{"id":5067,"date":"2026-07-06T07:21:49","date_gmt":"2026-07-06T07:21:49","guid":{"rendered":"https:\/\/practicalhealthpsychology.com\/?p=5067"},"modified":"2026-07-06T07:56:44","modified_gmt":"2026-07-06T07:56:44","slug":"the-integrative-model-of-adjustment-to-continuous-challenges-imacc-understanding-and-supporting-biopsychosocial-adjustment","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/da\/2026\/07\/the-integrative-model-of-adjustment-to-continuous-challenges-imacc-understanding-and-supporting-biopsychosocial-adjustment\/","title":{"rendered":"The Integrative Model of Adjustment to Continuous Challenges (IMACC): understanding and supporting biopsychosocial adjustment"},"content":{"rendered":"

By Lis Dreijer Hammond, Aalborg University (DK), Christian Karlsen Hansen & Martin Lehmkuhl Kristensen, Rehabilitation Centre for Refugees, North Jutland Regional Health Services (DK) and Chalotte Glintborg, Aalborg University (DK)<\/strong><\/p>\n

When illness or major negative life events occur, life often does not return to what it was before. For people living with long-term conditions, the challenge is not simply managing symptoms but <\/span>adjusting to a changed life<\/span><\/a>. When this adjustment process is disrupted, it can contribute to <\/span>anxiety, depression, poorer physical health outcomes<\/span><\/a>, and <\/span>increased use of healthcare services<\/span><\/a>. Estimates of how well people adjust to long-term conditions vary widely, depending on how adjustment is measured. Poor adjustment shows estimates between <\/span>16.9<\/span><\/a> and <\/span>62%<\/span><\/a>. For good adjustment the estimate ranges from <\/span>13<\/span><\/a> to <\/span>36,3%<\/span><\/a>. Globally, <\/span>more than 1 billion people live with long-term multimorbidity<\/span><\/a>. If up to two-thirds experience adjustment difficulties, there is an urgent need to improve support for adjustment to long-term conditions.<\/span><\/p>\n

<\/p>\n

Adjustment is not limited to adherence to medical advice, nor does it merely concern health behaviours. <\/span>The Integrative Model of Adjustment to Continuous Challenges [formerly \u201cto Chronic Conditions\u201d] (IMACC)<\/span><\/a> is a theory of the biopsychosocial adjustment process, as experienced by the person. IMACC was developed through a <\/span>study on type 2 diabetes<\/span><\/a> and later <\/span>verified for applicability to adult-onset epilepsy<\/span><\/a>. Using IMACC collaboratively may provide a window directly into the person\u2019s adjustment process as described below.\u00a0<\/span><\/p>\n

Adjustment is a normal and lifelong process<\/span><\/a>; when life changes, we change with it. However, negative life changes can be difficult to adjust to. IMACC stipulates that to make everyday life function as well as possible, it may be necessary to change thoughts and behaviours that are no longer helpful under the new conditions. Such changes are called <\/span>adjustment<\/span><\/i> tasks<\/span><\/i>.<\/span> Successful resolution of these leads to better adjustment, a more functional everyday life, and positive identity change. Adjustment difficulties may be caused by <\/span>obstacles<\/span><\/i> getting in the way of changing, which may stall the adjustment process and, over time, lead to poor adjustment, deterioration of mental and physical health, and negative identity changes.\u00a0<\/span><\/p>\n

How IMACC is structured<\/strong><\/p>\n

IMACC consists of three interacting levels:\u00a0<\/span><\/p>\n

Level 1: Personality and life-changes<\/strong> concern past personality, beliefs and behaviours. The focus is on aspects that may impact on the adjustment process, either as <\/span>obstacles<\/span><\/i> to the process or as <\/span>strengths<\/span><\/i> that may support adjustment. In addition, <\/span>determining experiences<\/span><\/i> occurring in relation to the negative life events causing the need to adjust, may also impact on the adjustment process, both negatively (e.g., health care incidents) and positively (e.g., support).\u00a0<\/span><\/p>\n

Level 2: Ongoing adjustment cycle<\/strong> consists of five areas with adjustment tasks. When facing a long-term health condition or disability, the person starts by <\/span>Taking Stock<\/strong>. They process initial emotional reactions such as shock or anger while reflecting on what may need to change to make life function again. This involves developing motivation to adjust.<\/span><\/p>\n

The person then moves into <\/span>Learning<\/strong>, gaining <\/span>knowledge<\/span><\/i> about the condition and available options, as well as <\/span>skills<\/span><\/i> for self-management and coping. This typically involves developing new <\/span>attitudes<\/span><\/i> toward life and others. Their <\/span>Surroundings<\/strong>\u00a0play an important role. Family, work, health professionals, and the broader environment influence adjustment, as does the person\u2019s perception of their surroundings and their own life roles.<\/span><\/p>\n

As adjustment progresses, the person needs to engage in <\/span>Letting Go<\/b>, processing losses related to past functioning or future dreams and plans that are no longer feasible. Attitudes or behaviours, that no longer work in the new situation, may need to be relinquished. Over time, for each change the person may <\/span>Accept and Integrate<\/b>\u00a0the new way of living, by integrating and maintaining new attitudes and behaviours in their daily life.<\/span><\/p>\n

