Wednesday, September 18, 2013


It’s a glorious day here in my neck of the woods.  The summer is on its way out, and the mornings are becoming crisp.  The kids are back in school and in a few days, autumn will officially be here.  The changing seasons are one of the things I love about living in North Carolina.  Each season is unique, and the transitions from one to another always bring a sense of anticipation for the upcoming time of year right alongside a yearning for the waning season and all the gifts it brought.  Every change is like this, it seems – both a beginning and an end.

The past few months have been full of changes for me personally and professionally, and I’ve been thinking a lot about the way we relate to change.  Some changes aren’t choices and so we may seek to develop skills for managing them with some degree of resiliency and good humor.  Other changes are things that we initiate, and even though they may be challenging, we feel as if we have a little more control on how and when they are implemented.

In my work as a nurse practitioner and a health coach, I help people who want to make changes that will enhance their health and well-being.  Before they begin behavior change, though, each client must ask themselves:  “Am I ready?” 

What makes someone ready to make a change?  This question has been researched and studied extensively.  One of the more well-known theories of behavior change, Prochaska’s Stages of Change, describes behavior change as a progressive process made up of five distinct steps:

1)  Precontemplation – The individual is not considering any type of change to his or her behavior. 
Example:  Jeff is a high achiever who gets 5-6 hours of sleep a night.  He keeps himself energized with coffee and energy drinks, and has no intention of slowing down any time soon.

2)  Contemplation -- The individual is considering making a behavior change.  He or she is weighing the pros and cons, but isn’t ready to take action.
Example:  Mary has a very busy life and has noticed feelings of tension, irritability, and fatigue.  She has wondered about trying meditation as a tool for stress management, but she isn’t sure that she can find the time.

3)  Preparation
– The individual wants to make a change and has decided the time is right.  He or she starts to gather information and resources to prepare for the change successfully.
Example:  Steve has just sent his last child off to college.  Next summer, the family is planning a big hiking trip.  Steve wants to be physically fit for the challenge so that he can fully enjoy this time with his family.  He is doing a lot of reading and gathering information about resources that will help him prepare.

4)  Action --  The individual initiates action on the desired behavior change.  This is where the rubber hits the road!
Example:  Lisa has decided that she wants to increase the amount of vegetables in her diet to at least three per day.  She has researched some recipes, made a trip to the farmer’s market, and has menu plan ideas for the week.  She is keeping track of her progress via an app, and the first week is going great!

5)  Maintenance --  The individual has successfully integrated the change into their lifestyle.  They are “keeping the change!”
Example:  David is an enthusiastic gardener and has a big commitment to taking good care of the Earth.  Last year, he started composting as a way to reduce food waste and enrich the soil in his garden.  He tried a few different methods before he found one that worked for him.  He now keeps a small container in his kitchen and has developed a habit of putting his scraps there and adding those to his outside compost bin regularly.

As you can imagine, an individual could be at different stages in the change process for different health behaviors.  People don’t move through the stages at a predictable pace.  Some folks may get “stuck” or may relapse.  In my work, I help clients learn from the challenges they encounter so that they can create an action plan that is sustainable for them.  The whole process, though, is dependent on their willingness to commit to a change.

Here’s an example of how the change process has been at work in my own life:

In a recent newsletter, I shared that I had challenged myself to a goal of being able to do a chin-up by my next birthday.  In my youth, my favorite physical activities were dancing and hiking, and upper body strength didn’t seem that important (precontemplation).  I learned to appreciate the importance of upper body strength as I became a mom and also developed an interest in gardening (contemplation).  As I approach my 50th birthday, I decided to devote more energy to building my strength since I want to be strong and active for many years to come (preparation).  I tried doing body-weight exercises and using a chin-up bar at home, but this wasn’t enough to help me reach my goal.  In working with a medical massage therapist, I became more aware of which muscles were weak points for me.  I also started working with a trainer who helped me identify the specific exercises that I needed, and showed me how to do them effectively (action).  I can now do a chin-up and am using the chin-up bar to maintain the strength that I’ve gained! (maintenance).

As I noted in the beginning, any change is both a beginning and an end.  Taking on my birthday goal has meant that I have had to give up letting myself off the hook for this aspect of my fitness.  On the other hand, accomplishing this goal has given me new strength, a sense of satisfaction and momentum to take on other goals.  It has also helped me fulfill my commitment to being a strong role model for my daughters.

