By Jonathan Howard

Objectives:

• Define the nine dimensions of wellness
• Identify health problems in the United States
• Identify the behaviors that promote wellness
• Behavior Modification: how change occurs, barriers to change, and how to successfully overcome barriers and make lasting lifestyle changes

Why Study Wellness?

As most college students do, you have probably set goals. Obviously, your individual goals differ from those of your fellow classmates, but everyone’s goals share one common attribute: their intention to improve individual wellbeing. However, there are as many ideas about how to do that as there are individuals. Do your goals involve making more money, achieving better health, improving your relationships? Holistic wellness involves all those aspects of life and more. This chapter explains the importance of overall wellness, which is about more than being physically and mentally healthy, free from illness and disease. In fact, the study of wellness incorporates all aspects of life. Achieving overall wellness means living actively and fully. People in this state exude confidence, optimism, and self-efficacy; they have the energy reserves to do what needs to be done today and to plan for a better tomorrow. The most effective and transformative goals are those designed to achieve the highest level of personal wellness.

Dimensions of Wellness

Wellness is a familiar term, but what is its true definition? Is it simply the absence of disease? This chapter will define all the components of holistic wellness and describe the factors that contribute to     not only a person’s physical and mental health, but also their ability to develop, thrive, succeed, enjoy life, and meet challenges head on with confidence and resolve.

To achieve this type of overall wellness, a person must be healthy in nine interconnected dimensions of wellness: physical, emotional, intellectual, spiritual, social, environmental, occupational, financial, and cultural. A description of each dimension follows.

The Nine Dimensions of Wellness

• Physical Wellness

People who are physically well actively make healthy decisions on a daily basis. They eat a nutritionally balanced diet; they try to get an adequate amount of sleep, and they visit the doctor routinely. They make a habit of exercising three to five times per week; they have the ability to identify their personal needs and are aware of their body’s limitations. They maintain positive interpersonal relationships and make healthy sexual decisions that are consistent with their personal values and beliefs.

• Emotional Wellness

An emotionally well person successfully expresses and manages an entire range of feelings, including anger, doubt, hope, joy, desire, fear, and many others. People who are emotionally well maintain a high level of self-esteem. They have a positive body-image and the ability to regulate their feelings. They know where to seek support and help regarding their mental health, including but not limited to, seeking professional counseling services.

• Intellectual Wellness

Those who enjoy intellectual wellness engage in lifelong learning. They seek knowledge and activities that further develop their critical thinking and heighten global awareness. They engage in activities associated with the arts, philosophy, and reasoning.

• Spiritual Wellness

People who can be described as spiritually well have identified a core set of beliefs that guide their decision making, and other faith- based endeavors. While firm in their spiritual beliefs, they understand others may have a distinctly different set of guiding principles. They recognize the relationship between spirituality and identity in all individuals.

• Social Wellness

A socially well person builds healthy relationships based on interdependence, trust, and respect. Those who are socially well have a keen awareness of the feelings of others. They develop a network of friends and co-workers who share a common purpose, and who provide support and validation.

• Environmental Wellness

An environmentally well person appreciates the external cues and stimuli that an environment can provide. People who have achieved environmental wellness recognize the limits to controlling an environment and seek to understand the role an individual plays in the environment.

• Occupational Wellness

An occupationally well person enjoys the pursuit of a career which is fulfilling on a variety of levels. This person finds satisfaction and enrichment in work, while always in pursuit of opportunities to reach the next level of professional success.

• Financial Wellness

Those who are financially well are fully aware of their current financial state. They set long- and short-term goals regarding finances that will allow them to reach their personal goals and achieve self-defined financial success.

• Cultural Wellness

Culturally well people are aware of their own cultural background, as well as the diversity and richness present in other cultural backgrounds. Cultural wellness implies understanding, awareness and intrinsic respect for aspects of diversity. A culturally well person acknowledges and accepts the impact of these aspects of diversity on sexual orientation, religion, gender, racial and ethnic backgrounds, age groups, and disabilities.¹

Health Problems in the United States

Americans today experience health problems that people who lived 100 years ago did not encounter. What are the factors that account for these health problems that have arisen over the past 100 years?

Most health problems faced by people in the U.S. are chronic diseases that are preventable and caused by everyday choices and unhealthy lifestyles.

The link below provides more information about the leading causes of death in the United States:

Leading Causes of Death

To see a 2014 chart that shows the leading cause of death by age group, click on the link below:

Leading Cause of Death by Age Group
(from the Center for Disease Control and Prevention)

In the video linked below, you will learn about the determinants of health as outlined by Healthy People 2020. Healthy People 2020 is a federal advisory committee comprised of non-federal, independent subject matter experts who gather data and provide advice on how to promote health and prevent disease in America:

Healthy People 2020 and Determinants of Health
(from the Office of Disease Prevention and Health Promotion – Click to the site and watch video)

The link below is to Healthy People 2020’s website, which contains data and technical information about this organization’s objectives:

Healthy People 2020 Website

Behaviors That Promote Wellness

Bad habits are hard to break, but choosing to eat healthier and exercise more provides benefits that go far beyond a more ideal body weight and shape. Being physically fit can stave off many of the diseases and medical conditions discussed in the previous section, including heart disease, the number 1 killer in America. Exercise reduces stress and eases depression.

