Dealing with change is undoubtedly the most stressful thing for humans to have to endure. No, allow me to rephrase that. Stress isn’t caused by change, change becomes stressful when we don’t adapt. When we don’t roll with the punches. And it really can feel like a punch in the gut. There are times when life throws you a barrage of many small, new – or even just slightly different – situations, people, rules, restrictions and routines; for example, moving house or changing jobs. There’s the sucker punch of change that you don’t even see coming. The one that leads to an avalanche of sudden difficult decisions; think of divorce or losing a loved one. And then sometimes life tries to knock you out entirely with a combination of both: a global pandemic that changes absolutely everything. For everyone. Forever.

Yet, nothing in life is constant. Change is inevitable. Whether you roll with it or fight against it, it’s going to happen. When you think about it, it’s not change itself that we don’t like. It’s the uncertainty, loss of control, unexpectedness and upset of the status quo that we have gotten so used to, that we don’t like. It’s completely normal to feel these emotions. The trick is to not sit with those emotions for too long. Feel it, acknowledge it and then move on. In other words: roll with the punches. 

So what can we do to be okay with change? When you are irritated for having to wear a mask. Or tired from homeschooling and working. When you no longer have the precious alone-time twice a day to listen to music or read a book on the train. How do you get your head around all this newness when you can’t sleep because you wish things could return to how it was?

Here are a few suggestions:

Everyone is different

Remember that you are not the only one going through this shift in ways of working, shopping, travelling and socializing. Even if you are super adaptable and not at all fazed, others aren’t. Everyone deals with change differently and at their own pace, and we need to be mindful of these differences.

If dealing with change is about being adaptable, then it’s also about making the decisions required for adaptability. In 1987 Alan Row and Richard Mason identified four decision-making styles. Each style has the following characteristics: 

• Analytical coping strategy – You see change as a challenging puzzle that can be solved as long as you have the time to gather information and draw conclusions. You will resist change if you are not given enough time to think it through. 
• Conceptual coping strategy – You are interested in how change fits into the big picture. You want to be involved in defining what needs to change and why. You will resist change if you feel excluded from participating in the change process. 
• Behavioural coping strategy – You want to know how everyone feels about the changes ahead. You work best when you know there is support for the change. If the change adversely affects someone close to you, you will perceive change as a crisis.
• Directive coping strategy – You want specifics on how the change will affect you and what your role will be during the process. If you know the rules of the change process and the desired outcome, you will act quickly. You resist change if the rules or procedures are not clearly defined.

Can you see yourself in any of these descriptions? What about when you think about how your boss typically makes decisions? Or your work bestie? Once you have a rough idea of what you and your closest colleague’s decision-making styles are, you will know how to reduce the anxiety around change.

Let’s use the example of having to return to the office post-lockdown: 

Analyticals should give themselves plenty of time to consider and gather as much information as possible about the best train, cycle, or walking routes to get to the office. Behaviourals should stay in touch with colleagues to offer and receive, support for the first day back in the office. Directives and Conceptuals rely heavily on information, so seek out the information or make sure you provide it to them. 

When the Conceptual lawyer can’t provide the Analytical secretary a floorplan showing exactly where the hand sanitizers will be located, because he is happy enough just knowing that there will be “some around the office”, that is going to lead to frustration and even fear on the secretary’s part. 

If you are the person in charge of readying the office for the return, it is imperative that information is shared well in advance and that the information be as detailed as possible. Some people don’t need or want the details, but others take great comfort in knowing the details.  

We’re in this together

It might seem impossible to focus on someone else’s needs when you yourself are struggling, but research has shown that once you can look outside yourself and take the time to be kind to someone else when they have to deal with change, you will have a more positive outlook. Brain imagine studies show that kind and compassionate feelings cause physical changes in the prefrontal cortex of the brain – the area associated with positive emotions. The area grows, just as a muscle would do when exercised, with repeated acts of kindness. As a result, it becomes easier to access the positive emotions area of the brain, which in turns makes it easier to have a positive outlook in general.

There’s no point denying it

It helps to accept that things have changed (again). No matter how tempting it is to pretend that everything is still the same, it really isn’t. It’s actually more stressful to deny reality than it is to say to yourself “Things have changed, and I’m okay with that.” Repeat this mantra as many times as you need to. 

