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/

How happy are you? Did you know that happiness influences your health? Did you know that you can influence your happiness LIVE MORE – Happy is the third book from Dr Darren Morton, Director -  Lifestyle Medicine and Health Research Centre at Avondale University College in Australia.  Published in 2018, its message is as relevant as ever today. Morton is a leading researcher in lifestyle medicine and has been published widely in medical and scientific journals. To understand the context for this book, it’s useful to also understand a little of his passion for lifestyle medicine and its link to happiness. In 2016, after several years of researching and observing the ways in which discoveries in neuroscience, positive psychology and lifestyle medicine could impact happiness, Morton developed The Lift Project, a 10-week program which in an early study led to some marked changes in experiences of depression, anxiety and stress. Since then, The Lift Project has been a Profit – for – Purpose and has raised over $50,000 for various charities. Morton’s ultimate goal is to “lift” 10,000,000 lives. LIVE MORE – Happy is the outworking of that program and neatly covers current neuroscience research related to happiness for the every-day reader. Having an experience of happiness, or even joy, is central to behaviour change. Why would we make any change in our lives, regardless of what health benefit it may bring, if it didn’t also bring some measure of happiness or contentment in some way? Beginning with the links between motivation and happiness, Morton walks us through the function and power of the brain’s limbic system, the strong links between physical movement and positive emotional experience and the influence that diet has on happiness. In one British study he discusses, a strong dose-response relationship was uncovered between fruit and vegetable consumption, and happiness. He goes on to demonstrate the influence that lifestyle factors we so often take for granted directly, and indirectly, influence our level of happiness – sleep, social connection, stress management, service to others and simply getting out in nature. Every chapter explores the science in an approachable way – Morton has a capacity to take the big ideas and complex research findings and distill them in a way that allows the reader to understand and apply in their own lives – each chapter concludes with some practical steps to take, grounded in positive psychology. LIVE MORE – Happy is a book to read if you want to learn more about the aspects of your life you can control to experience greater happiness and contentment. It’s approachability and practical application make it universally appealing. It’s also a book for health and wellness coaches, forming a trove of well-researched science and ideas for personal change. In the hands of skilled coaches, the book’s ideas can be transformed into open appreciative inquiry which will cultivate in their clients a sense of control and even an urgency to experience greater happiness and health in their own lives.

Many of us have come into contact with picky eaters over the course of our careers. Whether you’re a family physician, a dietitian, nutritionist, a psychologist like I am, or any number of other allied health professionals, the likelihood is that picky eating or fussy eating has been a feature of some of the clients and patients you’ve worked with. One of the challenges of “picky eating” (which may also be referred to as fussy eating) and which can further present as an element of the diagnosis of ARFID - Avoidant/Restrictive Food Intake Disorder1 - is discerning whether it most represents the formation of a cemented and largely unexamined pattern of dietary behaviour over time or whether it better represents an underlying psychological disorder. Of note here is that ARFID frequently occurs with other conditions, such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) and that a fear response is often involved when presented with particular foods. Furthermore, ARFID is most prevalent in children, so the presence of picky eating in adults is much less likely to be a sign of ARFID. The clients that I have seen with picky eating behaviour have often had a history of feeling “badgered” about their eating (sometimes by medical and health professionals, sometimes by family members and sometimes going as far back as childhood) and as a consequence have developed an understandable defensiveness and even a “practitioner – induced resistance” to changing their dietary habits. With health coach training, comes awareness of concepts like the “righting reflex”2, as well as the pitfalls of arguing strongly for change, which tends to evoke “sustain talk”2 rather than “change talk”2 founded in the appreciative exploration of what could be. In a recently published paper in the American Journal of Lifestyle Medicine3, I argue that health coaching is an efficacious response to non-ARFID picky eating and its frequently observed co-morbidities. Picky eating is not necessarily a benign condition. While little is understood about adult picky eating and its origins, it’s reasonable to conclude from other data that a long term and highly restricted diet, which may be focused on foods of a particular colour, or texture, or flavour profile may result in detrimental metabolic conditions. A suitably qualified and mindful health coach can begin with an appreciative and empathetic engagement. Although it may seem paradoxical to some, taking the time to understand the ways in which the apparently restricted diet and picky eating behaviour support the person will immediately begin to build and develop the practitioner-client relationship. In my experience, it is uncommon for a client to present with picky eating as the issue or concern they wish to manage. More frequently, people present with a desire for increased well-being, weight loss, reduction in prescribed medication usage or a desire for capacity to do something functional that they currently struggle to do. It’s in this context that information about picky eating behaviour tends to emerge. The creation of a personal vision for health, or that profound “Why” which fuels motivation, sits at the heart of behavioural change. Trained health coaches, of course, are adept at this “envisioning” and immediately recognise the powerful value of a conversation which begins here, rather than a conversation beginning with attempts to challenge and change picky eating. While picky eating can be assessed with tools, straightforward open inquiry is every bit as useful in gaining understanding of it. The following inquiries can help to paint a picture of what the person is eating day to day: What does a typical dinner/breakfast/ lunch look like for you? What do you eat between main meals? What new foods have you tried this year? What vegetables do you routinely eat? An inquiry such as the following can begin to develop discrepancy for the person about their eating behaviour and their health vision: What has been the impact of this eating pattern on your overall health, in your view? Beyond this, a coaching approach which focuses on the whole person and their entire health (not simply picky eating behaviour) almost always leads to an engagement in which the person feels like their needs, values, successes and struggles are understood. This itself forms the foundation of lasting behavioural change. It also addresses the deeply held and often unexpressed fear people have that the practitioner they see is “just going to be another person who tells me what I need to do.” From this point, working with a client who wishes for improved health and also has a habit of picky eating is broadly similar to working with a person who has a habit of eating “junk food” or a habit of not exercising or staying up late and missing sleep. A process of moving between the “Why?” (Vision) and the “What and How?” (SMART goals) supports the client to design goals which are personally meaningful and which enable them to make steps towards sustainable health behaviour change. Use of Motivational Interviewing2 skills, and in particular the Decisional Balance2 tool, can support the client to dispassionately explore the various dimensions of what it may mean to either make a behavioural change or continue as they are, without experiencing judgment for acknowledging that there are down sides to change and there are likely upsides for them to staying the same! As is the case with practitioners in any discipline, health coaches should remain mindful of scope of practice and if necessary, support the client to liaise with their physician, a psychologist or a social worker who may be able to provide adjunctive treatment. On the surface, picky eating may appear to present as a difficult clinical challenge. While it may have a more complex and comorbid basis, particularly in children, in adults it is most likely to represent a long-standing habitual pattern of behaviour. When the client is engaged in broadly considering their own vision for health and well-being, the opportunity to co-create multiple pathways to this outcome arises. Many of these pathways will almost certainly involve changes to picky eating behaviour. RESOURCES 1 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013 2 Miller, William R., and Stephen Rollnick. Motivational Interviewing: Helping People Change. 3rd ed. New York, NY: Guilford Press, 2013 3 Matthews, S. Health Coaching as an Intervention for Picky Eaters. American Journal of Lifestyle Medicine. Published online 29 July 2020. Available at: https://doi.org/10.1177/1559827620943821

