A Model for Stress Research with Some Implications for the Control of Stress Disorders

  • Howard Leventhal
  • David R. Nerenz


For the past several years, we have been engaged in a program of research with the aim of understanding how people comprehend and cope with illness threats. Our early studies examined people’s beliefs and behavior in response to health communications urging them to stop smoking, use good dental hygiene practices, drive safely, or take inoculations to protect against tetanus (Leventhal, 1970). Later studies dealt with ways of preparing patients to cope with painful or unpleasant medical procedures such as endoscopy, childbirth, and cancer chemotherapy, and preparing students to cope with cold pressor pain in laboratory settings (Leventhal & Everhart, 1979; Leventhal & Johnson, 1982). Although the studies covered a number of different subject populations and health settings and spanned a period of 15 years, they have been linked by a common thread. Throughout, we have attempted to describe how people, as active agents, interpret and represent the information they receive about health threats from outside sources and from their bodies, and how their subsequent actions depend on their understanding of that information.


Stressful Life Event Time Line Psychosomatic Medicine Coping Response Illness Episode 
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  1. Appley, M. H., & Trumbull, R. On the concept of psychological stress In M. H. Appley & R. Trumbull (Eds.), Psychological stress: Issues in research. New York: Appleton-Century-Crofts, 1967.Google Scholar
  2. Averill, J. R. A selective review of cognitive and behavioral factors involved in the regulation of stress. In R. A. Depue (Ed.), The psychobio logy of the depressive disorders: Implications for the effects of stress. New York: Academic Press, 1979.Google Scholar
  3. Ax, A. F. The physiological differentiation between fear and anger in humans. Psychosomatic Medicine, 1953, 15, 433–442.PubMedGoogle Scholar
  4. Bair, J. H. Development of voluntary control. Psychological Review, 1901, 8, 474–510.CrossRefGoogle Scholar
  5. Balint, M. The doctor, his patient, and the illness. New York: International Universities Press, 1957.Google Scholar
  6. Bandura, A. Principles of behavior modification. New York: Holt, Rinehart & Winston, 1969.Google Scholar
  7. Bandura, A. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 1977, 84, 191–215.PubMedCrossRefGoogle Scholar
  8. Bandura, A., Blanchard, E. B., & Ritter, B. Relative efficacy of desensitization and modeling approaches for inducing behavioral, affective, and attitudinal changes. Journal of Personality and Social Psychology, 1969, 13, 173–199.PubMedCrossRefGoogle Scholar
  9. Ben-Sira, Z. The structure and dynamics of the image of diseases. Journal of Chronic Disease, 1977, 30, 831–842.CrossRefGoogle Scholar
  10. Ben-Sira, Z., & Padeh, B. “Instrumental coping” and “affective defense”: An additional perspective in health promoting behavior. Social Science and Medicine, 1978, 12, 163–168.Google Scholar
  11. Bonadonna, G., & Valagussa, O. Dose-response effect of adjuvent chemotherapy in breast cancer. New England Journal of Medicine, 1981, 304, 10–15.PubMedCrossRefGoogle Scholar
  12. Bowlby, J. Attachment. New York: Basic Books, 1969.Google Scholar
  13. Broadbent, D. E. The hidden preattentive processes. American Psychologist, 1977, 32, 109–118.PubMedCrossRefGoogle Scholar
  14. Brown, G. W., & Harris, T. Social origins of depression. London: Tavistock Publications, 1978.Google Scholar
  15. Bruner, J. S. On perceptual readiness. Psychological Review, 1957, 64, 123–152.PubMedCrossRefGoogle Scholar
