Applying Leventhal's self regulation model to adaptation and intervention in rheumatic disease



Chronic illnesses are the leading cause of death, disability, and health care expenditure in the US and UK. Although advances in medical care have improved survival, people are often left with major limitations in physical, emotional, social and occupational functioning. The potential role of psychology to contribute to the prevention and management of chronic illness is now being recognized (Smith and Nicassio, 1995). This paper discusses the application of Leventhal's self regulation model to rheumatic disease (Leventhal et al., 1980, 1984, 1992a,b). Psychological research in rheumatic disease has explored a number of issues: (1) The role that psychological factors may play in the onset and course of the disease; (2) the psychological consequences of the disease; (3) whether psychological variables may mediate between the disease and its outcome; (4) psychological interventions (Anderson et al., 1985; Young, 1992). This paper considers whether the self regulation model provides a useful framework for guiding research in this field. The nature of rheumatic diseases and the challenges they present are considered first followed by a discussion about application of the self regulation model to rheumatic disease. Research that has investigated the role that self regulation processes may play in adaptation to rheumatic disease is reviewed. Finally we discuss psychological interventions for rheumatic disease and consider whether an understanding of self regulation processes could improve the design and outcome of these interventions. © 1998 John Wiley & Sons, Ltd.