““Illness is in the mind”: Illness is in the mind”:

Illness Consequences of Illness Consequences of Schematic ActivationSchematic Activation

Caroline Henderson, PhDCaroline Henderson, PhD

An Apple a Day Keeps the An Apple a Day Keeps the Doctor Away Doctor Away

(but only if it’s encoded into a (but only if it’s encoded into a specific illness schema)specific illness schema)

Or…Or…

Caroline Henderson, PhDCaroline Henderson, PhD

The Common Sense Model of The Common Sense Model of Illness (CSM)Illness (CSM)

IdentityTimeline

ConsequencesControl

Cure

Emotion focusedActive coping

Taking medication

Get better?

Illness coherenceEmotional representation

Cause

Specificity of Illness SchemataSpecificity of Illness Schemata Henderson, Hagger, & Orbell (2007). Does the priming of a specific Henderson, Hagger, & Orbell (2007). Does the priming of a specific

illness schema result in an attentional information processing bias for illness schema result in an attentional information processing bias for specific illness? specific illness? Health PsychologyHealth Psychology

Individuals exposed to external sources or lay information about an Individuals exposed to external sources or lay information about an illness will form or activate an illness-specific schema.illness will form or activate an illness-specific schema.

Schematic organisation – stored at a subconscious level, an Schematic organisation – stored at a subconscious level, an elaborative cognitive structure. Activation of one aspect of an illness elaborative cognitive structure. Activation of one aspect of an illness representation should lead to activation of all interrelated representation should lead to activation of all interrelated representations contained within the schema.representations contained within the schema.

Two studies, using narrative prime, with modified Stroop colour-naming Two studies, using narrative prime, with modified Stroop colour-naming task containing common cold-related, cardiovascular disease-related task containing common cold-related, cardiovascular disease-related and neutral words.and neutral words.

ConclusionsConclusions The two studies used two illnesses, one acute and one chronic, and The two studies used two illnesses, one acute and one chronic, and

showed that knowledge about each illness could be explicitly showed that knowledge about each illness could be explicitly primed.primed.

Evidence from both studies suggests that any individual can Evidence from both studies suggests that any individual can possess a schema specific to an illness, regardless of the possess a schema specific to an illness, regardless of the experience had with the illness and of its chronic or acute nature.experience had with the illness and of its chronic or acute nature.

Does the priming of a specific illness schema result in an Does the priming of a specific illness schema result in an attentional information processing bias for specific attentional information processing bias for specific illness?illness?

Back to the modelBack to the model

A Tale of Two StudiesA Tale of Two Studies Henderson, Hagger, & Orbell (Henderson, Hagger, & Orbell (20092009). ). Illness schema activation and Illness schema activation and

attentional bias to coping procedures. attentional bias to coping procedures.

Previous research showed that specific illness schemata can be Previous research showed that specific illness schemata can be activated – can specific coping strategies associated with that illness be activated – can specific coping strategies associated with that illness be activated concomitantly?activated concomitantly?

Exploring another key hypothesis of the CSM; activation of specific Exploring another key hypothesis of the CSM; activation of specific illness representations will lead to activation of appropriate coping illness representations will lead to activation of appropriate coping strategies; or “if-then” rules (Leventhal at al., 1998)strategies; or “if-then” rules (Leventhal at al., 1998)

Repeated or frequent use of a coping strategy may lead to it’s retention Repeated or frequent use of a coping strategy may lead to it’s retention as a ‘default’ value in the schemaas a ‘default’ value in the schema

Coping behaviour may become active along with the other specific Coping behaviour may become active along with the other specific information about the illness when the schema is activated. information about the illness when the schema is activated.

A Tale of Two StudiesA Tale of Two Studies ““The representation of an illness can affect behaviour only when it is The representation of an illness can affect behaviour only when it is

activated, though activation does not imply that the representation activated, though activation does not imply that the representation will be fully consciouswill be fully conscious” Leventhal, et al. (1998)” Leventhal, et al. (1998)

Implicit (subliminal) rather than explicit prime to examine automatic Implicit (subliminal) rather than explicit prime to examine automatic links.links.

Response to word “LEMSIP” or “LOZENGE” as a coping-related Response to word “LEMSIP” or “LOZENGE” as a coping-related word in a word identification task – the GDT!word in a word identification task – the GDT!