  16. Bruner, J. S., Goodnow, J. A., & Austin, G. A. A study of thinking. New York: Wiley, 1956.Google Scholar
  17. Burchfield, S. R. The stress response: A new perspective. Psychosomatic Medicine, 1979, 41, 661–672.PubMedGoogle Scholar
  18. Carver, C. S. A cybernetic model of self-attention processes. Journal of Personality and Social Psychology, 1979, 37, 1251–1281.CrossRefGoogle Scholar
  19. Coelho, G. V., Silber, E., & Hamburg, D. A. Use of the student-TAT to assess coping behavior in hospitalized, normal and exceptionally competent freshmen. Perceptual and Motor Skills, 1962, 14, 355–365.PubMedCrossRefGoogle Scholar
  20. Coelho, G. V., Solomon, F., Wolff, C., Steinberg, A., & Hamburg, D. A. Predicting coping behavior in college. Journal of Nervous and Mental Disease, 1969, 149, 386–397.PubMedCrossRefGoogle Scholar
  21. Croog, S. H., & Levine, S. Social status and subjective perceptions of 250 men after myocardial infarction. Public Health Reports, 1969, 84, 989–997.PubMedCrossRefGoogle Scholar
  22. Dewey, J. The theory of emotion: (I) Emotional attitudes. Psychological Review, 1894, 1, 553–569.CrossRefGoogle Scholar
  23. Dewey, J. The theory of emotion: (II) The significance of emotions. Psychological Review. 1895, 2, 13–32.CrossRefGoogle Scholar
  24. Dohrenwend, B., & Dohrenwend, B. P. (Eds.). Stressful life events: Their nature and effects. New York: Wiley, 1974.Google Scholar
  25. Dunn, J. Distress and comfort. Cambridge, Massachusetts: Harvard University Press, 1977.Google Scholar
  26. D’Zurilla, T. J., & Goldfried, M. R. Problem solving and behavior modification. Journal of Abnormal Psychology, 1971, 78, 107–126.PubMedCrossRefGoogle Scholar
  27. Ekman, P., Friesen, W. V., & Ellsworth, P. Emotion in the human face. New York: Pergamon Press, 1972.Google Scholar
  28. Fabrega, H., Jr. The need for an ethno-medical science. Science, 1975, 189, 969–975.PubMedCrossRefGoogle Scholar
  29. Folkman, S., & Lazarus, R. S. An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior, 1980, 21(3), 219–239.PubMedCrossRefGoogle Scholar
  30. Fordyce, W. Behavioral methods for chronic pain and illness. Saint Louis: C. V. Mosby, 1976.Google Scholar
  31. Furedy, J. J, & Riley, D. M. Classical and operant conditioning in the enhancement of biofeedback: Specifics and speculations. In L. White & B. Tursky (Eds.), Clinical biofeedback: Efficacy and mechanisms. New York: Guilford Press, 1980.Google Scholar
  32. Gardner, H. The shattered mind. New York: Knopf, 1975.Google Scholar
  33. Graham, D. T. Psychosomatic medicine. In N. S. Greenfield & R. A. Sternbach (Eds.), Handbook of psychophysiology. New York: Holt, Rinehart & Winston, 1972.Google Scholar
  34. Hayes-Bautista, D. E. Modifying the treatment: Patient compliance, patient control and. medical care. Social Science and Medicine. 1976, 10, 233–238.CrossRefGoogle Scholar
  35. Hayes-Bautista, D.E. Chicano patients and medical practitioners: A sociology of knowledge paradigms of lay-professional interaction. Social Science and Medicine, 1978, 2, 83–90.Google Scholar
  36. Hempel, C. G. Philosophy of natural science. Englewood Cliffs, New Jersey: Prentice-Hall, 1966.Google Scholar
  37. Herzlich, C. Health and illness: A social psychological analysis. New York: Academic Press, 1973.Google Scholar
  38. Holmes, T. H., & Masuda, M. Life change and illness susceptibility. In B. S. Dohrenwend & P. P. Dohrenwend (Eds.), Stressful life events: Their nature and effects. New York: Wiley, 1974.Google Scholar
  39. Holmes, T. H., & Rahe, R. J. The social readjustment rating scale. Journal of Psychosomatic Research, 1967, 11, 213–218.PubMedCrossRefGoogle Scholar
