Person-centered Health Promotion in Chronic Disease

Main Article Content

C. Robert Cloninger

Abstract

Health promotion must be person-centered, not organ- or disease-centered, in order to be effective because physical, mental, social, and spiritual aspects of human functioning are inextricably intertwined.  Chronic medical disorders, such as heart disease, chronic obstructive pulmonary disease, diabetes, cancer, asthma, and arthritis, are strongly associated with immature personality, emotional instability, and social dysfunction.  All indicators of physical, mental, and social well-being are strongly related to the level of maturity and integration of personality, so personality is a useful focus for the promotion of well-being. Assessment of personality also facilitates the awareness of the clinician and the patient about the patient’s strengths, weaknesses, and goals, thereby contributing to an effective therapeutic alliance.  Health, well-being, resilience, and recovery of function all involve increasing levels of the character traits of Self-directedness, Cooperativeness, and Self-transcendence. Person-centered programs that enhance self-regulation of functioning to achieve personally valued goals improve compliance with medical treatment and quality of life in people with chronic disease.  Effective therapeutic approaches to health promotion activate a complex adaptive system of feedback interactions among functioning, plasticity, and virtuous ways of thinking and acting.  The probability of personality change can be predicted by high levels of Self-transcendence, which give rise to an outlook of unity and connectedness, particularly when combined with the temperament traits of high Novelty Seeking and high Persistence. In summary, person-centered psychobiological treatments that facilitate the development of well-being and personality development are crucial in the prevention, treatment, and rehabilitation of chronic medical diseases. 

Article Details

Section
Regular Articles
Author Biography

C. Robert Cloninger, Sansone Family Center for Well-Being at Washington University School of Medicine, St. Louis, MO, USA

Prof Cloninger is Wallace and Lucille Renard Professor of Psychiatry, Professor of Psychology and Genetics, and Director of the Sansone Family Center for Well-Being at Washington University School of Medicine in St. Louis. He is also Scientific Director of the Anthropedia InstituteDr. Cloninger received his B.A. with High Honors and Special Honors in Philosophy, Psychology, and Anthropology from the University of Texas at Austin, 1966.  He received his M.D. from Washington University in 1970 and an Honorary Doctorate from the University of Umea, Sweden in 1983.  He has published 10 books and more than 400 articles in psychiatry, psychology, and genetics.   His recent books include the Origins of Cooperation and Altruism by Springer, Feeling Good: The Science of Well-Being by Oxford University Press, and Personality and Psychopathology by American Psychiatric Press.  Among his many awards, Dr. Cloninger has received the American Psychiatric Association’s Adolf Meyer Award (1993) and Judd Marmor Award (2009), and lifetime achievement awards from the American Society of Addiction Medicine (2000) and the International Society of Psychiatric Genetics (2003).  He is a Distinguished Life Fellow of the APA, a fellow of the American Academy for the Advancement of Science, and a member of the Institute of Medicine of the National Academy of Sciences.  The Institute of Scientific Information ranks him among the most highly cited psychiatrists and psychologists in the world. His personality inventories have been used in more than 4000 peer-reviewed publications.

References

Rosenstrom T, Jokela M, Cloninger CR, Hintsanen M, Juonala M, Raitakari O, Viikari J, Keltikangas-Jarvinen L, Associations between dimensional personality measures and preclinical atherosclerosis: The cardiovascular risk in Young Finns study. J Psychosom Res 2012; 72:336-43.

Kobau R, Sniezek J, Zack MM, Lucas RE, Adam B, Well-being assessment: An evaluation of well-being scales for public health and population stimates of well-being among US adults. Applied Psychology: Health and Well-being 2010; 2:272-297.

Timmreck TC. Dictionary of Health Services Management. Owings Mills, MD: National Health Publishing, 1987.

Pleis JR, Ward BW, Lucas JW, Summary health statistics for U.S. adults: National Health Interview Survey, 2009. Vital Health Stat 10 2010:1-207.

Cloninger CR, Cloninger KM, Development of instruments and evaluative procedures on contributors to health and illness. International Journal of Person-centered Medicine 2012; 3:446-455

Balluz LS, Okoro CA, Mokdad A, Association between selected unhealthy lifestyle factors, body mass index, and chronic health conditions among individuals 50 years of age or older, by race/ethnicity. Ethn Dis 2008; 18:450-7.

Mokdad AH, Marks JS, Stroup DF, Gerberding JL, Actual causes of death in the United States, 2000. JAMA 2004; 291:1238-45.

Cloninger CR, Cloninger KM, Person-centered Therapeutics. International Journal of Person-centered Medicine 2011; 1:43-52.

Pickett K, Wilkinson R. The Spirit Level: Why greater equality makes societies stronger. New York: Bloombury Press, 2009.

Wilkinson RG. The Impact of Inequality. New York: New Press, 2005.

Kirmayer LJ, Dandeneau S, Marshall E, Phillips MK, Williamson KJ, Rethinking resilience from indigenous perspectives. Can J Psychiatry 2011; 56:84-91.

Glass TA, Goodman SN, Hernan MA, Samet JM, Causal inference in public health. Annu Rev Public Health 2013; 34:61-75.

