Wellness Coaching: Supporting clients to engage fully in wellness Margaret Moore/Coach Meg Founder & CEO Wellcoaches Corporation www.wellcoaches.com Co-Director Institute of Coaching Harvard ard Medical School www.instituteofcoaching.org How Coaching Works at YouTube 1
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www.institutelifestylemedicine.org 3
Agenda Vision of World of Well-Beings Coaching Standards & Models in Healthcare & Wellness Science Theory & Research Coaching Mechanisms of Action, Skills Client examples Exercises Q&A 4
Scientists have discovered the DNA of Well-Beings Energy (physical health) Meaning (life purpose) Emotions (positive emotions, emotional intelligence) Strengths (flow, personal growth) Relationships (growthpromoting) Only 20% of adults are thriving i (Well-Beings). 5
What does it take to change? Change is good you go first. Mac Anderson & Tom Feltenstein Change or Die Alan Deutschman Changing for Good Prochaska, Norcross, DiClemente 6
Changing for Good No problem can be solved from the same level of consciousness that created it. We must learn to see the world anew. Albert Einstein i One cannot understand a level of consciousness above one s own. Adapted d from Bob Kegan, In Over Our Heads 7
Definition of Health and Wellness Coaching Health and wellness coaches facilitate a partnership and change process that enables clients to change their mindsets, and develop and sustain behaviors proven to improve health and well-being, going beyond what they have been able to do alone. 8
National Team: Standards, Certification & Evidence for Health & Wellness Coaches 80 organizations including coach training & education, nurse and physician organizations, medical centers, universities, iti health plans, health professional organizations. Plan 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 scope of practice for health professionals 9
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 Lifestyle-related l t disease amelioration or prevention Health professionals Laser coach nurse line, disease management, call center lifestyle or health coaching Healthcare providers learn basic coaching skills 10
Physician + wellness coach collaboration What will it take? Credibility of professional coaches and coaching psychology Evidence positive p outcomes in welldesigned studies
Science of Coaching Evidence-based Coaching Competencies Dianne Stober Anthony Grant Stephen Palmer Alison Whybrow Margaret Moore Bob Tschannen-Moran 12
Theories underpinning coaching psychology 1. Positive psychology 2. Self-efficacy 3. Appreciative inquiry 4. Transtheoretical model 5. Motivational interviewing 6. Relational l cultural l 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 13
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) 14
Conclusions: Coaching Research Studies There is evidence in the medical literature that coaching alone is effective at improving health outcomes: Cardiovascular disease Diabetes Asthma Cancer pain Cancer survivors Weight loss ADHD 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, managing stress, handling adversity, leadership skills, ability to focus) Behaviors establishing new behaviors or habits (interpersonal relations, management, health and wellness) Psychological resources - mindfulness, selfmotivation, emotional regulation, confidence, hope, optimism, self-awareness, insight 16
Science-based Coaching Mechanisms of Action 1. Build growth-promoting relationship 2. Elicit motivation jet fuel for change journey 3. Develop capacity to change 4. Facilitate process of change both mindset and behavior 17
Client examples Dave - 52 Teresa - 46 High cholesterol and Pre- diabetes blood pressure, family history of heart disease BMI 35 BMI 32 Tried most NYTimes bestseller diets and many High work stress types of exercise Weekend warrior High nutrition literacy Minimal literacy in nutrition Low body intelligence Positivity ratio 2:1 Can t stick to a plan, loves sweets, and doesn t enjoy exercise Positivity ratio 1.7:1 18
Build Growth-Promoting Relationship Autonomy Self-awareness Empathy + tough love Coaching Presence Self-Determination Theory Relational l Cultural l Theory Motivational Interviewing Nonviolent Communication Mindfulness Emotional Intelligence 19
Client Examples Growth Promoting Partnership Dave Recognizing resistance to his wife pressing him to eat better Taking more responsibility for eating choices Reflecting more on the negative impact of his lifestyle Awakening to damage of stress on health and relationships Teresa Self-empathy Self-awareness of pattern of relying too much on expert Appreciation of lessons learned Noticing how negative emotions lead to eating 20
Physician/Expert & Coach Relationships PHYSICIAN APPROACH Authority Partner Educator COACH APPROACH Facilitator of change Defines agenda Elicits client s agenda Feels responsible for client s health Solve problems Client is responsible for health Foster possibilities Focus on what s wrong Focus on what s right Has the answers Co-discover the answers Interrupt if off topic Learn from client s story Wrestles with client Dances with client 21