Healthier employees are also more productive. Being physically fit nurtures the mind, body, and spirit and is the cornerstone of wellness. The links below provide information about behaviors within your control that contribute to an improved quality of life and increased wellness.

Behavior Modification

Making permanent lifestyle changes is one of the greatest challenges a person can face. This section will explore how changes to behavior occur, the psychological barriers that hamper efforts to change, and tips for making lasting change.

How Changes in Behavior Occur

The Trans-theoretical Model, also called the Stages of Change Model, was developed by James Prochaska and Carlo DiClemente in the late 1970s. Considered the dominant model for describing how behavior changes occur, it evolved through studies examining the experiences of smokers who quit on their own and comparing them with the experiences of those requiring further treatment. The goal of those studies was to understand why some people were capable of quitting on their own. It was determined that people quit smoking if they were ready to do so. Thus, the Trans-theoretical Model (TTM) focuses on the decision-making of the individual and is a model of intentional change. The TTM operates on the assumption that people do not change behaviors quickly and decisively. Rather, change in behavior, especially habitual behavior, occurs continuously through a cyclical process. The TTM is not a theory but a model; different behavioral theories and constructs can be applied to various stages of the model where they may be most effective.

The TTM posits that individuals move through six stages of change: pre-contemplation, contemplation, preparation, action, maintenance, and termination. Termination was not part of the original model and is less often used in application of stages of change for health- related behaviors. For each stage of change, different intervention strategies are most effective at moving the person to the next stage of change and subsequently through the model to maintenance, the ideal stage of behavior.

Six Stages of Change:

• Stage 1: Pre-contemplation

In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences.

People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior.

• Stage 2: Contemplation

In this stage, people are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months). People recognize that their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behavior.

• Stage 3: Preparation (Determination)

In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life.

• Stage 4: Action

In this stage, people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.

• Stage 5: Maintenance

In this stage, people have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages.

• Stage 6: Termination

 In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs.

To progress through the stages of change, people apply cognitive, affective, and evaluative processes. Ten processes of change have been identified, with some processes being more relevant to a specific stage of change than other processes.

These processes result in strategies that help people make and maintain change.

Ten Processes of Change:

• Consciousness Raising – Increasing awareness about the healthy behavior.
• Dramatic Relief – Emotional arousal about the health behavior, whether positive or negative arousal.
• Self-Reevaluation – Self-reappraisal to realize the healthy behavior is part of who they want to be.
• Environmental Reevaluation  – Social reappraisal to realize how their unhealthy behavior affects others.
• Social Liberation – Environmental opportunities that exist to show society is supportive of the healthy behavior.
• Self-Liberation –  Commitment to change behavior based on the belief that achievement of the healthy behavior is possible.
• Helping Relationships – Finding supportive relationships that encourage the desired change.
• Counter-Conditioning – Substituting healthy behaviors and thoughts for unhealthy behaviors and thoughts.
• Reinforcement Management –  Rewarding the positive behavior and reducing the rewards that come from negative behavior.
• Stimulus Control – Re-engineering the environment to have reminders and cues that support and encourage the healthy behavior and remove those that encourage the unhealthy behavior.

Limitations of the Trans-theoretical Model

Limitations of the model include the following:

• The theory ignores the social context in which change occurs, such as socioeconomic status and income.

• The lines between the stages can be arbitrary with no set criteria of how to determine a person’s stage of change. The questionnaires that have been developed to assign a person to a stage of change are not always standardized or validated.

• No clear sense exists for how much time is needed for each stage, or how long a person can remain in a stage.

• The model assumes that individuals make coherent and logical plans in their decision-making process when this is not always true.

The Trans-theoretical Model provides suggested strategies for public health interventions to address people at various stages of the decision-making process.

Using strategies suggested by TTM can result in interventions that are more effective because they are tailored for a specific group of people. In other words, the interventions involve a message or program component that has been specifically created for a target population’s level of knowledge and motivation. The TTM encourages an assessment of an individual’s current stage of change and accounts for relapse in people’s decision- making process.²

One of the most effective tools for changing behavior is goal setting. The links below provide information on how to set goals effectively to achieve greater success in goal attainment.

