Application of Social Cognition Theory to the Medical Management of a Patient Diagnosed with Fibromyalgia - Essay Example

Application of Rotter’s Concept of Locus Control and Weber’s Social Hierarchy Theory to the Clinical Management of a Patient with Fibromyalgia Introduction This essay concerns the application of social cognition theory to the medical management of a patient diagnosed with fibromyalgia whose symptoms date to 2007. This assessment involves the evaluation of psychological and sociological concepts as they relate to issues of clinical care. Psychological social models have important applications in the understanding and management of medical disorders such as fibromyalgia that have complex aetiological origins and have psychological and psychosocial effects on the patient. The psychological concept that will be explored in this essay as it relates to the medical management of this patient is Rotter’s concept of locus of control. The sociological concept to be evaluated in this context involves Weber’s social class hierarchy. Patient Profile The patient is a 45 year old female who has suffered from symptoms diagnosed as fibromyalgia for approximately 1.5 years. She was employed as a retail manager until she lost her job one year ago. She has been employed only sporadically since that time. She engages in no consistent activities or sports. The patient stated that she drinks occasionally and smokes 20 cigarettes per day. She is currently suffering from depression and, although she has seen a psychologist on a few occasions, she is not currently receiving psychotherapy. The current medical issue involves osteopathic management of lower back pain with associated paraesthesias in both legs that appear to be associated with the fibromyalgia. Additional symptoms reported by the patient include headaches, sleep disturbances, and gastrointestinal disturbances. Her currently prescribed medications include amitryptylline and pain medications that provide a moderate amount of relief from these symptoms. Psychological and Sociological Applications of Patient’s Condition Fibromyalgia is a disorder that is very difficult to define clinically as it is associated with a broad spectrum of symptoms that lack a precisely defined physiological origin (Leventhal, 1999). In addition to chronic pain and physical disability, the disease also may have a significant effect on mental health and is frequently associated with depression (Wolfe et al, 1998). The broad-spectrum clinical profile of this disease makes it highly amenable to multi-faceted therapeutic approaches that address the physical, psychological and social consequences of this disease. The therapeutic domain has been described as a social setting in which a specific treatment plan is enacted. In the case of long-term chronic illnesses associated with pain and physical disability, it is extremely important that the patient is given a primary role in the treatment plan. In this context, Rotter’s Social Learning Theory as it relates to the concept of “locus of control” constitutes a valuable psychological concept as it applies to patient involvement in therapeutic management. Julian Rotter: Social Learning Theory and Locus of Control Rotter’s Social Learning Theory challenges the basic Freudian concept that internal thought processes are the sole driver of human behaviour. In contrast, Rotter’s basic view is that the determinants of personality and behaviour are intrinsically linked to one’s environment (Rotter, 1954). In this context, one can only assess one’s psychological motivations and behaviour if the circumstances and environmental factors that affect the individual are incorporated into a psychological evaluation. According to Rotter’s Social Learning Theory, human behaviour is the result of the interactions of personality traits that generate a spectrum of potential responses depending on the nature of one’s situation and environmental stimuli (Rotter, 1966). Rotter’s concept of “locus of control” refers to generalised expectancies for control of reinforcement. According to the Social Learning Theory, expectancy refers to one’s personal belief that a particular behaviour will result in a specific outcome (Rotter, 1975). Reinforcement is defined as the outcome of behaviour. Based on these definitions, locus of control refers to one’s generalised beliefs regarding the control of outcome. Individuals differ in the degree to which their locus of control is internal or external. Individuals with a strong internal locus of control believe that the major determinants of reinforcement lay within themselves and are, therefore, a direct result of their actions and behaviour. Individuals with a strong external locus of control view reinforcers associated with outcome to be determined by forces beyond their control. According to Rotter, these attributes tend to be generalised in the sense that they may occur across a broad spectrum of behaviours. However, specific responses may occur and there is great variation along the spectrum of individual perceptions of locus of control that are based on personality as well as on life history and personal experiences (Rotter, 1990). As these concepts apply to psychological problems, Rotter rejects the notion that mental health disorders are medical diseases, but rather are the result of behavioural issues that result from dysfunctional learning experiences. In this context, behaviour is a learned response based on experience (Rotter, 1990). To alter the behaviour therefore, one must offer the individual new learning experiences that will reinforce a behavioural change. There are several important ways in which Rotter’s concept of locus control may apply to an understanding and clinical management of this patient’s disorder. Environmental stresses have been indicated as a contributory component of fibromyalgia. Thus, an application of locus of control theory to therapeutic management plan could involve attention to the stresses associated with chronic illness and the specific events in this patient’s profile that may have a contributory role in the development of this complex disease. For example, the loss of employment experienced by this patient was co-incident with the occurrence of