The wellness process for healthy living: a mental tool for facilitating progress through the stages of change

AMAA Journal,  Winter, 2005  by Steven Jonas

• E-mail
• Print
• Link

Introduction

The U.S. media are filled with advice about how to make personal health-promoting behavior changes. How to exercise: choice of sports, schedules, techniques, and equipment. How to lose weight: diets, food choices, and advice on shopping, cooking, and how to eat. How to quit smoking, how to drink wisely, and so on. There is also a great deal of information available on the consequences of unhealthy lifestyles. Yet Americans continue to engage frequently in unhealthy behaviors and the rates are increasing. It is apparent that if most people are to achieve success, advice on techniques, schedules, diets, and the "how-to's" of behavior modification, and information on "what is good for you and what is not" are not sufficient.

Over many years I've observed people who have successfully changed their behaviors. In every case, a significant amount of mental work was necessary before the how-to's were undertaken. I've also observed that this mental work follows a particular pattern. Yet in most of the health-promoting advice that is offered, very little attention is paid to that essential mental process. The ideas in this article were born out of approximately 20 years of observation, anecdotal interviewing, and personal experience (1). Further research, using epidemiological science and statistical methods, is certainly indicated. Since such research is very complex, difficult to carry out, and expensive, for now this result of descriptive research will hopefully be of use.

After we look at some definitions of health and wellness, we'll consider the well-known and well-accepted paradigm of personal behavior change called the Stages of Change (2-5). Finally, we'll consider my concept of the Wellness Process for Healthy Living (WPHL). It is a practical, organized approach to the mental work that appears to be necessary for achieving success. In practice, its use can be very helpful in assisting patients in proceeding from the second of the Stages of Change, Contemplation, through the fifth, Maintenance (Table II).

Some Definitions of Health and Wellness

Health can be defined as a state of being that can be measured at any given point in time: anything from height and weight, through the results of a physical exam, to an examination of the levels of various components of the blood, to "how do you feel today," to an evaluation of how well one is functioning in one's work, play, family life, community, and nation. Health can also be defined in terms of health-promoting behaviors that a person may engage in. In personal health promotion, a "Basic Ten" can be recognized (Table I).

In contrast to health, a state of being, wellness is a process of being. It can be described as a journey that is lifelong if one makes it so, a central element that it shares with the Taoist religion. Wellness is a pathway along which one can proceed during one's lifetime, to achieve and maintain a healthy state of being in the broadest sense, as is maximally feasible for each person at each phase of his or her life. It is also a process that provides a guide to living a healthy life, as well as a life that is both happy and productive--well beyond the usual parameters of health.

My good friend known as the "Dean of Wellness," Donald Ardell, PhD, of Tampa, Florida, has been writing definitions of the term "wellness" for 30 years or so. He is always coming up with some new insight on the subject. A recent definition of his is:</p> <pre> Wellness is a philosophy. It's also a lifestyle. It could as well be characterized as a mindset. [It is] a positive approach, not just for health but for a high quality of life. Wellness is first and foremost a choice to assume responsibility for the quality of your life. Wellness is a choice that will increase the chances that you will be fit, committed to personal responsibility, and as healthy as your genetics, environment, and good fortune permit. With a wellness lifestyle, you won't be normal (i.e., overweight, under-fit, stressed, and easily fooled). You will, more likely than not, be emotionally intelligent, a critical thinker, open to and alert for discoveries that add meaning and purpose in life. With a wellness lifestyle, you'll also value fun, play, tolerance, and the common decencies (6). </pre> <p>Wellness is a particular path that one can choose to follow that will enable the maximization of positive outcomes for whatever part of life one chooses to apply it to. It is a road that has many milestones but no end point, other than the one that death brings. Thus broadly, in my view, the goal of wellness is to enable us to pursue:</p> <pre> A way of life and living in which one is always exploring, searching, finding new questions and discovering new answers, along the three primary dimensions of living: the physical, the mental, and the social; a way of life designed to enable each of us to achieve, in each of the dimensions, our maximum potential that is realistically and rationally feasible for us at any given time in our lives (1). </pre> <p>How does wellness, a process of being, relate to health, a state of being? How do we use the wellness concept to make healthy choices, to help us to function at higher levels, and make that "conscious commitment" to making changes in our personal health status? Wellness, as Dr. Ardell shows, can help us function more effectively and happily at a variety of levels. Being on the wellness pathway through life becomes part of health, of being healthy, at any given time. The WPHL is a tool for implementing the wellness concept, for making it real for ourselves and our patients. For engaging in personal health-promoting behavior change, for example, it organizes, focuses, and directs the mental work that experience and observation have shown is necessary if attempts to move through the Stages of Change are to be successful.