Box Breathing: for relaxation and centering

Box breathing: for relaxation and centering
Every state and emotion has a corresponding breathe pattern. Breathe has the ability to voluntarily bring you in and out of emotions. It can be used to activate your sympathetic or parasympathetic nervous system causing stimulation or relaxation. It can influence your hypothalamic pituitary adrenal axis (HPA-axis) your stress response system, as well as all your neurotransmitters and hormones. Box breathing is an excellent and easy way to decrease your stress, cortisol, and bring you into a calm state in minutes.
Box Breathing steps

Step 1
Sitting upright, slowly exhale, getting all the oxygen out of your lungs. Focus on this intention and be conscious of what you’re doing.
Step 2
Inhale slowly and deeply through your nose to the count of four. In this step, count to four very slowly in your head. Feel the air fill your lungs, one section at a time, until your lungs are completely full and the air moves into your abdomen.
Step 3
Hold your breath for another slow count of four.
Step 4
Exhale through your mouth for the same slow count of four, expelling the air from your lungs and abdomen. Be conscious of the feeling of the air leaving your lungs.
Step 5
Hold your breath for the same slow count of four before repeating this process
Box breathing can be performed anywhere and can have its calming effect in minutes. The army use it, and I use it while driving, while working, before I meditate, and any time I want to bring myself in a calmer state of mind.

The health coach revolution To change behaviors that lead to chronic disease, doctors aren’t enough

***This article was originally posted on Tony Robbins website:

***This article was contributed to by Chris Kresser who’s bio and a link to his book can be found at the bottom of this page!


The health coach revolution

To change behaviors that lead to chronic disease, doctors aren’t enough

This article was contributed by special guest Chris Kresser – see full bio below.

Did you make a New Year’s resolution this year? How did it turn out?

If you’re like most people, you didn’t get very far. In fact, a commonly cited statistic suggests that only 8% of people keep their resolutions.

There are many reasons for this, but they can be summed up this way: changing our behavior is hard, and most people don’t know how to do it successfully.

This is a huge problem, because it is now clear that that the number one cause of the chronic disease epidemic is not genetic, but behavioral – people making the wrong choices about diet, physical activity, sleep and other lifestyle factors.

In fact, a recent study found that 85% of the risk of chronic disease is due to these environmental factors. Another study found that fewer than 5% of adults engage in the top health behaviors, and only 20% of adults are thriving.

The consequences are severe:

Given these statistics, it should be clear that 1) chronic disease is the biggest threat to our health that we face, and 2) changing our behavior is the most important step we can take to prevent and reverse chronic disease.

We don’t need more information or more doctors to solve this problem

It’s tempting to think that we can solve this problem simply by better educating people about the changes they need to make. But it is now well-established that knowledge is not enough to support lasting behavior change. If it was, we wouldn’t have divorced marriage counselors, crazy shrinks, or doctors that smoke cigarettes!

Most people know that eating poorly, not exercising, not getting enough sleep and engaging in other unhealthy lifestyle habits is not good for them. Yet they continue these behaviors anyway, or they chase quick fixes that don’t last for more than a few weeks.

What about doctors? Shouldn’t they be the ones to lead this change? We simply don’t have enough of them to address the problem. The most recent statistics suggest that we’ll have a shortage of 52,000 primary care physicians by the year 2025.

But even if we didn’t have a shortage of doctors, most of them have neither the training nor the time necessary to support people in making lasting behavioral changes. The same is true for most other healthcare professionals, including nurse practitioners and physician assistants.

We could start training doctors and other healthcare providers in this area, but that still wouldn’t solve the problem. Our “sickcare” system is not set up to deliver this type of care. The average visit with a primary care provider in the Unites States is ten to twelve minutes, with newer doctors spending as little as eight minutes per visit with patients. That’s barely enough time to say hello, review the patient’s current medications, and possibly prescribe a new one. It’s not even remotely enough time to assess what behavior and lifestyle changes would be most effective for the patient and provide the support necessary for sustaining them for a lifetime.