You are not powerless

Focus on what you can change. In the most basic of terms, that’s your breathing. If anxiety sets in at the mere thought of going back to the office, the Square Breathing technique will help you slow down your breath. Start by breathing out completely. Then take a deep breath to a count of 4, hold to a count of 4, breath out to a count of 4, then hold for a count of 4. Repeat. 

On a practical level, think about what aspects of working from home and/or returning to the office, is within your control. If your office gives you a choice of office hours for the return, that’s control. If you work from home, you decide what to do with the time you would have spent on your commute. That’s control. 

Take it easy

Pace yourself. Adapting to change can’t happen overnight, so don’t force yourself to get to grips with it all in one on go. Break it down into smaller, manageable parts. For example, first try to get used to wearing a mask on the bus. When you feel more comfortable with that, pat yourself on the back and work on accepting that you will have to queue on the sidewalk for your Pret sandwich. (On the other hand, you could take a packed lunch to work and regain a bit of control over how you spend your lunch break.) Take it one day at a time and be kind to yourself. Some days you may find you take everything in your stride, and other days it will feel like a battle. That’s okay too, as long as you try again tomorrow. 

You’ve come this far

You’ve been through changes before, and you survived. You can do it again. And hey, any changes in your life post-COVID19 are going to feel like a walk in a park (while keeping an appropriately safe distance), in comparison. 

*This article was written for and first appeared in the July 2020 newsletter of The Institute of Legal Secretaries & PAs.

I have always been fascinated by aromatherapy and the power of smell to evoke happy memories. Whenever I smell jasmine I am reminded of my first holiday in Corfu. A large jasmine plant covered the walkway to our room. When we sat outside or left the room, the smell would envelop us. And when I smelled freshly baked bread, I am taken back to my childhood and the utter delight of seeing that our housekeeper had baked a loaf of bread while I was at school. She always left it on the kitchen counter, covered in a damp tea towel and the mouth-watering smell filled the whole house.

If aromas can help recall memories and recreate the feelings associated with those memories, it would make sense that we harness it as a tool for increased wellbeing.

Essential oils are used topically in face creams and lotions to rejuvenate, heal and soothe. I can attest to its benefits from my skincare routine, but for this assignment, I wanted to focus on its benefits for enhanced emotional wellness, calmness, mental focus or rejuvenation.

The science behind aromatherapy

When inhaled, the scent molecules in essential oils travel from the olfactory nerves directly to certain areas of the brain. For example, clary sage oil stimulates the thalamus in the brain to release dopamine that creates a sense of euphoria and gives pain relief. Lavender, chamomile and neroli stimulate the release of serotonin, which has a positive effect on mood and reduces anxiety.

Past experiences with aromatherapy

A few years ago, I purchased Aromatherapy Associates Inner Strength rollerball to help me through a difficult time at work. I applied the roller to my pulse points when I felt stressed during the day and before meetings, but I can’t say that it made me more relaxed. However, applying the essential oils and breathing in deeply to inhale the aroma was a soothing ritual.  

A month ago, I started to use The Body Shop Satsuma shower gel in the morning. It very soon became my favourite for the invigorating and uplifting effect it had on me. No matter how groggy I was or how tired from my morning Pilates, as soon as I smelled the satsuma essence, it was like an energising switch had been flipped. I was not expecting it to be so effective, and it continues to invigorate me no matter how many times I use it.

Comparing these two experiences made me wonder how important is the aroma of the essential oil  (as in the satsuma shower gel), versus the calming effect of deep breathing and performing a ritual (as in the Inner Strength roller ball). And if you know what the aroma is meant to do for you, would that determine what effect it has on you?  

The experiment

I asked my husband to randomly choose an essential oil from the Holland & Barrett website for me to try. He chose black pepper. Neither one of us looked at the description of the essential oil, so we had no idea what its benefits were. 

I applied the black pepper essential oil in the form of a body mist three times a day for one day. I made the body mist by combining water, a pinch of Himalayan pink salt to act as an emulsifier and 25 drops of the oil in a 100 ml spray bottle. On the second day I used it in an Aromatherapy Diffuser.

