Earlier this year, the Journal of American Medical Association (JAMA) published an article entitled “Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults." (Yaffe et al. 2024) The purpose of the study in this prestigious medical journal, was to determine if a multi-pronged program featuring health coaching might reduce dementia risk in group of at-risk adults averaging nearly 76 years of age.  In the ever-growing body of research defining health and well-being coaching (HWC), this is one of the first studies to directly address dementia – a debilitating and feared condition associated with old age.  The design of this study was unique in that it targeted a personalized approach to risk reduction and used HWC to deliver the intervention.  Here are some of the details of this important and applicable work. WHO:  Participants in this study were dementia-free but had two or more dementia risk factors which include: 1) physical inactivity, 2) uncontrolled hypertension, 3) poor sleep, 4) prescription meds affecting cognition, 5) high depressive symptoms, 6) uncontrolled diabetes, 7) social isolation, and 8) currently smoking.  These were all independently living older adults who were part of the Kaiser-Permanente Health Care System.  Participants (N = 172) were randomized into the intervention or control group for this two-year randomized and controlled trial (RCT). HOW:  The study was conducted before and during the COVID pandemic making much of the intervention remotely delivery.  Dementia risk was assessed for each participant and health coaches helped them prioritize related goals and then work toward achieving those goals.  Sessions were initially about 45 minutes long every 4-6 weeks, and after three months, were reduced to about 20 minutes every six weeks for the next 15 months.   A nurse was also part of the primary care team meeting every three months with those participants who had uncontrolled diabetes, hypertension, or risky meds. MEASURED: The primary outcome was a neuropsychological test battery measuring attention, memory, language, and global cognition. The authors also measured physical activity using a written scale and a waist-worn accelerometer. Blood pressure and A1C (diabetes indicator) were measured along with quality of life, sleep quality, social isolation, depression, and smoking.  These measures were made every six months. FINDINGS:  When the composite cognitive outcome measure was assessed, the HWC group improved substantially more than the control group.  The intervention participants also had a significantly better dementia risk profile at the end of the study than the control group.  In general, most other outcome measures (quality of life, sleep, social satisfaction, depression) showed the HWC participants to be better off than the control participants who did not receive HWC.  Finally, those who received HWC expressed greater satisfaction with the study protocol than the controls, who were given relevant health education materials to read and apply. WOW:  This study demonstrated that an intervention featuring HWC could very possibly alter the trajectory for the development of dementia in older adults. Alzheimer's and other related dementia diseases are some of the most feared and dreaded conditions associated with aging.  When asked, most people would rather not live than to go on with severe cognitive decline.  This is not the first study to show that risk factor reduction can improve cognition.  What makes this RCT unique is the personalized, or client-centered approach, ……AND the extensive of use of health coaches to deliver the intervention.  According to the authors, this approach appears to be more effective than what is seen in other studies that emphasize a general and directed risk reduction for all participants. The authors go on to say that COVID may have affected some of their outcome measures (e.g., social isolations) and the delivery of the intervention (remote rather than in-person sessions).  BUT …..they guess the HWC treatment effects might have been better if not for this interruption in their protocol. WRAP-UP: The application of HWC continues to grow.  Prolonging a lifespan with effective cognitive function is the hope of just about every aging person.  Doing this without extensive medication and medical intervention is a further goal that may be considered icing on the cake.  This JAMA-published study asks if HWC can be part of the solution to this pressing problem.  What we see is that It appears HWC has the potential to be of great help to older adults, especially those with greater risk for cognitive decline.  This is just another great example of how applying HWC can successfully assist with prevention of a life-threatening medical condition (see diabetes, heart disease, obesity) through lifestyle modification.  As the client base for HWC expands, it becomes clear how important this strategy may be as a global healthcare intervention. References Yaffe K, Vittinghoff E, Dublin S, Peltz CB, Fleckenstein LE, Rosenberg DE, Barnes DE, Balderson BH, Larson EB. Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults: The SMARRT Randomized Clinical Trial. JAMA Intern Med. 2024 Jan 1;184(1):54-62. doi: 10.1001/jamainternmed.2023.6279.

Let’s chat for a sec about authenticity, Merriam-Webster's word of the year. It makes sense that authenticity is in demand as we’ve had to work harder and harder to separate genuineness from falsity in the news, in marketing, and in technology. And, amidst the noise of pundits, influencers, and conflicting data, many of us grapple with having a clear point of view about life and about ourself. The value of living authentically is that it yields personal freedom and power. Practically speaking, when we live and lead authentically, we communicate and relate more easily, make decisions with less turbulence, and fall asleep more quickly because there’s less mental buzz of conflicting thoughts and stress. And while the pursuit of authenticity is a mainstay for spiritual seekers and personal growth devotees, leaders and the world at large are increasingly focused on authenticity because deceit and confusion has become perfected and machine-driven, and followers take solace in having authentic leaders. I've been exploring what it means to live and lead authentically for close to 40 years, and want to share just one important aspect to make your efforts in this path more fruitful. I've found that typical education and cultural notions