What are the changes that you’ve been contemplating or have already undertaken?  How did you know when you were ready?  I look forward to hearing anything you’d like to share! 

Special Thanks:
In addition to my family, I’d like to extend a special thank-you to two other partners in my health journey -- Christi-Anne Holder of Moonshadow Medical Massage and Tom Davis, originator of the GRAB strength training program at Whole Health Solutions.

Wednesday, May 15, 2013

Elbow Room

If you or your kids have grown up in the U.S.A. in the last thirty years or so, you may remember a Saturday morning educational program called Schoolhouse Rock.  This series of animated musical films covered subjects such as math, English grammar, science, and history.  One of the episodes that I remember was called “Elbow Room”, and it was all about westward expansion in the U.S.  The main idea of the song was about how our need for more space drove us to explore new areas and push our national boundaries farther.  It is an idea that is very familiar in our culture:  We crave spaciousness.

What is it about spaciousness that is so appealing to us?  It seems that there is something about the expansiveness of “wide open spaces” that invites creativity and possibility.  Conversely, when we feel cramped or crowded, we may feel inhibited and limited.  The desire for more spaciousness can show up in the kinds of workspaces we seek, the neighborhoods we choose, or the homes and vehicles we buy. 

Another value common to our culture is the desire for freedom.  We long to make our own choices and are excited about having options!  I would venture to say that a sense of spaciousness is closely linked to our sense of freedom.

There are times when values of freedom and spaciousness may be in conflict – especially when we do not develop healthy self-care practices.  Having more freedom means that we have to make more choices, and sometimes we get tired of choosing.  Choosing takes effort, and when we have too many choices, we can feel overwhelmed. 

In his research on self-control and willpower, Roy Baumeister describes the “ego depletion” that occurs with every decision we make.  Self-control is a finite resource and when we have too many choices to make, we have a hard time maintaining our willpower.

What happens when we are too tired or overwhelmed to choose?  We delay decisions.  “I’ll get to that later”, we think, or maybe we deliberately decide that we want to keep our options open – hang on to that email, piece of paper, clothing, furniture, etc.  Soon, our delayed decisions are encroaching on our space – physically, mentally, and emotionally.

When we feel cramped, we may be tempted to just seek more “Elbow Room.”  Sooner or later, though, expansion becomes unsustainable.  Then what? To maintain our sense of spaciousness, we must increase our clarity about what is most important to us, and create rules about what we will keep and what we will let go.  Then, we must cultivate our ability to “let go”. 

The idea of increasing our clarity and learning to let go may sound simple – but it is not necessarily easy.  Nonetheless, if we want “elbow room” in our lives, these are practices that are worth nurturing.

This month on “The Nudge”, we’ll be exploring the domain of Physical Environment with a discussion about “Clearing the Clutter.”  I hope you’ll join me and guest expert, Elisabeth Galperin at noon on May 23 as we discuss this important part of self-care!

"Elbow Room" From Schoolhouse Rock

Wednesday, March 13, 2013

Spring into a New Beginning

It won’t be long now before the coming of spring – that hopeful time of year when new beginnings are all around us. It is a time of energy and growth for many of us, and it brings a welcome change of pace from the more reflective mood of the winter months.

Before you “spring into spring” though, I encourage you to take some time to be thoughtful about where you will put your energy. It’s no secret that our culture here in the U.S. promotes us to be overly busy. There is always more “to do"! Optimal self-care invites us to take strategic actions that are aligned with our vision and values. When we are clear about what we want to create in our lives, and what is most important to us, it becomes easier for us to know what actions are appropriate.

Do you have a clear vision of what you would like to create for your health and well-being? What would optimal health look like for you? Notice that I said “optimal health” – not perfect health. What you consider “optimal” will be quite personal. This isn’t about perfectionism – it’s about increasing your level of well-being, wherever you are, and making progress towards a level of health that would support you in doing and being all that you feel called to do and be. What would your best life look like?

If you’ve never stopped to ask yourself these questions, you might feel overwhelmed and unsure of where to start. Here are a few suggestions to get you going:

Fill in the blank:

Imagine yourself living a life of optimal health and well-being. If it helps, close your eyes and create a picture for yourself. Then, ask yourself the following questions:

1.  What would optimal health feel like for me?

2.  What would I be doing if I were optimally healthy?

3.  What would be different?

Once you've got your ideas down on paper, you can even turn them into a picture by making a word cloud.  Just cut and paste your words into an application like Wordle or Tagxedo.


