) used the PBIQ and followed up 115 patients over a
12-month period following an acute psychotic episode. They found that over a third of these
people became depressed following the episode and this was not directly related to the
psychotic symptoms they had experienced. Depression, however, was related to beliefs about
the illness. In addition to beliefs about the consequences of the illness (see Section 4.1.3),
postpsychotic depression was also associated with attribution of the cause of psychosis to
factors internal to the self. This suggests that for some people depression may have been a
psychological reaction to the experience of having a psychotic episode, rather than a
symptom of the illness per se.
4.1.3. Consequences
This dimension assesses what the individual believes will be the consequences of having
the health problem on their lives. The perceived consequences of the individual’s experience
have been shown to be associated with variations in coping (Kinney, 1999; Tarrier, Harwood,
Yusopoff, Beckett, & Baker, 1990), depression (Birchwood et al., 1993, 2000a, 2000b), and
medication adherence (Adams & Scott, 2000; Budd, Hughes, & Smith, 1996).
Patients with a diagnosis of schizophrenia are able to identify strategies that they use to
cope with their symptoms (Fallon & Talbot, 1981). The beliefs that they have about the likely
consequences of symptoms appear to mediate this relationship. Kinney (1999) showed that
patients who perceived their symptoms as more taxing and burdensome were more likely to
report effortful attempts to cope. A cognitive behavioural style intervention known as Coping
Strategy Enhancement (CSE) developed by Tarrier et al. (1990) includes an assessment of the
individual’s appraisal of their experiences, and uses belief modification strategies to aid the
development of existing and new coping skills, where necessary. This intervention has shown
to be effective at reducing positive symptoms.
Some authors have suggested that beliefs about the consequences of symptoms can lead to
adoption of behaviours that although intended by the individual to prevent harm, in fact
exacerbate the problem. Morrison (1998) proposed that the experience of psychotic
symptoms regularly results in the use of safety behaviours such as distraction or avoidance.
Some support for this theory comes from a study by Freeman, Garety, and Kuipers (2001) in
which they found that higher levels of anxiety were associated with greater use of safety
behaviours. Morrison argues that strategies to reduce the use of safety behaviours, such as
challenging negative beliefs about the consequences of symptoms, can be used to help people
to drop safety behaviours and test out their beliefs associated with feared consequences of the
symptoms.
Birchwood et al. (1993) found a significant association between the perception of
negative social consequences of symptoms, including stigmatisation and social contain-
ment, and depression in people with a diagnosis of depression. More recently, Birchwood
et al. (2000a, 2000b), in the study described previously, found that individuals who
appraised their illness as constituting a loss of autonomy and valued role, as humiliating,
and who felt entrapped by their illness, were more likely to become depressed than those
who did not.
Finally, perceived consequences have been associated with medication adherence. Budd et
al. (1996), using the health belief model as a basis to investigate adherence, found that perceived
severity of symptoms was associated with greater medication adherence. In addition, percep-
tions of susceptibility and beliefs about the benefits of the medication were also important.
Adams and Scott (2000), also using the health belief model, found perceptions of severity of
symptoms and perceived benefits from mediation to be important in medication adherence.
4.1.4. Timeline: acute/chronic

No studies were identified that explored patients’ beliefs about how long their experiences
were likely to last and the impact of these beliefs. This is surprising in light of the very
variable outcome for people who experience a psychotic episode (e.g., Mason et al., 1995).
One reason for a lack of research in this area may be that the timeline for any individual is
very hard to predict, therefore, challenging beliefs associated with distress would be very
difficult.
4.1.5. Control
This dimension of the SRM assesses beliefs about how the problems can be controlled. A
useful distinction has been made recently between beliefs about control by treatments, and
beliefs about personal control (Moss-Morris et al., 2001).
4.1.5.1. Personal control. Appraisals of controllability of symptoms by the individual have

been investigated and shown to be associated with a number of important outcomes.
One of the first studies to investigate people’s beliefs about their symptoms in severe
mental health was undertaken by Romme, Honig, Noorthoorn, and Escher (1992) and
focussed on how voice hearers coped with their experiences. Following a TV program about
hearing voices, they contacted people who telephoned in to the programme, and sent them a
questionnaire about their voices. They found that over half of the sample felt that they were
unable to cope with their voices. This subgroup was more likely to be in psychiatric care and
was more likely to use distraction as their main strategy. Those who did feel able to cope were
more likely to use strategies that reflect the belief that they could control their voices
including setting limits on the voices. More recently, Hoffman, Kupper, and Kunz (2000) in a
prospective study found that negative self-concepts, external loci of control, and depression
correlated to a greater extent with depressive-resigned coping strategies such as self-pity,
resignation and brooding, than did schizophrenic symptoms. Controlling for negative
symptoms, external control beliefs still had a predictive value for the outcome.
Beliefs about the ability to control psychotic experiences have also been shown to be
directly associated with level of distress. Freeman and Garety (1999) identified factors
implicated in the meta-cognitive model of anxiety as also present in a group of people
experiencing persecutory delusions. The level of distress reported by individuals in relation to
a belief was not only associated with its content, but also with beliefs about not being able to
control their thinking about the feared persecution. Similarly, it has been suggested by
Morrison, Wells, and Nothard (2000) that hallucinations become distressing only when
appraised as uncontrollable and dangerous.
Finally, expanding the work discussed previously by Beck-Saunder, Birchwood, and

Chadwick (1997) and Chadwick and Birchwood (1994) found that in addition to beliefs about
malevolence/benevolence of the voice, beliefs about ability to control the voice were
significantly associated with compliance with command hallucinations. People who experi-
enced these but who believed that they retained subjective control over their voices were less
likely to comply with all types of demands.
Appraisals of controllability of symptoms have been shown to be associated with type of
coping strategies used (Romme et al., 1992) hopelessness (Hoffman et al., 2000), distress
(Freeman & Garety, 1999), and compliance with auditory hallucinations (Beck-Sander et al.,
1997). These findings are particularly important as perceived controllability has been shown
to be amenable to treatment using CBT interventions (Chadwick, Sambrooke, Rasch, &
Davies, 2000; Drury, Birchwood, & Cochrane, 2000).
4.1.5.2. Treatment. Beliefs about the potential for various treatments to control unwanted
symptoms have been associated with treatment adherence. This is extremely important as
nonadherence in mental illness is an extensive problem ranging from 11% to 80% [see
review by Corrigan, Lieberman, & Engel, 1990, and a review by Fenton, Blyler, &
Heinssen, 1997 suggests a median 1-month to 2-year nonadherence rate of 55% (range
24%–88%)]. Nonadherence is strongly associated with admission to hospital (Green,
1988), relapse (Linn, Klett, & Caffey, 1982), increased length of admission (Caton, Koh,
Fleiss, Barrow, & Goldstein, 1985; McEvoy et al., 1984), and trouble with the police
(Smith, 1989).
In two studies which used a different social cognition model, the health belief model
(Becker, 1974), to investigate medication adherence, perceived benefits of medication came
out as a significant predictor of adherence to medication (Adams & Scott, 2000; Budd et al.,
1996). Nonadherence to psychological treatment, usually assessed by drop out, is also
associated with beliefs about the ability of the treatment to control the symptoms. Tarrier,
Yusupoff, McCarthy, Kinney, and Wittkowski, (1998) questioned people who had dropped
out of cognitive behavioural treatment: the most common reason given was that the patients
did not perceive the treatment as suitable for their problems.
4.1.6. Coherence
This dimension refers to a sense of having a comprehensive understanding of the illness.
This does not seem to have been explicitly investigated in people with a mental illness. A
related concept, however, is that described by McGlashan, Levy, and Carpenter (1975) as a
continuum of recovery styles ranging from full integration of the experience into their sense
of self, to sealing over in which the psychotic experience is spilt off from the sense of self
and high levels of denial regarding the severity of the experience are evident. Integrators
tend to be curious about their symptoms, regard them as part of their life pattern, and gain
information about them. In contrast, people who seal over tend to isolate the psychotic
experience and view it as alien to themselves. Contrary to predictions, there is some
evidence that at least for people experiencing first episode of psychosis, integration may not
be the best style. Integration has been associated with an increase in depression in
individuals undergoing psychological intervention for early psychosis (Jackson et al.,

