Ruth Q Wolever

Vanderbilt University | Vander Bilt · Department of Physical Medicine and Rehabilitation

Objetivo: El bajo Neuroticismo, la alta Extraversión y el alto nivel de Conciencia están relacionados con la actividad física (PA, por sus siglas en inglés). Probamos si el tamaño pequeño y la heterogeneidad de estas relaciones se deben a que los rasgos de personalidad se influyen entre sí, así como a que las facetas estrechas, en lugar de los domi...

Background As the popularity and demonstrated effectiveness of Health and Wellness Coaching (HWC) continue to grow to address chronic disease prevalence worldwide, delivery of this approach in a group format is gaining traction, particularly in healthcare. Nonetheless, very little empirical work exists on group coaching and there are currently no p...

Objective: Accessible interventions are needed to prevent coronary heart disease (CHD) and Type 2 diabetes (T2D). This prospective, randomized, controlled trial evaluated remote health coaching (HC), genetic risk testing (GRT), or both added to standardized risk assessment (SRA) in at-risk military primary care patients. Method: Using a 2 × 2 fa...

Background: The randomized clinical trial is generally considered the most rigorous study design for evaluating overall intervention effects. Due to patient heterogeneity, subgroup analysis is often used to identify differential intervention effects. In research of behavioral interventions, such subgroups often depend on a latent construct measure...

Background Network analysis provides a new method for conceptualizing interconnections among psychological and behavioral constructs. Objective We used network analysis to investigate the complex associations between depressive symptoms and patient activation dimensions among patients at elevated risk of cardiovascular disease. Methods This secon...

Background Despite numerous gaps in the literature, mindfulness training in the workplace is rapidly proliferating. Many “online” or “digital mindfulness” programs do not distinguish between live teaching and recorded or asynchronous sessions, yet differences in delivery mode (eg, face-to-face, online live, online self-guided, other) may explain ou...

BACKGROUND Despite numerous gaps in the literature, mindfulness training in the workplace is rapidly proliferating. Many “online” or “digital mindfulness” programs do not distinguish between live teaching and recorded or asynchronous sessions, yet differences in delivery mode (eg, face-to-face, online live, online self-guided, other) may explain ou...

The concept of frailty as it pertains to aging, health and well-being is poorly understood by older adults and the public-at-large. We developed an aging and frailty education tool designed to improve layperson understanding of frailty and promote behavior change to prevent and/or delay frailty. We subsequently tested the education tool among adult...

Although mindfulness-based stress reduction (MBSR) can improve health and well-being, less is known about factors that predict outcomes. This prospective observational study examined gender and baseline anxiety and sleep quality as predictors of change in emotion regulation and stress symptoms following an 8-week MBSR program. Women and men reporte...

Objective Describe the two-phase validation process for a taxonomy of skills learned through mindfulness practice. Methods Phase I (development) utilized 11 subject matter experts (SMEs) over 5 months. Phase II (judgment) enrolled 60 international SMEs from 116 invited through snowball sampling. They were mostly white (80%) or Asian (15%) women (7...

Background: While recent health-care trends rely on activated patients, few studies report direct observations of how to engage and activate patients to be full participants in their own health care. The interpersonal processes and communication strategies used in integrative health coaching (IHC) may offer important insight into how clinicians ca...

Cancer patients often experience poor quality of life (QoL) during chemotherapy (CT) treatments due to side effects including fatigue, insomnia, pain and nausea/vomiting. Mindfulness-based cancer recovery (MBCR) is an evidence-based intervention for treating such symptoms, but has not been investigated as an adjunctive treatment during CT. This stu...

Objectives Following the British Medical Research Council recommendations for pilot trials, this study aims to increase experience with a complex integrative medicine (IM) intervention in a randomized controlled design to assess the feasibility for studying this intervention in a larger trial. Specific objectives are to: 1) assess the feasibility o...

Background: Integrative health is an expanding field that is increasingly called upon by conventional medicine to provide care for patients with chronic pain and disease. Although evidence has mounted for delivering integrative therapies individually, there is little consensus on how best to deliver these therapies in tandem as part of whole perso...

Background and purpose Trauma is highly prevalent, with estimates that up to 90% of the U.S. population have been exposed to a traumatic event. The adverse health consequences of trauma exposure are diverse and often long-lasting. While expressive writing has been shown to improve emotional and physical health in numerous populations, the feasibili...