  40. Horowitz, M. J. Image formation and cognition. New York: Appleton-Century-Crofts, 1970.Google Scholar
  41. House, J. S. The relationship of intrinsic and extrinsic work motivations to occupational stress and coronary heart disease risk. Dissertation Abstracts International, 1972, 33, 2514–A.Google Scholar
  42. Izard, C. E. The face of emotion. New York: Appleton-Century-Crofts, 1971.Google Scholar
  43. Izard, C. E. Human emotions. New York: Plenum Press, 1977.Google Scholar
  44. Janis, I. L. Psychological stress. New York: Wiley, 1958.Google Scholar
  45. Janis, I. L., & Leventhal, H. Human reactions to stress. In E. Borgotta & W. Lambert (Eds.), Handbook of personality theory and research. Boston: Rand McNally, 1968.Google Scholar
  46. Johnson, J. E. Stress reduction through sensation information. In I. G. Sarason & C. D. Spielberger (Eds.), Stress and anxiety (Vol. 2). Washington, D. C: Hemisphere Publishing, 1975.Google Scholar
  47. Johnson, J., & Leventhal, H. Effects of accurate expectations and behavioral instructions on reactions during a noxious medical examination. Journal of Personality and Social Psychology, 1974, 29, 710–718.PubMedCrossRefGoogle Scholar
  48. Johnson, J. E., Rice, V. H., Fuller, S. S., & Endress, M. P. Sensory information, instruction in coping strategy and recovery from surgery. Res. Nurs. Health, 1978, 4-17.Google Scholar
  49. Kagan, A. Epidemiology and society, stress and disease. In L. Levi (Ed.), Society, stress and disease (Vol. 1). London: Oxford University Press, 1971.Google Scholar
  50. Kanfer, F. H. The many faces of self-control, or behavior modification changes its focus. In R. B. Stuart (Ed.), Behavioral self-management: Strategies, techniques and outcomes. New York: Brunner/Mazel, 1977.Google Scholar
  51. Kasl, S. V., & Cobb, S. Blood pressure changes in men undergoing job loss. Psychosomatic Medicine, 1970, 32, 19–38.PubMedGoogle Scholar
  52. Kollar, E. J. Psychological stress: A reevaluation. Journal of Nervous and Mental Disease, 1961, 132, 382–396.PubMedCrossRefGoogle Scholar
  53. Kornzweig, N. D. Behavior change as a function of fear arousal and personality. Unpublished doctoral dissertation, Yale University, 1967.Google Scholar
  54. Lacey, J.I. Somatic response patterning of stress: Some revisions of activation theory. In M. Appley & R. Trumbull (Eds.), Psychological stress. New York: Appleton-Century-Crofts, 1967.Google Scholar
  55. Lang, P. Imagery in therapy: An information processing analysis of fear. Behavior Therapy, 1977, 8, 862–886.CrossRefGoogle Scholar
  56. Lang, P. J. A bio-informational theory of emotional imagery. Psychophysiology, 1979, 16, 495–511.PubMedCrossRefGoogle Scholar
  57. Lang, P. J., Kozak, M. J., Miller, G. A., Levin, D. N., & McLean, A., Jr. Emotional imagery: Conceptual structure and pattern of somatovisceral response. Psychophysiology, 1980, 47, 179–192.CrossRefGoogle Scholar
  58. Lazarus, R. Psychological stress and the coping process. New York: McGraw-Hill, 1966.Google Scholar
  59. Lazarus, R. S. The concept of stress and disease. In L. Levi (Ed.), Society, stress and disease (Vol. 1). London: Oxford University Press, 1971.Google Scholar
  60. Lazarus, R. S., & Launier, R. Stress-related transactions between person and environment. In L. A. Pervin & M. Lewis (Eds.), Perspectives in interactional psychology. New York: Plenum Press, 1978.Google Scholar
  61. Leventhal, H. Findings and theory in the study of fear communications. In L. Berkowitz (Ed.), Advances in social psychology (Vol. 5). New York: Academic Press, 1970.Google Scholar
  62. Leventhal, H. Emotions: A basic problem for social psychology. In C. Nemeth (Ed.), Social psychology: Classic and contemporary integrations. Chicago: Rand McNally, 1974.Google Scholar