When I smelled it the first time, my immediate thoughts were “warm and comforting”. It also reminded me of men’s aftershave.  After two days I had not experienced much of an emotional benefit, but it did open my airways. On the second day I combined it with lavender and sandalwood oil but I still didn’t like the smell that much. If I do use black pepper again, it will be in a small quantity (1 drop to 4 drops of any other oil).  After two days I looked up the benefits online. Aromaweb says:

‘Therapeutically, Black Pepper Oil helps to improve circulation and can help to ease the pain of aching muscles. Emotionally, Black Pepper Essential Oil is stimulating and is a good choice for inclusion in blends intended to help enhance alertness and stamina. Black Pepper should be avoided before bedtime.’

Neil’s Yard Remedies also mention the effectiveness to relieve muscle pain when used in massage. Emotionally the key benefit is that it is energising.

My experience of black pepper essential oil didn’t match what aromatherapy suggests the benefits are. I do however think this may be down to the fact that I just don’t like the smell of black pepper.

As I am writing this assignment, I am using lavender oil in the diffuser on my desk. I noticed that it has made me calmer. Unlike the Aromatherapy Associates rollerball, I didn’t have to inhale deeply because the vapour from the diffuser, fills the room. The calming benefits I felt was therefor from the lavender oil, and not from deep breathing.

Conclusion

I will continue to experiment with essential oils in a diffuser. I look forward to trying tangerine, rosemary and peppermint. Studies have shown that rosemary improves memory and focus, which makes it ideal to use when I am working. Peppermint is effective in preventing fatigue and improving exercise performance, and as mentioned before, citrus aromas have an energising effect on me. I will combine peppermint and citrus oils in the diffuser when exercising.

In a coaching environment, I would try to combine visualisation techniques with smell. Visualisation is more effective when combined with one of the other six senses. For example, if someone is trying to overcome a fear of public speaking, they can use an essential oil while creating the mental image of themselves giving a flawless speech and enjoying being on stage. Before going on stage, they could smell the essential oil, and the smell would quickly help conjure that mental image.   Different essential oils can also be sprayed in a consulting room depending on the type of session and needs of the client. For instance, to create a feeling of calm, focus or to enhance intuition.

I believe aromatherapy to be a useful wellness intervention that can easily be incorporated into a coaching practice.

*This blog post is based on the assignment I completed for Module 11 of my Integrated Resilience & Wellness Coaching studies.*

Obesity has been evidence linked as a significant risk factor for cardiovascular disease, diabetes, cancer, chronic diseases, sleep apnea and depression. Weight loss can significantly reduce the risk of developing up to 18 health conditions linked to obesity. Not only does obesity impact the quality of life of the individual, it puts a strain on health care systems. According a NHS report 10,660 hospital admissions in 2017/18 were directly attributable to obesity and 29% of adults classified as obese. Despite the obvious health benefits of weight loss, many healthcare professionals are still unable to persuade their patients to lose weight.

Resistance to change often stems from ambivalence, which leads to procrastination. The individual might have contradictory ideas about losing weight (not wanting to give up their sugary Cola, yet at the same time not wanting to be diabetic) which leads them to not making any changes to their diet.

Healthcare professionals are traditionally trained to promote change by being the expert, distilling information and giving instructions in order that the patient will make the necessary changes.  This might work for patients who are unaware of the impact their weight has on their health, but many patients are completely aware of the reasons why they should lose weight, yet they are ambivalent about making the required dietary changes. In these cases Motivational Interviewing “MI” can be used to elicit change.

MI is an empathetic and collaborative counselling style that elicits and strengthens motivation for change in a person. The aim is to get the person to overcome their ambivalence, examine their options and eventually talk themselves into changing. 

Sapadin and Maguir identified six procrastinator styles:

Procrastination Style	Examples within a weight-loss setting
The perfectionist delays a task because they might not achieve their own high standards.	Delays starting a diet because they may not reach their goal weight at all. Or if the goal weigh is reached, they think they may not be able to sustain it.
The dreamer has unrealistic or grandiose ideas.	Wants to reach goal weight within 1 week, or a middle-aged person who wants to be the same weight they were as a teenager.
The worrier fears things will go wrong and feels overwhelmed.	Delays starting the diet because the lifestyle change seems too big of an adjustment. May also feel as if family members or doctors are pressuring them to lose weight.
The crisis-maker likes leaving things until the situation is so bad that someone else has to step in, or they hope the situation will resolve itself if they leave it long enough.	Delays starting a diet until they are unable to find clothes in their size, or lives in the hope that their doctor will prescribe a miracle cure.
The defier will go against instructions or good advice because they don’t like to be told what to do.	Will not go on a diet unless the idea is their own.
The over-doer stays busy with unnecessary tasks and avoids spending time on important issues.	Spends time researching various diets and may even start a diet, but loses interest and starts researching other diets.

