Integrative Health Coaching
for Breast Cancer Survivors:
Creating lasting lifestyle changes to live your best life
Introduction
Health coaching is a relatively new approach to lifestyle
and lifestyle change that can be very beneficial – these lifestyle factors are
primarily nutritional guidelines, physical fitness or exercise, and stress
management or relaxation techniques.
Most people actually know what healthy lifestyle behaviors are, but can
have a very difficult time making or sustaining the necessary changes. Therefore, health coaching after a breast
cancer diagnosis, can be very important because it will help to promote an
optimal quality of life and healing, as well as help to prevent a possible
cancer recurrence.
What is Health Coaching?
Health coaching can be defined as the process of helping
clients and patients gain the knowledge, skills, tools and confidence to become
active participants and owners in their care, so that they reach their
self-identified health-related goals.
During this process, there are a number of techniques that are used, but
two of the most important are positive psychology and mindfulness. Some of the central characteristics of
this health coaching process also include client or patient centered care,
self-discovery, a learning or educational process, supportive relationships,
drawing on all important resources and accountability.
Another key feature of health coaching is creating a health
and wellness vision, as well as three-month goals and weekly or biweekly goals. Health coaches are most often nurses, nutritionists,
mental health professionals, physical therapists or exercise physiologists, or
have other similar health related backgrounds.
Positive psychology
is an important cornerstone of health coaching because it helps to draw on
people’s strengths and successful experiences. Our healthcare system has really been more of a disease care
system, and as we have seen, has not been very successful at promoting health
and wellbeing or creating effective lifestyle changes. Positive psychology brings other
beneficial approaches as well, such as a positivity ratio of 3:1 (ratio of
positive to negative thoughts and comments), which has been found to be
associated with happier people, and a 5:1 ratio for happier marriages –
research suggested that 80 % of people have a positivity ratio below 3:1. This is important because happier
people are more flexible and creative, and more importantly for breast cancer
survivors, tend to be healthier and have greater longevity.
Mindfulness is
another cornerstone of health coaching, for both the client and the coach. Mindfulness is important for stress
management and sets the tone for a coaching process that is most helpful for clients
to achieve their health-related goals and for health coaches to most
effectively support clients in this process. With both clients and coaches being fully present in a
non-judgmental and mindful environment, it becomes a safe place to explore any
thoughts or feelings that arise.
This can be a sacred place, where health-promoting and healing steps can
occur, by discussing a variety of concerns or issues that range from the
practical to the spiritual – one example would be to put the right healthcare team
in place, that could include a good primary care physician, oncologist,
counselor or psychologist, physical therapist, nutritionist, health coach and/or any
other needed or desired practitioners.
Another example would be to talk about fears, losses or other painful
experiences and insure a connection with a counselor, psychologist or other
practitioner who can more thoroughly and effectively process these
feelings.
As we know, cancer survivorship often puts the most severe
stresses and strains on people who may need to make important decisions about
their care and lifestyle, or may be facing their mortality. In addition, the cancer experience can
have a profound impact on relationships with spouses, and with family members
and friends, vital to a healthy, loving and healing social support system.
Positive Study Results for Health Coaching for Cancer Survivors
One cancer survivor study of mostly women with breast cancer
found that wellness coaching significantly improved depression, anxiety, and quality
of life (QOL- see reference).
Also, participant self-reports suggested improvement in vegetable and
fruit consumption, as well as weight and body-mass index (BMI).
Practical Steps to Get Health Coaching
Now that we have defined and described health coaching, this
next section will more specifically give examples and scenarios of who would
benefit most from health coaching, how it is done and what the process would
look like.
Although health
coaching is most helpful for people who have completed active treatment
(most commonly, surgery, chemotherapy and/or radiation therapy), health
coaching during treatment can also be beneficial. For those who have completed treatment, the focus can be
totally on healing physically, emotionally and spiritually. As many people have experienced
however, the cancer survivorship journey with ongoing treatment can often feel
like a roller coaster so health coaching can be a helpful and a useful tool as
part of an overall program that addresses a range of symptoms, side effects and
other issues that may develop.
Who would be helped most by health coaching?
