1. Psychosomatic Research Center PSRC@mui.ac.ir هوالحکیم

2. Disease/Illness Disease – biological event with pathology – disease as a specific entity Illness – subjective experience – devalued changes Disease does not exist as a social phenomenon until we agree it does, who labels this: Dr? Patient? Science?

3. illnessDisease Patient’s viewDoctor’s view More subjectiveMore objective IndividualizedGeneralized ConcreteAbstract NarrativeCategorical Bio-psychosocialBiomedical PhenomenologicalRational/ Experimental Disease Vs. Illness

4.  A medical model which is based on multilevel interactions, from molecule to society.  Multilevel assessment/ intervention  The scope of psychosomatic medicine?  Person – centered not disease - oriented Psychosomatic Approach to Disease & Illness

5. Thoughts & Images Physiology (Central Chemistry) Emotions Behaviour Cognitive Model Environment

6. Triggers stress, distress, anxiety, illness, symptoms Physical symptoms Meaning/interpretation Threat, loss, inability to cope Emotional response Anxiety Depression Behaviour: rest, checking, reassurance seeking, medication, treatments Cognitive Model of Somatisation

7. Probability x (perceived cost) awfulness Anxiety = Perceived ability to cope + chance of help (rescue) Cognitive behavioural approach to understanding health anxiety

8. Factors involved in the maintenance of health anxiety Physiological & biological Symptoms Bodily variations Medical information (Selective attention) (Arousal) Beliefs about being ill Probability Cost Coping Rescue Reassurance seeking, Checking, safety behaviours Mood changes anxiety depression (Prevent disconfirmation) (Alters perception)

9. Approach to patients: disease or illness oriented ?  Ideas, Beliefs  Cognitive styles  Emotion  Function  Expectation  Concerns, questions

10. What is sick role? The protective role given an individual who is physically or mentally ill or injured; it may be assumed by the individual or it may be imposed as a part of social custom. A behavior pattern in which a person adopts the symptoms of a physical or mental disorder to be cared for, sympathized with, and protected from the demands and stresses of life.