BiofeedbackVolume 35, Issue 3, pp. 101-104

©Association for Applied Psychophysiology & Biofeedbackwww.aapb.org

Bio

feedb

ack Ô Fall 2007

101

This article describes a hybrid model of coaching and biofeedback for wellness and health promotion that has been used with more than 4,000 executives. A one-on-one health consultation is described in detail. Executives contend with a high level of job stress along with the stress of everyday living. Quality-of-life issues, satisfaction with life, work-life balance, and psychophysiologic data are gathered. These data lead to the formulation of behavioral goals, an action plan, and stress reduction strategies for each executive seen. Biofeedback adds value to executive health coaching interventions.

We combine coaching and biofeedback procedures during a consultation hour aimed at improving the lives of high-functioning, successful, generally healthy people. We consult with executives presenting to a preventive medicine clinic for a day-long executive health evaluation by a multidisciplinary team consisting of physicians, nurses, nutritionists, exercise physiologists, audiologists, and executive health coaches. For this group of executives, a traditional psychological evaluation intended to diagnose psychopathology is inappropriate. We consult with each executive on a one-to-one basis using a personal and executive coaching model (Auerbach, 2001) that is similar to corporate executive coaching, and we emphasize wellness, behavioral health, and satisfaction with life. There is an expanding role for consultants to offer services for health promotion, including developing a healthy lifestyle (Hershberger, Edwards, & Rudisill, 2005; Miller, 2001).

Work-life balance is the cornerstone of our approach, and it has been readily accepted by the more than 4,000 executives and professionals we have seen to date. Work-family conflict is a wide area of study and important to organizations and high-level employees (Kasper, Meyer, & Schmidt, 2006) because of its deleterious effects on productivity, health, and quality of life. There is growing evidence of crossover effects of work-family conflict on job-related behaviors and performance (Kalimo, Pahkin, & Mutanen, 2002), and in the clinic, we see spillover effects on health status.

The executives we see are a highly educated, predominantly male group, with the majority having a bachelor’s degree or higher. The consultation has four broad components: (a) assessment using self-report and biofeedback monitoring; (b) discussion of work-life health issues; (c) identification of problem areas and identification of areas that aren’t problems but where enhancement is desired, plus setting of goals and development of an action plan; and (d) disposition with self-help materials and follow-up recommendations. By the conclusion of the consultation, an individualized written plan of health goals and an individualized behavioral action plan have been developed jointly by the coach and the client. Each participant also leaves with relaxation CDs and other training materials for stress management.

AssessmentQuality of LifeTraditional psychological measures, including personality inventories, stress symptom inventories, and various screening questionnaires, are available to assess quality of life. We began our program using some of these, but we found that they were not helpful as most scores were well within normal limits. Because we are working with a generally healthy population, we found the use of self-report inventories measuring quality of life and satisfaction with life to be the most helpful. The instrument we settled on is the Pillars of a Balanced Life (POBL), which was developed by Ben Dean, PhD, at MentorCoach, Inc. It consists of 10 self-anchoring visual analog scales assessing quality and satisfaction of life in 10 domains. The client is asked to assign a whole number from 0 to 10 for each domain in response to the single question, “To what degree were your needs fulfilled during the past year in this area of life?” A rating of 10 represents total fulfillment, a rating of 5 represents halfway fulfilled, and a rating of 0 represents no fulfillment. It is emphasized that these numbers are subjective units, solely defined by the individual. The rated domains of life are professional, financial, physical, spiritual, social support,

SPECIAL ISSUEExecutive Health Coaching Consultation to Reduce Stress and Enhance Life SatisfactionJerome F. Kiffer, MA, and Michael G. McKee, PhDCleveland Clinic, Cleveland, OH

Keywords: executive coaching, biofeedback, satisfaction with life, stress, work-life balance

102

Executive Health Coaching Consultation

Fall

2007

Ô B

iofe

edb

ack

intimacy, family, learning/growth, home/office, and play/fun (see Figure 1).

The self-report data on the POBL, after completion by the client, are depicted in the form of a graph. Many graphic patterns that represent the client’s unique experience over the past year are possible. We find it helpful to introduce two prototype graphs to initiate a discussion of work-life balance.

The first prototype graph consists of high scores in the areas of work, moderate scores in loving relationships, and very low scores in the play/fun and home/office areas. This negative slope graph is depicted in Figure 2. This prototype is the profile of the all work, no play approach to life, reflecting overcommitment at work, moderate fulfillment in loving relationships, and a low level of play. The risks of this pattern are burnout and demoralization, consistent with the executive stress syndrome and the sacrifice syndrome (Boyatzis & McKee, 2005). There is an intuitive aspect of this graphic POBL profile that executives seem immediately to grasp: the price paid for high work achievement and overwork with not enough time devoted to other aspects of life. It can be a striking recognition of “what I’m missing out on in life, of the price paid for success.” This is at the heart of uncovering the conflict between work, home life, and personal needs.

