Is Health Coaching Effective?

Abstract:
Because health coaching is so new, outcomes of its use and implementation are somewhat limited, especially its impact on cost. However, a brief review of the literature shared here reveals findings that we hope you’ll find useful in your work, as many of you have requested to know what types of results others are obtaining in health coaching and in what populations. If you are aware of other organizations or individuals who have achieved various outcomes in health coaching/motivational interviewing, please these send our way with your references, and we’ll send this information out to everyone on our email list! Thanks!

Evidence-based practice is highly encouraged in healthcare, and it’s no different in health coaching! It is the author’s opinion that motivational interviewing (MI), the primary evidence-based foundation for the NSHC’s health coaching education and certification program, has been the single most influential method to date of addressing the patient’s agenda and self- motivation for behavior change. Why?

Dr. William Miller began describing its use in the early1980s as a clinical intervention for those patients in whom problem drinking was particularly difficult to abate. He found that MI was as effective as other methods to assist these patients, but achieved results more quickly. Because of this success, MI began to be used in the early 1990s to help those with chronic conditions change their behavior, in which one finding the motivation to change is also problematic. Dr. Miller has conducted numerous studies on the subject of MI. While health coaching takes on many forms today, clearly the work of Dr. Miller and his colleagues was the catalyst for the fresh, new approach: evidence-based health coaching that the National Society of Health Coaches (www.nshcoa.com) promotes today.

Dr. S. Butterworth et al. of Oregon Health and Science University studied the response of 276 self-selected medical center employees in a 3-month study¹ using MI-based health coaching. The intervention included a minimum of one initial session and two follow-up contacts. The Short Form 12 Health Survey was used to describe health status. The treatment group showed significant improvement in health status versus the control group.

Mayo Clinic 2005² health coaching outcomes revealed the following:

  • 64% increased exercise time
  • 42% tobacco users quit at 6 mo and 37% at 12 mo
  • 61% increased healthy eating choices

Dept of Cardiology, St. Vincent ’s Hosp, Melbourne, Australia³

  • At 6 mo, serum Total-C and LDL-C levels significantly lower
  • Being coached had an effect of equal magnitude to being prescribed lipid-lowering drug therapy.

HCIN 2010 Benchmarks Survey4

  • 34.4% decreased claims cost
  • 36% say ROI increased from 2 to >4:1; 64% said too early to tell about ROI

Ribak et al. performed a systematic review and meta-analysis that was published in the British Journal of Medical Practice in 2005 that found many positive outcomes in the use of motivational interviewing in the studies evaluated.

  • 95% confidence level for combined effect estimates for BMI, total blood cholesterol, systolic BP
  • Three of four studies revealed an equal effect on physiological and psychological diseases at 72 and 75% respectively.
  • In 64% of the studies, the use of motivational interviewing showed an effect even in brief 15-minute encounters.

References:

  1. Butterworth,S., Linden ,A., McClay,W., Leo, M.C., (2006). Effect of motivational interviewing-based health coaching on employees’ physical and mental health status. Journal of Occupational Health Psychology, 11(4), 358-365.
  2. Healthcare Intelligence Network. (2007). Coaching in the healthcare continuum: Models, methods, measurements and motivation. Manasquan , NJ : author.
  3. Vale, M.J., Jelinek,M.V., Best, J.D., & Santamaria, J.D. (2002, March). Coaching patient with coronary heart disease to achieve the target cholesterol: A method to bridge the gap between evidence-based medicine and the “real world”- randomized controlled trial. Journal of Clinical Epidemiology, 55(3), 245-52.
  4. Healthcare Intelligence Network. (2010). 2010 Health coaching benchmarks. Manasquan, NJ: author
  5. Rubak,S., Sandbæk,A., Torsten, L., & Christensen, B. (2005, April). Motivational interviewing: A systematic review and meta-analysis. British Journal of General Practice. Review Article, p305-312. Retrieved Sept 28, 2010, from http://www.motivationalinterview.org/library/RubakMIreview.pdf

