Wellness Coaching: Supporting clients to engage fully in wellness

Margaret Moore/Coach MegFounder & CEOFounder & CEOWellcoaches Corporationwww.wellcoaches.com

Co-DirectorInstitute of CoachingHar ard Medical SchoolHarvard Medical Schoolwww.instituteofcoaching.org

How Coaching Works atHow Coaching Works at YouTube

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www.institutelifestylemedicine.org

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Agenda

Vision of World of Well-Beings

Coaching Standards & Models in Healthcare & Wellness

Science – Theory & Research

Coaching Mechanisms of Action, Skills

Client examples

Exercises Exercises

Q&A

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Scientists have discovered the DNA of Well-Beings

Energy ( h i l h lth) Energy (physical health)

Meaning (life purpose)

Emotions (positive emotions, emotional intelligence)

Strengths (flow personal growth) Strengths (flow, personal growth)

Relationships (growth-promoting)

Only 20% of adults are th i i (W ll B i )thriving (Well-Beings).

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What does it take to change?

Change is good…you go first….Mac Anderson & Tom FeltensteinMac Anderson & Tom Feltenstein

Change or DieChange or DieAlan Deutschman

Changing for GoodProchaska, Norcross, DiClemente

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Changing for Good

“No problem can be solved from the same level ofNo problem can be solved from the same level of consciousness that created it. We must learn to see the world anew.”

Alb t Ei t iAlbert Einstein

“One cannot understand a level of consciousnessOne cannot understand a level of consciousness above one’s own.”

Ad t d f B b K I O O H dAdapted from Bob Kegan, In Over Our Heads

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Definition of Health and Wellness Coaching

Health and wellness coaches facilitate a partnership and change process that enables clients to change their mindsetsenables clients to change their mindsets, and develop and sustain behaviors proven to improve health and well-being, going b d h t th h b bl t dbeyond what they have been able to do alone.

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National Team: Standards, Certification & Evidence for Health & Wellness Coaches

80 organizations including coach training & education, nurse and physician organizations, medical centers,

i iti h lth l h lth f i l i tiuniversities, health plans, health professional organizations.

Plan Build National Board of Certification of Health & Wellness Build National Board of Certification of Health & Wellness

Coaches

Establish coach training and education standards

Pursue a multi-site coaching research strategy

Investigate reimbursement models

Set standards for basic coaching skills to be integrated into Set standards for basic coaching skills to be integrated into scope of practice for health professionals

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Coaching Models in Healthcare

Professional coaches

Health & Wellness coach – build personal Health & Wellness coach – build personal responsibility and motivation, develop capacity, and make lasting improvements in health and well-being

Lif t l l t d di li ti ti Lifestyle-related disease amelioration or prevention

Health professionalsHealth professionals

Laser coach – nurse line, disease management, call center lifestyle or health coaching

Healthcare providers learn basic coaching skills

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Physician + wellness coach collaborationWhat will it take?

Credibility of professional y pcoaches and coaching psychology

Evidence – positive poutcomes in well-designed studies

Science of CoachingEvidence-based Coaching Competencies

Dianne Stober Anthony Grant

Stephen Palmer Alison Whybrow

Margaret MooreBob Tschannen-Moran

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Theories underpinning coaching psychology

1. Positive psychology2. Self-efficacy3 Appreciative inquiry3. Appreciative inquiry4. Transtheoretical model5. Motivational interviewing

R l ti l lt l th6. Relational cultural theory7. Cognitive behavioral therapy8. Solution-oriented therapy9. Flow and Relational flow10. Emotional intelligence11. Self-determination 12. Nonviolent communication13. Adult development14 Goal setting/Planned behavior14. Goal setting/Planned behavior

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Coaching Research in Healthcare

Randomized Controlled Studies (16)

Non Randomized Study (1)

Qualitative Reports (4)

Case Study (1)

Project Demonstration (1)

Descriptive Articles (7)

Medical Education (2)

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Conclusions: Coaching Research Studies

There is evidence in the medical literature that coaching alone is effective at improving health outcomes: Cardiovascular disease

Diabetes

Asthma

C i Cancer pain

Cancer survivors

Weight loss Weight loss

ADHD

Co-morbid mental and physical conditions Co morbid mental and physical conditions

Coaching outcomes What do we need to measure?