Women
who need to lose weight (decreasing insulin resistance and the risk of a cancer
recurrence) Those
who still have fatigue and/or brain fog Those
who may still feel some depression and/or anxiety (these women also need to be seeing a counselor or
other mental health practitioner) Those
who are having a difficult time putting their lives and lifestyles back
together after treatment is completed Those
who feel like there is little coordination of aftercare Those
who still feel that they need to heal more and/or feel overwhelmed
Creating a Health and Wellness Vision, Three Month Goals and Weekly or
Biweekly Goals
Clients begin coaching by puting together a meaningful
health vision that can be inspiring and motivating, as well as three month and
weekly goals that help them focus their actions to help them achieve their
health vision. The developed goals
are S.M.A.R.T. goals – specific, measurable, actionable, realistic, and
timely. When the goals are
reached, great results occur, however, when they are not met or are only
partially met, there are lessons to be learned. The coach then discusses with the client any insights gained
from the process, and can provide reflections, feedback, problem-solving tips,
when they are invited to do so.
Coaches cooperate with clients to better understand challenges or
barriers and develop approaches that may help clients to move forward more
effectively and be more successful.
This also helps to develop trust, respect and rapport.
Other benefits of Health Coaching for Cancer Survivors
Experienced health coaches, who also have significant
expertise working with cancer survivors, can help support the development of
healthy lifestyles, as well as help to sort through differences of opinion
regarding healthy dietary guidelines, nutritional supplementation, physical
fitness/exercise programs, and emotional and spiritual well-being. Creating this healthy lifestyle is
essential for feeling comfortable and confident with your lifestyle program, as
well as optimizing your physical and emotional health and well-being.
Coaching experiences –
these come more from my general coaching practice since I am currently adapting
my programs for cancer survivors and building that part of my coaching practice
Wendy* – I had met
Wendy originally to provide nutritional counseling to help her lose
weight. She did well for a while
(lost 15 pounds) and then gained it all back. We reconnected after I got my coaching certification and worked
together using the health coaching structure. What we found is that she would do well until she came to
challenging issues related to her diet or maintaining her lifestyle program
when she had so much other work to do (she was the Director of a non-profit
organization in Philadelphia).
What she discovered is that she was much better taking care of others
and her work responsibilities, which often prevented her from taking the time
that she needed for herself.
Secondly, we found that when she got to points where she was unsure
about what steps to take, she gave up.
In her Director role however, she would face many similar business and
related decisions that needed to be made and was very good at doing that - so
she had the ability, but just needed to stay focused and follow through,
supported by our coaching relationship.
Jack* – was about 50
pounds overweight and had diabetes when we first started to work together. He was very good with his exercise
regimen but had much more difficulty controlling his eating because he was a
good cook, and truly enjoyed food and the company of family and friends that
often went with it. With my weekly
or biweekly support and encouragement, we designed a framework that allowed him
to lose 40 pounds and help his blood sugar return to normal levels. We are now working on a clear and easy
framework that promotes weight maintenance and well-being
Group coaching experience
I have just started to
do group health coaching for cancer survivors - this is a good way to provide
lifestyle information and coaching, within a group format that can take
advantage of group dynamics and be less costly. The first group that
I ran was a smaller group of 3 cancer survivors but they all reported that they
got good information, insights and suggestions about nutrition, fitness and
stress management. They also felt that the coaching format, along with the
ability to look at all of these issues together, was very helpful.
Steps to finding the right health coach:
1.
Ask your healthcare providers to recommend
someone or look at other reliable sources for health coaches.
2.
See what training, experience and
certification they have – check their website or ask them about these.
3.
Talk with them, and ask them some questions
to make sure you feel comfortable with their responses/approaches – it should
be a good fit.
Concluding Thoughts and Future Directions
Health coaching is an exciting and new approach to healthy
lifestyle and well-being for cancer survivors. It is another potentially important part of an overall
team of practitioners and approaches that can help to maximize quality of life
and cancer survivorship outcomes when support is needed most. Accumulating experiences and research
will hopefully create greater awareness, acceptance and use of the health
coaching framework and approaches in private practices, cancer centers and
academic oncology departments.
References and Other Resources
Galantino ML, Schmid P, Milos A, et al. Longitudinal benefits of wellness
coaching interventions for cancer survivors. Inter J Interdisciplinary Soc Sci 2009;4:42-57.
Positivity: Top-notch research reveals the upward spiral
that will change your life, Barbara L. Fredrickson, PhD, Crown Publishing
Group, New York, 2009.
Full Catastrophe Living (revised edition): Using the wisdom
of your body and mind to face stress, pain and illness, John Kabat Zinn, Bantom
Books, New York, 2013.
The gifts of imperfection: let go of who you think you’re
supposed to be and embrace who you are, Brene Brown, Hazelden Books, Minnesota,
2010.
Changing for good: a revolutionary six-stage program for
overcoming bad habits and moving your life forward. James O. Prochaska, John C. Norcross and Carlo C.
DiClemente. HarperCollins
Publishers, New York, 2006.
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