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Resolving to Be Coached

Resolving to Be Coached

The secret to sticking with your resolutions may be having a coach to help strategize and cheer you on.

My teenage patient looked nervous as I reviewed her glucose readings from her glucometer and her glucose logbook, which people with diabetes use to track their blood-sugar test results. There were a lot of high levels — ranges in the 12’s and 14’s, when the goal was around 7 or 8. The peaks were mostly in the middle of the day and on weekends. (This was in Canada; blood glucose readings of 12 to 14 are equivalent to 216 to 250 mg/dL in the United States.)

“What do you usually eat at home?” I asked. She said that her mother was careful to make her a breakfast that balanced carbohydrates with protein. Her dinners were similar.

“What do you usually eat at lunch?” I asked. My patient started tearing up. She ate whatever her friends were eating in her high school’s cafeteria that day — like spaghetti, hamburgers or pizza, and something like a cupcake for dessert. This was probably what led to her readings being so high.

She had met with diabetes educators before, and she knew what uncontrolled glucose does to a person with diabetes, from speeding up nerve damage in the feet to hastening blood vessel damage in the back of the eyes and the kidneys, to increasing her risk of heart disease.

I knew she could have told me all of that, so lecturing her wasn’t going to help.

Instead my patient needed empathy and the tools to help her make healthier decisions, and part of that required understanding what was important to her, specifically “fitting in” with her friends in high school, the ones who didn’t have a chronic disease. It also would have involved helping her find the motivation within herself to make the change.

But my skill set for helping her was limited, especially on top of everything else I had to cover within our allotted time of 45 minutes.

Research suggests that behavioral and lifestyle factors are a big part of what contributes to chronic disease. In medical training, we learn a lot about the body and how to prevent and treat disease, but little about how we can motivate a patient to change old habits or even stick with a current management plan.

It struck me that what my patient really needed was a coach. At this time of year when many of us have made resolutions to get healthier, working with a health coach might be one way to reach those goals.

A health coach is someone trained in behavior change, who primarily uses an interview style called “motivational interviewing” to help patients see their ability to make change. While some may have clinical training in fields like nursing or medicine, they hail from a wide variety of disciplines or train in health coaching as a secondary career.

As a relatively young field, it’s still finding its footing — for instance, a systematic review found that the definitions of “health coaching” varied widely, though the authors recommended that health coaches take a patient-centered approach to help with goal setting while encouraging self-discovery and accountability.

The evidence that health coaching may spur general lifestyle changes is mounting. A 2018 study looked at clinical trials for coaching for nutrition and weight management and found that over 80 percent of these studies found improvement. And a 2017 study found that coaching can lead to increased physical activity in older adults. Studies suggest that health coaching may also provide benefits for conditions such as obesity and diabetes as well as attention deficit hyperactivity disorder, chronic pain, hypertension and high cholesterol. A recent review found that health coaching can improve quality of life and reduce hospital admissions among patients with chronic obstructive pulmonary disease, and it may help patients to become more engaged in the health care system.

It may even improve health outcomes through encouraging patient adherence to medication.

“Health coaching recognizes that we cannot help people by expecting them to act if that person is not ready to act,” said Leila Finn, a health coach based in Atlanta. “We help people take big goals and break them down into accessible, bite-size pieces — not by telling clients what to do but by helping clients figure out what will work for them.”

Health coaching gets to the heart of what providing good health care is about: acceptance, partnership, compassion, and helping patients feel respected and understood.

Though my clinical training is in pediatric medicine, inspired by what I had read, I recently completed a certificate in health coaching myself. The experience was eye-opening and humbling. I learned new ways of communicating with my patients, specifically ways to encourage them to see their own ability to make lifestyle changes while setting manageable goals. I also learned ways to cheer them on when they reach their goals, without shaming them if they relapse: Both pieces are critical to the process of making sustainable change.

While research is beginning to show the value of health coaching, the principles of communicating with the intent to inspire and motivate are transferable to all health professions — and could reap dividends if taught early on in the training of nursing students, medical students, pharmacy students, and other allied health professionals.

And when I think back to my teenage patient with diabetes, while I was empathetic, that was only half of the solution. The second half could have involved coaching her to see which small changes she could begin to make moving forward. I’m hoping that choosing my words more effectively, even within the pressures of time, may make all the difference for my other patients.

**Originally published in the New York Times**

Could a VR walk in the woods relieve chronic pain?

Could a VR walk in the woods relieve chronic pain?

When pain researcher Diane Gromala recounts how she started in the field of virtual reality, she seems reflective.

She had been researching virtual reality for pain since the early 1990s, but her shift to focusing on how virtual reality could be used for chronic pain management began in 1999, when her own chronic pain became worse. Prior to that, her focus was on VR as entertainment.