Studies have shown that MI is an effective coaching style to eliciting change in patients that lead to a reduction in body weight. A meta-analysis of 11 published studies published in Obesity Reviews, showed that motivational interviewing was associated with a significant reduction in body weight (- 1.47kg) compared to those in the control group.

Healthcare professional however need to be taught MI techniques. The American Academy of Paediatricts launched a free app called “Change Talk: Childhood Obesity” which health care providers can use to learn MI techniques. The app simulates a virtual practice environment in which the health care provider assume the role of a pediatrician and decide what to say to a mother and her son about his weight. The app was launched after paediatricians and dietitians who used MI to counsel parents about their child’s weight, were successful in reducing the children’s BMI by 3.1 more points than comparison children over a 2-year period. 

The key to MI’s success is that the coach or healthcare provider do not portray themselves as the expert, giving orders to the patient and expecting the patient to immediately comply. Instead the healthcare professional displays empathy and patience and assumes that the person with the problem (the patient) is the one who holds the answer to solving the problem.

Stephen Rollnick sets out the four general principles, or RULEs of MI, for practitioners as follows (7):

• Resist the urge to change the person’s mind by giving instructions, dumping information on them or portraying yourself as the expert.
• Understand that it’s their reason for change, not yours, that will elicit a change in behaviour. Also understand that change will happen when they feel ready, not when you think they should be ready.
• Listen to what they are saying. They need to know they are being understood. The individual is the one who holds the key to solving their weight problem.
• Empower them to understand that they have the power to change their behaviour.

To quote Stephen Rollnick, strategies for use of MI in healthcare “is a shift in approach that is at the same time both fundamental and simple: instead of badgering patients to change their ways, you briefly connect or come alongside, and help them to do this for themselves.”

When patients are shown that they in fact are capable of change and can reduce their weight on their own terms, they feel empowered.  As an added benefit, an empowered patient lifts the responsibility from health care professionals to solve every problem because the patient is able to self-motivate and make the required changes.

*This blog post is based on the assignment I completed for Module 7 of my Integrated Resilience & Wellness Coaching studies. Citations were included in the submitted assignment.*