the symptoms of fibromyalgia. Psychological counseling might be recommended as part of the medical management plan for this patient to explore issues of control as they relate to the capacity to alter one’s personal circumstances in ways that may decrease the stresses that may contribute to the environmental stresses that may contribute to the development of fibromyalgia. In this context, the loss of a job can cause profound psychological stress that may be associated with this disease. Moreover, the patient has suffered depression, which is understandable given her physical and economic plight. Often, individuals whose locus of control is externally focused believe that there is little they can do to mitigate unfortunate circumstances. This sense of hopelessness that results from an external locus of control may contribute to the development of depression. Therefore, it would be important that these issues be explored with this patient. Another issue that relates importantly to the treatment plan of this patient is the osteopathic management of the pain and weakness in the back and lower limbs. Pain itself is a major issue in patient care management; moreover, the fear of inducing additional pain may immobilise a patient and cause her to refrain from exercise and physical therapy designed to strengthen muscles and reduce pain and inflammation. The physical therapy should be administered in the context of ongoing explanations of the importance of such therapy in the treatment process. A shift to an internal locus of control may empower this patient to take a more active role in therapies and exercise rituals that may have a healing effect. Moreover, the positive outcome associated with physical therapy in a controlled setting may lead to changes in behavioural expectancy on the part of the patient such that she might take a more active role in engaging in exercise and activities that could strengthen her health and promote an overall sense of well-being. The importance of preventive healthcare should also be addressed with this patient, particularly in regard to cigarette smoking. Internalising one’s locus of control and demonstrating positive behavioural outcome that is motivated by positive intention may allow this patient to conquer this destructive habit. Max Weber: Social Class Hierarchy The patient suffered the loss of her job and has been unable to secure permanent, fulfilling employment for most of the duration of her illness. The loss of this job may have had a profound impact on the development of this disease such that many of the stress components of fibromyalgia reported by this patient may be linked to this devastating event (Henriksson and Liedberg, 2000). The loss of a job affects one’s economic status, social position and sense of personal fulfillment in ways that may have a profound effect on one’s psychological and physical well-being. This important link between social hierarchy and personal fulfillment was first described by the sociologist/economist Max Weber. Weber defined social class as a perception driven by power, wealth and prestige (Swedberg,1999). These concepts, particularly prestige, are valued ideas based upon social perceptions. These ideas are incorporated into the sociological concept of symbolic interactionist perspective (Green, 1959). “Verstehen” as defined by Weber connotes the meaning of social action as determined by individual members of society (Swedberg, 1999). His precisely defined social hierarchy of social class, status and party were the essential elements of what he defined as “life chances” (Green, 1959). These specifically refer to the opportunities that an individual may be afforded to improve his/her quality of life. According to Weber, these life chances were positively correlated with one’s social status and could be described in a probabilistic sense as defining one’s chances of achieving personal fulfillment based on autonomous choices as determined directly by one’s position in the social hierarchy (Swedberg, 1999). Weber’s theory applies to circumstances involved in this patient’s case history as they relate to the potential effects of job loss on mental and physical health. In this context, the loss of employment may be viewed as a change in the patient’s position in the social hierarchy that may directly affect the “life chances” currently perceived by this patient. The loss of employment affects all of the stated parameters of Weber’s social hierarchy in very specific ways. First, there is the issue of change in economic circumstances associated with loss of employment that is directly associated with a loss of social class as it is determined by wealth and economic status. Secondly, the loss of employment is associated with the loss of one’s professional identity that is correlated with Weber’s designation of status or prestige. Finally, the effects of job loss on social class and status affect one’s position of power in society, generating a sense of powerlessness that is associated with the social effects of lost wealth and prestige. Therefore, Weber’s sociological assessment of the social roots of personal identity have important applications in understanding the enormous social stress experienced by this patient as a consequence of an altered social status due to loss of employment. It is thus critical that the issues of loss of economic and social status be incorporated into the management of this patient. Role of Social Cognition Theory in Medicine as it Relates to the Theories of Rotter and Weber These considerations of psychological and social issues as they relate to the occurrence of complex stress-associated disorders represent a holistic approach to patient care, as they take into account not only the medical and physiological components of disease, but also the social and psychological issues that may directly impact one’s physical health and recovery. The social psychological models of intervention in health behaviour are based on social cognition theory, which suggests that the social behaviour of the individual is largely driven by the individual’s beliefs and perceptions about behaviour and the social context in which the behaviour occurs (Connor and Norman, 2001). Social cognition theory thus