Gromala, 56, was diagnosed with chronic pain in 1984, but the left-sided pain that extended from her lower stomach to her left leg worsened over the next 15 years.

“Taking care of my chronic pain became a full-time job. So at some point I had to make a choice — either stop working or charge full force ahead by making it a motivation for my research. You can guess what I chose,” she said.

Now she’s finding that immersive VR technology may offer another option for chronic pain, which affects at least one in five Canadians, according to a 2011 University of Alberta study.

“We know that there is some evidence supporting immersive VR for acute pain, so it’s reasonable to look into how it could help patients that suffer from chronic pain.”

Gromala has a PhD in human computer interaction and holds the Canada Research Chair in Computational Technologies for Transforming Pain. She also directs the pain studies lab and the Chronic Pain Research Institute at Simon Fraser University in Burnaby, B.C.

Using VR to relieve or treat acute pain has been done for a while.

In the 1990s, researcher Hunter Hoffman conducted one of the earliest studies looking at VR for pain relief in the University of Wisconsin human interface technology lab. His initial focus was burn victims.

Movement and exercise

Since then, the field has expanded. Gromala’s lab focuses on bringing evidence-based therapies that work specifically for chronic pain, such as mindfulness-based stress reduction. They have published studies on their virtual meditative walk to guide and relax patients.

Movement and exercise are a key part of chronic pain management in general. But for many patients, it can be too difficult.

“Through VR we can help create an environment where, with a VR headset, they can feel like they are walking through a forest, all while hearing a guided walking meditation,” Gromala said.

The team also designed a meditation chamber — where a person lies in the enclosed space, breathing becomes more relaxed and a jellyfish viewed through VR dissolves.

Each experiment gives real-time feedback to the patient through objective measures of pain such as skin temperature and heart rate. For instance, while feeling pain, skin surface temperature and heart rate can increase.

While pain medications can be important, chronic pain treatment should also address lifestyle aspects, says Neil Jamensky, a Toronto anesthesiologist and chronic pain specialist.

“Physical rehabilitation therapy, psychological support and optimizing things like nutrition, exercise, sleep and relaxation practices all play key roles in chronic pain management,” he said.

Going global

Other researchers like Sweden’s Dr. Max Ortiz-Catalan from Chalmers University of Technology have looked at virtual and augmented reality for phantom limb pain — the particularly challenging syndrome among amputees who experience pain in a limb that is not physically there.

In his study, published in The Lancet in December 2016, Ortiz-Catalan demonstrated a 47 per cent reduction in symptoms among VR participants.

He believes the reason behind it is a “retraining” of the brain, where pathways in the brain effectively re-route themselves to focus more on movement, for instance.

“We demonstrated that if an amputee can see and manipulate a ‘virtual’ limb — which is projected over their limb stump — in space, over time, the brain retrains these areas.

“Through this retraining, the brain reorganizes itself to focus on motor control and less on pain firing,” said Ortiz-Catalan.

With only 14 patients, this was a pilot study, but he plans to expand the work into a multi-centre, multi-country study later this year. The University of New Brunswick is one of the planned study sites.

There’s an app for this

Others in the United States have published their own findings of VR for chronic pain.

Last month, Ted Jones and colleagues from Knoxville released results of their pilot study of 30 chronic pain patients who were offered five-minute sessions using a VR application called “Cool!” — an immersive VR program administered through a computer and viewed through a head-mounted device.

All reported a decrease in pain while using the app — some decreased by 60 per cent — and post-session pain decreased by 33 per cent. The findings were presented in the journal PLoS.

“What was interesting to observe was that the pain decreased for six to 48 hours post-VR experience. It’s not as long as we would like, but does illustrate that relief can be sustained over some period of time,” Jones said.

His team will be expanding the research this year and will also look at how VR can help with the challenging mental health side-effects of chronic pain.

Next steps

Jamensky points out while VR could be a promising treatment one day, one challenge with clinical trials is the dependence on looking at pain scores when assessing the effectiveness of VR. This may overshadow individual patient goals.

For instance, while the ability to decrease any individual’s pain score from a “seven out of 10” to a “three out of 10” can be challenging, improving functionality and quality of life can often be more valuable to the patient.

“A pain score may not always be the best way to assess treatment success, since the therapeutic goal may not be to eliminate pain or improve this score, but to ensure better sleep, better mobility, improved mood or even an ability to return to work,” he said.

VR as a technology for chronic pain management is in its infancy. Gromala notes that further research, in addition to standardizing the VR delivery devices, is needed before it becomes a standard of care. And future studies must include practical outcomes.

“It is important to realize that the ‘pain’ of chronic pain may never go away, and that ultimately the individual must learn to deal with the pain so that they can function better,” Jamensky said.

Gromala agrees.

For her, developing an awareness for how sleep, mood and exercise affect her own pain experience has made a huge difference.