Sample Word Cloud
based on my business mission and logo
Draw a picture:

Imagine yourself with a level of well-being that would delight you. Then, get a blank piece of paper and the writing tools of your choice (crayons and colorful markers make it extra fun!). Start to draw a picture with words and/or images that capture the vision you created. There are no right answers. Just allow yourself to play and see what you notice!

For more information about the powerful effect that drawing can have, I recommend Patti Dobrowlowski's TED talk, "Drawing Your Future", available on my resources page.

Make a vision board:

Get a stack of old magazines and start leafing through them. If you notice a picture or a phrase that appeals to you, tear it out. You don’t need to know why it appeals to you. Just start tearing or cutting things out until you have accumulated a stack. Next, get a piece of blank poster-board and start laying the images or words out on them in a way that pleases you. Notice how you are feeling and which selections “resonate” with you most. Once you have everything laid out, glue it down.

  • Don’t want to commit? Pin your selections to a corkboard or secure them with magnets so you can move them around at will.
  • Want to go digital? Consider doing a vision board on Pinterest.  (if you're new to Pinterest, you can get my tutorial here)
  • Want some support? Have a vision-boarding party and let your friends in on the fun!

Creating a personal health vision is a great way to get to know yourself better and to get in touch with your hopes and dreams. In my coaching work, this is the place where every journey towards positive change begins!

There are lots of other ways to increase your self-knowledge. This month on The Nudge, our guest, Lisa Wickham will be leading us in an exploration of the topic “Inviting Wellness through Mind-Body Connection”. I hope you’ll consider joining us for this chance to hear from Lisa and interact with us.

When you think about your own well-being, what is your “dream destination”? Knowing that, where will you put your energy? I’d love to hear what inspires you!

Wednesday, February 13, 2013

Matters of the Heart

This month, those of us who live in the U.S. are especially focused on matters of the heart.  In addition to celebrating Valentine’s Day, we also are hearing lots about how to have a healthier cardiovascular system.

When you think of keeping your heart healthy, what comes to mind?  For many of us, the first things we think about are aerobic exercise (like walking, cycling and swimming) and avoiding unhealthy foods.  Did you know that strength training (or resistance training) is also good for your heart? 

Aerobic exercise (exercise that helps you maintain a target heart rate of 60-85% of your predicted maximum heart rate) has well-known benefits of lowering blood pressure and making your heart pump more efficiently.  The current recommendations from the Department of Health and Human Services are that adults get at least 150 minutes of moderate-intensity (i.e. aerobic) exercise spread throughout each week.  Those recommendations also call for muscle-strengthening exercises (using all of the major muscle groups) at least two days a week.  In addition to causing your heart to beat more quickly, strength training also causes your heart to generate more force.  Both factors make your heart a stronger muscle.  In addition, strength training also improves glucose metabolism and cholesterol levels – additional factors that impact heart health.

For those of you that don't have time to go to the gym (or don't like it), strength training isn’t just about lifting weights.  You can design a strength exercise program at home using resistance bands or body-weight exercises.

Next week, I’m offering a great opportunity for folks to get their questions answered about resistance training. I hope that you’ll join me for this new complimentary program that I’m calling “The Nudge”. Our lunchtime call on February 21 will feature strength-training expert (and my good friend) Dr. Travis Triplett.  You can register for the call here or click here to learn more about Dr. Triplett.  If you have questions, feel free to email me!

May this month bring you new opportunities to take care of your heart – and your heart’s desires!

Friday, January 18, 2013

Put on Your Life Ring!

As many of us are discovering, a large part of our health and well-being depends on our self-care -- the health choices that we make every day.  Self-care encompasses a wide range of choices – from where we choose to put our attention and our energy, to our eating habits, or perhaps how we relate to others, manage risks, and use health care resources.  The good news is that over 50% of chronic disease can be prevented based on the choices we make.  The bad news is that we may feel overwhelmed and unprepared to take on the responsibility of managing our self-care effectively.

