Houses of Healing

Journey to Wellness - Changing Your Beliefs

Excerpted from Journey to Wellness

Because of the predominance of behavioral and psychological factors in all aspects of health and well-being in determining lifestyle choices, understanding behavior and how people change can have the key role to play in improving health and health care. In some research done by Essi Systems - a research based consulting firm - they found that the only factor with significant relationship to a person’s ability to cope with work related stress is personal power. "Our testing revealed that out of 21 stress related factors we examined, personal power was the only factor that could predict who got sick and who stayed healthy in work situations with high amounts of pressure." (Childre, 1994)

Assisting people in changing their attitudes and moving from "helplessness and hopelessness to the determined optimism of the little engine that could" (Belar, 1996) is necessary. Increasing personal power and self-belief become essential foundations for action.

Developing a longevity preventive approach can encompass mental and physical health and all aspects of well being. In one APA survey of 1200 men and women in the United States more than 8 in 10 people surveyed said they believed that good psychological health plays an important role in maintaining good physical health. In a separate series of focus groups it was revealed that the public believes strongly in a connection between the mind and the body and saw psychological and behavioral services as "an important part of treatment for physical illness and disease, enhancing both the ability to cope with the disease and the recovery from it." (Newman, et. Al., 1996)

In our evolution towards addressing total health care and wellness concerns we can focus on all aspects of health and wellness throughout our life span in all the developmental stages of human growth. In order to improve the quality of our life we can take the lead in balancing beliefs that favor hospitalization and acute care with beliefs and programs that promote shifting from focusing on taking something to alleviate symptoms to looking at behavioral changes that are needed for long term preventive care. The split between mind and body is no longer useful in understanding health care and health and well being and we can be the advocate for its elimination. A comprehensive knowledge base can be built based on both clinical and scientific practice as we move towards a way of living with a much broader involvement and influence that will improve the total life span and its quality for millions of people. Our medical system is ill equipped by itself to do this but we can take the lead by understanding the importance of mind and behavior and how they impact how long and well we live.

Journey to Wellness - The Potential of Behavior and Lifestyle Enhancement

Excerpted from Journey to Wellness

It is important to develop a paradigm that bridges the gap between psychological functioning, behavior and lifestyle choices and biological functioning. It is important to know what the psychological and behavioral components of an illness are; what the important psychological and behavioral components of delivering medical and health care are; what the psychological and behavioral components of getting people to adhere to medical and wellness regimes are; and what the psychological and behavioral components of getting people to not only adhere to medical regimes are but also how to move beyond that to implement restorative and preventive practices and behaviors.

What you do, how you think, how you feel and how you life your life every day is important for health. The accumulative data clearly shows the importance of your choices and behaviors in the prevention and treatment of and recovery from illness and disease. Addressing behavior, behavior changes, and behavioral interventions has great potential for assisting people in changing unhealthy health habits and lifestyle patterns. Effective behavior change technologies and education methodologies that will significantly enhance health promoting behaviors and lifestyles can be and already are created. Lifestyle enhancement can make a significant impact not only on illness and disease but also on the critical aspects of health and well being. Prevention approaches can amass or access the knowledge base necessary to design systems, programs and interventions that will appropriately and effectively treat behavioral and psychological aspects of health conditions and relieve the strain on the over utilization of the medical and surgical system. The involvement of behavioral change and lifestyle enhancement in health care is essential to providing clinically effective programs and treatments.

"This, now, is the challenge facing [us] in the late twentieth century and beyond: How to help people adopt and stick with lifestyle changes that foster continuing good health. We all can, if we choose to, achieve the goal established for humanity by the ancient Greeks: to die young – as late in life as possible". (Resnick, et. Al., 1999)

Journey to Wellness - Change Your Behavior, Change Your Health

Excerpted from Journey to Wellness

Interventions for psychological and behavioral factors must be available if treatment is to be successful in preventing those million deaths per year attributable to lifestyle factors. It is clear that behavioral and psychological intervention is needed for that 60% -80% of physician visits that are either translating emotional distress into physical symptoms or have a real physical illness complicated by psychological factors or brought on by lifestyle choices.

