New 2nd Edition Of Wellness Coaching For Lasting Lifestyle Change

New Second Edition!

New Second Edition!

In 2007 Wellness Coaching For Lasting Lifestyle Change became the first comprehensive health and wellness coaching book published. Written expressly for the practitioner, it quickly became the foundational book of the field and has remained so to this day. Updated in 2009 it has served as the go-to book for independent coaches, health care and wellness professionals, and is often used as a text for college and university classes.

I’m now proud to announce that our fully revised and updated Second Edition of Wellness Coaching For Lasting Lifestyle Change has been released by my publisher – Whole Person Associates ( Copies are available through Whole Person (with quantity discounts available with bulk orders), and through Amazon and Barnes and Noble. Just look for the beautiful new color design on the book cover image.  2nd Ed Cover - Med

Since the last update of Wellness Coaching For Lasting Lifestyle Change our company, Real Balance Global Wellness Services, Inc., (, has trained thousands and thousands of health and wellness coaches around the world. I’ve personally trained many, taught advanced wellness coaching classes, done mentor coaching with students on the ICF Path, reviewed hundreds of case studies and listened to hundreds of coaching session recordings. I drew upon what I learned from these experiences in my revisions of the book and feel that the new edition provides enough new material to warrant recommending the purchase of this second edition by those who already have the first. Many pages were deleted and the new total is over fifty pages greater than the old edition…over 300 pages!

All of that teaching and mentorship helped me realize where coaching students, and practicing coaches, need more guidance when it comes to coaching and to wellness coaching in particular. I found the places where students get confused, where they are unsure how to proceed, where they get stuck, where their progress slows down. Those thousands of hours taught me what coaches need to know more about.

In the new edition there is more on the actual coaching skills that wellness coaches need to be effective. Both the mindset, the facilitative conditions of coaching that create “coaching presence”, and the techniques that increase coaching effectiveness are elaborated upon. I found that coaches often need help going beyond exploration and must have skills and methods to “forward the action”.

The most important and complete revisions are found in Chapter Eight. We are told over and over again that the Wellness Mapping 360° Methodology ™ is what coaches find most valuable and in this new edition we’ve refined it much further. So many coaches just do “goal setting” with their clients. Here we show how to really co-create a fully integrated wellness plan for lasting lifestyle change. This structure and methodology allows the coach or coaching program to “get behavioral about being holistic”. We work with the whole person, including mind, body, spirit and environment (real wellness), and yet “put legs under it” with a behavioral process and tools that allow for greater tracking, accountability and support.

Wellness Coaching For Lasting Lifestyle Change has touched lives around the world. It is so gratifying when I hear from people across the United States and Canada about how powerful the book has been for them, both personally and professionally. Additionally phone calls, emails and wellness coach training class registrations show up from Australia, Brazil, Portugal, the Philippines, Russia, Poland, Ireland, and all over. I am both touched and excited to know that through its international distribution, we truly are CREATING ALLIES FOR A HEALTHY WORLD.

Wellness Coaching For Lasting Lifestyle Change, 2nd Edition

Michael Arloski, Ph.D., PCC, CWP

Michael Arloski, Ph.D., PCC, CWP

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Process Coaching: Yes, Coaches “Do Emotions”


The landscape of emotion is best walked with an ally.

The landscape of emotion is best walked with an ally.

How can we walk with our clients through the landscape of emotion and stay on solid and fertile ground? How can we avoid the mud, or even the quicksand of faux-counseling/psychotherapy? We want our clients to harvest the insights and benefit from the emotional release that comes telling their story, while feeling heard, understood, and even affirmed. We want them to know that we are true allies who won’t abandon them the first time they reach for a tissue.

Coaches may treat the world of feelings like they are all stored in a “Pandora’s Box”. Open the lid and we may be headed straight for disaster. Better to keep it closed tight. I’ve been alarmed to hear reports of wellness & health coaches out there working in systems where they say they “don’t do emotions”.

Probably the most challenging territory for coaches who do not have a mental health background is how to do what the life coaching profession calls “process coaching”. Sure, it’s easy to hear a client say they want to lose thirty pounds and quickly construct a wellness plan that has them increasing activity and improving their diet. Goals and action steps are set up and a system of tracking behavior may be implemented. Sounds great…until your client comes in talking about how they only walked one time last week. They feel embarrassed. They say they are sorry they let you down. And now they are almost crying as they relate how frustrating and painful it has been to be overweight most of their life. Like it or not coach, you’ve got to stay with them as they explore these feelings. Shut them down through either changing the subject or just non-verbally communicating your discomfort and you will likely damage the coaching relationship and the client will lose the opportunity to integrate their emotions around this important subject. The client needs to process their feelings.

edge-of-cliffCoaching Caution

There are also coaches who are more than willing to jump into the territory of emotion. I was very alarmed when I discovered a group of coaches in Northern California who, on their website, promise “deep emotional healing”. It did not appear that any of them were licensed mental health professionals, yet they were inviting clients to come to them to deal with their trauma. As a psychologist who has dealt with the full range of mental health problems and crises, I believe it is far beyond the scope of practice for coaches to enter this realm. It is dangerous and unethical for coaches who fancy themselves as “healers” to offer such false services.

Coaches can effectively work with mental health patients, if they limit their work to coaching and leave the counseling to the mental health pros. A recent article in Psychology Today explored some of the ways coaches are helping in the realm of mental health and also raises some important guidelines and warnings. (

Be sure to review my previous blog post “The Wellness Coach And Referring Clients To A Mental Health Professional: PART ONE – WHEN” ( ) for more in-depth information about making referrals. Another great reference is: “Coaching versus Psychotherapy in Health and Wellness: Overlap, Dissimilarities and the Potential for Collaboration” By Meg Jordan and John B. Livingstone appearing in Global Advances In Health And Medicine, Volume 2, Number 4, July 2013 •

Exploring both the external barriers to change, and the internal barriers is an essential part of most effective coaching. Clients benefit greatly by looking at their own self-defeating behavior patterns and do not always do so dispassionately. It may be essential for a client to ask for support in their life with their lifestyle improvement efforts. Yet, their reluctance to ask for help may be an emotional issue. Its roots may never reach Freudian depths. They simply may need to get in contact with their feelings, realize how tender this subject is for them, then, with the unwavering support of their coach, take the risk of reaching out to others.

