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Dec 17, 2018

Getting Started With Lifestyle Coaching Skills For Stress

by Dr. Dan Kalish

Step One

Use of Questionnaires:

Have your patient fill out Stress Questionnaire and Adrenal Questionnaire and review those to give ideas for direction of conversations you will have. Why do we place this big a focus on stress? Because we are testing and then correcting the stress response by measuring cortisol and in order to do this successfully we need to have a good understanding of what stress levels are currently and what stress they have been under in the past. Use the questions from the questionnaires with your patients.

Who Needs More Than Supplements:

Determining who will respond to adrenal programs with just supplements and lifestyle changes alone and who will need additional help is an initial challenge we face.

I had a patient once who lost both her parents, her sister and her brother and several grandparents - seven deaths total - within an 18 month period. That level of stress will cause us to crash in terms of health and adrenal function. I have had two patients recently who were suffering through having their adult child murdered. A parent can’t recover from this type of stress without our help. Sadly, many patients have had a history of childhood sexual abuse; these patients need professional therapy and counseling work in tandem with our adrenal stress program.

The point here is to identify people in advance who will not respond to our adrenal repair programs alone because they have other issues going on that must also be addressed along with our program. If not spotted early in the process, these patients will become your failures and seem like non-responders to the program when in fact they are complex cases that need more help than we can offer through functional medicine. However, we as functional medicine practitioners can identify these patients and get them the help they need and manage their case. You may be the only health care practitioner able to set up a comprehensive program for them. Your adrenal program will be a critical component in restoring their health.

Step Two

Assessing Current Levels of Stress in Patient Interview:
  • Ask the patient to describe how much stress they are under now and what their current major sources of stress are at the present time.
  • Then ask them about past stresses - what were the most stressful times in their past.
  • Explain to them about the impact of stress on the body including how abnormal cortisol increases our risk for cancer, heart disease, diabetes as well as brain disorders, weight gain, fatigue, depression, GI problems and female hormone issues. Try to uncover all their sources of stress, such as not being happy in their job, being in relationship that is not working well, stress of caring for kids or aging parents and any others they can come up with.
  • Discuss how high their current levels of stress are. Once you have a sense of this, then ask them if these stressors will be on-going or if some are going to be coming to an end. On-going high stress situations will clearly require longer treatment times and we don’t expect the same speed of recovery and same symptomatic relief in the early stages of the program.
  • Brainstorm about ways to eliminate or minimize the on-going stressors.
  • If they do not have much in the way of current stress then the patient should respond as we would predict.

Step Three

Assessing Past Levels of Stress in Patient Interview:
  • Assess your patient’s history of stress by asking them what the most stressful period in their life was. Dig and ask questions along these lines for a few minutes - it takes some time for people’s memories to be jogged. You may need to ask about past divorces or deaths in the family. Also check on alcoholic parents, mental health problems in the family like depression, bi-polar disorder, suicides, alcoholic spouses, abusive relationships - keep digging as much as you are comfortable with.
  • Some people have had relatively normal amounts of stress in their past. In general, those that are chronically ill have had significantly more stress in their lives. Typically, the more advanced their adrenal exhaustion the more emotional stress they have had.
  • Be on the lookout for non-responders early in the process. These people will have a history of extraordinary family based stressors including childhood physical abuse and childhood sexual abuse, alcoholic parents, or parents that were suffering from mental health problems. These early childhood experiences have a profound and lasting effect on physical health and clearly will not be overcome with even the best designed supplement program. Breakout this subgroup of patients and continue to work with them, of course. They need help more than most - get them to the psychological counseling work that they need. They will not respond well to supplement programs and lifestyle changes alone. They will require an interdisciplinary approach in order to heal. A well designed adrenal hormone balancing program will speed their recovery dramatically.
  • The next category is easier to work with. These are people who had relatively normal childhoods and in adulthood went through extreme stress, had a health crisis develop during that period of high stress, and are now in a position to heal and repair. This group will benefit greatly from our programs and may not need any outside counseling or help.

Step Four

Common areas to coach people to reduce stress who are highly functional, do not have extensive psychological issues and just need to chill out:

Get patient to list out in detail their exact schedule from what time they wake up to when they go to sleep. Help them organize their day to inject a new and fresh focus on self-care. Consider:

  • Carving out an hour in the mornings for exercise or extra sleep.
  • Getting childcare coverage for stay at home moms so they have some personal time to exercise.
  • Making it a practice to only check email at work at specific times throughout the day, also limiting meetings and work disruptions to specific times to allow for more focused time for work with less distraction.
  • Refraining from emailing and work after 6pm - 8pm range.
  • Not working on weekends.
  • Taking one Friday a month off work.
  • Taking one week every three months off, as a means of de-stressing. Many people can’t take that much time off, but many can and just need permission to do so. We can grant that by letting them know the time off is the essential component to adrenal recovery and in fact a part of their health program. (Think back in time to the European physicians who would prescribe time at the seaside for recovery.)

Step Five

Key questions to ask:

“When did your health problems first start?” followed by “What else was going on in your life around that time, within a year or two?” You will usually see an overlay between the most stressful period of their life and the onset of their main health complaints. Death and grief and loss are the major sources of stress in most people’s lives. Asking questions about these issues may be uncomfortable at first but over time is well worthwhile. Always check in about addiction and family mental health history.

Every new patient needs to be assessed for addiction issues whether it’s their own personal addiction problems with alcohol, food or drugs or if they have family members struggling with addiction. This subgroup of patients also needs to be broken out separately from our over all patient load as they will require extra attention and will not get well just applying the regular methods. Common examples include food addiction, where the person cannot, despite literally struggling for years, ever completely eliminate gluten and sugar. These addictive behaviors will undermine the success of your programs and these people will not respond as anticipated. It’s best to identify them as early as possible so they can get the help they need from addiction counselors and 12 step programs or your programs will be doomed.

Dr. Dan Kalish

Dr. Dan Kalish

Founder of the Kalish Institute
Dan Kalish, DC, IFMCP, is founder of the Kalish Institute, an online practice implementation training program dedicated to building Integrative and Functional Medicine practices through clinical and business courses.