Performance – reaching a quantifiable destination (biometrics such as weight or blood pressure, sales target, new job, run a marathon)

Skills – developing new skills or abilities(how to exercise, how to cook, mindful eating,(how to exercise, how to cook, mindful eating, managing stress, handling adversity, leadership skills, ability to focus)

Behaviors establishing new behaviors or habits Behaviors – establishing new behaviors or habits (interpersonal relations, management, health and wellness)

Psychological resources - mindfulness, self-motivation, emotional regulation, confidence, hope, optimism, self-awareness, insight

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Science-based Coaching Mechanisms of Action

1. Build growth-promoting relationship

2. Elicit motivation – jet fuel for change journey

3. Develop capacity to changep p y g

4. Facilitate process of change – both mindset and behavior

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Client examples

Teresa - 46

Pre- diabetes

Dave - 52

High cholesterol and Pre diabetes

BMI – 35

Tried most NYTimes

High cholesterol and blood pressure, family history of heart disease

BMI 32 bestseller diets and many types of exercise

High nutrition literacy

BMI – 32

High work stress

Weekend warrior High nutrition literacy

Can’t stick to a plan, loves sweets, and doesn’t enjoy

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Weekend warrior

Minimal literacy in nutrition

exercise

Positivity ratio – 1.7:1 Low body intelligence

Positivity ratio – 2:1

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Build Growth-Promoting Relationship

Autonomy

Self-awareness

Empathy + tough love

Coaching Presence

Self-Determination Theory

R l ti l C lt l ThRelational Cultural Theory

Motivational Interviewing

Nonviolent CommunicationNonviolent Communication

Mindfulness

Emotional IntelligenceEmotional Intelligence

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Client Examples Growth Promoting Partnershipg p

Teresa Dave

Self-empathy

Self-awareness of pattern of relying

Recognizing resistance to his wife pressing him to eat better

pattern of relying too much on expert

Appreciation of lessons l d

Taking more responsibility for eating choices

learned

Noticing how negative emotions lead to

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Reflecting more on the negative impact of his lifestyle

eatinghis lifestyle

Awakening to damage of stress on health and relationships

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relationships

Physician/Expert & Coach Relationships

COACH APPROACH

Partner

PHYSICIAN APPROACH

Authority Partner

Facilitator of change

Elicits client’s agenda

Authority

Educator

Defines agenda g

Client is responsible for health

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Feels responsible for client’s health

Foster possibilities

Focus on what’s right

C di th

Solve problems

Focus on what’s wrong

H th Co-discover the answers

Learn from client’s story

Dances with client

Has the answers

Interrupt if off topic

Wrestles with client Dances with client Wrestles with client

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People are generally better persuaded by thePeople are generally better persuaded by the reasons which they have themselves discovered, than by those which have come , yinto the mind of others.

Pascal’s Pensees (17th Century)

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Get out of sales and into fishing

a. Inquiry - ask what + how questions with a beginner’s mindbeginner s mind

b. Listen – don’t think about anything else including what you’re going to say nextg y g g y

c. Reflect to show that you are listening and you understand

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Spark insights – small changes of mind that lead to small changes in behavior

I want this more than I realizedI can do more than I believedI’ve done more than I imagined possible

I don’t want to go back . My new lifestyle is non-negotiable.

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Coaching Exercise: Get into the Passenger Seat

Put your patient in the Driver’s Seat

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Elicit Motivation

Motivation is the jet fuel for the journey of changefor the journey of change

Self-Determination Theory

Motivational Interviewing

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Self-determination theory:Intrinsic motivation & Integrated regulation

External regulation - low investmentg

Introjected regulation - self-imposed related to self-esteem – motivation unstable

Integrated regulation - done for the sake of outcome

Intrinsically motivated - behaviors that are exciting, interesting, and

f d f ti f ti lperformed for satisfaction alone

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Victor Frankl, PsychiatristMan’s Search for Meaning

The quest for meaning is the key to mental health and human flourishing (including overcomingflourishing (including overcoming adversity).

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Values: One wish

One who has health has a thousand wishes.

One who doesn’t has but one.

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Vision – a higher purpose

Help people define a compelling vision which beckons – more energy, vitality, higher quality of life,beckons more energy, vitality, higher quality of life, allowing us to be our best selves and serve our higher purpose.