Process Coaching

Coaching is not just about goals and action steps. It’s about the person’s own experiencing of their life as it intersects with this world. There is continually a lot to integrate. There is also so much growth that is possible. The authors of Co-Active Coaching (2012) explain that “Process coaching focuses on the internal experience, on what is happening in the moment. The goal of process coaching is to enhance the ability of clients to be aware of the moment and to name it… Sometimes the most important change happens at the internal level and may even be necessary before external change can take place.”

These authors also urge us to look at feelings as information rather than symptoms. Our inescapable humanness demands that we accept the fact that we are emotional beings. Recent research confirms that our decision-making processes draw upon feelings 60% of the time rather than logic. Part of the coaching journey is to assist our clients in sorting out their feelings so they can make the best decisions possible. That may mean acknowledging the validity and importance of certain feelings like when a client decides to live according to their values of closeness with their family and turns down the job offer that would keep them on the road most of the month.

Summit sunset coach & clientTen Guidelines For Process Coaching

1. The vast majority of your clients are functioning at a level where they can handle emotions well. They can gain insight from talking about their feelings.
2. In your initial discussions with your client about coaching you make it clear that your agreement with your client is that coaching is not a substitute for any form of treatment.
3. Read my blog “The Wellness Coach And Referring Clients To A Mental Health Professional: PART ONE – WHEN” ( For a good reference on when to refer.
4. “Get yourself out of the way!” – Realize when the difficulty you are having exploring emotions with your client (or your reluctance to) is really about your own feelings. You may have some emotional work to do yourself. You may have come across an area so tender for you that you have to ask the client’s permission to not explore this topic and help them find other resources to do so. You can also “be in the way” when exploration with your client is more about your own ego-needs.
5. Use the basic active listening skill – Reflection Of Feeling. Don’t just paraphrase what the person says. Offer your observation about the feeling that is apparent in your client as they speak.
6. When your client begins to dive deeper into their history of an emotional issue, “presentify” it. Ask the client to tell you how that experience/history relates to today. “So, I understand how critical your mother must have been, but how does that affect your taking time for self-care today?”
7. Ask permission. Don’t assume that it’s okay with your client to go forth into a new area that is likely filled with emotion. The necessary trust may not be there yet.
8. FAVE: First acknowledge, validate and empathize. Check out my previous blog post on the importance of acknowledging feelings: (
9. Allow your client to feel what they feel. Check your temptation to rescue your client when they are still in the shallow end of the pool. Convey your supportive presence as they contact their sadness, grief, joy or anger. Allow them to go beyond an intellectual conversation “about” feelings. Connection with feelings often is what allow a shift to take place within your client and through insight the path to action opens up. Don’t ask “why” the person feels they way they do. Explore it and acknowledge it. Let the client work with their own emotions, with your support and non-judgmental trust.
10. Forward The Action. Real progress is made when clients can take their new awareness and translate it into action. Coaches can get stuck in a carousel of feeling exploration that can go on infinitely. Develop your coaching skills for forwarding the action. Ask powerful questions that explore what the client is ready to do about their new awareness. How can they take what they are now aware of and apply it to what they want in their life? How can what they know now help them make progress towards their goals? Co-create experiments for the client to try out and support them by helping them with ways to be accountable to themselves for carrying it out. When clients stay stuck in that carousel of emotion, when they seem unable to translate their new awareness into action repeatedly it is most likely that you are looking at the need for a referral to a counselor/therapist. This, in fact, is one of the best indicators of the client’s ability to handle emotion and make great use of coaching…or not.

One of the most brilliant things I heard recently was that coaching is not a helping profession. It is an assisting profession. A critical distinction of mindset. We coaches who seek to be “helpers” and “healers” should look into other professions. There are lots of ways to be of great service helping others to heal themselves. If we are okay with “assisting” in the process of working with clients whom we see as “naturally creative, resourceful and whole”; if we are fine with evoking the wisdom within our clients so they can make life-changing use of it, then coach on!


Kimsey-House, H., Kimsey-House, K., Sandahl, P., Whitworth, L. (2011) Co-Active Coaching: Changing Business, Transforming Lives. 3rd Ed. Nicholas Brealey America.

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Lessons From Albert Bandura For Wellness Coaches


“Self-efficacy or belief in one’s ability to perform determines whether behavior will be initiated, how much effort will be expended, and whether the effort will be sustained.”

“People with high assurance in their capabilities approach difficult tasks as challenges to be mastered rather than as threats to be avoided.”        Albert Bandura

From ancient philosophers to Sigmund Freud and down to today’s latest psychological research, people have been attempting to understand what drives human behavior. If you were to pose the idea that what we do as human beings is a result of what we think and how we interact with our environment you would get few arguments. Yet such a theory is a relatively recent development in the study of psychology. Social psychologist Albert Bandura ( was primary among the people who have helped us validate the idea that our behavior is an interplay between what we observe in the world around us, how we self-reflect about it, and how we decide to go forward with action.

“With the publication of Social Foundations of Thought and Action: A Social Cognitive Theory, Bandura (1986) advanced a view of human functioning that accords a central role to cognitive, vicarious, self-regulatory, and self-reflective processes in human adaptation and change. People are viewed as self-organizing, proactive, self-reflecting and self-regulating rather than as reactive organisms shaped and shepherded by environmental forces or driven by concealed inner impulses.” (Pajares, 2002)

Bandura Model RD



Model Of Reciprocal Determinism – Bandura

Because Social Cognitive Theory sees our behavior as part of a reciprocal, continually interacting circle, our counseling or coaching efforts can directed at the personal, environmental and behavioral factors.

For the wellness professional who works with people to help them improve their lifestyle behavior this is an easy theory to sign on with. We see our clients continuously facing inner and outer barriers that challenge their attempts at behavioral change. Inner barriers include the Personal Factors that Bandura talks about: cognitive, affective and biological events. Or more simply put, the ways in which our thoughts and belief systems limit us; the ways in which our emotions override our logic in self-defeating ways; and our own emotional-biological connection. Outer barriers include the Environmental Factors that add stress and/or support to our lives.