8 Steps of CBC in the GROW Model

Step 1: Setting the Scene for Cognitive Behavioural Coaching (“CBC”)	“The way you think about events in our life profoundly influences the way you feel about them: change the way you think and this will, in turn, change the way you feel.” (Life Coaching A cognitive behavioural approach, Neenan & Dryden)   With CBC we look at the automatic thoughts you have following an event or a situation, and how those thoughts, beliefs, or mental images – not the event or situation – determines how you feel and act.  The aim is to change the pattern of thinking so that you can overcome the obstacle.
Goal
Step 2: Problem identification	I get angry at the mere thought of having to do exercise, if I do push myself to do the exercise I am irritable, I give up very quickly and look for excuses not to exercise again. Yet I really want to have a toned body, lose weight, and feel good in my clothes. I can’t seem to get into a habit of doing exercise, stick to it and enjoying it.
Step 3: Goal Selection	I want to find exercise enjoyable so that I will look & feel good, and if I enjoy exercise I will continue to do it.
Reality (past and present)
Step 4: Choices and consequences	Choice 1:  don’t do any exercise  – Consequence 1: continue to be unfit Choice 2: Push past the anger – Consequence 2: I get irritable Choice 3: Get someone to join me in exercise – Consequence 3: Don’t want to involve others. I want to resolve the issue and self-motivate. Choice 4: Find the right type of exercise for me – If I enjoy the exercise I will continue to do it. Pilates and/or yoga looks nice.
Step 5: Exploring and challenging faulty thinking	Why do I feel angry when I have to do exercise? Feeling angry is the emotional response to a thought I have about exercise. This is the faulty thinking I need to explore.     Q: On a scale of 1 to 10 how angry and annoyed do I feel when I have to exercise? A: 8   Q: What makes exercising so terrible that it makes me angry? A: I get sweaty, hot, my face goes red. I feel self-conscious about how I look in the leggings and embarrassed that I’m so out of breath and red in the face.   Q: Is it realistic to expect that when exercising I should never sweat or get out of breath? A: No. That’s the whole point of exercising.   Q:  Think back to the last time I tried exercising in a class. How did the other women look? A: Everyone was focused on their own body and they got sweaty. They didn’t appear to care how they look or how the others in the class look.    Q: So looking at these answers – that being hot and sweaty is to be expected in a gym class, and that everyone seems to be focused on themselves, is it fair to say that I have been unrealistic in my thinking about what it’s like doing exercise? A: Yes. When you are focused and working hard, you will sweat and you won’t be looking around at others.   Q: Would I consider that I have given the idea of going to the gym a faulty label? A label that might be generating feelings of anger? A: I do think of going to the gym as something that young people do to show off their bodies and to impress. This is probably based on an experience I had in my 20’s. It annoyed me then that men were “hitting on me” while I was sweating, red in the face and trying to exercise. Maybe that’s where the anger and self-consciousness stems from.   Q: So is the label that a gym is a “pick up place” correct and still relevant? A: No, not really. I am married now so I don’t need to care what other people (men) think of me.  And in group classes (not on the gym floor) everyone is focussed on themselves.   Q: If a feeling of anger comes up again and I push through the anger and exercise anyway, what might happen? A: It’s just anger. If I’m prepared for it and willing to push past it, I may notice that I like exercise and feel good afterwards. As long as the type of exercise I do is not too difficult and I’m part of a class of mostly women. If I struggle to keep up in the class I may give up.
Options
Step 6: Decision making and action planning	Action: Go to a beginner yoga class. Resource needed: Find a local yoga studio. Not a gym. Date: Once a week, starting next week. Action: Wear loose-fitting clothes. Resource needed: Go shopping. Date: Before the first class
Will
Improving client motivation (willpower)	Take body measurements and weight once a week. As I notice changes in my body it will encourage me to continue to exercise. To motivate me further, I will treat myself to a manicure when I have been to yoga class three times in a row.
Step 7 and 8: Implementation and Evaluation	After each class, measure the level of anger on a scale of 1 to 10.  Also consider going to pilates classes and/or increasing the number of classes per week.

*This blog post is based on the assignment I completed for Module 6 of my Integrated Resilience & Wellness Coaching studies.*

Attention and interest

A way to show that you are paying attention to and showing interest in what a person is saying is by having an open body language. Body language encompasses facial expressions, micro-expressions, voice, gestures, and postures.

I often find myself leaning forward when I’m intently listening. This comes naturally to me. Having an open and forward posture shows that a person is actively accepting what is being said. The person who is speaking when I hold this posture would see this posture as a sign that I am truly paying attention and that I am genuinely interested in what they have to say.

I use my hands a lot when speaking, both in an iconic way to illustrate the meaning of my words, and a metaphoric way to explain a concept. In a coaching situation, this way of demonstrating my thoughts with my hands should make it easy for the coachee to see that I have grasped what they are trying to tell me. That being said, emotions can be revealed with hand gestures – I wring my hands when nervous. I am aware of this and that I can come across as insecure, so I have made a conscious effort to stop doing this. The voice can also reveal emotions that are not conveyed by the words spoken. For instance, I speak faster when nervous. This could be a problem in the coaching session where my nervous chatter could make the coachee nervous as well, and not leave enough quiet time for her to process what I have said.  To make myself feel more relaxed when speaking I have been making short videos about my coaching studies, which I post on Instagram. I wanted to force myself to get used to speaking to a camera and expressing my ideas without stammering, rambling, or speaking too fast. It has been a good exercise because I feel much more confident in my abilities to express coaching ideas and sharing knowledge. Looking at myself on camera while talking has made me more aware of my facial expressions, how much I use my hands and in one video I could see how I got out of breath when speaking about something I felt passionate about. That video taught me the value of slowing down and breathing. I upload the videos in one take so that it won’t come across as rehearsed, but also so that I can see where I go wrong, work on it, and am able to monitor my progress.

Exploration skills

Active listening and effective questioning are the main explorations skills that a coach needs to develop. Active listening requires many different skills, one of which is to show understanding which can be achieved with the use of confirming words and/or gestures like nodding. This comes naturally to me but I do need to be aware that if used too often or at the wrong time during a conversation, it can make the speaker feel rushed, interrupt their chain of thought or lose it’s meaning because of overuse.

