The relationship between illness representations and well-being

Asthma is a chronic inflammatory disease characterized by repeated episodes of dyspnea, while severity and frequency vary from one person to the next. Asthma has many implications on the functioning and well-being of patients throughout their lifespan. Numerous studies examined the different aspects related to well-being of people with asthma (Hughes & Dunne, 2016). Yet, despite the fact that a link has been established between cognitive perceptions and emotional reactions toward chronic diseases in people with other chronic diseases (Benyamini, Goner-Shilo, & Lazarov, 2012; Richardson, Schuz, Sanderson, Scott, & Schuz, 2017), no such links between these aspects and well-being have been studied in people with asthma. One of the objectives of the current study was to examine these links.

The current study is based on the Self-Regulation Model of Leventhal and colleagues (SRM; Leventhal, Meyer, & Nerenz, 1980), which offers a theoretical framework of cognitive perceptions and emotional reactions of people with regard to the threat posed by their disease. According to the model, cognitive perceptions are referred to as ‘illness representations’, and these are subjective cognitive beliefs regarding the illness or a threat to one's health. The 'illness representations' are schematically organized in memory, and they include seven dimensions: identity, causes, time, consequences, controllability, illness coherence, and cyclicality. ‘Emotional illness representations’ are emotional reactions to the perceived threat of the disease, and they include fear, depression, anxiety and worry.

The Self-Regulation Model (Leventhal et al., 1980), suggests that 'illness representations' function as filters and interpreters of schemes regarding information sources for the disease, and constitute action guides aimed at reacting to the threat posed by the disease. This means that the element of knowledge is of crucial importance to the perceptions of the disease (Kintner et al., 2015). The element of knowledge is of importance also in regard to the mechanism of coping with the disease. According to the model, coping is defined as a cognitive or behavioral action, which is either performed or not performed by the individual, in order to promote health, reduce levels of emotional stress and ease the perceived threat posed by the disease. According to Folkman and Lazarus (1980), there are two main coping strategies; 'problem-focused coping strategy', which aims to help solve the problem and 'emotion-focused coping strategy', which aims to help reduce or manage emotional distress.

The expression of emotions is often part of psychological interventions aimed at patients with a chronic disease (Larsan, Krogdtad, & Wahl, 2017). Furthermore, it has been found that alexithymia, which is a mental difficulty in identifying and expressing emotions, may be related to difficulties in coping with the disease. Alexithymia is a psychological trait characterized by difficulties in perceiving and expressing emotions as well as physical sensations. It is a cognitive-based disorder that is also related to developmental factors and life events (Bagby & Taylor, 1977).

Hence, the current study aims to examine an integrative model that will enable to observe a possible link between cognitive and emotional illness representations, knowledge about the disease, coping strategies, and alexithymia, on the one hand, and psychological well-being among people with asthma on the other, based on the Self-Regulation Model (Leventhal et al., 1980).

The current study included 207 adult (over age 18) participants, who have a diagnosis of asthma. The participants were recruited with convenience sampling, by menas of social media and health-related internet forums, and via snowball sampling. Participants filled a questionnaire on cognitive and emotional illness representations, knowledge about the disease, coping strategies, alexithymia, well-being and socio-demographic variables. The study findings pointed to several key links between illness representations and alexithymia (difficulty in identifying and expressing emotions), and well-being. It has been found that a high level of well-being was associated with perceiving the disease as controllable and, reporting less negative emotional illness representations, and fewer difficulties in identifying and describing emotions. The data further revealed that control, emotional illness representations and alexithymia accounted for 25% of the psychological well-being variance.

This study is of high importance, both theoretically and practically. Theoretically, it was the first study to examine the link between cognitive and emotional illness representations of asthma and well-being among people with asthma, based on the Self-Regulation Model, thus enhancing research-based knowledge of this topic. In addition, considering alexithymia as part of the Self-Regulation Model, constitutes a significant theoretical contribution to the model, since very few studies examined alexithymia as being related to the model (Khosravani, Alvani, Shari, Jamatti, & Akbri, 2016; Larsan et al., 2017). Practically, intervention programs can be developed based on the study findings, and these will strengthen people sense of control, assist in handling negative feelings of anxiety, depression and anger towards the disease, and help them identify and handle their emotions, all in order to improve the well-being of people with asthma.