1998).
The acceptance of the role of an individual with psychosis is likely to be associated with
stigma, negative stereotypes, and lack of hope about returning to premorbid levels of
functioning (McGorry & McConville, 1999).
4.1.7. Other dimensions

Two important areas of work do not initially seem to fit easily within any one of the SRM
dimensions. Birchwood et al. (2000a, 2000b) attempted to understand the impact of perceived
social rank on voice hearing. The second is beliefs about treatment, which have been shown
to be a necessary addition to understand adherence responses (Horne & Weinman, 1997;
Horne, 1998). These are not beliefs about whether or not the illness is amenable to treatment
(which is included in the SRM), but beliefs about specific treatments such as their perceived
advantages and disadvantages.
Birchwood et al. (2000a, 2000b) investigated the use of ranking theory in understanding
the relationship that people have with their voices, and how this may impact on outcome.
This work builds on the theory that how an individual views himself or herself in relation
to significant others in their lives can have a determining role in their emotional state
(Gilbert, 1992). Using a range of questionnaire measures to assess social rank and power of
the dominant voice and significant others in their lives, the authors found that the perceived
difference in rank between the voice and voice hearer is mirrored in their perceptions of
social rank differences between self and others. Greater perceived differential was associated
with depression in patients. Birchwood et al. argue that interpersonal schemata are
responsible for both the experience of auditory hallucinations as dominant, and the
depression.
The attempt to understand people’s beliefs within a social context is an important step
forward in our view, and is entirely consistent with the SRM, which places a clear
emphasis on the importance of the sociocultural context (Leventhal et al., 1997). However,
the concepts of social rank and power may benefit from being more clearly defined. Both
concepts seem to incorporate issues of identity, control, and consequences. Exploring these
concepts within the SRM may actually help define more clearly the beliefs behind these
concepts.
The SRM focuses on beliefs about health/illness. Research into adherence with
medication has highlighted the need to investigate beliefs about treatment as well. Day,
Bentall, and Warner (1996) found that patients reported experiences of neuroleptic
medication reflected a complex interrelationship between costs and benefits of taking
medication, interactions with the prescribers, and issues of autonomy. Horne and Wein-
man (1999) have suggested that this may be generally true for a range of treatments and
have begun to investigate beliefs about treatment as an addition to beliefs about illness in
a range of physical health problems. In particular, beliefs about the necessity of
medication and concerns about the potential adverse effects seem to be important and
need to be addressed in any intervention focused on increasing adherence (Horne &
Weinman, 1995).
4.1.7.1. Using the SRM to investigate beliefs about mental illness. Two attempts to
investigate beliefs outlined in the SRM in relation to schizophrenia have both used the
IPQ. Clifford (1998) administered the IPQ to a sample of 38 psychotic patients. The subscales
showed acceptable levels of internal reliability (a’s .60 – .92). There was a positive
association between nonadherence to medication and a perception of fewer and less severe
symptoms, a shorter duration of illness, external attribution of cause, and more severe
negative consequences.
The IPQ was also used with people with a diagnosis of schizophrenia by Talley (1999).
She found that only the subscales measuring consequences and symptoms were internally
reliable. The consequences subscale also showed some concurrent validity in correlating with
other measures of the impact of the illness.
These studies suggests that the SRM is a potentially useful model for understanding mental
illness, but that the IPQ may require some modification before it can be reliably used with this
population.
Summary. All of the above research supports the assertion that models of mental illness
held by individuals are an important area for investigation if we are to understand variation in
outcome. There is a clear need to focus more on each individual’s appraisal of their
experiences, and to develop more sophisticated ways to investigate these. To quote Rogers
et al. (1998, p. 1322), ‘‘future practice and research might fruitfully examine the way in which
placing value on patients’ own definitions of their problems, experience and management
strategies presents an opportunity for rethinking the nature of professional/patient encounters
about medication and mental health policy more generally.’’ In order to do this a framework
for examining patients’ own definitions of their problems, experiences and management
strategies is needed.
4.2. Beliefs held by relatives/carers
Cognitive representations of mental illness held by relatives/carers are likely to be