Allowing for silence and quiet reflective time during a coaching session is important. Though I am very comfortable with silences (I’m not one to feel compelled to speak in an elevator) I often grasp what a person wants to say while they are still talking and I have to force myself to keep quiet so that they can finish their chain of thought. I am conscious of this and have taught myself to stop doing that. It is comforting to know that an established coach like Julie Starr believes “… with strong intention and practice, focused listening is a muscle that you develop over time”.

In addition to focused listening, The Coaching Manual also refers to Deep Listening where coaches experience physical sensations in the body that guide them to change or pursue a subject broached by the speaker. I have experience of this, though I never thought of it as a sign of Deep Listening. The hairs on my arms rise and I get cold chills from the crown of my head all way down to my toes when I am in conversation with someone and I or the speaker say something profound. I think of it as Spirit’s way of showing me in a very real way, that the conversation is on the right track. In a coaching situation, I will look out for these signs.

As an active questioning technique, Julie Starr advises against asking a question that begins with “why” because it can make the coachee feel they have to validate their actions to you. As a coach you want to know the why behind a coachee’s actions or thoughts, yet instead of simply asking why one should choose a different open question to get to the “why”. It is clear that a coaching conversation requires more thought than a “regular” conversation. Learning the skills to ask simple, direct questions that can remove barriers and unlock hidden information, takes practice.

Understanding skills

I find the VARK model of learning styles very interesting. If I can teach myself to listen out for examples of visual, kinaesthetic, or auditory language, I would be able to use similar language when engaging with a coachee. Understanding how someone processes information will also be useful when I want them to grasp a technique or solidify an outcome we reached. If I can pass on information to them in their natural learning style, it will greatly increase their trust in me as well as the coaching process.

Action skills

Planning has always come naturally to me and makes me feel safe and in control. My job as a legal secretary requires that I keep detailed records, think a few steps ahead and make meticulous plans. I know that a good plan and being fully prepared can save you a lot of time and effort – especially in legal disputes.  I will easily be able to utilise the structured coaching techniques like SMART goals and the GROW model, or worksheets as used in The Relaxation & Stress Reduction Workbook in coaching sessions. I can also see how asking a new client to complete a questionnaire before our first session, and asking them to send their “homework” to me before each session will allow me to prepare for the coaching session. If I am fully prepared for each session, I will feel more confident. My coachee will pick up on my confidence and see that I take our sessions seriously.

*This blog post is based on the assignment I completed for Module 5 of my Integrated Resilience & Wellness Coaching studies.*

Michael Neenan says in his book Developing Resilience that “resilience is forged through pain and struggle, and the willingness, however reluctantly undertaken, to experience them”. I certainly learned resilience when I had surgery to correct inward rolling ankles and dropped arches in both my feet. My feet had been this way since birth and I was forced to wear orthotic insoles from the age of 12. By my mid-30’s I was suffering from early-onset arthritis in my big toes and had hip problems. The first operation was to my right foot in June 2016, followed by the left in January 2017.  The surgery involved reconstructing the arch of my foot, reinforcing the arch with a titanium screw and straightening my ankle by placing a second screw into my heel. Each time I was in a plaster cast from toe to knee for 8 weeks and had to inject myself with blood thinners every night. Post-surgery rehabilitation was 12 weeks of physiotherapy where I had to re-learn how to walk and retrain my leg and foot muscles. In April 2017 it became apparent that the bones in the arch of my left foot had not fused properly and that the screw had snapped in half. Treatment was the use of an ultrasound bone growth stimulator for 90 days.

The following four mind-sets helped me make it through two years of pain and helplessness, even when I experienced setbacks.

Keeping perspective

I reminded myself that I didn’t need surgery to correct a life-threatening condition or because of trauma. Many people go through much more invasive surgery and after all, the leg casts would be removed after 8 weeks. I knew there was an end date and I counted down to that date. Seen in the big picture of my life, these surgeries were relatively small inconveniences yet it would have a major, lifelong impact on my life and stop the early-onset arthritis from worsening.

