BERLIN — The most important change in medical culture in the past decade is likely the notion of patient participation and empowerment. Although this is something that has been encouraged by doctors for much longer, people are beginning to accept that there is often more to dealing with a medical condition, especially a chronic one, than waiting for a doctor to pronounce them cured.

As part of this emerging culture researchers at Stanford University developed a program called “Living Well” aimed at helping those suffering from chronic conditions to better participate not only in their own treatment, but also to take better control of other aspects of their lives that may have been affected by the condition.

Laura Small, who runs the “Living Well” program sponsored by Atlantic General Hospital, can’t say enough about the program’s influence in helping people find a new way to focus their energy.  “Living Well” is all about finding one’s own limits and learning to incorporate them into their lives rather than surrender to whatever limitations they might have.

Chronic conditions can include psychological as well as physical impediments. “Living Well” is, in the main, about goal-setting and accomplishment. It is about finding tactics for success and improvement not only in they way a person can move but also in the way they construct their lives.

“It helps you to be a better self-care manager,” Small said. “It’s amazing what this program does.”

Although the course is free, participants are able to purchase the “Living Well” workbook that helps them to develop action plans that will best enable them to figure out an action plan for daily living.

Participants range from people who feel as if they would like to better learn to deal with stress to those with physical impediments to walking. Although the plan is general, each of the solutions are specific to what a person feels they would like to do in relation to what they are capable of.

One of the centerpieces of the program is learning to break big goals up into smaller parts and accomplish those parts as part of a schedule. A goal that might seem overwhelming at first is just psychologically to deal with if it is broken into steps and stretched out over a longer period of time.

Small and the other facilitators take the class as much as they lead it. Everyone starts the six-week course together by discussing their goals and limitations and composing different tactics for accomplishing them.

The course is not only about goal setting and accomplishment, however. Goals are only a piece of the project aimed primarily at getting people to demonstrate to themselves what they are capable with by planning and recording their progress.

Small said that some people use exercise as  means to improve their condition while others attack their various problems with dietary changes or household reorganization.

While the course is geared toward any problem, one of the emerging diagnosis, fibromyalgia, is a difficulty with which a number of attendees have to deal. Small said it is common for people dealing with fibromyalgia to have real improvements as the result of taking the class.

“For some this is that ‘last chance’ thing that they haven’t tried,” she said.

Fibromyalgia might best be described as acute general malaise. Formerly undiagnosed and often discarded because the symptoms were too general to indicate an origin, in recent years it has been studied and classified. The prevailing medical opinion is that it is caused by the brain overreacting to pain messages sent from the nervous system. Symptoms include pervasive exhaustion, joint and muscle pain, and increased incidences of tension headaches.

While there is no cure, programs like “Living Well” are generally thought to be helpful treatments, especially the stress-reduction techniques. Fibromyalgia can often be triggered by a physical or psychological trauma, surgery or infection but sometimes its onset is totally without definable cause.

Because the range of maladies can be so significant, Small said the weekly course is run in a way that best accommodates the different troubles people may have.

“We have people with back problems who have laid down on the floor, or stood up during the session, people who’ve brought their own chairs,” she said. “We encourage that.”

Since so much of the class is about learning to plan for and make the kinds of adjustments that allow people to better participate in the things they would like to, Small is always clear that people should make sure they are comfortable while participating. If that means bringing a special pillow or sitting on a mat, it is fine with her. The point is to be comfortable enough to learn the tactics for being even more comfortable in relation to one’s affliction.

While the dominant number of participants attend to learn better or at least alternate pain management techniques, Small said that among the most underrepresented demographics are people who suffer from stress or anxiety.

One of the recurring topics in the self-care management program is to remember to take the time to relax. The relaxation techniques, which include but are not limited to guided imagery, are useful for people whose stress level has an affect on their daily lives.

Moreover, there is an intersection of interests for people who are caregivers for their loved ones. In addition to learning to better incorporate stress-reduction techniques into their lives, an emphasis is placed on how to best facilitate communication between physicians and those being treated.

“Everyone, at the end of the six-weeks says the commitment is worth it,” Small said.

The program is two-and-a-half hours one day a week for six weeks. Although the first class began May 4, people may still register for the course until May 11.