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People are generally better persuaded by the reasons which they have themselves discovered, than by those which have come into the mind of others. Pascal s Pensees (17 th Century) 23
Get out of sales and into fishing a. Inquiry - ask what + how questions with a beginner s mind b. Listen don t think about anything else including what you re going g to say next c. Reflect to show that you are listening and you understand 24
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. 25
Coaching Exercise: Get into the Passenger Seat Put your patient in the Driver s Seat 26
Elicit Motivation Motivation is the jet fuel for the journey of change Self-Determination Theory Motivational Interviewing 27
Self-determination theory: Intrinsic motivation & Integrated regulation External regulation - low investment 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 performed for satisfaction alone 28
Victor Frankl, Psychiatrist Man s Search for Meaning The quest for meaning is the key to mental health and human flourishing (including overcoming adversity). 29
Values: One wish One who has health has a thousand wishes. One who doesn t has but one. 30
Vision a higher purpose Help people define a compelling vision which beckons more energy, vitality, higher quality of life, allowing us to be our best selves and serve our higher purpose. 31
Client Examples Elicit self-motivation Dave Wants to be a better role model at work Wants to be more present with family Wants more energy Wants health to be a high priority Teresa Wants calm and peace Wants to feel more in control Wants to help daughter who is gaining weight 32
Coaching exercise a. What do you value or treasure most in your life? 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 next 3. Do not give advice 33
Fish: Importance and Confidence C O N F I D E N C E 10 9 8 7 6 5 4 Maintenance Action Preparation Contemplation 3 2 1 Precontemplation 0 0 1 2 3 4 5 6 7 8 9 10 I M P O R T A N C E 34
Develop Capacity to Change Hope Self-efficacy efficacy Resilience Positive Psychology Social Cognitive Theory Hope Psychology 35
Frederickson (Positivity) Positive Emotions build Capacity to Change Positive emotions are fleeting Negative emotions stick like VELCRO Positive emotions broaden thinking: flexibility, creativity, open-mindedness, big picture Positive emotions build resources: mental, physical, psychological, social Tipping Point: 3:1 positive to negative emotions www.positivityratio.com 36
Positivity is the Mechanism of Action Happiness Unpacked: 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 37
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 Chronic stress damages health High positivity people have more effective immune systems Positive emotions reduce physical symptoms Happy people are more likely to engage in healthy behaviors 38
Build self-efficacy I can do it! a. Build positive emotions b. Start t with area/behavior with highest h self-efficacy 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, early rewards and wins g. Explore, validate, and celebrate success 39
Client Examples Build capacity Dave Recall what he loves about his job and cultivate more gratitude Apply work strengths to self-care Commit to experimenting with small steps Put health first two days a week Teresa Develop more positive emotions at home Celebrate small wins Focus on strengths and not weaknesses Improve relationship with daughter and collaborate on this project 40
Coaching exercise build positivity a. What energizes you, makes you come alive, and how can you do more of it? 41
Facilitate Process of Change Vision, goals, plan Accountability Outcomes Transtheoretical Model Appreciative Inquiry Hope Therapy Immunity to Change (Kegan) Goal-setting Theory Adult Learning Theory 42
Mount Lasting Change Thinking and doing building blocks which support change that lasts 43
Constructing a wellness plan Vision Three Month Behavioral Goals Weekly Goals 44
Client Examples Process of change three month goals Dave Healthy breakfast and evening snacks Teresa Eating more protein and breakfast and lunch 3x30-minute 30 treadmill Enjoy one 50-100 workouts per week calorie sweet daily One family fun evening and one date with wife each week One yoga class and two 40-minute walk/jogs with daughter each week I enjoy making healthy eating choices! I can be the captain of my ship! 45
Visit YouTube: How Coaching Works 46
Wellness Coaching: Supporting clients to engage fully in wellness Margaret Moore/Coach Meg Founder & CEO Wellcoaches Corporation www.wellcoaches.com Co-Director Institute of Coaching Harvard ard Medical School www.instituteofcoaching.org How Coaching Works at YouTube 47