I recently presented at the annual conference of The Australasian Society of Lifestyle Medicine – held in Auckland (Tāmaki-makau-rau) New Zealand (Aotearoa). It was a brilliant time not just of learning but of connection and friendship with our brother and sister health and wellness professionals. On the morning of the final day of the conference, it was a delight to hear from Dr N Margarete Ezinwa, the Director of the Lifestyle Medicine Global Alliance. She spoke of the power of story to change and told a moving story of her own showing the power of Lifestyle Medicine to change lives. No spoilers, but the story was of someone very dear to her who had his own journey from Olympic champion to declining health and then incredible recovery. At the conference dinner the evening before, we were treated to an amazing story of redemption from a Māori man who set his own vision for better health at the point that he weighed over 600 pounds (275kg). He is now a champion of health behavior change in his own community. I want to tell you another story. I’m not going to name the individuals, not because I think they’d mind, but because I want to make sure the message of the story is paramount. On the Friday late afternoon of the conference I chanced upon a delegate. We got talking and it turned out he is a final year med student, born in Canada and studying in Australia. He was attending the conference through a collegiate connection but with perhaps some degree of skepticism or at least reserved judgment about the evidence behind lifestyle medicine. We spent the next hour or so chatting and connected over our own stories (including both sharing the same former occupation!) and he told me that this was the first ever medical conference he had attended. We connected briefly a couple more times during the conference and he indicated that he was enjoying his time. Fast forward to the last day of the conference – I was chatting with a Physician who has his own incredible story of recovery from near death and who had appreciated some input I had had at the conference. By way of gratitude, he gifted me a book he has written, inscribed with a personal message. I mentioned to him during our conversation my new colleague and that this was his first medical conference –  a Lifestyle Medicine conference! The response: “I want to give him one of my books too”. About 20 minutes later, I was handing over a copy of this book inscribed personally and with the message “Welcome to the Club”. As the conference concluded on Sunday afternoon, I farewelled my new medical student colleague and we agreed to stay in touch. As we parted, he said “Thank you for making me feel so welcome…” and then added “I think this conference has changed the course of my life”. I’ll admit to having a small tear rolling down my cheek as I write this, knowing that the power of story to change lives – personal and professional – is extraordinary. It appears that the worldwide movement of Lifestyle Medicine has a new member. And I’m confident that in time, he will have his own stories to tell to encourage the healing and enrichment of other lives. The stories our clients have about themselves and the stories they want to be able to tell about themselves are extraordinary. Our job as health coaches is to listen, to hear them and help to amplify the elements that lead to re-visioning and redemption, harnessing the genius, power and magic that lies in story. Simon Matthews is the CEO of Wellcoaches® Australia. He’s a Fellow of the Australasian Society of Lifestyle Medicine, IBLM Diplomate and Member of the Australian Psychological Society.

Watch HOW COACHING WORKS: A SHORT MOVIE Ten years ago, we released a movie titled “How Coaching Works” as a way to explain coaching, using an animated cartoon. Now viewed over 1.5 million times, this blog series aims to share the psychological underpinnings of the cartoon. Tell me about your day yesterday. Really – take a moment and write down what happened yesterday.  I’ll be here when you are finished… Keep writing…. Now, tell me about the best part of your day yesterday. Write about your best memory of yesterday. Keep writing… Next, take a look at both of your responses. What do you notice? What are the differences between the two? If you are like most of us, your first answer was a list focused on the craziness of the day – a hurried, breathtakingly-busy list which included highlights of the annoying or frustrating elements. The first answer usually includes information, but not details, about the day. Did the best part of your day even make it onto that list? It’s not likely. The second question was called an “appreciative inquiry”; a question that may have inspired you to think differently about your experience with the world. Rather than following our natural tendency to focus on all that is wrong with our day, a simple shift in words can change our focus. You may have even noticed a difference in how you felt when you considered the best part of your day. Many experience a greater sense of calm or joy, for example, that isn’t felt when only recalling what happened during the day.Because what we focus on grows, coaches encourage clients to look first to the things that are right with their world. The second question may have supported you in savoring that “best experience.”  Savoring experiences, positive psychologist have learned, is one key to happiness. This reminds me of the quote a colleague has on her wall, “We do not remember days, we remember moments.” Our days get lost and forgotten in the blur of activities, unless we pause to savor the moments. When we look at our lives appreciatively, we are better able to find the beauty in them, even amidst the inevitable chaos; we leverage our strengths to face our challenges; and, we focus on what we wish for, rather than what we don’t want. You can use appreciative inquiries in your interactions with others, and as reflection tools for yourself.  A few of the key elements of appreciative inquiries are that they: – Evoke values and ultimate concerns by asking about high point stories or most valued qualities. – Use positive questions that build on positive assumptions. – Enhance the possibility of storytelling by using open-ended questions that focus on personal experiences. Here are a few appreciative inquiries for you to consider as you move through your day: – Recall a time in your life when you felt great joy, a great delight inspired by something exceptionally good or satisfying. What was happening during that time? What led to the emotion? What were you able to do as a result? – What was the best choice you made about your health today? What strengths supported you in making that choice? What values did you honor? – If you could have any three wishes granted that would support you in being your best self, what would they be?

