Wellness

 

 

Dr. Jane Myers, University of North Carolina at Greensboro, is co-author of one theoretical model of wellness (Sweeney & Witmer, 1991; Witmer & Sweeney, 1992; Myers, Sweeney, & Witmer, 2000) and two evidence-based models of wellness (Myers, Luecht, & Sweeney, 2003; Myers & Sweeney, 2003; Sweeney & Myers, 2003) and assessment instruments based on these models. She teaches a course on wellness and is an advocate for wellness lifestyles for her students and others, of all ages across the lifespan. She both conducts and assists other researchers in conducting studies of wellness for diverse populations. Dr. Myers lectures, consults, and conducts research nationally and internationally on issues related to counseling, aging, and wellness.

 

The following information includes a definition of wellness, summary of two models of wellness, overview of wellness assessment instruments, and summary of research on the models and instruments.

 

Wellness Definition

 

Wellness refers to a holistic approach in which mind, body, and spirit are integrated. It is a way of life oriented toward optimal health and well-being in which body, mind, and spirit are integrated in a purposeful manner with a goal of living life more fully (Myers, Sweeney, & Witmer, 2000). Wellness is more than the absence of disease, a state defined as “health,” and incorporates a concern for optimal functioning.

 

Wellness in Counseling

Wellness has been variously defined as a new paradigm in health care (Larson, 1999), a strengths-based approach to mental health care (Smith, 2001), and as the paradigm for counseling and development (Myers, 1992). Over the past two decades, a variety of models of wellness have been proposed, the earliest ones being based in the physical health professions (e.g., Hettler, 1984; Ardell, 1977), and the most recent reflecting correlates of psychological well-being identified through the positive psychology movement (Seligman, 2002; Snyder & Lopez, 2001).

 

Three current models are based in counseling theory, the first being the Wheel of Wellness, first introduced in the early 1990s (Sweeney & Witmer, 1991; Witmer & Sweeney, 1992) and later modified to incorporate new findings relative to issues of diversity and self direction (Myers, Sweeney, & Witmer, 2000). As was true of earlier models, the Wheel model evolved from an examination of the existing knowledge base relative to components of wellness.

 

Research using the Wheel model and an assessment instrument based on that model, the Wellness Evaluation of Lifestyle, led to the development of a new model, the Indivisible Self, based on exploratory and confirmatory analyses of a large data base. This model includes a three-levl factor structure, with one higher order wellness factor, five second order factors of the self, and 17 third order factors. The components of the model are assessed with the Five Factor Wel Inventory.

 

Further analyses with a revised instrument led to another model, currently under development, which we call the Four Factor Wellness Model. This model will have the advantage of providing a reliable and brief screening measure for total wellness and the major factors of body, mind, and spirit; however, it will have the disadvantage of not providing the breadth of information for facilitating clinical change that is found in the Five Factor model.

 

 

Three Wellness Models

Based in Adlerian Counseling Theory

 (click on model to enlarge)

 

 

 

 

 

 

 

 

 

 

 

The Wheel of Wellness: A Theoretical Model

 

            …….including 17 discrete Factors of wellness……

           

The Wheel of Wellness model, first introduced by Sweeney and Witmer in 1991 and Witmer & Sweeney in1992 was the first theoretical model of wellness based in counseling theory. It is an integrative model based on Adler’s Individual Psychology and cross- disciplinary research on characteristics of healthy people who live longer and with a higher quality of life. The Wheel includes five interrelated life tasks: spirituality, self-direction, work and leisure, friendship, and love. When first proposed, the model included 7 subtasks of self-direction. Incorporating new research, Myers, Sweeney, and Witmer (2000; Figure 1) presented the Wheel with 12 subtasks in this area: sense of worth, sense of control, realistic beliefs, emotional awareness and management, problem solving and creativity, sense of humor, nutrition, exercise, self‑care, stress management, gender identity, and cultural identity.

 

The Wheel is conceptualized as a circumplex, with spirituality at the core as the central and most important characteristic of a healthy person. The tasks of self-direction are conceptualized as functioning similar to spokes in a wheel—that is, they provide the self-management necessary to meet successfully the requirements of Adler's major life tasks, work, friendship, and love, as well as spirituality and self (Mosak & Dreikurs, 1967). The components of individual wellness described all operate within the contexts of family, community, government, media, business and industry, education, and religion. In addition, global events influence individual wellness.

 

The components of the Wheel of Wellness are measured using the Wellness Evaluation of Lifestyle.

