Wellness Coaching: Supporting clients to engage fully in wellness

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Wellness Coaching:

Supporting clients to engage fully in wellness

Margaret Moore/Coach Meg Founder & CEO

Founder & CEO

Wellcoaches Corporation www.wellcoaches.com Co-Director

Institute of Coaching Har ard Medical School Harvard Medical School

www.instituteofcoaching.org How Coaching Works at

How 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 Feltenstein Mac Anderson & Tom Feltenstein

Change or Die

Alan Deutschman

Changing for Good

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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 i Albert 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 d

Adapted 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 mindsets

enables 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 d

beyond 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 ti

universities, 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

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 professionals Health professionals

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

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Physician + wellness coach collaboration

What will it take?

 Credibility of professional y p coaches and coaching psychology

 Evidence – positive p outcomes in well-designed studies

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Science of Coaching

Evidence-based Coaching Competencies

Dianne Stober Anthony Grant Stephen Palmer Alison Whybrow Margaret Moore Bob Tschannen-Moran

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Theories underpinning coaching psychology

1. Positive psychology 2. Self-efficacy 3 Appreciative inquiry 3. Appreciative inquiry 4. Transtheoretical model 5. Motivational interviewing R l ti l lt l th

6. Relational cultural theory 7. Cognitive behavioral therapy 8. Solution-oriented therapy 9. Flow and Relational flow 10. Emotional intelligence 11. Self-determination

12. Nonviolent communication 13. Adult development

14 Goal setting/Planned behavior 14. 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

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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,

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 change

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

i  Weekend warrior  Minimal literacy in nutrition exercise  Positivity ratio – 1.7:1  Low body intelligence

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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 Th

Relational Cultural Theory Motivational Interviewing Nonviolent Communication Nonviolent Communication Mindfulness Emotional Intelligence Emotional Intelligence 19

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Client Examples

Growth Promoting Partnership

g

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

eating his lifestyle

Awakening to damage of stress on health and

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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

g

 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 the

reasons which they have themselves

discovered, than by those which have come

,

y

into the mind of others.

Pascal’s Pensees (17

th

Century)

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Get out of sales and into fishing

a.

Inquiry - ask what + how questions with a

beginner’s mind

beginner s mind

b.

Listen – don’t think about anything else

including what you’re going to say next

g

y

g

y

c.

Reflect to show that you are listening

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Spark insights – small changes of mind that

lead to small changes in behavior

I want this more than I realized I can do more than I believed

I’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

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Elicit Motivation

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

l

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Victor Frankl, Psychiatrist

Man’s Search for Meaning

The quest for meaning is the

key to mental health and human

flourishing (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 energy

weight Wants health to be a high

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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 Coaches

1. 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

Maintenance 9 10 E N C E Action 7 8 9 C O N F I D E Contemplation Preparation 5 6 p 3 4 Precontemplation 1 2

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Develop Capacity to Change

 Hope  Self-efficacy  Self efficacy  Resilience Positive Psychology

Social Cognitive Theory Hope Psychology

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Frederickson (Positivity)

Positive Emotions build Capacity to Change



Positive emotions are fleeting



Negative 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

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Positivity is the Mechanism of Action

Happiness Unpacked:

P

iti

E

ti

I

Lif S ti f

ti

Positive 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 Diener

High positivity people are healthier



Morbidity – long term positive emotions reduce

incidence of disease and mortality



Happiness prevents getting ill - longevity impact

comparable to not smoking – several years

p

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

t

b.

Start with area/behavior with highest

self-efficacy

c

Connect with strengths

c.

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

ins

early rewards and wins

g.

Explore, validate, and celebrate success

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Client Examples

Build capacity

p

y

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

project Put health first two

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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

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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

Vision

Three Month Behavioral Goals Weekly Goals

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Client Examples

Process of change – three month goals

g

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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