The What, the How and the Why of Lifestyle Improvement
Health and wellness folks are sometimes confused about the role each professional might play inhelping individuals to live their best life possible. Our clients are seeking to be healthier by losing weight, managing stress, stopping smoking, becoming less isolated, and often, managing a health challenge of some kind. To do so they need:
excellent wellness information
great treatment (if that is called for)
and a way to make the lifestyle changes that will ensure lasting success.
So, who is responsible for what?
Fitness trainers, rehabilitation therapists, physical therapists, dietician, various treatment professionals and health educators can help their clients/patients to know what lifestyle behavioral changes will move them towards improved health and wellbeing. What we often hear from these medical and wellness pros is frustration with a lack of success on their client’s part in making the recommended changes and making them last. The reality is, most people simply don’t know that much about how to change the ingrained habits of a lifetime.
The physical therapist works with their client in their session and sends them home with exercises that must be done every day. The dietician creates a fantastic meal plan that their client must put into practice. The fitness professional creates a tailor-made workout plan, but their client needs to exercise on their own, not just in front of their trainer.
Health educators, treatment professionals, etc. provide the
Health and Wellness Coaches provide the
Our Clients find their
Everyone’s challenge is the how. It takes more then will power and motivation. What is often lacking is an actual well-thought out plan that the client has co-created with the help of someone who can provide support, accountability and a well-developed behavioral change methodology. Translating the lifestyle prescription into action and fitting it in to an already busy life is often where, despite good intentions, our clients struggle. This is where having a trusted ally in the cause of one’s wellness pays off.
As field of health and wellness coaching grows, the challenge coaches sometimes face is clarity about their own role. Sometimes the confusion is all about the what and the how. For coaches to be proficient at “writing” the lifestyle prescription they need additional qualifications. It becomes a question ofScope of Practice.
To guide coaches the National Board for Health and Wellness Coaches (NBHWC) has developed a Scope of Practice Statement. Here is the part most relevant to our question.
“While health and wellness coaches per se do not diagnose conditions, prescribe treatments, or provide psychological therapeutic interventions, they may provide expert guidance in areas in which they hold active, nationally recognized credentials, and may offer resources from nationally recognized authorities such as those referenced in NBHWC’s Content Outline with Resources.” (https://nbhwc.org/scope-of-practice/ )
If coaches can “wear two hats” professionally they can combine the what and the how. Otherwise the key is to coordinate with other wellness professionals or work with the lifestyle prescription that their client already has.
Beyond the what and the how is the why. The “why” of behavior is all about motivation – initiating and sustaining behavioral change efforts by drawing upon the energy and desire to do so. The key here once again is the question of who is responsible for supplying this. People may initiate behavior based upon external motivation – the urging and cheering on of others, the fear of negative outcomes. In order to sustain that motivation, it has to come from within. The challenge here for all wellness professionals is to help our client to discover their own unique sources of motivation.
Seasoned wellness professionals realize they can’t convince or persuade anyone to be well. However, when we help our clients discover their own important sources of what motivates them, they discover their why. Motivation is fuel. Now with the aid of a coach our clients can find the vehicle to put in. They know what they need to change. Now they have a way how to change and grow, and they know themselves, why. (See our previous post Motivation Plus Mobilization: Coaching For Success At Lifestyle Improvement. https://wp.me/pUi2y-mn)
(A modified form of this blog has appeared in the Medical Fitness Network)
Michael Arloski, Ph.D., PCC, NBC-HWC is CEO and Founder of Real Balance Global Wellness Services, Inc. (www.realbalance.com). Dr. Arloski is a pioneering architect of the field of health and wellness coaching. He and his company have trained thousands of coaches around the world.
In the last ten years the field of health and wellness coaching has continued to evolve as a professional filed with standards, credentials (https://nbhwc.org) and a solid evidential base (https://journals.sagepub.com/doi/full/10.1177/1559827619850489). We’ve attained more clarity about what effective health and wellness coaching looks like and more awareness of what all coaches need to learn. Coaches have an ethical obligation to constantly be learning and growing in our profession.
So, what are the “must reads” for the wellness or health coach? Ten years ago, I posted a three-part blog on this topic.
Now, in 2020, what I want to share with you are the top fifteen books that will influence the way you do coaching, the way you prepare for professional exams, and books that you will want to have at arm’s reach. These are the books on my own bookshelf that I find myself recommending over and over again to the thousands of wellness coaches that Real Balance has trained. There are many great resources out there, but here is my own very biased (as you’ll see when I recommend my own books) and opinionated list. In contrast to my own previous blogs this time I’m listing them in rank-order of importance to the coach practicing in the field.
15 Vital Books for the Wellness Coach – 2020 – Straight Off My Shelf
1. Wellness Coaching For Lasting Lifestyle Change,2nd Ed. , Arloski 2. Masterful Health & Wellness Coaching: Deepening Your Craft, Arloski (In Press) 3. Co-Active Coaching, 4th Ed., Whitworth, Kimsey-House & Sandahl 4. Changing to Thrive, Janice & James Prochaska 5. Becoming a Professional Life Coach, Williams & Menendez 6. Motivational Interviewing 3rd Edition, Miller & Rollnick 7. The Coaching Psychology Manual, Moore, Tschannen-Moran and Jackson 8. The Blue Zones, Dan Buettner 9. Your Journey To A Healthier Life: Paths of Wellness Guided Journal, Vol. 1, Arloski 10. Taming Your Gremlin, Rick Carson 11. The Wellness Workbook, Jack Travis & Regina Ryan 12. The Open Heart Companion, Maggie Lichtenberg 13. The Craving Mind, Judson Brewer 14. Raw Coping Power, Joel Bennet 15. The Way We’re Working Isn’t Working, Tony Schwartz
1. Wellness Coaching For Lasting Lifestyle Change,2nd Ed. (2014), Michael Arloski. (https://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml) Like I said, a very biased list. Yet, I will have to say that this book (which is now also available in Mandarin) is used by many colleges and universities, as well as other commercial wellness coach training organizations all around the world. The 2014 2nd edition has expanded its coverage of coaching skills and the process of co-creating a wellness plan. The Wellness Mapping 360 Methodology provides the coach with a complete approach to behavioral change that distinguishes this book from others. The integration of what we know from the field of wellness and health promotion is another unique feature of this resource.
2. Masterful Health & Wellness Coaching: Deepening Your Craft, (2020)(In Press) Michael Arloski. (https://wholeperson.com/store/masterful-health-and-wellness-coaching.html) Coaching is both an art and an applied science. In this book my intention is to provide guidance for the health & wellness coaches who wants to go beyond competence to proficiency and embark on a journey towards mastery. The book is divided into four sections, Transformation, How To Be, What To Do, and Coaching People with Health Challenges. We will explore what distinguishes masterful coaches form those who are just learning their craft. Thoroughly substantiated by the evidential literature and providing in-depth lessons on all the major behavioral change theories, Masterful Health & Wellness Coaching will allow the reader to take their coaching to an advanced level.
9. Your Journey To A Healthier Life: Paths of Wellness Guided Journal, Vol. 1, 2nd Ed., (2017) Michael Arloski. (https://wholeperson.com/store/your-journey-to-a-healthier-life.shtml) A wellness journal for the client, this book outlines an entire wellness coaching process from self-assessment, to visioning, wellness planning, meeting challenges to change, tracking behavior and setting up accountability and support through connectedness for success. Many of the coaches I’ve trained use this with each of their clients either individually, or as a group guide (works very well in a 12-session format). Many coaches love it simply as their own guide for how they coach their clients.