about being authentic and finding our authentic self, range from naïve to misleading to bamboozling. At the heart of this mess is a collective agreement – a mistaken assumption – that hidden somewhere deep within us is an authentic self. Typical pursuit of authenticity implicitly assumes that we have a static and stable (read, authentic) Self that, with enough effort and skill, can be chiseled out and released. Unfortunately, this isn’t helpful as it flies in the face of science, philosophy, and spirituality. All of our wisdom fields  agree that everything in life fluxes and changes. From galaxies to molecules, and from markets to moods, everything is impermanent – constantly shifting and changing. Impermanence is a universal fact that touches every aspect of life, including authenticity. It is not possible, therefore, to locate a static and unchanging self, is it? We, too, are subject to change and flux. So, to clean up this limiting idea, embrace the fact of impermanence. Then you can replace your search for an “authentic self” with a notion of “authentic expression.” An expression is dynamic. An expression honors change and flux. An expression grasps that from our birth to our (hopefully) ripe old age, we continuously unfold and grow in a myriad of domains—mental, emotional, physical, interpersonal, and spiritual. An expression acknowledges that there’s no end to learning and evolving; we are constantly unfolding. It’s natural. When we embrace our authentic expression, we honor our past selves, and welcome our emerging self. We accept that changing our mind and values is a feature of evolving and maturing. We can gracefully let go of the versions of self that were sculpted by others, and make room for our unique expression of creativity and care. We bow deeply to the Universal inevitability of impermanence. When we embrace authentic expression, we attune our awareness to an unfolding self-expression. Why not do the work of authenticity in 2024? It is personally gratifying, and it is a leadership magnet to other people of depth and substance. Clarify your values. Identify child-aged beliefs and let them go. Set boundaries with people. Share your creativity and perspective more often. And as you do all this, be deeply curious about what’s emerging. This isn’t the kind of work that just end – there’s no certificate that declares that you are complete. Your authentic expression is a flow, not a pool. This work is good for your team and for your company. This work is good for your loved ones and community. And this work is ancient spiritual practice. Wishing you an amazing 2024. Happy New Year. Eric

The journal Patient Education and Counseling recently published an exciting study entitled “The Impact of Health and Wellness Coaching (HWC) on Patient-Important Outcomes in Chronic Illness: A Systematic Review and Meta-Analysis." The study was conducted by a Mayo Clinic team. Meta-analysis allows for statistically combining results of many unifocal (e.g., HWC) experimental studies to provide broad conclusions and recommendations. Meta-analysis is often the most trusted form of evidence in policy decision-making and is typically considered the pinnacle of scientific topic review. WHAT and HOW: The study’s purpose was to determine the effects of HWC programs on quality of life (QoL), self-efficacy (SE), depression, and anxiety in chronically ill patients. Chronically ill was defined as any condition limiting self-care for more than 12 months. The authors only used randomized and controlled trials (RCTs), which are considered the most rigorous and powerfully designed experimental studies. Keep in mind, to be included in this review, a study had to be an HWC RCT in chronically ill patients measuring QoL, SE, depression, and/or anxiety. In the end, they selected and analyzed 30 RCTs from the 1337 HWC articles returned by their electronic search of the literature from 2005 – 2023. The 30 retained studies had over 8600 participants that were included in the meta-analysis. FINDINGS: The meta-analyses revealed that HWC had a beneficial impact on QoL, SE, and depression. Each outcome improved at a different time point (e.g., at 3, 6, or 12 months) relative to starting a coaching intervention. Only anxiety was not found to improve after coaching. QoL, SE, and depression were measured in 14, 13, and 15 studies, respectively, while anxiety was measured in only 7 studies. MAIN POINTS: HWC intervention is beneficial for chronically ill patients and can likely improve QoL, SE, and depressive symptoms. It was difficult to determine how long the HWC effects persisted and whether booster sessions were needed because reviewed studies generally did not have adequate follow-up measures after HWC sessions stopped. Successful coaching programs attended to aspects of the Theory of Patient Capacity (TPC). Typically, three TPC constructs were addressed in HWC studies that reported beneficial findings – more on TPC below. CONCLUDING CONSIDERATIONS: The authors cited many limitations in the literature they reviewed. They called for stronger study designs, standardization of outcome measures, and longer follow-up periods. OUR COMMENTARY: Given the design of this review and meta-analysis, it is difficult to say anything about the sustainability of HWC intervention. This study specifically used papers that measured QoL, SE, depression, and anxiety but did not seek to find papers that emphasized long-term follow-up outcome measures. If you are interested in the potential long-term effects of coaching, then check out a study that was designed to address this question (Ahmann 2023). We recently reviewed Ahmann et al. 2 in this column and concluded there are sustained beneficial effects of HWC beyond the coaching period. An interesting concept discussed by authors of this study involved framing HWC treatments in terms of the TPC constructs (Biography, Resources, Environment, Work, and Social Functioning – BREWS). According to this theory, patients draw on these capacities they may possess to deal with the challenges of their treatment. It may be beneficial to plan HWC programs to address these capacities. The figure below provides a graphic of patient capacities. If you want to learn more about the TPC, then start with the reference cited below3. CONCLUSIONS: We now have further evidence of a beneficial effect of HWC on psychometric outcomes such as life quality and self-efficacy in a patient population. These are such important self-reported constructs. Consider, now, that we can be comfortable saying that participation in several months of coaching can positively impact the quality of one’s life – a strong statement even when taken in isolation from the other beneficial HWC effects reported here. The meta-analysis described here also verifies the effectiveness of HWC for addressing depressive symptoms, though, surprisingly, the papers analyzed did not support a similar impact on anxiety. A concept like the Theory of Patient Capacity might inform your coaching. Consider looking into it, especially if you work with patients with self-treatment limitations. REFERENCES Boehmer KR, Álvarez-Villalobos NA, Barakat S, de Leon-Gutierrez H, Ruiz-Hernandez FG, Elizondo-Omaña GG, Vaquera-Alfaro H, Ahn S, Spencer-Bonilla G, Gionfriddo MR, Millan-Alanis JM, Abdelrahim M, Prokop LJ, Murad MH, Wang Z. The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis. Patient Educ Couns. 