In wellness and health coaching (referred to hereafter as wellness coaching), effective methodologies go beyond simple assessment and goal-setting and recognize that what derails the best laid wellness plans are usually these inner and outer barriers. Central to the coach approach is the contention that human beings are accepted in coaching as being “naturally creative, resourceful and whole.” (Kimsey-House, H., Sandahl, P., Whitworth, L., 2011) ( They are seen as having the ability, with the right support, to positively impact their world and their own lives.

“Social cognitive theory is rooted in a view of human agency in which individuals are agents proactively engaged in their own development and can make things happen by their actions. Key to this sense of agency is the fact that, among other personal factors, individuals possess self-beliefs that enable them to exercise a measure of control over their thoughts, feelings, and actions, that “what people think, believe, and feel affects how they behave” (Bandura, 1986, p. 25). Bandura provided a view of human behavior in which the beliefs that people have about themselves are critical elements in the exercise of control and personal agency. Thus, individuals are viewed both as products and as producers of their own environments and of their social systems.” (Pajares, 2002)

What wellness coaches observe is that there is often great disparity regarding the degree to which their clients believe that the efforts they make to improve their health and well being will be effective. Do they believe that they can affect their own health, and to what degree? For the wellness coach and client, this is the very essence of “self-efficacy”.

mtn climb hand up“Of all the thoughts that affect human functioning, and standing at the very core of social cognitive theory, are self-efficacy beliefs, “people’s judgments of their capabilities to organize and execute courses of action required to attain designated types of performances” (p. 391).” (Pajares, 2002)

“Self-efficacy beliefs provide the foundation for human motivation, well-being, and personal accomplishment. This is because unless people believe that their actions can produce the outcomes they desire, they have little incentive to act or to persevere in the face of difficulties. Much empirical evidence now supports Bandura’s contention that self-efficacy beliefs touch virtually every aspect of people’s lives—whether they think productively, self-debilitatingly, pessimistically or optimistically; how well they motivate themselves and persevere in the face of adversities; their vulnerability to stress and depression, and the life choices they make.” (Pajares, 2002)

Many clients arrive to wellness coaching having experienced failure experiences which have negatively impacted their self-efficacy. Discouraged by perhaps numerous attempts to quit smoking, manage stress, or attain and then maintain a healthy weight, their belief in the own ability to succeed at lasting lifestyle improvement has been damaged. Yet, as Bandura has shown us, this belief needs to be strengthened for the person to garner the motivation to change and the tenacity to succeed.

How do we then build self-efficacy? Fortunately effective wellness coaching methodologies have built into them the very factors that Bandura has found effective.

“Reality is not so much what happens to us; rather, it is how we think about those events that create the reality we experience. In a very real sense, this means that we each create the reality in which we live.” ~ Dr. Albert Ellis

“All that we are is the result of what we have thought; it is founded on our thoughts; it is made up of our thoughts. A man’s life is the direct result of his thoughts… We are what we think. All that we are arises with our thoughts. With our thoughts we make the world.” ~ Gautama Siddhartha (Buddha)

Though he’s not quoted as saying so, the essence of Bandura’s work would agree with the old saying that “We create our own reality.” Most human motivation is cognitively generated, Bandura argues. We anticipate our actions with forethought and figure our chances of success largely based upon our past experience in this arena. This forms beliefs about what we can and can’t do. We set goals and form plans to realize the outcomes we desire. The way we set those goals is largely determined then by our perception of our past experience and our level of self-efficacy. This combined with our current thinking yields our performance in attempting to reach our desired outcome.

Causal Structure


Perception of our Past Experience affects our Self-Efficacy. This in turn affects our expectations and the level at which we set our personal goals. This is then filtered through our thinking, or as Bandura puts it, our Analytic Strategies and this combination of Personal Goals and Thinking affects our Performance or outcome. So, if I have a history of failure at weight loss and low self-efficacy about succeeding at another attempt at losing weight I will set personal goals that may be minimal, or may be unrealistic. I then attempt to achieve these goals using strategies that are influenced by my lack of confidence, discouragement, and self-doubt, and my performance, or outcome suffers.

A Coach Approach Difference



Let’s say I now have a wellness coach helping me with the process of change. Firstly as I speak to my coach about my Past Experience, and they help me reframe my experience less negatively. I get empathy and support, even acknowledgement for how challenging weight loss has been for me, but I don’t get sympathy. My coach helps me discover what in my past experience was effective. What did work that I can use again?

My coach also works with me to improve my self-efficacy (see below) and help me build my feelings of greater self-esteem, self-confidence and helps me recognize and acknowledge my strengths that I can use in this change process. My coach is using the Positive Psychology approach that is inherent in coaching. Together my coach and I co-create a better set of Personal Goals that are optimistic, yet realistic. Through the coaching I discover more of the motivation that I have for improving my life, including losing weight. The coaching helps me see the motivational link between what action I am taking and how it will help me reach my greater desired outcome of living my healthiest, best life. This motivation helps me produce greater effort, push through barriers and, with my coach’s help, strategize though both internal and external barriers. The result is an improved Performance.


Now, when I look at my recent Performance I am encouraged by at least some level of progress. I now begin the Causal Structure of Change process again, and this time I begin by basing it on my Recent Performance, not my Past Performance. This helps push a higher level of Self-Efficacy within me. I set even better Personal Goals. My Thinking, my Analytic Strategies are more positive and effective and this all yields even better Performance. We are now on a positive circle of action and success that can be repeated, instead of a vicious circle of defeat.


How To Build Self-Efficacy

Most wellness professionals are already very familiar with the term self-efficacy and set improved self-efficacy as a desired outcome in virtually all of their wellness programming. Wellness coaches seek to help clients have greater belief in their ability, capacity, and confidence in positively affecting their health and improving their lifestyles. The question is “How?”.

Bandura (1997) identified four sources of information that affect our self-efficacy:
• Mastery Experiences – Self-mastery
• Vicarious Experiences – Role Modeling
• Verbal Persuasion – Social Persuasion
• Physiological Cues

Let’s look at how wellness coaches can help clients improve self-efficacy by working with these four factors.

MtnSummittSmallMastery Experiences

Mastery experience is the strongest and most effective source of building self-efficacy. As we say in coaching “Nothing succeeds like success!” An effective coach helps their client recognize and acknowledge themselves for even the smallest accomplishment. Many clients are notoriously poor at giving themselves credit for what the do accomplish and coaching can help them reframe this.