This blog article was inspired by a conversation I had with a friend about our strengths as related to the workplace. Though not the first time, I had recently completed the Values in Action (VIA) Character Strengths Survey, which assesses your qualities that come most naturally for you. For the first time, however, love was my number one strength. I had anticipated (honestly, hoped for) top strengths such as leadership, teamwork, etc., those which seemed  more relevant for the workplace. I would be remiss not to mention that I compared my strengths to seemingly more desirable strengths of others, which is in no one’s best interest given that character strengths are about being your natural self. I recall rhetorically saying to my friend something along the lines of, What am I supposed to do with love in the workplace? As I was finishing the question, I noticed what I was saying, and at the same time, my friend said essentially what resounded in my head and heart, "Everything." I quickly became aware that I had viewed love as a soft skill that was less accepted and valued in the workplace arena than technical skills. Sadly, I had toned down my natural strength of love because of this viewpoint. Humility, Vulnerability, & Authenticity I called upon humility to acknowledge and accept that I had missed the mark regarding use of my strengths and being true to my real self (and others). Why had I done this? It was my way of resisting the discomfort of vulnerability, which in her book, Daring Greatly, Researcher and Author, Brene Brown describes as “uncertainty, risk, and emotional exposure” that comes with stepping out of your comfort zone. The truth of toning down my love strength was a disheartening realization because love is everything to me. To live any part of my life from anyplace other than a place of love is to deny my true self, my authenticity. How might you relate to this experience? Consider the importance of authenticity in coaching relationships and the impact on cultivating a genuinely warm, safe space in which vulnerability, transparency, and genuinely being are cultivated. As with the power of silence upon empathically reflecting or profoundly inquiring, it is important to allow your strengths to naturally [do their] work by showing up as and being your authentic self. This minimizes chances of contributing to discord or disconnection and invites your clients to be their authentic selves. Gracefulness & Gratefulness In writing this article, I also want you to know that you do not have to perfect your strengths before or in order to use them. Your strengths naturally invite connection, opportunities, and relationship with others. Why is that important? There is great need in our world for authenticity and your strengths just as you need others and their strengths. Every strength is valuable. The beautiful part is that all you have to do is be your unique, magnificently imperfect, natural self. In doing so, you are gracefully and gratefully becoming and, simultaneously, modeling ongoing, transformative change that effects positive social change for greater good. You do not have to know or have it all figured out right now. You can use what you know and have to do what you can at any moment. You will learn with each experience as you apply what you learn. Each step that you take is an act of courage and faith.  Even a step backward is progress when you are genuinely trying. Keep trying. What are your strengths? How might you use your strengths to “harness the power of your positive traits to live a more fulfilling life” or to make a difference in someone else’s life? Since gaining deeper understanding of the importance and value of character strengths, I intentionally use my strength of love in expressing compassion and loving-kindness through my words, actions, and way of authentically being, including in the workplace. Heeding the freeing words of a dear friend, I am learning to “love hard and hold loosely.” Everything is Everything When it comes to coaching [and the workplace], then, love has absolutely everything to do with it because everything we, as coaches, do comes from a place of love. This is particularly true regarding empathy and compassion. The more loving and compassionate we are toward ourselves and others, the more genuinely and authentically we can relate with and guide our clients through transformative, evolutionary experiences toward achieving their goals and realizing their dreams. I encourage you to know and use your strengths to their full potential. Why should you do this? You add value to lives, including your own, by using and sharing your strengths from the gift of the real, true, authentic you. Suggested Resources Daring Greatly, Brené Brown VIA Character Strengths Survey. https://www.viacharacter.org/survey/account/register