Today we want to explore a 2019 scientific paper on the connection between life purpose and health, titled: PURPOSE IN LIFE AND CONFLICT-RELATED NEURAL RESPONSES DURING HEALTH DECISION-MAKING. First, the authors summarize the literature indicating that a strong sense of purpose in life, or a set of goals based on one’s core values, is associated with reduced risk of stroke, cardiovascular events, cognitive impairment, enhanced glucose metabolism and reduced mortality risk. Interestingly, a sense of purpose reduces the wear and tear on the body caused by stress, what’s called allostatic load. Research also shows that people with value-based goals and purpose engage more in healthy behaviors, including more exercise, and taking their medications as prescribed. Their health matters because it serves their pursuit of valued goals. Why does a strong life purpose improve health? The processes underlying the link between health and purpose is unclear. The authors designed a study that sought to understand: Why are sedentary and overweight people with a stronger sense of purpose more receptive to health messages that explain the health benefits of physical activity? Impact of decisional conflicts Often people who are living an unhealthy lifestyle, and are at high risk for adverse health events, are defensive or resistant to change because they deal with conflicting motivations – the desire for self-improvement and the desire to maintain self-worth by denying the value of the healthy behavior. They may seem indifferent to the healthy behavior in order to sustain a positive self-review, and don’t reveal their inner conflict. These inner conflicts can arise when people are unclear about their core values and goals, which bring clearer direction to one’s choices, reducing decisional conflict. Brain activity in decisional conflicts In this study of 220 sedentary and overweight adults, the researchers tested whether those with a stronger life purpose were more likely to endorse positive health messages on physical activity. The participants listened to 30 messages (focused on risks, reasons, and strategies) and rated the degree that they agreed with the messages and were confident that they could do what the message recommended. While participants listened to the messages, the researchers used brain scans of multiple regions involved in neural processing of internal conflicts to learn whether the strong life purpose correlated with a lower level of activity in the brain regions involved in decisional conflict, a better test than self-reports of decisional conflict. Study results The study showed that people with greater purpose showed less activity in the brain regions involved in conflict processing during health decision-making, which in turn predicted greater endorsement of self-relevant health advice. The effect of purpose in life was stronger when participants were exposed to “how” messages than “why” messages. The broader “why” provided by life purpose may provide motivation and openness to “how” messages. Greater purpose may reduce internal conflicts or negative self-protective responses to health messages. What’s in it for coaches? The good news is that coaches apply science-based processes which helps clients connect with their values and develop visions and goals which are meaningful and purposeful, as taught in the Wellcoaches model. Now we know more about why the Wellcoaches tools helps people who are ambivalent about change. The field of neuroscience has delivered an underpinning to Nietzsche’s assertion: S/he who has a why to live can bear almost any how.” How cool is that! Coach Meg Reference: PURPOSE IN LIFE AND CONFLICT-RELATED NEURAL RESPONSES DURING HEALTH DECISION-MAKING. KANG, STRECHER, KIM, FALK. (2019) HEALTH PSYCHOLOGY.

Starting January 2020 in the US, physicians will be able to deliver health and well-being coaching services to their patients, putting to use what are called CATEGORY III CPT CODES AWARDED BY THE AMERICAN MEDICAL ASSOCIATION (AMA). The CPT coding system is the basis for healthcare reimbursement in the US. The AMA defines coaches as “non-physician healthcare professionals certified by the National Board for Health and Wellness Coaching (NBHWC) or the National Commission for Health Education Credentialing (NCHEC),” organizations responsible for unified national standards and certifications for health and wellness coaches and health educators respectively. The US Department of Veteran’s Affairs led the application to the AMA so that the VA can immediately start delivering and tracking coaching services nationwide. The VA, NBHWC, and NCHEC are now collaborating on the path to reimbursement by the US government and health plans. You will recall Gary Sforzo, Wellcoaches research advisor, is the lead author of TWO PUBLISHED COMPENDIA OF HEALTH AND WELLNESS COACHING (HWC) RESEARCH, which now includes 100+ randomized controlled studies as of mid-2018. The compendia includes a primary care practice-based study of coaching for weight loss described in this article. BEN CROCKER, Wellcoaches-trained physician at Massachusetts General Hospital, refers patients to the health and wellness coach on his team when they want support for weight loss, stress management, and managing chronic diseases. In their study titled – PRIMARY CARE-BASED HEALTH COACHING INTERVENTION FOR WEIGHT LOSS IN OVERWEIGHT/OBESE ADULTS – Wellcoaches coach Ryan Sherman delivered an average of 11 coaching sessions for the participants in the coaching group in the first year. The first 60-minute session was in-person and the ongoing phone sessions lasted an average of 31 minutes. Bottom line? The coaching intervention led to an average weight loss at 12 months of 7.24 percent of body weight—a mean of 15.4 pounds. At two years, average weight loss was well sustained at 6.8% of body weight. Leveraging the Strengths of Coaching The study included 271 overweight or obese adults already receiving care at the practice. Study groups were defined as such: – Coaching group (98): eligible patients who received weight loss coaching for at least three months; – Comparison group (121): eligible patients who did not receive coaching for weight loss; – Drop-out group (21): coaching group members who didn’t complete three months of coaching for weight loss; and – Non-weight coached group (29): eligible patients who received coaching for a reason other than weight loss, providing comparison for general motivation to change. Those in the coaching group completed a self-assessment of their health behaviors, met with the coach in person initially, and continued with coaching sessions by phone. The coaching protocol included techniques based upon transtheoretical