2023 Sep 15;117:107975. doi: 10.1016/j.pec.2023.107975. Ahmann E, Saviet M, Conboy L, Smith K, Iachini B, DeMartin R. Health and Wellness Coaching and Sustained Gains: A Rapid Systematic Review. American Journal of Lifestyle Medicine. 2023;0(0). Boehmer, K.R., Gionfriddo, M.R., Rodriguez-Gutierrez, R. et al. Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis. BMC Fam Pract 17, 127 (2016). https://doi.org/10.1186/s12875-016-0525-9

On November 2, the US Centers for Medicare and Medicaid Services (CMS) announced that Health & Well-being Coaching (HWC) Services will be added to the Medicare Telehealth List in 2024 in a temporary phase to study outcomes. Let's share an abundance of gratitude for everyone's amazing contributions. First, the pioneering souls who co-founded the national standards as early board members of what became the National Board for Health & Wellness Coaching: Richard Cotton, ACSM - enabled the HWC job task analysis Cindy Schultz - the first NBHWC Chair, led the project for CDC DPP group coaching standards Karen Lawson, MD - secured funding for the 2010 retreat, which enabled NBHWC formation Linda Bark PhD, RN, MCC, NC-BC, NBC-HWC - first integrative health coach, brought nurse coaches together with NBHWC Leigh-Ann Webster, NBC-HWC - built operational and marketing foundation Meg Jordan, PhD, RN, NBC-HWC - developed coaching skills standards Ruth Q. Wolever, PhD - first HWC researcher, led a systematic review that defined HWC Michael Arloski, PhD - first wellness coach, coaching standards leader Tim Cline, PhD - built a group coaching curriculum for the CDC DPP program and NBHWC Francis "Frank" Ardito, EdD - developed the NBHWC program approval system Linda Smith, PA - coaching standards leader Pamela Peeke, MD – steering board and advocacy Margaret Moore, MBA – co-leader of national standards, certification development, NBHWC formation Second, NBME leaders who believed in our co-founders' passion: David Eisenberg, MD, introduced NBME to co-founders Donald Melnick, MD, NBME past President Peter Katsufrakis, MD, NBME CEO Agata Butler - enabled HWC certification examination Craig Mills - negotiating lead of NBME/NBHWC agreement Jack Hinke - helped NBHWC establish a viable financial path Lisa Rawding - helped NBHWC establish a viable strategic path Third - Dr. Kavitha Reddy, Veteran’s Health Administration, who led the 2019 approval of CPT codes for health and well-being coaching services with our help at NBHWC. Fourth, our team who met with CMS twice in 2019 to discuss HWC services in Medicare: Brian Carey, JD, Foley Hoag Ross Margulies, JD, Foley Hoag Linda Lysoby, NCHEC Francis "Frank" Ardito, NBHWC Thomas Rebbecchi, M.D., NBME Ben Crocker, MD, MGH George Guthrie, MD, ACLM Fifth, our team that prepared and advocated for the HWC codes at the AMA CPT Panel in May 2023 and the CMS decision in November 2023: Kavitha Reddy, MD, VHA Moain Abu Dabrh, MBBCh, MS, NBC-HWC, Mayo Clinic Janet Clark, MD, VHA Melissa Opp, NCHEC Beth Frates, MD FACLM DipABLM, ACLM Michael Parkinson, MD, MPH, FACPM, ACPM Angela Fitch MD, FACP, FOMA, Dipl. ABOM, OMA Jacob Mirsky, MD, MA, DipABLM, MGH Monte Ward, ACSM Karen Avino EdD, RN, AHN-BC, HWNC-BC, SGAHN, AHNCC Leigh-Ann Webster, NBC-HWC, NBHWC Jessica Matthews, DBH, MS, NBC-HWC, DipACLM, FACLM, UCSD database Gene Kallenberg, MD, UCSD Scott Morcott, MD, NBHWC Jennifer Lundman, LCSW, NBHWC Steven Stranne, MD, JD, Foley Hoag John McInnes, MD, JD, Consultant Katy Goodell, Outreach and utilization data management Gary Sforzo, PhD, Evidence review Bettina Beech, Dr.P.H., CPT submission Jocelyn Weiss, PhD, Evidence review Margaret Moore, MBA, Team Lead What a transformational accomplishment, a milestone we will long celebrate. After 14 intense years (starting in late 2009) and 10,000 volunteer hours, I resigned from my NBHWC board and policy leadership roles in October 2023. In our next phase, I am focused on fully supporting the Wellcoaches community on our collaborative journey together. Onward & upward! Here’s to our next big milestone. Coach Meg

the decline of moments of being well While looking for an image to express the concept of well-being, I came across this photo of Japanese snow monkeys relaxing in a hot spring on a winter's day. I don't know about you, but it makes me pause, exhale, feel the warmth, and appreciate the good. In case it doesn't do that for you, consider it a warm invitation to find something that does. In pandemic time, most of us need more human warmth, more long exhalations, and more appreciation of what is good. Moments of being well, of well-being, are elusive today. A 2021 survey using a respected measure of flourishing shows that around 60% of non-boomer adults (under age 58) are NOT flourishing. The level of burnout, a terrible crisis of ill-being - mental, emotional, physical, and spiritual depletion - is at an all-time high in healthcare and other industries devastated by the pandemic. Many things that had nourished our well-being, or kept ill-being at bay, keep appearing and disappearing, like unreliable magic tricks. We are not yet skilled hunters and gatherers of the moments of well-being that make up a life well-lived, particularly for young people. well-being models As you would guess, the concept of well-being, like many human endeavors, is complicated and multi-faceted. Along with the flourishing model, we have an abundance of science-based well-being models to choose from - positive psychology, PERMA, positivity, Gallup, Self-Determination Theory, Maslow's model of Self-Actualization, CDC, and lifestyle medicine - to name some respected models. Focused since 2000 on understanding and fostering wellness and well-being through coaching, our Wellcoaches contributions include: designing coaching as a science-based well-being intervention in its own right, even when coaching isn't explicitly focused on health and well-being goals organizing and integrating well-being elements into our natural multiplicity - the mind has multiple parts, each with its own well-being formula Models of work well-being have arrived (Gallup, job crafting, research handbook, for example), along with our enlightened discovery that individual well-being, leading well, and organizational well-being are profoundly interdependent. Work is a vital source of well-being. Well-being enables great work. None too soon, well-being has become a leadership priority, not just a line item in the HR budget. well-being vs wellness With all of the scientific attention, the cool factor of well-being has overtaken the fading construct of wellness, which now seems out of fashion. While the APA defines wellness as a dynamic state of well-being, others have relegated wellness to the corner of physical health, despite an abundance of well-constructed, whole-person wheels of wellness that convey the deep interconnections of mind, body, life, and work wellness or well-being. In 2019, when our NBHWC and VA team worked with the American Medical Association (AMA) to establish healthcare billing codes for coaching services, the AMA decided on "health and well-being" rather than health and wellness. Thank goodness - at last there is a healthcare profession focused on well-being, something most agree is good for physical health, even if wellness got demoted in the process. suffer well Another thing most everyone agrees on is that we need to get better at navigating our negative emotions and experiences. In particular, we need to suffer well by turning the near-universal pandemic trauma of a severely disrupted present and future into post-traumatic growth - more appreciation, meaning, strength, possibilities, creative acts, and richer relationships. Not just bouncing back with resilience, but fully experiencing the losses and fears so they carry us forward to a better place, better able to thrive during the next tough times. a life well lived - together Whether we are enjoying moments of well-being, or experiencing and turning difficult moments into good - strength, growth, and new opportunities, we are living work and life well. Reaching out to help others, helps us feel better. Asking others for help, looking to people who are thriving or flourishing, does them a favor. They feel even better (social well-being!). We are in a well-being reboot. We are in this together. Coach Meg www.coachmeg.com More resources: Everyday Health: Mental Health Stigma Wellcoaches: A New Duet

Featuring Dr. Sonal Ullman A Beautiful Story of Coaching and Collaboration Wellcoaches & Beth Israel Deaconess Hospital In 2018, I led a grand rounds session on coaching skills for physicians at Beth Israel Deaconess Needham Hospital. Among the participants was GI physician leader Sonal Ullman, who now leads the hospital’s physician group. That auspicious session spawned a close collaboration of Wellcoaches and the hospital’s administrative, physician, and nurse leaders, giving life to a variety of initiatives: since 2019, an ongoing senior leadership/coaching program for around 50 leaders, including an annual retreat 2020-2021 - an intense burnout group coaching program at the height of the pandemic of 15+ early morning group sessions 2020-2021 - private burnout coaching of 30+ physicians by nine Wellcoaches coaches Along with four other hospital leaders, Dr. Ullman went on to complete the Wellcoaches certification and become a physician coach In early 2022, one of Dr. Ullman’s patients, Dana Martin, died of gastric cancer. In deep gratitude for her services, Dana donated $100,000 to the hospital for a project of Dr. Ullman’s direction. Her story of working with Dana is a beautiful one of deep service and impact. She published the story in a Stanford Medicine newsletter. Dr. Ullman used the donation for an internal professional coaching program to support hospital employees, named the Martin Family Coaching Program (more details at the end of the blog). Both Coach Meg and Erika Jackson are supporting the Beth Israel team of physician and nurse coaches. What happens when coaches and physicians come together? More well-being in healthcare. Onward and upward, Coach Meg MARTIN FAMILY COACHING PROGRAM DESCRIPTION A new workforce development program for staff and providers at BID Needham Collaborate, Cultivate, Partner, Foster Possibilities, Co-Discover, Broaden Thinking The Martin Family Coaching Program is a philanthropically-funded program and part of BID Needham's commitment to workforce development—one of the hospital's top strategic initiatives for 2022—with the goal to maximize your professional potential. This structured staff and physician coaching program provides you the opportunity to meet one-on-one with a professionally trained coach who is also a BID Needham employee or physician for up to six hours over the course of six months. A well-being coach is a trained facilitator of positive habits, change and growth who partners with you in a thought-provoking and creative process. This program is open to all staff—both clinical and non-clinical—and to physicians. Benefits of the coaching program · Increase self-awareness, insight and creativity as you set goals for your career development · Tap into your strengths and experiences to help address challenges · Become an expert in your wellness and personal path · Collaborate with a coach who understands your work environment · Increase quality of life at work through better use of internal and external resources Could a well-being coach help you? A coach will be your partner in professional development, helping you set goals and maximize your opportunities for growth. In addition, a coach can help you learn from difficult situations, as well as develop and practice tools to address workplace challenges. What you will gain Resilience, Engagement, Clarity, Meaning, Future, Connection, Strengths, Strategies, Vision, Confidence, Gratitude, Leadership, Flow, Purpose, Learning, Meaning, Fulfillment Connect with a coach today! If you would like to learn more about how you might benefit from the Martin Family Coaching Program, email BIDN-coaching@bidneedham.org.

