Adherence leads to success!

Research continues to point patients and health care providers to the awareness that adherence to a weight loss (and if diabetic, better glucose control) program is somewhat complicated.
What actually is adherence?  In simple terms, it’s the patient’s purposeful attitude and behaviors that result in success over time in following the self-management regimen, whether it’s weight loss or glucose control or lowering your blood pressure.  Adherence is a different concept that the older ‘compliance’ model.  Compliance infers an obedience and behavior based on another person's demands. We know now, that if you only follow your doctor’s orders, because he or she said you must, you are more likely to fail in successful self-management of your health challenges.  If you take on some of the responsibility, learn as much as you can about your diagnosis or health problem, ask questions of your health care professionals and make your own personal commitment to health improvements, you will be much more successful in the outcome!  What do you think?  Reply to my blog and let me know if any of this resonates with what you are experiencing!

Biopsychosocial explanations for disease and health

Research into explanations for illness and disease and research of successful interventions are increasingly acknowledging the need to address the illness through a biopsychosocial lens.

The biological component is the focus on the physiology and physical features of the individual.  The biological includes family history, current illnesses, past illnesses, exercise and activity levels, nutrition, hormones, age, sleep hygiene, cholesterol levels, blood glucose levels and other biometric assessments as warranted.  Typically, the biological component of the biopsychosocial model is what most of us experience when we visit our physician due to illness.  However, research has demonstrated over and over again that the medical (biological) model, as a sole answer to our health issues and diseases, is not enough.  For example, we know now that stressors – stress events as well as chronic stress contribute to the disease process through the inflammatory pathways.

The psychological portion of the biopsychsocial model helps in part to explain both the disease process and poor health versus good health in many individuals.  For example, having the diagnosis of depression can wreak havoc on our immune system.  Taking psychotropic medications lend themselves to problems with libido, blood pressure and weight gain, to name a few.  Stress, as highlighted earlier, is a large contributor to the inflammatory processes in progression of disease.  Positive cognitions and positive perceptions - including feeling hopeful, encouraged and inspired, help to counter the inherent negative feelings of fear and anxiety when diagnosed with a disease.  The current research on mindfulness is showing promising results in demonstrating how the relaxation and meditative processes lend themselves to improved health status.  The psychological theories addressing motivation – called ‘readiness to change’ theories, are demonstrating that individuals can be much more successful in making positive health regimen changes when in the action stage.  The understanding of one’s own health beliefs and core assumptions can contribute to understanding the fears and assumptions one may have about disease. The list goes on and on regarding research that demonstrates the psychological component as being key to explanations for disease processes and health and wellness.

The third component of the biopsychosocial model is definitely not the least of the three, but instead, offers a more complete understanding of disease, health and wellness processes.  Some of the newest research in community identifies social contagion as a factor in happiness, group health behavior change and obesity.  Research on social support has taught us that we may report having a supportive family, but in truth, family may also contribute to our failures in self management of our disease.  Group belonging, meaning and recreation helps to counter the feelings of anxiety and the fear of illness in death in cancer patients.  These few points are just a sampling of the varied research and interventions applied to enhance our understanding of health and wellness and offset the stress and difficulties that accompany disease within a family member.

Remember the importance of viewing your own health, wellness and disease issues through the biopsychosocial lens.  Such an approach will give you an improved understanding of what you can and cannot do to change what can be changed and accept what cannot.  Many people find that increasing their knowledge and understanding of the disease and health and wellness processes gives them more confidence and increases their sense of hope and motivation.

Core Assumptions About Illness

When a person is diagnosed or is struggling with an ongoing illness, how the family adapts, manages and copes with that family member and the illness, arises from core beliefs based on generational perceptions, values and explanations for illness.  Within the family culture, any illness and healing process represents two sets of core beliefs: 1) beliefs of the family members; 2) beliefs of the ill patient.

Most people have rather firm convictions and beliefs as to why disease occurs as well as why one person is afflicted and another is not.  Even though science may provide the intellectual explanation of the disease process, core beliefs including values and spiritual matters typically arise to provide another level of explanation, justification or rationale regarding the disease.

