Monday, March 10, 2008

The Whole-Person Integrated-Care (WPIC) Wellness Solution: Part 4

In my last post, I discussed the personalities, coping strategies, and need of the "Wannabes." This time I examine the "Inactives."

Inactives think about their health on occasion, but do not believe they should or can do anything to improve their health and wellbeing. This is because they tend to have thoughts such as:
  • "I doubt I'll be able to do what's required to improve my health, so why even bother."
  • "I don't deserve to be sick…it's not my fault…so why should I have to be the one to do anything about it"—or—"I do deserve to be sick…Illness is my punishment…I'm just getting what I deserve."
Inactives, therefore, doubt that they can deal effectively with their health risks and problems, which causes them great stress. Some of them also believe they don't deserve what has happened to them, which makes them feel resentful and angry. This stress and resentful anger not only distracts them from focusing on constructive health improvement activities; it is also likely to worsen their physical health since illnesses such as coronary heart disease and cancer may be exacerbated by a negative psychological state (for examples of how this mind-body connection affects one's health, see: this link, this link, and this link). Other Inactives may have different views, such as believing they deserve to be sick and there's no hope because they are doomed.

The result is that the Inactives, like the Wannabes, lack the self-confidence and motivation they need to improve their health and wellbeing. But what makes Inactives less likely to change their unhealthy lifestyles is that:
  • Their self-doubt is stronger because it comes from the belief that they are not able (rather than may not be able) to (a) make the correct decision about treatment for an existing problem or (b) make the attitude and behavior changes required for better health and wellbeing.
  • Their inertia (inaction) may be exacerbated by (a) fear that they will be shamed if they try to improve their health and fail causes them to resist taking constructive action, (b) the belief that there is no good way to solve their health problems or prevent their health risks from becoming problems, and (c) despair related to the belief they deserve to be ill.
  • Their stress and resentful anger likely worsens their health through distraction and the adverse affect of negative emotions on physiology.
Furthermore, they will likely look for reasons for not adhering to the wellness care plan, such as:
  • Money problems that prevent them from carrying out their wellness plan of care (e.g., buying more healthy foods, a gym membership, prescribed medications, diagnostic tests, etc.)
  • Family and other demands that consume their time and thus make lifestyle change difficult
  • Physical handicaps or cognitive impairments.
The result is that Inactives fail to deal with their health risk and problems in a timely and effective manner, while at the same time worsening their health and wellbeing through inertia and emotional distress.

The way Inactives attempt to cope with their pessimism, fear, anger, resentment, and despair is similar to the negative avoidance strategies the Wannabes use. That is, they may
  • Try to feel better by doing enjoyable or interesting things, rather than focus on the problem
  • Act as if nothing has happened or try not to think about their problems
  • Express negative emotions by yelling or crying, taking it out on others, or avoiding certain people, rather than doing something constructive
  • Hope a miracle will somehow make things better or that one's wishes or prayers would be answered, rather than gaining knowledge and developing a plan of action
  • Resign themselves that nothing can be done to improve the situation, even though they lack adequate understanding and fail to exert adequate effort.
While these coping strategies may alleviate their emotional distress temporarily, they are maladaptive in the long-term since their inaction allows their health risks to emerge as serious problems and their existing health problems to worsen.

Nevertheless, since Inactives think about their health & wellbeing on occasion, it is possible for them to become more focused and motivated with the help of wellness coaches/counselors and useful health information technologies. They may be willing, for example, to take health risk assessments that evaluate their health status, especially if they have concerns about their physical health or emotional state. They may also be willing to gain greater knowledge about their problems, risks, and constructive strategies for dealing with them, although they will likely have to be convinced (through counseling, and maybe incentives) to use these tools and professionals. And they may be willing to get help to:
  • Use the knowledge they gain to make a treatment decision for dealing with an acute physical or mental health problem
  • Implement a wellness care plan designed to self-manage a chronic condition
  • Make positive lifestyle changes to avoid a risk factor from becoming a health problem.
All this means they will need wellness counseling, which should focus on:
  • Overcoming their inertia, changing their self-defeating cognitive and emotional blocks (including self-doubt, fear, anger and shame)
  • Replacing their negative avoidance-based coping strategies with the positive strategies of the Activists.
This counseling ought to include powerful forms of persuasion in which well-care professionals--using next-generation health information technologies, which I will describe in a future post--help increase their willingness to take responsible action that improves their health and wellbeing. This is likely to involve significant effort focused on changing beliefs/thoughts. Note that I have previously posted about the relationship between beliefs and physical health, starting at this link.

In my next post, I examine the fourth and most difficult personality type: the "Ignorers/Deniers."

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