Insight-motivated Learning: A Model to Improve Stress Management and Adherence in Chronic Health Conditions

Robert A. Ronzio and Patricia A. Ronzio. Integrative Medicine: A Clinician's Journal. 2012;11:2:22-28.

ABSTRACT: Patients' nonadherence to prescriptive behavioral changes presents a frequent limitation in the treatment of chronic illness and serves as a focal point for educational programs and clinicians' support of patients' self-management. Recurrent emotional stress can compromise adherence. Insight motivated learning (IML)TM is a holistic model in which personal insights form a basis for understanding recurrent stressors and related responses. Case examples, derived from coaching clients toward healthy lifestyles and monitoring the progress of patients with fibromyalgia, suggest that explorations of the physical, mental, spiritual and emotional dimensions of wellness and insight-inspired solutions, enhance self-efficacy and improve stress management. The field needs empirical studies to assess the capability of IML to improve self-management of treatment-resistant health conditions and promote long-term healthful lifestyle change.


Medical non-adherence - A world-wide challenge

In developed countries only 50% of patients with chronic illness follow prescribed treatment for critically important health conditions as diabetes, cardiovascular disease or HIV treatment. Similarly, fewer than 50% of Americans follow dietary recommendations to prevent chronic disease and foster good health. Consequently, strategies that improve adherence are likely to have a significant positive impact on public health.

Psychological stress presents a barrier to patient adherence [compliance] and self-management

stressrelaxdreamstimeextrasmall 24164286While the reasons for patient non-adherence are complex, psychological stress often plays a role. Stress -- often expressed as "too tired", "too busy", "burned out" -- can limit patients' willingness to follow lifestyle recommendations, exacerbating treatment-resistant conditions. These include chronic somatic syndromes such as fibromyalgia and irritable bowel syndrome. Equally important are self-care issues ranging from weight management, adequate rest, prudent diet to regular physical activity.

Insight Motivated Learning [IML]TM

We developed a model of insight-motivated learning based upon stress-related case studies at a fibromyalgia clinic as well as personal life coaching for women. The goal is to improve management of chronic stress, and ultimately modify personal lifestyle habits to prevent a wide range of chronic health conditions associated with aging. The IML model enhances insight learning to facilitate lasting behavior change.

The IML model features a reiterative interaction between the patient and the healthcare provider. The model encourages individual insight via in-depth exploration of a stress-related problem, and it can be extended to a wide range of life issues within the wellness domains - body, mind, spirit and emotions - to promote lasting behavioral change beyond the clinical setting.    

Step 1. Identify a specific energy drain. Patient identifies a pressing recurrent stressor which blocks resolution of a presenting health problem. A patient's choice of stressor may be unrelated to perhaps obvious health issues.

Step 2. Early opportunity for insight. Patient evaluates prior strategies that she or he used to deal with this stressor.  Which strategies worked, which were not effective?

Step 3. Further extended opportunities for insight. Healthcare provider encourages the patient to see the problem in a new light.  As an example: “Beyond the physical aspects of your issue (such as adequate diet, exercise, or physical discomfort), does even 1 % of the problem relate to a thought or belief, a purpose in life or a strong negative emotion?"

Step 4. Follow Through. Patient selects a realistic goal.  New awareness and insights (input from steps 2 and 3) help the patient formulate a specific, achievable goal. The healthcare provider can help the patient adjust details, e.g. duration, schedule, until she feels relatively certain of following through.

Step 5. Take Action. Discover Further Insights. Patient chooses to act on the goal. The healthcare provider encourages the patient to consider consequences, whether or not the goal was attained. Rather than seeing an outcome as a "failure," the patient can view choices as learning opportunities (fresh insights). Follow up contacts can help recall patients' victories and build resilience to overcome future obstacles.

Recommendations to facilitate insight-motivated learning by patients

  1. Acknowledge that patients possess an innate capacity to discover insights and best solutions for their immediate circumstances.
  2. Validate patients’ insights as an important motivation for behavioral change.
  3. Replace predetermined advice with guidance to help patients foster fresh insights and self-determined goals.
  4. Actively listen and reflect patients’ thoughts and emotions.
  5. Emphasize empathy and acceptance of patients' choices, regardless of outcomes.
  6. Beyond apparent physical manifestations, encourage patients to explore ramifications of stressors within the mental, spiritual, and emotional dimensions of wellness.
  7. Withhold personal judgment of patients' choices and insights.

Conclusion: The Insight-motivated Learning model provides a framework by which healthcare professionals encourage patients to use insight learning to manage persistent stressors that block healthy lifestyle change. Potentially, IML can help bridge the gap between educating patients with a disease focus and encouraging patient self-management and self-efficacy.