Implicit theories of illness: Contents, structures and impact on efficacy of treatment, compliance, illness behavior and coping

Research project P 13393 Implicit theories of illness Gabriele AMANN 28.06.1999 In the last decades it turned out, that the availability of effective treatments often yields no benefit either because patient compliance is low or because patients do not seek this kind of treatment at all. Therefore it is necessary to aquire a better understanding of patients` perspectives of illness and to examine the impact of these implicit theories of illness on illness behavior, compliance, coping, and efficacy of treatment. The present project is oriented towards these objectives and strategies for modification of implicit theories of illness will be developed. In a previous project implicit theories of subjects were examined, who were affected by different mental disorders (schizophrenia, depression, anxiety and somatoform disorders; N = 285). Additionally illness behavior, compliance, coping and efficacy of treatment were assessed - factors relevant for illness and treatment. These factors should be related to the implicit theories of illness. A further question was to examine the impact of experience with illness on implicit theories. For this purpose a sample of laypeople, unaffected by any mental disorder, was examined too (N = 70). The aim of the present project is to analyse the collected data, to clarify the presented objectives, to derivate strategies for modification of implicit theories of illness from these results and to examine these strategies in first unsystematic studies. The data will indicate which domains and contents of implicit theories of illness will be related to positive illness behavior, good compliance, positive coping and high efficacy of treatment. The elaborated strategies will serve to reinforce these domains and contents in order to modify the factors relevant for illness and treatment for the better. As a result course of illness, adaptation and well-being of affected people should be improved in the long-term.

In recent decades, a large number of methods and strategies for treating mental illness has been developed by research in psychology, psychiatry and psychotherapy. They have been proved highly effective in the treatment of psychiatric disorders. Nevertheless, the availability of effective treatments often yields no benefit either because patient compliance is low or because patients do not seek this kind of treatment at all. Therefore, it is necessary that we acquire a better understanding of the patients perspective on illness. Patients have a profound influence on the state and course of their own illness. So research on knowledge, conceptions, attitudes of patients, cognitions and emotions about their illness have an critical impact on the progress of general mental health care. This project is guided by following objectives: - to determine the contents and the structures of implicit theories of patients with several mental disorders; - to determine the contents and the structures of implicit theories of lay persons without any mental disorder; - to examine the impact of the extent of experience with illness on the content, structure and refinement of the implicit theory (lay persons vs. short term illness vs. long term illness); - to examine the impact of stigma connected with illness on the content, structure, and refinement of the implicit theory; - to examine the impact of the content, structures and refinement of implicit theories on illness behavior, efficacy of treatment, compliance and coping with illness. The results of this study show pathways to improve mental health care by elaborating therapeutic strategies that support "positive" aspects of implicit theories. By knowing the specific contents and structures of implicit theories that are associated with positive illness behavior, adequate coping, high compliance and higher efficacy of treatment, it is possible for us to modify them for the better and to prevent relapse or chronicity more effectively. The results of this study can also guide the elaboration of strategies for health psychology that try to support these "positive" aspects of implicit theories in the community. All of these interventions can help people to notice the onset or relapse of a disorder and seek appropriate treatment in time, to comply with treatment, and to develop adequate coping strategies and illness behavior to overcome their illness. These strategies can have a crucial effect on the course of mental health problems, especially on the long-term effects of treatments, and can also save the community considerable health care resources.