 

 

The Indivisible Self: An Evidence-Based Model of Wellness

 

…….including 17 third order factors of wellness, five second order factors, and one higher order factor……

 

A new evidence-based model of wellness, The Indivisible Self, provides an alternative perspective for viewing wellness across the lifespan, incorporating 17 separate wellness dimensions, five factors, and one higher order Wellness Factor (see Figure 2; Myers & Sweeney, 2003; Sweeney & Myers, 2003).

 

The Higher Order Wellness Factor

An examination of the items measuring wellness was necessary to explain the higher order factor. The strong loadings of disparate concepts and items on a single factor was confusing. Adlerian theory provided a unifying theme for explaining these results. Adler proposed that the self was indivisible, and that purposiveness was central to understanding human behavior. This philosophy provided a structure for making sense of studies in which wellness emerged both as a higher order and seemingly indivisible factor and as a factor comprised of identifiable sub-components as originally hypothesized (Myers et al., 2000; Sweeney & Witmer, 1991).       

 

Five Second-Order Factors

Five second-order factors were identified through exploratory and confirmatory factor analyses using the original 17 scales of the WEL (Hattie et al., in press). Adlerian theory was again used as a foundation for examining and making sense of the five factors, which were eventually named the Essential Self, Social Self, Creative Self, Physical Self, and Coping Self. These were seen as the factors comprising the self, or the indivisible self.

Essential Self. The Essential Self is comprised of four components: spirituality, self- care, gender identity, and cultural identity. Spirituality, not religiosity, has positive benefits for longevity and quality of life, and was viewed by Adler as central to holism and wellness (Mansager, 2000). It incorporates one’s existential sense of meaning, purpose, and hopefulness toward life. Both gender and cultural identity are conceptualized as filters through which life experiences are seen and as influences upon how others are experienced in response to ourselves. Both affect our essential meaning-making processes in relation to life, self, and others. Self-care includes proactive efforts to live long and live well. Conversely, carelessness, avoidance of health promoting habits, and general disregard of one’s well being are potentially signs of despair, hopelessness, and alienation from life’s opportunities, reflected in loss of a sense of meaning and purpose in life.

Creative Self. Adler spoke of the creative self as the combination of attributes that each of us forms to make a unique place among others in our social interactions (Adler, 1954; Ansbacher & Ansbacher, 1956). There are five components to this factor: thinking, emotions, control, positive humor, and work. As research and clinical experience suggest, what one thinks affects the emotions as well as the body. Likewise, one’s emotional experiences tend to influence one’s cognitive responses to similar experiences. Control is a matter of perceived capacity to influence events in one’s life. Positive expectations influence emotions, behavior, and anticipated outcomes, and positive humor is known to have a pervasive influence on physical as well as mental functioning. Enriching one’s ability to think clearly, perceive accurately, and respond appropriately can decrease stress and enhance the humor response that medical research has shown affects the immune system positively. Likewise, work is an essential element in human experience that can enhance or exacerbate one’s capacity to live life fully.

Social Self. The Social Self includes two components: friendship and love. Friendship and love can be conceived of as existing on a continuum and, as a consequence, are not clearly distinguishable in practice. Sexual intimacy is sometimes thought to be a distinction between love and friendship but no such distinction seems appropriate as physical attraction and true love can sometimes (or often) have little in common. What is clear, however, is that friendships and intimate relationships do enhance the quality and length of one’s life. Isolation, alienation, and separation from others generally are associated with all manner of poor health conditions and greater susceptibility to premature death, while social support remains in multiple studies as the strongest identified predictor of positive mental health over the lifespan. The mainstay of this support is family, with healthier families providing the most positive sources of individual wellness. Importantly, healthy families can be either biological or families of choice.
Physical Self. The Physical Self factor includes two components, exercise and nutrition. These are widely promoted and, unfortunately often over-emphasized to the exclusion of other components of holistic well-being reported here that also are important. The research evidence is compelling with regard to the importance of exercise and nutrition especially with changes over the life span. Not surprisingly, preliminary data suggest that “survivors,” i.e., individuals who live longest, attend to both exercise and diet/nutrition.

