Who inspired Dr. Beth Frates to passionately pursue lifestyle medicine? How does she empower her patients? What motivates her to stay on track with her optimal health plan? This interview takes you through the steps to ENVISION optimal well-being to BE AWARE and then TAKE ACTION!
Beth Frates, M.D.
The “COACH APPROACH”
“Do this, not that!” This type of demanding dictator approach does not empower people to make sustainable lifestyle changes. People need to exert their own autonomy, feel a connection with another person, and feel competent in order to stay motivated to make change and meet goals. This is described in Ryan and Deci’s self-determination theory. Instead of the demanding dictator approach, the COACH approach is more effective when working with people who are trying to lose weight, start an exercise program, . This approach uses collaboration and negotiation to help people identify their own motives to make a change and to craft SMART Goals that are Specific, Measurable, Action Oriented, Realistic, and Time-sensitive. The COACH is a mnemonic that stands for
C = curious
O = open-minded
A = appreciative
When we are communicating with others and working to empower them to make healthy lifestyle changes, we must remain curious about the person’s motivations to change, their past successes as well as failures, their goals and their vision of themselves in the future. Then, whatever their answers, we must stay in a space of non-judgment and keep an open-mind. If we try hard enough, we can find something positive in what they are saying. We can appreciate any past successes or steps in the direction of healthy change. When people reveal their problems and vulnerabilities, we can express compassion and a strong desire not only understand but also to help. No matter what the situation, we must be honest. We can treat delicate matters gently, but we must tell the truth. When we embody these characteristics, we are “being” a helpful coach. These are the “being” qualities of a coach.
“Being” coach like is important and “doing” the work of a coach is equally important. The doing follows a five collaboration cycle which can be used in any situation requiring teamwork. Here are the 5 steps
- Express empathy
- Align motivation
- Build confidence
- Set SMART goals
- Set accountability
The first thing we need to do when working to empower someone to change is to express empathy. Listen carefully to not only the words they are saying but also their body language, tone of voice, and facial expressions. This helps you to fully understand the person in front of you. After you have expressed your empathy by reflecting what the person said to you and saying “It sounds like you had a really hard time when your father died,” or something that accurately recaps what they shared with you. The next step is to ask the person, “What makes you want to make this change now?” Let them speak. People like to be heard. After they have determined their motivators for change, then it’s time to build their confidence so that they are empowered to make the change. This can be accomplished by asking them to list their strengths and if they can’t so that then invite them to tell you about a time when they were successful reaching a goal. Again, listen carefully and help the person identify their strengths from their story. The fourth step is to help the person create their own meaningful goal that is specific, measurable, action oriented, realistic and time sensitive such as “I will eat healthier this week by cutting out sweets and replacing cakes, cookies, and candies after dinner with a piece of fruit.” And, the final step is to set accountability. Make sure to set a time for another check in either in person, by email or text when the person will report to you how they did. When they do report back, the cycle starts again and the first thing you do is express empathy.
This COACH Approach can be used with colleagues, friends, and family members who long to make a change in their lifestyle. It can also be used for meeting goals outside of lifestyle too. The approach is a collaborative way to help people take steps towards the best version of themselves at work or at home.
Beth Frates, MD, is trained as a physiatrist and a health and wellness coach. Her expertise is in lifestyle medicine, and she works to empower patients to reach their optimal level of wellness by adopting healthy habits. Elected to the Board of Directors of the American College of Lifestyle Medicine (ACLM) in 2016, Dr. Frates is helping to shape the scope of this new specialty. She is an award-winning teacher at Harvard Medical School and developed and taught a college lifestyle medicine curriculum at the Harvard Extension School, which is one of the most popular courses offered at the school. As the Director of Wellness Programming at the Stroke Institute for Research and Recovery at Spaulding Rehabilitation Hospital, Dr. Frates has created and implemented a twelve-month wellness program for stroke survivors and their caregivers. She is co-author of the book, Life After Stroke: TheGuide to Recovering Your Health and Preventing Another Strokeand co-author of three chapters on behavior change in different medical textbooks, and multiple journal articles on lifestyle medicine topics including exercise prescription, connection prescription, lifestyle medicine case series, and walking meeting for sustained weight loss. She shared a lifestyle medicine syllabus, which can be downloaded through the ACLM website, in hopes that her work can serve as a template for other instructors and professors hoping to teach a course in lifestyle medicine. Dr. Frates is the co-author of the Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits.For the past 9 years, Dr. Frates has been the faculty advisor for the Lifestyle Medicine Interest Group at Harvard Medical School, and she works with the Professionals In Training (PiT) group at ACLM to help create more LMIGs in medical schools and other health care professional training schools. Dr. Frates is passionate about developing programs focused on lifestyle medicine and wellness.