Glass TA, McAtee MJ, Behavioral science at the crossroads in public health: extending horizons, envisioning the future. Soc Sci Med 2006; 62:1650-71.

Greenhalgh T, Patient and public involvement in chronic illness: beyond the expert patient. BMJ 2009; 338:b49.

Malone AM, Walker SN. Measuring healthy lifestyles, In: Frank-Sromborg M and Olsen SJ, eds. Instruments for clinical health-care research. Third Edition edn. Boston: Jones & Bartlett Publishers, 2004:401-415.

Cloninger CR. Feeling Good: The Science of Well-Being. New York: Oxford University Press, 2004.

Cloninger CR, Zohar AH, Hirschmann S, Dahan D, The psychological costs and benefits of being highly persistent: personality profiles distinguish mood disorders from anxiety disorders. J Affect Disord 2012; 136:758-66.

McCraty R, Atkinson M, Tomasino D, Impact of a workplace stress reduction program on blood pressure and emotional health in hypertensive employees. J Altern Complement Med 2003; 9:355-69.

Nigg CR, Burbank PM, Padula C, Dufresne R, Rossi JS, W.F. V, Laforge RG, Prochaska JO, Stages of change across ten health risk behaviors for older adults. Gerontologist 1999; 39:473-482.

Prochaska JO, Velicer WF, The transtheoretical model of health behavior change. American Journal of Health Promotion 1997; 12:38-48.

Prochaska JO, Velicer WF, Rossi JS, Redding CA, Greene GW, Rossi SR, Sun X, Fava JL, Laforge R, Plummer BA, Multiple risk expert systems interventions: impact of simultaneous stage-matched expert system interventions for smoking, high-fat diet, and sun exposure in a population of patients. Health Psychology 2004; 23:503-516.

McCraty R, Atkinson M, Lipsenthal L, Arguelles L, New hope for correctional officers: an innovative program for reducing stress and health risks. Appl Psychophysiol Biofeedback 2009; 34:251-72.

Cloninger CR, The science of well-being: an integrated approach to mental health and its disorders. World Psychiatry 2006; 5:71-6.

Fjorback LO, Mindfulness and bodily distress. Dan Med J 2012; 59:B4547.

Bertisch SM, Wee CC, Phillips RS, McCarthy EP, Alternative mind-body therapies used by adults with medical conditions. J Psychosom Res 2009; 66:511-9.

Chiesa A, Serretti A, A systematic review of neurobiological and clinical features of mindfulness meditations. Psychol Med 2009:1-14.

Servan-Schreiber D. Healing Without Freud or Prozac. London: Rodale International, 2005.

Bann CM, Kobau R, Lewis MA, Zack MM, Luncheon C, Thompson WW, Development and psychometric evaluation of the public health surveillance well-being scale. Qual Life Res 2011:in press.

WHO. Definition of Health: Preamble to the Constitution of the World Health Organization. New York: World Health Organization, 1946.

Amering M, Schmolke M. Recovery in Mental Health. New York: John Wiley & Sons, 2009.

Cloninger CR, Zohar AH, Personality and the perception of health and happiness. J Affect Disord 2011; 128:24-32.

Stevenson A, Lindberg CA. The New Oxford American Dictionary. Third edn. New York: Oxford University Press, 2010:2096.

Antonovsky A. Unravelling the mystery of health. San Francisco: Jossey-Bass, 1987.

34. Cloninger CR, Salloum IM, Mezzich JE, The dynamic origins of positive health and wellbeing. International Journal of Person-centered Medicine 2012; 2:1-9.

Eley DS, Wilkinson D, Cloninger CR, Physician heal thyself, and develop your resilience. British Medical Journal Careers 2013.

Kim JW, Lee H-K, Lee K, Influence of temperament and character on resilience. Comprehensive Psychiatry 2013.

. Cloninger CR, What makes people healthy, happy, and fulfilled in the face of current world challenges? Mens Sana Monogr 2013; 11:16-24.

38. Seligman ME. Flourish. New York: Free Press, 2011.

Ericsson M, Lindstrom B, Validity of Antonovsky's sense of coherence scale: A systematic review. Journal of Epidemiology & Community Health 2005; 59:460-466.

Lindstrom B, Eriksson M, Contextualizing salutogenesis and Antonovsky in public health development. Health Promot Int 2006; 21:238-44.

Keyes CL, Shmotkin D, Ryff CD, Optimizing well-being: the empirical encounter of two traditions. J Pers Soc Psychol 2002; 82:1007-22.

Manderscheid RW, Ryff CD, Freeman EJ, McKnight-Eily LR, Dhingra S, Strine TW, Evolving definitions of mental illness and wellness. Prev Chronic Dis 2010; 7:A19.

Mezzich JE, Salloum IM, Cloninger CR, Salvador-Carulla L, Kirmayer LJ, Banzato CE, Wallcraft J, Botbol M, Person-centred integrative diagnosis: conceptual bases and structural model. Can J Psychiatry 2010; 55:701-8.