  63. Leventhal, H. The consequences of depersonalization during illness and treatment. In J. Howard & A. Strauss (Eds.), Humanizing health care. New York: Wiley, 1975.Google Scholar
  64. Leventhal, H. A perceptual-motor processing model of emotion. In P. Pliner, K. Blankstein, & I. M. Spiegel (Eds.), Advances in the study of communication and affect: Perception of emotions in self and others (Vol. 5). New York: Plenum Press, 1979.Google Scholar
  65. Leventhal, H. Toward a comprehensive theory of emotion. In L. Berkowitz (Ed.), Advances in experimental social psychology (Vol. 13). New York: Academic Press, 1980.Google Scholar
  66. Leventhal, H., & Everhart, D. Emotion, pain, and physical illness. In C. Izard (Ed.), Emotions and psychopathology. New York: Plenum Press, 1979.Google Scholar
  67. Leventhal, H., & Johnson, J. E. Laboratory and field experimentation: Development of a theory of self-regulation. In R. Leonard & P. Wooldridge (Eds.), Behavior science and nursing theory. St. Louis: C. V. Mosby, 1982.Google Scholar
  68. Leventhal, H., Singer, R. P., & Jones, S. Effects of fear and specificity of recommendations upon attitudes and behavior. Journal of Personality and Social Psychology, 1965, 2, 20–29.CrossRefGoogle Scholar
  69. Leventhal, H., Brown, D., Shacham, S., & Engquist G. Effect of preparatory information about sensations, threat of pain and attention of cold pressor distress. Journal of Personality and Social psychology, 1979, 37, 688–714.PubMedCrossRefGoogle Scholar
  70. Leventhal, H., Meyer, D., & Nerenz, D. The common sense representation of illness danger. In S. Rachman (Ed.), Medical psychology (Vol. 2). New York: Pergamon Press, 1980.Google Scholar
  71. Leventhal, H., Nerenz, D. R., & Straus, A. Self-regulation and the mechanisms of symptom appraisal. In D. Mechanic (Ed.), Psychosocial epidemiology. New York: Neal Watson, 1980.Google Scholar
  72. Leventhal, H., Shacham, S., Boothe, L. S., & Leventhal, E. The role of attention in distress and control during childbirth. Unpublished manuscript, University of Wisconsin, Madison, Wisconsin, 1981.Google Scholar
  73. Locke, E. A. Is “behavior therapy” behavioristic? (A analysis of Wolpe’s psychotherapeutic ethods). Psychological Bulletin, 1971, 76, 318–327.PubMedCrossRefGoogle Scholar
  74. Mahoney, M. J., & Arnkoff, D. Cognitive and self-control therapies. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change: An empirical analysis. New York: Wiley, 1978.Google Scholar
  75. Mandler, G. Mind and emotion. New York: Wiley, 1975.Google Scholar
  76. Marlatt, G. A., & Gordon, J. R. Determinants of relapse: Implications for the maintenance of behavior change. In P. O. Davidson & S. M. Davidson (Eds.), Behavioral medicine: Changing health lifestyles. New York: Brunner/Mazel, 1980.Google Scholar
  77. Mason, J. W. A reevaluation of the concept of “non-specificity” in stress theory. Journal of Psychiatric Research, 1971, 8, 323–333.PubMedCrossRefGoogle Scholar
  78. Mechanic, D. Social psychological factors affecting the presentation of bodily complaints. New England Journal of Medicine, 1972, 286, 1132–1139.PubMedCrossRefGoogle Scholar
  79. Mechanic, D. Discussion of research programs on relations between stressful life events and episodes of physical illness. In B. Dohrenwend & B. Dohrenwend (Eds)., Stressful life events: Their nature and effects. New York: Wiley, 1974.Google Scholar
  80. Mechanic, D. Medical sociology: A selective view (2nd ed.). New York: Free Press, 1978.Google Scholar
  81. Mechanic, D., & Greenley, J. The prevalence of psychological distress and help-seeking in a college student population. Social Psychiatry, 1976, 11, 1–14.CrossRefGoogle Scholar