Let’s face it. “Earth is a tough place!” We all are trying to face each day with the best intentions for our best physical and mental health for ourselves and others at a time that is feeling like “The Era of The Sociopath.”
Tune in for tips, tools and more:
***Here is the article I wrote in preparation for the launch of a mental health awareness initiative at NBA Summer League:
As a society we are starting to have discussions that are long over due. Every day the news reports a new spin on what is going on in the world of mental health, addiction and mental wellbeing.
This is a hot topic for all of us and thankfully our Ambassadors of Change (Owners, Commissioners, Coaches and Players, Fans) are rising to the challenge of being role models and strategic thinkers as to how we can think, talk and act about mental health in new ways.
This past March Nation launched an article, “Does the NBA Have a Mental Care Crisis On Its Hand” by sports editor Dave Zirin.
It starts, “Last weekend, NBA Commissioner Adam Silver spoke as a panelist at the MIT Sloan Sports Analytics Conference in Boston. He was asked by Book of Basketball author Bill Simmons why so many NBA players seem, for lack of a more exact phrase, “unhappy.” Silver’s response was quite unexpected. Instead of a canned answer about how players are actually feeling hunky-dory, and accusations that Simmons was just talking “fake news,” Silver said, “We are living in a time of anxiety. I think it’s a direct result of social media. A lot of players are unhappy.”
He then went on to speak about the depth of the sadness, isolation, and even depression many players feel. He also said that players sometimes reach out to him on the road to discuss their feelings. “I’m an anxious person myself,” he said. “That’s why the players like talking to me.””
Not surprising as anxiety disorders are the most common mental health challenge, they affect 40 million adults in the United States every year, ~18% of the population.
According to the April 2016 Center for Disease and Prevention Report, the number of suicides have been on the rise since 1999 in everyone between the ages of 10 and 74. In 2014, 13 people out of every 100,00 took their own lives, compared with 10.5 persons in 1999. The suicide rate increased every year from 1999 to 2014 among both women and men and in every age group except those 75 and older.
I am not sharing these statistics to instill any fear, just the opposite.
Awareness about the importance of OUR mental health is the first step in taking action.
This is why it is paramount to have the discussion about mental health in new ways, with less stigma , and with less shame.
Empowering ways of talking about our feelings and our inner world, “our mindscape”will give people permission to lead their best life not only physically but mentally too.
This is why I introduced the term neurostyle defined as “The unique way in which we each process and perceive the world.”I wrote an article in this magazine,“Embrace Your NeuroStyle”to further give examples as to how to use this neutral and nonjudgmental term.
WE can all come together with new ways of thinking, talking and acting about mental health that allows education, prevention and early intervention.
Since anxiety is such a hot topic Susan asked me to dive deeper on this discussion.
Here we go:
What Are Anxiety Disorders?
Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention.
Anxiety disorders differ from normal feelings of nervousness or anxiousness, and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect nearly 30% of adults at some point in their lives. –American Psychiatric Association
There are different types of anxiety and usually when someone comes to see me they have a combination of symptoms and more than one type.
