Self-management training: potential for primary care

Self-management training (SMT) is an intervention that focuses on the integrative functions of the brain to teach patients to manage their bodies. This training captures the knowledge base found in social learning, cognitive, and psychophysiologic theories to interpret the mechanisms by which neural control interferes with healthy homeostatic processes, thus producing disease. Hypertension is a case in point. The brain masterminds the links between cortical activity, neuroendocrine action, metabolic change, autonomic nervous system activity, end organs, and peripheral activity to produce elevated blood pressure. Patients trained in SMT can reduce or eliminate the need for pharmacotherapeutic intervention. SMT incorporates the concepts of self-regulation, personal control, cognitive/affective strategies, and coping as the foundation for development of an intervention. The intervention requires the commitment of the patient through goal setting and contractual agreement in a program of care. On the part of NPs, SMT requires a time commitment and a willingness to provide feedback to their patients over a series of visits to guide them into a healthy self-regulatory pattern. Primary care settings that can accommodate this type of care for chronic conditions will be more likely to succeed in holistic health care provision.