important for a number of reasons. Evidence reviewed below suggests that models can have
an impact on the emotional response of the relative and on the way in which relatives respond
to the person experiencing the mental illness, which in turn may impact on their progress. In
addition, because beliefs are likely to be influenced by cultural and social norms (Leventhal et
al., 1997), relatives’ beliefs are likely to play some role in shaping the representation held by
the person experiencing the mental illness, especially give the often long duration of
untreated illness (Beiser et al., 1993; Larsen, McGalshan, & Moe, 1996; Loebel et al.,
1992). There is also some evidence from the physical health literature to suggest that
relatives’ models can have an impact on the adaptive outcome for patients (Heijmans et al.,
1999; Heinzelman & Baguley, 1970).
The importance of relatives’ beliefs about mental illness in designing treatment
interventions to help relative’s coping responses has been strongly emphasized in the work
of Tarrier, Barrowclough, and colleagues (Barrowclough et al., 1987; Tarrier, 1991; Tarrier
& Barrowclough, 1986). Their development of interventions for families with an individual
with schizophrenia have been guided by evidence suggesting that providing information
alone can have very little impact (Berkowitz, Eberlein-Fries, Kuipers, & Leff, 1984;
McGill, Fallon, Boyd, & Wood-Swerio, 1983). They argue that this is because relatives
already have models that will be used to actively process additional information that is
provided, leading to rejection and accommodation of incongruent facts. Therefore,
successful intervention requires the therapist to ‘‘. . .assess and take into account both
patients and relatives perceptions of the illness prior to embarking on the task of giving
information’’ (Tarrier & Barrowclough 1986, p. 462, lines 7–9). This allows the amount,
type, and speed of presentation of information to be tailored to the individual. Failure to do
this is likely to be one reason for high nonadherence to psychological interventions (Tarrier,
1991).
Most of the work in this area has been focused on the attributions that relatives make about
the symptoms and problems of the person experiencing a mental illness. Weiner’s theory of
attribution (Weiner, 1985a, 1985b, 1988, 1990) suggests that our attributional appraisals play
a key role in our emotional and behavioural reactions to another individual’s behaviour.
Specific causal dimensions have been linked to discrete affects. In particular, Weiner has
suggested that anger is linked to beliefs that the individual can control their behaviour, pity to
beliefs that the individual is unable to control their behaviour, and guilt to beliefs about
personal responsibility. Weiner has also suggested that causal attributions are associated with
behavioural responses. In experimental situations the belief that a person is drunk is
associated with attributions of personal control to the person and neglect behaviour on the
part of the observer, whereas beliefs that an individual has a disability/illness is associated
with perceived lack of personal control to the person and helping behaviour on the part of the
observer. This theory has been developed and used to explore how relatives’ attributions
about the patients’ behaviour can impact on their responses. Results of these studies are
reviewed below. Some work exploring the impact of the social consequences perceived by the
relative is also described in a study that explicitly used the SRM (Barrowclough et al., 2001).
We were unable to identify studies in which beliefs about the identity, or a sense of coherence,
were explored in relation to outcome for the patient or the relative.
The main outcomes that have been assessed for relatives include distress, expressed
emotion (EE), subjective level of burden, and relative’s coping strategies.
EE is a measure of the emotional climate within the home environment. It is assessed using a
structured interview with a relative at the time of patient hospitalisation. The taped interview
can be reliably rated to classify relatives as high or low EE on the basis of criticism, hostility, or
emotional over-involvement. High EE has been reliably associated with higher rates of relapse
in schizophrenia (see Butzlaff & Hooley, 1998 for a meta-analytical review), as well as being
associated with patient outcome in numerous other mental and physical health problems (see
Wearden, Tarrier, Barrowclough, Zastowny, & Rahill, 2000 for a review of EE in health care
research). Recent research and theory about the attributions of relatives of people with a mental
health problem (Hooley, 1987) and relatives of patients with schizophrenia (Barrowclough,
Johnston, & Tarrier, 1994; Brewin, 1994; Brewin, MacCarthy, Duda, & Vaughn, 1991;
Greenley, 1986; Hooley, 1985; Lopez, Nelson, Snyder, & Mintz, 1999; Weisman, Lopez,
Karno, & Jenkins, 1993) suggests that relatives’ beliefs about the nature and symptomatology
of the mental illness may help to understand the high EE response in some relatives.
4.2.1. Cause
Attributions of causality for symptoms have also been shown to be associated with levels
of relatives’ distress (Barrowclough, Tarrier, & Johnston, 1996; Heinrichsen & Lieberman,
1999), emotional response to the patient (Barrowclough et al., 1994, 1996), and relative’s
coping (Chesla, 1989; Rose, 1983).
In general, there is some preliminary evidence to suggest that relatives are more likely to
attribute the cause of schizophrenia to biological factors than psychosocial factors, when
compared to a general population sample (Angermeyer & Matschinger, 1996). This study was
done on a German sample of people in a self-help organization, and the authors suggested that
it could be due to increased exposure to a medical model via contact with psychiatric services,
or an attempt to reduce feelings of guilt that may be associated with a psychosocial model.
Self-blaming attributions are generally accompanied by high levels of distress (Barrowclough
et al., 1996). In addition, Heinrichsen and Lieberman (1999) found that relatives who
attributed symptoms to the patients’ moral failings or psychological problems from earlier life
were more likely to report poor emotional adjustment.
Attributions of cause that are internal to the patient are generally found in relatives who are
hostile in their response, as rated on the CFI, whereas relatives who tended to attribute all
behaviours to illness were rated as emotionally overinvolved (Barrowclough et al., 1996).
Support for the importance of the role of carer beliefs is increased by the finding from one
study that such beliefs are better predictors of outcome than EE ratings (Barrowclough et al.,
1994).
Chesla (1989) and Rose (1983) have shown an association between attributions of cause of
mental illness and the type of coping strategies used by relatives. Relatives who saw mental
illness as being caused by a chemical imbalance strongly reinforced the use of medication,
whereas those who saw irrational thoughts as the cause tried to reason with the patient to
think differently and avoided reinforcing any delusional ideas.
4.2.2. Consequences
When asking relatives about the consequences of the mental illness, it is important to
recognize the distinction between consequences for the relative and consequences for the
person experiencing the mental health problem. Barrowclough et al. (2001) used a modified
version of the IPQ to assess both of the dimensions. As would be expected, relatives who
perceived greater consequences for themselves also scored higher on measures of distress and
sense of burden. In addition, the relatives’ perception of consequences for the patient was
associated with the patient’s perception of the their relationship with their relative. The more
consequences of the illness that the relative perceived for the patient, the more the patient both
expressed negative feelings towards the relative and perceived negative feelings from them.
4.2.3. Timeline: acute/chronic