The coach helps their client avoid repeating self-defeating strategies they’ve used in the past and helps them devise more effective experiments at change. As clients set in place a wellness plan that sets out manageable goals and specific (easy) action steps that are in alignment with the client’s “readiness for change” (Prochaska, 1994) ( the probability of success is much greater. As the client experiences “mastery” it is very self-reinforcing and self-efficacy beliefs elevate.

bluezonesYogaAmazing OldsterVicarious Experiences – Role Modeling

A cornerstone of social psychology is that we all learn from one another and this influences our own behavior. Much of Bandura’s work has been around modeling whether it was the famous BoBo Doll Experiment (Bandura, 1961), or filming people crossing the street against a traffic light just because a well-dressed man carrying a briefcase did so. When we see someone being successful at certain behavior we are more likely to try it ourselves. Thus the omnipresence of fad diets and all the fitness trends we witness. Television and the internet serve to expose us to even more models to imitate. Self-efficacy, then, can be affected by observing what others experience.

People who observe a model successfully perform in a challenging situation are more likely to develop an expectation that they can acquire the same skill (Alderman, 1999). So, coaches can encourage clients to find models that will both encourage them and perhaps show them strategies and the skills they need to be successful like their models.

What we know about effective models is that they need to be people we feel positive about and can relate to. Most fitness and wellness magazines, for example, forget this and continuously hold up exceptional examples for us to follow. We may find it extremely hard to identify with celebrities, or a seventy-five year old ultra-marathoner who was an All-American track star in college. Models who are seen as having similar attributes (age, gender, ethnicity, etc.) as ourselves and who have struggled imperfectly, but persevered and succeeded at a similar task are most effective.

coaching-1Verbal Persuasion – Social Persuasion

The messages we get from others can have a profoundly positive or negative effect upon our efficacy expectations. When one receives encouragement that “you can do it” our belief in our own capacity for change increases. For these positive verbal statements to be effective though, they must be believable and conveyed by someone the person sees as trustworthy.

The term “persuasion” may be a bit misleading for the coach. The reality is that we really can’t “persuade” someone to be well. It’s not a convincing sales pitch that works, but instead the kind of “I believe you can do it, I believe in you!” statements that a coach sincerely makes that go beyond simple cheerleading.

At the heart of good coaching is what we call “coaching for connectedness” (Arloski, 2009). A key to successful and lasting lifestyle improvement is coaching with the client to help them consciously develop a system of support that will help them attain and maintain the changes they seek. This social support is a central part of Bandura’s message. When clients find walking buddies, social groups with positive peer health norms, or learn how to ask for the support they need, they are much more likely to succeed.

RelaxMP3Physiological Cues

Individuals sometimes judge their capability to perform a task by their own physical/emotional experience as they face the task or perform it. If they doubt their ability, possibly fear the consequences of failure, etc., they may experience anxiousness, increased heart rate, sweating, etc. Awareness of these symptoms can trigger even more self-doubt and fear and plunge self-efficacy beliefs further down and affect performance.

Bandura contends that individuals have the capacity for self-regulation. We can affect our physiological states through our awareness, our thought processes and through techniques of breath and relaxation. Wellness coaches can help their clients to become aware of these patterns of anxiousness and help them seek out methods for self-management. Coaching takes it further by helping clients establish accountability around practicing these self-management techniques. Positive mental rehearsal can also be used to reduce anticipatory anxiety and increase confidence in one’s capacity for positive performance. The coach and client can even rehearse in role play for an upcoming event for the same purposes.

Theory and Practice

Social Cognitive Theory (formerly known as Social Learning Theory) helps us see ways to be more effective in working with our clients. It also is very validating to the “coach approach” taken by professional life coaches and professional wellness coaches. There is tremendous congruity between what coaches do and what this theory advises.

Alderman, M. K. (1999). Goals and goal setting. Motivation for ahievement: possibilities for teaching and learning. New Jersey: Lawrence Erlbaum Associates.

Arloski, M. (2009) Wellness Coaching For Lasting Lifestyle Change. Updated Ed. Duluth, MN: Whole Persons Associates.

Bandura, A.; Ross, D.; Ross, S. A. (1961). “Transmission of aggression through the imitation of aggressive models”. Journal of Abnormal and Social Psychology 63 (3): 575–582. doi:10.1037/h0045925. PMID 13864605.

Bandura, A. (1977) Toward A Unifying Theory Of Behavioral Change. Psychol Rev. 1977 Mar; 84(2):191-215.

Bandura, A., (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, p. 122-147.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman

Kimsey-House, H., Sandahl, P., Whitworth, L. (2011) Co-Active Coaching: Changing Business, Transforming Lives. Nicholas Brealey; Third Edition.
THE Coaching “Bible”! Best book on basics of coaching and coaching skills.

Naydock, G. R. How Would Bandura Increase Self-Efficacy In Therapy.

Pajares, Frank (2002) Overview of Social Cognitive Theory and of Self-Efficacy, Emory University, Archived at:

Prochaska, J., Norcross, J, & Diclemente, C. (1994) Changing For Good. New York, NY: Harper Collins/Quill. 1994 Harper Collins, 2002 Quill reprint.


Content is the copyrighted material of Real Balance Global Wellness Services, Inc., 2014 and may be used only for educational purposes and only when complete credit is given for its source.

Michael Arloski, Ph.D., Ph.D., CWP, is a psychologist, certified wellness coach and Founder and CEO of Real Balance Global Wellness Services, Inc. and Dean of The Wellness Coach Training Institute.

Michael Arloski, Ph.D., PCC, CWP

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Yes, We ARE Getting Healthier!

How Does Your State Rank?

How Does Your State Rank?

In the midst of the healthcare crisis, America’s actual health, in many ways, is improving! It’s easy to feel discouraged by the political struggles, obesity and diabetes “epidemics”. Hearing that the U.S. has a worse life expectancy than Slovenia and Chile is very disheartening. Yet, despite some huge challenges that aren’t going away, there is an upside.