model, appreciative inquiry, self-determination theory, positive psychology, motivational interviewing, and relational flow. From the study’s authors: “We believe that the intervention’s success is attributed to the specific use of a fully integrated coach. Health coaching techniques focus on patient empowerment, as opposed to standardized behavioral prescription and patient education. Eliciting from and supporting patients to leverage their unique strengths empowers them to choose their goals and create their own plan. Monitoring for obstacles to these goals and recognizing and celebrating achievements with patients develops self-awareness and builds self-efficacy. As a result of this behavioral change, health coaching may have a sustained effect on weight loss beyond the limited intensively active relationship with the patient.” Spreading the Word Monique Tello, MD, MPH, who also practices medicine at Massachusetts General Hospital, wrote about the study in LEAN FORWARD, Harvard Medical School’s CME blog. She noted that the results were “impressive” and “incredibly important.” She linked the findings to the CDC’s National Diabetes Prevention Program (DPP); participants in the DPP program—which includes group coaching and comprehensive support of lifestyle change including nutrition and exercise—lowered their chances of developing Type 2 diabetes by 58 percent compared with those participating in a non-coaching intervention. “Why aren’t we offering this sort of supported behavior change in every primary care doctor’s office across the country?” Tello asked. “The first argument is that it’s too expensive. After all, as the study authors point out, health coaching is not yet reimbursed by insurance companies. The study authors did a cost analysis and figured out that assuming a $60,000 annual salary of the coach, the cost per coached patient is about $289 per year (for all patients). For those who used the services more (and achieved minimum weight loss of 5 percent total body weight) the cost was $480 per patient per year.” The cost is, she continued, “peanuts” compared to the expense of weight loss surgery or most commercial weight loss programs—and without the inherent risks or unreliable results. Takeaways for Coaches Combining this real-world practice-based study with the larger HWC literature base leads to takeaways for coaches: 1. Supporting sustainable behavior change and weight loss is an ideal role for coaches. More than 70 percent of Americans age 20 and older are overweight or obese, according to the CDC. “Because of the medical and financial impacts of obesity,” the authors wrote, “the U.S. health care system is in need of effective and cost-efficient weight loss interventions.” 2. The CDC DIABETES PREVENTION PROGRAM, a group lifestyle coaching model for pre-diabetes with a target of 5% body weight loss at 12 months, is now reimbursed by Medicare and many health plans, and provides a benchmark for reimbursement for coaching services in primary care. 85 million US adults have pre-diabetes, bringing an epidemic of diabetes to primary care physicians in the next decade or so. 3. Health and wellness coaches are encouraged to complete an NBHWC-approved program and the NBHWC CERTIFICATION so that they meet the standards for the new CPT codes and are ready to collaborate with physicians, under their supervision and billing. Adapted from Research Dose published  by the Institute of Coaching. Featured Article Sherman, R. P., Petersen, R., Guarino, A. J., & Crocker, J. B. (2017). Primary Care-Based Health Coaching Intervention for Weight Loss in Overweight/Obese Adults: A 2-Year Experience. American journal of lifestyle medicine, 13(4), 405–413. doi:10.1177/1559827617715218. HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC6600613/

In the middle of 2019, I experienced a medical event which could have changed my life considerably. Ultimately it didn’t. I suffered a torn and detached retina in my left eye. By the time I was having surgery, my vision was severely affected. The skill and experience of my surgeon (who has conducted this repair procedure over 5000 times!) along with his dedication and passion for his work meant that the surgery was successful and my vision was restored. If you don’t know much about retinal detachment, I won’t bore you except to say this: the condition itself is painless, the surgical treatment is painless and the after effects are mild soreness for a day or so and the development of a cataract around 12 months later. If you experience any sudden change in your vision, get to a hospital, physician or optometrist straight away! Time matters here. Fast forward from July 2019 to late February 2020. I woke up one morning, thought something looked odd in my right eye vision and went straight to an optometrist. After insisting he dilate my pupil and gaze into my eye, he exclaimed “Oh wow – there’s a big horseshoe shaped tear there!” I arranged to go straight to my surgeon who confirmed the diagnosis and I was having surgery within hours. While it’s not the point of the story, the surgery was successful and my vision was restored again. Thankfully, we only have two eyes! A friend of over 30 years collected me from the hospital (my wife was working out of town and had arranged to return earlier than planned but not before I was discharged). He then drove me to my surgical post-op appointment the following day. After the Surgeon confirmed that everything was looking good in my eye, I had coffee with my friend. We got to talking about education and skill and technology and incredible advances in health care and friendship. And in an instant I felt overwhelmed with gratitude – that my sight had been saved not once but twice; that I live in a country with excellent health and medical care; that I live close to the centres of excellence for that care; that I have friends who I can call on and who change their own plans to accommodate me; that my Surgeon has the education, technical skill, experience and passion to do what he does. The restoration of my vision enabled me to capture and hold another vision – a life imbued with gratitude. Gratitude, of course, sits front and centre both in coaching and in health and wellness. Practices of gratitude appear linked to optimism, improved mental health, stress management, sleep quality, self-efficacy and even heart health! Supporting others to experience gratitude is a great gift! If you’re not familiar with the recent literature on gratitude, here’s a great WHITE PAPER published by the Greater Good Science Center at UC Berkeley. So…all of this has left me pondering a question that I invite you to consider:  Is it possible for a person to be sufficiently grateful?