  82. Meichenbaum, D. Cognitive-behavior modification: An integrative approach. New York: Plenum Press, 1977.CrossRefGoogle Scholar
  83. Meichenbaum, D., & Novaco, R. Stress inoculation: A preventive approach. In C. Spielberger & I. Sarason (Eds.), Stress and anxiety (Vol. 5). Washington, D.C.: Hemisphere Publishing, 1978.Google Scholar
  84. Melzack, R. The puzzle of pain. New York: Basic Books, 1973.Google Scholar
  85. Meyer, D. The effects of patients’ representation of high blood pressure on behavior in treatment. Unpublished doctoral dissertation, University of Wisconsin, 1980.Google Scholar
  86. Meyer, D., Leventhal, H., & Gutmann, M. Symptoms in hypertension: How patients evaluate and treat them. New Englandjournal of Medicine, in press.Google Scholar
  87. Miller, G. A., Galanter, E., & Pribram, K. H. Plans and the structure of behavior. New York: Holt, 1960.CrossRefGoogle Scholar
  88. Miller, N. E. Some psychophysiological studies of motivation and of the behavioral effects of illness. Bulletin of the British Psychological Society, 1964, 17, 1–20.Google Scholar
  89. Neisser, U. Cognitive psychology. New York: Appleton-Century-Crofts, 1967.Google Scholar
  90. Nerenz, D. Control of emotional distress in cancer chemotherapy. Unpublished doctoral dissertation, University of Wisconsin, 1979.Google Scholar
  91. Nerenz, D. R., Leventhal, H., & Love, R.R. Factors contributing to emotional distress during cancer chemotherapy. Cancer, in press.Google Scholar
  92. Niles, P. The relationships of susceptibility and anxiety to acceptance of fear arousing communications. Unpublished doctoral dissertation, Yale University, 1964.Google Scholar
  93. Nisbett, R. E., & Wilson, T. D. Telling more than we can know: Verbal reports on mental processes. Psychological Review, 1977, 84, 231–259.CrossRefGoogle Scholar
  94. Pennebaker, J. W., & Skelton, J. A. Psychological parameters of physical symptoms. Journal of Personality and Social Psychology, 1978, 4, 524–530.CrossRefGoogle Scholar
  95. Pennebaker, J. W., & Skelton, J. A. Selective monitoring of bodily sensation. Unpublished manuscript, University of Virginia, 1980.Google Scholar
  96. Posner, M. I. Cognition: An introduction. Glenview, 111.: Scott, Foresman, 1973.Google Scholar
  97. Powers, W.J. Feedback: Beyond behaviorism. Science, 1973, 179, 351–356.PubMedCrossRefGoogle Scholar
  98. Ringler, K. Processes of coping with cancer chemotherapy. Unpublished doctoral dissertation, University of Wisconsin, 1981.Google Scholar
  99. Rosen, T. J., Terry, N. S., & Leventhal, H. The role of esteem and coping in response to a threat communication. Journal of Experimental Research in Personality, 1982, 16, 90–107.CrossRefGoogle Scholar
  100. Safer, M. A., Tharps, Q. Jackson, T., & Leventhal, H. Determinants of three stages of delay in seeking care at a medical clinic. Medical Care, 1979, 17(1), 11–29.PubMedCrossRefGoogle Scholar
  101. Salloway, J. C, & Dillon, P. B. A comparison of family networks and friend networks in health care utilization. Journal of Comparative Family Studies, 1973, 4, 131–142.Google Scholar
  102. Schachter, J. Pain, fear and anger in hypertensives and normotensives. Psychosomatic Medicine, 1957, 19, 17–29.PubMedGoogle Scholar
  103. Schachter, S. The interaction of cognitive and physiological determinants of emotional state. In L. Berkowitz (Ed.), Advances in experimental social psychology (Vol. 1). New York: Academic Press, 1964.Google Scholar
  104. Schachter, S., & Singer, J. E. Cognitive, social and physiological determinants of emotional state. Psychological Review, 1962, 69, 379–399.PubMedCrossRefGoogle Scholar
