The Pathways Model for Improved Health and Wellness

  • Angele McGrady
  • Donald Moss


The Pathways Model was developed by Angele McGrady and Donald Moss (Pathways to illness, pathways to health, Springer, New York, NY, 2013), as an integrative model for improving health and remediating illness. The Pathways Model utilizes a coaching-based approach to assess the individual’s readiness for health-supportive changes and articulates a three-level plan for enhancing health and wellness. The Pathways Model begins with the formation of an “alliance for health” with each prospective patient. The Pathways self-care plan is a personally forged and committed program for self-directed changes, in coordination with professional support.

The Pathways Level One plan includes self-directed lifestyle changes and behavioral change to restore the body’s biological rhythms. Level One activities are simple and practical, reflecting the individual’s life experience and choices. The Level Two plan involves acquiring specific skills for improved coping and self-regulation. Level Two activities can be supported by educational resources and community programs, such as a relaxation training CD, community-based mindfulness or meditation classes, or instruction at a yoga or wellness center. The Pathways Level Three plan consists of interventions delivered by a trained health care professional, including health psychologists, psychotherapists, physicians, physical therapists, nutritionists, herbalists, naturopaths, acupuncturists, and others.

This chapter promotes the inclusion of religious and spiritual practices at each Level in the Pathways Model, and advocates for including complementary therapies in the Pathways Model.