involves a cross-sectional study of elements of behavioural psychology and sociology as they relate to health and disease. Social cognition models generally involve the motivational stage of intentional behaviours. The post-decision volitional event deals with a behavioural component that is the result of the specified intention. Social cognition theory has many applications in patient care management, including the assessment of risk related behaviours and health enhancing behaviours (Connor and Norman, 2001). As demonstrated in this discussion of this patient with fibromyalgia, the theories of Rotter and Weber may be incorporated into social and psychological models of intervention on health care management. Moreover, additional theoretical components of social psychological models may have direct application to the care management of this patient. Risk perception and optimistic bias theory, developed by Weinstein, explore the nature of perceived invulnerability that allows individuals to engage in high-risk behaviour (such as smoking) without sufficiently internalising the potential negative outcome of such activities (Weinstein and Nicolich, 1993). This may be attributed to wishful thinking and defensiveness to some extent, but may also be the result of cognitive factors associated with an unrealistic assessment of risk (Van der Pligt and de Vries, 1998). The Health Belief Model suggests that individuals will engage in preventive health behaviours depending on their perceived risk of contracting disease or disability as a consequence of the stated behaviour (Becker, 1974). It also relates to one’s cognitive beliefs about the potential efficacy of the preventive intervention. This notion is related to Rotter’s Social Learning Theory and locus of control as it connects a specific behaviour with perceptions of outcome that may directly affect one’s behavioural intentions (Wallston and Wallston, 1981). The Theory of Planned Behaviour is an expectancy model is based on the predictability of attitudes, subjective norm and behavioural intentions that predict behavioural outcome (Ajzen, 1991; Godin and Kok, 1996). Attitude is the product of personal beliefs about a given concept and subjective norm is associated with societal pressure to perform a certain act. The two together comprise intention (Hoorens, 1996). Implementation intentions may also play a significant role in the conversion of intention to a specific planned behaviour based on memory and repetitiveness (Boer and Seydel, 1996). Again, this model is related to Rotter’s locus of control concept in regard to the role of environmental stimuli in directing the intentions of the individual as they relate to behavioural outcome. The Theory of Planned Behaviour (Ajzen, 1991) is also related to Weber’s theory of Social class hierarchy in that the hierarchical model is based upon perceived “life chances” as they relate not only to the quantifiable advantages of wealth and power, but also to one’s perception of one’s role in society and attitudes that result from this hierarchical structuring (Ajzen and Madden, 1986). The Theory of Planned Behaviour is an important cognitive approach to the treatment plan of this patient, since the more fully aware she is of her role in securing a positive therapeutic outcome through her actions and behaviours, the more likely she will engage in behaviours that will contribute to a positive clinical therapeutic benefit. Conclusion This essay has evaluated the potential contributions of Rotter’s concept of locus control and Weber’s concept of social hierarchy to the medical treatment plan for a patient diagnosed with fibromyalgia. Fibromyalgia is a complex, multi-faceted disorder of unknown physiological aetiology, but with many symptoms associated with stress-related disease (Kaplan, Schmidt, and Cronan, 2000). As such, it is an excellent candidate for health management strategies that incorporate social psychological model approaches. This patient suffers from chronic pain and other symptoms that may benefit from approaches that incorporate the concept of locus control to empower the patient’s sense of control over her physical well-being. Rotter’s Social Learning Theory and its integral concept of locus of control has important applications in health care management. This theory stresses that behaviour is the result of learned experiences and that behaviour may be modified in the context of an altered environment. Thus, interventions designed to empower a patient to understand the benefits of therapy or the importance of avoiding high risk behaviours may impact the therapeutic outcome in a positive fashion. Moreover, the locus of control concept involves an evaluation of the patient’s awareness of those factors important to healthcare management and disease prevention that may be under their control. This may result in a more positive outlook and the adoption of behaviours that promote good health. Weber’s contributions to social theory also have important applications to medical health care management in that it stresses the demographic and situational components of a patient’s circumstances or life experiences that may impact physical and psychological well-being. In this case, Weber’s concept of social hierarchy may help to explain the role of the loss of employment in its effect on social and economic status that may contribute to disease in the patient suffering from fibromyalgia. These social psychological models generate a framework for intervention that includes physical therapy, regular exercise, psychological counseling and pain management approaches that may facilitate the amelioration of this chronic disabling condition.   References Ajzen, I. (1991) The Theory of Planned Behavior, Organizational Behavior and Human Decision Processes, 50: 179–211. Ajzen, I. and Madden, T.J. (1986) Prediction of goal-directed behavior: attitudes, intention, and perceived behavioral control, Journal of Experimental Social Psychology, 22: 453–74. Becker, M.H. (1974) The Health Belief Model and sick role behavior, in M.H. Becker (ed.) The Health Belief Model and Personal Health Behavior. Thorofare, NJ: Charles B. Slack. Boer, H. and Seydel, E.R. 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