As the COVID-19 pandemic spreads widely throughout America and the rest of the world, public health officials and government authorities are asking, then telling, then demanding that all of us keep our distance from each other. The US Centers for Disease Control define social distancing as “…remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible”.1 Where I live, all non-essential businesses have been ordered to be closed and people have been told to stay at home. The reason is to avoid spreading SARS-CoV-2, the coronavirus that causes COVID-19. This is extremely important, in order to slow down the epidemic, lest our hospitals and health care workers become overwhelmed with more patients than the system can handle. It’s not hard to imagine that the phrase social distancing was adopted because – from an infectious disease epidemiologist’s point of view – it conveyed the notion of keeping infected people away from non-infected people. “Social distancing” is, unfortunately, not an apt turn of words. Social distance, however, is a sociology term meaning the separation of social intimacy between two groups, primarily of racial difference.2 Distancing, a verb, means to increase the distance between two things, such as two people. One might logically conclude that social distancing is to act on social distance, decreasing one’s intimacy, one’s connectedness, with others (and especially of others of a different race). But that is not what social distancing means. To slow down the epidemic of coronavirus, we all must increase the physical distance between ourselves. In other words, avoid getting physically close to each other, not touching each other, not touching the same objects without cleaning them between uses, and so forth. In particular, race is irrelevant. Coronavirus doesn’t care about race, it will kill with no regard for race. Failure to stay away from each other will kill a lot of people, of all races, who otherwise don’t have to die. The importance of physical distancing cannot be overemphasized. But as we take these preventive measures, one thing everyone really must do is resist the tendency for allowing the physical distance between us to cause emotional isolation, decreasing your intimacy with friends, family, co-workers, neighbors and perhaps even strangers. We must maintain our sense of community. As this epidemic causes emotional distress for everyone, it is not helpful to become more emotionally isolated, no one need suffer through this epidemic, feeling alone and isolated. As we go through this crisis, and perhaps even more so during the economic consequences that will surely follow this epidemic, we need to feel more love for each other, not less. The great news is that, today, we have many technological tools that allow us to maintain our human connections, even though we must physically stay apart. But one needn’t have a smartphone, tablet or a computer to stay connected. A regular old phone is perfectly good for reaching out to your friends and family. It’s very comforting to just hear someone’s voice. So take some great advice from the 1976 hit by the band Heat Wave, ALL YOU DO IS DIAL (and cheer yourself up by giving it a listen on YouTube!). When you’re missing someone or feeling lonely, give your friend or family member an old-fashioned phone call. Once you do, you may still both be quarantined, but those feelings of isolation will melt right away. RESOURCES – CDC website on Coronavirus Disease 2019 (COVID-19). HTTPS://WWW.CDC.GOV/CORONAVIRUS/2019-NCOV/PHP/RISK-ASSESSMENT.HTML (accessed March 24, 2020) – Park RE. The Concept of Social Distance As Applied to the Study of Racial Attitudes and Racial Relations. J Applied Sociology 8 (1924): 339-344. HTTPS://BROCKU.CA/MEADPROJECT/PARK/PARK_1924.HTML (accessed March 24, 2020) – Heat Wave. All You Do Is Dial, from Too Hot to Handle, CBS Records, 1976. HTTPS://WWW.YOUTUBE.COM/WATCH?V=LX_CZSR1UYK (accessed March 24, 2020)

On center stage of this pandemic are our beautiful and sometimes fragile, human lungs. For thousands in hospital with COVID-19, the struggle to breathe by ravaged lungs is a struggle to live. Hospital workers on the front-line find it hard to breathe while wearing personal protection equipment. We were asked by wellness coach, Carol Scott, to provide tips on breathing for her colleagues, particularly those who are working on the front-line in personal protective equipment. We are all more conscious of breathing, knowing that if we have been infected, our breath spreads the virus whether or not we have symptoms. Many of us spend a good deal of our waking hours holding our breath, bracing for the next wave of bad news. Pandemic times are breathtaking, remarkable and astonishing in how they are taking our breath away in so many ways. Pre-pandemic, it was easy to take for granted the ability to breathe, not seeing it as a valuable possession, and forgetting that life starts with the first breath and ends with the last. Those of us who are breathing with healthy lungs now, know that breathing is a most precious gift. We also know that so long as we can breathe freely, we can be strong and able members of the team that carries us all through pandemic recovery, when that time comes. Reflecting on the profundity of breathing in this moment, I reached out to EDDIE HARROLD, a master of modeling and teaching the art and science of breathing to executives, athletes, and coaches. Eddie helps us appreciate that the simple act of breathing properly is the path to calm, focus, resilience, and a healthy immune system. Here are some of Eddie’s wise tips on breathing with benefits. Use your nose. Breathe deep. Slow your breath. Try the four-part breath. Try the ocean sound breath. Nose breathing Give extra attention to breathing through the nose, and not the mouth, which engages the lungs’ air filtration system, the tiny hairs or cilia in nasal passages designed to protect the lungs from foreign invaders like viruses. Breathe deeply Breathing under stress is quick and shallow, inhaling and exhaling into the upper portion of the lungs where nerves signal a challenge and activate a stress response (sympathetic nervous system). Imagine your lungs as balloons that you are slowly filling up with air from the bottom of your lungs, all the way to the top of your lungs just under your collar bone. Notice the diaphragm pushing down as you inhale allowing the lungs and ribcage to expand, and rising up when you exhale. Keep your shoulders down and still. Breathing low and deep stimulates the nerves at the bottom of the lungs, activating the relaxation response (parasympathetic nervous system). Nasal, diaphragmatic breathing enhances the production of nitric oxide in the nasal passages, which boosts the immune system. Take long, slow breaths Breathing deeply in itself lengthens and slows the pace of the breath. When the rate of breathing is fewer than ten breaths a minute (6 seconds per breath), the relaxation response is activated. When we breathe at a rate of 4-6 breaths a minute (10-15 seconds per breath), the heart