©2010 NSHC All rights reserved.I

How to be Happier – a Guide to Mindful Meditation

I’ve been fascinated with meditation for years, the idea that by simply sitting one can experience insights and transformations is intriguing.  The fact that various meditation techniques are ubiquitous in spiritual disciplines across the continents and through time is telling of their importance for growth.  Yet for many modern
scientifically minded westerners the idea of engaging in a spiritual discipline evokes all kinds of psychological resistances. Many meditation schools make unverifiable claims or are instructed with a language embedded in a culture and a philosophy that does not lend itself for export in our modern world.  However, in the last few decades mindfulness meditation was distilled and exported into the West.  Mindfulness meditation contains no doctrine or ‘woo-woo’ attached to its practice and philosophy.  Mindfulness can be thought of as simply paying attention to the aspects of experience.  When we are mindful of our experience we  become conscious of our bodily sensations, our body movements, our perceptions (internally generated sights, smells, sounds, etc.), our emotions, and our thoughts (cognition).  In the practice of mindfulness we become an uninvolved observer of our experience, that is, we allow thoughts, feeling, and emotions, etc., to arise and fall without us examining, judging, or inspecting them.  Most mindfulness meditation practices have a central object of attention , such as the breathe which one orientates themselves towards, and as inevitable aspects of experience pull the attention away one simply and nonjudgmentally pull themselves back to the meditation object, in this case the breathe.
Here is a mindfulness meditation technique for beginners:
1. Find a quiet and comfortable place. Sit in a chair or on the floor with your head, neck and back straight but not stiff.
2. Try to put aside all thoughts of the past and the future and stay in the present.
3. Become aware of your breath, focusing on the sensation of air moving in and out of your body as you breathe. Feel your belly rise and fall, the air enter your nostrils and leave your mouth. Pay attention to the way each breath changes and is different.
4. Watch every thought come and go, whether it be a worry, fear, anxiety or hope. When thoughts come up in your mind, don’t ignore or suppress them but simply note them, remain calm and use your breathing as an anchor.
5. If you find yourself getting carried away in your thoughts, observe where your mind went off to, without judging, and simply return to your breathing.
Remember not to be hard on yourself if this happens.
6. As the time comes to a close, sit for a minute or two, becoming aware of where you are. Get up gradually.

Meditation is a discipline.  It requires training to become proficient at paying attention.  We live in a busy world, and most of the time we are easily distractible and our attention constantly switches and orientates all over the place. Meditation can be difficult to start and to maintain a routine. Yet the outcomes of meditation and experiences one may encounter are profound.  There are now hundreds, if not thousands of studies on meditation proving profound benefits to stress levels, the immune system, and the felt sense of peace and acceptance.  As well as thousands of years of anecdotal reports of various kinds of spiritual transcendence and growth.  Once again, many of the explanations and mechanisms of growth are embedded in religious philosophy that does not lend itself for understanding for the scientifically minded. However, through the work of Dr. Daniel Siegel, an eminent researcher in the areas of the developing brain, interpersonal neurobiology, and attachment we now have a language for which we can discuss possible mechanism of the growth associated with mindfulness meditation.
Before we can discuss the benefits of meditation on the mind we must first discuss the brain.  In particular I want to draw attention to an area of the brain known as the medial prefrontal cortex. In the words of Dr. Daniel Siegal:
“The prefrontal areas coordinate and balance input from the cortex, limbic, brainstem, and bodily regions as these are connected even to the input from other brains (that is, other people). In this way, the prefrontal cortex integrates social, somatic, brainstem, limbic, and cortical systems all into one functional whole.”
The prefrontal cortex is a pivotal area for everything involved in being human.  What the paragraph above says is that our brains have different regions of brain tissues specialised for processing our social experience, or felt presence in the body (somatic), and our emotions (limbic).  All the information processing in these areas is then sorted by the prefrontal cortex and integrated into our conscious experience. Thus the prefrontal cortex is a central hub for our sense of self and the felt experience of the here and now playing a role in our decision making and integration of various aspects of experience. Now, let’s further explore and prefrontal cortex and its 9 functions according to Daniel Siegel and then relate it to the benefits of mindfulness meditation.
The nine functions of the pre-frontal cortex, according to Daniel Siegel:
1. Body Regulation — Functions of the body such as heart rate, respiration and digestion that are controlled by the nervous system.
2. Attunement — When we attune to others we allow our own internal state to shift, to come to resonate with the inner world of another.
3. Emotional Balance — Even the healthiest person may be temporarily thrown off and feel out of balance but the middle pre-frontal region functions to bring us back to equilibrium. The ability to stay focused on the inside when the storms of life are raging on the outside.
4. Response Flexibility — This ability to pause before responding is an important part of emotional and social intelligence.
5. Empathy — The capacity to create mindsight images of other people’s minds. These you-maps enable us to sense the internal mental stance of another person, not just to attune to their state of mind.
6. Self-Knowing — Mental time travel in which we connect the past to the present and the anticipated future.
7. Fear Extinction — After experiencing a frightening event, we may come to feel fear in the face of a similar situation. But the middle prefrontal region has direct connections that pass down into the limbic area and make it possible to inhibit and modulate the firing of the fear-create amygdala.
8. Intuition — Can be seen as how the pre-frontal cortex gives us access to the wisdom of the body. This region receives information from throughout the interior of the body, including the viscera (heart, intestines) and uses this input to give us a “heart felt sense” of what to do or a “gut feeling” about the right choice.
9. Morality — Moral reasoning seems to require the integrative capacity of the pre-frontal cortex to sense the emotional meaning of present challenges and to override immediate impulses in order to create moral action in response to challenges.
Any activity which bolsters improvements across these 9 domains has the potential to radically transform a persons life.  Studies have shown repeatedly that experienced mindfulness meditators can alter their grey matter in regions of the prefrontal cortex.  Grey matter being a measure the functionality of the region, thus, that is to say, that meditation causes changes in the brain that result in improved function of the
prefrontal cortex. Its not a far leap to look at the functions of prefrontal cortex such as increased empathy and morality to see its connection with spiritual disciplines.  Also as Dr. Siegel points out the intuition associated with a better mind body awareness to our gut feelings or gut-nervous system may be an explanation for what people mean when they discuss listening to the mind and heart in various religious philosophies.
The research is becoming quite clear as to the possible mechanisms by which meditation provides its benefits. The idea that meditation as merely a spiritual practice for the religious is unnecessary and frankly it turns off many people from practicing a discipline that can cause radical personal transformation which can in turn benefit the wider social environment.  As such, I’m deeply encouraged when I hear that mindfulness is now being taught to many kids in elementary schools.  Now if only we could integrate the practice into the lives of all those who grew up without it.
Did you read this article and find some value?  Give me some feedback in the comments to help me improve my writing.  Or tell me about your experience (or non-experience) with meditation 🙂