10. Taming Your Gremlin: A Surprisingly Simple Method for Getting Out of Your Own Way (updated edition) (2003), Rick Carson. (https://www.amazon.com/Taming-Your-Gremlin-Surprisingly-Getting/dp/0060520221/ref=sr_1_1?dchild=1&keywords=Taming+Your+Gremlin%2C+Rick+Carson&qid=1601159057&sr=8-1) Whenever the wellness coaching client takes on change their own personal “Gremlin” or “inner-critic” will be there to oppose it, even if it’s the best thing in the world for that person. Our clients have plenty of external challenges to their attempts at change, but the internal ones can be the most devastating. This classic little book shows us how to spot the self-talk of the gremlin early and get it out of the way (as we get out of our own way!). Another true must read. I know of coaches who supply their clients with copies of this book when folks sign on to coaching.
11. The Wellness Workbook, 3rd ed: How to Achieve Enduring Health and Vitality, (2004) John W. Travis and Regina Sara Ryan . (https://www.amazon.com/Wellness-Workbook-3rd-Enduring-Vitality/dp/1587612135) Health & Wellness coaches need a thorough understanding of wellness and health promotion. This is the foundational book to understand what wellness is truly about. Jack Travis is one of the modern-day founders of the wellness movement and he lays out his theoretical foundation and theories in the introductory thirty-six pages which is worth the price of the book alone.
12. The Open Heart Companion: : Preparation and Guidance for Open-Heart Surgery Recovery, (2006) Maggie Lichtenberg. (https://www.amazon.com/Open-Heart-Companion-Preparation-Open-Heart/dp/0977606309) The psychological side of a major health challenge is often ignored. Maggie Lichtenberg, a PCC level coach, went through mitral valve repair surgery, saw a big missing piece and filled it admirably with this excellent book. As a wellness coach, whether you deal with heart patients or not, this book is an ultimate guide to helping your client with self-efficacy and self-advocacy. I make sure anyone I know (client or not) who is headed into any kind of major surgery (but especially heart surgery) either has a copy of this book or knows about it.
So, there you have it! Happy reading and keep on learning!
Michael Arloski, Ph.D., PCC, NBC-HWC is CEO and Founder of Real Balance Global Wellness (https://realbalance.com) a premier health & wellness coach training organization that has trained thousands of coaches around the world.
Adequate sleep and rest are like magic. When we have enough of it our immune system is stronger, healing occurs faster, and very importantly we replenish our supply of energy that allow us to function at our best.
The Mayo Clinic tells us that “During sleep, your immune system releases proteins called cytokines, some of which help promote sleep. Certain cytokines need to increase when you have an infection or inflammation, or when you’re under stress. Sleep deprivation may decrease production of these protective cytokines. In addition, infection-fighting antibodies and cells are reduced during periods when you don’t get enough sleep.” (https://www.mayoclinic.org/diseases-conditions/insomnia/expert-answers/lack-of-sleep/faq-20057757) The relationship between sleep, adequate rest and our immune system is solid. We’ve all likely had the experience of catching a cold when we fell behind in our sleep.
Today with the Covid-19 Global Pandemic and its accompanying economic hardships many coaches and their clients may have lots to lose sleep over. Anxiety, fear of an uncertain future, seeing infection rates rise, and all of the stress of the ‘functional paranoia’ it takes to stay reasonably safe can all interfere with our sleep. We may also find ourselves cutting back on needed rest during the day as we juggle children at home, adapting to a new work-at-home routine, etc.
Take a good look at the Wellness Plan that you and your client have co-created. Chances are it will have some fairly active components: becoming more active, eating better, expanding friendship circles, etc. Ask yourself if all the efforts your client is making to improve their lifestyle require an expenditure of energy. Does that same Wellness Plan contain elements that replenish energy? Is their Wellness Plan restorative and regenerative? Is there a balance between these active endeavors, and the more passive and relaxing ones? Essentially, is there a Yin/Yang balance? (See The Tao of Wellness Coaching: Part Two – Practical Applications – https://wp.me/pUi2y-lT )
Perhaps your client would benefit from combining their more active wellness efforts with ones like relaxation training, meditation, Mindfulness Based Stress Reduction, Yoga, or Tai Chi. They may want to include more direct efforts such as effective napping and sleep hygiene strategies.
The Beauty and Benefits of a Good Nap
What do Margaret Thatcher, Barbara Walters, Winton Churchill, Salvador Dali, Thomas Edison, John F. Kennedy, Theodore Roosevelt, Leonardo da Vinci, and Albert Einstein have in common? They are or were all confirmed nappers!
Adequate sleep and rest are important for all of us and especially for our clients with chronic health challenges. Regular napping has multiple health benefits: reducing stress, improving mood, boosting memory, improving job performance and increasing alertness. The Sleep Foundation (https://www.sleepfoundation.org/articles/how-sleep-affects-your-immunity ) suggests “If your sleep schedule is interrupted by a busy workweek or other factors, try to make up for the lost rest with naps. Taking two naps that are no longer than 30 minutes each —one in the morning and one in the afternoon—has been shown to help decrease stress and offset the negative effects that sleep deprivation has on the immune system.”
A key to effective napping is to set an alarm and only nap for 20-30 minutes. That way you can return to full alertness much quicker. Napping is more effective than caffeine at helping us to the same thing. In fact, clients who might have to avoid caffeine for medical reasons might especially find naps more helpful.
Clients who struggle with full-on napping might find that simply allowing their body to go from vertical to some form of horizontal for even short periods of time provides refreshing rest. ‘Putting your feet up’ and closing your eyes while slowing down and deepening breathing may allow for a rejuvenating shift in energy.
Our client may not know some of the sleep hygiene tips that can make getting to sleep and staying asleep much easier. You can point them in the right direction with resources and have them study these strategies on their own time, perhaps even set up some accountability around doing such homework.
• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations. • Set a bedtime that is early enough for you to get at least 7 hours of sleep. • Don’t go to bed unless you are sleepy. • If you don’t fall asleep after 20 minutes, get out of bed. • Establish a relaxing bedtime routine. • Use your bed only for sleep and sex. • Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature. • Limit exposure to bright light in the evenings. • Turn off electronic devices at least 30 minutes before bedtime. • Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack. • Exercise regularly and maintain a healthy diet. • Avoid consuming caffeine in the late afternoon or evening. • Avoid consuming alcohol before bedtime. • Reduce your fluid intake before bedtime.
Coaching for Better Sleep and Napping
Wellness coaching is about helping your client to transform what to do into how to do it in their life. Educating one’s self about the importance of sleep and rest may be the first step, but then putting strategies into action is where coaching can help. If your client sees the value in attempting some of these sleep hygiene strategies or establishing more frequent naps, we can co-create with them agreed upon Action Steps that they are willing to make a commitment to doing. Establishing a way of tracking sleep will help our clients to be consistent in their sleep practices. We can set up a system of accountability with them where they might report in about it at the next coaching session or use text or email to do so.