rate slows down and heart rate variability improves, with more relaxation and recovery. Experiment with a four-part breath, counting to 5 on a full, slow, deep inhale, and a pause for 3 at the top of the inhale. Then count to five or more on a slow, full exhale, and pause at the bottom of the exhale for 3, or longer until the natural urge to inhale arrives. Notice a pleasant stillness of the mind when you gently pause your breath at the top and the bottom of the breath. Try the ocean sound breath Who knows whether we will be together on beaches anytime soon, so in the meantime play around with the ocean sound breath. Make an ocean sound with your breath: it sounds like DARTH VADER. Slow the pace, breathing in and out slowly and deeply. The ocean sound helps slows the pace of breathing because we are constricting the epiglottis muscle on the inhale and exhale. Now, travel quickly in this video with Eddie through these breathing practices – nose, deep, slow, four-part, ocean sound. Next time the pandemic takes your breath away, bring it back. Rather than unconsciously holding your breath, inhale and exhale through your nose, deep and slow. Add a conscious pause, a shortcut to a calm and still mind. Then… Breathe in your vehicle before you go into your workplace.. Breathe in the shift change huddle IF you are a leader, practice ’team breathing’ Breathe before your put on PPE Breathe on breaks (if you get one). Alone or with a partner. Breathe after a challenging case or code Breathe when you get back into your vehicle. Breathe deeply with those with COVID-19 who are struggling to breathe. Breathe slowly to appreciate health care workers on the front line. Breathing is our future! Onward and upward. Coach Meg & EDDIE HARROLD

A new article titled Leadership Coach Effectiveness as Fostering Self-Determined, Sustained Change, features Intentional Change Theory developed for leadership coaching by Richard Boyatzis. This theory is quite similar to the Wellcoaches vision tool, developed independently for the Wellcoaches curriculum in 2002 for health and wellness coaches. The Wellcoaches blog on this article is adapted from an Institute of Coaching (IOC) research dose co-authored by Margaret Moore. RESEARCH DOSES are translations of top scientific articles into coaching practice. Become an IOC member at the WELLCOACHES SPONSOR RATE (annual $100 rather than full $180 for a member donation) to access the research doses and a treasure chest of coaching resources, including don’t miss IOC conference videos. The intentional change process walks through five discoveries for optimal and sustained change. 1. Envision, Articulate and Commit to an Ideal Self The ideal self is the one we aspire to be, doing what we desire to do or become, as opposed to what we may feel obligated to do or become. 2. Assess the Real Self in Comparison to the Ideal Self The real self, in contrast, is the current state or snapshot of one’s knowledge, capabilities, traits, etc. The real self serves as a benchmark or point of comparison in relation to the ideal self. It’s invaluable to get input from others we know or work with, by asking directly or through coaching stakeholder interviews or 360 surveys. 3. Develop a Learning Agenda to Transform the Real Self Toward the Ideal Self The learning agenda articulates how to begin the journey from the real self to the ideal self, using the strengths one has as a key resource to create the plan for change. 4. Practice and Experiment with Elements in the Learning Agenda As the practice occurs, one is testing new ways of behaving and gathering data on the tests. Through persistence, these new behaviors will lead to a transformation of the real self towards the realization of the ideal self. 5. Develop Trusting, Reassuring Relationships That Provide Support and Encouragement During the Other Four Discoveries and Throughout the Change Process. The role of a coach is critical, as the coach’s role is to facilitate intentional change by supporting the client as s/he moves through the various discoveries. The discoveries bring a bonus as they also help satisfy the THREE CORE PSYCHOLOGICAL NEEDS DEFINED IN SELF-DETERMINATION THEORY (i.e. autonomy, relatedness, and competence). The authors of the article then connect the three core needs in self-determination theory to the five discoveries of ICT with well-crafted coaching questions. Need: Autonomy Coaching Questions: -What are your core values and beliefs? (Ideal Self) -Imagine it is the year 2030, and a documentary on your ideal life is being filmed. What are you doing? By whom are you surrounded? (Ideal Self)- -What do you wish your legacy to be? (Ideal Self) -What feedback have you received that will help you move toward your ideal self? (Real Self) -What surprises you about feedback you are getting? (Real Self) -What actions do you want to take to get you closer to your ideal self? (Learning Agenda) -What are you willing to say “no” to in your life to allow you the time and energy to pursue your learning agenda? (Learning Agenda) -Out of the actions you chose to take in your learning agenda, which actions are helping the most to get you closer to your ideal self? (Experimentation and Practice) Need: Relatedness Coaching Questions: -Who helped you the most to be the person you are today? (Ideal Self) -Who is the best role model for you? (Ideal Self) -Who do you admire most and would like to emulate? (Ideal Self) -What impact would you like to have on others? (Ideal Self) -How do others see you differently than you see yourself? (Real Self) -What strengths do others see in you that you see differently? (Real Self) -Who in your life will be most supportive of your learning agenda and why? How can you engage their support? (Learning Agenda) -How might the actions in your learning agenda help you build stronger relationships with others? (Learning Agenda) -How have the actions you are experimenting/practicing helped you build stronger relationships with others? (Experimentation and Practice) Need: Competence Coaching Questions: -What are your enduring strengths and unique capabilities to carry forward? (Ideal Self) -What core aspects of your identity are central to who you would like to be in the future? (Ideal Self) -What common themes arise in feedback from others? (Real Self) -What blind spots are revealed in feedback from others? What sense do make of them? (Real Self) -How have you made the actions in your learning agenda fit into the current structure of your life? (Learning Agenda) -Who are you excited about “reality testing” the actions in your learning agenda with? (Experimentation and Practice) -How have the actions you have been taking strengthened your confidence that you can change? (Experimentation and Practice) -Here’s to the intentional inquiry that enables intentional change for ourselves as coaches and everyone we serve. Coach Meg Featured Article: Taylor, S. N., Passarelli, A. M., & Van Oosten, E. B. (2019). Leadership coach effectiveness as fostering self-determined, sustained change. The Leadership Quarterly, 30(6).

