1. CARING FOR YOUR WHOLE SELF Strategies to Optimize Well-Being
Anna Stecher, MD

2. Well-Being
So what is health?

3. Health?
So what is health?

4. Absence of illness?
Is it the absence of illness? A lot of my medical training would have me think so. In medicine, we call that “pathogenesis,” the development of disease. But is lack of disease really what makes wellness? I think most of you would tell me that is a part of it, but that is not the whole story. And that rather wellness being the absence of illness, there is a entire spectrum beyond illness that actually determines your wellbeing.

5. PATHOGENESIS SALUTOGENESIS
Aaron Antonovsky, a professor of Medical Sociology, suggested it is not a dichotomy between health and illness. He coined the term salutogenesis, and suggested there is a spectrum between pathogenesis and salutogenesis. Now, if you are like me, I had never heard the term salutogenesis before preparing for this presentation, despite studying health for the last 12 years of my life. And although I could use context clues to figure out that it was related to wellness, I looked it up and found that salutogenesis is a focus on the factors that support health and well-being, rather than focusing solely on the factors that influence disease.

6. PATHOGENESIS SALUTOGENESIS
It suggests that you can have no disease or illness and yet not have any true well-being.

7. PATHOGENESIS SALUTOGENESIS
And because there are so many types of wellness, which we’ll talk about in a few minutes, there is probably some sort of overlap.
Because we know that there are many factors that play into one’s sense of well-being.

8. PATHOGENESIS
SALUTOGENESIS

9. 10 9 8 7 6 5 4 3 2 1
Now before we talk about all of the things that make up well-being, I want you to do an exercise with me as a way to get us all to start thinking about our own well-being. I want you to think of this ladder as a way of picturing your life. The top of the ladder represents the best possible life FOR YOU, and the bottom rung represents the worst possible life FOR YOU. Think about your life right now and decide where you fall on that ladder.
Now think about where you expect to fall in 5 years.

10. Self-Anchoring Strive Scale
Cantril
Self-Anchoring Strive Scale
(Hadley Cantril, 1965) 10 9 8 7 6 5 4 3 2 1
Does everyone have their answers in their minds?
This is called the Cantril Self-Anchoring Strive Scale, and it was developed in 1965 and it has been used since that time as a measure of well-being on an international level.
If you answered 7 or above as your first answer (where your life is right now), and if you answered 8 or above for your second answer (where you expect to be in 5 years), you fall into the category of THRIVING. People who are THRIVING have significantly fewer health problems, fewer sick days, less worry, less stress, less anger, more enjoyment and respect.
If you answered 4 or below to both questions, you fall into the category of SUFFERING. These people are more likely to lack basic needs such as food and shelter, more likely to have health issues, stress, sadness, anger, and more than double the disease burden of those who are thriving.
If you did not fall into either of those categories, you are described as STRUGGLING, which means well-being that is moderate or inconsistent. These people have more moderate views of their present life or of the future, and have more worry. More likely to be smokers and less likely to eat healthy.
And is it really important to note that as I describe the common things about people in these categories, there is no clear cause or effect. For example, in the struggling category are more likely to smoke and less likely to eat healthy. Do they eat less healthy because it is harder for them to access healthy food? Or is the fact that they eat less healthy making them

11. PATHOGENESIS
SALUTOGENESIS

12. Aaron Antonovsky Pathogenesis-Salutogenesis Spectrum
Developed theory while studying stress and effects on health
29% of women who survived concentration camps had positive emotional health (compared to 51% of control group) – they had NOT been emotionally impaired by their experiences
So then he began to look at what factor, what quality, what magic, what is it that can allow some people to go through something as terrible as living in a concentration camp, and still come out on the other side with positive well-being. AND, although I hope none of us ever face anything as terrible as a concentration camp, he theorized that this is the same factor that allows some people to thrive in the face of stress, while others suffer.
He called this factor the Sense of Coherence.

13. Aaron Antonovsky Sense of Coherence
Explanation for the role of stress in human functioning
What determines whether stress will cause you harm is whether or not the stress violates your sense of coherence
Global orientation that expresses the extent to which one has a pervasive, enduring feeling of confidence that:
The stimuli from one's internal and external environments in the course of living are structured, predictable and explicable
Resources are available to meet the demands posed by these stimuli
Demands are challenges, worthy of investment and engagement
In other words, one’s sense of coherence could be called the sense one has that they or those who support them (relationships, spiritual, etc) are able to handle the stressors.

14. Aaron Antonovsky Sense of Coherence
Explanation for the role of stress in human functioning
What determines whether stress will cause you harm is whether or not the stress violates your sense of coherence
Global orientation that expresses the extent to which one has a pervasive, enduring feeling of confidence that:
The stimuli from one's internal and external environments in the course of living are structured, predictable and explicable
Resources are available to meet the demands posed by these stimuli
Demands are challenges, worthy of investment and engagement
In other words, one’s sense of coherence could be called the sense one has that they or those who support them (relationships, spiritual, etc) are able to handle the stressors.
Comprehensibility