Once our client is practicing their sleep hygiene habits it is important to explore their experience with it. Look for ways to increase intrinsic motivation by bringing their attention to how they feel when they are practicing these habits. This exploration can also uncover barriers that arise when your client attempt to improve their sleep or get more rest.
Coaching Through the Barriers to Healthy Sleep and Rest
A great coaching technique is to anticipate barriers before they are encountered. As you and your client select sleep strategies to try, ask them if they would anticipate any things that might get in the way of practicing these strategies. Do they share a bedroom with someone else? Would that person be amenable to these new strategies? Perhaps their partner loves having a television in the bedroom and are a fan of late-night TV. The very first step may be to ask your client if they feel that a conversation with their partner about what they are trying to achieve (improved health and wellbeing) and these sleep strategies they hope to use, would be worthwhile.
Other barriers will arise as your client puts their sleep and rest improvement strategies into action. They may get support or push-back. They may discover that their situation at work or home will require some real creativity to develop strategies that can work. You and your client can then engage in some strategic thinking and possibility thinking to tackle these barriers.
Coaching Through Barriers Related to Stress
The ability to rest and sleep can obviously be interfered with by stress and anxiety. Coaching for effective stress management requires knowledge and skills that can be found in my previous blog posts (The Psychophysiology of Stress – What the Wellness Coach Needs to Know. https://wp.me/pUi2y-nJ) and in recordings of my Real Balance Monthly Webinars: 11/16/18 – Stress! Recovery & Resilience: How the Wellness Coach Can Help – Part 1, 1/19/19 – Stress! Recovery & Resilience: Recovery – Part 2 and 2/15/19 – Stress, Recovery & Resilience: Building Resilience – Part 3. (https://realbalance.com/wellness-resources) Adequate sleep and rest help our clients to recover from stress and build resilience. Helping them reduce stress and anxiety in the first place may require some form of relaxation training or other strategies that are discussed in the above resources.
Sleep difficulties, including more severe insomnia, may need to be evaluated by more clinical resources. Since difficulty sleeping and relaxing is a major symptom of both physical and mental/emotional conditions, there may be times when your client’s challenges are more appropriate for clinical treatment than coaching.
Sleep and Rest are Keys to Wellness
Many wellness models include healthy sleep as an essential component of a healthy, well-functioning person. Certainly, it is hard to achieve much of one’s potential when sapped of energy by chronic sleep deprivation. The reality is that people in our modern world are frequently sleep-deprived. “Poor sleep health is a common problem with 25 percent of U.S. adults reporting insufficient sleep or rest at least 15 out of every 30 days.” “Adequate sleep is necessary to: Fight off infection; Support the metabolism of sugar to prevent diabetes; Perform well in school; Work effectively and safely. Sleep timing and duration affect a number of endocrine, metabolic, and neurological functions that are critical to the maintenance of individual health. If left untreated, sleep disorders and chronic short sleep are associated with an increased risk of: Heart disease; High blood pressure; Obesity; Diabetes; All-cause mortality.” (https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health)
Making adequate sleep and rest part of a holistic Wellness Plan may make a positive difference in all of our client’s wellness goals. Think of it as energy management. With a well replenished energy supply our client can have what they need to be more fully engaged in their health and wellness.
Maintaining strong immune systems and helping people to manage their current illnesses is part of the vital work that health & wellness coaches are doing every day.COVID-19 is causing much higher mortality rates among people with chronic health challenges – the very population that health & wellness coaches and wellness professionals serve. The world needs the work you do now more than ever.
There are two issues at play during this pandemic crisis: how can we best serve our clients/members, etc.; and how can we remain healthy and well enough to be of service and maintain our own wellness?
Serving Your Clients/Members/Patients
As wellness professionals face the new realities and restrictions of the pandemic and our responses to it unique challenges confront us.
Remaining in contact with your clients/members/patients while both you and they are working remotely.
Adjusting to remote contact when you’ve always worked in-person with those you serve.
Helping people who work on the frontlines of the medical world’s response to the pandemic.
Dealing with clients, members, or patients who are reporting more stress, depression and anxiety.
Helping people who feel frightened and helpless in the face of this crisis.
Helping people get the services they need, including your own, when those services are overwhelmed.
At the end of this piece I’ve listed some great resources to help with some of these challenges.
What Do You Need Now?
Many of us who are in the human-helping business tend to step up and be there for others with little hesitation. The other side of this is our own tendency to not attend enough to our own needs during this time. What kinds of demands are you facing in your workplace? Some wellness and coaching services are under greater demand and stress. Independent coaches, fitness trainers, etc., may be facing a reduced number of clients. What are you up against?
What are you doing for your own wellness and self-care now? As each of us reach out to our clients and others to be an ally we also need to nourish ourselves. In time of crisis, when it seems that we don’t have time for our own care, it is actually time for extreme self-care. Stress has a terrible toll on the immune system and that is exactly what we all need to work on maintaining right now.
We are also not invulnerable to the same fears, anxieties and stresses that our clients and members are facing. Perhaps you are working at home trying to juggle your work obligations with having a house full of family members trapped by social distancing guidelines.
Be compassionate with yourself. As you work with others during this crisis the emotional toll it takes upon you may be not just exhausting, it may be traumatic. Secondary traumatization takes place when we are exposed to the trauma that others are going through. It can have many of the same symptoms and effects upon us as direct exposure to trauma. Here is an excellent resource for learning more about this. Emergency Responders: Tips for taking care of yourself. (https://emergency.cdc.gov/coping/responders.asp)
People that go through any kind of wellness training always develop a wonderful appreciation for their fellow classmates. We see this when we all attend professional conferences and feel the support of like-minded colleagues. Attempts to keep in touch are usually hard to maintain as everyone returns to their busy lives. Now, with the cancelation of live conferences and such, we are left without that usual opportunity for rejuvenation and support. You may be feeling alone, but you are not.
We know that the way through crisis, the way to build resilience is through CONNECTION, through reaching out and support. As you saw in my previous blog post, (Social Distancing – Not Social Isolation: Coaching for Connectedness in the age of COVID-19https://wp.me/pUi2y-p5 ) social distancing is not the same as social isolation. Reach out to friends, but also reach out to your wellness colleagues. They are going through many of the same experiences as you and can be primary sources of support.
Let me invite you to connect in many ways. One way is to GET A SUPPORTIVE CONVERSATION GOING by engaging in conversation about your concerns, fears, hopes and stresses that you are experiencing right now with COVID-19 happening worldwide.
Let’s make these forums one place where we can do that. Please contribute to these conversations.Building COMMUNITY takes participation.
Another opportunity will be April 24th. Our April Free Monthly Webinar will be: Wellness Coaching in the Time of Covid 19: Self-care and Helping Otherswith very special guests James and Janice Prochaska and Pat Williams.