What’s more, doctors are trained in the “expert” approach of simply telling people what to do and expecting them to do it. That might work well when someone is facing a serious, acute health crisis (like an appendicitis), but it fails miserably when it comes to long-term behavior changes like losing weight, managing stress, or adopting an exercise routine. Doctors aren’t trained to work collaboratively with their patients. This is painfully reflected by the fact that patients get to speak for only 12 seconds on average before being interrupted with advice from their physician.

Health coaches are the solution

If more information and more doctors won’t solve the problem, what will?

Health coaches.

People want to feel good, avoid chronic disease and live a long life. They want to see their children and grandchildren grow up and have the energy to play with them. They want to perform better at work, enjoy their relationships, and be well enough to get the most out of life. But there’s a big difference between wanting the benefits of being healthy and consistently engaging in the behaviors that lead to health.

That’s where health coaches come in. Coaches are trained in a number of disciplines that support people in making lasting change. These include (but aren’t limited to):

  • Positive psychology, which leverages people’s strengths (rather than focusing on their weaknesses) to make changes
  • Motivational interviewing, which helps people to link behavior changes to their deepest needs and goals (e.g., “I will change my diet because I want to live to see my grandchildren graduate from college.”)
  • Habit formation and reversal, which supports patients in making positive habits, or breaking negative ones

Coaches are also trained to work with patients in a more collaborative way, rather than with the expert approach that is common in medicine. In the expert approach, the “authority” assesses the problem, delivers advice, recommends solutions, and in some cases, teaches new skills. In the collaborative approach, the coach acts as a partner or ally, encourages clients to discover their own solutions and become their own advocate and supports them in developing the skills they need to embrace new behaviors.

This collaborative approach empowers the client to become the primary driver of change. It also builds confidence, self-awareness, and self-actuation – all of which are crucial for long-term change, since the client will likely not work with the coach for the duration of his or her lifetime. To use the old analogy, the doctor gives the patient a fish so she can eat for a day, whereas the coach teaches the client to fish so she can eat for a lifetime.

Not surprisingly, studies have consistently shown that coaching interventions improve health outcomes for several chronic diseases, including diabetes, heart disease, obesity, and cancer. This is not a small effect. In fact, some research has shown that applying evidence-based principles of behavior change can increase the chances of success by over 1,000%!

A visit with a health coach is often more affordable than a visit with a doctor, whether the client is paying directly or the insurance company is covering it. This is critical, because more frequent visits are required to support effective behavioral change.

Along the same lines, the barriers to entry to become a health coach are significantly lower than to become a doctor, nurse practitioner, or physician assistant. This is also important, because we’ll need at least ten times the number of health coaches than doctors in order to make a significant dent in preventing and reversing chronic disease.

Coaches and doctors working together: the best of all worlds

I’m not arguing that health coaches will replace doctors. Doctors and other licensed clinicians will always be required to order lab tests, analyze those results, diagnose disease, prescribe treatment and coordinate care. Health coaches aren’t trained to do those things, just as doctors aren’t trained to support behavior change.

I’m advocating for an approach that utilizes the professional that is best trained and suited for each particular need: health coaches to support diet, lifestyle, and behavior change, and doctors to practice medicine.

What would this look like in practice? Imagine the healthcare population as a pyramid:

The top 5% of the pyramid – those experiencing acute or emergency problems that require intensive care, often in a hospital or specialized setting – are best served by conventional medical intervention.

The 25% of patients in the middle of the pyramid – those dealing with fairly significant chronic health challenges – will likely require the ongoing support of a licensed clinician (ideally practicing Functional Medicine) but would also benefit from working with a health coach to implement the recommendations of the licensed provider.

The 70% of patients at the bottom of the pyramid – those with less severe chronic health problems, or those who are generally healthy – might be best served by working primarily with a health coach, with occasional visits with a doctor for labs, check-ups, etc.