“To experience peace does not mean that your life is always blissful. It means that you are capable of tapping into a blissful state of mind amidst the normal chaos of a hectic life.” ―Jill Bolte Taylor Note: This was previously published as an IOC Research Dose Introduction In today’s turbulent world, dealing with constant and ever-changing stressors is the norm. Although these are typically not large-scale stressors like death of a spouse or child, or a major trauma, chronic stressors cumulatively over time harm physical and mental health and well-being. Ongoing stress impairs the immune system, cognitive functioning, engagement at work, and makes us more prone to burnout. It has been difficult to study the cumulative effects of everyday stressors and how to prevent them without a tool for measuring them. The new Personal Sustainability Index (PSI) described and validated in a 2021 article by Boyatzis et al in Consulting Psychology Journal: Practice and Research titled “Thrive and Survive: Assessing Personal Sustainability” can provide that measurement. The authors note: “there are four types of experiences that activate and exaggerate stress: (a) the degree to which an activity is important to a person; (b) the degree of uncertainty the person is experiencing; (c) the degree to which others are watching or evaluating; and (d) the anticipation of any of these experiences.” The PSI tracks not only the frequency and variety of everyday stress events but also “renewal” events, such as walking in nature, playing with a child, or meditating, that help to counteract stress events. The article’s authors explain that reducing stress only helps us to survive, while increasing renewal instead helps us to thrive, and that the PSI is a critical tool for helping us get there. The Stress Response Boyatzis et al provide practical definitions of both stress and renewal. Stress activates the sympathetic nervous system (SNS), while renewal activates the parasympathetic nervous system (PNS). The SNS is a network of nerves important in the “fight-or-flight” response and is more active when a person is stressed or in danger. The body secretes adrenaline in response to danger, which increases heart rate, breathing capacity and the availability of energy stores. If the threat continues, the body releases cortisol, the primary stress hormone, to increase sugars in the bloodstream and keep the body primed for action. The PNS, associated with hormones like oxytocin and vasopressin, is the brake that shuts down the stress response. The fight-or-flight response was very effective at helping early humans evade predators. Once the sudden threat passed, the PNS shut the stress response down. However, in today’s hectic world, where low-level stress awaits at every busy corner or failed internet connection, the stress response remains switched on, with serious consequences for physical and mental health. For example, such chronic stress can increase the likelihood of heart disease, heart attack and stroke, cause sleep problems or weight gain and lead to anxiety and depression. Because we are so accustomed to these low-level stressors, such chronic stress can fly under the radar. Boyatzis et al describe the problem: “Adapting to life can enable us to adjust to dangerous or dysfunctional levels of stress. The ordinariness of many episodes may deceive us into tolerating stress and not acknowledging or even noticing the strain from the cumulative impact.” The Importance of Renewal The authors summarize the current theories on the need for a balance of stress events and renewal events: “…the degree of renewal (parasympathetic nervous system) needed is determined by the degree of stress (sympathetic nervous system) activated in the person during the recent past. The renewal experiences, if sufficient in arousal, can help to return the body to its prestress levels. The result is that the person has resources and energy in relationships, work, and life to feel more engaged, excited, and satisfied.” Many of the previous measures of stress have heavily weighted major life events like death of a loved one (e.g., Social Adjustment Rating Scale) or focused on posttraumatic stress (e.g., Impact of Events Scale). Other scales were meant to measure recovery from stress, such as unwinding after work (Recovery Experience Questionnaire), or coping with it, as for example by venting of emotions or seeking emotional support (Multidimensional Coping Inventory). Unlike these scales, the PSI focuses on the cumulative impact of everyday stressors and measures the events that not just reduce stress but that activate the PNS to shut it down. It inventories 16 renewal and 17 stressful everyday events, which were gleaned from the psychological and medical literature on chronic stress. In the words of Boyatzis et al, “Renewal is not assessed as low stress but as actual experiences that invoke the PNS.” By measuring not just everyday stressors but also renewal events, the PSI provides an important tool for better understanding and managing chronic stress. What the researchers found Using structural equation modeling to analyze the survey results, investigators found that depressed or anxious people may be less likely to engage in a variety of renewal activities. Subjective well-being, work engagement and career satisfaction were all significant positive consequences. Variety was a stronger determinant of these relationships than frequency, though frequency often but not always moderated variety’s effects. Boyatzis et al summarize the findings as follows: “To use the analogy of dosage from the pharmaceutical industry, a person would feel and function better if they had more episodes of renewal each week than stress, as well as a greater variety of types of renewal experiences each week.” Conclusion The PSI is an innovative tool for measuring everyday stress and renewal events. It helps us appreciate how low-grade stressors contribute to chronic stress and how renewal events can build resources and resilience. The PSI can be an informative tool for measuring how well a client is managing stress. It could also support the optimizing of stress management and improving the coaching experience. Takeaways for Coaches Using the PSI directly or being inspired by its principles, coaches can: Develop a list of renewal events (e.g., coaching, volunteering, showing compassion, exercise, nature, yoga, breathing, reflection, meditation, prayer, play, laughter, enjoyable meal) building on those inventoried in the PSI. Brainstorm on renewal activities with clients to counter their stress. Suggest that clients do a renewal activity just before or at the beginning of a coaching session to help them engage more in the growth process. Incorporate renewal activities into the coaching session to help clients integrate the skills learned. Encourage clients to track and manage their everyday stress and renewal activities. Help clients understand the importance of renewal activities not only for themselves but also for others at their organization. Citation: Boyatzis, R. E., Goleman, D., Dhar, U., & Osiri, J. K. (2021). Thrive and survive: Assessing personal sustainability. Consulting Psychology Journal: Practice and Research, 73(1), 27.