High or low past use of Lemsip and lozenges – dichotomised High or low past use of Lemsip and lozenges – dichotomised participants into two groups.participants into two groups.

Lemsip? Lozenges?Lemsip? Lozenges? Previous research showed that the coping strategy of using Lemsip Previous research showed that the coping strategy of using Lemsip

for a common cold was associated with treatment control.for a common cold was associated with treatment control.

67 undergraduate students listed all single words related to coping 67 undergraduate students listed all single words related to coping with the common cold or flu.with the common cold or flu.

Rated for frequency, and 20 most frequently reported rated Rated for frequency, and 20 most frequently reported rated independently for highness of association with only the common independently for highness of association with only the common cold or flu.cold or flu.

““Tissues” most highly related – “Lemsip” second most related, Tissues” most highly related – “Lemsip” second most related, “lozenge” third most related.“lozenge” third most related.

G.D.T.G.D.T. Grammatical Decision TaskGrammatical Decision Task

Allows response time measurement from a single target stimulus Allows response time measurement from a single target stimulus word – Lemsip and lozenge.word – Lemsip and lozenge.

““Verb” or “non-verb” choice, so better than LDT, as no confusion of Verb” or “non-verb” choice, so better than LDT, as no confusion of ‘reality’ of words like Lemsip.‘reality’ of words like Lemsip.

Instructions given to say not necessarily a word found in the Instructions given to say not necessarily a word found in the dictionary, and included other brand names (Hoovering, Cadbury) dictionary, and included other brand names (Hoovering, Cadbury) so no confusion over words like Lemsip.so no confusion over words like Lemsip.

13 nouns and 12 verbs as filler items, each repeated three times. 13 nouns and 12 verbs as filler items, each repeated three times. LEMSIP or LOZENGE was the target.LEMSIP or LOZENGE was the target.

MethodologyMethodology

XQFBZRMQWBX

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FLU or XXX

LEMSIP

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17ms

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45 participants (13 male, 32 female, 45 participants (13 male, 32 female, mean age = 21.4, SD = 5.01) in the mean age = 21.4, SD = 5.01) in the LEMSIP study.LEMSIP study.

59 participants (9 male, 50 female, mean 59 participants (9 male, 50 female, mean age = 20.5, SD = 5.77) in the LOZENGE age = 20.5, SD = 5.77) in the LOZENGE study.study.

ResultsResultsLemsip Lozenge

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No significant main effectsNo significant main effects

2 x 2 between participants ANOVA (high-low 2 x 2 between participants ANOVA (high-low Lemsip use by prime) revealed Lemsip use by prime) revealed a significant a significant interaction between the prime and past high-interaction between the prime and past high-low use of Lemsip low use of Lemsip ((FF (1, 41) = 6.52, (1, 41) = 6.52, pp < .05, < .05, ETA2 = .14)ETA2 = .14)

Univariate analysis also significantUnivariate analysis also significant

No significant main effectsNo significant main effects

2 x 2 between participants ANOVA (high-low 2 x 2 between participants ANOVA (high-low lozenge use by prime) revealed lozenge use by prime) revealed a significant a significant interaction between the prime and past high-interaction between the prime and past high-low use of lozenge low use of lozenge ((FF (1, 55) = 6.89, (1, 55) = 6.89, pp < .05, < .05, ETA2 = .73)ETA2 = .73)

Univariate analysis also significantUnivariate analysis also significant

ConclusionsConclusions Participants primed for a common cold exhibit response inhibition Participants primed for a common cold exhibit response inhibition

for the specific common cold coping-related words (Lemsip and for the specific common cold coping-related words (Lemsip and lozenge), when there is high past use of that strategy.lozenge), when there is high past use of that strategy.

Past use only inhibits the accessibility of the coping procedure when Past use only inhibits the accessibility of the coping procedure when the illness schema has been activated.the illness schema has been activated.

Suggests that specific coping strategies are embedded in the Suggests that specific coping strategies are embedded in the specific illness schema, and are activated along with that schema.specific illness schema, and are activated along with that schema.

If the subliminal prime contained sufficient information to activate If the subliminal prime contained sufficient information to activate the specific illness schema, the if-then rules regarding the the specific illness schema, the if-then rules regarding the identification of the coping procedure may also be automatic.identification of the coping procedure may also be automatic.

Specific coping strategies can be activated along with Specific coping strategies can be activated along with specific illness schemata…specific illness schemata…but only in those who have used that strategy before.but only in those who have used that strategy before.