 Contextual Variables

The importance of context, or systems, in understanding human behavior, has been well established. A complete understanding of the individual cannot be made without incorporating a concern for environmental factors, which always can operate for better or for worse in relation to individual wellness. Thus, the Indivisible Self is both affected by and has an effect on the surrounding world. In Figure 2, four contexts are presented. Local contexts include interactions with and the central influences of those systems in which we live most often – our families, neighborhoods, and communities. Institutional contexts – education, religion, government, business and industry, and the media –affect our lives in both direct and indirect ways. Global contexts, including politics, culture, global events, and the environment, are made more salient and personal through the influence of the media. The final context, chronometrical, reflects the recognition that we change over time in important ways. Wellness involves the acute and chronic effects of lifestyle behaviors and choices throughout an individual’s lifespan (Myers, Sweeney, & Witmer, 2001).

 

Importantly, each of the components of the IS-WEL model interacts with all others to contribute to holistic functioning. Similarly, the contextual factors each have an influence or impact on the individual, and the individual affects his or her context. These interactions may be for better or for worse, individually and collectively.

 

The components of the IS-WEL model are measured with the Five Factor Wel Inventory.

 

The Four Factor Wellness Model

…….including 4 Factors of wellness……

 

The Five Factor Wel, the latest version of The Wellness Evaluation of Lifestyle (WEL), was examined using a new 3,993-person database. A new four-factor solution provided the best fit for the data. Physical, Mental, and Spiritual Wellness factors were defined along with one, strong General Wellness factor (see Myers, Luecht, & Sweeney, 2003)..

 

Although four factors emerged in our analyses, examination of the items loading on each factor suggested a very different pattern of content for General Wellness as juxtaposed to the three other factors. The General factor included items from each of the original 17 discrete scales of the 5F-Wel, with the exception of Realistic Beliefs. This finding was not surprising, as the Realistic Beliefs scale has consistently demonstrated low internal consistency, low intercorrelations with the other scales, and has raised the most questions from users in relation to the interpretation of scores. The finding of one main factor is also consistent with both the original theoretical model (Myers et al., 2000) and the hierarchical structure proposed by Hattie et al. (2002), in which a single factor called “Wellness” was identified as a higher order factor underlying the items and scales of the WEL and subsequently the 5F-Wel.

 

The General Wellness construct suggests that holistic wellness and prevention attitudes, behaviors, and activities cannot be decomposed into one of the other three factors. Or, consistent with a new theoretical model of wellness proposed by Sweeney and Myers (in press), the self is indeed, as Adler proposed, “indivisible.”

 

The finding of three factors that map directly onto the well-known body-mind-spirit triad, all being essential components in an overall profile of wellness, was of interest in this study. It seems apparent that the ancient Greeks who first identified this triad of human functioning were correct in their assessment. Alternately, since the original WEL was developed in part based on this historical definition of holism (see Myers et al., 2000), it may simply be that the items and factors indeed are accurate measures of the true theoretical nature of well-being as defined through multiple bodies of literature and knowledge over the past 2,000 years. Regardless, the meaning of the three factors becomes important in understanding the nature of holistic wellness.

 

The Physical Wellness construct relates to nutrition, diet, and physical activity/exercise and related behaviors. The connection to “body” is obvious. The items in this factor are similar to those in the Physical Self factor identified by Hattie et al. (2000), and consistent with the content of the original Wheel of Wellness model and other wellness models in which physical wellness is a common component.

 

The items in the Mental or Cognitive Wellness factor reflect a combination of two factors identified in the study by Hattie et al. (2000), termed Interactive Self and Intra-active Self. The items are drawn from the original 5F-Wel scales representing intellectual stimulation, problem solving, and creativity, sense of control, emotional responsiveness and management, sense of humor, work and leisure, sense of worth, and stress management.

 

Finally, Spiritual Wellness relates to having a particular belief and value system and engaging in associated relevant activities that may be religious or cultural in nature. Consistent with the findings of Hattie et al. (2000), cultural identity is an important component of one’s spiritual self, or spiritual self-identity.

 

Wellness Assessment:

The Wellness Evaluation of Lifestyle (WEL Inventory)

The Five Factor Wel Inventory (5F-Wel)

The Four Factor Wel Inventory (4F-Wel)

 

The Wellness Evaluation of Lifestyle (WEL Inventory)

 

The Wellness Evaluation of Lifestyle, or WEL inventory (Myers et al., 1996) was developed to assess each of the individual characteristics in the Wheel of Wellness model (see Figure 1). The model was disassembled to form 17 measurement constructs, one for each of the components within the four inner circles of the Wheel. The originally-combined life task of work and leisure was further divided based on preliminary factor analyses to form two separate constructs, thus resulting in 17 measured constructs, one corresponding to each of the individual components in Wheel model. The most recent version (WEL-S) includes 120 items scored on a 5-point Likert-type scale. Scores are simple sums of responses divided by the total points possible; thus scores represent “percent of total wellness.