It is necessary to provide behavioral interventions through lifestyle management and modification for many health problems including weight management, stress reduction, heart disease, cancer, smoking cessation, and alcohol abuse and many other conditions. It important to understand what these behavioral factors are and to educate and train both the practitioner and the general public in what will lead to maintenance of health and well-being throughout the life span. By including a strong focus on behavioral and psychological preventive health care along with lifestyle enhancement a significant impact on the quality of life for millions of people can be made. "… 100% of all medical visits are psychological and that Cartesian mind-body dualism simply does not belong in any conceptualization or implementation of the health care system. Behavior and health are inextricably intertwined …" (Belar, 1996)

Successful health outcomes

Behavior is the fundamental variable in obtaining successful health outcomes. Medical knowledge, services, and technology are important but will make little impact unless people engage in the appropriate preventive or adherence behaviors. "It has become increasingly evident that health is not just a result of genetic and environmental contributions, but the behavior of the person plays a critical role in disease prevention as well as health outcomes once a disease process has begun." (Park, 1996)

But people can not adjust their health behaviors in the direction of optimal development and successful adaptation unless they know what behaviors not only prevent disease but also what leads to optimal wellness. The successful treatment of illnesses or the obtainment of preventive goals may also require that people understand what to do, how to do it, and why they should do it. To deliver effective treatments it may be necessary for medical and health care providers to know how to deliver their care in accordance with their clients needs, goals, attitudes and beliefs.

To implement successful health care behaviors and lifestyle enhancement it is important to: understand more fully the relationships between health and behaviors; to know more about what the important health and well-being objectives are; to understand how different environments, roles and expectations, activities, education, family, support systems, and other life and lifestyle conditions affect health and wellbeing; to be more aware of the characteristics of well being in different developmental stages and for males and females; and to have a better understanding of the social, cultural, mental, emotional characteristics of each particular life stage.

Journey to Wellness - The limitations of our medical system

Excerped from Journey to Wellness

Our current medical system is an emergency/ crisis care system and not a lifestyle management / preventative health care system. Even our national health policy is geared more toward a "general hospital policy and not a health policy". Hospitalization and extensive inpatient testing and procedures are given priority over preventive health care measures. Insurance payment favors payment for medical interventions focused on managing existing symptoms and illness. Insurance coverage for prevention and early interventions in outpatient settings for healthy lifestyle patterns and habits for the most part does not exist. In some cases there are even economic disincentives for such strategies. (Newman, et. Al., 1996) Serious behavioral and psychological preventive measures to maintain health before a disease, illness, or condition arises are not promoted. It is imperative that greater focus be put on behavioral and psychological interventions for medical conditions.

The prevalence of psychological and behavioral problems – anxiety, depression, attention deficit hyperactivity disorder, substance abuse, obesity, and domestic violence – and the resulting lifestyle choices in persons seeking care by physicians puts great strain on our present medical system.

Biomedical treatments alone are not sufficient in the management of these and other mental health and behavioral problems and lifestyle choices. Our current medical system is not equipped to handle that 60 to 80% of visits to medical doctors that are arising from behavioral and psychological factors. There is a tremendous economic drain on our medical services in trying to care for "the millions of physician visits by somaticizing patients". Through the appropriate behavioral and psychological interventions and the resulting lifestyle changes a significant reduction in the inappropriate use of medical surgical care can occur.

The changing viewpoint

We are starting to recognize that "understanding disease mechanism is entirely insufficient without understanding both the psychological mechanism underlying the use of and adherence to treatments and the prevention behaviors individual can engage in so that they will not need to be treated at all – and they will stay healthy." (Parks, 1996) As medical costs increase and the large population of baby boomers gets older Americans will need to take more responsibility for their own health care. Health and vitality are important contributors to well being throughout the life span and people will need to know what behaviors lead to good health. Until recently the focus of most research within the National Institute of Health has been on basic disease mechanisms and treatment with less attention being paid to behavioral factors. (Park, 1996) This is changing however.