RESOURCES for helping others and helping ourselves during this crisis:
We all still need each other. Even in the age of COVID-19, our health continues to depend upon healthy supportive relationships. Real Balance https://realbalance.com has always stressed what we call Coaching for Connectedness. We‘ve seen lifestyle improvement occur and last more often when people receive support for the changes they are making to live healthier lives. When a coaching client sets up an action step we ask “Who/what else can help support you in this?”. Research on what makes health behavior last points primarily to two factors: a shift in self-concept and community support. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753403/ It’s also a well-established fact that people who are more socially isolated have significantly higher rates of all major chronic illnesses. https://www.apa.org/monitor/2019/05/ce-corner-isolation
Our challenge in the midst of a pandemic situation is how we distance from each other while remaining connected to each other. Yes, follow the CDC guidelines for social distancing. We can still greet each other with elbow bumps, and then go for a walk, a bike ride, a cruise in kayaks, etc., and continue to avoid the proximity that puts us at any risk. We can connect via phone and receive the nourishment of live, interactive conversation that texting and e-mail don’t quite match. We can climb on board a web-based platform such as Zoom and Skype provide where we are face-to-face for our conversation. We also have all sorts of apps such as Facetime, WeChat, and many more that allow us to have face-to-face interaction for live conversations.
As coaches we can continue to work remotely with our clients, as the majority of coaching is already done. As we do, explore the feelings that the changes brought about by social distancing are bringing out in your clients. Empathize. Explore. When people talk about their fears, the intensity of those fears almost always lessens. As people become less afraid, their thinking improves. They aren’t so quick to jump into dismissive all-or-none thinking. They are then able to engage in strategic thinking with their coach to find unique solutions to staying healthy.
• The fitness center is shut down. How can you shift to working out at home? Use stretch bands. Modify a spare room into a place to do Yoga, floor exercises, etc. Spring brings better weather allowing more cardio outdoors. • Do more outdoor exercise/activity with other people – just keep your proper distance. • Encourage clients to find new ways to electronically visit their friends, grandchildren, and others. Play online games together. • Check in with your clients to make sure they have CDC information/WHO information about how to stay safe during the COVID-19 pandemic.https://www.cdc.gov/coronavirus/2019-ncov/index.html. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
Take heart at how people are showing concern for each other during this time. Younger people who are at somewhat less risk are engaging in social distancing, handwashing, etc. not only for themselves, but for the older and more vulnerable people who could be affected by the contact they are having. People in neighborhood chatlines are volunteering to go pick up groceries and prescriptions for older or more sickly neighbors. Hopefully what will come out of all of this is a greater sense of how we are all in this together. Distancing does not mean isolating. The truism of Jack Travis is still valid: Connection is the Currency of Wellness.
Be well and stay well!
Michael Arloski, Ph.D., PCC, NBW-HWC is CEO and Founder of Real Balance Global Wellness Services, Inc.
One of the first things we learn about in the fields of Wellness & Health Promotion and Health & Wellness Coaching, is that our lifestyle choices are a primary determinant of our health and wellbeing. It seems straightforward that making the right or healthy choice is a rational process based upon having the best information. We often then address how challenging it is for a person to put that choice into practice by looking at their social support, environmental conditions, etc. Much of the focus for wellness coaching becomes helping our client to create a wellness plan based upon those healthy choices and implementing with support and accountability. Let’s stop and take a closer look at those decisions.
Anyone in the healthcare or wellness fields is keenly aware that clients don’t always opt for the best, or healthiest choice. They also often observe clients changing these choices for no apparent reason. One day our client is convinced to start working towards a largely plant-based diet, and on another day, they show little if any desire to do so. We can explore ambivalence, of course, but what is really going on in our client’s decision-making process?
Applying what we know about the role that emotions play in decision-making can be extremely useful to the wellness coach. Learning how to coach our client in this emotional realm is often critical to their success. (See my previous post: “The Great Utility of Coaching In The Emotional Realm”, https://wp.me/pUi2y-lA)
Emotions and Making Lifestyle Choices
Making lifestyle choices are like any other decision-making process – they are more complex than it seems at first. Understanding how our emotional bias fits into this process may help coaches to be less perplexed by some of the self-defeating lifestyle choices we see that our clients have made and continue to make.
Emotions emerge as a response to external stimuli, or the recollection of it, or the imagining of it. “That stimulus generates an unfelt emotion in the brain, which causes the body to produce responsive hormones. These hormones enter the bloodstream and create feelings, sometimes negative and sometimes positive… So, to review, it’s stimuli, then emotions, then hormones and, finally, feelings. In other words, your emotions impact your decision-making process by creating certain feelings.” (Whitener, 2018)
How we interpret or frame those feelings and how we respond to them results in our choices executed in our behavior.
In this model it is not the emotions that we are aware of, it is the resultant feelings that we feel. When our clients contemplate making lifestyle changes, they often experience a variety of feelings. They may experience positive anticipation or dread. The memory of past failures may bring up the emotion of fear resulting in feelings of embarrassment, regret, shame or guilt. Likewise, a history of more pleasant experiences may lead to positive anticipation. What Stage of Change the client is in may be heavily influenced by the feelings they are experiencing.
Expand Your Emotional Vocabulary
Psychologist Paul Ekman’s research on emotions opened a huge doorway to understanding how people express themselves. A key from his work that can help the coach is to look at how (as in our model above) emotions generate feelings and how those feelings differentiate. Researcher Tiffany Watt Smith has listed 154 different worldwide emotions and feelings. (1). Studying Ekman’s Wheel of Emotions can help a coach to expand their own knowledge and use of emotional terminology. As you coach with your client you can explore more possibilities to help your client clarify exactly what they are feeling.
Ekman’s Wheel of Emotions
How The Coach Can Help: Coaching With Emotions and Feelings
1. Coaching Presence – Your coaching presence sends an ongoing message that either gives permission to explore feelings or denies it. 2. Notice – Be keenly observant of the emergence of feelings on the part of your client. Be continually scanning not just their words, but how they say them. Hear the changes in tone of voice, volume, rapidity, etc. Notice all of the nonverbal information you can gather. 3. Contact – Help you client to connect with their feelings. Use the Active Listening Skill of Reflection of Feelings. Share observations of patterns you see. “I’m noticing that each time you talk about taking time for self-care you begin speaking about your partner.” 4. Name it – Help you client to name their feelings. As we saw above emotions can generate a wide variety of feelings. Expand your own emotional vocabulary and help your client to drill down to what they are truly experiencing. “Well, it’s not really anger, it’s more like resentment.” 5. F.A.V.E. – First Acknowledge the client’s experience and what they have been through. Then Validate their feelings. It’s okay for them to feel the way they feel about it. (Regardless of how rational or appropriate their feelings may seem.). You absolutely must not judge their feelings. Most importantly Empathize. Show real empathy and compassion and put it into words. 6. Process – Help your client to explore and process their feelings. Allow them to expand and talk about them. Once the initial release has taken place, they will usually start to analyze what is going on for them, looking to make sense (and meaning) out of their feelings. 7. Insight – Is your client able now to gain some insight from what they have learned in this process? 8. Application/Integration – Are they able now to take their insights and turn them into action? Now you can coach your client on ways they can modify their behavior or create experiments in their lives to improve their lifestyle.
Note – If you find that you are answering the questions in items 7 & 8 with the negative, your client may benefit more from counseling instead of (or in addition to) coaching. That is, if they just continue to process feelings, and process feelings without it leading to insight, or if they are unable to put their insights into action, and instead return to processing feelings (and emoting), then begin to explore the alternative of counseling. See my blog on this topic – Coaching a Client Through To A Mental Health Referral Using The Stages of Change (https://wp.me/pUi2y-lp).
