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longitudinal data, symptoms, symptom management, temporal patterns, time



  1. Henly, Susan J.
  2. Kallas, Kathryn D.
  3. Klatt, Colleen M.
  4. Swenson, Karen K.


Background: The experience of unpleasant sensations associated with the presence of symptoms prompts self-care or help seeking to obtain explanations for the symptoms, manage emotional responses, or obtain treatment for symptom alleviation and elimination.


Objective: The purpose of this article is to summarize and comment on three existing symptom theories, with special attention to temporal factors.


Methods: Existing theories are synthesized as the time dimensions of symptom experiences and symptom management processes are elucidated. Clinical examples and findings from empirical studies illustrate critical points.


Discussion: Existing theories describing the symptom experience and the process of symptom management refer implicitly to the role of time or use limited dimensions of time. Symptom experiences in time (SET) theory is proposed as a synthesis and extension of existing theories. The SET theory conceives the symptom experience as a flow process that explicitly incorporates temporal dimensions. Four dimensions of time are recognized: clock-calendar, biologic-social, perceived, and transcendent time. The four temporal dimensions are placed against a backdrop of "meaning-in-time" that brings forth the potential for transformation in a symptom experience. Increasing sophistication in design, measurement, and data analysis is required to test and evaluate SET theory-based propositions.


Conclusions: The SET theory extends previous work by incorporating multiple temporal dimensions that reflect the human experience of health and illness manifested in the expression and management of symptoms.


Symptoms as experienced by individuals are unpleasant sensations or perceived changes in normal functioning or appearance. The appearance of symptoms is characteristic of a shift in health status from well to ill, as in the sudden occurrence of abdominal pain and nausea at the onset of an appendicitis episode. Persistence of symptom clusters over time, such as the fatigue and myalgia of lupus, is a hallmark of chronic disease. Paradoxically, treatment for disease often produces predictable patterns of unpleasant sensation and dysfunction, such as the constellation of pain, immobility, fear, and sleeplessness common to many postoperative recovery experiences. Another example is the cluster of periodic and predictable treatment-related symptoms that appear over the course of cancer chemo-therapy.


Although often associated with illness, symptoms are a part of health experiences as well. Developmental transitions such as puberty may be marked by moodiness or growing pains. Nausea and vomiting occur frequently during early pregnancy, usually without signifying illness. Athletes striving for peak performance encounter symptoms as they push themselves to a personal best beyond normal limits and abilities. Vision seekers expect or hope for symptom experiences that, if endured, move them beyond the usual limits of time and space to some greater understanding or plane of existence.


Anticipation of unpleasant sensations or their actual manifestation prompts cognitive evaluation and emotional response. Correct and timely identification of the cause for symptoms or the need for help by the person experiencing symptoms can be critical to survival in some situations (e.g., myriad symptoms of myocardial infarction). Typically, individuals engage in self-care or help seeking to obtain an explanation for their symptoms, manage emotional responses, or obtain treatment for symptom alleviation and elimination.


The processes, interactions, and changes associated with health and illness phenomena (Donaldson & Crowley, 1978), including symptom experiences, all imply a temporal context (Bailey, 1987;Rogers, 1987). Calls for the longitudinal study of symptom experiences and symptom management processes (Hegyvary, 1993, p. 163) and the repeated measures designs of many National Institutes of Health (NIH)-funded studies currently underway (available using the key words "symptoms" and "longitudinal" at reflect a sense that time is an essential aspect of symptom-related phenomena. Ironically, the ever-present nature of time may disguise its importance as a factor in symptom experiences and symptom management processes.


Symptom experiences in time (SET) theory is proposed as a synthesis of existing models. The SET theory includes explication of temporal dimensions. Implications for design, measurement, and data analysis in symptom-related research are outlined.