The Task Force on Aging Research, 1995 has released a document prioritizing research objects for the future with respect to aging. There are a total of 192 goals specified across the 10 domains. "What is particularly exciting is that 131 of them (68%) have a behavioral component or objective. Of course, one would expect categories such as social and behavioral functioning to have behavioral objective. But what is most telling is that behavioral goals permeate every category, even basic medical objectives. For example in the category of disease and disabilities there are numerous goals that are primarily behavioral, including frailty prevention; exercise, strength training, and metabolism, cancer prevention and early detection in older persons, and the effect of aging on biomechanical efficiency. Under the category of health care, behavioral objectives include, compliance with health promotion and disease prevention measures, prevention of falls, smoking cessation and autonomy in health care decision making." (Park, 1996)

Journey to Wellness - Behaviors Lead to Chronic Disease

Excerpted from Journey to Wellness

Behavioral factors are significant contributors to the development of many chronic diseases, some of which are currently the most serious and most costly threat to the nation’s health, including cancer, heart disease, hypertension, chronic back pain, diabetes. A variety of behavioral and psychological protocols for a number of physical conditions have been shown to be at least as effective and less costly than medical and surgical interventions (e.g. for back pain) and they compare favorably to long-term medication for some conditions (e.g. hypertension). "Virtually every medical authority (textbook, organization, journal, et.), including the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, has recommended that non-drug therapies be used in the treatment of borderline to mild hypertension in place of drugs. (Pizzoron, et.al., 1999) Significant and clinically meaningful decreases in several measures of cardiovascular health have been found to occur with behavioral interventions with patients with severe heart disease. (Ornish1982) Brief presurgical psychological intervention has been consistently associated with fewer postsurgical complications, less medical usage, and an average of 1.5 fewer hospital days. (Bray, 1996) The provision of psychological services also results in the reduction of overall health care costs. A variety of protocols for a variety of physical conditions that are at least as effective and far less costly than surgical interventions (e.g. for back pain) and even compare favorably to long-term medication use aimed at the same conditions (e.g. hypertension)

Your psychology impacts your health

Psychological interventions have improved a number of physical symptoms and conditions including:

Asthmatic episodes Pain during dressing change in burn patients Fecal and urinary incontinence Cramping and diarrhea in irritable bowel syndrome Anticipatory nausea with chemotherapy Vasopasms associated with Raynaud’s disease Dyspnea with chronic obstructive pulmonary disease Headache severity, frequency, and duration Muscle spasms Insomnia and other sleep disorders Itching in neurodermatitis

Psychological factors can also have an impact on health and disease other than through the direct effect of behaviors. Stress can negatively affect immune functioning and result in immunologically mediated diseases including viral and bacterial infection, autoimmune diseases, certain forms of cancer, lower thyroid functioning, and HIV related illness. (Newman, et. Al., 1996) Also chronic conditions and medical illness can easily result in emotional distress. " Research has demonstrated that emotional distress can complicate medical treatment and thus elevate medical cost and that psychological interventions targeted to those with chronic diseases can actually reduce medical costs. In fact, there is an extensive body of knowledge concerning the medical cost offset of psychological services that in and of itself has been used to argue for the availability of psychological services in health care."(Belar, 1996)

Journey to Wellness - The Case for Lifestyle Enhancement

Excerpted from Journey to Wellness

Health, particularly before it gets to illness, appears to be a behavioral, psychological and lifestyle choice issue and not primarily a medical issue. Most visits to medical doctors are not for medical issues but are due to stress or the need for reassurance.

What’s the real problem in disease or illness?

An analysis of the records of over 1000 patients followed over 3 years in an internal medicine clinic found that for the 14 most commonly presented complaints a clear organic etiology was established in less that 16% of the cases. Significant psychological distress was present in over 80%. (Newman, et. al., 1996) In another study 1989 patients from an internal medicine clinic were reviewed. Only 16% had clear organic causes established for their problems, 10% had clear psychological problems and nearly 80% had significant psychological distress. (Bray, 1996) It has been estimated that between 60 and 80% of visits to primary care physicians are for stress related problems that are created by behavioral and psychological factors and the resulting lifestyle choices which can be taken care of through self care habits that affect the behavioral issue. (DeLeon, et.al., 1996) Almost all injuries have behavioral risk factors – reckless driving, failure to wear seat belts, abuse.