15. Aaron Antonovsky Sense of Coherence
Explanation for the role of stress in human functioning
What determines whether stress will cause you harm is whether or not the stress violates your sense of coherence
Global orientation that expresses the extent to which one has a pervasive, enduring feeling of confidence that:
The stimuli from one's internal and external environments in the course of living are structured, predictable and explicable
Resources are available to meet the demands posed by these stimuli
Demands are challenges, worthy of investment and engagement
In other words, one’s sense of coherence could be called the sense one has that they or those who support them (relationships, spiritual, etc) are able to handle the stressors.
Comprehensibility
Manageability

16. Aaron Antonovsky Sense of Coherence
Explanation for the role of stress in human functioning
What determines whether stress will cause you harm is whether or not the stress violates your sense of coherence
Global orientation that expresses the extent to which one has a pervasive, enduring feeling of confidence that:
The stimuli from one's internal and external environments in the course of living are structured, predictable and explicable
Resources are available to meet the demands posed by these stimuli
Demands are challenges, worthy of investment and engagement
In other words, one’s sense of coherence could be called the sense one has that they or those who support them (relationships, spiritual, etc) are able to handle it.
Comprehensibility
Manageability
Meaningfulness

17. What are the factors that foster a strong sense of coherence?

18. What factors make up well-being?
Things that make up well-being…

19. Wheel of Wellness. https://i. pinimg

20. Even if you have excellent well-being in some or even most areas, you really need to maintain well-being in each area. Because if you don’t, you end up with this…
Wheel of Wellness.

21. A flat tire.
And what does a flat tire do?
You can’t steer straight with a flat tire.
You can’t go quickly with a flat tire.
It leads to accidents and injuries.
You do not get to your destination.

22. Social/Relational Wellness
Relationships
Respect
Community Interactions
How we connect and communicate with those who surround us

23. Social/Relational Wellness
Make time each day to be with family, either in person or over phone/FaceTime.
Arrange a day out with friends you haven't seen for a while.
Talk to someone new
Volunteer
Strive for in- person interactions, not via social media

24. Gallup. World Happiness Report. http://worldhappiness

25. Occupational Wellness
Fulfillment in your occupation
Skills
Balance
Satisfaction
Finances

26. Occupational Wellness
Important part of well-being.
Gallup polls show a substantial drop in sense of well-being during working days.
Only 12% of people answered positively to the question “I have a substantially higher overall sense of well-being because of the employer I work for today.”
What is important regarding well-being in career?
Sense of skill and accomplishment at job
Fairness, appreciation, and teamwork nurtured by boss

27. Occupational Wellness
Look for and remember your purpose. What inspired you to pursue this field?
Learn new skills
Cultivate work/life balance
Optimize your work environment (e.g. plants, opportunities for exercise during work day, ergonomics)

28. Financial Wellness Ability to meet needs/wants
Healthy relationship with money

29. Financial Wellness Budget Set goals Hire a financial planner
Donations/generosity
Release of endorphins
Linked to increased happiness (Soyoung et al. 2016)
Generosity linked to improved cardiovascular health (Whillans et al. 2016)
Being generous has been found to actually increase activity in the ventral striatum, a part of the brain that modulates happiness. It has also be shown to be linked to better heart health.
Health Psychol Jun;35(6): doi: /hea Epub 2016 Feb 11.
Is spending money on others good for your heart?
Whillans AV1, Dunn EW1, Sandstrom GM1, Dickerson SS2, Madden KM3.
Those who were instructed to spend money on others had a statistically significantly drop in blood pressure

30. Emotional Wellness Feelings Emotions Reactions
The ability to handle your emotions constructively

31. Emotional Wellness Stop complaining. Be intentional about optimism.
Take time for yourself. Take time to be mindful.

32. Physical Wellness
Nutrition
Activity
Sexual
Environmental

33. Physical Wellness Exercise Nutrition Healthy Lifestyle
Taking control of your health by making consciously healthy decisions
Psychological benefits:
Adults who are physically active are less likely to develop depression (Strawbridge et al. 2002)
Exercise is as effective as cognitive behavioral therapy in the treatment of depression (Freemont & Craighead. 1987)
Longitudinal studies show that adults that are physically active are less likely to develop depression (Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA. Physical activity reduces the risk of subsequent depression in older adults. Am J Epidemiol 2002; 156: 328–34)
Exercise is as effective as cognitive therapy and counseling in the treatment of depression (Freemont J, Craighead LW. Aerobic exercise and cognitive therapy in the treatment of dysphoric moods. Cogn Ther Res 1987; 2: 241–251; Harris DV. Comparative effectiveness of running therapy and psychotherapy. Exercise and mental health, WP Morgan, SE Goldston. Hemisphere, Washington, DC 1987; 123–30)

34. Spiritual Wellness
Values and Morals
Finding purpose in life
Those who have a “why” to live, can bear almost any “how.”
Vikter Frankl (1905 – 1995, neurologist and psychiatrist)
Frankl was a holocaust survivor

35. Spiritual Wellness Prayer Meditation Reading spiritual texts
Practicing the tenets of faith – love, generosity, grace

36. Intellectual Wellness
Creativity
Critical thinking
Curiosity
Lifelong learner

37. Intellectual Wellness
Learn something new
Visit a museum or art gallery
Read a new book
Tackle a do-it-yourself project
Sign up for a class
Learn a new hobby

38. How are you going to improve YOUR well-being?

39. Questions?