Have you noticed any uncharacteristic changes in your behavior or client behavior as  Covid 19 has impacted life in numerous other  ways? As Covid 19 became a reality to the U.S. I began to notice changes in my clients and some of the  coaches I supervise.  In some, it was a focus on things that weren’t important in the past. For others it was an edge to their behavior that I hadn’t seen previously. And then one day, it happened to me. I had an internally alarming and uncharacteristic reaction to a health concern a supervisee shared with me. I managed to reign it in  before it flew out of my mouth, but my presence was impacted, and upon reflection, I realized I missed a number of opportunities and nuances of the session. I also realized my shadow side was making an appearance. Psychologist Carl Jung was first to use the phrase “shadow side” According to Jung, we all have parts of our personalities that we reject and therefore repress. We avoid admitting to our negative tendencies, and are often not conscious that they exist, until we blurt something out or behave in ways that are unacceptable. The Jung-inspired Myers-Briggs Type Indicator identifies uncharacteristic behaviors as “being in the Grip” as we are subject to uncharacteristic behaviors as a response to stress. Psychologist Robert Hogan, took this concept step further labeling it our “dark side“ and assigning 11 personality traits to our dark side. According to Hogan, the behaviors that the dark side of our personalities exhibit are the result of primitive negative emotions and are behaviors we wouldn’t consciously choose,  including: -Seeing oneself as a victim -Quick to criticize people in less power -Harshly judging others on an impulse -Projecting our insecurities onto others -Unacknowledged bias -Overreacting to small issues -Emotional outbursts -Vacillating between dire and optimistic predictions of the outcome -Developing conspiracy theories -Inability to make decisions -Hoarding -Take a business as usual stance and not addressing the human side of change -Violating norms and policies -Micromanaging According to Jung, self-acceptance is a key to moving beyond these unconscious behaviors. Learning to manage our stress response can also keep us out of “The Grip” and keep our dark side content to remain behind the scenes. When our clients seem to be behaving uncharacteristically, our curiosity on their behalf may help clients become aware of their behavior and help us stay in the flow of coaching. When my client brought up his health issue, a thoughtful reflection, following by a simple, curious  question on my part could have helped me stay focused and help us move through his uncertainty together.

As I was doing some pandemic research for this post, two curious book titles resurfaced on multiple search pages: The Art of Saying No and The Joy of Imperfection. As I thought through the possibilities, I landed on uncertainty as a connection. How has the criteria changed for our decision-making today versus yesterday? What are the values we emphasize in our lives today  versus what we valued  most yesterday? In “normal”  times we engage in multiple routines that reinforce our sense of certainty – go to work 5 days a week, book club meeting once a month, soccer practice 3 times a week…We also engage in planning that reinforces our sense of certainty in the future – planning a wedding 6 months out, summer vacation, new car next year. And yet, certainty does not really exist. We are able to observe that truth  in all of its chaotic mess with the current extreme example of the pandemic. On a daily basis, we often focus on what we believe to be certain, avoiding the existential reality that nothing in life is certain.  When faced with an example, we don’t often look at the aberrations from a certainty perspective.  I am certain I am going to work on Monday, and I  have a car accident on the way, which ultimately prevents me from getting there. I focus on the accident, maybe what I missed at work, but not that the accident is an example of life’s uncertainty. So how do we coach effectively through such visible uncertainty, and are there hidden treasures in this pandemic that we can find and use? Having curiosity as a primary value and having positivity at the center of my life for so many years automatically leads me to two questions – What are the potential benefits of this pandemic? What can I learn from this?  The fears of the worst don’t go away, but they are muted as they are not the object of my focus. A client who owns an interior design studio and retail home furnishings store has struggled to hang-on to what she loves doing, overshadowed by large retail outlets that have attracted many of her clients.  In view of the pandemic, we brainstormed possible opportunities for her business. The result was a thought that people who normally shop in malls, might come back to local small businesses with fewer customers, and this may be a chance for her to regain some of her customer base. She sent out a flyer and over the next week saw several new and returning customers. I have watched with some amazement the focus on hoarding toilet paper that has emerged since the pandemic has hit the U.S. Friends in Canada and Australia are observing the same thing. I found it curious – why toilet paper? What can I learn from this? I first learned that 90% of toilet paper in the U.S. is manufactured in the U.S. I also learned that, for many, having enough toilet paper provides a sense of control. Then I saw the groupthink bias in full swing – if everyone is hoarding toilet paper, so should I. Perhaps the biggest learning for me has been what I have observed in myself in the midst of this.  Many of my clients are health care leaders – physicians, administration  leaders, health system leaders.  I have wondered  about the risk of seeing these clients in their settings during this time. As I observed my willingness to continue to meet in person, what came up was “This isn’t going to happen to me.”  It is part mantra, part based on expert predictions of who is at high risk, and part totally irrational but none-the-less convincing  belief that facing the fear of in-person meetings will somehow immunize me  from the potential reality. How did  I translate what I learned about myself to my coaching practice? – Look beyond the presenting concerns of my clients (i.e. toilet paper) and encourage them to look more closely at their core beliefs and values and how those can serve them during this unprecedented time. – Invite clients to brainstorm ideas about the potential upside of this time. I have a client who works for a multibillion dollar retail organization that has never allowed headquarters employees to telecommute. He is using the pandemic to hopefully persuade the CEO that telecommuting makes sense now… and in the future. – Invite clients to look more deeply into themselves , their beliefs, their values and articulate what they are learning about themselves that can serve them. – Recognize the importance of having a sense of some certainty and its place in motivation What can you learn about yourself that will help your practice during such uncertain times? Suggested Resources: THE PLACES THAT SCARE YOU, by Pema Chodron EMBRACING UNCERTAINTY, by Susan Jeffers UNCERTAINTY: TURNING FEAR AND DOUBT INTO FUEL FOR BRILLIANCE, by Jonathan Fields