In the primary care setting the diagnosis of depression is missed in about 55% of cases in those with a major depressive disorder seeking treatment for some other complaint (DeLeon, et.al., 1996) These patients often present with chronic headaches, back pain, or gastrointestinal disturbances. And because their depression is not diagnosed it is often not treated. "The translation of psychological conflict and stress into physical symptoms takes a heavy economic toll on our health system. Beyond that, there is the fact when 60% of all visits to a physician are somaticized complaints, the patients are not receiving the appropriate behavioral treatment to ameliorate their pain and suffering. Repeated visits to a physician who attempts to reassure the patient by repeating medical tests only strengthen patient’s conviction that a physical illness exists and will be found during the next round of tests". (Cummings, 1996)

Journey to Wellness - Today’s Lifestyle and Disease Creation

Excerpted from Journey to Wellness

We live in a society and a time that is geared toward the creation of disease. More than one-third of the American population is chronically ill. (Null, 1999) That number represents only those people who have actually been diagnosed with a condition or illness. It does not count all of those people who are unwell before they are diagnosed with a condition or illness.

It can take some fifteen or twenty years for a cancer tumor to grow. (Null, 1999) At the time of diagnosis years and years of damage and attempted adaptation has occurred in the body before the body just could not adapt any more and finally developed the actual tumor.

Before you would manifest signs of heart disease your arteries may need to be 90 percent occluded. Some believe that it may take as long as 40 years for your arteries to become that badly occluded. (Null, 1999)

Some researches estimates that as many as 100 million people may be walking around who are processing a disease that is not yet diagnosed. There may be another 50 million people who are in the early stages of disease.

Fifty percent of ten-year-olds already have the beginnings of coronary heart disease, arthritis, loss of smell, or taste due to over-stimulated lives. Today’s children eat more processed foods and less naturally prepared foods than ever before. They spend more time watching TV and playing video games than ever before. They spend less time exercising and being outside than ever before. They spend more time in closed, indoor polluted school environments than ever before. They spend more time in high-pressured academic pursuits than ever before. They spend more time achieving and less time in childhood playing, day dreaming, imagining, and following the natural rhythms of their body than ever before. (Edlin, et.al., 1999)

Lifestyle and normal vision

Lifestyle is even affecting the development of normal vision. Many children and adults today wear glasses as a result of our modern lifestyle Being outside and looking at distant objects tends to produce normal vision. Today almost all children have less time spent outside and tend to watch TV and computer screens and read a lot – all of which require close-up vision. These activities lead to the development of myopia (near sightedness) in many children. The increase in the need for glasses to correct for nearsightedness has been documented in the United States and other countries and attributed to the adoption of modern lifestyle behaviors such as watching more TV, working with computers and increased reading. (Edlin, et.al., 1999)

Poor dietary habits

Only one in five children eat the recommended five servings of fruits and vegetables daily, and nearly 25 percent of all the vegetables they consumed are French fries (which of course are not really vegetables). (Mortimore, 1998) The food that we eat everyday makes a difference in how we feel and in our long term and short term health and wellness. Eating more vegetables and salads will create a stronger immune system; help you fight fatigue and maintain a healthy weight. Fresh vegetables and salads contain essential minerals and vitamin. They also supply powerful phytochemicals that are protective against cancers and other degenerative diseases. Numerous population studies have repeatedly demonstrated that a high intake of carotene rich and flavonoid rich fruits and vegetables reduces the risk of heart disease, cancer, and strokes. (Mortimore, 1998)

One of every two American women consumes inadequate amounts of almost every vitamin and mineral studied. On any four consecutive days, only 14 percent of women eat even one dark green vegetable. Almost 50 percent of all women avoid fruit. .Four out of five Americans believe that it is all right to eat whatever they want whenever they want it. (Mortimore, 1998)