In the study referred to above, Barrowclough et al. (2001), an association was also found
between the relatives perception of how long the symptoms would last for and their level of
EE. Relatives who had a more chronic timeline perception of the illness were more likely to
be rated as lower EE.
4.2.4. Control
In exploring the link between perceptions of control and outcome for relatives, it is
important to distinguish between personal control that they believe that patient to have over
the symptoms and personal control that they believe themselves to have.
Relative’s beliefs about their own control have been associated with level of subjective
burden (Maurin & Boyd, 1990) and beliefs about patient control have been associated with
emotional response to the patient (Barrowclough et al., 1994; Lopez et al., 1999).
Relatives’ distress levels can be due to many different life events independent of the
patients’ symptoms. Subjective burden is a more situation specific measure of ‘‘personal
appraisal of the situation and the extent to which they perceive they are carrying a burden’’
(Hoenig & Hamilton, 1966). Interestingly, there is not a strong correlation between
measures of subjective burden and patient characteristics (Scazufca & Kuipers, 1996).
Studies have demonstrated that the relationship is mediated by a number of factors
including social support, coping strategies, economic status, other life events, and
symptoms associated with social withdrawal, but also by perceptions of the problem,
including a belief in having some control over the problems (see Maurin & Boyd, 1990 for
a review).
A central and consistent finding is that critical and hostile relatives tend to attribute more
control and personal responsibility to the patients for their symptoms and associated problems
(Barrowclough et al., 1994). There is also some evidence to suggest that higher levels of
warmth are associated with more universal and less controllable attributions (Barrowclough et
al., 1994; Lopez et al., 1999).
4.2.4.1. Using the SRM to investigate beliefs about mental illness in relatives. Barrowclough
et al. (2001) explicitly used the SRM to assess the beliefs held by relatives of people with
schizophrenia. The results showing associations between specific beliefs and outcomes have
been summarized in the sections above. The study also concluded that a modified version of
the IPQ was a reliable measure of relatives’ perceptions of schizophrenia.
Summary. This research would suggest that beliefs about mental illness held by relatives
are important. However, much of the evidence is based on correlational evidence and would
benefit from being supported by experimental designs. In addition, there is still a lack of a
clear theoretical framework to highlight which beliefs are likely to be key and what specific
role these beliefs play. Most of the research into relative’s responses has been dominated by
attributions of cause and controllability. More extensive research is needed to explore the
impact of beliefs such as how long the relative thinks that the behaviour will last for, beliefs
about the consequences of this behaviour for their own lives and the lives of their relatives,
and beliefs about treatment.
4.3. Beliefs held by professionals
Beliefs held by professionals about mental illness have also been investigated and links
have been made with behavioural and attitudinal outcomes. These include the relationship
between the client and professional, and treatments that are potentially offered to clients.
4.3.1. Identity
No studies were identified that measured the relationship between professionals’ beliefs
about the label and/or symptoms of mental illness, and their responses. However, it has been
hypothesized that belief in the validity of the concept of schizophrenia may be one factor
associated with whether or not professionals choose to work with this population. Bellack
(1986) argued that the reason why so few clinical psychologists in the USA were working
with people with a diagnosis of schizophrenia was that they held certain beliefs about the
disorder, including not believing in the validity of the concept. Beliefs about schizophrenia
held by psychologists working in Ireland and the UK partially support this hypothesis, with
33% disagreeing with the validity of the concept (Gallagher, Gernez, & Baker, 1991).
However, the hypothesized association between such beliefs and choosing to work with the
population of people who receive such a diagnosis has not been demonstrated and there are
examples of extensive work done in this area by people who question the validity of the
concept (e.g., Bentall, 1990; Bentall, Jackson, & Pilgrim, 1988).
4.3.2. Cause
Beliefs about the cause of mental illness have been associated with treatment plans. Cape,
Antebi, Standen, and Glazebrook (1994) found a strong correlation between belief in a causal
role for psychosocial factors and use of nonmedical treatments, such as psychotherapy,
among psychiatrists. Psychiatrists who felt that psychosocial factors were important in the
aetiology of schizophrenia were more likely to rate social support as important prognostically
and were less likely to see the patient as needing medication for the rest of his/her life.
4.3.3. Control
4.3.3.1. Personal. Beliefs that professionals have about the amount of control that an
individual has over their mental illness have been associated with the patient’s perception of
the quality of the therapeutic relationship. Barrowclough et al. (2001) assessed feelings and
thoughts of both staff and patients on a low secure inpatient facility for people with severe
mental illness. They found that patients were very sensitive to staff feelings for them, and
there was an association between less positive feelings reported by the staff and the staff
attributing more control to the patients over their symptom-related behaviour. This finding is
particularly important given that Weiner’s theory would predict that this attribution of
controllability would result in less helping behaviour by the staff (Weiner, 1985a, 1985b,
1988).
4.3.3.2. Treatment. Beliefs about how well treatment can control symptoms have been
explored but have not been directly linked to any important outcome variables.
Jorm et al. (1997) found that both Australian GPs and psychiatrists believed that patients
with schizophrenia or depression had a better prognosis if they were to receive professional
help. In a large survey of Australian mental health professionals (Caldwell & Jorm, 2000),
nurses were significantly more positive than psychiatrists about many interventions including
seeing a naturopath or herbalist, taking vitamins or sedatives, courses on relaxation,
meditation or yoga, seeing a counseller, stress management, close friends, physical activity,
getting out more, hypnosis, diet, etc. They were generally more negative than psychiatrists
about a visiting a GP, admission to a psychiatric ward, and ECT.
Gallagher et al. (1991) found that the majority of psychologists they surveyed in Ireland
and the UK believed that schizophrenia was not adequately treated with medication, and
strongly disagreed with the view that schizophrenia is too severe a condition for psychol-
ogists to work with. This suggests that negative beliefs about the potential effectiveness of
psychological interventions are not dominant and therefore unlikely to reduce the likelihood
of psychologists working with this population.
How these beliefs about the potential effectiveness of treatments impact on actual practice
has not been tested. However, this is an important area for future research due to the likely
impact of such beliefs on the treatments that patients are offered.
Using the SRM to investigate beliefs about mental illness in professionals. To our
knowledge, the SRM has not been explicitly used to assess how beliefs held by mental health
professionals impact on their responses to their patients. However, some important lessons
can be learned from studies using the SRM to assess beliefs held by professionals working
with physical illness. This work has suggested that what may be more important than either
the patients’ beliefs about their mental illness, or those of the professional, is the amount of
agreement between the two models. There is considerable evidence to suggest that there is
often a poor fit between patient and practitioner models and, more importantly, that this is
often not addressed or even assessed. Helman (1985) studied people with chronic physical
problems but for whom there was a recognised psychosomatic component. They found that
there was substantial variation in agreement levels between the doctors’ and patients’ models.
In general, doctors had a very poor understanding of patients’ models and this was worse for
patients in lower socioeconomic and educational groups. They suggest that the accuracy of
the doctor’s understanding of the patient model will predict future adherence.
4.3.3.3. Summary. Some studies cited above have suggested that beliefs about cause,
control, and likely response to treatment may vary within and across professional groups, and
that these beliefs may impact on the treatment that patients receive. However, studies that are
able to assess the direct impact of beliefs on practice, rather than relying on self-report would
greatly increase the validity of findings in this area. Such studies would benefit from a clear
theoretical model to guide exploration of which beliefs may be key. Important beliefs within
the SRM that have not been explored in this area include beliefs about identity, timeline, and
consequences. In addition, exploration of the importance of similarity of models between
client and practitioner in mental health is clearly warranted.
5. Limitations of illness models
It is hypothesised that models of illness that have been found to be helpful in physical
illness may be usefully applied to mental illness to further our understanding of people’s
responses to illness. It is likely that modifications will be necessary and that different
dimensions of understanding to those identified in physical illness may be critical. However,