A wellness coach may think that it is their job to get their client to make the right lifestyle choices. When coaching deteriorates into convincing or persuading, we are stepping away from the coaching process. We can certainly warn our clients about misinformation they may have about fad diets, or unproven remedies, etc. However, effective coaches honor their client’s autonomy. The reality is that after a coaching session, our clients will go on living their lives doing what they choose to do despite our urging. Trust the coaching process. Help your client to factor in their emotions in a more conscious way so that the lifestyle choices they make are working for them instead of against them.
(1) Tiffany Watt Smith. “The Book of Human Emotions: An Encyclopedia of Feeling from Anger to Wanderlust” (PDF). Anarchiveforemotions.com. Retrieved 2017-05-28.
(2) Ekman, Paul (1999), “Basic Emotions”, in Dalgleish, T; Power, M (eds.), Handbook of Cognition and Emotion (PDF), Sussex, UK: John Wiley & Sons.
Medical noncompliance is a vast and complex issue that results in widespread human suffering and immense healthcare costs. Of the 3.8 billion pharmaceutical prescriptions written each year (USA) it is estimated that more than 50% of them are taken incorrectly or not at all. Medical noncompliance also includes failure to do medical self-care, self-testing and attend follow up appointments with the treatment team.
As wellness and health coaches are given more opportunities to help people, especially people who have, or may soon develop, a chronic illness (heart disease, diabetes, cancer, arthritis, COPD, etc.), we will face again and again what has stymied healthcare professionals for decades; the patient who has heard the diagnosis but has made virtually no changes to improve their health. They have gotten the news but haven’t woken up and smelled the coffee.
The story is far too familiar. You may have seen it amongst the people you work with, your friends or in your own family. It may have been what you have experienced yourself. The person gets a new diagnosis of a life-threatening disease or is warned that such a disease is immanent (e.g. pre-diabetic) unless they make significant lifestyle changes. Or, perhaps they experience a sudden health event like a heart attack. Given medical treatment, they are also given a “lifestyle prescription”. They are told to make lifestyle changes: quit smoking; be more active and less sedentary; improve their diet; manage their stress better, etc. Such immediate lifestyle changes are conveyed as absolutely essential to their continued survival: a low-sodium diet for the hypertensive patient; lower stress levels for the post-heart attack patient; complete restructuring of the diet of the newly diagnosed diabetes patient, etc. Then, far too often, the healthcare professional watches, as do family and friends, in total astonishment, as the patient makes none of these changes. So, when lifestyle changes are necessary what determines a person’s ability to make the needed changes in the quickest way possible?
Readiness For Change
Working with clients around medical compliance and adherence to the lifestyle prescription is the place where Prochaska’s “Readiness for Change”, Elizabeth Kubler-Ross’s “Stages of Grief “, and Maslow’s “Hierarchy of Needs” all intersect. What we, the caregivers often fail to understand is that when a person has experienced a truly life changing event, like the onset or worsening of a health challenge they feel a loss of control that may threaten their safety, they experience grief at the loss of health, ability, or dreams, and often need to redefine their identity.
Pre-contemplation → Contemplation → Preparation → Action → Maintenance → Termination (Adoption)
This is certainly a helpful way to understand where someone is at regarding a particular behavioral change. Knowing if they are in the Contemplation or Preparation stage, for example, helps us know how to work with them. This single lens, however, is not enough. In the patient/client who astounds us with their level of non-adherence we find we are encountering more than just lower levels of readiness, we are encountering grief and loss.
Grief And Loss
A loss is a loss.The loss of a loved one through death, the loss of one’s health, or the loss of the dream held for how life would be, are all perceived as losses to be grieved. To help you understand a person’s reaction to a health challenge, diagnosis, etc., and to help you, as a coach or healthcare provider, respond more compassionately and effectively, put all of it in the perspective of the classic stages of grief. The work of Elizabeth Kubler-Ross, Stephen Levine and others have shown us that the grieving process is a multi-layered experience that affects us powerfully.
Kubler-Ross identified the five stages of grieving that are present for any significant loss: 1) Denial; 2) Anger; 3) Bargaining; 4) Depression; and 5) Acceptance.
I talk about this extensively in chapter ten (“Health and Medical Coaching- Coaching People With Health Challenges”) of my book, Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., 2014 (https://www.amazon.com/Wellness-Coaching-Lasting-Lifestyle-Change/dp/1570253218/ref=sr_1_1?ie=UTF8&qid=1530811214&sr=8-1&keywords=arloski+wellness+coaching). When we see the astonishingly non-compliant patient/client, they are often experiencing this first stage of denial. They minimize the importance of the event, downplay its seriousness, and do all they can to return to “business as usual”. Talking about the event or diagnosis becomes a forbidden subject and the person may become quite defensive. They are angry that this tragedy has befallen them, and understandably depressed about what has happened, and the state they are in. The idea of change has no appeal and they often seek the comfort of the familiar — including self-soothing habits such as smoking, overeating, etc.
The experience of a “brush with death”, or even the news that such a threat is imminent, can automatically push us into survival mode. No matter what level we were at in getting our needs met on Abraham Maslow’s Hierarchy of Needs (see Chapter One – “Toward A Psychology of Wellness” in my book, Wellness Coaching For Lasting Lifestyle Change, 2nd Ed. 2014) such an experience necessarily drives us down to the survival need level. We feel profound threat to our “safety needs” and “physiological needs”. Our very physical existence is threatened. Life becomes about the real basics of survival; the next breath, food, water, shelter. It becomes about the basics of safety; feeling secure, going back to the familiar, whatever reassures us that we will be OK.
It is no wonder that people going through such an experience may embrace the status quo, resist change and psychologically minimize the threat that they perceive.
This brings up questions about the health challenged persons readiness to change:
* How long will they stay at these survival levels seeking to meet their physiological and safety needs when they are encumbered by the initial stages of grief?
* How effective can one be at functioning and rising up through both the stages of readiness for change and the lower levels of the needs on Maslow’s model if they are in denial and minimizing, acting out in an angry manner or shackled by depression?
What needs to be considered to work effectively with health challenged clients is the intersection of these three widely accepted psychological theories Once understood, a Wellness Professional can truly motivate their client towards lasting lifestyle change.
Maslow’s theory of motivation contends that as people get their needs met at the lower levels of the Hierarchy of Needs Triangle they naturally move on up to the higher levels (their being needs). When we encounter a patient/client who fits the picture we are talking about here, do we acknowledge where they are at and do we help them get their needs met at that level? Or, do we demand immediate behavioral change just because the value and urgency of it is so great?
Meet Them Where They Are At
Our first job is to help them feel like they have an ally, someone who supports them and has their best interests at heart. This helps meet their safety needs and even some of their social needs. We then need to check in with the person and see how they are doing at the survival level. Are they receiving the medical care they need? Is their living situation allowing them to cover the basics of shelter, food, and safety? Much of this comes down to how their health challenge affects the security of their way of making a living. How do they perceive (and it is their perception that counts) their health challenge as a threat to their livelihood? Do they fear losing their job, falling behind in production, having their business falter or fail? How much are they into catastrophic thinking about all of this?
What is more frightening than to believe we are powerless? The threat to our very survival is there, like a cave bear at the mouth of our cave, and we believe we can do nothing to stop it. If our patient/client feels powerless to affect the course of their illness, then they wonder why should they make all the effort required to achieve lifestyle improvements? When we feel powerless we often don’t go to fight or flight, we freeze.