Wellcoaches Professional Health and Wellness Coach Cami Smalley’s book, MINDFUL PAUSE: A SELF-CARE GUIDE TO RESILIENCE AND WELL-BEING STOP.BREATHE.THINK.CHOOSE, arrived on the literary horizon it seems at just the right time. In early March when her book was first launching and we were just starting to hear rumblings about a potential health concern, she shared her thoughts on Wellcoaches, mindfulness, and impact of worksite culture. The guidance within her book are just the sort of anchoring tools any person, especially a coach, needs right now. The four steps to a mindful pause are: stop, breathe, think, choose. And within the context of a pandemic and the experience of fear at an all time high, her steady reminders to breathe and consider “what is also true” in this time are game-changers. Cami’s niche focus of resilience both for her clients and her readers is focused on the fact that many need help with self-regulation and that emotional domain is critical for being successful in other behavior-change habits. She encouraged that we all need to take care of ourselves in this time so we don’t “freak out.” It’s important to not be hijacked by the fear of “what could happen.” And while you wait for Cami’s book to arrive on your doorstep or on your Kindle, here are two simple exercises that she suggests using to ratchet down the stress, fear and/or anxiety: 1. Remember the power of the breath— without knowing it we hold our breath. 2. Employ equally true: while we can use the facts around the current state of things to be vigilant. She says that fear, anxiety, worry can be useful in motivating putting systems into place like good hygiene or social distancing. But then shut it off. Let go of the worry and allow space for what is equally true. Such as: the sun is out, we have loving relationships, we have ways to satisfy our meaning and purpose. She encourages keeping our focus wide. She credited her Wellcoaches education for part of that outlook, “I am so grateful for my Wellcoaches training” stating that one of the powerful tools she learned was the power of positivity. When working with clients, she provides perspective and a reminder that we are wired to protectively look for negativity and that can be to our detriment. “I reinforce that with care providers and we have a built-in negativity bias to protect us. And skill development to look for what’s wrong … at the deficit of sustainability.” She encourages her clients: “When you leave work and you leave the hospital you may notice the potholes and not the sky. The other drivers are annoying you. You are finding ways to fix the city’s despair instead of noticing the blue sky.” Cami came to the process of Mindful Pause because she said she needed the skills for herself but was also clear that her approach is one of many. There are many ways to find a process of self-care and regulation that work. She says, “I couldn’t write a prescription of self-care the way some clients come up with.” Cami shared one of the ways taking a pause has been helpful for her is being able to choose between alter egos of truck driver or church lady. She said she can be hot-tempered and sharp-tongued and was even celebrated for that, it became part of her identity. She said she was often loved for that but sometimes it’s hurtful. And she didn’t want that to be how she showed up all of the time — for that to be “all of me,” she said. “I needed mindful pause to give me a gap.” A place where she got to decide. When she can think, “is it appropriate for me to truck driver or do I need to continue with breathing to shift and do my church lady?” “That’s why Margaret’s work with Internal Family Systems and the different voices is so important,” she said. What voice is most predominant is attached to a particular strength. She said, creating enough of a gap to decide how to share the mic and allow a lesser-used voice some air time is sometimes more appropriate and life-giving. Cami is a wealth of information but one of the greatest parting reminders and pieces of knowledge is that it’s the heart’s job to supply blood flow and nutrients to the body, so we can live. It only does that after supplying blood flow to itself first. Self-care is about being able to supply oneself first, then get to the work of helping others.

Mind-body medicine is one of the fastest growing evidence based areas of healthcare.  According to Moss et al. (2003) mind-body medicine is a revolutionary 21st century approach to managing one’s health that includes combining a wide-range of behavioral and lifestyle interventions including wellness coaching, along with traditional medical interventions.  Assessment, diagnosis, and treatment interventions focus on the whole patient in totality of mind, body, and spirit.  Mind-body medicine employs the use of a partnership among medical and healthcare practitioners and results in an integrated care team addressing patient health and disease. The foundational principles of mind-body medicine are: 1) A focus on healing the whole person versus treating symptoms, 2) collaboration between the healthcare provider and the patient, 3) partnership among various and diverse healthcare providers for the individual patient, 4) empowerment of the patient specifically in their healing and treatment decision-making, and 5) a focus on the whole person including the relationships among the physical, emotional, social, environmental, mental, behavioral, and spiritual. These foundational principles have a primary focus on the whole person and emphasize healing and curing versus treating symptoms.  A critical asset of mind-body medicine is the partnership among an integrated team of caregivers who work well together, respecting each other’s practices in an effort to identify the root cause of distress and disease.  Treatment addresses the mind, body, and spirit for all patient conditions.  This integrated team often includes care-givers of from many specialties, for example, physicians, nurses, various mind-body medicine specialists, massage therapists, physical and respiratory therapists, nutritionists, and even wellness coaches, counselors, chiropractors, and yoga teachers, etc. (Moss et al., 2003). Mind-body medicine’s collaborative partnership between the patient and the healthcare provider places the patient at the center of the treatment based decision-making.  Much like in wellness coaching, Moss (2003) describes the relationship between the patient and physician as a collaborative process where patient autonomy is a crucial aspect of the treatment decision-making process. As I write this, I recall an uncomfortable interaction I had with my ex-physician and her staff many years ago.  I had pain in my abdomen that had been bothering me for about eight months.  I had a full physical exam and many laboratory tests.  Everything came back normal.  Even though this pain was not causing me any difficulty eating, sleeping, or carrying out the habits of daily living, (it was simply a dull but quite annoying pain), my physician strongly encouraged me to have a CAT scan.  Not wanting to be exposed to the radiation, I decided to pass.  Even though I said, no to the CAT scan, the physician office continued to call me to schedule.  During the third nagging phone call I received from the physician office, I more firmly told them not to call me again and requested that my medical files be transferred to my new doctor.  