Taking Care of You: Body, Mind, Spirit—A Unique Stress Management Program That Improves Lifestyle Behaviors

Introduction

The effects of stress on our physical and mental health are well-known. Not only is there a direct relationship between the effects of stress on the health of our body and mind, but stress also negatively influences our health behaviors.

Research shows that stress causes (American Psychological Association, 2008; American Psychological Association, 2009; Cohen, Janicki-Deverts, & Miller, 2007; Ng & Jeffery, 2008; Roohafza et al., 2007):

• Poor food choices
• Sedentary behaviors
• Increased use of alcohol
• Falling short on planned physical activity
• Smokers to smoke more and to be less likely to quit

Furthermore, people report stress as a barrier to improving their health behaviors (American Psychological Association, 2009). As a result, stress is a major contributor to lifestyle-related chronic conditions, conditions that are the leading causes of death in the United States and major drivers of increasing health care costs (Fuduko & Morimoto, 2001; Xu, Kenneth, Murphy, & Tejada-Vera, 2007).

While a multitude of stress management programs with a wide range of approaches exists, mindfulness-based stress management programs are the one type that consistently displays evidence of effectiveness. Evaluations show they significantly reduce stress levels and improve physiological and psychological health markers (Murphy, 1996; Grossman, Niemann, Schmidt, & Walach, 2004; Richardson & Rothstein, 2008). However, only a limited number of stress management programs address, much less provided evidence of, improving lifestyle behaviors (Evers & Prochaska, 2006; Hughes & Fetsch, 2008; Katzer et al., 2008; Timmerman, Emmelkamp, & Sanderman, 1998; Rosenzweig et al., 2007).

University of Missouri Extension (UME) set out to develop a mindfulness-based stress management program that would resonate well with adults living in rural areas and effectively decrease stress levels and improve lifestyle behaviors.

Program Description

The Taking Care of You: Body-Mind-Spirit program takes a unique approach to integrating both mindfulness and a variety of other research-based positive psychology concepts and strategies (e.g., appreciation, hope, forgiveness, joy) as well as holistic wellness concepts. Program content and format was carefully selected to ensure its acceptance at workplaces, faith-based centers, and other community-based settings. Through group experiential activities, self-reflection, and mini-lectures interspersed with large and small group discussions, the program teaches participants very practical research-based techniques easily incorporated into their busy everyday lives.

The program's content was selected to improve participants' stress management skills and increase positive thoughts and emotions; a secondary aim was to indirectly improve participants' health behaviors by teaching participants how to better take care of themselves, including body, mind and spirit. See extension.missouri.edu/takingcare and Table 1 below for more program details.

Taking Care of You: Body-Mind-Spirit is appropriate for adults of any age and has shown success in rural, urban, and suburban areas throughout the state of Missouri. The program is facilitated by UME Extension field faculty with expertise in health education or human development. It is delivered through eight, 1-hour weekly, sessions in groups of 10-20 participants in various types of worksites and community settings such as community centers, county-based UME offices, and churches.

Evaluation

A pilot evaluation of Taking Care of You: Body-Mind-Spirit was conducted with eight trained facilitators, who taught 18, 8-week programs from fall 2009 through summer 2010, reaching over 200 participants with an overall attrition rate of 11.7%. Pilot program participants were 75% female and 92% Caucasian; the majority were of working age (90% aged 25-64); and 75% were employed full-time.

The evaluation assessed changes in participants' perceived stress levels and lifestyle behaviors compared to an UME exercise program, which was delivered in a similar format (10 weekly, 1-hour, sessions). Both programs were facilitated by Extension field faculty throughout the state. Participants in both programs completed surveys at the start (time 0) (n = 477), immediately following (time 1) (n = 390) and three months following (time 2) (n = 299) the program. Surveys at each time point assessed participants' stress levels using the Perceived Stress Scale (Cohen & Williamson, 1988) and lifestyle behaviors using the Health Promoting Lifestyle Profile II (Walker, Sechrist, & Pender, 1987), which assessed nutrition, physical activity, health responsibility, stress management, and social health and spiritual health. Repeated measures analyses of covariance assessed changes across time points, between and within the two program groups, for each of the outcome measures.

Both programs showed reduced stress levels and improved lifestyle behaviors. However, across the three time-points the Taking Care of You participants showed significantly greater reductions in stress levels and significantly greater improvements in lifestyle behaviors, specifically nutrition, health responsibility, and stress management behaviors. Physical activity behaviors improved within both groups equally. This result is noteworthy because physical activity was the focus of the exercise program, whereas the Taking Care of You program did not include exercise. Overall, participants of both programs significantly maintained reductions in stress levels and improvements in lifestyle behaviors after the programs ended.

Discussion & Future Plans

The pilot evaluation provides evidence that Taking Care of You is a viable program for assisting people in not only reducing their stress levels, but also making and sustaining lifestyle behaviors changes. Despite the robust connection between stress and unhealthy lifestyle behaviors, few health education programs focus on managing stress as a means of improving lifestyle behaviors (e.g., Richardson & Rothstein, 2008). Because of this connection, Extension professionals working in the area of health behavior change should address individuals' ability to manage and cope with life's challenges and stressors as a means to improving health behaviors.

Based on the pilot program evaluation, the Taking Care of You program was modified slightly. Since the pilot, 45 field faculty have been trained to facilitate the program throughout the state. The program is currently being expanded to health professionals (i.e., nurses, physicians, dietitians, psychologists) to facilitate the program in clinics as well as share concepts and strategies of the program within one-on-one interactions with patients. In addition to stress levels and lifestyle behaviors, the program plans to evaluate absenteeism and work engagement in programs occurring at worksites and in clinical measures (e.g., blood pressure, weight) for those programs conducted in clinical settings.

Acknowledgements

University of Missouri Institutional Review Board approved the research conducted to evaluate this program. To obtain more information about the program, including facilitator materials, please contact Molly Vetter-Smith, University of Missouri Extension, vettersmithm@missouri.edu.

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