As a nurse practitioner and a health coach, it is my joy and passion to assist people in taking on their self-care in a proactive and powerful way.   Becoming an expert in your own self-care is a journey that involves increasing knowledge, deepening self-awareness, building skills, and taking action.  It’s a lot of work – exhilarating work – but work nonetheless!  To support those who are embarking on this journey, I’m beginning a series of blog posts that will offer resources on various aspects of self-care.  These posts are based on my program, Supporting Optimal Self-Care (SOS) for Life, and I hope that you will find them helpful.

Have you ever felt overwhelmed – like you were drowning and having trouble keeping your head above water with all the demands of life?  You are not alone!  In our busy culture, it seems that this feeling is becoming more common.  We are constantly being exposed to new information and new expectations, and it can feel hard to “keep up.”  Unfortunately, when we are faced with challenges, most of us are inclined to work harder and faster, which often only adds to our stress and overwhelm.

The metaphor of “drowning” suggests a powerful solution.  When we’re “in over our heads”, we need a Life Ring  (or life preserver) to keep us afloat.  Without this additional support, we risk having a bad outcome.  When we feel overwhelmed, what is the Life Ring that helps you keep your head above water? 

For me, the Duke Wheel of Health is a great visual tool to accompany the idea of a “Life Ring”.  This model depicts a comprehensive view of different aspects of self-care and professional care that relate to our health and well-being.  I invite you to consider using it as a way to support your health journey! 

Too often, when we are overwhelmed, our self-care goes out the window.  We may stop exercising, fail to get enough rest, eat poorly, ignore our body signals  -- you get the picture.  My experience is that, in order to address stress effectively, we need to increase our level of self-care to help us through the challenges!  The Wheel of Health reminds us that well-being begins with paying attention to what we need and taking appropriate actions in different areas of self-care and professional care to get our needs met.

As you consider the Wheel of Health, I invite you to think about what self-care strategies are most helpful for you when life gets challenging.  Then, the next time you feel yourself “drowning”, remember to put on your Life Ring!

Your well-being begins with YOU!

Wednesday, December 12, 2012

New Year's Resolutions: Dream Big, Plan Small

As we draw closer to the end of the year, many folks start to think about their hopes and plans for the New Year.  The New Year brings an opportunity to recommit to those things that are important to you, or to start something new entirely.  For some of us, we may frame these commitments as New Year’s Resolutions.

The bad news about resolutions is that, too often, our best intentions don’t get us the results that we want. Research confirms that more than half of resolutions aren’t sustained for longer than six months, and some suggest that that percentage is even higher.  If you’ve failed to maintain a New Year’s resolution, or seen someone else fail, you might be inclined to avoid making a commitment.  After all, that way you won’t be disappointed!

The good news is that people who make resolutions are far more likely to achieve their goals than people who aren’t.   In one study, only 4% of people who didn’t make resolutions achieved their goals, as opposed to 54% of people who did make them.  That’s a huge difference!  So, if you’ve got a goal in mind, don’t be afraid to commit.

If you’ve decided to commit to a goal or resolution, research has also found that there are strategies that are more likely to help you succeed.

1.  Little by little – People who break their larger goals into smaller, more achievable ones are more likely to succeed over the long-term.
2.  Celebrate successes – People who reward themselves for the goals they achieve are more likely to continue them.
3.  Get support – Those who share their goals with friends or other support networks are more often successful in reaching their goals.
4.  Accentuate the positive – Those who focus on the benefits of success rather than the risks of failure are more likely to succeed.   For example, someone who wants to quit smoking might focus on the benefits of breathing easier, smelling better, and regaining their sense of taste and smell (instead of thinking about how failure might increase their risk of chronic disease or death).
5.  Track your progress – Those who keep some kind of journal or log of their progress are more likely to succeed. 

These findings are completely consistent with my real-world experience as a health coach, and they probably make a lot of sense to you too.  Making lasting healthy behavior change is a journey that requires inspiration, commitment, planning, and support.  The important take-home message to me is that there are particular steps that one can take to get where you want to go.  It isn’t mysterious, and success isn’t just a matter of willpower.  As I often tell my clients – the goal is learning how to work smarter, not harder.

As you consider your aspirations for the New Year, I hope that you will be inspired to Dream Big and determined to Plan Small.  Dreaming Big will give you the energy you need to get started.  Planning Small will help you overcome obstacles and give you the structure you need to stay on track. 