Within the family, explanations for the illness may include spiritual beliefs such as judgment (God is punishing), hope (prayers for healing) and acceptance (it’s God’s will, meditation and mindfulness).  In some families, there is a core belief that illness is shameful. For the ill family member, this may results in feelings of guilt, resentment and despair.  Another approach in some families is that of denial, in which members of the family willingly deny (frequently out of fear) the diagnosed member expression of his experience, his fears or procedures undertaken.   Family beliefs may also be based on scientific studies and understanding (he should have taken better care of himself) or psychological reasoning (she gets so stressed out it’s no wonder she got the disease).

In addition to one’s family influenced beliefs, individual core beliefs also come to the fore when illness enters a family member’s life. Individual core beliefs may be based on ethnic and cultural belief systems as well as familial systems.  We tend to turn to personal core beliefs in times of crisis, struggle, difficulty, uncertainty. For example, an adult daughter may think:  “My father is very ill;” “good daughters care for their ill parents”

Researchers have found that core beliefs about the meaning of one’s own diagnosis of illness vary a great deal across diseases and even within one disease.  For example, the person diagnosed with diabetes may think that it is simply a disease that is caused by too much sugar in one’s diet and as an opportunity to make some positive changes; another person, diagnosed with diabetes, may immediately catastrophize and think of the worst possible outcome (I’m going to die; God is punishing me). Researchers are beginning to realize that these individual core beliefs about one’s illness may more accurately predict adherence and long term self care surrounding the diagnosis.

Newest research on Stress

At the American Psychological Association National Convention, August, 2010, Dr. Janice K. Kieolt-Glaser presented some of the newest behavioral medicine research on stress entitled "How stress kills: Assessing the damage and various remedies."
(Janice K. Kiecolt-Glaser, PhD, Jean-Philippe Gouin, MA, Nan-Ping Weng, MD, PhD, William B. Malarkey, MD, David Q. Beversdorf, MD, Ronald Glaser, PhD; Institute for Behavioral Medicine Research, Ohio State University College of Medicine).

The study investigated the effects of stress on individuals who reported having experienced childhood adversity in a sample of adults who are caretakers of a parent or spouse diagnosed with  Alzheimer’s disease. Conclusions based on this research suggest that childhood adversity worsens effects of stress, adding to current hardships. In other words, children who experience trauma  - be it physical abuse, sexual abuse or neglect, may be more prone to entering a cycle of negative emotion, i.e., depression and anxiety that may lead to problems in later life and possibly precipitate early death.

For example, children who experiences highly stressful events – such as death of a parent, witnessing severe marital problems or experienced abuse, may be more vulnerable to stressors as adults.
The research suggests that childhood adversity may for some,  have a long term, negative affect on health.  These childhood stressors may also contribute to inflammation and cell aging much earlier than for those who did not experience the stressful events in childhood.

The average age of the men and women who participated in the study was 70 years.  The participants were a community sample of 58 caregivers for a spouse or parent with Alzheimer’s disease or another progressive dementia.  The participants depression levels,  report of childhood trauma and biochemical markers of stress were analyzed and compared to a control group.


The researchers measured several blood inflammatory markers: cytokines interleukin (IL-6), tumor necrosis factor-alpha (TNF-a) and telomere length. (Telomeres are the ends of strands of DNA. Shorter telomeres have been linked with aging, age-related diseases and death. IL-6 and TNF-a have also been linked to a number of cardiovascular, including diabetes, autoimmune and infectious diseases).

Conclusions from the study found that " childhood adversity was associated with shorter telomeres and increased levels of inflammation even after controlling for age, caregiving status, gender, body mass index, exercise and sleep," said Kiecolt-Glaser.
"Inflammation over time can lead to cardiovascular disease, osteoporosis, arthritis, Type 2 diabetes and certain cancers.“  Childhood abuse and caring for an ill spouse or parent was also associated with higher levels of depression, she said.


Clearly, results of this study suggest the importance of early intervention to prevent the stress effects as well as undertaking immediate  interventions in those affected - for the  reduction of symptoms and increased ability to cope.  These interventions should include psychological treatment for depression and anxiety as well as the building of coping skills, encouraging regular exercise and instruction and practice in mindfulness.