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Client Examples Elicit self-motivation

Teresa Dave

Wants calm and peace

Wants to feel more in control

Wants to be a better role model at work

Wants to be more control

Wants to help daughter who is gaining

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Wants to be more present with family

Wants more energyweightWants health to be a high

priority

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Coaching exercise

a. What do you value or treasure most in your life?y

b. How does being fit and healthy connect to what you value or treasure most?

Tips for Coaches1. Listen mindfully and be completely present

2. Don’t think about anything including what you want to say nexty

3. Do not give advice

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Fish: Importance and Confidence

Maintenance9

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E N

C E

Action7

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C O

N F

I D

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Contemplation

Preparation

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Precontemplation1

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210 3 4 5 6 7 8 9 100

I M P O R T A N C E34

Develop Capacity to Change

Hope

Self-efficacy Self efficacy

Resilience

Positive PsychologySocial Cognitive TheoryHope Psychology

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Frederickson (Positivity)Positive Emotions build Capacity to Change

Positive emotions are fleeting

Negative emotions stick like VELCRONegative emotions stick like VELCRO

Positive emotions broaden thinking: Positive emotions broaden thinking:

flexibility, creativity, open-mindedness, big picture

Positive emotions build resources: Positive emotions build resources:

mental, physical, psychological, social

Tipping Point: 3:1 positive to negative emotions

www positivityratio com www.positivityratio.com

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Positivity is the Mechanism of Action

Happiness Unpacked:

P iti E ti I Lif S ti f tiPositive Emotions Increase Life Satisfaction by Building Resilience - Fredrickson, 2009

80% of adults are below the 3:1 ratio

• Positivity starts a psychological chain reaction that allows you to step up to the next level of existence

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Health & Happiness - Ed DienerHigh positivity people are healthier

Morbidity – long term positive emotions reduceincidence of disease and mortalityincidence of disease and mortality

Happiness prevents getting ill - longevity impact comparable to not smoking – several yearsp g y

Chronic stress damages health

High positivity people have more effective High positivity people have more effective immune systems

Positive emotions reduce physical symptoms Positive emotions reduce physical symptoms

Happy people are more likely to engage in healthy behaviors

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Build self-efficacy – I can do it!

a. Build positive emotions

b St t ith /b h i ith hi h tb. Start with area/behavior with highest self-efficacy

c Connect with strengthsc. Connect with strengths

d. Avoid all or nothing

e. Match skills with challenge – a little stretch

f. Set baby step goals designed new skills, earl re ards and insearly rewards and wins

g. Explore, validate, and celebrate success

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Client Examples Build capacityp y

Teresa Dave

Develop more positive emotions at home

Celebrate small wins

Recall what he loves about his job and cultivate more

tit d Celebrate small wins

Focus on strengths and not weaknesses

gratitude

Apply work strengths to self-care

Improve relationship with daughter and collaborate on this

Commit to experimenting with small steps

projectPut health first two days a week

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Coaching exercise – build positivity

a. What energizes you, makes you come alive, and how can you do more of it?

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Facilitate Process of Change

Vision, goals, plan

Accountability

Outcomes

Transtheoretical Model

Appreciative Inquirypp q y

Hope Therapy

Immunity to Change (Kegan)

Goal-setting Theory

Adult Learning Theory

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Mount Lasting Change

Thinking and doing building blocks which support change that lasts

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Constructing a wellness plan

VisionThree Month Behavioral GoalsWeekly Goals

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Client Examples Process of change – three month goalsg g

Teresa Dave

Eating more protein and breakfast and lunch

Enjoy one 50-100

Healthy breakfast and evening snacks

3 x 30-minute treadmill Enjoy one 50 100 calorie sweet daily

One yoga class and two 40 i t lk/j

3 x 30 minute treadmill workouts per week

One family fun evening and one date with 40-minute walk/jogs

with daughter each week

and one date with wife each week

I can be the captain of my ship!

I enjoy making healthy eating choices! my ship!

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eating choices!

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Wellness Coaching: Supporting clients to engage fully in wellness

Margaret Moore/Coach MegFounder & CEOFounder & CEOWellcoaches Corporationwww.wellcoaches.com

Co-DirectorInstitute of CoachingHar ard Medical SchoolHarvard Medical Schoolwww.instituteofcoaching.org

How Coaching Works atHow Coaching Works at YouTube

47