The reflexive response to fear is contraction. Hearing a sudden, loud noise, we instantly tense up and contract all our major muscle groups. Feeling scared, we hold on. We reflexively hold on to what we have and to the way things are. Change seems even scarier than what frightened us to begin with. We are like the person in the path of a hurricane who won’t leave the safety of home, sweet home, even though it will probably be flooded and blown away. For our client to “let go” and trust in the change process their physiological and safety needs have to be met. If they doubt this they may give the appearance of compliance, but their probability of follow-through is questionable.
Beyond the very basics of survival, we can help our client then to get their needs in the next two levels met: Social Needs (sense of belonging, love) and Self-esteem Needs (self-esteem, self-worth, recognition, status). This is where coaching for connectedness plays a priceless role. We know that isolation is a real health risk and at this crucial time the presence and engagement of an extended support system can provide huge benefits. Our client will need the help of others in many practical ways, but they will fare far better if they are getting the emotional support that comes with getting their needs for belongingness, acceptance and compassion met. We, the helper can only provide a very small part of this and some of our best efforts may be to help the person we are working with to find, develop and expand sources of support in their lives. The nature of the support they receive from others is important as well. This person needs understanding, empathy and support, not criticism and pressure to make lots of changes immediately. We need to encourage our client to ask for the support they need in the ways that they need to receive it.
Coaching to improve self-esteem allows the client to move on up through Maslow’s triangle through the next level. We all need to feel good about ourselves, to receive recognition and praise. When one is hit with a health challenge they may feel anything but good about themselves. Perhaps they are framing the health event or onset of an illness as a personal failing. There may be embarrassment and/or shame that they are no longer completely healthy. Their own “inner-critic” may be very harsh on them, filling their mind with self-critical thoughts that, again, cause them to do anything but take action for change. Helping the person to regain a sense of power and control in their life can also reclaim self-esteem. When we feel powerless to control events and circumstances in our lives we feel weak, vulnerable and impotent. When we discover what we can actually do through our own lifestyle choices to affect the course of our illness for the better, we feel empowered and regain confidence and strength.
Ten Ways to Effectively Coach the Health Challenged.
When we encounter: the person who has had a heart attack and is still downplaying the importance of it, almost pretending that it didn’t happen; the person diagnosed as pre-diabetic who has made no dietary changes at all and remains as sedentary as ever; the person diagnosed with COPD who is still smoking, etc., we need to respond to them in a more coach-like way. In each step consider that their readiness for change will be determined in part by their stage of grief and where they fall in Maslow’s hierarchy of needs. How quickly they move through the change process will be in part determined by past experiences and in part by the support they have in the present to change.
1) Meet Them With Compassion Not Judgment.
Catch yourself quickly before you criticize their lack of adherence to the recommended lifestyle changes they have been told to do. Bite your tongue, so to speak, and instead of forcefully telling them what they should be doing, and warning them, once again, of the dire consequences of non-adherence, respond with sincere empathy and listen. 2) Acknowledge And Explore Their Experience.
Ask them what it was like when they found out about their health challenge; diagnosis, or what is was like when they experienced this health event. Don’t jump to solutions or start problem solving. Just listen, really listen. Reflect their feelings. Acknowledge what was and is real for them. Explore it with them and see if there isn’t some fear that needs to be talked about here. 3) Don’t Push, Stay Neutral In Your Own Agenda, And Explore More.
While it may feel like this person needs to take swift action with tremendous urgency, be patient. Readiness for change grows at a different rate for each step of the journey. 4) Be Their Ally.
Help them feel that they are not facing this alone. This helps meet their need for safety and even some of their social needs. Does the client understand their health challenge? To what degree does the client understand and buy into the lifestyle changes suggested? 5) Address Survival First.
Make sure they are getting all the medical help and information they need. Explore their fears about maintaining income, job, career, business, and how it all will be impacted by their health challenge. Help them gain a sense of control and feel more safe and secure in all ways. Help them to see that they are not completely helpless and vulnerable, but that there are ways they can affect their situation. 6) Help Them Process The Loss.
Talking through the grief is very powerful. The loss of health is felt to the level that it is perceived. That perception will be part reality and part fear. Help your patient/client to process their feelings, to give a voice to the part of them that is afraid. Accept their initial tendency to minimize but slowly help them feel safe enough to move through the other stages of grief (anger, bargaining, depression and finally, acceptance). 7) Help Them Form A Plan.
Even if it is very basic, help them develop a plan for becoming healthy and well again and how to face their health challenge. Meet them where they are currently remembering that preparing to take action is a vital readiness for change stage. What do they need to know? Having a plan will give them both hope and a sense of purpose and direction, a map to find their way out of their current situation. It is something to hold on to. 8) Coach For Connectedness.
If the basic survival needs feel met the person can reach out to others and will benefit from a sense of belonging. Family and friends need to be inclusive and not critical. Support from co-workers is also extremely helpful. The fear that is brought up by the onset of serious health problems sometimes frightens others and efforts need to be made to break through this initial resistance. Coach them through their own reluctance to asking for support. 9) Build Self-esteem.
Recognize, acknowledge and reinforce all progress. There is no wrong! Help your patient/client to exhibit greater self-efficacy because as they take charge of their health and their life, their self-esteem grows. 10) Nothing Succeeds Like Success.
Help the health-challenged person to take small steps to prepare for change and then experiment with actions where they are most ready. Build on these easier successes and leave the tougher challenges for later after confidence has been built.
Maslow reminds us that “growth forward customarily takes place in little steps, and each step forward is made possible by the feeling of being safe, of operating out into the unknown from a safe home port, of daring because retreat is possible.” (Toward A Psychology of Being, 1962) . To emerge from that home port, our client needs to be in the process of working through their grief, they need to be moving up the spiraling stages of change, and how better to set sail towards the unknown lands of change than with a good ally?
Michael Arloski, Ph.D., PCC, CWP, NBC-HWC
The first version of “Astonishing Noncompliance” was originally published in the Real Balance Global Wellness Services, Inc. Newsletter in 2009. It has also been published by a number of other organizations such as the American Holistic Nurses Association (https://ahha.org/selfhelp-articles/astonishing-non-compliance/)
Arloski, M. (2014) Wellness Coaching For Lasting Lifestyle Change, 2nd Ed. Duluth, MN: Whole Persons Associates.
Kubler-Ross, Elisabeth. (1997) On Death and Dying. NY, NY. Scribner.
Maslow, Abraham. (1962) Toward a Psychology of Being. Princeton, N.J., VanNostrand.
Prochaska, James, and Janice. (2016) Changing To Thrive. Hazelden Publishing.
Prochaska, J., Norcross, J, & Diclemente, C. (1994) Changing For Good. New York, NY: Harper Collins/Quill. 1994 Harper Collins, 2002 Quill reprint.