This approach would not only be more effective for preventing and reversing chronic disease, but it would also save us an enormous amount of money. Given that we spend nearly $4 trillion on healthcare each year, if utilizing health coaches could reduce that by even 25% (which is entirely reasonable) that would save us a trillion dollars a year. That’s no small thing, since some estimates suggest that the United States will be bankrupt by the year 2035 if healthcare spending continues to increase at its current pace. And since medical expenses are the number one cause of individual bankruptcy, using health coaches in this way could have a significant impact on each American’s pocketbook as well.

The writing is on the wall: chronic disease is destroying our quality of life, shortening our lifespan, bankrupting our country and threatening the health of future generations. It’s clearer than ever that our “disease management” system, which was designed to address medical emergencies and other acute conditions, is not prepared for the challenge of chronic disease. We desperately need a new solution – one that is affordable, timely and suitable for the task at hand. In short, we need a health coach revolution!

About Chris Kresser

Chris Kresser is the author of Unconventional Medicine: Join the Revolution to Reinvent Healthcare, Reverse Chronic Disease, and Create a Practice You Love, a book for healthcare practitioners and the general public that proposes a bold solution to the chronic disease epidemic. He is also the founder of Kresser Institute, an organization that trains healthcare practitioners in applying Functional Medicine and an ancestral diet and lifestyle in their practices; the creator of (one of the top natural health websites in the world); and the New York Times best-selling author of The Paleo Cure. His new book Unconventional Medicine will be released on November 7th.

Is Health Coaching by Telephone Effective?

Health Coaching Via Telephone: Is it Effective?

By: Melinda Huffman, BSN,MSN,CCNS,CHC

According to Dr. John Piette, “Individuals often remember little of what they are told during outpatient encounters.” Many people are not well prepared to manage their conditions without intermittent help and guidance along the way. Managed care organizations have had plenty of experience in using the telephone as a primary means of communication with members, but other healthcare providers have been slow to adopt telephony as a means to guide care. With health coaching and motivational interviewing emerging as a unique and different way of improving outcomes and communicating with individuals, it only seems reasonable that we pay proper respects to phone communication as a means to implement this fresh, new approach.

There are several reasons to consider the telephone as an effective means by which a healthcare provider can communicate with individuals seeking support, guidance, and information about their health risk, condition(s), or illness:

  • Ninety-eight percent of American households have phone communication
  • Enhanced timeliness of appointments
  • Affords more frequent contact
  • Cellular communication affords mobility for the users; no specific locale needed for a meeting place
  • Improved adherence to treatment plans
  • Healthcare costs continue to soar

A study conducted by Thomson Reuters and American Specialty Health concluded that a program of telephone-based health coaching for weight management can change employees’ behavior and reduce their health risk factors. At the end of one year, the study of 890 employees demonstrated significant decreases in risk prevalence for poor eating habits (21.3% reduction) and poor physical activity (15.1% reduction). All of the biometric measures related to overweight and obesity also decreased, including percent overweight or obese (5.8% reduction), weight (4.5 pounds reduction), and body mass index (0.9% reduction).

Pinnock et al. found that assessments conducted via phone increased the proportion of those with asthma who received appropriate monitoring versus those receiving face-to-face encounters in the clinic setting. While there was no difference in “quality of life” in both groups, patients’ access was increased and outcomes were comparable with telephone communication.

Simon, et al found that using the telephone to engage the depressed patient in cognitive behavioral therapy was substantially effective. After six months, those who received counseling over the phone were more likely to have improved depressive symptoms and were more satisfied with treatment.

As you evaluate your current telephone program or as you consider implementing interventions via phone, Piette listed several factors that should be considered:

  1. Content should be clearly structured
  2. Don’t try and accomplish too much in one setting
  3. Target those individuals who are likely to benefit most in your population
  4. Most effective programs are linked to outpatient clinical follow-up
  5. Incorporate outcome measures to validate program’s impact

Telephone outcomes that can be considered for measurement include, but aren’t limited to:

  1. Confidence level of the individual to reach goal(s)
  2. Number of phone appointments kept
  3. Satisfaction with phone encounters
  4. Improvement in symptoms, weight, exercise, diet, stress

To improve health outcomes in the population you serve, consider a wider use of the telephone as an adjunct to the individual’s treatment plan or if you already use the telephone to provide interventions, make sure that your active listening skills are sharp, that distractions are minimal to none, that you have an appointment for the call, and that you have an agreed upon agenda for the call!