A guide to the 5 components of balanced living

SLXLM

The act of balancing  is a constant affair of action and adjustment
The sun is shining down and its a summer afternoon.  I’m willfully determined to learn to handstand.  With my bare feet kissing the warm grass I prepare my body to be flipped upside down.  In my minds eye I picture my body with my head below feet and in a straight line. I bow my head and splay my fingers on the ground.  I gently push off with my legs and center my core above my hands.  Splat!  I fall into the hard earth. My intention is not sufficient to balance upside down. I stand back up and place my hands in position, visualize my ascent, and launch my legs into the air. This time teetering for a mere second before falling back to earth.  Again and again, I push off until I can linger longer.  Eventually my nervous systems learns the new position and I’m able to reflexively respond to the changes in my balance and thus able to maintain my handstands for several seconds.
As I handstand I’m never in a state of stillness, there is constant need for adjustment.  It takes a greater deal of proprioception, or mind-body awareness to be conscious of where my body is, where the weight is placed, how gravity is affecting my stance, and which fine motor movements to make in order to respond to the changes of motion in such a way as to remain stable in a upside down positon.
Learning to handstand is a good metaphor for leading a balanced life because they work on a similar principle, a mindful awareness of the current conditions and the necessary adjustments to remain in balance. When hand standing I need to be aware of my body and the movement of my limbs that may need adjustment.  When discussing balance in your our lives, you must be aware of many more factors.  Factors that aren’t easily quantifiable and as obvious as the movement of a limb.  There are many ways one can parse up the essential needs of a person to remain in healthy balance, but one such model relies on 5 factors: nutrition, socialization, mental stimulation, fitness, and emotional health/spirituality.  These 5 core competencies are essential in any individuals health and wellness. In the following paragraph I will break down the 5 core competencies and hw they relate to health and balance.
The 5 core competencies of health and wellness:
Nutrition:
You are what you eat! The nourishment from the food we consume is broken down and then forms the building blocks of your body.  The food we eat has a direct relationship with our emotions, our energy levels, and our satisfaction in life. Eating is pleasurable, its a social activity with central importance in many cultures.  Its integral to fueling your mind and body.  Adequate nutrition is preventative for all diseases and essential in the total number of healthy years lived.  When we neglect our diet, we neglect our bodies.  When we continually consume harmful foods we give up control of our health. also of consequence, by fueling unhealthy food industries we further the disease burden by investing in harmful products rather than investing in nourishing and health promoting foods.  Taking control of your diet is a process.  Our eating habits are conditions and enforced over many days, months, and years, and breaking patterns is an effortful process.  Like any behaviour change you must be able to understand the need for change, identify your resistances to change, and then identify your resources and make a plan of action.
Socialization:
We are social animals! We need connection, we need love, we need other people.  There is a sinister trend in our society to live quite alienated lives.  But connection and relaxed social engagements are a necessary component of a healthy, happy, human being. What one will find is that any one of the 5 competencies is not singular, that is, our need for socialization is directly related to our emotional health, and one way we can socialize is to eat and exercise with one another.  In this way, a  healthy life is a blend of all the core competencies that synergisticly work together.
The importance of socialization cannot be overstated.  There are individuals without health, nourishing food, intellectual stimulation, but living on love.  Humans have a remarkable ability to share in the burden of life, for tragedy is built into reality, there is no avoiding struggles, and it is only through our shared relationships with other people, and plants and animals for that matter that we can survive and thrive.  Disconnection is closely associated with loneliness, addiction, and depression.  If you have identified a deficit of your socialization in life there are countless ways of reaching out.  There are many organizations with kind hearted individuals serving and helping other people, such as food banks and not for profit charities. There are sports and other competitive engagement that foster team building and positive interactions among people. There are religious gatherings and festivals.  Remember, everyone needs connection, so everyone is searching for good hearted people in there lives.
Mental stimulation:
