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      The IARA Model as an Integrative Approach to Promote Autonomy in COPD Patients through Improvement of Self-Efficacy Beliefs and Illness Perception: A Mixed-Method Pilot Study

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          Abstract

          Chronic obstructive pulmonary disease (COPD) is one of the most deadly and costly chronic diseases in the world characterized by many breathing problems. The management of COPD and the prevention of exacerbations are a priority goals to improve the quality of life in patients affected by this illness. In addition, it is also crucial to improve the patients' adherence to care which, in turn, depends on their knowledge and understanding of some factors such as the prescribed medical treatment, changes in dailylife, and the process of breathing. In turn, the adherence to care leads to greater autonomy for the patient who is thus able to better manage his illness. Here we presented the application of the Model IARA in patients affected by COPD in order to achieve their autonomy in illness management which, in turn, leads to a better quality of life. IARA is an intervention program which improve the awareness and knowledge of patients with respect to both the disease and symptoms through health education. Moreover, through IARA the patients are encouraged to become more actively involved in COPD care process, also regarding drug therapy adherence. Using St. George's Respiratory Questionnaire combined with qualitative analysis, we demonstrated that IARA could be considered a useful approach in COPD management.

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          Most cited references48

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          Mindfulness: A Proposed Operational Definition

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            Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder.

            Mindfulness-based stress reduction (MBSR) is an established program shown to reduce symptoms of stress, anxiety, and depression. MBSR is believed to alter emotional responding by modifying cognitive-affective processes. Given that social anxiety disorder (SAD) is characterized by emotional and attentional biases as well as distorted negative self-beliefs, we examined MBSR-related changes in the brain-behavior indices of emotional reactivity and regulation of negative self-beliefs in patients with SAD. Sixteen patients underwent functional MRI while reacting to negative self-beliefs and while regulating negative emotions using 2 types of attention deployment emotion regulation-breath-focused attention and distraction-focused attention. Post-MBSR, 14 patients completed neuroimaging assessments. Compared with baseline, MBSR completers showed improvement in anxiety and depression symptoms and self-esteem. During the breath-focused attention task (but not the distraction-focused attention task), they also showed (a) decreased negative emotion experience, (b) reduced amygdala activity, and (c) increased activity in brain regions implicated in attentional deployment. MBSR training in patients with SAD may reduce emotional reactivity while enhancing emotion regulation. These changes might facilitate reduction in SAD-related avoidance behaviors, clinical symptoms, and automatic emotional reactivity to negative self-beliefs in adults with SAD.
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              The challenge of patient adherence

              Quality healthcare outcomes depend upon patients' adherence to recommended treatment regimens. Patient nonadherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors. These include realistic assessment of patients' knowledge and understanding of the regimen, clear and effective communication between health professionals and their patients, and the nurturance of trust in the therapeutic relationship. Patients must be given the opportunity to tell the story of their unique illness experiences. Knowing the patient as a person allows the health professional to understand elements that are crucial to the patient's adherence: beliefs, attitudes, subjective norms, cultural context, social supports, and emotional health challenges, particularly depression. Physician–patient partnerships are essential when choosing amongst various therapeutic options to maximize adherence. Mutual collaboration fosters greater patient satisfaction, reduces the risks of nonadherence, and improves patients' healthcare outcomes.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                05 October 2017
                2017
                : 8
                : 1682
                Affiliations
                [1] 1Psychology, Università Cattolica del Sacro Cuore , Milan, Italy
                [2] 2Kiara Association , Turin, Italy
                [3] 3Psychology, Università degli Studi eCampus , Novedrate, Italy
                [4] 4Department of Medicine, Surgery and Health Sciences, Nursing School, University of Trieste , Trieste, Italy
                [5] 5Department of Health, Life and Environmental Sciences, University of L'Aquila , L'Aquila, Italy
                [6] 6Brain and Behavioral Sciences, University of Pavia , Pavia, Italy
                [7] 7Engineering and Architecture, University of Trieste , Trieste, Italy
                Author notes

                Edited by: Gian Mauro Manzoni, Università degli Studi eCampus, Italy

                Reviewed by: Andrea Purro, Ospedale Humanitas Gradenigo, Italy; Luigi Cirio, University of Turin, Italy

                *Correspondence: Andrea De Giorgio andrea.degiorgio@ 123456uniecampus.it

                This article was submitted to Clinical and Health Psychology, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2017.01682
                5640890
                29062286
                8cadcdec-3c26-4608-882f-c4f95487c189
                Copyright © 2017 De Giorgio, Dante, Cavioni, Padovan, Rigonat, Iseppi, Graceffa and Gulotta.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 09 May 2017
                : 12 September 2017
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 64, Pages: 10, Words: 8505
                Categories
                Psychology
                Original Research

                Clinical Psychology & Psychiatry
                iara model,copd,respiratory illness,guided imagery,educational health care,awareness,autonomy

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