the work on illness perception in physical illness provides us with a methodology to develop
and test a framework that is needed to further work in this area.
One of the main criticisms of the models of illness literature has been a lack of testing of
proposed causal links between beliefs and outcomes, most of the evidence being based on
associations. Early attempts to directly impact on beliefs and demonstrate a clear link between
change in belief and change in outcome are beginning to be reported (e.g., Yardley, Beech, &
Weinman, 2001). Cognitive behaviour therapy, more commonly discussed in the clinical
psychology literature, could be more extensively used to modify beliefs and demonstrate
directly the causal role of beliefs in outcome.
Other shortcomings in the methodology of models of illness need to be acknowledged and
overcome. Firstly, although Leventhal’s original model highlights beliefs about identity,
cause, consequences, timeline, and cure/control, many studies have explored single beliefs in
relation to outcome. The pattern of beliefs across the dimensions are likely to have a very
different impact from single beliefs in isolation; ‘‘the examination of isolated variables may
prove valuable in particular situations, but will do little to advance understanding or aid in the
development of a communicable body of knowledge’’ (Leventhal & Cameron, 1987, p. 134).
Again, notable exceptions to this criticism can be found in studies that have attempted to
explore patterns of beliefs (Buick, 1997). Secondly, most studies have used people’s self-
report of what they think or what they say they would do. There is generally very little
correlation between this and what they actually do (Ajzen & Fishbein, 1980) so more valid
assessments are required.
Other limitations are more difficult to rectify. Firstly, models such as the SRM are dynamic
models in which the variables all impact on one another. Beliefs that influence responses are
themselves modified in light of the appraisal of the outcome. This can make the identification
of dependent and independent variables in research very difficult, and models need to be
assessed over time as they are constantly evolving. Secondly, it could be argued that
investigating illness models in people with a diagnosis of a mental illness is less relevant
that in those with a physical illness because the nature of the problem may interfere with their
ability to reflect on their experiences and form meaningful models. However, this argument
implies a distinction between physical and mental experiences that is not supported by
evidence. Problems identified as physical in their diagnosis, such as diabetes, can have a
significant impact on an individuals’ cognitive ability and their psychological functioning
(see Frier, 2001). Psychological factors also play a large part in outcome via their impact on
help seeking behaviour (see Kreitler, 1999). Similarly, patients diagnosed with a problems
considered by many to be psychological, experience very real physical symptoms, as in the
case of fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and atypical facial
pain (see Cameron, 2001 for further discussion of this issue). Our own clinical experience
with people with a mental illness suggests that they clearly do form cognitive representations
about their experiences, even if these are at odds with the representations held by their key
worker or psychiatrist.
Finally, it is important that where illness models are used to increase our understanding of
peoples’ responses to mental illness, it is recognised that they are theoretical models that are
tools to help testing of hypotheses and to guide us to potentially important areas for
intervention. Models are inevitably limited and cannot replace individual formulations,
which provide a far more complex and useful guide to the individual’s understanding of
their illness and the meaning it has for them.
References
Adams, J., & Scott, J. (2000). Predicting medication adherence in severe mental disorders. Acta Psychiatrica
Scandinavica, 101, 119 – 124.
Ajzen, I. (1988). Attitudes, personality and behaviour. Milton Keynes: Open Univ. Press.
Ajzen, I. (1991). The theory of planned behaviour. Organisational Behaviour and Human Decision Processes, 50,
179 – 211.
Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behaviour. Englewood Cliffs, NJ:
Prentice Hall.
Amador, X. F., & David, A. S. (Eds.) (1998). Insight and psychosis ( pp. 1 – 384). New York, NY: Oxford Univ.
Press.
Amador, X. F., Strauss, D., Yale, S. A., & Gorman, J. M. (1991). Awareness of illness in schizophrenia.
Schizophrenia Bulletin, 17, 132 – 133.
American Psychiatric Association (1994). DSM-IV; Diagnostic and Statistical Manual of Mental Disorders
(4th ed.). Washington, DC: The Association.
Angermeyer, M. C., & Matschinger, H. (1996). Lay beliefs about mental disorders: a comparison between western
and the eastern parts of Germany. Social Psychiatry & Psychiatric Epidemiology, 34(5), 275 – 281.
Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, 122 – 147.
Bandura, A. (1991). Self-efficacy mechanism in physiological activation and health promoting behaviour. In J.
Madden (Ed.), Neurobiology of learning, emotion and affect (pp. 229 – 270). New York: Raven Press.
Barrowclough, C., Johnston, M., & Tarrier, N. (1994). Attributions, expressed emotion, and patient relapse: an
attributional model of relatives’ response to schizophrenic illness. Behaviour Therapy, 25, 67 – 88.
Barrowclough, C., Lobban, F., Hatton, C., & Quinn, J. (2001). Investigation of models of illness in carers of
schizophrenia patients using the Illness Perception Questionnaire. British Journal of Clinical Psychology, 40,
371 – 385.
Barrowclough, C., Tarrier, N., & Johnston, M. (1996). Distress, expressed emotion, and attributions in relatives of
schizophrenic patients. Schizophrenia Bulletin, 22(4), 691 – 701.
Barrowclough, C., Tarrier, N., Watts, S., Vaughn, C., Bamrah, J. S., & Freeman, L. (1987). Assessing the func-
tional value of relatives’ knowledge about schizophrenia: a preliminary report. British Journal of Psychiatry,
151, 1 – 8.
Bartels, S. J., & Drake, R. E. (1989). Depression in schizophrenia: current guidelines to treatment. Psychiatric
Quarterly, 60(4), 337 – 357.
Bartko, G., Herczeg, I., & Zador, G. (1988). Clinical symptomatology and drug compliance in schizophrenia
patients. Acta Psychiatrica Scandinavica, 77, 74 – 76.
Becker, M. H. (1974). The health belief model and sick role behaviour. Health Education Monographs, 2, 409 – 419.
Becker, M. H., & Maimon, L. A. (1983). Models of health-related behaviour. In D. Mechanic (Ed.), Handbook of
health, health care and the health professions (pp. 539 – 568). New York: Free Press.
Beck-Sander, A., Birchwood, M., & Chadwick, M. (1997). Acting on command hallucinations: a cognitive
approach. British Journal of Clinical Psychology, 36, 139 – 148.
Beiser, M., Erickson, D., Fleming, J. A. E., et al. (1993). Establishing the onset of psychotic illness. American
Journal of Psychiatry, 150, 1349 – 1354.
Bellack, A. S. (1986). Schizophrenia; behaviour therapy’s forgotten child. Behaviour Therapy, 17, 199 – 214.
Bentall, R. P. (1990). Reconstructing schizophrenia. London: Routledge.
Bentall, R. P., Jackson, H. F., & Pilgrim, D. (1988). Abandoning the concept of schizophrenia: some implications
of validity arguments for psychological research into psychotic phenomena. British Journal of Clinical Psy-
chology, 27, 303 – 324.
Bentall, R. P., & Kaney, S. (1989). Content specific information processing in persecutory delusions: an inves-
tigation using the emotional stroop test. British Journal of Medical Psychology, 62, 355 – 364.
Berkowitz, R., Eberlein-Fries, R., Kuipers, L., & Leff, J. (1984). Educating relatives about schizophrenia. Schiz-
ophrenia Bulletin, 7, 418 – 429.
Birchwood, M., Iqbal, Z., Chadwick, P., & Trower, P. (2000a). Cognitive approach to depression and suicidal
thinking in psychosis: I. Ontogeny of post-psychotic depression. British Journal of Psychiatry, 177, 516 – 521.