In fact, it has motivated her to continue both advocating for chronic pain patients and to partner with clinical pain specialists on research.

” ‘Taking care of yourself’ means a different thing for chronic pain sufferers. It’s much tougher,” Gromala said.

“So as researchers we have a big task ahead of us, and sometimes it means exploring whether out-of-the-box methods like VR can help.”

**Originally published on CBC.ca**

How Sound Baths Ended Up Everywhere

How Sound Baths Ended Up Everywhere

“Bring yourself back to your awareness,” said Sara Auster, a self-proclaimed sound healer, after 45 minutes in a ballroom at a hotel in Chicago where she created vibrations using crystal bowls and tuning forks as well as a traditional Indian accordion, known as a shruti box. Seventy-five people got up like a gaggle of toddlers being shaken from a nap.

The session, which cost $30, and was like many popping up in churches, community centers and even some prisons and hospitals. The goal, practitioners say, is to use sound to tackle individual and collective anxiety, depression, insomnia and more.

Recently, musicians like Erykah Badu and the Icelandic band Sigur Ros have also dipped into sound healing.

Over in the tech world, mindfulness is deeply in vogue. Jack Dorsey, the chief executive of Twitter, swears by meditation. Since 2016, Ms. Auster, 40, has been invited as well to perform for various Google company initiatives. This past April, Adrian DiMatteo, a musician in Brooklyn who has a degree in jazz performance, led a sound bath in the neighborhood of Greenpoint for leaders at Instagram. (“They approached us to do a corporate bonding event, as they’re moving towards doing more events without alcohol,” Mr. DiMatteo said. “They had lots of questions about the instruments and the bowls.”)

Some health facilities have taken note as well. Ms. Auster has performed for Harlem House Clubhouse, an outpatient psychiatric rehabilitation program at Harlem Hospital in New York. Darren Austin Hall, a ceremonial musician and sound healer in Toronto, has performed in the atrium of Toronto General Hospital with a Canadian organization called Music Can Heal.

The Children’s Hospital of Philadelphia has also discussed incorporating sound baths. Mr. DiMatteo has offered them in the waiting area at NYU Langone through a program called Music That Heals, as well as at Coney Island Hospital and “about a dozen others,” he said.

Diane Mandle, who has offered sound healing in Encinitas, Calif., for 19 years, said: “It’s not curing, it’s healing.” She has also provided sound sessions in an oncology unit at Sharp Memorial Hospital in San Diego, as well as at a workshop for inmates at the Vista Detention Center.

“Healing is an ongoing process that contributes to a better sense of well-being,” Ms. Mandle said.

What are sound baths?

Sound baths are an experience in which a group of people gather, often while lying on a mat, to listen to sounds produced through various instruments. There is no licensing procedure for leading sound baths, and though Ms. Auster wouldn’t say where she received her training, her music background and meditation training are strong influences.

For centuries, various cultures, including my own, South Asian, have used sound as a part of religious ceremonies and prayer, with one goal being to promote and facilitate meditation. In that sense, it’s not terribly different from singing hymns in a church. Most religions and cultures use music and sound for spiritual reasons.

But what about the promise of healing? After all, the use of sound is advertised as an activity that can do many things, including “realigning your chakras” and “mind expansion.”

“Personally I have an issue with the word ‘healer,’ which is why I turn down a lot of wellness events,” Ms. Auster said. “There are all sorts of expectations with that label, and I don’t want to be seen as some magical guru person or for people to assume they could not possibly have an understanding of the experience.”

Like other forms of music, sound baths bring people together, but with an added meditative element. Anaïs Maviel, a musician in New York, said that she is often asked to perform for grass-roots organizations as part of “community-building” efforts.

Does sound have an effect on our health?

One way sound is related to health is through noise pollution: traffic noise, planes flying overhead, loud concerts. The World Health Organization lists noise pollution as an increasing threat to human health, and recently set limits on environmental noise.

This may also explain the boom in A.S.M.R. — soothing sounds that, like sound baths, aim to address stress and anxiety. A.S.M.R. has become an internet phenomenon, particularly on platforms like YouTube.

Sound, in the form of music, has been used for various conditions, including dementia. As Oliver Sacks wrote in his book “Musicophilia,” a variety of neurological conditions including symptoms of dementia and psychiatric conditions like depression and schizophrenia may also benefit from music.

But where is the evidence for sound baths? It’s unclear when “sound healing” was first used. However, medicine has used the concept for years specifically for acoustic therapy for tinnitus, a condition that involves hearing unwanted noise without a clear stimulus.

With tinnitus, essentially, the brain perceives sound as entering the ear, even though there is no sound. It is similar to phantom pain in that regard: a situation in which there is a misperception that can cause immense grief.

Often described as “acoustic therapy,” sound healing was listed as an appropriate treatment in clinical practice guidelines. But this therapy involves neither bowls nor chimes. It is typically a form of low-frequency white noise played through a hearing aid or through an app.