The second prototype pattern in Figure 2 is characterized by high scores on work and play but low scores in the areas of loving relationships. This profile puts one at risk for sudden changes in relationships and captures the erosive effects of a high level of marital or relationship strain, potential for divorce, and lack of social support. Again, the graphic V-shaped pattern can signify the price of success in terms of loneliness, isolation, and lack of emotional intimacy, exquisitely capturing a measure of human relatedness, which is a basic human need (Ryan & Deci, 2000). This pattern exemplifies discord between work achievement strivings and needs for intimacy and social connectedness.

BiofeedbackThe introduction of biofeedback equipment changes the focus of the interaction to include the real-time monitoring of physiologic activity. The biofeedback is informal and introduced as a learning process intended to increase awareness of mind-body variables and stress reactivity (McKee, & Kiffer, 2000). Yet standard psychophysiologic profiling can be done to provide information regarding stress reactivity. Biofeedback of finger temperature, heart rate, heart rate variability, abdominal breathing, and electromyography allow an individual to acknowledge the silent physical reactivity that accompanies the interaction with the coach in discussing emotionally sensitive material. We favor using this informal approach because it emphasizes increased awareness on the part of the client of his or her own internal reactions, facilitating the discussion of physical and other symptoms that may be stress related.

The biofeedback process is disarming. For highly defensive individuals, as these executives tend to be, this approach reveals their reactivity in a way that intrigues them and usually leads to a conversational focus on stress-related problems along with self-regulation and relaxation techniques to cope better with stress. We demonstrate and have the client practice relaxed breathing and muscle relaxation. We also use this process as an opportunity to discuss attitudes and beliefs that predispose them to stress reactions.

Work-Life Health IssuesThe results of the two assessment approaches, POBL and biofeedback, set the stage for a discussion of areas of life that require change. The clients have already completed a medical history form that also asks them to rate their job stress as low, moderate, heavy, or very heavy. A great many of our clients deny that the stress affects them. “Sure, there

Figure 1. Copyright 2000, MentorCoach. Figure 2. Copyright 2000, MentorCoachn.

103

Kiffer, McKee

Bio

feedb

ack Ô Fall 2007

is high stress, but I handle it” is a common attitude. Yet this public self-presentation is invalidated when private psychophysiologic information is displayed for viewing by client and coach. Biofeedback provides a window into the interior milieu. Often, just by seeing their own reactivity with biofeedback monitoring, clients become much more open to talking about a variety of stress reactions, such as sleep problems, headaches, escalating blood pressure, temper outbursts, or the general inability to relax.

At this point in the session, the POBL and biofeedback assessment process has led to a collaborative discussion of quality-of-life issues. From a macroscopic perspective, using a numeric rating scale, the client has determined to what degree his or her needs are being fulfilled. From a microscopic perspective, the biofeedback has given information about internal physical reactivity. This dual self-disclosure provides information on values, difficulties, and strengths. Identification of immediate goals and development of an action plan to reach those goals is the next step in the process. Coaching interventions assess work-life balance not only to identify areas of dissatisfaction and areas where even greater satisfaction is desired but to lead to corrective actions (Auerbach, 2001).

Motivational interviewing techniques can be used to cement the collaborative discussion of health behavior change (Miller & Rollnick, 2002). This discussion allows clients to take the lead in identifying reasons for change, organizing goals, and anticipating obstacles. There is evidence that this approach increases the chances for successful behavioral change (Resnicow et al., 2002).

Goal Setting and Action PlanExplicit personal goals that are congruent with implicit motivation are more likely to be achieved and can lead to positive changes in subjective well-being (Michalak & Holtforth, 2006). The process of goal setting is a crucial culmination of the interaction with the client. By this point, clients have increased their awareness through the assessment process and have identified potential areas for improvement. Personal life goals and/or health-related goals are clarified, and specific plans to reach these goals are written down for the client to keep. The simplest approach in using the POBL scores for change is to set as a goal the raising of one or more of the lowest ranked areas. Then, an action plan can be developed to identify small, specific steps leading to enhanced fulfillment.

We use a simple goal-setting form for clients to complete and take home. It requires them to identify a minimum of three specific goals with subheadings involving action steps. We have found that the simpler the goal-setting form, the

better it is received. It is important that goals be specific (Locke & Latham, 2002) and precisely worded. A general goal of “improving my quality of life” is not acceptable. We require a specific goal, such as, “I will spend 5 extra hours with my family every week.” “I need to exercise more” is not acceptable, whereas “I will run on the treadmill for 25 minutes on Monday, Wednesday, and Friday mornings” is acceptable.