What The World Health Organization dubbed “Lifestyle Disease” is a global phenomenon. The increase of non-communicable disease is going up the fastest in what is sometimes called the developing countries of the world. “Twenty-five years ago, the number of people with diabetes in China was less than one percent. Today, China has more than 114 million people suffering from the disease, the highest number of any country in the world. It is estimated that 11.6 percent of Chinese adults have diabetes, a proportion higher than the U.S. with 11.3 percent. Experts blame the increase in sedentary lifestyles, high consumption of sugary and high-calorie Western diets, excessive smoking and lack of exercise.” (http://www.counterpunch.org/2015/07/24/the-increasing-burden-of-diabetes-in-china/)
From the very start of my work in developing the field of wellness coaching my vision was to bring wellness worldwide. Real Balance Global Wellness Services, Inc. (http://www.realbalance.com) has now trained over 6,000 health and wellness coaches around the globe. We have trainers in Ireland, Brazil and Australia. We have trained people from places like Dubai, Ethiopia, Hong Kong, Denmark, Korea, and many more countries through our fully-interactive webinar trainings.
Now we are continuing with our global mission by TAKING WELLNESS COACHING TO CHINA ! We are proud to announce that Real Balance is teaming up with Chestnut Global China EAP (http://chestnutglobalpartners.org) to bring wellness and health coach certification training to China! I will deliver a certification training in Shanghai March 14-19, and then travel on to Beijing to promote wellness coaching and do a book signing.
The book I will be signing in Beijing is Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., newly translated into Mandarin and published in China! The challenges of “lifestyle disease” are rapidly increasing in China as more people move to urban areas, diets change, smoking continues to increase, culture shifts and stress increases as well. Helping people gain access to allies that can help them succeed at lifestyle improvement is just as important here as anywhere else.
We are exploring other ways to connect with people around the world to contribute to the health of the planet and its people. Please be a part of creating Allies For A Healthy World.
Back In The U.S.A.
Please join us in beautiful Colorado Springs, at The Art & Science of Health Promotion Conference (https://www.healthpromotionconference.com). March 27-31.
Real Balance will be exhibiting there and I will be delivering two workshops: “Five Key Coaching Skills For Motivating Sustainable Lifestyle Improvement”, and “Mastering The Science and Craft of Health & Wellness Coaching: Higher-Level Methods And Skills.” See you there!
Every potential coaching client is looking to have the question ‘What’s in it for me?’answered. Every coach needs to be able to succinctly answer that question by conveying what they will provide for their client.
Potential coaching clients are rarely familiar with what a coach, especially a health & wellness coach, can do for them. They are used to dealing with educators and consultants, medical and otherwise, not coaches. Usually clients expect to be directed, educated, and led in the best direction for them. All too often they hear a wellness coach tell them something like:
“I’m not going to tell you what to do. I’m not going to tell you what to eat or how to exercise. You’re the one in charge. You’re the one behind the steering wheel. You’ll be making your own wellness plan, and I’ll help you follow it.”
Why should this person become your client when it appears that they,
themselves, are going to be doing all the work? Our client-centered approach to coaching does not mean we are not providing value, however we have to communicate the value of what we offer, and do it very clearly. What will the client gain from coaching?
This is true for the self-employed coach as well as the coach working for a wellness program, a disease management company, an insurance carrier, or any other organization that provides wellness and health coaching. It is about engagement. When coaches are confronted with the “incentivized” client, who is reluctantly complying with coaching in order to get their prize (or much-needed insurance discount), conveying the Health And Wellness Coach’s Value Proposition is more vital than ever.
Here is my way of presenting The Health And Wellness Coach’s Value Proposition. Please adapt to your own words and use it!
The Health And Wellness Coach’s Value Proposition*
“Thank you for your interest in improving your lifestyle and your life. You may be new to coaching, and especially wellness coaching, so let me share with you the value that it brings.
Wellness/health coaching is all about you living the best life possible for you. To do that most people find there needs to be some improvements in their way of living, their lifestyle. Making those improvements, those changes is challenging when you have to do it all by yourself. Perhaps you’ve already had some experience with that.
When I work with someone in coaching I’m here to serve you. You are the one in charge of your life and our work together. It’s your hands on the steering wheel. I’m not going to tell you what to do and give you a pre-maid wellness plan. But, together we can co-create a plan to help you succeed at making the lifestyle improvements that you want to make.
As your coach I will be working with you to get very clear about where you are at with your health and well being right now. We’ll help you take stock of that by exploring together, using some coaching tools that will help give you a more complete picture, and by going over the lifestyle improvement recommendations you’ve gotten from treatment professionals. Then we’ll work together to help you form a clear picture of the kind of life you want to live, your healthiest life possible for you. We’ll compare where you’re at and where you want to be and together form a solid plan to help you get there.
Once we have that plan we’ll work together as allies to help you be accountable to yourself and follow through on the steps you need to be taking on a regular basis to help you achieve the goals you have in your plan. I’ll be with you throughout the journey. I’ll be there to help you strategize over, under, around and through the barriers that come up. I’ll help you with challenges that make it tough for you to live the healthy life you want and together we’ll help you keep on track. Together we’ll help you find and develop the sources of support that will make your changes last. We’ll evaluate our progress and adjust the course along the way as we need to. My goal is to assist you in becoming self-sufficient in your wellness, to be able to live a healthy life in a completely sustainable way.
I bring the value of a professional that knows about succeeding at lifestyle improvement. I bring the value of an ally.”
*(Created by Michael Arloski, Ph.D., PCC, CWP) Please adapt to your own words and use it! If used intact you must include authorship credit and contact information (web address for Real Balance Global Wellness Services, Inc. https://www.realbalance.com)
In two previous blog posts I shared some ideas about Market Development for the self-employed wellness coach. Please check them out for additional resources. The Self-employed Wellness Coach and Market Development – Part One: Closed Doors, Open Doorshttp://wp.me/pUi2y-9LThe Self-employed Wellness Coach and Market Development – Part Two: Being So Much More.http://wp.me/pUi2y-bc
The theme of the 41st Annual National Wellness Conference was “Spotlight On Sustainability”. While we often think about sustainability and our environmental practices, as a wellness coach and psychologist I immediately thought of sustainable behavioral change. As I prepared for my presentation on this topic my research revealed that we actually know very little about how effective our efforts at helping people improve their lifestyles actually are.
Maintaining success at lifestyle change is often daunting. Most wellness coaching clients have a history of initiating efforts at losing weight, stopping smoking, managing stress, etc. For many, however, there is a trail of failures at maintaining those new ways of living in the long run. The result is a lowering of self-efficacy and lingering feelings of discouragement. As I explored in a previous blog post “Lessons From Albert Bandura For Wellness Coaches” (http://wp.me/pUi2y-dB) there is much for coaches to learn about self-efficacy.
When we go to trusted sources looking for help with making healthier behavior last, what do we find? Unfortunately, not much. From Harvard Medical School’s online publication Healthbeat I found “The Trick To Real And Lasting Lifestyle Changes”. (http://www.health.harvard.edu/healthbeat/the-trick-to-real-and-lasting-lifestyle-changes) Though this title sounds like the exact resource to look for, all it advised was a simplistic review of SMART Goals.
Turning to the APA Psychology Help Center we find “The key to making lasting lifestyle and behavioral changes: Is it will or skill?” (http://www.apa.org/helpcenter/lifestyle-behavior.aspx) This disappointing short article could only offer this: “Lasting lifestyle and behavior changes don’t happen overnight. Willpower is a learned skill, not an inherent trait. We all have the capacity to develop skills to make changes last,” said Katherine C. Nordal, PhD, executive director for professional practice at APA. “It is important to break down seemingly unattainable goals into manageable portions.” The article mostly talked about how ineffective we are at making any changes in our behavior and did not even address making changes last!