In July 2023, Medicare shared their laudable mission informing proposed changes for 2024: “If finalized, the proposals in this rule ensure the people we serve experience coordinated care focused on treating the whole person, considering each person’s unique story and individualized needs — physical health, behavioral health, oral health, social determinants of health, and are inclusive of caregivers, which are all so important to providing the care that people with Medicare deserve.” What Moves is Medicare proposing? 1. Coding and payment for social determinants of health risk assessments. 2. Separate coding and payment for community health integration services (supporting SDOH), including person-centered planning, health system coordination, promoting patient self-advocacy, and facilitating access to community-based resources to address unmet social needs. 3. Improve access to behavioral health in Medicare by allowing marriage and family therapists and mental health counselors, including addiction counselors, to enroll in Medicare and bill for their services for the first time. Increase payment for crisis care, substance use disorder treatment, and psychotherapy. 4. Payment for Principal Illness Navigation services to help patients navigate cancer treatment and treatment for other serious illnesses. These services are also designed to include care involving other peer support specialists, such as peer recovery coaches for individuals with substance use disorder. 5. Pay for certain caregiver training services in specified circumstances, so that practitioners are appropriately paid for engaging with caregivers to support people in carrying out their treatment plans. 6. Relevant to coaches – add health and well-being coaching services using the Category III coaching CPT codes, to the Medicare Telehealth Services List on a temporary basis for CY 2024. While temporary, Medicare’s proposal to open the door to 2024 payment for health and well-being coaching services is a pivotal and promising move for our field, particularly in the context of better addressing health equity and SDOH. It’s time, time for more and more people to grow and thrive with our help as the best health and well-being coaches! The Excited Wellcoaches Team

Last month the American Journal of Lifestyle Medicine published an article entitled “Health and Wellness Coaching and Sustained Gains: A Systematic Review" (Ahmann et al., 2023). Three of the six authors of this paper were Wellcoaches trained! The study’s purpose was to determine what is known about long-lasting effects for coaching clients after completing a health and wellness coaching program. To make this determination, the authors reviewed 231 HWC data-based research studies housed in the Compendium of Health and Wellness Coaching (Sforzo et al., 2020). They ultimately selected 28 articles of sufficient quality to examine the sustainability of a coaching effect post-intervention. Physiological, psychological, behavioral, and health risk outcomes were measured in these studies. It was essential that clients received NO additional coaching before the follow-up measurements, which usually occurred 3-12 months after the initial coaching period. The authors rated the results of each of the 28 retained studies as gains not sustained, gains partially sustained, gains fully sustained, or gains improved at follow-up compared to post-intervention. The average length of coaching intervention for the 28 studies was 6.4 months with about 8 coaching sessions over this time. The time for follow-up measures averaged nearly seven months after the completion of the coaching intervention. So, in essence, the question being addressed in this paper was, are beneficial coaching changes still evident more than six months after the cessation of a six-month coaching program. The authors found that coaching effects were sustained in 25 of the 28 studies examined (nearly 90%). This finding is supported by a large JAMA-published cluster RCT that found blood pressure changes after coaching were sustainable for up to four years (Nguyen-Huynh et al., 2020)! Sustainability of treatment benefits is a robust achievement for health and wellness coaching. Consider that, short of surgery, the effects of most other health interventions are not maintained long after halting treatment. For example, medications must be taken regularly, or the effect quickly fades away – cholesterol will go up if the patient stops taking daily doses of a statin. Take rehab programs (e.g., cardiac rehab or PT for orthopedic reasons) that typically last 2-4 months. After these programs, patients will show a loss of gains made after 2-4 weeks of detraining, with all benefits likely lost within 3-6 months if treatment is fully halted. And we are all acutely aware of what happens when a client falls off a successful diet plan and returns to old eating habits – they will certainly regain most, if not all, of whatever weight was lost. Long-lasting Effects of Coaching – I’ll have mine in BRICK, please! The present study demonstrated that a coaching program, supporting and encouraging behavior change, can have long-lasting benefits. In fact, in nine studies examined outcomes of interest (e.g., physiological and psychological) actually improved months after ceasing the coaching process. This likely indicates that healthy behaviors habits, newly formed during the coaching process, yielded enhanced benefits months after the last coaching session. Health and well-being coaching appears to be a unique form of health intervention that keeps on giving well after the process stops. In the 3 studies where outcomes were not sustained, it was likely to be physiological outcomes (e.g., BMI, A1C, or BP) that reverted to baseline. Improved psychological (e.g., stress or anxiety) or behavioral outcomes (e.g., exercise or eating habits) were more stable than physiological outcomes, typically being maintained for months of follow-up after coaching ended. These physiological parameters matter greatly in healthcare, and we do not want our clients to revert to baseline on these outcomes. Practically applied, this finding might lead coaches to discuss with their client how to best follow-up after completing the initial coaching intervention. As with all coaching, this would be a client-centered discussion and would consider that maintaining beneficial physiological changes might take careful attention and may require a maintenance strategy. That strategy might include using new resources or on occasional coaching booster at a lesser frequency than initially prescribed. As part of their coaching competencies, the National Board of Health and Wellness Coaches clearly and formally encourages coaches to assist clients in finding a sustainable pathway forward. The authors of this rapid systematic review strongly conclude that they provide “…evidence for the efficacy of sustaining gains beyond the active coaching period.” They continue, “…the unique value and important contribution HWC can make for varied health conditions….” It is hard not to agree with their conclusions! A well-delivered program of health and wellness coaching not only helps a client during the process but also for a substantial period after the intervention is stopped. With careful attention to follow-up management, our patients and clients can expect gains made during a coaching program to stick with them for an indefinite length of time. Not too many health or medical interventions can make that claim. Viva health and well-being coaching …. and the clients who benefit! References Ahmann E, Saviet M, Conboy L, Smith K, Iachini B, DeMartin R. Health and Wellness Coaching and Sustained Gains: A Rapid Systematic Review. American Journal of Lifestyle Medicine. 2023;0(0). Sforzo GA, Kaye MP, Harenberg S, et al. Compendium of Health and Wellness Coaching: 2019 Addendum. American Journal of Lifestyle Medicine. 2020;14(2):155-168. doi:10.1177/1559827619850489 Nguyen-Huynh MN, Young JD, Ovbiagele B, Alexander JG, Alexeeff S, Lee C, Blick N, Caan BJ, Go AS, Sidney S. Effect of Lifestyle Coaching or Enhanced Pharmacotherapy on Blood Pressure Control Among Black Adults With Persistent Uncontrolled Hypertension: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2022 May 2;5(5):e2212397. doi: 10.1001/jamanetworkopen.2022.12397