 

The WEL was developed and pilot tested as an iterative process. A series of seven studies were conducted over a ten-year period to field test items and to improve the psychometric properties of the reported scales (Myers, 1998; Hattie et al., in press).


The WEL is available from Mindgarden, Inc.

 

Psychometric Investigations of the WEL

 

Test-retest reliability coefficients for the scales, established with a sample of 99 undergraduate students (Myers, 1998), ranged from 0.68 for cultural identity to 0.88 for nutrition. Internal consistency measures of reliability (i.e., a-coefficients, Cronbach, 1947) ranged from a low of .60 for the realistic beliefs scale to a high of .94 for friendship within a larger and more diverse sample of 2,295 adults across the lifespan. Convergent and divergent validity were investigated by comparing scores on the various WEL scales to similar scales on instruments such as the Coping Resources Inventory (Hammer & Marting, 1987) and Testwell (National Wellness Institute, 1983).  Myers (1998) and Hattie et al. (in press) found that scores measuring conceptually similar constructs had high correlations (convergent validity) and scores measuring different constructs had lower correlations (divergent validity).

 

The Five Factor Wellness Inventory (5F-Wel)

 

The 5F-Wel measures the higher order Wellness factor, five second-order factors, and the original 17 discrete scales measured in the WEL. These scales are measured using 74 scored items and a number of experimental items. The latter items include a 6-item perceived safety scale, a 3-item perceived wellness scale, and an 8-item context scale. Demographic items are also included.

 

Exploratory and confirmatory factor analyses support each of the scales – 17 discrete factors, 5 second-order factors, and a higher order wellness factor. Alphas for the 5F-Wel second order factor scales range from .90 to .94, with an alpha of .94 for Total Wellness, the single higher order factor.

 

The 5F-Wel is available for research purposes by writing

 

Dr. Jane Myers, Professor

222 Curry Building

University of North Carolina at Greensboro

Greensboro, NC 27402

jemyers@uncg.edu

           

Separate versions of the 5F-Wel are available for children (3rd grade reading level), adolescents (6th grade reading level), and teenagers and adults (9th grade reading level). The 5F-Wel has been translated into Korean, Hebrew (middle school or teenage version), Turkish, and is currently being translated into Spanish (Southwestern United States). Brief descriptions of the individual scales of the instrument follow.

 

Creative Self

 

Thinking. Being mentally active, open-minded; the ability to be creative and experimental; having a sense of curiosity; ability to apply problem-solving strategies to social conflicts.

Emotions. Being aware of or in touch with one's feelings; ability to express appropriately positive and negative feelings.

Control  Beliefs about your competence, confidence, and personal mastery; beliefs that you can usually achieve the goals you set out for yourself.

Work. Satisfaction with one's work; feeling that one's skills are used appropriately; feeling one can manage one's workload; feeling a sense of job security; feeling appreciated in the work one does.

Positive Humor. Being able to laugh at one's own mistakes; the ability to use humor to accomplish even serious tasks.

 

Coping Self

 

Leisure. Satisfaction with one's time spent in leisure; feeling that one's skills are used appropriately.

Stress Management. On-going self-assessment of one's coping resources; ability to organize/manage resources such as time, energy, setting limits.

Self- Worth.  Accepting who and what one is, positive qualities along with imperfections; a sense of being genuine within oneself and with others.

Realistic Beliefs. Ability to process information and perceive reality accurately; absence of persistent irrational beliefs and thoughts and need for perfection.

 

Social Self

 

Friendship. Social relationships that involve a connection with others individually or in community, but which do not have a marital, sexual, or familial commitment; having a capacity to trust others; having empathy for others; feeling understood by others.

Love. The ability to be intimate, trusting, self-disclosing with another; the ability to give as well as express affection with significant others and to accept others without conditions.

 

Essential Self

 

Spirituality. Personal beliefs and behaviors practiced as part of the recognition that we are more than the material aspects of mind and body; belief in a higher power; hope and optimism; practice of worship, prayer, and/or meditation; purpose in life; compassion for others; moral values; and transcendence (a sense of oneness with the universe).

Gender Identity. Satisfaction with and feeling supported in one's gender; ability to be androgynous.

Cultural Identity. Satisfaction with and feeling supported in one's cultural identity; cultural assimilation.

Self-Care. Taking responsibility for one's wellness through self-care and safety habits that are preventive in nature.

 

Physical Self

 

Nutrition. Eating a nutritionally balanced diet; maintaining a normal weight (within 15% of the ideal).