Americans believe this in spite of the fact that the US Departments of Agriculture and Health and Human Services promote dietary guidelines designed to help prevent disease that result from poor nutrition including: heart disease, cancer of various organs, and obesity from diets high in total fat, cholesterol, and saturated fat; cancer of the colon from too much consumption of meat; diseases of the gastrointestinal tract from not consuming sufficient fiber; tooth decay and high blood pressure from unbalanced diets. (Edlin, et.al., 1999)

The cost of our sleep habits

Our sleeping habits also promote the creation of disease. We are a nation of sleep deprived individuals. Over the last couple of generations we are sleeping less and less. In a study commissioned by the US National Commission on Sleep Disorders the total cost of sleep related accidents in 1988 was $56 billion dollars. There were a total of 24, 318 deaths that resulted from accidents related to sleepiness.

Disabling injuries resulting from accidents in which the decreased mental efficiency and attentiveness due to sleep loss was the major underlying factor totaled 2,474,430. The total time lost due to sleep related accidents plus the future time lost due to these same accidents is an astonishing 204,650,000 days of productive work. (Coren, 1996)

The cost for the individual in terms of their high level health and wellness is just as great. Adequate amounts of sleep are necessary for strong immune system functioning. Our immune systems are more active when we sleep. During sleep there are regular waves of immune system activity, which seem to be synchronized with the working of our digestive system. Our deep immune responses are most active during our periods of deep sleep. This is one of the reasons that you tend to get sleepy when you are getting sick or when you are really sick. Your body is trying to activate its full immune response. The increased activity of the immune system during our periods of deep sleep defend the body from any microbes that our challenging your body. Recent studies show that after a loss of just a few hours of sleep the normal pattern of the immune system response will be disrupted. (Coren, 1996) Less sleep equals a weaker immune response. Sleep deprived individuals have shown reduced numbers of lymphocytes and their immune system seems to be weaker in many other ways as well.

Studies show that rats deprived of sleep first start to lose weight then lose the ability to regulate body temperature and then die of a bacterial infection. (Coren, 1996) The fatal bacteria are strains that the rats come into contact every day and that normally their immune systems have no trouble eliminating. In the sleep-deprived rats it appears that their immune systems crash and their body didn’t have a chance. In humans, the immune system may not crash with deprived sleep but the overall long-term effect is unhealthy. Several large studies show that the people (controlling for the original health status) at greatest risk for dying early are those who slept the fewest hours each night. (Coren, 1996)
When researchers looked at the natural length of the sleep cycle of humans deprived of clocks and artificial timing they have found that the natural sleep needs might be closer to 10 hours a night rather than the 7-71/2 hours that is typical today. (Coren, 1996) Extending the sleep time to 9-10 hours of sleep at night has consistently shown improved alertness, performance, and functioning, higher test scores, greater enthusiasm, relief of depression, improved psychological status and mood, and more energy. Still Americans live lifestyles that do not make room for sufficient amounts of sleep even though the benefits to their health and well being would be great.

Too busy to exercise

Only 22% of Americans engage in regular, leisure time physical activity. The vast majority of our population is sedentary. Study after study demonstrates that regular physical activity contributes to our health and well being. (Edlin, et.al., 1999) Exercise lowers the risk of many diseases, including high blood pressure, obesity, diabetes, stroke, heart disease, osteoporosis, colon cancer and ovarian cancer. Regular exercise also produces a relaxation response in your body, reduces the effects of stress, increases energy and overcomes fatigue, relieves depression and lifts mood, boosts your immune responses, and helps you cope more effectively with life’s ups and downs.

Your overall risk of a heart attack is about 50% less if you exercise regularly than if you inactive. (Edlin, et.al., 1999) With regular exercise you can reach a level of physical fitness comparable to an inactive person 10 to 20 years younger. Regular exercise increases the output of the neurotransmitters and endorphin like substances that produce feelings of euphoria, increased alertness, inner peace, concentration, and creativity. (Edlin, et.al., 1999)

Thirty minutes a day five days a week is all that is required to obtain these health and wellness benefits. With all of these benefits so easily within their grasp 78% of Americans still do not exercise on a regular basis. How much is your life worth to you? Enough to change…?