Mindfulness-Based Stress Reduction (MBSR) is an 8-week meditation program known to improve anxiety, depression, and psychological well-being. Other health-related effects, such as sleep quality, are less well established, as are the psychological processes associated with therapeutic change. This prospective, observational study aimed to determine...

Objective Mindfulness-informed cognitive behavioral interventions for obesity are promising. However, results on the efficacy of such treatments are inconsistent which in part may be due to their substantially different methods of practice. This study is the first direct comparison of two theoretically distinct mindfulness-based weight loss approac...

Until system reforms allow adequate time and reimbursement for primary care providers to focus on lifestyle change to prevent and mitigate chronic disease, primary care providers need a manageable, defined role to support lifestyle change. The authors suggest this role is to serve as a catalyst, priming the patient for change; educating and pointin...

Integrative health modalities can provide useful tools in the management of persistent pain in the primary care setting. These modalities, such as acupuncture, mind-body medicine, diet and herbs, and movement strategies can be safely used and may provide patients with hope and empowerment. It is highly recommended that the patient work alongside tr...

Background Obesity is a significant public health issue with no consensus regarding optimal medical management. Integrative medicine (IM) may help to fill this gap. Objectives (1) To characterize the sociodemographics, psychosocial functioning, health behaviors, and current medical conditions across BMI classifications in patients seeking IM; and...

The purpose of this study was to describe the lived experiences of adult clients who sought Integrative Health Coaching (IHC) to address a chronic health condition. Moustakas’ phenomenological approach was applied to engage nine participants in recorded in-depth interviews and photo-elicitation interviews. Analysis revealed the essence of participa...

Objective and methods: Research supports relationships between stress and gastrointestinal (GI) symptoms and disorders. This pilot study assesses relationships between perceived stress, quality of life (QOL), and self-reported pain ratings as an indicator of symptom management in patients who self-reported gastroesophageal reflux disease (GERD), i...

Background The pressing need to manage burgeoning chronic disease has led to the emergence of job roles such as health and wellness coaches (HWCs). As use of this title has increased dramatically, so has the need to ensure consistency, quality and safety for health and wellness coaching (HWC) provided in both practice and research. Clear and unifor...

Purpose: Participants completing an RCT of massage therapy for OA knee pain were invited to complete the Post-Intervention Survey (PIS), a brief questionnaire about massage-seeking behavior since study completion. Since no validated instrument existed for this purpose, the PIS was developed and used to collect participants' opinions regarding willi...

Objective Medication adherence requires underlying behavior skills and a supporting mindset that may not be addressed with education or reminders. Founded in the study of internal motivation and health psychology, integrative health coaching (IHC) helps patients gain insight into their behaviors and make long-term, sustainable lifestyle changes. Th...

Obesity is increasingly prevalent in the industrialized world. Obese workers have two times the number of workers’ compensation claims as those of non-obese workers. Worksite interventions may be especially effective because employees spend a large part of their day in the work environment, and both employee and employer have incentives to improve...

Background: Integrative medicine (IM) provides patient-centered care and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person's health. IM is a "whole systems" approach that employs multiple modalities as opposed to an isolated complementary therapy. Thus, studying outcomes o...

Research suggests that the development of mind-body skills can improve individual and family resilience, particularly related to the stresses of illness, trauma, and caregiving. To operationalize the research evidence that mind-body skills help with health and recovery, Samueli Institute, in partnership with experts in mind-body programming, create...

Tinnitus is a prevalent and costly chronic condition; no universally effective treatment exists. Only 20% of patients who report tinnitus actually seek treatment, and when treated, most patients commonly receive sound-based and educational (SBE) therapy. Additional treatment options are necessary, however, for nonauditory aspects of tinnitus (e.g.,...

The purpose of this article is twofold: (1) to announce the findings of the job task analysis as well as national training and education standards for health and wellness coaching (HWC) that have been developed by the large-scale, collaborative efforts of the National Consortium for Credentialing Health and Wellness Coaches (NCCHWC) and (2) to invi...

Integrative medicine (IM) is a rapidly growing field whose providers report clinical success in treating significant stress, chronic pain, and depressive and anxiety symptoms. While IM therapies have demonstrated efficacy for numerous medical conditions, IM for psychological symptoms has been slower to gain recognition in the medical community. Thi...