The 2013 Annual Report by America’s Health Rankings® is in and the word is better than we may have expected. The longest running annual assessment of the nation’s health on a state-by-state basis, America’s Health Rankings has spent 24 years assembling health data to help us see our progress and challenges. (

The almost twenty-five year trend of increasing obesity appears to have leveled off since 2012. The scientists aren’t ready to predict which way the scales will tip on this one, but at least it’s not another increase. In 1990 almost thirty percent of Americans smoked. In the last year we finally edged just under twenty percent with seventeen states showing a decrease in smoking.

Healthier Hearts

Healthier Lifestyles, Healthier Hearts

Healthier Lifestyles, Healthier Hearts

A real eye-opener is learning that cardiovascular deaths have declined 36 percent since 1990 and each year continues to see a 2-3 percent decrease. We’re also doing a better job of helping people avoid ending up in the hospital when it could have been prevented. “Preventable hospitalizations continue to decline. In 2001, there were 82.5 discharges per 1,000 Medicare enrollees; in 2013, there were 64.9 discharges per 1,000 Medicare enrollees.”

The American workplace is also becoming safer. “Occupational fatalities have declined slightly in the last 6 years from 5.3 deaths in 2007 to 3.8 deaths per 100,000 workers in the 2013 Edition. Rates have reached a 23 year low.”

Though most of the decline happened between 1990 and 1999, infant mortality is 39 percent less than it was in 1990. Though not dropping much recently, there has been no increase in recent years. At the same time though, the number of children living in poverty continues to increase with the 2013 report telling us that slightly more than one in five American children live below the poverty line.

As you look at the state-by-state maps in the report the geographic and other disparities are painfully obvious. A close to home example show us this. “The prevalence of physical inactivity varies from a high of 52.8 percent of adults aged 25 and older who did not graduate high school in Arkansas to a low of 6.7 percent of college graduates aged 25 and older in Colorado.”

While challenges remain and stats like those found in the America’s Health Rankings report can help drive the changes we will need to improve our country’s health, the progress needs to be hailed. The knowledge that we can and in fact are being successful in improving the health of populations helps empower us all. When we see that a state like Nevada can lead the nation in decreased smoking there’s motivation to do more in our own neck of the woods!

Dr. Arloski

Dr. Arloski

The Coach’s Take Away

Many wellness coaching clients are discouraged not only by their own failure experiences, but also by the never-ending barrage of negative press that spotlights one problem after another. While a head-in-the-sand approach to life only leads to more problems, and we do need to increase our vigilance about the food we eat, etc., everyone needs to know that our country-wide wellness efforts are paying off. We talk about the client’s “self-efficacy”; their degree of belief that it is possible to positively affect their own health. Stats like America’s Health Rankings can show that there is reason to increase our collective sense of health & wellness efficacy. Positive psychology works!

Wellness Is About The Big Picture!

Wellness Is About The Big Picture!

Coaches also need to be involved in wellness beyond the one-on-one or small group work that they do. In a company, the key to a successful wellness coaching program is for it to be part of a larger comprehensive wellness program. Such programs provide not only coaching, but education, wellness skill building, opportunities to be well (healthier food access, physical fitness access, built-in movement throughout the day, etc.), and a thorough effort at establishing a culture of wellness throughout the organization at all levels. The natural extension of all of this is community and environmental wellness. Demonstrated progress can show decision makers in both industry and government that wellness works, and most importantly, is worth funding. Coaches who care about wellness can benefit by caring about the bigger picture as well.

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Ten Steps To Forward The Action In Your Life

Photo by M. Arloski Glendalough, Ireland

Photo by M. Arloski
Glendalough, Ireland

In the coaching process we listen, clarify and help our clients explore their lives, taking stock of their current life situation and health status. Eventually we have to go beyond our basic listening skills, summarizing and helping our client get very clear about where they currently are. At that point we help them get clear about what they are ready to do (referencing all we know about readiness for change theory) ( and we boldly ask them what they are willing to do. 

In listening to recordings of some of my mentor coaching clients I’ve realized that many new coaches struggle with what we call “forwarding the action”. If all a coach does is summarize, paraphrase, empathize, and reflect the client often continues to tell their story and stay wrapped up in it. One of the most powerful things that coaches do for people is to help them realize that they are not their story! They are much more.

Powerful questions challenge a client to look at things in new ways, to develop new perspectives and try on new ways to frame an old problem. Coaches can still be “client-centered” but share their own perspective on what the client is saying, pointing out observations, helping the client recognize patterns. At some point we ask “What’s one small thing you can do to make progress on that?” or “What’s one small step you can take between now and the next time we talk to work on that?”

Whether we are a coach acting as an ally in the growth process with our client, helping them move forward with their lives, or an individual whose own growth demands some “forward momentum” here are my

Top Ten Ways To Forward The Action

1. Contemplate Well
“Thinking about change” does not necessarily mean you are stuck. We may need to reflect deeper about an anticipated change. Ideally we may use three different methods that help us explore more completely: 1) thinking about it by ourselves; 2) writing about it – which often yields very different insights since we are drawing upon a different part of our brain; and 3) talking about it with someone else such as a coach.

Inadequate contemplation/exploration/research often yields pre-mature goal setting and usually results in failure. Talking it through is important, but of course this wears out its usefulness at some point. If you think you continually need to know more before you act, ask yourself. When will I know that I know enough?

2. Never Make A Decision Just To Relieve Anxiety

This is a phrase I developed in my years of work as a psychotherapist and it’s a good maxim to follow. Research shows that we make 60% of our decisions based on emotion, not logic. Remember that lemon of a sports car your bought on stylish looks alone? When making decisions about how to move forward with our lives we need to acknowledge the emotions, maybe even process them more, but temper them with our rational thinking. This is easier said than done and another argument for processing it with others, such as our coach.

3. Distinguish Between Cautious Wisdom And Gremlin TalkTaming Your Gremlin cover

There is a part of us that has our best interests at heart. This part can caution us to consider changes carefully, to hold back sometimes until we have all the facts. That part is a friend to be listened to. The inner-critic or so-called Gremlin, is not. This part of us is the home of our self-doubt, all our self-recrimination, and in fact is the accumulation of all the untrue statements about ourselves that we, and others, have made throughout our years. If we listen to the Gremlin we will never grow. Maintaining the status quo is the Gremlin’s full-time job so change, even wonderful improvements, is its enemy.