Finding new challenges

Basic tasks like taking a shower, moving around, carrying things and even getting dressed were challenging and required planning. Giving myself injections every day was especially tough. The biggest challenge, however, was learning to just accept that this was going to be a challenging time for me. I couldn’t rip off the cast no matter how much I wanted to be free from it. Being confined to the cast was put to the test when I developed an allergic reaction to the skin plaster that was placed over the scar, under the cast, after the second operation. I had an intense burning sensation on my foot 24 hours a day for 8 weeks. It was only after the cast was removed that we realised I had a severe skin reaction which I had been putting up with for 8 weeks. At times I irrationally wanted to pull my foot out of the cast just to get relief from the burning, and other times I had mild panic attacks and bouts of low mood. Yet, I knew that what I was putting myself through was going to be worth it.

When I look back at what I had gone through, and how I dealt with it, I feel proud of myself. Not only did I face the challenge once, but twice. Knowing I can deal with challenges has given me the courage to make other changes in my life, including embarking on this course and the career change that will follow.

Understanding control

I quickly realised that I had to give up on trying to change things that were out of my control. I had to accept that walking on crutches was going to be the only way I could get around. I had to accept that I had to inject myself every evening. I also had to accept that the cast was staying on for 8 weeks and no matter how much I wanted to be rid of it, there was nothing I could do about it. What I could control however was what I ate, the supplements I took, how much sleep I got, what I was thinking, and asking for help. Once I let go of what I couldn’t control and took charge of what I could, I reduced my stress which in turn helped with the healing process.

Nurturing an optimistic view of yourself

Of the four mindsets I identified, I think an optimistic view was the most influential in building my resilience. After the first surgery, I was so relieved to get rid of the cast that I was quite disappointed when I realised the hard work had only just begun. Physiotherapy was long, painful and at times I just wanted to give up. I, however, knew I had to get my right leg strong enough to literally carry me through the second operation. I went through physiotherapy again after the second operation and felt elated when the surgeon gave me the all-clear. It was a huge disappointment when I started to develop severe pain in my left foot and was told that proper bone fusion hadn’t taken place after all.  I felt very disheartened but I was still able to see the positive: the right foot had healed, I had come this far in the journey and wasn’t going to give up at the last hurdle, I had private medical aid that would cover the expense of the ultrasound machine, I had an incredibly loving and supportive husband that I could rely on, and I just had to look at my beautiful right foot to see why it was all going to be worth it. I did cry sometimes and I felt frustrated, but I didn’t dwell on those negative feelings. I visualised myself wearing sandals while walking on a beach and even bought a pair of beautiful open heel sandals that I could look at it every day.

During physiotherapy, I was introduced to pilates and yoga. I had never tried it before and found that I love it. I was very aware of how weak my muscles were and I never wanted to feel so “flabby” and weak again. I now do yoga and/or pilates three times a week to keep me toned and strong. I am also very happy to say that both my feet are fully healed and I wear beautiful shoes every day.

I have had challenges in my personal life and more will follow, but I know that with the right mind-set it is possible to face a challenge and emerge a stronger person – in my case, literally and figuratively.

*This blog post is based on the assignment I completed for Module 3 of my Integrated Resilience & Wellness Coaching studies.*

The NHS’s Action for Diabetes has made it clear that in order to improve the health outcomes of those living with diabetes, education around self-management of the condition need to be improved and individuals have to become empowered to take charge of their own care.  Studies have shown that wellness coaching is able to bridge the gap between clinical intervention and patient self-management at all three stages of diabetes.

Stages of diabetes

Prediabetes

When blood glucose levels are higher than normal, but not high enough to be diagnosed as type 2 diabetes, a patient is in the prediabetic stage. At this stage, type 2 diabetes can still be avoided. Weight loss of as little as 5% is enough to significantly reduce the risk of progression to type 2 diabetes.

Type 2 diabetes

The risk of contracting type 2 diabetes is increased if a person is overweight or obese. Type 2 diabetics have insulin resistance, meaning the body doesn’t produce enough insulin to function properly, or the body’s cells don’t react to insulin. The effects of type 2 diabetes can potentially be reversed and definitely managed with a healthy diet, exercise and weight loss. Insulin is often prescribed for type 2 diabetic patients. There is no permanent cure, but the condition can be prevented and put into remission by losing weight.

Type 1 diabetes

The risk of contracting type 1 diabetes is not affected by lifestyle or weight. It is an autoimmune condition where the body is unable to produce any insulin. Management is through insulin injections, testing of blood glucose levels, counting carbohydrates, regular exercise and maintaining a healthy balanced diet. There is no permanent cure.

