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.

How Self-Efficacy can help

When a person is challenged with trying to adhere to a weight loss program, wellness program or a diabetes management regimen, researchers have identified factors called individual differences that may contribute to success. One of these individual differences factors  is self-efficacy.

Researchers have found that a high sense of  self-efficacy has been shown to be related to better self management, and better outcomes for many individuals.   Even if other psychosocial supports are not all favorable, a strong sense of self-efficacy can offset these difficulties.

The concept of self-efficacy was proposed by Bandura (1977) and was developed within the framework of social learning theory.  The self-efficacy model identifies the individual’s perception of his or her ability to carry out a given behavior or group of behaviors.  This perception or sense of self efficacy has an effect on the person’s emotions, cognitions, and motivation in difficult or threatening situations such as facing life-long self management of diabetes.   In other words, if a person faced with the demands of self-management believes that she can be successful, her mood, her thoughts and her motivation to continue to try will be enhanced.    This most often results in better self-management and better results!

Depression and what you can do about it.

Almost everyone gets the blues. Who hasn't felt sad at one time or another? But what if the blues hang on and on, affecting you day after day? What if a persistent sadness permeates all aspects of your life: your ability to perform, how you eat, how you sleep, and how you deal with friends and family? It could be that depression may have you in its grip.  Many times, with help from a psychologist- especially one who works from a cognitive behavioral perspective - you can work through your depression, get relief from your symptoms and find proactive ways to prevent re-occurrence.   Sometimes, medication plus cognitive behavioral therapy is the most helpful treatment. Here are some markers and symptoms that may be a sign of clinical depression:

•    You feel sad or cry a lot, and it doesn’t go away.
•    You feel guilty for no real reason; you feel like you’re no good; you’ve lost your confidence.
•    Life seems to have no meaning. You feel like nothing good is ever going to happen again.
      You feel  pessimistic or it seems like you have no feeling at all.
•    You don’t feel like doing a lot of the things you used to enjoy like listening to music,
      playing sports, being with friends, going out and you want to be left alone most of the time.
•    It’s hard to make up your mind. You forget lots of things, and its hard to concentrate.
•    You get upset easily. Little things make you lose your temper; you overreact.
•    Your sleep pattern changes; you start sleeping a lot more, or you have trouble falling asleep
      at night. Or you wake up really early most mornings and can’t get back to sleep.
•    Your eating pattern changes; you lose your appetite, or you eat a lot more.
•    You feel restless and tired most of the time.
•    You may be starting to feel so badly that you start to wonder if life is worth living, you think
      about death, or may even have thoughts about committing suicide.

If you experience symptoms of depression for more than two weeks, it's wise to talk to your doctor or a mental-health professional even if you think the symptoms are caused by something else. Most importantly, don't be afraid to ask for help.

STEP OUT to STOP DIABETES!

Join me for the American Diabetes Association STEP OUT to STOP DIABETES Event at Knott's Berry Farm, Oct. 9, 2010.  There is no fee to enter the event. You can donate your money, your energy, your time or all three!  Let me know if you want to join me!

Together we can help to STOP DIABETES!  Read below (from the  ADA website ) and remember that the American Diabetes Association is a great resource for weight loss management, diabetes management and preventing diabetes!

For more helpful information, check out the STOP Diabetes link today:
http://stopdiabetes.diabetes.org
Why Stop Diabetes?
Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors appear to play roles. There are 23.6 million Americans living with diabetes, a disease that is outpacing heart disease, cancer and AIDS. Diabetes is a disease that has deadly serious consequences, and there is no cure.

Did you Know?  When you walk, you help Stop Diabetes.

Walking is one of the easiest, most relaxing forms of exercise for many people, but especially for those living with diabetes. Walking helps control blood glucose levels in people with diabetes and improves overall quality of life. It is also an activity that can help prevent or delay the onset of type 2 diabetes in people at risk.

You can walk almost anywhere at any time. And walking can give you more energy and help relieve stress. It?s a simple, positive way to improve your health. You don?t need expensive equipment ? just a good pair of walking shoes!

And walking for the cause helps raise funds for the mission of the American Diabetes Association: to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

Join me! Email me! Don't hesitate to contact me if you have questions:  drjburkhardtpino@gmail.com.