Listen carefully to your self-talk. Distinguish between being cautious and being negative. Does it sound like familiar old recordings being played again? Is your Gremlin hitting you with hurtful thoughts about how you don’t deserve a better life? Or is your self-talk simply asking you to examine your contemplated changes carefully and go forward with your eyes wide open?

4. Link To Motivation By Beginning With The End In Mind

Stephen Covey’s second habit of his Seven Habits Of Highly Effective People (, “Begin With The End In Mind”, helps us remember to start our journey with the destination clearly in mind. Coaches are rightfully notorious for asking “What would it look like…?” Instead of how will I solve the problem or overcome the barriers (which is often where we stay stuck) get clear about what you really want. Visualize, fantasize, imagine, dream. It’s all good.

Align that visualization with your values, with how you really want your life to be. We are talking about you changing your life so you can live in that healthier, more self-actualizing way for the rest of your entire life. Take the time to get clear about “what’s possible”.

Connect a motivational link by seeing how even the smallest action step you take is helping you achieve the goals you have that are part of you living your best life possible, the life that you have imagined. This puts purpose behind even the most mundane action step.

5. Anticipate The Roadblocks And Strategize Through Them

It’s easy to hold ourselves back by fearing the potential consequences of making change happen. Better not to stir the pot. Unfortunately not to decide is to decide. We usually know that our efforts at improving our lives will be met with support from some corners and resistance from others. Anticipate the highly probable negative reactions you may see and come up with effective strategies for how to respond. Anticipate some of the practical barriers like costs, time schedules, etc. You may want to communicate your intentions behind your new ways of behaving proactively to pre-empt potential conflicts. Here is where working with a coach can be so valuable as you work together developing new strategies to insure success.

When you're ready, go for it!

When you’re ready, go for it!

6. Take On The Challenge

Words matter. We may do ourselves a great disservice by dismissing semantics. Reframe your “problems”, barriers, obstacles, diseases, and diagnoses, as challenges. Improving your life, your lifestyle, your wellbeing may be daunting but see it as a challenge that, with the help of others, you are up for!

I always teach coaches that they can challenge a client more when their relationship with them is strong. It’s about conveying your belief in them, in their abilities, capacity, talents, and character. From the individual’s point of view it’s a combination of remembering these qualities and staying around positive and supportive people. This is not a time for hanging out with “dream drainers” and pessimists.

7. Experiment!

It’s easier to “go for it” when we lessen the risk involved. Most of the risk comes at us in terms of our own fear of failure. Adopting an “experimental attitude” allows us to frame our attempt as less risky when we are not putting our entire self-worth on the line. If it doesn’t work we go back to the drawing board. It was an experiment. How can we tweak the experiment to get better results next time? That’s all.

The word “try” or “trying” gets a bad rap from some motivational speakers. “Just do it! Don’t try!” Certainly a half-hearted “Well, I’ll try, if I have to, I guess” is most likely doomed to failure. Yet, I’ve had a number of clients really take to the idea of “trying” something enthusiastically, and yet because they were “trying” it seemed like there was less at risk. They were willing to “try”. One might think of it like trying on a piece of clothing. There is no need for a commitment “to buy”, just see how it fits, how it works for you.

8. Write It Downjournaling

Think it. Dream it. Speak it. Write it down! When we look back over our shoulders at our lives we start to realize that most of the ideas that we birthed and brought to fruition were things that we finally wrote down. Nurturing our thoughts into action works best when we get them outside of our heads. Ideally it begins when we start saying it out loud to others and then when we actually write it down, even if we show no one else, we’ve made a commitment to ourselves. It gets real.

In coaching this is where writing out action plans, wellness plans, business plans, funnel all of our thoughts and ideas into a focused reality. We have a map. We’re actually going to get somewhere!

9. Track it!

Trackers find what they are looking for. Forwarding the action doesn’t just mean getting started. It means knowing where you are on the trail. Coaches ask their clients “How will you know when you are being successful?” Well, I guess I’ll have to keep track of what I’m doing.

It’s always astonished me how often I get a negative answer when I have asked a wellness coaching client if they have ever kept track of their behavior (activity level, what they are eating, any biometric markers, etc.). Never thought of it. People try to make changes with revved up will power, lots of effort and sometimes little else. If they try to keep track of their efforts in their head it almost always becomes a muddle of uncertainty and usually results in abandoning the change process. Use phone apps or even a simple wall calendar but don’t deceive yourself, track it! Seal the deal with accountability to yourself and perhaps strengthen that by sharing that accountability with a coach.

10. Refresh Your Efforts.

Most folks will tell you that maintaining change is the hardest part. The real challenge is usually staying consistent and on your plan for the long run. It’s the smoker getting beyond the point of constant craving. It’s the weight-loss client maintaining through the dreaded plateau phase. It’s any of us staying with our wellness self-care when stress amps up in our lives.

One important part of maintaining action is to refresh it often. Are we following through on the actions we’ve committed to? If not do we need to “Reset, Re-commit or Shift” ? Perhaps we need to reset the frequency of our actions, less walks in one week or perhaps shorter ones. We may choose to re-commit to our existing action steps for another week, or maybe it’s time to shift to entirely new and different actions.

Refreshing may also include adding a greater dose of fun into the mix. Ditch the treadmill and head outdoors for a walk/run every time you can. Perhaps adding a social aspect, including others, will make it easier to get out bike riding, hiking, or walking. A Mediterranean cooking class might be just the thing to recommit to healthier eating and adding the skills to do it easily.

Beach runnerForward Momentum

Merriam-Webster’s Dictionary has a great definition of momentum. Think of this in terms of getting things moving in your life.

the strength or force that something has when it is moving
: the strength or force that allows something to continue or to grow stronger or faster as time passes
physics: the property that a moving object has due to its mass and its motion


With this definition it seems that improving our lives, our lifestyles is all about number one, getting things moving. This is what allows our efforts to gather strength, to gather force. Once moving it will grow stronger over time and essentially take on an energy of its own that is self-sustaining. Physics and psychology seem to complement each other here. Overcoming inertia (objects at rest tend to stay at rest), beating our stuckness, vanquishing our self-doubt, finding the support that bolsters our confidence and accepting the challenge seems to get us moving. Having a clear destination helps us set our course. Then once we are on our path with clear direction and a plan, our movement gets easier and easier (objects in motion tend to stay in motion). Now we’re getting somewhere!