What does this mean?What does this mean?

Illness ConsequencesIllness Consequences Automatic activation of a previously used coping strategy could Automatic activation of a previously used coping strategy could

suggest automatic activation of previously used behaviours or suggest automatic activation of previously used behaviours or illness typical behaviour in line with the schematic representationillness typical behaviour in line with the schematic representation

Activation of a common cold illness schema, may lead individuals to Activation of a common cold illness schema, may lead individuals to demonstrate behaviours they automatically associate with having a demonstrate behaviours they automatically associate with having a common coldcommon cold

Behaviours could be encoded in the illness schema, just like coping Behaviours could be encoded in the illness schema, just like coping strategies.strategies.

Typical behaviours for the common cold:Typical behaviours for the common cold:““I feel run down” / “I have no energy”I feel run down” / “I have no energy”““I can’t concentrate” / “My head feels woolly”I can’t concentrate” / “My head feels woolly”

““I feel run down”I feel run down”

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FLU or XXX

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Ostensible visual acuity task – does the Ostensible visual acuity task – does the flash appear on left or right of screen. flash appear on left or right of screen. Subliminal prime presented 120 times.Subliminal prime presented 120 times.

Participants asked to walk from computer Participants asked to walk from computer booth after computer task to a more booth after computer task to a more comfortable room to complete the comfortable room to complete the questionnaire – 10m distance recorded questionnaire – 10m distance recorded by infra-red motion sensors hidden by infra-red motion sensors hidden covertly in corridor wallscovertly in corridor walls

Experimenter blind to conditionExperimenter blind to condition

45 participants (males = 14; females = 45 participants (males = 14; females = 31; mean age = 27.82, SD = 11.12)31; mean age = 27.82, SD = 11.12)

XQFBZRMQWBX

““I feel run down”I feel run down”

One-way ANOVA revealed a significant effect of the prime on One-way ANOVA revealed a significant effect of the prime on walking speed (walking speed (FF (1, 43) = 3.55, (1, 43) = 3.55, pp < .05, ETA2 = .10). < .05, ETA2 = .10).

Those who received the common cold prime walked slower Those who received the common cold prime walked slower following the task (mean = 8.18 s) than participants in the following the task (mean = 8.18 s) than participants in the

control condition (mean = 7.58 s).control condition (mean = 7.58 s).

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““I can’t concentrate”I can’t concentrate”

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WORD

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Free recall memory taskFree recall memory task

3 lists of 24 words, each word 3 lists of 24 words, each word presented following subliminal prime.presented following subliminal prime.

One minute free recall time following One minute free recall time following each list.each list.

23 participants (males = 9; females = 23 participants (males = 9; females = 14; mean age =33.52, SD = 12.25)14; mean age =33.52, SD = 12.25)

1000ms

500ms

““I can’t concentrate”I can’t concentrate”

One-way ANOVA revealed a significant effect of the prime on One-way ANOVA revealed a significant effect of the prime on word recall (word recall (FF (1, 22) = 4.91, (1, 22) = 4.91, pp < .05, ETA2 = .19) < .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).

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Conclusions Conclusions Automatic activation of an illness schema can result in actual Automatic activation of an illness schema can result in actual

behaviours related to that illness.behaviours related to that illness.

This has been demonstrated with two types of behaviour: one This has been demonstrated with two types of behaviour: one physical, one cognitive.physical, one cognitive.

BUT we need to assess this with more than just two behaviours perceived to be related to the illness.

The next Big thingThe next Big thing It seems that illness-related behaviour can be automatically It seems that illness-related behaviour can be automatically

activated in line with the schematic representation.activated in line with the schematic representation.

Would it help to look at different illnesses? What other kinds of Would it help to look at different illnesses? What other kinds of illness behaviour should we be looking for?illness behaviour should we be looking for?

Can activation of an illness schema lead to assimilation of a sick Can activation of an illness schema lead to assimilation of a sick role? Can hearing about a co-worker being ill decrease role? Can hearing about a co-worker being ill decrease productivity in an entire department?productivity in an entire department?

What are the limitations of activation?What are the limitations of activation?

Is illness schema activation the same as actual illness activation Is illness schema activation the same as actual illness activation – evidence from neuropsychological tests?– evidence from neuropsychological tests?

Thank youThank you