©2010 NSHC All rights reserved.


5 Strategies for Weight Loss (evidence based)

Greetings! All the best to whoever reads this article.  The following paragraphs will cover 5 strategies to help you and anyone you know take the steps towards achieving their weight loss goals.

  1. Understand Your Motivation for Weight Loss and Set SMART Goals

What are the reasons that foster a desire to lose weight? Is it a health issue? Is it an emotional one? What are some realistic steps you can take to work towards your goals?

2. Identify Your Beliefs and Values around Food, Weight, Body Image, and Self-Worth

If you don’t like fitness, what are the reasons? Try to peel away the onion to see what the core values and beliefs you have about weight, eating, fitness, body image, and self-worth. Long-term changes may not last if you’re not keenly aware of the drivers of your inner motivation.

3. Mindful Eating Approach to Weight Management

Whether it is a bushel of broccoli or a bag of cookies, anytime you eat in excess to what your body needs for fuel the excess is stored as fat. One way of preventing excess fat is eating just enough fuel that your body requires for its needs. Not too much (will cause weight gain) or too little (will decrease metabolism). One way of providing your body with the right amount of fuel is through mindful eating.

Mindful Eating is eating with the awareness of your hunger and satiety cues. Basically, you eat when you feel physical symptoms of hunger and stop when satisfied. There is a difference between true and false hunger. With several other mindful eating strategies and bringing attention and intention to how you eat, the excess holiday weight will come off naturally.

Those with a strong emotional connection to overeating have found journaling to be particularly helpful. An Awareness Journal is different from a Food Diary. The food diary allows you to record the quantity, type of food and the time it is eaten. Conversely, thoughts, feelings, and physical signs of hunger and fullness are recorded in an Awareness Journal. What thoughts and feelings do you say to yourself when having an overeating episode or when you have a “good day” of restrictive eating? What, if any, associations are there? Carefully reflect on these and enter them in the Journal.

Additionally, make SMART goals (Specific, Measurable, Accountable, Realistic, and Timed)! For example when it comes to fitness, instead of having a general goal of working out 4 times a week; instead, a SMART goal would be “I will do cardio once a week for at least 30 min, yoga once a week for at least 20 min and weight training twice a week for at least 20 min”.

4. Engage in “Change Talk”

The research of Drs. Miller and Rollnick have discovered that the more one talks about change, the more likely one is to change. Keep talking about change and surround yourself in the environment, or mood of change, because the more you think, talk, behave positively towards change, the more likely change will happen. When you take a step towards your goal, congratulate yourself and use those positive feelings to move another step closer.

Are you ambivalent towards change? Do you have the desire, but find yourself in negative or limiting thought patterns? Ask yourself how you can change them into more positive thoughts. For example, when you find yourself in February or March exercising less than four times a week and thoughts of “I enjoy yoga, but I’m too busy”…”, but I’m too tired” creeping in, carefully consider what you can effectively do about the factors preventing you from moving forward to your goal. What are the options?

Perhaps changing those negative thoughts into statements like: “My health is important to me”, “I will make time for fitness”, “I feel great when I exercise”…and” I want more of that” will be more productive alternatives!

5. Recognize Your Readiness for Change

Of the six stages of change (pre-contemplation, contemplation, preparation/determination, action, maintenance, relapse) what stage are you currently in? If you’re in the contemplation stage (recognize there’s a problem, but not ready to change) what are some small steps to get you closer to the determination stage then action stage?

Ask yourself on a scale from 1-10 how important it is for you to create the change you want to get to achieve your SMART goal. Also, on a scale from 1-10 how confident are you that you can make the change? Once you are actively pursuing your goal(s), continually assess your score and bring in the support you need to keep the score high!



©2010 NSHC All rights reserved.

Is Health Coaching Effective?

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 ( 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.


  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

©2010 NSHC All rights reserved.I