As I deepened my research quest I found that other behavioral scientists had been concerned enough about this issue to establish an impressive research consortium to tackle it. The result was a publication in The American Journal of Health Behavior (2010 Nov-Dec; 34(6): 647–659) entitled The Science of Sustaining Health Behavior Change: The Health Maintenance Consortium. The authors (Marcia G. Ory, PhD, MPH,1 Matthew Lee Smith, PhD, MPH, CHES, CPP,2 Nelda Mier, PhD,3 and Meghan M. Wernicke, MPH4) did a thorough research synthesis of articles spanning 2004-2009, amassed resources and funded twenty-one projects to look at this issue of lasting change in health behavior. Here is what they concluded.
What we are up against when it comes to lasting change.
• How long can positive gains be sustained without additional long-term support? • In most cases this is unknown because studies only track maintenance for a year or two after the post-intervention phase. • In the majority of cases, intervention effects on lifestyle behaviors are often strongest in the one or two years closest to active intervention. • Without additional support, positive effects tend to diminish over time, or treatment differences vanish.
What they found was frankly, not a lot.
• It’s not realistic to expect long-term maintenance based on initial interventions. (Single-variable research) • Moderate-intensity behavioral interventions may need to be coupled with more environmental changes to sustain long-term effects. • In other words people need the support of healthier communities and workplaces, peer groups, etc. • Incorporation of physical activity into the self concept emerged as the strongest predictor, with self-efficacy having a major indirect influence confirming it as an important predictor for both behavioral initiation and maintenance
In summary:The authors conclude that no single mediator makes a large impact; rather, there is a “long and winding road” with maintenance achieved through a multitude of modest interrelated meditational pathways from behavioral initiation to maintenance.
There are many reasons for our scarcity of knowledge. One is that much research of this nature is done by universities where graduate students need short-term projects that allow them to finish up and…graduate! We may learn more from larger sociological and epidemiological studies such as The Framingham Study (https://www.framinghamheartstudy.org) , the work of The Blue Zones, (https://www.bluezones.com) etc. However, here we are not isolating variables. We can’t really say if it was the plant-based diet, the supportive extended family, or the red wine that made the healthy difference. It seems we have to be satisfied with the shotgun approach and put our best bets on culture and environment.
What can we conclude about making positive changes in health and wellness behavior last?
• Changes must be sustainable over a lifetime
• Intrinsic motivation trumps extrinsic every time
• Most research looks at single interventions and doesn’t track more than one or two years
• Long-term studies show that a combination of environmental support and “internal” shifts sustain lifestyle improvement better. Culture, environment, attitude and beliefs!
• We must ask how can coaching support shifts towards “well” attitudes and beliefs?
The Five Keys of Coaching For A Lifetime of Wellness
• 1. Build Self-Efficacy • 2. Nurture Visionary & Intrinsic Motivation • 3. Focus On The Maintenance Stage (TTM) • 4. Co-create Relapse Prevention Strategies • 5. Coach For Connectedness
1. Build Self-Efficacy
Bandura’s Social Cognitive Theory (formerly AKA Social Learning Theory) shows tremendous congruity between it and the foundational principles of coaching. Bandura deeply explored the concept of Self-Efficacy which is foundational to wellness coaching. (Again see the previous blog post “Lessons From Albert Bandura For Wellness Coaches” (http://wp.me/pUi2y-dB)
2. Nurture Visionary & Intrinsic Motivation
Much of our coaching work is around helping people to envision the outcome they want. When we have a clear picture of both where we are (our current state of wellness) and where we want to be (our Well Life Vision) we can “coach to the gap” between the two and coach around what needs to change to attain that Well Life Vision. Such a positive psychology approach is foundational to coaching and motivates better than just fear and illness avoidance.
To COACH for intrinsic motivation: * Notice! – Help your clients to focus on the enjoyment, the pleasure that they perceive as they are performing the behavior. * Inquire! – Ask about the details of their experience. When a client reports about taking a walk, hike or bike ride outdoors ask about what they saw, what they experienced, what they felt. * Inquire about Bonus Benefits. Clients sometimes fixate on their goal of weight loss for example, but what else is happening during their efforts? Are they experiencing more energy? Better sleep? More mental concentration? * Avoid incentivizing. Incentives tend to decrease intrinsic motivation. * Take a Kai Zen Approach. (https://www.amazon.com/Small-Step-Change-Your-Life-ebook/dp/B00GU2RHCG/ref=sr_1_1?s=books&ie=UTF8&qid=1467763620&sr=1-1&keywords=robert+maurer#nav-subnav) Coach with your client to set up action steps that are so small that they are very doable and allow continuously successful progress towards their goals.
3. Focus On The Maintenance Stage (TTM)
Of all of the Stages of Change that Prochaska talks about in his Transtheoretical Model of Change (https://www.amazon.com/Changing-Good-Revolutionary-Overcoming-Positively-ebook/dp/B003GYEH2Y/ref=sr_1_1?s=books&ie=UTF8&qid=1467763816&sr=1-1&keywords=prochaska+changing+for+good#nav-subnav), coaching around the Maintenance Stage may be the most vital. Here the coach again takes a positive psychology approach and acknowledges and reinforces what is working. As the old saying from coaching goes “Nothing succeeds like success!” A key in this stage is for the client to see the value in Tracking Behavior and to do it regularly. Avoiding self-deception is key. Use whatever works for keeping track of new healthier behaviors: calendars, charts, apps, activity monitoring devices, etc. Then the Accountability that coaching provides makes the process conscious, deliberate and increases consistency. Lastly, coaches really prove their worth here as they coach their clients through the barriers and the “push-back” that sometimes is received by those who clients were hoping would provide support.
4. Co-create Relapse Prevention Strategies
Relapse happens! Count on it! James Prochaska is fond of back-up plans. We all know that life throws us curve-balls all the time. Our best-laid plans run up against life realities. This is where coaching can get creative! Coach clients to come up with their own back-up plans for then things don’t go as they would like, or when temptation increases. Going to a potluck dinner where the dietary direction of friends tends to be sabotaging of your wellness efforts? Be sure to bring an entrée to share that will satisfy your own needs. Not enough time to do your hour-long exercise routine? Having a quick and simple set of exercises you can do anywhere fills in “better than nothing” and maintains engagement in your program.
Pivotal to this key is self-compassion. There is a real difference between excuse-making and true compassionate understanding. Coach your client to be less self-critical and more forgiving. Help them keep a healthy perspective on their wellness plan.
5. Coach For Connectedness
In our Real Balance Wellness & Health Coach training (https://www.realbalance.com) we emphasize coaching for connectedness from day one. The amount of time any client spends in coaching is a brief moment compared to the lifetime they have to live in a new way. In addition to the support of the coach, other sources of support must be encouraged, discovered or consciously developed. For each step of action we ask “Who or what else can support you in this?” If our client has little support then making the development of such support a deliberate area of focus to work on in coaching is vital. This is where the role of culture, community, workplace, peer groups, family, friends, and relationships becomes a part of coaching that cements lasting lifestyle change.
Living a wellness lifestyle is a lifetime job! Providing the kind of coaching that goes beyond simplistic goal-setting and allows our clients to transform who they are can build the foundation for a lifetime of wellness.