Dream Big:  Are you ready to inspire yourself? I invite you to join me for a month-long "Picture of Health" event that I’m hosting on Facebook.  Once you join the event, just make a virtual health vision board (using Pinterest as a tool) and then post a link to your board in the comments section of the event page.  Then, please take a look at other boards that have been posted and share your ideas and inspiration!

Plan Small:  Once you know where you want to go, make a personalized plan that works for you!  I invite you to join me for a complimentary teleseminar on December 31 to help you do that.  I’d love to share more strategies about how to “Turn your New Year’s Resolutions into Long-term Solutions”!

So, will you make a New Year’s Resolution for 2013?  As you consider the possibility, let me share a quote by Peter Drucker:  “Unless commitment is made, there are only promises and hopes…but no plans.”

I’d love to hear what commitments that you’re making to your well being in the coming year!

Monday, November 26, 2012

Seven Guidelines for Mindful Eating

How do you nourish yourself?
These days we’re hearing a lot about the power of mindfulness, and its amazing capacity to help us increase awareness, decrease stress and make wiser choices.  Although programs like Mindfulness-Based Stress Reduction (MBSR), originated by Jon Kabat-Zinn at the University of Massachusetts, continue to provide opportunities for individuals to explore pathways to mindfulness, the concept may still seem a bit nebulous to the general public -- particularly folks who aren’t used to the idea of a meditative practice.
Mindfulness and  "The Wheel of Health"

The good news is that mindfulness is something that we’ve all experienced, and it can be cultivated simply.  It is nothing more than “paying attention on purpose”, and it can be developed through formal or informal practice.  Like any habit, mindfulness becomes easier the more we do it.  As a coach, I find mindfulness to be a powerful tool in facilitating behavior change, and it is at the very core of the model that guides my practice.

Mindfulness is a particularly important habit to cultivate with respect to nutrition.  We’ve all heard about the trends – U.S. citizens are becoming increasingly obese, and our nutrition choices are a major reason why.  According to a 2006 study by the Pew Research Center, more than half of U.S. adults estimate that they overeat “junk” food at least some of the time.  Increasing our mindfulness about how we nourish ourselves, is an important first step towards making healthier choices.

Dr. Lilian Cheung, a nutritionist and health promotion researcher at Harvard School of Public Health, identifies seven behaviors that are key to mindful eating. 

1)  Honor the food – In remembering where our food comes from, we enhance our sense of connection to our food and our appreciation of its role in supporting our well-being.
2)  Engage all your senses – Sensory awareness is a mindfulness strategy that, when applied to eating,  allows us to fully experience our nutrition choices.  In addition to helping us slow down, this practice also allows us to notice what thoughts or feelings come up to interrupt our full participation.
3)  Be mindful of portion sizes – When we cultivate the habit of taking smaller portions, we reduce the likelihood of overeating.  Cheung recommends using a plate no larger than 9 inches.  A number of research studies confirm the link between large portions and overeating.
4)  Chew your food – Many of us have trained ourselves to eat quickly, but this habit does not promote healthy nutrition.  Chewing food completely allows us to fully experience our food and to digest it more completely.  It also helps us to eat more slowly.
5)  Eat slowly – Our sensation of being satisfied after eating (satiety), is driven by stretch receptors in our digestive system.  It takes approximately 20 minutes for these receptors to provide feedback to our brains that we are full.  If we eat too quickly, we are more likely to overeat because we don’t sense that we’ve had enough until we’ve already eaten too much.  Studies confirm that eating slowly reduces our food intake!
6)  Do not skip meals – Skipping meals during the day can negatively impact your nutrition plan for a couple of reasons.   Skipping meals alters your metabolism and may increase your risk for diabetes. Also, when you skip meals, you are less likely to make thoughtful food choices the next time you eat.
7)  Eat a plant-based diet – Plants are rich in fiber and phytonutrients, both essential to a healthy metabolism.  In addition, all the fiber that comes with eating plants increases our sense of fullness.  While one can find a wide variety of nutrition advice, all eating plans seem to agree on the value of eating more vegetables.  For an interesting summary about the research on plant-based diets, I recommend viewing the documentary Forks Over Knives.

In this three-minute video, Dr. Cheung shares her perspective about these habits.  It’s well worth your time!

What about you?  Which of these strategies have you tried and what have you discovered?  I’d love to hear what you think!