The Role of Integrated Resilience and Wellbeing Coaching in Long-Term-Condition Management

Anna Cleary Ikin (Diploma in Life Coaching Skills)

In England about 15 million people have a long-term health condition. Long-term conditions or chronic diseases are conditions for which there is currently no cure, and which are managed with drugs and other treatment. Projections for the future of long-term conditions are not straightforward. The Department of Health (based on self-reported health) estimates that the overall number of people with at least one long-term condition may remain relatively stable until 2018; however, analysis of individual conditions suggests that the numbers are growing, and the number of people with multiple long-term conditions appears to be rising.

If better management of long term conditions (LTCs) is to be achieved, then transformational change is required – both within the health service and, this is perhaps more challenging, to culture and behaviour.

Living with a long-term condition can be a daily challenge. However old, and however long someone has lived with a condition, each person will have different levels of tolerance and ways of coping.

“Self-care”, when someone takes care of their own health, can help a person to overcome the day-to-day challenges of their condition. This can help a person make the most of life, rather than avoiding or missing out on things because of it. Self-care puts the person in control. Research shows that people with long-term conditions who take more control of their health have a much better quality of life.

What is Health/Wellbeing and Resilience Coaching?

Health/Wellbeing coaching is a process that facilitates healthy sustainable behaviour change by challenging, listening to inner wisdom, identifying values, and transforming goals into action.

Resilience coaching is learning how to adapt and bounce back when things don’t go as planned, through developing and sustaining positive mindsets, enhancing self-motivation and self-regulation. Characteristics of resilience refer to a client’s capacity to deal with discomfort and adversity and are traits that can enrich life.

In this context, I will present my own experience of an acquired life-changing health condition that includes adrenal fatigue, and that of my sister, who was born with a congenital condition that means she has vision in one eye.

Why Use Coaching in Health Conditions?

Diagnosis of a health condition or disease or making a lifestyle change for health reasons can require a change to lifestyle and/or diet. There could be psychological effects of coming to terms with one or multiple conditions at the same time, and some or all of the diseases or conditions experienced could be temporary and managed in the short term, while others could be long term and require management not only to improve health but to maintain or sustain it.

Health coaching is one approach used to encourage and promote self-management and activation, either alone or as part of a delivery system for long term conditions management. It can improve satisfaction and facilitate healthy sustainable behaviour change by challenging a client to listen to their inner wisdom, identify their values, and transform their goals into action. Many health conditions that people develop can be long term health conditions (LTC) or chronic illness and are conditions for which there is currently no cure and which are managed with drugs and/or other treatment. The psychological effects of developing a disease or health condition(s) can lead to psychological distress, such as unpleasant feelings or emotions, anxiety, stress, depression or symptoms of mental illness, that impact a person’s level of functioning and interfere or impact upon daily living and can result in negative views of the environment and the self.

As defined above, resilience coaching is another approach to develop/enhance a person’s ability to adapt and bounce back when things don’t go as planned.

What is Integrated Healthcare?

Integrated Resilience and Health/Wellbeing Coaching helps a person facilitate healthy sustainable behaviour using the safest and most effective combination of approaches and treatments. It challenges a person to listen to their inner wisdom, identify values and transform goals into action whilst managing stress, developing ways to cope and thrive with nutrition, exercise, environmental and psychological wellbeing, selected according to evidence based practice, expertise, experience or insight.

Being aware of how the body works and deals with chronic conditions and stress can help a person to manage physical health, stress and stressful situations.

The Effects of Stress on the Human Body

After a stressful period the human body can go into a ‘recovery mode’ where increased appetite and food cravings become more prevalent. At the same time metabolic rates drop to conserve energy. Being aware of these patterns can help a person manage their stress levels and through nutrition, diet and resilience coaching can help their body recover from stressful periods more rapidly and minimise negative effects.

The role of nutrition is essential for the body to heal and maintain health, wellbeing and mental health. An adequate, well balanced diet combined with regular physical activity is considered in relation to the body’s dietary needs and is a cornerstone of good health. Poor nutrition can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity.

Studies show people with medical conditions are most vulnerable to the negative consequences of stress; parts of the nervous system that control the glands, heart, digestive system, respiratory system, and skin and any pre-existing medical condition that is influenced by a nervous system response such as chronic pain, irritable bowel syndrome (IBS), digestive disorders, or headaches are likely to become exacerbated by stress and the already overworked system becomes overloaded by additional stress. In addition to the already known physical effects, anyone who suffers from a history of mental illness, such as depression and anxiety, is also at risk for a worsening of symptoms at times of extreme stress. Stress can also make healthy people more vulnerable to sickness by weakening the immune system and making it easier to catch a cold or other disease or condition.

Is there a Role for an Integrated Approach for Resilience and Wellbeing Coaching in Long Term Condition Management?

While my own and my sister’s experience shows the benefit of coaching in adrenal fatigue and visual disability, objective evidence to demonstrate the advantages of an integrated approach to coaching for adrenal fatigue or visual disability is difficult to find. I will look at aspects of health/wellbeing coaching and resilience coaching to consider how a client could use both types of coaching to self-manage and transform their goals into action.

Adrenal Fatigue

There are many ways in which stress can impact a person’s health. Chronic stress in particular can lead to hormonal depletion, exhaustion, and adrenal fatigue. Adrenal fatigue is a collection of signs and symptoms, known as a syndrome, which results when the adrenal glands function below the necessary level. Most commonly associated with intense or prolonged stress, its paramount symptom is fatigue that is not relieved by sleep, but it is not a readily identifiable entity like measles or a growth on the end of your finger. A person may look and act relatively normal with adrenal fatigue and may not have any obvious signs of physical illness, yet live with a general sense of non-wellbeing, tiredness or “grey” feelings.