Introduction Given the high population prevalence of mental health issues, more and more coaching professionals are being called to support people who want to improve psychological well-being and are encountering a shortage of mental health professionals. This article briefly chronicles the 25-year history of the distinctions, overlap, and collaboration of mental/behavioral health professionals and coaching professionals, enabling an evolving collaboration, a beautiful duet going forward. Phase 1: Distinctions in scope of practice Over the past 25 years, clear distinctions between the scope of practice of mental/behavioral health professionals and coaching professionals have formed the basis of their work with different, although overlapping, populations. In the US, mental/behavioral health professionals invest in years of education, including Master's and PhD degrees, followed by rigorous state licensing and insurance credentialing requirements, in order to be skilled and qualified in helping people restore or improve their mental health. They routinely roll up their sleeves to deal with tough challenges that impair daily functioning, including past trauma, depression, anxiety, addictions, grief, and relational disturbances. Behavioral health professionals work with addiction, substance abuse, eating and mood disorders etc. This work is intense. It can be fraught with risk, especially when people are harming themselves or at risk of harming themselves, or their situations are straining their significant relationships. This sacred work, hidden from view, helps people heal and stabilize their mental and emotional health. It is a calling that is not for the faint of heart. On the other hand, coaching professionals in leadership, business, and health and well-being are trained to work with people who have stable mental health and want to improve themselves, their work, and their lives. Coaching helps people expand their internal and external resources to self-actualize and reach their greatest potential. Coaches are not trained nor qualified to help people better manage and overcome trauma, depression, anxiety, addiction, or loss/grief. They refer out to mental health professionals when they encounter such mental health challenges. Occasionally a client works with both a mental health professional on their mental health issues as well as a coach on their path forward to positive growth in parallel. Phase 2: Overlaps in interventions This simple distinction - mental health professionals working with people suffering with mental health challenges, and coaches working with people to realize their full potential, began to get blurry over the past decade or more. Both professions began to get training in interventions that can be applied in both contexts. For example, cognitive behavioral therapy was repurposed as cognitive behavioral coaching; similarly, solution-focused therapy as solution-focused coaching. The immunity to change model was developed for coaches, and is based on a cognitive behavioral framework. Acceptance and commitment practices are used in therapy and coaching, as are motivational interviewing, readiness to change, mindfulness, and self-compassion practices. Internal family systems practices are now taught to coaches who have embraced working with the multiplicity of mind. Going the other way, positive psychology interventions are now used by mental health professionals. Psychologists are trained in behavioral strategies and interventions now also used by coaches to support lifestyle change as a treatment for chronic psychological disorders. All in all, the new and emerging interventions have enriched the work and increased the flexibility of therapists and coaches. There is indeed a symbiotic relationship here. While coaches and therapists still work with distinct populations – the overlap is becoming more fluid and common. Phase 3: New Collaboration Emerging developments are launching a third phase of opportunities – a collaboration phase: The epidemic of mental health conditions in recent years has led to a serious shortage of mental health professionals. Coaching interventions are showing promise in improving psychological well-being, including autonomous motivation, efficacy, and forward growth, including those with burnout and recent suicide ideation. The evidence for lifestyle medicine (exercise, plant-forward nutrition, emotional resilience, healthy sleep, and social connections) to address the harm to the mental health of metabolic issues, has opened the door for coaches in health and well-being to work with this population. Addressing all of the recent trends, large health insurance companies Cigna and United Healthcare have begun to support “behavioral health” coaches and coaching for employees with mental health conditions. What then is important to the flourishing of this new collaboration? First and foremost, the responsibility for clinical evaluation, diagnosis, creating, and implementing treatment plans for mental health conditions rests with mental health/behavioral health professionals. Ideally, a client or patient who is willing, ready, and able to engage in lifestyle medicine is offered the option of a coaching program by mental health professionals or physicians, which would then be supervised by the referring professional. Having basic training in mental health literacy, coaches are able to collaborate effectively with mental health professionals. That said, coaches focus on the coaching process that moves people toward positive well-being goals, not focused directly on the mental health diagnosis and treatment plan. Supervising mental health professionals would lead regular check-ins to monitor and support progress and other resources that might be needed. Similarly, mental health professionals are beginning to get trained in coaching methodologies and some are offering a hybrid model that involves the resolution of past traumas and the movement towards goals and aspirations going forward. The opportunity for lifestyle medicine coaching to improve mental health is a new frontier. In a time of great population need, shortage of mental health professionals, and evidence for lifestyle medicine in improving mental health, a new collaboration of mental health and coaching professionals will help more people than ever to both restore mental health and move onto a path toward well-being. Margaret Moore, MBA, NBC-HWC Simon Matthews, MHlthSc, NBC-HWC Randy Kamen, EdD, Licensed Psychologist

As coaches and exercise professionals, you are in the unique position to accompany our clients through the ups and downs of their lives. What a gift it is to be with them in the moments of success– that first 5k, a successful week of workouts, the discovery of a new physical activity. It’s fun to be included in the celebration and to cheer them on. But lasting relationships include the whole of a person’s experiences – the losses, challenges, fears, and anxieties. To truly support our clients in achieving their goals (big and small), we need to have the skills to be present to a range of feelings. It’s easy to smile along with clients when they are happy; we are well-versed in affirmative statements and high-fives. The not-so-happy feelings, however, can feel intimidating – even scary. We can be tempted to avoid (change the subject), change the channel (try to talk them into feeling better), or hyper-focus (fix it/them). Here are some strategies that will prepare you for creating a connecting space with your clients without letting those “negative” feelings swallow you both whole. 1. Don’t mix up your story with theirs. When someone is suffering, it’s human nature to be reminded of the similar ways we’ve experienced the same feelings. We might recall when we went through the same circumstances. Take a breath and shift your focus to their story and their circumstances. Your story isn’t the antidote to their pain. 2. Make a guess. Most people don’t want or need to, be “rescued” from their feelings, they want to be heard. Sometimes, all it takes for the intensity of a feeling to be reduced if for it to be named. Take a guess about what your client is feeling and ask them about it. “Are you feeling disappointed?” or “It sounds like you are feeling anxious” gives them an invitation to say what they are experiencing. Most importantly, don’t rush past this. Discomfort is okay and part of working with humans. 3. Ask what they need. Your client knows best about what is helpful, and unhelpful, to them. Allow time in the conversation to explore strategies. Resist the temptation to take over and be the hero. Your client has ideas and experiences to draw from; encourage their ideas and their capability to find a resolution if there is one. 4. Let it go out the door. As a caring professional this can be the most difficult step – letting go of the need to take responsibility or fix it. When your time with your client is over, allow yourself to release any of your own intense emotions. Step away, take a breath, find whatever you need to reconnect with your work, and be fully present for your next client. Steps 2 and 3 above can be useful for you too!