Birchwood, M., Iqbal, Z., Chadwick, P., & Trower, P. (2000b). Cognitive Approach to depression and suicidal
thinking in psychosis: II. Testing the validity of a social ranking model. British Journal of Psychiatry, 177,
522 – 528.
Birchwood, M., Mason, R., MacMillan, F., et al. (1993). Depression, demoralisation and control over psychotic
illness: a comparison of depressed and non-depressed patients with a chronic psychosis. Psychological Med-
icine, 23, 387 – 395.
Brewin, C. R. (1994). Changes in attribution and expressed emotion among the relatives of patients with schiz-
ophrenia. Psychological Medicine, 24, 905 – 911.
Brewin, C. R., MacCarthy, B., Duda, K., & Vaughn, C. E. (1991). Attribution and expressed emotion in the
relatives of patients with schizophrenia. Journal of Abnormal Psychology, 100, 546 – 554.
Budd, R. J., Hughes, I. C. T., & Smith, J. A. (1996). Health beliefs and compliance with antipsychotic medication.
British Journal of Clinical Psychology, 35, 393 – 397.
Buick, D. L. (1997). Illness representations and breast cancer; coping with radiation and chemotherapy. In Petrie, &
Weinman (Eds.), Perceptions of health and illness ( pp. 379 – 411). Harwood Academic Publishers.
Butzlaff, R. L., & Hooley, J. M. (1998). Expressed emotion and psychiatric relapse. Archives of General Psy-
chiatry, 55, 547 – 552.
Caldwell, T. M., & Jorm, A. F. (2000). Mental health nurses’ beliefs about interventions for schizophrenia and
depression: a comparison with psychiatrists and the public. Australian and New Zealand Journal of Psychiatry,
34, 602 – 611.
Cameron, O. G. (2001). Introception; the inside story; a model for psychosomatic processes. Psychosomatic
Medicine, 63(5), 697 – 710.
Cape, G., Antebi, D., Standen, P., & Glazebrook, C. (1994). Schizophrenia; the views of a sample of psychiatrists.
Journal of Mental Health, 3, 105 – 113.
Caton, C. L., Koh, S. P., Fleiss, J. L., Barrow, S., & Goldstein, J. M. (1985). Re-hospitalisation in chronic
schizophrenia. Journal of Nervous and Mental Disease, 173, 139 – 148.
Chadwick, P., & Birchwood, M. (1994). The omnipotence of voices. A cognitive approach to auditory hallucinations.
British Journal of Psychiatry, 164, 190 – 201.
Chadwick, P., & Birchwood, M. (1995). The omnipotence of voices: II. The Beliefs About Voices Ques-
tionnaire (BAVQ). British Journal of Psychiatry, 166, 773 – 776.
Chadwick, P., Sambrooke, S., Rasch, S., & Davies, E. (2000). Challenging the omnipotence of voices: a group
cognitive behaviour therapy for voices. Behaviour Research and Therapy, 38, 993 – 1003.
Chesla, C. A. (1989). Parents’ illness models of schizophrenia. Archives of Psychiatric Nursing, 2(4), 218 – 225.
Clifford, C. (1998). Compliance with medication in psychiatric patients: the self-regulatory model and the health
belief models. Master of Health Psychology Thesis, University of Surrey.
Connor, M., & Norman, P. (1995). The role of social cognition in health behaviours. In M. Connor, & P. Norman
(Eds.), Predicting health behaviour: research and practice with social cognition models (pp. 1 – 23). Buck-
ingham, PA: OUP.
Corrigan, P. W., Lieberman, R. P., & Engel, J. D. (1990). From non-compliance to collaboration in the treatment of
schizophrenia. Hospital and Community Psychiatry, 41, 1203 – 1211.
Crisp, A. H., Gelder, M., Rix, S., Meltzer, H. I., & Rowlands, O. J. (2000). Stigmatisation of people with mental
illnesses. British Journal of Psychiatry, 177, 4 – 7.
Croyle, R. T. (1992). Appraisal of health threats; cognition, motivation and social comparison. Cognitive Therapy
and Research, 16, 165 – 182.
Croyle, R. T., & Ditto, P. H. (1990). Illness cognition and behaviour: an experimental approach. Journal of
Behavioural Medicine, 13(1), 31 – 52.
Day, J. C., Bentall, R. P., & Warner, S. (1996). Schizophrenic patients’ experiences of neuroleptic medication: a Q-
methodological investigation. Acta Psychiatrica Scandinavica, 93, 397 – 402.
de Valle, M. N., & Norman, P. (1992). Causal attributions, health locus of control beliefs and lifestyle changes
among the pre-operative coronary patients. Psychology and Health, 7, 201 – 211.
Drury, V., Birchwood, M., & Cochrane, R. (2000). Cognitive therapy and recovery from acute psychosis:
acontrolled trial. Five-year follow-up. British Journal of Psychiatry, 177, 8 – 14.
Fallon, I. R. H., & Talbot, R. E. (1981). Persistent auditory hallucinations: coping mechanisms and implications
for management. Psychological Medicine, 11, 329 – 339.
Fenton, W. S., Blyler, C. R., & Heinssen, R. K. (1997). Determinants of medication compliance in schizophrenia:
empirical and clinical findings. Schizophrenia Bulletin, 23(4), 637 – 651.
Freeman, D., & Garety, P. A. (1999). Worry, worry processes and dimensions of delusions: an exploratory
investigation of a role for anxiety processes in the maintenance of delusional distress. Behavioural and
Cognitive psychotherapy, 27, 47 – 62.
Freeman, D., Garety, P. A., & Kuipers, E. (2001). Persecutory delusions: developing the understanding of belief
maintenance and emotional distress. Psychological Medicine, 31, 1293 – 1306.
Frier, B. M. (2001). Hypoglycaemia and cognitive function in diabetes (Review). International Journal of Clinical
Practice, 123, 30 – 37.
Galdi, J. (1983). The causality of depression in schizophrenia. British Journal of Psychiatry, 142, 1149 – 1154.
Galdi, J., Reider, R. O., Silber, D., & Bonato, R. R. (1981). Genetic factors in the response to neuroleptics in
schizophrenia; a psychopharmacogenetic study. Psychological Medicine, 11, 713 – 728.
Gallagher, A. G., Gernez, T., & Baker, L. J. V. (1991). Beliefs of psychologists about schizophrenia and their role
in its treatment. Irish Journal of Psychology, 12(4), 393 – 405.
Garety, P. A., & Hemsley, D. R. (1994). Delusions: investigations into the psychology of delusional reasoning.
Oxford: Oxford Univ. Press.
Garety, P. A., Kuipers, E., Fowler, D., Freeman, D., & Bebbington, P. E. (2001). A cognitive model of the positive
symptoms of psychosis. Psychological Medicine, 31, 189 – 195.
Gilbert, P. (1992). Depression; the evolution of powerlessness. Hove: Lawerence Erlbaum Associates.
Green, J. H. (1988). Frequent re-hospitalisation and non-compliance with treatment. Hospital and Community
Psychiatry, 38, 55 – 60.
Greenley, J. R. (1986). Social control and expressed emotion. Journal of Nervous and Mental Disease, 174,
24 – 30.
Hampson, S. E., Glasgow, R. E., & Foster, L. S. (1995). Personal models of diabetes among older adults: relation
to self-management and other variables. Diabetes Educator, 21, 300 – 307.
Hampson, S. E., Glasgow, R. E., & Toobert, D. J. (1990). Personal models of diabetes and their relations to self-
care activities. Health Psychology, 9, 632 – 646.
Hampson, S. E., Glasgow, R. E., & Zeiss, A. (1994). Personal models of osteoarthritis and their relation to self-
management activities and quality of life. Journal of Behavioural Medicine, 17, 143 – 158.
Heijmans, M., de Ridder, D., & Bensing, J. (1999). Dissimilarity in patients’ and spouses representations of
chronic illness; exploration of relations to patient adaptation. Psychology and Health, 14(3), 451 – 466.
Heinrichsen, G. A., & Lieberman, J. A. (1999). Family attributions and coping in the prediction of emotional
adjustment in family members of patients with first-episode schizophrenia. Acta Psychiatrica Scandinavica,
100, 359 – 366.
Heinzelman, F., & Baguley, R. (1970). Responses to physical activity programs and their effects on health
behaviour. Public Health Reports, 85, 905 – 911.
Helman, C. G. (1985). Communication in primary care: the role of patient and practitioner explanatory models.
Social Science and Medicine, 20(9), 923 – 931.
Hoenig, J., & Hamilton, M. W. (1966). The schizophrenic patient in the community and his effect on the
household. International Journal of Social Psychiatry, 12, 165 – 176.
Hoffman, H., Kupper, Z., & Kunz, B. (2000). Hopelessness and its impact on rehabilitation outcome in schizo-
phrenia—an exploratory study. Schizophrenia Research, 43, 147 – 158.