Importantly, for each issue that requires change, the person moves through the <\/span>Ongoing<\/b> adjustment cycle<\/b>, meaning several areas may be active at the same time.<\/span><\/p>\n

Level 3: Maintenance cycle<\/b> shows what happens in challenging moments. It is a classic cognitive-behavioural maintenance cycle with one difference: The cognitions are characterised by a conflict between either <\/span>Taking Stock<\/span><\/i> or <\/span>Learning<\/span><\/i> (depending on where in the adjustment process the person has stalled), <\/span>Letting Go<\/span><\/i> and <\/span>Surroundings<\/span><\/i>. To illustrate, a (stereo-)typical example is a woman, who struggles to <\/span>learn<\/span><\/i> a greater focus on self-care, because she cannot <\/span>let go<\/span><\/i> of her role as the person cooking and cleaning out of fear of being a \u201cbad mother\u201d or a \u201cbad wife\u201d. Maintaining her close relationships (social <\/span>surroundings<\/span><\/i>) feels more essential than looking after herself (underlying <\/span>attitude<\/span><\/i>).\u00a0<\/span><\/p>\n

Practical recommendations<\/strong><\/p>\n

Identify a meaningful goal<\/strong>:<\/b> Support reflection on which changes in the person\u2019s daily life might make a positive difference (e.g. health behaviour change). Discuss how they can integrate this change in their daily routine. Being specific about the details (time, place, etc.) makes it easier to get started. Ask what it would mean for them to make this change \u2013 and what it might mean, if they do NOT change. Meaningful goals help motivation.<\/span><\/p>\n

Work through the obstacles<\/strong>:<\/b> Review attempts to implement the change and normalise any difficulties there might be. Discuss a recent attempt to change and listen out for the underlying values and attitudes (e.g. \u201cI must help others before myself\u201d or \u201cI must finish a task before resting\u201d).\u00a0<\/span><\/p>\n

Consider the role of others<\/strong>:<\/b> Ask the person what impact they believe the change might have on close relationships. For instance, if a need to improve self-care means doing less for others, what do they think the consequences might be? What would it mean for their identity (e.g. change of life roles). What do they believe others might think, say or do?\u00a0<\/span><\/p>\n

Support negotiations of change<\/strong>:<\/b> What might the person need to talk to others about? They might need to ask what it means to others (instead of relying on own assumptions). They might need to negotiate adjustments to daily routines or to improve their skills in communicating their needs (e.g. fluctuating pain levels \u2013 what can others expect they will be able to do today).<\/span><\/p>\n

Improve<\/strong> basic body awareness<\/b><\/a>: <\/b>Support the person learning to understand bodily symptoms and sensations, what they mean and how to use them to guide self-care. Help them manage the stress involved in behaviour change and the impact of change on close relationships.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

By Lis Dreijer Hammond, Aalborg University (DK), Christian Karlsen Hansen & Martin Lehmkuhl Kristensen, Rehabilitation Centre for Refugees, North Jutland Regional Health Services (DK) and Chalotte Glintborg, Aalborg University (DK) When illness or major negative life events occur, life often […]<\/p>\n","protected":false},"author":9,"featured_media":4512,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[22,13,36,24,35],"tags":[],"class_list":["post-5067","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-behavioural-theory","category-interventions","category-mental-health","category-self-regulation","category-stress-and-coping"],"translation":{"provider":"WPGlobus","version":"3.0.2","language":"da","enabled_languages":["en","id","my","bg","zh","hr","cz","da","de","es","fr","gr","he","it","ja","kr","lv","lt","hu","nl","no","pl","pt","ro","ru","sk","sr","fi","sv","tr","uk"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"id":{"title":false,"content":false,"excerpt":false},"my":{"title":false,"content":false,"excerpt":false},"bg":{"title":false,"content":false,"excerpt":false},"zh":{"title":false,"content":false,"excerpt":false},"hr":{"title":true,"content":true,"excerpt":false},"cz":{"title":true,"content":true,"excerpt":false},"da":{"title":false,"content":false,"excerpt":false},"de":{"title":true,"content":true,"excerpt":false},"es":{"title":false,"content":false,"excerpt":false},"fr":{"title":true,"content":true,"excerpt":false},"gr":{"title":false,"content":false,"excerpt":false},"he":{"title":false,"content":false,"excerpt":false},"it":{"title":true,"content":true,"excerpt":false},"ja":{"title":false,"content":false,"excerpt":false},"kr":{"title":false,"content":false,"excerpt":false},"lv":{"title":true,"content":true,"excerpt":false},"lt":{"title":false,"content":false,"excerpt":false},"hu":{"title":false,"content":false,"excerpt":false},"nl":{"title":true,"content":true,"excerpt":false},"no":{"title":false,"content":false,"excerpt":false},"pl":{"title":true,"content":true,"excerpt":false},"pt":{"title":false,"content":false,"excerpt":false},"ro":{"title":false,"content":false,"excerpt":false},"ru":{"title":true,"content":true,"excerpt":false},"sk":{"title":true,"content":true,"excerpt":false},"sr":{"title":false,"content":false,"excerpt":false},"fi":{"title":false,"content":false,"excerpt":false},"sv":{"title":false,"content":false,"excerpt":false},"tr":{"title":false,"content":false,"excerpt":false},"uk":{"title":true,"content":true,"excerpt":false}}},"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t