Let me start this piece with a confession. I am addicted to watching Penn and Teller. There. I said it. If you haven’t seen one of their TV shows or their live shows (I’ve seen both), you’re seriously missing out on one of the greatest experiences of wonderment of the modern age. Their magic is incomparable and having been a performing duo for nearly 50 years, they have a capacity to entertain and amaze like no other. Entertainment and witty banter aside, the thing I love most is their capacity to completely fool me. I simply do not know how they do what they do. I watch. I watch again. I replay in slo-mo. I see nothing. And nothing gives me greater joy than not knowing. It’s that experience of not knowing that I really relish. If I knew how all their tricks were done, I think it would be a little tedious to watch quite frankly. Not knowing has an enchanting quality to it. It’s the place from which questions can be asked. It’s the place from which discoveries can be made. It’s the place from which new ideas can be considered, without having to commit to any of them. It’s the place from which anything might be, because nothing is yet known. Not knowing is also the position from which I’ve endeavoured to carry out my professional work as both a psychologist and coach for 30 years. This means I must ask; and I must be prepared to hear anything in response. Furthermore, I’ve learnt that the best questions to ask are those that are difficult to answer – those questions which first elicit a response of: “I don’t know – I’ve never thought about that…” In the practice of coaching, inquiry and questions are one of the basic ingredients we use – a little like flour to a baker, if you will. Powerful questions can ignite self-reflection, insight, awe, motivation, realization, and a host of other responses. But how do you get to the point of being able to ask questions that can do this? In the 1990s I was fortunate to study with and be taught and supervised by some very talented family therapists. That experience really has been a great foundation for my career since then. I’ve never let go of the power of questions to ignite imagination. Recently, I took one of the ideas I was exposed to in the 90s and re-imagined it. The result is an article just published in the American Journal of Lifestyle Medicine, entitled (it’s a mouthful!): The Question Cube Re-imagined – A 5-Dimensional Model for Cultivating Coaches’ Capacity for Curious Inquiry in Health Behaviour Change. I describe there a model for understanding and deconstructing the elements of a question. A common understanding of questions in coaching (and therapy!) really revolves around just one dimension – how open the question is; and even this dimension is often oversimplified into “open” and “closed” questions. In fact, the openness of a question really moves on a continuum from where a question may elicit a lengthy narrative response (open) all the way through to a single word response (closed - for example, yes or no). In the space between, there are wonderfully useful question formats such as rating or scaling questions (On a scale from zero to 10, how excited are you?) or ranking questions (Which of these appeals to you most? Which next?) and even forced choice questions (Which of those two emotions do you feel most strongly at the moment - anger or relief?). The next dimension relates to the focus of the question. We all likely have an intuitive appreciation of this dimension, but don’t necessarily realise the powerful way in which we can use it to shape the meaning and intent of a question. Questions may focus on what someone is doing (action), what they're feeling (emotion), as well as the quality of a particular relationship that they have, beliefs that they hold and meaning that they ascribe to their own actions, or the actions of others. For example, there are a number of ways in which I could inquire about a single event - a friend giving you a gift. I could ask: What was the gift? What feelings did you experience when you opened it? How important is this person in your life? What does the giving of this particular gift signify to you? What does this action say about your friendship? The third face of the question cube relates to the subject of the question. I could ask you a question about your own beliefs and values. I could also ask you about your perspective on another person’s beliefs or values and I could even ask you what views you imagine that other person might have about you. It's that last perspective that I find particularly useful because it invites the client to step out of their own frame of reference and consider a different perspective. It's much like crossing the road to look at your own front garden. When you sit inside your house, you can see your front garden, but you only have your own perspective of it. If you cross the road, you now get to see your front garden as people on that side of the road get to see it. If you've ever tried this in real life (go on - give it a go now) you will almost certainly notice different things in your front garden that were previously obscured from the view you have within your own house. The fourth dimension is fun - it's the dimension of time. Again, we probably know and use this intuitively, however it's really valuable to recognise that we can frame questions focused on the present, the past and the future. The usefulness of this is immediately obvious - it gives our clients (and us) a means of observing changes across time. If you ask me what I believe my best quality is, and you also ask me what I considered my best quality was two years ago, I'm now invited to engage in self-reflection on what those differences might be, and more importantly - what they might mean. The final dimension is that of reality and possibility. The things we do, the things we have, the people we are, are all real. They might be in the past, present or future. For example, I was born in Australia; I love watching Penn and Teller; I will be warmer later today when I light the fire. But we also inhabit a world of possibility - a world in which we are free to imagine actions we might take and parts of ourselves that have not yet been called into being. For me, this is one of the most exciting parts of coaching: to be able to explore all the possibilities that conceptually exist; all the things that might be. And of course we can frame questions focused not only on “What is?” but also “What might be?”. So the re-imagined Question Cube allows us to understand questions as ranging from “fully open” to “fully closed” as well as consider to whom the question is addressed, about whom, the subject matter, the timeframe and whether or not the question explores something that is or something that might be. As with anything in life, once you’ve deconstructed something and really understand how it works, you can reconstruct it in almost any way you like. I’ve written this in the hope that it might inspire you to engage in powerful inquiry; and if you are a teacher of coaching, counselling or therapy skills, my hope is that you’ll find this framework a straightforward and powerful means of teaching the compelling impact of well-crafted questions. Questions are like keys to rooms you’ve never been in. If you approach with an open mind, a recognition that you don’t know what’s behind, you may just open the door to one of the most extraordinary adventures you could have. What might be the best question you could ever ask? Matthews, S. M. (2023). The Question Cube Re-imagined–A 5-Dimensional Model for Cultivating Coaches’ Capacity for Curious Inquiry in Health Behaviour Change. American Journal of Lifestyle Medicine, 15598276231172910.