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Forging A New Wellness Path: Leaving Health Risk Reduction Behind

It's time to cut a new trail...innovate wellness!

It’s time to cut a new trail…innovate wellness!

Attending Lifestyle Medicine 2013 ( in the Washington, D.C. area this week I was heartened to be around so many enthusiastic people from the medical world who have embraced the realization of just how behavioral health is. The conference was “small but mighty” and had doubled in size since the previous year.

Dean Ornish ( spoke for two riveting hours. While he started out with the obligatory review of his professional research on the reversal of heart disease, etc., his last hour was spent focusing almost entirely on how the really key ingredients in health are social support, connectedness, and a person’s spiritual connection or meaning in life.

Dr. Dee Edington

Dr. Dee Edington

We heard from some of the real innovators and leaders in the field like David Katz, Caldwll Esselton, James McDougal and others. Someone on the schedule that I was really looking forward to hearing was Dee Edington  (  It would not be exaggerating to call him the “Godfather Of The HRA” (health risk assessment). His thirty-five years at the University of Michigan Health Management Research Center ( forged much of what we know today about health risk assessment and the tons of data that came from researching this field. As wellness programs developed during the 1980’s they all started with giving their populations an HRA and building their wellness programs around the results. HRA’s are still in widespread use as there is tons of evidence that when you can help a population reduce their number of health risks everyone is healthier and healthcare costs are significantly reduced.

HRA’s are hugely incentivized by employers who will offer health insurance premium discounts and/or hundreds of dollars in cash to employees for merely completing them. One upside is that HRA’s today are often what get someone through the wellness coach’s door as they do a follow up interpretation session.

Over the years however, many of us have seen little value in HRA’s from the client’s perspective. Being told that if you eliminate a number of your risky (and often much-loved) lifestyle behaviors will add about 7.2 years to your life usually falls far short of providing what you would call stimulating motivation for change! Most of the coaches that I have trained who are already out there working with clients say three things about HRA’s: 1) we love them for the aggregate data they provide; 2) client’s do not find them motivating (fear based motivation is easy to deny and just doesn’t last); and 3) so many employees do not trust their employers to keep it confidential that they “fake good” on them when they fill them out.

So, for me, Edington’s talk was much anticipated. Dr. Edington began slowly talking boldly about how upon visiting the Lifestyle Medicine website he was disappointed to see that their definition of Lifestyle Medicine was not about health…it was about disease.

“Lifestyle Medicine (LM) is the use of lifestyle interventions in the treatment and management of disease.” (

He then went on to remark how despite accomplishments in many areas, the impact of all our work in medicine, health promotion, etc. the health of the nation is in many ways no better today than it was thirty-five years ago when he began this work. The obesity epidemic and all the chronic diseases (lifestyle driven) that go with it are killing us. Looking back disheartened, he said that our health-risk reduction approach was a mistake. Looking back over thirty-five years and 12 million HRA’s administered, he said “I’d like to take most of them back. I was part of the problem.”

Here was the man everyone listened to for years and who lead an approach to wellness programming that thousands of companies and organizations followed, admitting that we have been on the wrong track all this time. What a huge realization, and what a huge admission!

“We’re in the mud, the muck, talking about risk factors and disease.” he said. What about health? What about real wellness? He urged us to consider instead of running away from healthcare costs, to run toward health!

It was another speaker who quoted Einstein that day (Arthur Franks) but it could just have easily fit into Dee’s Powerpoint presentation.

einstein-quotes-solve-problemsThe big challenge we face according to Dee is this question:

“How can you beat the natural flow of decreasing population health status?” His research was not all for naught. It showed us that if we provide nothing for the healthy people in a population to help them stay healthy they will become those high risk individuals with increasing health problems.

“Disruptive innovation!” is what Dee Edington is calling upon all of us in the health and wellness fields to do. We clearly need some new thinking if we are truly going to make a dent in the health problems we face. Innovate. Be bold.

Dee even chided the Holy Grail of “Evidence Based Medicine”. If you are oh-so-carefully following EBM he reasoned, “You are a follower. Be a leader!” he urged.

The outcome measures we should be shooting for are not these fearful risks, they should instead be things like “Engagement in life! Love, compassion and resiliency.”

Lifestyle medicine by it’s very nature is a form of “disruptive innovation”, as the wellness field was in it’s early years. What I now question is have we forgotten our innovative roots? In the late 1970’s when we got this wellness field moving it was indeed revolutionary. We shook up the status quo of remedial care and found more and more effective ways to look at what really influences health. Behavior. Culture. Belief. Connection.

As the years passed and every wellness program struggled for funding, and as the business model conquered the healthcare field with chilling completeness, we embraced the statistics, the algorithms, the data and, I think in many ways lost our way.

I would stand with Edington and ask us all “What is our vision of health and wellness?” What is our way forward so that we might once again embrace the whole person; mind, body, spirit and environment? We began this wellness journey almost forty years ago on the shoulders of Abraham Maslow and others who looked for ways we could help people live their best lives possible. When people are in fact on that journey to live their best possible life they are on the path of wellness. Let’s be the allies that help people find their way.


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High Altitude Wellness

Rocky Mountain National Park, Glacier Gorge.  Photo by M. Arloski

Rocky Mountain National Park, Glacier Gorge. Elevation at Trailhead 9,240 ft.  Photo by M. Arloski

Whether it’s a trek in the Alps or a time to be “Rocky Mountain High”, getting up in the mountains is a great way to be well physically, mentally and spiritually. Being well at higher altitude however requires some important knowledge and sometimes, some caution. The people a wellness coach works with may face some challenges at higher elevation, especially if they are dealing with health challenges to begin with.

Gaining elevation quickly is easy in a place like my home state of Colorado. Say you start your day in Fort Collins where, like Denver we are basically a “mile high” (5,003 ft.). Off you go to Estes Park (7,522 ft.) and suddenly you have experienced an elevation gain of 2,519 feet. Drive into Rocky Mountain National Park and up to Bear Lake (9,450 ft.) for a hike and now you’ve risen 4,447 feet. All the trails from there only go up and you could easily exceed 10,000 feet in altitude as you enjoy the stunning beauty of the area. Top it off later with a ride to the peak of Trail Ridge Road (12,183 ft.) and now you’ve attained 7,180 feet (2,188 meters) in elevation gain. That gain itself is higher than any mountain east of the Mississippi.

