Patients with chronic coronary artery disease, asthma or hypertension often find it difficult to adhere to an exercise or a medication plan to manage their disease. But they can help themselves by cultivating a positive mental attitude and practicing self-affirmation techniques, according to new research from a team of investigators that includes John Allegrante, Deputy Provost and Professor of Health Education at Teachers College.

The findings are detailed in three linked studies, involving 756 patients, published online on January 23 in the Archives of Internal Medicine, one of the journals associated with the Journal of the American Medical Association (JAMA). Allegrante served as co-investigator and senior behavioral scientist and health education specialist on each of the three studies and is a coauthor on the reports. The research was led by Mary E. Charlson, MD, Executive Director of the Center for Integrative Medicine at the Weill Cornell Medical College and the William T. Foley Distinguished Professor of Medicine and professor of integrative medicine at Weill Cornell Medical College, with whom Allegrante has collaborated for over 20 years on NIH-funded investigations. One study, of coronary artery disease patients, was led by Janey C. Peterson, a Teachers College alumna who completed her doctorate under the sponsorship of Professor Allegrante, who is now a faculty member in the Department of Medicine and the Center for Integrated Medicine at Weill Cornell.

Translating findings from psychological research, the three teams of researchers designed and implemented the same intervention approach for all three groups of patients. The participants were encouraged to think of something in their lives that makes them feel good (such as a beautiful sunset) when they arose in the morning and throughout the day. They were also encouraged to use self-affirmation techniques whenever they encountered obstacles to sticking to their health plan – increased physical activity or regularly taking medication – by remembering something in their lives that had made them proud (a graduation, for example). They worked from a script, created by Charlson and the team, which is now in the public domain and free to use. (See an excerpt from the script below)

Results were measured at the completion of the year-long studies. For coronary artery disease patients, 55 percent who practiced a positive attitude, or “affect,” and self-affirmations increased their physical activity compared with 37 percent in the control group; the positive affect group walked an average of 3.4 miles a week more than the control group. In the same study of African-Americans with high blood pressure, 42 percent of the positive affirmation group adhered to their medication plan compared with 36 percent in the control group. There was no difference in energy expenditure between the two groups of asthma patients; however, there was some benefit for patients requiring medical care during the trial. The subjects were randomly assigned to the positive affect group or the control group and telephoned every two months by the research team.

Writing in a commentary that accompanied publication of the three studies, Geoffrey C. Williams, MD, PhD, and Christopher P. Niemiec, PhD, from the University of Rochester, called the studies “…the first (to our knowledge) to show a salubrious effect of induced positive affect on sustained behavioral change in a clinical population.” 

“This work builds on the growing body of evidence that links emotional and physical health,” said Allegrante. “More importantly, it suggests that doctors have an important role to play in supporting patients’ emotional well-being and focusing on helping their patients to be positive – something that physician training has not always sufficiently emphasized – and provides tools that can help them do so.”

The studies were funded by the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH). Among the first for NIH-funded research, this intervention approach is now being more broadly used in the obesity-related behavioral intervention trials (ORBIT) sponsored by the NIH. The published studies, along with accompanying editorial and commentary, can be found online at the Archives of Internal Medicine: http://archinte.ama-assn.org/

Excerpt from Positive Affect/Self-Affirmation Script

First, when you get up in the morning, think about the small things that you said make you feel good, like babies in hats, or the sunrise. Then as you go through your day, notice those and other small things that make you feel good and take a moment to enjoy them. Second, when you encounter some difficulties or are in a situation that makes it hard for you (e.g., taking your blood pressure medications or exercising), think about things you enjoy or proud moments in your life, like a graduation, success of a child.

Published Monday, Jan. 30, 2012