Self-management psychology and the treatment of childhood asthma.

Self-management programs for childhood asthma are reviewed from the perspective of the psychology of self-managed change. Three characteristics of self-control behavior are discussed: (1) conscious effort, (2) conflict of choice, and (3) focused attention. The predominant model of self-control, the three-stage model developed by Kanfer and Karoly, is critiqued, and an alternate model for conceptualizing self-control, the expanded cognitive social learning model, is proposed. This is an interactive model whereby the individual is represented by cognitive and physiologic factors along with the physical and social environment and the individual's overt behaviors. Influence is seen as being multidirectional and interactive. This model, when applied to self-control programs, requires attention to the multiple ways in which an individual can influence his or her behavior and environment; behaviors, cognitive and physiologic processes, and specific environments must be evaluated as interactive factors in self-control. Based on the reciprocal model of self-control, nine criteria were derived and used for the review of 11 asthma self-management programs. Two programs are noted for their comprehensive application of the psychology of self-managed change to childhood asthma.