Objective: Mindfulness-based stress reduction (MBSR) is a secular meditation training program that reduces depressive symptoms. Little is known, however, about the degree to which a participant's spiritual and religious background, or other demographic characteristics associated with risk for depression, may affect the effectiveness of MBSR. There...

Obesity affects more than one-third of American adults and has recently been recognized as a disease by the American Medical Association. Interventions that incorporate mindfulness meditation, with a goal of increasing self-regulation, are well suited to the complexities of the behavioral, physiological, emotional, and cognitive dysregulation obser...

Objective: To assess psychosocial characteristics, symptoms and reasons for seeking integrative medicine (IM) care in cancer patients presenting to IM clinical practices. Study design and methods: A survey of 3940 patients was conducted at 8 IM sites. Patient reported outcome measures were collected and clinicians provided health status data. Th...

The role of patient engagement as an important risk factor for healthcare outcomes has not been well established. The objective of this article was to systematically review the relationship between patient engagement and health outcomes in chronic disease to determine whether patient engagement should be quantified as an important risk factor in he...

Cardiac rehabilitation (CR) has been shown to reduce cardiac risk and improve the psychosocial functioning of participants. This study examines gender differences on several psychosocial indicators across the course of CR. Patients (N = 380; 67.9% men and 32.1% women) referred from local inpatient and outpatient settings at a southeastern US academ...

Focus Area: Integrative Approaches to Care Tinnitus is a common problem for which there is no universally effective treatment. The best available estimates indicate that 10% to 15% of adults report having tinnitus symptoms, but only 20% of those who report tinnitus suffer from it and subsequently seek treatment. Individuals with persistent severe t...

The rise of health and wellness coaching holds significant promise for facilitating sustainable behavior change to help legions of individuals prevent and manage chronic disease. We all know the threats associated with the staggering epidemic of chronic disease and associated unhealthy lifestyles. But did we get here through a failure of personal r...

As rates of preventable chronic diseases and associated costs continue to rise, there has been increasing focus on strategies to support behavior change in healthcare. Health coaching and motivational interviewing are synergistic but distinct approaches that can be effectively employed to achieve this end. However, there is some confusion in the li...

Review the operational definitions of health and wellness coaching as published in the peer-reviewed medical literature. As global rates of preventable chronic diseases have reached epidemic proportions, there has been an increased focus on strategies to improve health behaviors and associated outcomes. One such strategy, health and wellness coachi...

Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a numb...

Binge eating is characterized by significant imbalance in food intake regulation and is often comorbid with obesity and depression. Mindfulness-based approaches may reduce compulsive overeating, address associated behavioral and emotional dysregulation, and promote internalization of change. This randomized trial explored the efficacy of Mindfulnes...

Type 2 diabetes (T2D) and coronary heart disease (CHD) are prevalent chronic diseases from which military personnel are not exempt. While many genetic markers for these diseases have been identified, the clinical utility of genetic risk testing for multifactorial diseases such as these has not been established. The need for a behavioral interventio...

Emerging healthcare delivery models suggest that patients benefit from being engaged in their care. Integrative health coaching (IHC) is designed to be a systematic, collaborative, and solution-focused process that facilitates the enhancement of life experience and goal attainment regarding health, but little research is available to describe the m...

To describe the evolution, training, and results of an emerging allied health profession skilled in eliciting sustainable health-related behavior change and charged with improving patient engagement. Through techniques sourced from humanistic and positive psychology, solution-focused and mindfulness-based therapies, and leadership coaching, Integra...

There is great need for cost effective approaches to increase patient engagement and improve health and well-being. Health and wellness coaching has recently demonstrated great promise, but the majority of studies to date have focused on individual coaching (ie, one coach with one client). Newer initiatives are bringing a group coaching model from...

Despite the tremendous growth of integrative medicine (IM) in clinical settings, IM has not been well characterized in the medical literature. To describe characteristics and motivation of patients seeking care at an IM clinic. Patients from a nine-site practice-based research network participated in this cross-sectional survey. Clinicians document...

Counselors may encounter clients who wish to make such lifestyle changes as healthy eating and weight management. Mindfulness, defined here as the practice of nonjudgmentally attending to the present moment while monitoring reactivity, has been adapted for use in treating many self-regulation disorders; mindfulness-based eating approaches support i...