Diener E, Wirtz D, Tov W, Kim-Prieto C, Choi H, Oishi S, Biswas-Diener R, New measures of well-being: Flourishing and positive and negative feelings. Social Indicators Research` 2009; 39:247-266.

Meara NM, Schmidt LD, Day JD, Principles and Virtues: A foundation for ethical decisions, policies, and character. Counseling Psychologist 1996; 24:4-7.

Cloninger CR, Svrakic DM, Przybeck TR, A psychobiological model of temperament and character. Arch Gen Psychiatry 1993; 50:975-90.

Hagger N. The Rise and Fall of Civilizations. Winchester, UK: O Books/John Hunt Publishing Ltd., 2008.

Cloninger CR, Svrakic DM, Integrative psychobiological approach to psychiatric assessment and treatment. Psychiatry 1997; 60:120-41.

Diener E, Emmons RA, Larsen RJ, Griffin S, The Satisfaction With Life Scale. J Pers Assess 1985; 49:71-5.

Cloninger CR, Svrakic NM, Svrakic DM, Role of personality self-organization in development of mental order and disorder. Dev Psychopathol 1997; 9:881-906.

Staudinger UM, Lindenberger U. Understanding Human Development: Dialogues with Lifespan Psychology. London: Kluwer Academic Publishers, 2003.

Josefsson K, Jokela M, Cloninger CR, Hintsanen M, Salo J, Hintsa T, Pulkki-Raback L, Keltikangas-Jarvinen L, Maturity and Change in Personality: Developmental Trends of Temperament and Character in Adulthood. Development and Psychopathology 2012; in press.

Clark NM, Management of chronic disease by patients. Annu Rev Public Health 2003; 24:289-313.

Clark NM, Dodge JA, Exploring self-efficacy as a predictor of disease management. Health Educ Behav 1999; 26:72-89.

Clark NM, Gong M, Management of chronic disease by practitioners and patients: are we teaching the wrong things? BMJ 2000; 320:572-5.

Rogers CR. On Becoming a Person: A therapist's view of psychotherapy. Boston: Houghton Mifflin, 1995.

Lambert MJ. Bergin and Garfield's Handbook of Psychotherapy and Behavior Change. New York: Wiley, 2003.

Tournier P. The Best of Paul Tournier: Guilt & Grace, The Meaning of Persons, The Person Reborn, To Understand Each Other. New York: Iverson-Norman, 1977.

Mezzich JE, Snaedal J, van Weel C, Botbol M, Salloum I, Introduction to person-centred medicine: from concepts to practice. J Eval Clin Pract 2011; 17:330-2.

Manier E, Ordona T, Cloninger CR. A "Good Lives" Approach to Rehabilitation, In: DeLisi M and Beaver KM, eds. Criminological Theory: A Life-course Approach. Burlington, MA: Jones & Bartlett Publishers, 2012:285-296.

Cloninger CR. Antisocial Personality Disorder: A review, In: Maj M, Akiskal HS, Mezzich JE, and Okasha A, eds. Personality Disorders. Chichester, UK: John Wiley & Sons, 2005:125-200.

Cicchetti D, Rogosch FA, Equifinality and multifinality in developmental psychopatology. Development and Psychopathology 1996; 8:597-600.

Bergman LR, Magnusson D, A person-oriented approach in research on developmental psychopathology. Dev Psychopathol 1997; 9:291-319.

Magnusson D, The person approach: concepts, measurement models, and research strategy. New Dir Child Adolesc Dev 2003:3-23.

Molenaar PC, On the implications of the classical ergodic theorems: analysis of developmental processes has to focus on intra-individual variation. Dev Psychobiol 2008; 50:60-9.

Molenaar PC, Psychological methodology will change profoundly due to the necessity to focus on intra-individual variation. Integr Psychol Behav Sci 2007; 41:35-40; discussion 75-82.

Molenaar PC, Sinclair KO, Rovine MJ, Ram N, Corneal SE, Analyzing developmental processes on an individual level using nonstationary time series modeling. Dev Psychol 2009; 45:260-71.

Waldrop MM. Complexity: The Emerging Science at the Edge of Order and Chaos. New York: Simon & Schuster, 1992.

Wuchty S, Scale-free behavior in protein domain networks. Mol Biol Evol 2001; 18:1694-702.

Crump C, Sundquist K, Winkleby MA, Sundquist J, Comorbidities and Mortality in Bipolar Disorder: A Swedish National Cohort Study. JAMA Psychiatry.

de Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Moller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S, Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011; 10:52-77.

de Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei DM, Newcomer JW, Uwakwe R, Asai I, Moller HJ, Gautam S, Detraux J, Correll CU, Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 2011; 10:138-51.

Colton CW, Manderscheid RW, Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis 2006; 3:A42.

Josefsson K, Cloninger CR, Hintsanen M, Jokela M, Pulkki-Raback L, Keltikangas-Jarvinen L, Associations of personality profiles with various aspects of well-being: a population-based study. J Affect Disord 2011; 133:265-73.

Mezzich JE, Psychiatry for the Person: articulating medicine's science and humanism. World Psychiatry 2007; 6:65-7.