Investigation of mood, illness representations and metacognitive structures of patients with type II diabetes in the framework of fennell four phase model

The Fennell Four Phase Model (FFPM) suggests that individuals with chronic illnesses adapt to the disease by going through four phases: crisis, stabilization, resolution and integration; and many psychological variables, especially emotional difficulties differ according to these phases. In addition, the mechanism of co-morbid emotional diffuculties is being investigated and current approaches indicate that these difficulties can be explained by metacognitive beliefs beyond illness representations. In this study, validity of FFPM was evaluated for Type 2 diabetes and the relationships between illness representations, metacognitive beliefs, metacognitions about symptom control, anxiety and depression levels were examined by considering the fear and susceptibility level of COVID-19. The study sample consisted of 153 patients with Type 2 diabetes. The data were collected using the Fennell Phase Inventory, Brief Illness Perception Questionnaire, Metacognition Questionnaire-30, Metacognitions about Symptoms Control Scale-Revised, The Hospital Anxiety and Depression Scale, Protection Motivation Theory Scale for COVID-19 Preventive Behaviors and sociodemographic and medical information form. Findings revealed that sociodemographic variables of individuals did not differ according to stages but illness representations, metacognitions, metacognitions about symptom control, depression and anxiety levels differed. Significant differences for these specified variables were mostly observed between crisis and integration phases. Metacognitive beliefs predicted both depression and anxiety levels more after controlling for gender, previous psychiatric illness, monthly income, fear of COVID-19, and illness representations. The results of the study suggest that stages of the adaptation to ilness maybe important for patients with Type 2 diabetes and should be considered in interventions. In addition, it can be said that targeting metacognitions rather than directly targeting illness representations may be beneficial in regulation of depression and anxiety levels.