Donald Moss, PhD

The Pathways Model for Improved Health and Wellness

The Pathways Model is based on two books by Angele McGrady and Donald Moss, Pathways to Illness, Pathways to Health (Springer Publishers, published 2013), and Integrative Pathways:  Navigating Chroic Illness with a Mind-Body Spirit Approach (Springer, 2018).

The face of illness has changed, and human beings are eager for new approaches to pursue health and wellness.  Increasing numbers of people seek out advice for health problems at the health food store, or visit Reiki energy healers, massage therapists, naturopaths, and other alternative medicine practitioners, instead of conventional medical care. 

The illnesses that brought patients into medical clinics 100 years ago, including infectious diseases, bacterial parasites, and unhealed physical trauma, have largely been conquered. Instead, today’s patients present with diseases of lifestyle, stress-related conditions, and chronic illnesses Moss, Mcgrady, Davies, & Wickramasekera, 2003). Hypertension, depression, anxiety, diabetes, fibromyalgia, chronic fatigue, and chronic pain are more typical problems today.  Many of the complaints presented in the clinic are strongly influenced by life-stress, relationship strain, sedentary lifestyle, and poor dietary choices. The conditions may involve biomedical elements, but the quality of the patients’ everyday lives causes the medical conditions to worsen or improve.

Conventional medicine is best prepared to treat conditions that can be measured by lab tests, imaging, and objective evidence. Many of today’s health problems worsen for no measurable reason. In turn, physicians are best prepared to provide medication or surgical intervention. For today’s problems, medication often provides symptomatic relief at best, and surgery sometimes compounds lifestyle based problem. 

The most effective approach for many of the stress-related and chronic conditions troubling patients today is one of lifestyle change, self-care, and illness “self-management.” George and Thomas (2010) for example, have estimated that patients must provide 90 % of their own care for diabetes. Unfortunately, less than half of medical patients follow through consistently with medical recommendations for self-care practices and lifestyle changes. The number of research publications on patient “compliance” and “adherence” with physician recommendations suggests the size of the problem.

For over two decades, experts in health and wellness promotion have identified a core group of behavioral and life-style changes that can greatly diminish illness and enhance wellness. Smoking cessation, regular sleep habits, aerobic activity, moderation in alcohol use, positive nutritional choices, and stress-management form a core of wellness recommendations that would greatly diminish the incidence of hypertension, diabetes, cardiovascular illness, and a variety of other medical and mental health problems. Yet, the general population is losing ground on many of these variables.  Sedentary lifestyles, avoidance of physical activity, poor nutritional choices, and weight gain are epidemic, with two thirds of the US population qualifying as overweight and one third as obese (Thorpe et al, 2004).

The Pathways Model presented in this book provides a comprehensive approach to integrating life-style changes, behavioral changes, self-care, and self-regulation skills into both health care and wellness care.  The Pathways Model conceives of illness as a pathway running from genetic predisposition, through diet and level of exercise, through a series of lifestyle choices, through the impact of life and work stress, culminating in medical conditions that are largely avoidable, and that in some cases can be reversed.  Human beings who can clearly see and understand their own role in illness creation, through past choices and lifestyle habits, can better dedicate themselves to new pathways, to wellness and health.

The Pathways Model addresses the continuum of health and disease, and the role of both health risk behaviors and well behaviors in shaping the individual’s overall health. The process begins with a Pathways Assessment that explores the onset of the individual’s illness or health problems, and identifies negative behaviors and lifestyle factors that may have contributed to the onset or continuance of health problems. In addition, the Pathways Assessment explores the individual’s current readiness for change (Prochaska & Velicer, 1997). If the person is still not at a point where change seems possible, and doubts that anything he or she does will make a difference in health problems, then the best designed wellness plan will have no effect, because the person will take no action.

The Pathways Model advocates health and wellness coaching to assist the individual in gaining a sense of self-efficacy, an inner conviction that “I can make changes in my behavior and they will make a difference in my health.” In addition, the Pathways Model advocates a step-wise approach to lifestyle change, beginning with small self-directed changes, and proceeding to more demanding changes only when the individual has experienced some initial successes with small steps.

The Pathways Model promotes a three level, step-wise framework for personal changes in health related lifestyle: 

Level One focuses on changes in everyday behaviors that are designed to re-establish normal body rhythms.  Changes at Level One are self-directed and simple. The individual may commit to improve the use of simple sleep hygiene principles to enhance the quality and quantity of sleep. She or he might commit to walk to a nearby park, or to utilize calming music for self-soothing at the end of the work day.

Level Two focuses on the individual learning self-regulation skills, and utilizing community resources and educational materials to support learning and lifestyle changes.  The individual may use an educational CD to learn mindfulness meditation, or attend a yoga class at the local YMCA. Progressive relaxation, autogenic training, and guided imagery are all basic self-regulation skills that can be learned with the use of written handouts, educational CDs or DVDs, and community-based classes.

Level Three involves professional interventions, the utilization of services provided by a health practitioner, such as hypnosis, energy therapy, psychotherapy, acupuncture, or medication management. The authors have found that patients benefit much more from professional services, when a well-organized program of lifestyle changes and self-care practices is already underway. The patient participates more actively in the interventions planned by the professional, and the process of change is more sustainable.  

The first book, Pathways to Illness, Pathways to Health (2013), presents the Pathways Model with practical guidelines for both self-care and professional intervention, and provides case studies showing how human beings with a variety of medical and emotional disorders have utilized the Pathways Model to pursue a positive recovery.

The second book, Integrative Pathways:  Navigating Chronic Illness with a Mind-Body-Spirit Approach (2018) applies the Pathways Model to chronic conditions such as diabetes, cancer, and chronic pain, and also integrates the use of both complementary therapies and spiritual interventions.


George, S. R., & Thomas, S. P. (2010). Lived experience of diabetes among older, rural people. Journal of Advanced Nursing, 66(5), 1092-1100. doi: 10.1111/j.13652648.2010.05278.x

Moss, D., McGrady, A., Davies, T., & Wickramasekera, I., (Eds.). (2003).  Handbook of mind-body medicine in primary care. Thousand Oaks, CA: Sage Publications.

Prochaska, J.O., & Velicer, W.F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12, 38-48.

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.

McGrady, Angele, & Moss, Donald (2013). Pathways to Illness, Pathways to Health.  New York, NY:  Springer Publications.

McGrady, Angele, & Moss, Donald (2016). Integrative Pathways:  Navigating Chronic Illness with a Mind-Body-Spirit Approach.  New York, NY:  Springer Publications.

These books and others by Donald Moss are available from and other sources. Find Amazon information at: 

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