When we experience how different it is to walk uphill at these suddenly higher elevations we often blame our lack of conditioning. The reality is based in physics and the resultant effect on our own physiology. This is not a time for a “try harder” attitude, in fact continuing to push may just invite serious trouble.

In Banff National Park, Canada

In Banff National Park, Canada

Simply Less Oxygen

Here is the best explanation of why we experience less oxygen at higher elevation. “The pressure in the atmosphere decreases as you gain elevation. The percent of oxygen is actually the same at all altitudes, 21%; however, it is 21% of a smaller number as one goes higher. The barometric pressure at sea level is 760 mmHg, and at 10,000 ft, it is 534 mmHg. Breathing the air of Telluride (Colorado) is the equivalent to breathing air with only 15% oxygen at sea level, instead of 21%. The net result is that there is 29% less oxygen in the air at Telluride compared with sea level. At 14,000 ft, the air has 43% less oxygen than at sea level. Because of the reduced air pressure at high altitude, the volume of air you breathe into you lungs contains less oxygen molecules in each breath.”

There are two main things to be concerned about at altitude: Acute Mountain Sickness (AMS) and your current state of health, especially looking at preexisting health conditions. AMS can affect people with symptoms at elevations as low as 6,500 feet, but usually we start to see greater occurrence when we exceed 8,000 feet. The Institute for Altitude Medicine (IAM) in Telluride, CO is an excellent resource for learning about AMS or altitude sickness. “One survey done at a Colorado ski resort at 9,800 ft. found that 60% of visitors developed a headache, the first sign of AMS, and also called high altitude headache. To meet the definition of AMS, other symptoms need to develop, such as loss of appetite, sometimes vomiting, weakness, dizziness, fatigue, and difficulty sleeping. AMS feels exactly like a bad hangover.” ( )

Preventing AMS is all about a slow ascent and adequate hydration. Treatment strategies depend upon severity but the first step is “go no higher”, rest, hydrate and consider immediate descent if there is no improvement. See the I.A.M. website and learn detailed information.

Preexisting Conditions And High Altitude

Rocky Mtn. N.P. The Ute Trail- elevation 11,466 ft. Photo by M. Arloski

Rocky Mtn. N.P. The Ute Trail- elevation 11,466 ft. Photo by M. Arloski

According to Peter Hackett, M.D., the director of I.A.M., experience at higher elevations can sometimes “unmask” preexisting health conditions that the person was not aware of. Struggling with breath and heart rate, feeling exhausted, can sometimes reveal heart and/or lung disease and is a red flag to get in to see your physician as soon as possible.

People with preexisting conditions such as high blood pressure, heart disease, valve disease, heart failure, heart arrhythmias, diabetes, Sickle Cell disease, and other conditions should know that higher altitude could aggravate their conditions. It is also important to know the effects of the medications you might be taking. For example, metoprolol, a beta-blocker, acts as a governor on your heart, preventing excessive heart rate, and thus inhibiting your athletic performance. This means being incredibly patient with yourself and allowing for more breaks when you are hiking uphill, skiing, etc.

Dr. Hackett says that while living at higher elevations can actually help some conditions (we develop more capillaries, asthma can be easier due to cleaner air, etc.) people with COPD and various lung diseases fair worse as they have difficulty transporting oxygen to the lungs.

The “High Country” does not have to be off limits to you, but knowledge about how altitude affects your condition, your medications, and what to do to make adjustments is vital. Again, the I.A.M. website is a treasure house of information. Enjoy the mountains and all their majesty, just do it wisely and well.

Small head cropped1The Coach’s Take Away

A key part of any coaching Foundation Session is getting to know where your client lives and what their lifestyle is like. Your telephonic client may live in a very different world from the one outside your door. If you discover that they live at or near higher elevation, or they visit such places on skiing or outdoors vacations then helping them understand and deal with “altitude wellness” could be vital.

Being in great physical condition does not make one immune to AMS. In fact it has no correlation whatsoever. The especially fit client may want to maintain their sea-level workout routines or push themselves past wise limits physically as they play in the mountains. They need to play by the rules of elevation gain and energy output like everyone else. There is simply less oxygen available to those well-toned muscles at higher altitude and performance goes down.

The standard wisdom is to gain a thousand feet of elevation a day and build in plenty of rest. Hydration is vital as we produce more red blood cells to absorb the decreasing amounts of oxygen available. This thickens the blood and our bodies steal water from all our cells to maintain proper viscosity. So, we get severely dehydrated if we don’t pound the water. (Again refer to the Altitude Medicine site for guidance.)

As wellness coaches work with clients with preexisting medical conditions this is perhaps the most important area to be aware that altitude often has a significant effect. Clients with diabetes may discover an increased insulin requirement. The Altitude Medicine institute recommends that “Only diabetics experienced with exercise and in good control should attempt vigorous exercise at high altitude.” Clients with high blood pressure, any type of heart condition or disease, anyone with lung disease, etc. can be vulnerable to the effects of high elevation. Coaches should help these clients become familiar with the information on the Preexisting Conditions page of the Altitude Medicine Website.

Wellness coaching clients may find that their medical condition and/or the medications related to these conditions limit their ability to exercise or do what they used to do. Experiencing these limitations can bring up lots of emotion. The person can feel angry, frustrated, and can even get in touch with grief over what they have lost due to their medical condition. This is where coaches can be the empathic source of support that helps the client process these feelings. Plug in what you know about grief, remembering that a loss of health is a loss. Help your client to grieve what is lost and emotionally move on. And, of course, if this yields greater grief than can be dealt with in coaching, make a good referral to a mental health professional.

A great way to begin with such a client is to inquire about their level of knowledge about both their health and the effects of higher altitude. If, like most folks, there is a lack of this specific information, ask if they could see the value in knowing more about it, then co-create a strategy and accountability for how they can go about finding out what they need to know to be healthy and well in the High Country.

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