Goal Setting Info from Oregon State University’s Academic Success Center

One Step at a Time Goal Achievement Video on S.M.A.R.T. Goals

Making S.M.A.R.T. Goals Activity

Lifestyle Modification Barriers

Dr. James M. Olson, a psychology professor at the University of Western Ontario, London, has identified several psychological barriers that commonly prevent people from taking action, even when inaction poses a threat to their health. These barriers occur during 3 stages of behavior modification: admission of the problem, initial attempts to change, and long-term change as outlined below:

• Barriers to Admission of the problem

The first step in lasting change is admitting a problem exists. People often fail to change behavior that poses a risk to their health because they deny a risk exists, trivialize their personal risk, feel invulnerable, make a faulty conceptualization, (i.e., they attribute early warning signs to a benign cause), or experience debilitating emotions when contemplating preventative measures.

• Barriers to Initial Attempts to Change

At this stage, people acknowledge the need to change but struggle to accomplish their goals. This failure is a result of lack of knowledge, low self-efficacy (the belief in one’s own ability to succeed at change), and dysfunctional attitudes.

• Barriers to long-term change

Just because a person has experienced success in changing a behavior, that doesn’t mean the change is permanent. Barriers to long-term change include cognitive and motivational drift (diminishing enthusiasm for the need to change), lack of perceived improvement, lack of social support, and lapses.

To read more about these barriers to change, including strategies for overcoming these barriers, read Dr. Olson’s entire article linked below:

Psychological Barriers to Behavior Change (link – from Consumerism Commentary)

A presentation (flowchart) on overcoming barriers to change by the National Institute for Health and Clinical Excellence (NHS) is linked below:

Overcoming Barriers to Change (link)

Fostering Wellness in Your Life

You are once again feeling motivated to eat better, exercise more, drink less caffeine or make any number of the positive lifestyle changes you have been telling yourself you want to make. You have tried before— probably declaring another attempt as a New Year’s resolution—but without experiencing much success. Making a lifestyle change is challenging, especially when you want to transform many things at once. This time, think of those changes not as a resolution but as an evolution.

Lifestyle changes are a process that take time and require support. Once you are ready to make a change, the difficult part is committing and following through. So do your research and make a plan that will prepare you for success. Careful planning means setting small goals and taking things one step at a time.

Here are five tips from the American Psychological Association (APA) that will assist you in making lasting, positive lifestyle and behavior changes:

• Makeaplanthatwillstick.

Your plan is a map that will guide you on this journey of change. You can even think of it as an adventure. When making your plan, be specific. Want to exercise more? Detail the time of day when you can take walks and how long you will walk. Write everything down, and ask yourself if you are confident that these activities and goals are realistic for you. If not, start with smaller steps. Post your plan where you will most often see it as a reminder.

• Startsmall.

After you’ve identified realistic short-term and long-term goals, break down your goals into small, manageable steps that are specifically defined and can be measured. Is your long-term goal to lose 20 pounds within the next five months? A good weekly goal would be to lose one pound a week. If you would like to eat healthier, consider as a goal for the week replacing dessert with a healthier option, like fruit or yogurt. At the end of the week, you will feel successful knowing you met your goal.

• Change one behavior at a time.

Unhealthy behaviors develop over the course of time, so replacing unhealthy behaviors with healthy ones requires time. Many people run into problems when they try to change too much too fast. To improve your success, focus on one goal or change at a time. As new healthy behaviors become a habit, try to add another goal that works toward the overall change you are striving for.

• Involve abuddy.

Whether it be a friend, co-worker or family member, someone else on your journey will keep you motivated and accountable. Perhaps it can be someone who will go to the gym with you or someone who is also trying to stop smoking. Talk about what you are doing. Consider joining a support group. Having someone with whom to share your struggles and successes makes the work easier and the mission less intimidating.

• Ask forsupport.

Accepting help from those who care about you and will listen strengthens your resilience and commitment. If you feel overwhelmed or unable to meet your goals on your own, consider seeking help from a psychologist.

Psychologists are uniquely trained to understand the connection between the mind and body, as well as the factors that promote behavior change. Asking for help does not mean a lifetime of therapy; even just a few sessions can help you examine and set attainable goals or address the emotional issues that may be getting in your way.

Start with “Why?”

Making changes in habitual behavior requires a deep and abiding belief that change is needed. Your desire to change may be motivated by personal goals, or it may be the result of the impact your improved wellness will have on those you love. Nietzsche said, “He who has a strong enough why can bear almost any how.”

Once you have a compelling reason to change, develop a plan and commit to that plan. If you experience a moment of weakness, do not waste time on self- condemnation. Revisit your compelling reason and reaffirm your commitment to change. The health, peace, and sense of wellbeing inherent in the highest level of your own personal wellness is more than worth the effort required to change.

Assessing Your Personal Lifestyle Behaviors

The full text of articles from APA Help Center may be reproduced and distributed for noncommercial purposes with credit given to the American Psychological Association. Any electronic reproductions must link to the original article on the APA Help Center.

1Auburn University Division of Student Affairs.

2Boston University School of Public Health