Purpose Highly stressed employees are subject to greater health risks, costs, and productivity losses than those with normal stress levels. To address this issue, work-site stress management programs must be able to engage individuals as well as capture data on stress, health indices, work productivity , and healthcare costs. In this randomized con...

Highly stressed employees are subject to greater health risks, increased cost, and productivity losses than those with normal stress levels. To address this issue in an evidence-based manner, worksite stress management programs must be able to engage individuals as well as capture data on stress, health indices, work productivity, and health care c...

Correspondence: Dr Wolever, Psychiatry and Behavioral Sciences, Duke University Medical Center, PO Box 102904, Durham, NC 27710 (ruth.wolever@duke.edu).Published Online: October 10, 2011. doi:10.1001/archinternmed.2011.508Financial Disclosure: None reported.1 +Eakin EG, Lawler SP, Vandelanotte C, Owen N.Telephone interventions for physical activity...

Stroke, diabetes, and coronary heart disease (CHD) remain leading causes of death in the United States and are largely attributable to lifestyle behaviors. Integrative medicine can provide a supportive partnership that focuses on improving health by identifying and implementing lifestyle changes based upon personal values and goals. This prospectiv...

Mindfulness-Based Stress Reduction is a secular behavioral medicine program that has roots in meditative spiritual practices. Thus, spirituality may partly explain Mindfulness-Based Stress Reduction outcomes. Participants (N = 279; M (SD) age = 45(12); 75% women) completed an online survey before and after an 8-week Mindfulness-Based Stress Reducti...

The aim of this study was to describe integrative health (IH) coaching as developed in three different interventions offered through a major medical center, as a step toward further defining the field of health coaching. An organizational case study was conducted with document analysis and interviews. Interviewees were the first six IH coaches at D...

This paper reviews the conceptual foundation of mindfulness-based eating awareness training (MB-EAT). It provides an overview of key therapeutic components as well as a brief review of current research. MB-EAT is a group intervention that was developed for treatment of binge eating disorder (BED) and related issues. BED is marked by emotional, beha...

The purpose of this study was to evaluate the effectiveness of integrative health (IH) coaching on psychosocial factors, behavior change, and glycemic control in patients with type 2 diabetes. Fifty-six patients with type 2 diabetes were randomized to either 6 months of IH coaching or usual care (control group). Coaching was conducted by telephone...

The ASK-20 survey is a previously validated patient-report measure of barriers to medication adherence and adherence-related behavior. To derive and validate a shorter version of the ASK-20 scale. Patients with asthma, diabetes, and congestive heart failure were recruited from a university medical center. Participants completed the ASK-20 survey an...

Eating disorders (ED) are complex multidimensional behavioral syndromes characterized by pervasive core deficits in the self-regulation of food intake, affect, and cognition (Dalle Grave, Di Pauli, Sartirana, Calugi, & Shafran, 2007; Deaver, Miltenberger, Smyth, Meidinger & Crosby, 2003; Shafran, Teachman, Kerry, & Rachman, 1999; Spoor, Bekker, Van...

This study examined the psychometric properties of the ASK-20 questionnaire, which was developed to assess barriers to medication adherence. Patients with asthma, diabetes, and congestive heart failure were recruited from a university medical center. Participants in this convenience sample completed the ASK-20 questionnaire and other questionnaires...

Five psychosocial risk factors have been consistently linked with the development of heart disease and worse prognosis for those with the disease (1,2): depression, anxiety, social isolation, hostility, and unmanaged stress. Leaders in the field of behavioral cardiology group these psychosocial risk factors into emotional factors (depression, anxie...

Integrative medicine is an individualized, patient-centered approach to health, combining a whole-person model with evidence-based medicine. Interventions based in integrative medicine theory have not been tested as cardiovascular risk-reduction strategies. Our objective was to determine whether personalized health planning (PHP), an intervention b...

This chapter discusses the treatment for eating disorders. The Diagnostic and Statistical Manual of Mental Disorders recognizes two primary eating disorders: anorexia nervosa (AN) and bulimia nervosa (BN). It also includes binge eating disorder (BED), sub threshold versions of AN and BN, and other disordered eating patterns. The most widely researc...