The final step is to identify a series of behaviors that can be implemented as actionable steps. Accomplishment of goals is much more likely when the specifics, such as where, when, and how, are articulated. In studies with nonclinical subjects, intentions specifying the where, when, and how of goal pursuit facilitated goal attainment (Gollwitzer & Brandstatter, 1997; Koestner, Lekes, Powers, & Chicoine, 2002). The action plan should include identified obstacles the client may encounter in changing behavior patterns and the corrective steps to be taken. Clients are asked to identify how they will know they have achieved the goal and to identify rewards and incentives for accomplishing their goals as well.

Disposition and Wrap-up of SessionWhat started as a consultation to identify quality of life and current functioning ends with a plan of action for improving the quality of one’s life. Individuals have gone through the process of examining the important domains of life and their personal levels of satisfaction. Goal setting with an action plan has been developed. The final aspect of the session involves giving further self-help materials to aid in accomplishing behavioral goals. We use a wide range of patient education materials on topics such as sleep hygiene, stress management, anxiety management, leadership, life span development, and so forth. By the end of the session, almost everyone we’ve seen has wanted help with stress management and/or sleep, so we give all clients CDs with relaxation techniques for daily use.

SummaryIn summary, executives are seen for a personal consultation to increase self-understanding and enhance health, happiness, and productivity. They rate satisfaction with life in 10 areas, are monitored for psychophysiologic reactivity, discuss these data, and end with developing goals along with an action plan for goal attainment. Each client leaves with stress management materials and an additional individualized packet of informational and self-help handouts, as well as his or her completed goals/action plan form.

Biofeedback appears to add incremental validity to executive health coaching by (a) technological validation

104

Executive Health Coaching Consultation

Fall

2007

Ô B

iofe

edb

ack

of mind-body connectivity; (b) adding valid measures of health variables, especially cardiac data; (c) reinforcing the collaborative partnership between coach and client, thus enhancing rapport; (d) promoting conversation of stress-related topics; and (e) demonstrating the salutary effect of relaxation.

The combined biofeedback and coaching consultation has been well received, with 99% of those surveyed saying they would definitely recommend the consultation to a friend or colleague.

ReferencesAuerbach, J. E. (2001). Personal and executive coaching: The

complete guide for mental health professionals. Ventura, CA: Executive College Press.

Boyatzis, R., & McKee, A. (2005). Resonant leadership: Renewing yourself and connecting with others through mindfulness, hope, and compassion. Boston: Harvard Business School Press.

Gollwitzer, P. M., & Brandstatter, V. (1997). Implementation intentions and effective goal pursuit. Journal of Personality and Social Psychology, 73, 186–199.

Hershberger, P. J., Edwards, J. M., & Rudisill, J. R. (2005). Consultation to help individuals cope with lifestyle modification. Consulting Psychology Journal: Practice and Research, 57, 133–141.

Kalimo, R., Pahkin, K., & Mutanen, P. (2002). Work and personal resources as long-term predictors of well-being. Stress and Health, 18, 227–234.

Kasper, H., Meyer, M., & Schmidt, A. (2006). Managers dealing with work-family-conflict: An explorative analysis. Journal of Managerial Psychology, 20, 440–461.

Koestner, R., Lekes, N., Powers, T. A., & Chicoine, E. (2002). Attaining personal goals: Self-concordance plus implementation equals success. Journal of Personality and Social Psychology, 83, 231–244.

Locke, E. A., & Latham, G. P. (2002). Building a practically useful theory of goal setting and task motivation: A 35-year odyssey. American Psychologist, 57, 705–717.

McKee, M. G., & Kiffer, J. F. (2000). Biofeedback and stress. In D. T. Kenny, J. G. Carlson, E. J. McGuigan, & J. L. Sheppard (Eds.), Stress and health: Research and clinical applications (pp. 163–178). Sydney, Australia: Harwood Academic.

Michalak, J., & Holtforth, M. G. (2006). Where do we go from here? The goal perspective in psychotherapy. Clinical Psychology: Science and Practice, 13, 346–365.

Miller, T. W. (2001). Consulting psychology: A vision for the new millennium. Consulting Psychology Journal: Practice and Research, 53, 3–9.

Miller, W., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press.

Resnicow, K., Dilorio, C., Soet, J. E., Borrelli, B., Hecht, J., & Ernst, D. (2002). Motivational interviewing in health promotion: It sounds like something is changing. Health Psychology, 21, 444–451.

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55, 68–78.

Correspondence: Jerome F. Kiffer, MA, The Cleveland Clinic, 9500 Euclid Av-enue/P57, Cleveland, OH 44195, email: kifferj@ccf.org or kifferj@aol.com.

Jerome F. Kiffer Michael G. McKee