  105. Schachter, S., & Singer, J. E. Comments on the Maslach and Marshall-Zimbardo experiments. Journal of Personality and Social Psychology, 1979, 37, 989–995.CrossRefGoogle Scholar
  106. Schwartz, G. E. Psychosomatic disorders and biofeedback: A psychobiological model of disregulation. In J. D. Maser & M. E. P. Seligman (Eds.), Psychopathology: Experimental models, San Francisco: W. H. Freeman, 1977.Google Scholar
  107. Schwartz, G. E. The brain as a health care system. In G. C. Stone, F. Cohen, & N. E. Adler (Eds.), Health psychology. San Francisco: Jossey-Bass, 1979.Google Scholar
  108. Schwartz, G. E. & Weinberger, D. A. Patterns of emotional response to affective situations: Relations among happiness, sadness, anger, fear, depression, and anxiety. Motivation and Emotion, 1980, 4, 175–191.CrossRefGoogle Scholar
  109. Seligman, M. E. P. Helplessness: On depression, development, and death. San Francisco: W. H. Freeman, 1975.Google Scholar
  110. Selye, H. The stress of life. New York: McGraw-Hill, 1956.Google Scholar
  111. Selye, H. The evolution of the stress concept. American Scientist, 1973, 61, 692–699.PubMedGoogle Scholar
  112. Selye, H. Stress without distress. Philadelphia: J. B. Lippincott, 1974.Google Scholar
  113. Selye, H. Confusion and controversy in the stress field. Journal of Human Stress, 1975, 1, 37–44.PubMedCrossRefGoogle Scholar
  114. Selye, H. Stress in health and disease. London: Butterworth, 1976.Google Scholar
  115. Sternbach, R. Principles of psychophysiology. New York: Academic Press, 1966.Google Scholar
  116. Sternbach, R. A. Pain patients: Traits and treatment. New York: Academic Press, 1974.Google Scholar
  117. Suchman, E. A. Stages of illness and medical care. Journal of Health and Social Behavior, 1965, 6, 114.CrossRefGoogle Scholar
  118. Tomkins, S. S. Affect, imagery, consciousness (Vol. 1). New York: Springer Publishing, 1962.Google Scholar
  119. Tulving, E. Episodic and semantic memory. In E. Tulvig & W. Donaldson (Eds.), Organization of memory. New York: Academic Press, 1972.Google Scholar
  120. Valins, S. Cognitive effects of false heart-rate feedback. Journal of Personality and Social Psychology, 1966, 4, 400–408.PubMedCrossRefGoogle Scholar
  121. Weiss, J. M. Psychological factors in stress and disease. Scientific American, 1972, 226, 104–113.PubMedCrossRefGoogle Scholar
  122. Withey, S. B. Reaction to uncertain threat. In G. W. Baker & D. W. Chapmen (Eds.), Man and society in disaster. New York: Basic Books, 1962.Google Scholar
  123. Wooley, S. C., Blackwell, B., & Winget, C. A learning theory model of chronic illness behavior: Theory, treatment, and research. Psychosomatic Medicine, 1978, 40, 379–401.PubMedGoogle Scholar
  124. Wortman, C., & Dunkel-Schetter, C. Interpersonal relationships and cancer. Journal of Social Issues, 1979, 35, 120–155.CrossRefGoogle Scholar
  125. Young, J. C. Illness categories and action strategies in a Tarascan town. American Ethnologist, 1978, 5, 81–97.CrossRefGoogle Scholar
  126. Zajonc, R.B. Feeling and thinking: Preferences need no inferences. American Psychologist, 1980, 35, 151–175.CrossRefGoogle Scholar
  127. Zborowski, M. People in pain. San Francisco: Jossey-Bass, 1969.Google Scholar
  128. Zillman, D. Attribution and misattribution of excitatory reactions. In J. H. Harvey, W. Ickes, & R. F. Kidd (Eds.), New directions in attribution research (Vol. 2). Hillsdale, New Jersey: Lawrence Erlbaum, 1978.Google Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Howard Leventhal
    • 1
  • David R. Nerenz
    • 1
  1. 1.Department of PsychologyUniversity of WisconsinMadisonUSA

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