Pathways Model Lifestyle medicine Coaching Complementary therapies Spirituality 


  1. Astin, J. (1998). Why patients use alternative medicine: Results of a national survey. Journal of the American Medical Association, 279(19), 1548–1553.CrossRefGoogle Scholar
  2. Bandura, A. (2004). Health promotion by social cognitive means. Health Education and Behavior, 31(2), 143–164.CrossRefGoogle Scholar
  3. Brown, K. W., & Ryan, R. M. (2004). Fostering healthy self-regulation from within and without: A self-determination theory perspective. In P. A. Linley & S. Joseph (Eds.), Positive psychology in practice (pp. 105–124). Hoboken, NJ: Wiley.Google Scholar
  4. Csikszentimihalyi, M. (1999). If we are so rich, why aren’t we happy? American Psychologist, 54(10), 821–827.CrossRefGoogle Scholar
  5. Egger, G., Katz, D., Sagner, M., & Stevens, J. (2014). The art and science of chronic disease management come together in a lifestyle-focused approach to primary care. International Journal of Clinical Practice, 68(12), 1406–1409. CrossRefPubMedGoogle Scholar
  6. George, S. R., & Thomas, S. P. (2010). Lived experience of diabetes among older, rural people. Journal of Advanced Nursing, 66(5), 1092–1100. CrossRefPubMedGoogle Scholar
  7. Hofbauer, R. K., Rainville, P., Duncan, G. H., & Bushnell, M. C. (2001). Cortical representation of the sensory dimension of pain. Journal of Neurophysiology, 86(1), 402–411.CrossRefGoogle Scholar
  8. Jahnke, R., Larkey, L., Rogers, C., Etnier, J., & Lin, F. (2010). A comprehensive review of health benefits of Qigong and Tai Chi. American Journal of Health Promotion, 24(6), e1–e25. CrossRefPubMedGoogle Scholar
  9. Jensen, M. P., & Patterson, D. R. (2014). Hypnotic approaches for chronic pain management. American Psychologist, 69(2), 167–177. CrossRefPubMedGoogle Scholar
  10. Lorig, K. R., Ritter, P., Stewart, A. L., Sobel, D. S., Brown, B. W., Bandura, A., et al. (2001). Chronic disease self-management program: 2-Year health status and health care utilization outcomes. Medical Care, 39(11), 1217–1223.CrossRefGoogle Scholar
  11. Maslow, A. H. (1968). Toward a psychology of being (3rd ed.). New York, NY: Wiley.Google Scholar
  12. McGrady, A., & Moss, D. (2013). Pathways to illness, pathways to health. New York, NY: Springer.
  13. Miek, J., van de Vijver, L., Busch, M., Fritsma, J., & Seldenrijk, R. (2012). Integration of complementary and alternative medicine in primary care: What do patients want? Patient Education and Counseling, 89(3), 417–422.CrossRefGoogle Scholar
  14. Moss, D. (Ed.). (1999). Humanistic and transpersonal psychology: A historical and biographical sourcebook. Westport, CT: Greenwood.Google Scholar
  15. Moss, D. (2015). Integration of mindfulness training into a comprehensive “Pathways Model” treatment program: The case of Jorge. Biofeedback, 43(3), 137–141.CrossRefGoogle Scholar
  16. Moss, D., McGrady, A., Davies, T., & Wickramasekera, I. (Eds.). (2003). Handbook of mind-body medicine in primary care. Thousand Oaks, CA: Sage.Google Scholar
  17. Murray, C., Atkinson, C., Bhalla, K., Birbeck, G., Burstein, R., Chou, D., et al. (2015). The state of US health, 1990–2010: Burden of diseases, injuries, and risk factors. Journal of the American Medical Association, 310(6), 591–608. CrossRefGoogle Scholar
  18. National Center for Complementary and Alternative Medicine. (2002). Basic and preclinical research on complementary and alternative medicine. Program Announcement Number PA-02-124. Retrieved from
  19. National Center for Complementary and Integrative Health. (2016). Complementary alterative or integrative health. What’s in a name? Retrieved from
  20. National Center for Health Statistics. (2016). Mortality in the US, 2015. NCHS Data Brief No. 267. Retrieved from
  21. National Institutes of Health. (2015). Basic and preclinical research on complementary and alternative medicine (CAM) (R15). Program Announcement Number PA-06-064. Retrieved from
  22. Ornish, D. (1996). Dr. Dean Ornish’s program for reversing heart disease. New York, NY: Ivy Books/Ballantine Books.Google Scholar
  23. Ornish, D., Scherwitz, L., Billings, J., Brown, S. E., Gould, K. L., Merritt, T. A., & Brand, R. J. (1998). Intensive lifestyle changes for reversal of coronary heart disease. Five-year follow-up of the Lifestyle Heart Trial. Journal of the American Medical Association, 280, 2001–2007.CrossRefGoogle Scholar
  24. Pearson, E. S. (2011). The ‘how to’ of health behavior change brought to life: A theoretical analysis of the co-active coaching model and its underpinnings in self-determination theory. Coaching: An International Journal of Theory, Research, and Practice, 4(2), 89–103.CrossRefGoogle Scholar
  25. Phelps, C. (2014). The lived experience of individuals with Type 2 diabetes who have sustained successful lifestyle change and achieved long-term positive health outcomes: A detailed look at the female experience (Doctoral dissertation). Retrieved from the ProQuest dissertation database (UMI No. 3642969).Google Scholar
  26. Pischke, C. R., Frenda, S., Ornish, D., & Weidner, G. (2010). Lifestyle changes are related to reductions in depression in persons with elevated coronary risk factors. Psychological Health, 25(9), 1077–1100.CrossRefGoogle Scholar
  27. Prochaska, J. O., & Norcross, J. C. (2001). Stages of change. Psychotherapy, 38(4), 443–448.CrossRefGoogle Scholar
  28. Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12, 38–48.CrossRefGoogle Scholar
  29. Rainville, P., Duncan, G. H., Price, D. D., Carrier, B., & Bushnell, M. C. (1997). Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science, 277(5328), 968–971.CrossRefGoogle Scholar
  30. Robinson, A., & McGrail, M. R. (2004). Disclosure of CAM use to medical practitioners: A review of qualitative and quantitative studies. Complementary Therapies in Medicine, 12(2–3), 90–98.CrossRefGoogle Scholar
  31. Ryan, R. M., & Deci, E. L. (2002). An overview of self-determination theory: An organismic-dialectical perspective. In E. L. Deci & R. M. Ryan (Eds.), Handbook of self-determination research (pp. 3–36). Rochester, NY: The University of Rochester Press.Google Scholar
  32. Sagner, M., Katz, D., Egger, G., Lianov, L., Schulz, K. H., Braman, M., et al. (2014). Lifestyle medicine potential for reversing a world of chronic disease epidemics: From cell to community. International Journal of Clinical Practice, 68(11), 1289–1292. CrossRefPubMedGoogle Scholar
  33. Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60(5), 410–421.CrossRefGoogle Scholar
  34. Shaffer, F., & Moss, D. (2006). Biofeedback. In C.-S. Yuan, E. J. Bieber, & B. A. Bauer (Eds.), Textbook of complementary and alternative medicine (2nd ed., pp. 291–312). Abingdon, Oxfordshire, UK: Informa Healthcare.Google Scholar
  35. Silberman, A., Banthia, R., Estay, I. S., Kemp, C., Studley, J., Hareras, D., & Ornish, D. (2010). The effectiveness and efficacy of an intensive cardiac rehabilitation program in 24 sites. American Journal of Health Promotion, 24(4), 260–266.CrossRefGoogle Scholar
  36. Spence, G. B., & Oades, L. B. (2011). Coaching with self-determination in mind: Using theory to advance evidence-based coaching practice. International Journal of Evidence Based Coaching and Mentoring, 9(2), 37–55.Google Scholar
  37. Thorpe, K., Florence, C., Howard, D., & Joski, P. (2004). The impact of obesity in rising health spending. Health Affairs, Suppl Web Exclusives, W4-480-6.Google Scholar
  38. Wolever, R. Q., Dreusicke, M., Fikkan, J., Hawkins, T. V., Yeung, S., Rakefield, J., et al. (2010). Integrative health coaching for patients with Type 2 diabetes: A randomized clinical trial. The Diabetes Educator, 36(4), 629–639. CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Angele McGrady
    • 1
  • Donald Moss
    • 2
  1. 1.Department of PsychiatryUniversity of ToledoToledoUSA
  2. 2.College of Integrative Medicine and Health SciencesSaybrook UniversityOaklandUSA

Personalised recommendations