1. “Illness is in the mind”: Illness Consequences of Schematic Activation Caroline Henderson, PhD

2. An Apple a Day Keeps the Doctor Away (but only if it’s encoded into a specific illness schema) Or… Caroline Henderson, PhD

3. The Common Sense Model of Illness (CSM) Identity Timeline Consequences Control Cure Emotion focused Active coping Taking medication Get better? Illness coherence Emotional representation Cause

4. Specificity of Illness Schemata  Henderson, Hagger, & Orbell (2007). Does the priming of a specific illness schema result in an attentional information processing bias for specific illness? Health Psychology  Individuals exposed to external sources or lay information about an illness will form or activate an illness-specific schema.  Schematic organisation – stored at a subconscious level, an elaborative cognitive structure. Activation of one aspect of an illness representation should lead to activation of all interrelated representations contained within the schema.  Two studies, using narrative prime, with modified Stroop colour-naming task containing common cold-related, cardiovascular disease-related and neutral words.

5. Conclusions  The two studies used two illnesses, one acute and one chronic, and showed that knowledge about each illness could be explicitly primed.  Evidence from both studies suggests that any individual can possess a schema specific to an illness, regardless of the experience had with the illness and of its chronic or acute nature.  Does the priming of a specific illness schema result in an attentional information processing bias for specific illness?

6. Back to the model

7. A Tale of Two Studies  Henderson, Hagger, & Orbell (2009). Illness schema activation and attentional bias to coping procedures.  Previous research showed that specific illness schemata can be activated – can specific coping strategies associated with that illness be activated concomitantly?  Exploring another key hypothesis of the CSM; activation of specific illness representations will lead to activation of appropriate coping strategies; or “if-then” rules (Leventhal at al., 1998)  Repeated or frequent use of a coping strategy may lead to it’s retention as a ‘default’ value in the schema  Coping behaviour may become active along with the other specific information about the illness when the schema is activated.

8. A Tale of Two Studies  “The representation of an illness can affect behaviour only when it is activated, though activation does not imply that the representation will be fully conscious” Leventhal, et al. (1998)  Implicit (subliminal) rather than explicit prime to examine automatic links.  Response to word “LEMSIP” or “LOZENGE” as a coping-related word in a word identification task – the GDT!  High or low past use of Lemsip and lozenges – dichotomised participants into two groups.

9. Lemsip? Lozenges?  Previous research showed that the coping strategy of using Lemsip for a common cold was associated with treatment control.  67 undergraduate students listed all single words related to coping with the common cold or flu.  Rated for frequency, and 20 most frequently reported rated independently for highness of association with only the common cold or flu.  “Tissues” most highly related – “Lemsip” second most related, “lozenge” third most related.

10. G.D.T.  Grammatical Decision Task  Allows response time measurement from a single target stimulus word – Lemsip and lozenge.  “Verb” or “non-verb” choice, so better than LDT, as no confusion of ‘reality’ of words like Lemsip.  Instructions given to say not necessarily a word found in the dictionary, and included other brand names (Hoovering, Cadbury) so no confusion over words like Lemsip.  13 nouns and 12 verbs as filler items, each repeated three times. LEMSIP or LOZENGE was the target.

11. Methodology XQFBZRMQWBX FLU or XXX LEMSIP 60ms 17ms 60ms 45 participants (13 male, 32 female, mean age = 21.4, SD = 5.01) in the LEMSIP study. 59 participants (9 male, 50 female, mean age = 20.5, SD = 5.77) in the LOZENGE study.

12. Results LemsipLozenge No significant main effects 2 x 2 between participants ANOVA (high-low Lemsip use by prime) revealed a significant interaction between the prime and past high- low use of Lemsip (F (1, 41) = 6.52, p <.05, ETA2 =.14) Univariate analysis also significant No significant main effects 2 x 2 between participants ANOVA (high-low lozenge use by prime) revealed a significant interaction between the prime and past high- low use of lozenge (F (1, 55) = 6.89, p <.05, ETA2 =.73) Univariate analysis also significant

13. Conclusions  Participants primed for a common cold exhibit response inhibition for the specific common cold coping-related words (Lemsip and lozenge), when there is high past use of that strategy.  Past use only inhibits the accessibility of the coping procedure when the illness schema has been activated.  Suggests that specific coping strategies are embedded in the specific illness schema, and are activated along with that schema.  If the subliminal prime contained sufficient information to activate the specific illness schema, the if-then rules regarding the identification of the coping procedure may also be automatic.  Specific coping strategies can be activated along with specific illness schemata… but only in those who have used that strategy before.

14. What does this mean?

15. Illness Consequences  Automatic activation of a previously used coping strategy could suggest automatic activation of previously used behaviours or illness typical behaviour in line with the schematic representation  Activation of a common cold illness schema, may lead individuals to demonstrate behaviours they automatically associate with having a common cold  Behaviours could be encoded in the illness schema, just like coping strategies.  Typical behaviours for the common cold: “I feel run down” / “I have no energy” “I can’t concentrate” / “My head feels woolly”

16. “I feel run down” + FLU or XXX 500ms 60ms Ostensible visual acuity task – does the flash appear on left or right of screen. Subliminal prime presented 120 times. Participants asked to walk from computer booth after computer task to a more comfortable room to complete the questionnaire – 10m distance recorded by infra-red motion sensors hidden covertly in corridor walls Experimenter blind to condition 45 participants (males = 14; females = 31; mean age = 27.82, SD = 11.12) XQFBZRMQWBX

17. “I feel run down” One-way ANOVA revealed a significant effect of the prime on walking speed (F (1, 43) = 3.55, p <.05, ETA2 =.10). Those who received the common cold prime walked slower following the task (mean = 8.18 s) than participants in the control condition (mean = 7.58 s).

18. “I can’t concentrate” XQFBZRMQWBX FLU or XXX WORD 60ms 17ms 60ms Free recall memory task 3 lists of 24 words, each word presented following subliminal prime. One minute free recall time following each list. 23 participants (males = 9; females = 14; mean age =33.52, SD = 12.25) 1000ms 500ms

19. “I can’t concentrate” One-way ANOVA revealed a significant effect of the prime on word recall (F (1, 22) = 4.91, p <.05, ETA2 =.19) One-way ANOVA revealed a significant effect of the prime on word recall (F (1, 22) = 4.91, p <.05, ETA2 =.19). Those who received the common cold prime demonstrated decreased ability to recall words (mean = 5.88) than participants in the control condition (mean 8.03).

20. Conclusions  Automatic activation of an illness schema can result in actual behaviours related to that illness.  This has been demonstrated with two types of behaviour: one physical, one cognitive. BUT we need to assess this with more than just two behaviours perceived to be related to the illness.

21. The next Big thing  It seems that illness-related behaviour can be automatically activated in line with the schematic representation.  Would it help to look at different illnesses? What other kinds of illness behaviour should we be looking for?  Can activation of an illness schema lead to assimilation of a sick role? Can hearing about a co-worker being ill decrease productivity in an entire department?  What are the limitations of activation?  Is illness schema activation the same as actual illness activation – evidence from neuropsychological tests?

22. Thank you