"It should be obvious to anyone involved directly or indirectly with medical care that most of the costly, chronic diseases that afflict Americans today are largely a consequence of how they live their lives: what and how much they eat, how they move their bodies, how they manage stress, whether they abuse alcohol or drugs or smoke cigarettes, and even whether they use seat belts. If you take an honest look at how Americans live, you might be forced to conclude that most have a death wish. Far worse though, than dying is living longer while ill. Chronic, debilitating, and fun-robbing diseases tarnish far too many Americans’ so called golden years." (Brody, 1999)) People need to adhere to their medical regimens, eat a more healthy diet, stop smoking and abusing drugs and alcohol, and start exercising. They need to be as liberal in adapting lifestyles and behaviors that promotes health and wellness as they have been in adapting lifestyles and behaviors that promote disease and illness.

To reverse the tide of chronic degenerative diseases and the tendency toward less than optimal human development our lifestyles will have to change. We will have to make choices that lead us away from disability and disease and move us toward optimal health and high –level wellness. The way in which we live our daily lives will have to be radically transformed. We will have to choose the road of preventive care by taking positive actions that create optimal health and high-level wellness and that help prevent acute and chronic illness and neutral or low-level health and wellness.

Journey to Wellness- The Crisis

There is a serious epidemic in American health care. It has been estimated to account for over a million deaths per year and there is good evidence to believe that most of these deaths could be prevented. The cause is not some rare and exotic disease or infectious organism. We ourselves are the cause through our own inability or unwillingness to change. Today the leading causes of illness and death are not due to some genetic or other uncontrollable factor such as infection. Lifestyle is the major cause of disease and death in modern society. (Edlin, et.al., 1999) We are a nation desperately in need of impactful, preventive health care programs.

When deaths are examined for their actual cause statistics have shown that approximately HALF of the 2.1 million deaths in the United States each year are due to lifestyle factors that could be prevented by changes in lifestyle behaviors. (McGuinnis and Foege, 1993) . Next to tobacco use, unhealthy diet and activity patterns contribute the most to deaths in the US These are all preventable deaths. Diseases such as heart disease, cancer and other chronic degenerative disease result from environmental factors, people’s behaviors, and the ways in which they choose to live their lives.

Heart disease and cancer, the two major causes of death in the United States, are lifestyle diseases. Infectious organisms do not cause them nor do genetics play the major role. Heart disease is related to stress, lack of control in one’s life, overeating and eating the wrong kinds of foods, eating over processed foods, cigarette smoking, lack of exercise, and high blood pressure and high cholesterol which are also mainly lifestyle diseases related to diet, exercise and stress. Cancer is believed to be associated with nutritional and environmental factors. Half of all cancer deaths are related to nutritional problems. (Edlin, et al., 1999). Improper nutrition, exposure to hazardous pollutants in the environment, and cigarette smoking all initiate biological changes that can result in cancer. In 1997, The American Cancer Society stated, "if everything known about cancer prevention were practiced by everyone up to two-thirds of all cancer could be prevented.” (Edlin, et.al., 1999)

According to the United States Public Health Service 7 of the 10 leading causes of death in the United States could be substantially reduced if people would change their behavior. (DeLeon, et.al., 1996) All of the top seven health risk factors in the United States – tobacco use, diet, alcohol, unintentional injuries, suicidal behavior, violence, unsafe sex – are behavioral. Unhealthy life style habits, unbalanced lifestyles, and destructive personal behaviors are at the root of suicide and homicide (alcohol, drugs, stress), accidents and injuries (alcohol, drugs, and stress), HIV infection (unsafe sexual practices), cirrhosis of the liver (alcohol abuse), and diabetes (improper nutrition and lack of exercise).

Tobacco use is the number one unhealthy lifestyle behavior. "In the United States approximately 47 million Americans continue to smoke. Over 400,000 preventable deaths per year are attributable to smoking. Globally the problem is catastrophic. Of the people alive today in the world 500 million are expected to die from this single behavior, losing approximately 5 billion years of life to tobacco use. If even modest gains could be made in behavioral science and the practice of smoking cessation, millions of premature deaths could be prevented and billions of years of life could be preserved."(Prochaska, et.al., 1996)