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
g
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
i ht
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
E
Contemplation
Preparation
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p
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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!
Visit YouTube: How Coaching Works
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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