The second component of the model suggests that, if symptoms occur, individuals will make some attempt to cope with them. Crucially, their choice of a particular coping strategy to cure or control the problem (e.g. taking lithium or using alcohol to contain the symptoms) will be influenced by whether that seems to be a logical step given their views (about the identity, cause, timeline, controllability and consequences of their symptoms) (Colom et al. 2005).

The individual will next appraise their coping strategy and come to a decision about how effective it has been. They will then continue to use this strategy or modify it accordingly. So a patient may refuse medication initially but later accept the need for lithium (or vice versa). Finally, it should be noted that individuals who perceive ‘coherence’ between (i) their experience of symptoms, (ii) the meaning they give to the symptoms (their interpretations) and (iii) the explanation offered to them by a significant other (which might be a clinician or a family member) are more likely to adhere to medication.

When reviewing the identity and consequences of the disorder, individuals will appraise the threat posed by their symptoms in terms of the severity of the illness and their susceptibility to relapses. If they see the threat as being real, they may be more inclined to accept the necessity of taking a mood stabilizer (see Clatworthy et al. 2009). Similarly, when considering whether the problem can be cured or controlled, adherence with lithium will be influenced by any concerns the individual has regarding taking medication (e.g. fear of ‘addiction’). Clatworthy et al. (2009) demonstrated that 30 % of 223 individuals with bipolar disorders had low levels of adherence and that adherence status was predicted by lower necessity-for-treatment beliefs (OR = 0.50; 95 % CI = 0.31–0.82) and more concerns about potential adverse effects (OR = 2.00; 95 % CI: 1.20–3.34). These predictors were independent of current mood state, illness and demographic characteristics, and, very importantly, it was noted that concerns about, rather than actual experience of, adverse events predicted lower levels of adherence. In addition, as an individual’s mental state improves, their beliefs about the necessity of taking lithium may diminish, whilst any concerns remain constant (or sometimes become more prominent in their thinking) – explaining why adherence status often changes over time.