The mind is the imagination, the imagination is infinite. With such a precious resource as the mind, we should be sensitive to realize that like the body and our emotions the mind has needs. Minds flourish through learning, curiosity, and complexity.  Take a lesson from nature, your either living and growing, or decaying and dying. The brain, like a extensive networks of roots, aims to grow and expand.  As you learn new cells and pathways in the brain are laid down, forming extensive networks like the splaying fingers of tree roots.  Mental stimulation can involve both taking in information and creating content. There is an infinite amount of data it the world, new facts, ideas, concepts, disciplines, and endeavours for the mind to wander through, find what interests you and pursue it, its important for your growth.  What your passionate about, other people will be passionate about if you share it with energy and enthusiasm.  Not only can you take in vast storages of information, but each and every person has an imagination. I don’t care if you think your a ‘creative’ person, or if you have a specific artistic talent like drawing or singing, we are all creators.  The very act of speaking is you creating new sentences.  Creativity is expressive and beneficial.  I’ve been reading a book on the psychotherapeutic effects of art therapy and its beautiful to read how the process of creating art can help people overcome trauma and even alleviate post-traumatic stress disorder.
Bottom-line: the minds creative capacity is infinite and its expression is essential to health and well-being.
Fitness:
In each and every moment we are a composite of our mind, body, and emotions. Many people live in one world, perhaps we think too much, and dissociate from our emotions and body.  Other people are overly emotional and think little.  Its easy to live in one world and to dissociate from either the mind, the body, or our emotions. However, in order to be healthy we must have a keen awareness of the current state of health of our minds, our emotions, and our body.   Once again, I will restate, balance is achieved through an awareness of current conditions and relies on your ability to make the necessary adjustments to maintain balance. Therefore, we must be acutely aware of our mind, body, and emotions at all times to make the necessary adjustments. Its a challenging affair to be mindfully present in experience.  As such, I recommend the practice of mindfulness meditation, which hones one’s ability to be present of all aspects of experience.  For more information on mindful meditation see my blog post on mindfulness and the brain.
Back to fitness and the body. Our bodies are meant to move.  Blood is meant to flow and our bodies are meant to express themselves in movement, dance, sport, and displays of emotions. Think about the happiest times in your life, they were probably when you were a kid, or perhaps a wedding or another celebration.  You were probably dancing, or laughing, or singing.  These are the actions of happy people.  If your life involves little dancing, laughing, and singing, well there’s an easy change you can make to enrich your life. Dancing, laughing, and singing are excellent stress reduction strategies for emotional health.  They balance the body, give energy, and help promote confidence and positive affect. Find what you love to do, it does not have to going to the gym, playing sports, hiking, or biking.  Just find what moves you to move (and do it daily)!
Emotional health/spirituality:
Society pays much more attention to our physical bodies then our emotional bodies. As a consequence we are not taught to value or pay as much attention to our emotional health as we should.  We are often performance and productivity driven at the expense of our emotions. Emotional health is closely correlated with our relative stress levels. As such things that promote emotional health are often stress reduction protocols.  But more than merely decreasing stress, emotional health and by extension spirituality grasp at deeper meaning.  It relates to the part of our human nature that seeks the transcendent aspects of reality, that is experiences and things beyond ourselves. For many people this is fulfilled through a religious structure and community.  Other people find transcendence in arts, or volunteering.
Emotional health takes into account our need for love, self-love, and love and connection with other people, places, and beings. If we don’t accept ourselves our bodies, our past experiences, and way we feel and act, how can we love ourselves?  As an extension, how can we expect others to love us, for when we don’t accept our own flaws people with automatically think we won’t accept them for their flaws.
Summary
The 5 competencies listed above are the core components necessary for health ad well-being.  If you have read through them and find yourself with a deficit in any one category then you have made the first step in identifying a need in your life you can take steps forward in improving. As mentioned in the paragraph on nutrition, once you have identified the need to change, you must take the steps to identify the barriers and resistances you have to changing, then identify your resources, your support, your strengths and create a plan of action that will take you forward.  If your out of balance, don’t carry it as a burden, balancing is always an act of adjustment.  At some level you will find balance, but then the world will throw you a curve ball, a tragedy, or a novel situation that will take you out of balance. The process of life and growth is falling, failing, and getting back up.
Best wishes, Zachary Koop
SMLXL