Hooley, J. M. (1985). Expressed Emotion: a review of the critical literature. Clinical Psychology Review, 5,
119 – 139.
Hooley, J. M. (1987). The nature and origins of expressed emotion. In M. J. Goldstein, & K. Hahlweg (Eds.),
Understanding major mental disorder: the contribution of family interaction research (pp. 176 – 194). New
York: Family Process Press.
Horne, R. (1998). Adherence to medication: a review of existing research. In L. Myers, & K. Midence (Eds.),
Adherence to treatment in medical conditions ( pp. 285 – 310). London: Harwood.
Horne, R., & Weinman, J. (1995). The Beliefs About Medicines Questionnaire (BMQ): a new method for
assessing lay beliefs about medicines. Proceedings of the Special Group in Health Psychology: British
Psychological Society.
Horne, R., & Weinman, J. (1997). Patients’ beliefs about prescribed medicines and their role in adherence to
treatment in chronic physical illness. Journal of Psychosomatic Research, 47, 555 – 567.
Horne, R., & Weinman, J. (1999). Patients’ beliefs about prescribed medicines and their role in adherence to
treatment in chronic illness. Journal of Psychosomatic Research, 47(6), 555 – 567.
Horne, R., James, D., Petrie, K., Weinman, J., & Vincent, R. (2000). Patients’ interpretation of symptoms as a
cause of delay in reaching hospital during acute myocardial infarction. Heart, 83(4), 388 – 393.
Huq, S. F., Garety, P. A., & Hemsley, D. R. (1988). Probabilistic judgements in deluded and non-deluded subjects.
Quaterly Journal of Experimental Psychology, 40A, 801 – 812.
Jackson, H. J., McGorry, P. D., Edwards, J., Hulbert, C., Henry, L., Francey, S., et al. (1998). Cognitively-oriented
psychotherapy for early psychosis (COPE): preliminary results. British Journal of Psychiatry, 172(suppl. 33),
92 – 99.
Janz, N. K., & Becker, M. H. (1984). The health belief model: a decade later. Health Education Quarterly, 11, 1 – 47.
Jorm, A. F., Korten, A. E., Jacomb, P. A., et al. (1997). Helpfulness of interventions for mental disorders; beliefs of
health professionals compared with the general public. British Journal of Psychiatry, 171, 233 – 237.
Junginger, J. (1990). Predicting compliance with command hallucinations. American Journal of Psychiatry,
147(2), 245 – 247.
Kaney, S., & Bentall, R. P. (1989). Persecutory delusions and attributional style. British Journal of Medical
Psychology, 62, 191 – 198.
Kaney, S., Wolfenden, M., Dewey, M. E., & Bentall, R. P. (1992). Persecutory delusions and recall of threatening
propositions. British Journal of Clinical Psychology, 31, 85 – 87.
Kinderman, P., & Bentall, R. P. (1996). Self-discrepancies and persecutory delusions: evidence for a defensive
model of paranoid ideation. Journal of Abnormal Psychology, 105, 105 – 111.
Kinderman, P., & Bentall, R. P. (1997). Causal attributions in paranoia and depression: internal, personal, and
situational attributions for negative events. Journal of Abnormal Psychology, 106(2), 341 – 345.
Kinney, C. F. (1999). Coping with schizophrenia; the significance of appraisal. Unpublished PhD thesis, Faculty
of Medicine, University of Manchester.
Kleinman, A. (1980). Patients and healers in the context of culture: an exploration of the borderline between
anthropology, medicine and psychiatry. USA: University of California Press.
Kleinman, A. (1988). The illness narratives: suffering, healing and the human condition. USA: Basic Books.
Kreitler, S. (1999). Denial in cancer patients (Review). Cancer Investigation, 17(7), 514 – 534.
Larsen, T. K., McGalshan, T. H., & Moe, L. C. (1996). First-episode schizophrenia: I. Early course parameters.
Schizophrenia Bulletin, 22, 241 – 256.
Lau, R. R., & Hartman, K. A. (1983). Common sense representations of common illnesses. Health Psychology, 2,
167 – 185.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.
Leventhal, H., Benjamin, Y., Brownlee, S., Diefenbach, M., Leventhal, E. A., Patrick-Miller, L., & Robitaille, C.
(1997). Illness representations; theoretical foundations. In K. J. Petrie, & J. Weinman (Eds.), Perceptions of
health and illness (pp. 19 – 47). London: Harwood Academic Publishers.
Leventhal, H., & Cameron, L. (1987). Behavioural theories and the problem of compliance. Patient Education and
Counselling, 10, 117 – 138.
Leventhal, H., Diefenbach, M., & Leventhal, E. A. (1992). Illness cognition: using common sense to understand
treatment adherence and affect cognition interactions. Cognitive Therapy and research, 16(2), 143 – 163.
Leventhal, H., & Nerenz, D. R. (1985). The assessment of illness cognition. In P. Karody (Ed.), Measurement
strategies in health psychology (pp. 517 – 554). Canada: Wiley.
Leventhal, H., Nerenz, D. R., & Steele, D. F. (1984). Illness representations and coping with health threats. In A.
Singer, & J. Singer (Eds.), A Handbook of psychology and health (pp. 219 – 252). Hillsdale, NJ: Erlbaum.
Liddle, P. F., Barnes, T. R., Curson, D. A., & Patel, M. (1993). Depression and the experience of psychological
deficits in schizophrenia. Acta Psychiatrica Scandinavica, 88, 243 – 247.
Linn, M. W., Klett, C. J., & Caffey, E. M. (1982). Relapse of psychiatric patients in foster care. American Journal
of Psychiatry, 139, 778 – 783.
Lloyd, K. R., Jacob, J. S., Patel, V., St. Louis, L., Bhugra, D., & Mann, A. H. (1998). The development of a Short
Explanatory Model Interview (SEMI) and its use among primary care attenders with common mental disor-
ders. Psychological Medicine, 28, 1231 – 1237.
Loebel, A. D., Lieberman, J. A., Alvir, J. M. J., et al. (1992). Duration of psychosis and outcome in first-episode
schizophrenia. American Journal of Psychiatry, 149, 1183 – 1188.
Lopez, S. R., Nelson, K. A., Snyder, K. S., & Mintz, J. (1999). Attributions and affective reactions of family
members and course of schizophrenia. Journal of Abnormal Psychology, 108, 307 – 314.
Maddux, J. E., & Rogers, R. W. (1983). Protection motivation and self-efficacy: a revised theory of fear appeals
and attitude change. Journal of Experimental Social Psychology, 19, 469 – 479.
Magliano, L., Fadden, G., Madianos, M., Caldas de Almedia, J. M., Held, T., Guarneri, M., Marasco, C., Tosini,
P., & Maj, M. (1998). Burden on the families of patients with schizophrenia: results of the BIOMED I study.
Social Psychiatry and Psychiatric Epidemiology, 33, 405 – 412.
Mason, P., Harrison, G., Glazebrook, C., Medley, I., Dalkin, T., & Croudace, T. (1995). Characteristics of outcome
in schizophrenia at 13 years. British Journal of Psychiatry, 167, 596 – 603.
Maurin, J. T., & Boyd, C. (1990). Burden of mental illness on the family: a critical review. Archives of Psychiatric
Nursing, 4, 99 – 107.
McEvoy, J. P., Apperson, L. J., Appelbaum, P. S., Ortlip, P., Breckosky, J., & Hammill, K. (1989). Insight in
schizophrenia: its relationship to acute psychopathology. Journal of Nervous and Mental Disease, 177,
42 – 47.
McEvoy, J. P., Howe, A. C., & Hogarty, G. E. (1984). Differences in the nature of relapse and subsequent inpatient
course between medication-compliant and noncompliant schizophrenia patients. Journal of Nervous and
Mental Disease, 172, 412 – 416.
McGill, C. W., Fallon, I. R. H., Boyd, J. L., & Wood-Swerio, C. (1983). Family education intervention in the
treatment of schizophrenia. Hospital and Community Psychiatry, 34(10), 934 – 938.
McGlashan, T. H., Levy, S. T., & Carpenter, W. T. (1975). Integration and sealing over: clinically distinct recovery
styles from schizophrenia. Archives of General Psychiatry, 32, 1269 – 1272.
McGorry, P. D., & McConville, S. B. (1999). Insight in Psychosis: an elusive target. Comprehensive Psychiatry,
40(2), 131 – 142.
Mechanic, D., McAlpine, D., Rosenfield, S., & Davis, D. (1994). Effects of illness attribution and depression on
the quality of life among persons with serious mental illness. Social Science in Medicine, 39, 155 – 164.
Morrison, A. P. (1998). A cognitive analysis of auditory hallucinations: are voices to schizophrenia what bodily
sensations are to panic? Behavioural and Cognitive Psychotherapy, 26, 289 – 302.