Living with adrenal fatigue is a daily battle, every part of the body is affected, and the physical, emotional, spiritual and psychological effects wreak havoc with daily living. It ranges from waking up in the morning, to having enough energy during the day, eating the right foods at the right times, to having difficulty falling and staying asleep and then waking up tired the next day; feeling stressed for no reason and becoming even more stressed, anxious and depressed, on top of an existing feeling of frustration and helplessness.

Good nutrition is essential in reclaiming and developing optimum health, and nutritional coaching for adrenal fatigue would be beneficial in aiding recovery from the condition. However, as the symptoms suggest, it is not only good nutrition on its own that should be the focus of this condition, but its psychological effects should also be attended to.

An Integrated wellbeing and resilience coaching approach could focus on key elements:

Nutrition to heal the body. Understanding what is important to help the body heal and maintain normal body function can enhance wellbeing.
Resilience for psychological and emotional stress. It is not necessary to have all the answers or to completely remove situations from life that cause stress. Understanding boundaries between self and situation can be an important first step.
Behaviour change to maintain and sustain the changes. Some changes are quick fixes but others need to be sustained over a period of time to be effective, which can be overwhelming; Get support from family, friends or social groups. Create small goals which can add up to achieve bigger goals. Being kind and patient with oneself and not expecting too much too soon can make the goal feel more achievable.

Visual Disability

There are currently 180,000 blind or partially sighted people in the UK. Being told you have a visual impairment that cannot be treated can be difficult to come to terms with. Some people go through a process much like bereavement, where they experience a range of emotions, including shock, anger and denial.

Negative emotions associated with facing a continuous challenge or life changing situation like visual disability can be stressful. If this stress continues, this can lead to distress. Physical symptoms can be experienced such as, headaches, upset stomach, elevated blood pressure, heart problems, asthma, skin problems, diabetes, arthritis, depression, anxiety and problems sleeping. Research suggests that stress can also bring on or worsen certain symptoms or diseases. Stress can also become harmful when people use alcohol, tobacco or drugs to relieve it.

Stress management coaching could be a useful approach to help those with impaired or partial sight to learn to cope with any distress they may be in, teaching ways to manage stress although not necessarily assuring against it. Developing ways to cope using a resilient mindset could be used as part of an integrated approach to develop/enhance a person’s ability to adapt, through developing and sustaining positive mindsets, enhancing self-motivation and self-regulation and developing the capacity to deal with discomfort and adversity to adapt or integrate into a sighted world. Maintaining good health and nutrition is key to maintaining psychological and emotional health and keeps mind and body primed to deal with difficult situations.

Key Elements to Building Resilience and Maintaining Health

When a disability is congenital or acquired, a person has to adapt because there is no other choice. Adaptation can be accompanied by shifts in self, self-identity, self-worth and value systems. Resilience coaching can help the person progress during their adaptation with the provision of an empathic supportive relationship that ideally develops. Through resilience tools and techniques, a person can develop self-efficacy, enhancing their own belief in their capacity to achieve their desired outcome of the coaching journey.

There are key elements that are essential to building resilience and maintaining optimum health:

Be positive. Resilient people can experience both negative and positive emotions even in difficult or painful situations and tend to find some silver lining in even the worst of circumstances. They find a way to also see the good. Research has found that the repertoire of emotions of people who are highly resilient is remarkably different from those who are not.
See solutions not problems. See challenges as opportunities to grow and evolve. Look at the problem and say, ‘What’s the solution to that? What is this trying to teach me?’
Being of service to others. Acts of kindness and the serotonin boosts that accompany them, have a cumulative effect. Researchers have found that serotonin, the neurotransmitter associated with feelings of happiness and well-being, is used more efficiently by people who have just engaged in an act of kindness. It can be as simple as a quick chat with someone or even a smile that brightens someone’s day.
Maintaining good physical and mental health. A regular routine of healthy habits is foundational to both mental and emotional resilience. Get enough sleep, keep a good nutritional balance. Mental breaks and relaxation also help keep stress chemicals at bay, reducing the likelihood of feeling, or becoming, overwhelmed and reactive. Spend time outdoors and surround yourself with people you enjoy.
Humour. Laughter and finding lightness in even the darkest situations has been found to promote health and emotional wellbeing. This is most likely because it helps to diffuse stress. The stress doesn’t go away, but the body and mind can take a moment to find relief, even in the midst of stress.

Conclusion

While a person can’t always control the circumstances of their health, they do have control over how they interpret and respond to it, meaning they can develop a positive attitude and a sense of purpose. A coach, having a wide range of tools and techniques available, would be able to offer access to a variety of approaches, at the same time as being able to build a ‘rapport’ with the client. Resilience and health/wellbeing coaching can be used in an integrative approach to help people live with long term conditions such as adrenal fatigue and visual disability, by challenging a client to listen to their inner wisdom, identify their values, and transform their goals into action. It can help develop a healthy behaviour change and a can do/can be mind-set by improving/managing resilience beyond managing stress, learning how to cope, thrive with nutrition, exercise and psychological wellbeing. The different approaches could be used during one session or planned over time to work through any different issues the client has.

References

Biographical Note

Anna Cleary Ikin BSc (Hons), RSci, MIBMS, is a HCPC registered senior biomedical scientist in cellular pathology, specialising in ophthalmic pathology.

View Course: Diploma in Life Coaching Skills