Exercise. Engaging in sufficient physical activity through exercise or in one's work to keep in good physical condition.

 

Total Wellness

 

General level of well being; composite score comprised of all items on the 5F-Wel.

 

Special Scales

 

Perceived Wellness. The extent to which you believe you have achieved wellness in all areas, or total wellness; your estimate of your total wellness.

Perceived Safety. The extent to which you believe you are safe in your home, neighborhood, and community, and the extent to which you feel safe from harm by terrorists.

Context. The extent to which your wellness is influenced, in a conscious manner, by individual, institutional, and global contexts, and the extent to which you are aware of and intentional in responding positively to changes in wellness over time.

 

 

The Four Factor Wel Inventory (4F-Wel)

 

The Five Factor Wel, the latest version of The Wellness Evaluation of Lifestyle (WEL), was examined using a new 3,993-person database. A new four-factor solution with a 35-item General Wellness factor provided the best fit for the data. Physical, Mental, and Spiritual Wellness factors were defined with 8, 10, and 7 items, respectively (see Myers, Luecht, & Sweeney, 2003). The four factors accounted for 51.9 percent of the total variance. Alpha coefficients for the four new scales exceeded .88.

 

Correlations computed between the factors can be literally interpreted as the “true-score” correlations among the scales (i.e., the disattenuated or reliability-adjusted correlations between the factors). Using 2,792 cases (case-wise deletion of missing data), the correlations between General Wellness and Physical, Mental or Cognitive, and Spiritual Wellness were .72, .87, and .77, respectively. Correlations between the Physical and the Mental and Spiritual scales were .78 and .67, respectively. Finally the Spirituality scale correlated .75 with the Mental Wellness scale. In general, the values suggest that the four factors are moderately-to-strongly related to one another.

 

From the standpoint of practical usefulness, the availability of the new 35-item General Wellness scale provides a new and as yet unavailable means for reliable and valid assessment of overall or general wellness. Thus, the revised instrument, the 4F-Wel, can be used as a clinically relevant screening assessment.

 

 

WELLNESS RESEARCH

 

The WEL and 5F-Wel have been used in multiple studies over the past 12 years primarily as outcome measures or dependent variable, and have been used to study wellness in relation to diverse psychological constructs and demographic indices. It also has been used for program evaluation. For example, Hensley and Smith (in press) used the 5F-Wel as a pre-post assessment for a college student success course for at-risk freshmen. They concluded that the inclusion of a wellness component increased the potential effectiveness of the course. In this section, studies of wellness among various populations are described, and studies examining correlates of wellness as well as cross cultural and cross-national studies are discussed. The reference list includes citations for doctoral dissertation research and published studies on wellness using our instruments and models.

 

Wellness of Various Populations

 

Several studies of wellness in minority populations have established the usefulness of the WEL and 5F-Wel in cultural studies. These studies have examined the major life tasks and wellness scores in relation to factors such as ethnic identity and acculturation of Native Americans (Garrett, 1999), Korean Americans (Korean translation; Chang, 2003), African Americans (Spurgeon, 2002), adult gay males (Dew, Myers, & Wightman, 2003), and mid-life lesbians (Degges-White, 2003). In each case, the wellness scales provided differential measures of population and subpopulation characteristics.

 

Correlates of Wellness

 

Multiple studies of psychological correlates of wellness using the WEL and 5F-Wel  have been conducted. For example, Hermon and Hazler (1999), in a study of 155 undergraduate students, found that both short-term state and long-term trait constructs of psychological well-being correlated positively with each of the major life tasks in the Wheel of Wellness model. Sinclair and Myers (2003) studied the relationship between components of objectified body consciousness and wellness in undergraduate, heterosexual, Caucasian females. They found a negative relationship between body shame and wellness and a positive relationship between appearance control beliefs and wellness. Shurts and Myers (2003) found positive relationships between healthy love styles and the life tasks in the Wheel of Wellness, and Connolly (2002) found positive associations between job satisfaction, mattering, and the life tasks.

 

Cross Cultural and Cross National Studies

 

The 5F-Wel has been translated/adapted into four languages and studies are in process to examine cross-cultural differences in wellness in Israel, Manila, and Turkey, as well as Spanish-speaking individuals in the United States. Studies have been conducted with Korean American, Native American, Caribbean American, and other minority adolescents in the United States. Adult populations studied include men, women, African American males, gay males, and lesbians. The list of dissertations, publications, and reference list provide specific citations for this research.

             

 

 

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