Morrison, A. P. (2001). The interpretation of intrusions of in psychosis: an integrative cognitive approach to
hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29(3), 257 – 277.
Morrison, A. P., & Haddock, G. (1997). Self-focussed attention in schizophrenic patients and normal subjects: a
comparative study. Personality and Individual Differences, 23, 937 – 941.
Morrison, A. P., Wells, A., & Nothard, S. (2000). Cognitive factors in predisposition to auditory and visual
hallucinations. British Journal of Clinical Psychology, 39, 67 – 78.
Moss-Morris, R., Weinman, J., Petrie, K., Horne, R., Cameron, L. D., & Buick, D. (2001). The revised illness
perception question. Psychology and Health, 17(1), 1 – 16.
Murphy, H., Dickens, C., Creed, F., & Berstein, R. (1999). Depression, illness perception and coping with
rheumatoid arthritis. Journal of Psychosomatic Research, 46(2), 155 – 164.
Nageotte, C., Sullivan, G., Duan, N., & Camp, P. L. (1997). Medication compliance among the seriously mentally
ill in a public mental health system. Social Psychiatry and Psychiatric Epidemiology, 32, 49 – 56.
Petrie, K. J., Weinman, J., Sharpe, N., & Buckley, J. (1996). Predicting return to work and functioning following
myocardial infarction: the role of the patients’ view of their illness. British Medical Journal, 312, 1191 – 1194.
Prochaska, J. O., & DiClemente, C. C. (1984). The transtheoretical approach: crossing traditional bounda-
ries of therapy. Homewood, IL: Dow Jones Irwin.
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: applications to
addictive behaviours. American Psychologist, 47, 1102 – 1114.
Rogers, A., Day, J. C., Williams, B., Randall, F., Wood, P., Healy, D., & Bentall, R. P. (1998). The meaning and
management of neuroleptic medication; a study of patients with a diagnosis of schizophrenia. Social Science
and Medicine, 47(9), 1313 – 1323.
Romme, M. A. J., Honig, A., Noorthoorn, E. O., & Escher, A. D. M. A. C. (1992). Coping with hearing voices: an
emancipatory approach. British Journal of Psychiatry, 161, 99 – 103.
Rose, L. E. (1983). Understanding mental illness: the experience of families of psychiatric patients. Journal of
Advanced Nursing, 8, 507 – 511.
Salkovskis, P. M. (1989). Somatic problems. In K. Hawton, P. M. Salkovskis, J. Kirk, & D. M. Clark (Eds.),
Cognitive therapy for psychiatric problems: a practical guide (pp. 235 – 276). Oxford: Oxford Univ. Press.
Sands, J. R., & Harrow, M. (1999). Depression during the longitudinal course of schizophrenia. Schizophrenia
Bulletin, 25(1), 157 – 171.
Scazufca, M., & Kuipers, E. (1996). Links between expressed emotion and burden of care in relatives of patients
with schizophrenia. British Journal of Psychiatry, 168, 580 – 587.
Scharloo, M. A., Kaptein, A. A., Weinman, J. A., Willems, L. N. A., & Rooijmans, H. G. M. (2000). Physical and
psychological correlates of functioning in patients with chronic obstructive pulmonary disease. Journal of
Asthma, 37(19), 17 – 29.
Schwarzer, R. (1992). Self-efficacy in the adoption and maintenance of health behaviours: theoretical approaches
and a new model. In R. Schwarzer (Ed.), Self-efficacy: thought control and action (pp. 217 – 243). London:
Hemisphere.
Scott, J., & Pope, M. (2002). Non-adherence with mood stabilizers: prevalence and predictors. Journal of Clinical
Psychiatry, 63(5), 384 – 391.
Seeman, M., & Seeman, T. E. (1983). Health behaviour and personal autonomy: a longitudinal study of the sense
of control in illness. Journal of Health and Social Behaviour, 24, 144 – 160.
Smith, L. D. (1989). Medication refusal and the rehospitalised mentally ill inmate. Hospital and Community
Psychiatry, 40, 491 – 496.
Talley, S. (1999). Self-regulation activities used by individuals with schizophrenia. Dissertation Abstracts Interna-
tional: Section B: The Sciences and Engineering, 59 (12-B), 6265. Univ. Microfilms International, US.
Tarrier, N. (1991). Some aspects of family interventions in schizophrenia: I. Adherence to intervention pro-
grammes. British Journal of Psychiatry, 159, 475 – 480.
Tarrier, N., & Barrowclough, C. (1986). Providing information about schizophrenia: some comments. British
Journal of Psychiatry, 149, 458 – 463.
Tarrier, N., Harwood, S., Yusopoff, L., Beckett, R., & Baker, A. (1990). Coping Strategy Enhancement (CSE): a
method of treating residual schizophrenic symptoms. Behavioural Psychotherapy, 18, 283 – 293.
Tarrier, N., Yusupoff, L., McCarthy, E., Kinney, C., & Wittkowski, A. (1998). Some reasons why patients
suffering with chronic schizophrenia fail to continue in psychological treatment. Behavioural and Cognitive
Psychotherapy, 26, 177 – 181.
van der Velde, W., & van der Pligt, J. (1991). AIDS related behaviour: coping, protection motivation, and
previous behaviour. Journal of Behavioural Medicine, 14, 429 – 451.
Van Putten, T., & May, P. R. (1978). ‘‘Akinetic depression’’ in schizophrenia. Archives of General Psychiatry, 35,
1101 – 1107.
Wallston, K. A., Wallston, B. S., & DeVellis, R. (1978). Development of multi-dimensional health locus (MHLC)
of control scales. Health Education Monographs, 6, 160 – 170.
Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28,
105 – 117.
Wearden, A. J., Tarrier, N., Barrowclough, C., Zastowny, T. R., & Rahill, A. A. (2000). A review of expressed
emotion research in health care. Clinical Psychology Review, 20(5), 633 – 666.
Weiner, B. (1985a). An attributional theory of achievement motivation and emotion (Review). Psychological
Review, 92(4), 548 – 573.
Weiner, B. (1985b). ‘‘Spontaneous’’ causal thinking. Psychological Bulletin, 97(1), 74 – 84.
Weiner, B. (1988). Attributional theory and attributional therapy: some theoretical observations and suggestions.
British Journal of Clinical Psychology, 27(1), 99 – 104.
Weiner, B. (1990). On perceiving the other as responsible (Review). Nebraska Symposium on Motivation, 38,
165 – 198.
Weinman, J., Petrie, K., Moss-Morris, R., & Horne, R. (1996). The Illness Perception Questionnaire: a new
method for assessing the cognitive representation of illness. Psychology and Health, 11(3), 431 – 445.
Weisman, A., Lopez, S. R., Karno, M., & Jenkins, J. (1993). An attributional analysis of expressed emotion in
Mexican – American families with schizophrenia. Journal of Abnormal Psychology, 102, 601 – 606.
White, R., Bebbington, P., Pearson, J., Johnson, S., & Ellis, D. (2000). The social context of insight in schizo-
phrenia. Social Psychiatry and Psychiatric Epidemiology, 35, 500 – 507.
Wichowski, H. C., & Kubsch, S. M. (1997). The relationship of self-perception of illness and compliance with
health-care regimens. Journal of Advanced Nursing, 25, 548 – 553.
Yardley, L., Beech, S., & Weinman, J. (2001). Influence of beliefs about the consequences of dizziness on
handicap in people with dizziness, and the effect of therapy on beliefs. Journal of Psychosomatic Research,
50(1), 1 – 6.

Role of Illness Models

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Role of Illness Models

Hochgeladen von

Copyright:

Verfügbare Formate

Clinical Psychology Review 23 (2003) 171 – 196

Keywords: Schizophrenia; Mental health; Illness models; Self-regulation model

2. The SRM (Leventhal et al., 1984)

Fig. 1. Outline of the self-regulation model (Leventhal et al., 1984).

3. Assessing beliefs about illness/health

4. Validity of the SRM in understanding mental illness

4.1. People who experience a mental illness

4.1.4. Timeline: acute/chronic

4.1.5.1. Personal control. Appraisals of controllability of symptoms by the individual have

Finally, expanding the work discussed previously by Beck-Saunder, Birchwood, and

individuals undergoing psychological intervention for early psychosis (Jackson et al.,

4.1.7. Other dimensions

4.2. Beliefs held by relatives/carers

Cognitive representations of mental illness held by relatives/carers are likely to be

4.2.3. Timeline: acute/chronic

4.3. Beliefs held by professionals

5. Limitations of illness models

dimensions of understanding to those identified in physical illness may be critical. However,

Das könnte Ihnen auch gefallen