A 2013 study of tinnitus, led by David Baguley, a professor of hearing sciences at the University of Nottingham, listed acoustic therapy as one of several interventions. However, in December 2018 a review of existing studies found no evidence of using sound versus placebo for tinnitus.

“Well, the absence of evidence doesn’t mean absence of benefit,” Dr. Baguley said. He also noted that some patients choose calming nature or ocean sounds as opposed to white noise, which could overlap with the suggested benefits of sound baths.

“It’s more than just a distracting noise,” Dr. Baguley said. “We know that sound has a massive influence on how the brain is organized.”

So, do sound baths actually heal?

A 2014 study found that for patients being weaned off mechanical ventilation, providing them with sounds of nature significantly reduced agitation and anxiety, as measured through heart rate, expressions of pain and blood pressure, when compared with patients who did not listen to these sounds.

More recently, a research psychologist reported that singing bowl sound meditation was helpful in reducing tension, depression symptoms, fatigue and anger in a group of 62 adults.

So far, the evidence for sound healing is limited, and is aligned with what we know about the effects of calming music and the benefits of meditation.

Ms. Auster also believes that one of the biggest benefits of sound baths is that they facilitate community.

“It’s people coming together to release and let go, but in the company of others around them,” she said. “If meditation is taking the stairs, a sound bath is taking the elevator.”

**Originally published in the New York Times**

4 Mindfulness Practices Your Kids Can Try

4 Mindfulness Practices Your Kids Can Try

For youth and children, there is a plethora of scientific evidence for mindfulness practices in this group, allowing programs to develop evidence-based initiatives for schools, while also incorporating evaluation of their programs.

Mindfulness has been defined by Susan Kaiser Greenland as “the capacity to be alert and open to life experience as it occurs in a non-reactive, resilient, and compassionate way.” Popularized in the west by Dr. Jon Kabat-Zinn, mindfulness may also be described as “paying attention on purpose, in the present moment, nonjudgmentally.” While secular, it derives its origins from Hinduism and Buddhism and has gained popularity in recent years, both as a tool for self-care but also within structured initiatives to manage stress, anxiety, and depression.

There have been a number of studies looking at the effects of mindfulness for a variety of things — anything from stress, overeating (and eating disorders involving food restriction), memory, and self-esteem. In particular, for youth and children, there is a plethora of scientific evidence for mindfulness practices in this group, allowing programs to develop evidence-based initiatives for schools, while also incorporating evaluation of their programs.

New initiatives such as MindupMindfulness in Schools, and Mindfulness Without Borders have flourished, as they offer unique curricula that can be used in the classroom to improve mental health and coping strategies among students.

Over the last two years, books such as A Still and Quiet Place by Dr.Amy Saltzman and The Mindful Teen by Dr. Dzung Vo have provided teachers, parents, and healthcare providers with techniques to incorporate mindfulness practices with children and youth.

This past summer I had an opportunity to complete a facilitator workshop with Mindfulness Without Borders (MWB), a Canadian charity, that teaches youth, educators, professionals and parents essential skills and strategies to increase attention, regulate emotions, build resilience, and be more compassionate towards others in a high stress world. The workshop focused on their robust evidence-based curriculum on mindfulness techniques for youth, and prepares facilitators to lead what is traditionally a 12-session workshop in classrooms and other youth settings. MWB’s programs are active within the Toronto Catholic District School Board, YMCA Academy, select Toronto District School Board High Schools and the York Regional Police. There is an upcoming training in Toronto through the Applied Mindfulness and Meditation Program at the University of Toronto, and a number of online opportunities to learn more about mindfulness techniques for youth on the website.

Here are just four of the techniques we covered, that are described in more detail on the MWB website. They can be tools to use on yourself, or with a child or youth in your life who expresses interest. I have linked to an audio example of each practice below.

1.Mindful Listening: This technique brings awareness into the way we typically listen (usually with a purpose and agenda to formulate our own responses), and encourages us to stay open to the speakers perspective while releasing our own personal agendas.

2.Tuza: Tuza means “slow down and relax,” in a Rwandan dialect, and is a breathing technique used to restore a sense of calm and balance in challenging situations.

3.Take Five: This is a breathing technique intended to center our mind and our breath (both which tend to become frantic during stressful situations), bringing regularity to our breathing. It begins with a deep inhale, a pause, and a slow exhale, followed by another pause. This can be repeated at least four other times (hence “take five”) in overwhelming situations.

4.Body Scan: The body scan is a popular mindfulness technique used anytime during the day, and can be particularly helpful before sleep, in an effort to relax the mind and body. This tool involves “intentional attention” placed on one part of the body at a time, encouraging openness and curiosity.

 

**This blog was originally published on Huffingtonpost.ca**

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