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Which of the following health conditions is not directly benefited by breathing exercises?
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 Self-Care: The Anatomy of Empowerment  
 
Stanford researcher Kate Lorig and her colleagues recently taught an arthritis self-care class—and got a big surprise. As predicted, their students experienced less pain after their training. But none of the subjects covered—the information, the exercises, or any combination of the two—accounted for the change.

After interviewing their subjects again, the researchers concluded that the class had produced an increased sense of control over their illness. It was that increased sense of control which produced the happy result. Those who saw themselves most firmly in the driver's seat showed the most dramatic decrease in pain. Those who felt they had little or no control showed little or no benefit, even though they practiced the exercises and mastered the information.' Bandura's Spider Study. How can an increased sense of self-mastery lead to a remission in symptoms? Psychologist Albert Bandura and his Stanford colleagues have found that the release of the chemical messenger catecholamine can be influenced by a person's sense of "self-efficacy." Bandura defines self-efficacy as the conviction that one can successfully change one's behavior to reach one's goals. Lorig, Bandura, and other researchers are discovering that a strong sense of self-efficacy can reduce symptoms and help bring about self-directed behavior change. Bandura worked with a dozen women who were afraid of spiders. He found that those who felt unable to cope with certain tasks (e.g. looking at a spider, putting a hand in a bowl of water containing a spider, or letting a spider walk across their hands) secreted higher levels of catecholamine than those who felt that they could handle these tasks. When the researchers used behavioral techniques to increase the women's sense of self-efficacy, their catecholamine outputs dropped.2

Healing. The growing body of self-efficacy research gives us some important insights into how people heal. The process of empowerment lies at the heart of healing. The key to empowerment is to offer tools, skills, information, and support for self-help. Lorig and her colleagues are just a few of the growing number of professionals who are attempting to do exactly that. Another health professional who practices empowerment is Dean Ornish, M.D., President of San Francisco's Preventive Medicine Institute and a leading researcher on the effects of lifestyle on heart disease.

"The notion of empowerment is critical because there's a lot that's pretty disempowering about modern medicine. But physicians who behave in a way that undercuts patients' sense of self-efficacy may actually have a negative effect on their health.

"I don’t give ‘doctor’s orders.’ If I order patients to do something, I’m not really empowering them. I may be making the problem worse."

"One of the most empowering things physicians can do is to help people understand how their problems are related to their lifestyle and thinking. The idea here is not to blame them or make them feel guilty, but to provide an opportunity to take responsibility. Illness can become a catalyst for getting people's attention, and starting them on the path to empowerment.

"I think that even more than feeling healthy, people want to feel free," Ornish says. "That is why I don't believe in 'doctor's orders.' If I order patients to do something, I'm not really empowering them. I may even be making the problem worse. My goal is to help people gain power and freedom. Because only then can they become more responsible."

Ornish believes that feelings of isolation and loneliness contribute significantly to stress related disease, and that increased intimacy can become an additional source of empowerment. Ornish encourages his patients to develop two kinds of intimate connections: intimacy with others, and intimacy with the higher parts of themselves.

"I encourage people to share those parts of themselves they fear might be rejected by others, feelings that they're not as smart or as rich or as secure or as beautiful as they feel they ought to be."

Ornish also encourages his clients to do altruistic things for each other, not to get an A or a gold star, but because altruistic actions free them from feelings of isolation. It is literally true that gifts often benefit the donor more than the recipient. This includes the gift of forgiveness. And the gift of listening.

Another way to transcend isolation is through meditation. In meditation we can stop identifying with our own little egos and experience the ways in which we are inextricably connected with all creation.

"A big part of the healing process is becoming more connected with the parts of yourself that feel most real,"' Ornish says. "When you live out of the most vital parts of yourself, you know you are living your own life and not just playing out someone else's idea of who you should be. "The more we realize that our sense of self-worth comes from within, that the ability to feel fulfilled is already inside us, the more autonomous we become, and the more fully empowered we are." How to Empower Other People.

  1. Include them in the process.
  2. Don't try to manipulate them to reach your goal. Offer alternatives.
  3. Encourage them to continue the process of listing, brainstorming, and developing new options.
  4. Encourage them to choose and pursue the goals that seem most important to them right now.
  5. Ask how you can support them to attain their own self-chosen goals, and do exactly as they request.


References

  1. Lorig, Kate, et al., "Failure of the Conventional Explanation to Account for Benefits of Health Education in Chronic Arthritis and a Suggested Alternative: Health Education in Chronic Arthritis," Stanford University School of Medicine. Karen Gravelle, "Can a Feeling of Capability Reduce Arthritis Pain," Advances, Vol.2, No.3, pp.8-13, 1985.
  2. Bandura, Albert, et al., "Catecholamine Secretion as a Function of Perceived Coping Self Efficacy," Journal of Counseling and Clinical Psychology, Vol. 58, No. 3, pp. 406-414, 1985.
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 About The Author
David Sobel MDDavid S. Sobel, M.D., M.P.H., is a practicing physician in adult medicine and Medical Director of Patient Education and Health Promotion for Kaiser Permanente Northern California. He is physician lead for the......more
 
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