Pressuring me to schedule the CAT scan and the physician office taking ownership of the decision-making for my health problem was not the integrative medical care I wanted.  In this example, there’s a lack of partnership and patient autonomy in my personal health care decision-making.  This example is the opposite of a patient’s experience in mind-body medicine.  Thinking my pain could be stress related, instead of the CAT scan, I decided to join a yoga studio.  Within two weeks of practicing yoga three times each week, my eight month pain was gone. Another important mind-body medicine principle is the focus on the whole person, including relationships among one’s physical, emotional, social, environmental, mental, behavioral, and spiritual health.  Gilbert (2003) highlights many studies that show how for example, environmental, social, mental, spiritual, and emotional facets directly impact our physical health.  Herbert Benson, MD, founder of the Mind Body Medical Institute at Massachusetts General Hospital says “mind-body medicine is interested in the interaction of thoughts, emotions, behaviors, faith, and an individual’s relationship to the environment and how those factors affect mental illness” (Gilbert, 2003, p. 568).  If we ignore the relationships among these parts of our whole self, this will get in the way of our health and healing.  In addition to the principles and philosophy of mind-body medicine, there are hundreds of mind-body medicine exercises and interventions that have been used with patients with various diseases and health conditions that have shown positive results in research studies. What’s ONE THING you do that helps you clear your mind and boost your resilience? Published research has shown positive findings for mind body medicine practices for various diseases and chronic health conditions including post-traumatic stress disorder, cancer, anxiety, depression, diabetes, heart disease, and the list goes on.  You can find much research on the websites and resources listed below including the Center for Mind Body Medicine and the Benson-Henry Institute for Mind Body Medicine at Mass General Hospital. As wellness coaches, we have an opportunity to learn more about our role in mind-body medicine and how we contribute as members of an integrative care team.  I had the gift of learning much about integrative medicine over the past decade especially as I worked to complete my Ph.D. in Mind-body Medicine and Integrative/Functional Nutrition.  In addition to I completed a Mind-Body Medicine Workshop at the Center for Mind Body Medicine and I’d like to share with you a small section of my specific notes of the mind-body medicine exercises that I incorporate into my coaching practice: – Shaking and dancing – James S. Gordon, MD of the Center for Mind-Body Medicine recommends dancing and shaking due to its significant benefits to the body, mind, and spirit including increases in energy, tension release, breaking habitual patterns, enhancing spirituality, self-discovery, and reprogramming physical, mental, and emotional holding patterns. – Drawing Exercise: Draw a picture of you now; draw a picture of you now with your biggest problem; lastly, draw a picture of you with your problem solved. – Raising the Qi – Raise your arms up and down as you breathe in and out; nine times. – Opening the heart – Raise the arms; open the arms wide; close the arms; lower the arms. – Waking up the Qi – Clap, rub your hands together fast for one minute; stop and steady your hands; pull your hands apart ever so slowly and move them together slowly to feel the energy. Repeat. – Self-empathy – Close your eyes and think of something stressful. Tell a partner about your thoughts and discuss what your feel showing up in your body as you think about and discuss your stressful situation.  What does this feel like?  You’re gaining awareness of the mind body stress response from the sympathetic nervous system; our fight or flight response. – Stare at another person and smile, don’t speak, just smile. Barbara Fredrickson’s research has shown this practice decreases cortisol which contributes to belly fat.  This also initiates our relaxation response and boosts our immune system. – Breathe in positive emotions – Think of a stressful situation that currently has a hold on you. Now:  Breathe in positive emotions (say positive words).  Next, smile and consider how that felt. – Writing exercise – Think of one physical or emotional issue you’re carrying right now. Does it have a name or image?  Engage in a 15 minute conversation with it, write down each piece of the conversation as you go. Debrief –Read to a friend or loved one what you wrote.  Be present to what you’re feeling in your body. – Chaotic Breathing – Press your lips together, breathe in and out filling your stomach quickly through your nose while you pump your arms imagining they are a bellow. Bounce by bending your knees while you do this for five to ten minutes to fast music. – Mindful eating of chocolate or grapes (your choice) as slowly as you can. As you’re eating consider:  What was that like?  What were your thoughts?  What did it feel like in your body? – Genogram – Draw four levels of your family tree and include all relationships. Then, share your genogram with a friend or family member by describing your picture with great detail. – Body awareness – Engage in a body awareness meditation. – Future Self – Draw a picture of how you feel now; draw a picture of how you want to be; draw a picture of how you will get there. Also, massage, acupuncture, chiropractic care, guided imagery, visualization, yoga as medicine,  and integrative and functional nutrition practices are all categorized as integrative medicine techniques along with health and wellness coaching. While mind-body medicine practices help treat core clinical imbalances and promote healing of many different types of diseases, they also promote resilience and can help you to for example unleash your best thinking, bring your best selves to the care of others, establish clarity and calm during chaos and help you live a happier and more fulfilled life.  Stress is linked to nearly every disease we know of so I invite you to consider:  What might you want to try?  How might you incorporate some mind-body medicine techniques into your self-care routine? What else might you want to learn about mind-body medicine?  Feel free to connect with me on LinkedIn or email me directly at Clombardo@Wellcoaches.com or Christina@ChristinaLombardo.com. References: Gilbert, M. D. (2003). Weaving medicine back together: Mind-body medicine in the twenty-first century. Journal of Alternative and complementary Medicine, 9(4), 563-570. Mind-Body Studies. (n.d.). Mayo Clinic. Retrieved May 30, 2020, from HTTPS://WWW.MAYO.EDU/RESEARCH/CENTERS-PROGRAMS/INTEGRATIVE-MEDICINE-HEALTH-RESEARCH/RESEARCH-STUDIES/MIND-BODY-STUDIES Mind and Body Research—Information for Researchers. (n.d.). NCCIH. Retrieved May 30, 2020, from HTTPS://WWW.NCCIH.NIH.GOV/GRANTS/MIND-AND-BODY-RESEARCH-INFORMATION-FOR-RESEARCHERS Mind-Body STREAM. (n.d.). Retrieved June 3, 2020, from HTTPS://MIND-BODYHEALTH.OSU.EDU/ Moss, D., McGrady, A., Davies T.C., and Wickramasekera, I., (Ed.). (2003). Handbook of mind-body medicine for primary care. Sage Publications. Teaching thousands to heal millions—The Center for Mind-Body Medicine. (n.d.). Retrieved May 30, 2020, from HTTPS://CMBM.ORG/