A Pathways Approach to Systemic Lupus Erythematosus

Abstract

Systemic lupus erythematosus (SLE) is a complex and typically chronic illness, producing a wide variety of symptoms and following an unpredictable course. SLE is an auto-immune condition, commonly affecting the skin, joints, kidneys, the brain, and other organs. This chapter describes the application of a multi-level integrative care plan, following the Pathways Model, to assist a patient with SLE in managing and moderating symptoms, and improving quality of life. The patient, Mary Anne, was a 33-year-old female nurse, with a 14-year history of living with SLE. Her initial response to her diagnosis of lupus was biomedical, with a passive reliance on a wide range of medications, and an increasingly inactive, sedentary lifestyle. Along with lupus she developed obesity, hypertension, migraine, sleep disturbance, depression, and anxiety. Her rheumatologist referred her for behavioral health interventions to help her learn non-pharmacologic forms of pain management and motivate her for illness self-management for her chronic conditions. The interventions were organized according to the three levels of the Pathways Model, developed by McGrady and Moss (Pathways to illness, pathways to health. New York, NY: Springer, 2013), and included: Level One—movement, sleep hygiene, and mindful eating; Level Two—Aquatherapy, an illness self-management support group, and a mindfulness class; and Level Three—heart rate variability (HRV) biofeedback, self-hypnosis training with healing imagery, a nutritional consultation, and a sleep medicine program. This patient mastered excellent skills with self-hypnosis, paced breathing, and HRV biofeedback. She increased physical activity and modified her diet. At the 3-year point, she reported less frequent pain and joint swelling, less nausea and sick feeling, moderate improvement in sleep, and less frequent and less severe Lupus “flares.”

This chapter is adapted with the permission of the Association for Applied Psychophysiology and Biofeedback from a previous version that appeared as: D. Moss (2016), Pathways interventions and systemic lupus erythematosus: The case of Mary Anne. Biofeedback, 44(2), 73-80. doi: 10.5298/1081-5937-44.2.05