How coaching can help

In all stages of diabetes, patients need knowledge, the skills to make lifestyle changes and the confidence to participate in their own care and management of their condition. Research supports coaching as a feasible way to help patients make the necessary behavioural changes. Because prediabetes is a precursor to diabetes, it is of critical importance that any treatment program should also include modification of lifestyle behaviours in order to reduce the risk of developing type 2 diabetes.

A study by Ramona S. DeJesus of the Mayo Clinic found that a 12-week wellness coaching program for prediabetic adults delivered by certified coaches, led to significant improvement in levels of exercise and healthy eating choices. Changes occurred as early as 6 weeks, with continued improvement at 12 weeks and sustained results at 24 weeks. 50% of the participants increased aerobic exercise time from 117 minutes to 166 and 199 minutes at 6 and 12 weeks respectively. Similar trends were also observed with self-efficacy and quality of life measures.

Unlike the study by Ramona S. DeJesus and many others that focused on nutrition and exercise alone, Mariam Kashini also integrated management of stress and sleep in her study. Patients received 14 personalised in-person or telephonic coaching sessions. Of the 107 prediabetic participants, 49 % showed normal blood glucose levels after 6 months irrespective of weight loss. Significant improvements were also made in blood pressure, fasting insulin, perceived stress levels, diet and participants reported feeling less tired.

According to Dr. Heather D. Bennett health coaching encompasses five principal roles. We will look at each if these roles in the context of diabetes as a long-term condition.

Five principle roles of the health coach

1. Self-management support

Diabetic individuals can make a dramatic impact on the progression of their disease by participating in their own care.  Disease-specific skills such as monitoring and responding to glucose levels, administering of insulin and limiting carbohydrate intake are essential parts of self-management that patients have to perform in their day to day lives. Coaches are able to train patients in these skills as well as provide information, promote behavioural change and teach problem-solving skills. A coach would also help co-create a wellness plan for the patient, set goals and make the patient accountable, thereby encouraging them to be active participants in their own healthcare.

2. Link between clinician and patient

It is easy for a disconnect to occur between a doctor and patient, e.g. in the prescription of insulin. The doctor prescribes medication, but can’t ensure that the patient will take the medication. A coach can assist by helping the patient overcome barriers or resistance that is preventing them from taking the medicine. For instance, a coach would follow up with the patient after a doctor appointment to make sure that  he/she collected the medication and ensure that the patients understands how to take the medication.

3. Navigation of health care system

NSH doctors and hospitals have long waiting times and appointments are rushed. Diabetics, especially newly diagnosed, can easily feel overwhelmed and be left with unanswered questions and concerns. A wellness coach can help the patient to prepare key questions before doctor appointments, and help the patient to feel empowered and confident enough to raise any concerns with their doctor.

4. Emotional support

Living with diabetes can be emotionally challenging. It is no surprise therefore that the chances of developing depression are twice as high for those living with diabetes. Being depressed can interfere with a person’s ability to participate in self-care activities such as monitoring, being active, eating healthy and taking medication; thereby perpetuating the cycle of depression and mismanagement of the diabetes condition.

A study by the American Association of Diabetes showed that mental health coaching was able to significantly ease depression and reduce blood sugar levels. Researchers used the the Patient Health Questionnaire (PHQ9) to measure anxiety and depression scores prior to and after intervention. Scores decreased by 49% on average after three months. Blood sugar levels dropped from an average of 8.8% to 7.7%. Those who received mental health coaching reported it was “life-changing, life-saving and helped them feel better and happier than they had in a long time”.

Diabetes UK recommends Cognitive Behavioural Therapy as an effective way for diabetics to learn techniques to cope with stress, triggers and negative thoughts.

5. Continuity figure

Coaches are able to connect with patients not only during in-person visits, but also between visits with telephone calls, text message and emails thereby creating a better sense of familiarity and continuity.

Conclusion

The very nature of wellness coaching is perfectly suited to help patients self-manage diabetes. Coaches facilitate a patient-directed process of evaluation and assessment, tracking and accountability. In the process of co-creating with the client, a coach can empower patients to self-manage their condition and bring about the lifestyle changes needed for a healthier life.

*This blog post is based on the assignment I completed for Module 2 of my Integrated Resilience & Wellness Coaching studies. Citations were included in the submitted assignment.*