Here are the types: Social Anxiety Disorder , Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder, Specific Phobia, Separation Anxiety Disorder
Here are the most common ways anxiety can present:
~ you care too much about what other people think
~ you have a specific fear (public speaking)
~you have generalized worry about the future that is so excessive that you are often missing out on the now moment
~you experience physiologic symptoms of panic, elevate heart rate, sweaty palms, stomach upset
~you obsess over thoughts in a way that is distressing and distracting
~you are distressed from separating from a loved one
When do I seek help if I am anxious?
There are different ways to view stress and the energy can be used to motivate us to meet a deadline, shoot the three pointer, or to have other “healthy adrenaline rushes”to reach optimal performance.
You can seek a performance coach for all different athletic, personal and professional goals to reach your thrive potential to deal with routinechallenges and stress.
An anxiety disorder goes beyond normal stress as it can be so debilitating that the symptoms get in the way of day to day life over a period of time.
Do not self diagnose as you can go down the wrong path for years and miss out on a greater quality of life.
For moderate to severe anxiety working with a cognitive behavioral therapist or a psychologist can be the first step to take.
What happens if I have done therapy for six months and I am not making progress?
If you have been in cognitive behavioral therapy, engaged in a type of performance coaching or other therapy and you are still suffering with distressing anxiety a medical assessment by a psychiatrist needed.
The evaluation includes a biological, psychological and social perspective to see why you are not improving. Routine lab work is done to make sure your thyroid is ok and to rule out any other cause for anxiety. A thorough family history and genetic factors are addressed.
What role does social media have on anxiety and our mental health?
This could be an entire article itself.
I can tell you from my clinical practice that a lot of social exclusion and cyber~bullying are trigger factors for unhappiness, depression, anxiety and suicide attempts that lead people to seek my help.
So social media use is definitely an influencer on our anxiety and depression levels yet it is difficult to make a precise correlation as our mental health is influenced by biological, psychologic, social, and cultural influences.
I will say it is interesting that increased suicide rates across all ages from 1999 to 2014 happen to coincide with the time of greater internet and social media use.
Social exclusion and peer pressure was discussed by NYU psychiatrist Dr. Jess Shatkin in his book Born To Be Wild , “To the brain and therefore to us, emotional pain due to social exclusion feels just like physical pain.”
He summarized Dr. Naomi Eisenberg’s study that involved putting college students in an fMRI scanner and had them play a computer game called Cyberball in which they thought they were having peer to peer play and it started out friendly and then quickly someone was left out.
The MRI results were intriguing, “The regions of the brain that process physical pain are the same ones that get activated when we experience social exclusion.”
Can you imagine if we were to do an fMRI study that revealed the physical and emotional pain of social exclusion with excessive social media use? We would then have a more precise answer on the direct influence of social media.
My social media advice is “less is more.”Social media is here to stay. So we need to be more mindful as to how we interact with one another and learn to self regulate with “digital detoxes”and screen free time.
Log off and spend time outside, go to the gym. When you do engage in social media be precise and kind with your words as often as possible. This will reduce stress and anxiety.
We also need to remember we still have a long way to go on destigmatizing the talks about mental health as Dave Zirin’s article further points out , “Yet not everyone was feeling Silver’s support for players and their mental-health travails. NBA Hall of Famer and media maven Charles Barkley on ESPN’s morning show Get Up!
“That’s the stupidest thing I ever heard any commissioner say. Listen…these guys are making $20, $30, $40 million a year. They work 6, 7 months a year. We stay at the best hotels in the world. They ain’t got no problems. That’s total bogus.”
Charles Barkley you have got this wrong.
I have multimillionaires, athletes and entrepreneurs that have sought my consultation that definitely do not escape mental health challenges and have fatal suicide attempts.
I can tell you that when someone seeks professional help there is no amount of money that can “wish away” their symptoms.
If you or a loved one has never suffered with a mental health challenge you might not be able to wrap your head around the topic of anxiety or mental health.
It is important to keep an open dialogue about these life saving discussions at the right moment…. NOW!
Are you ready to be inspired?
This week’s show is with “The Sports Doctor” aka Dr. Bob Weil.
He is a sports podiatrist specializing in custom orthotics treating kids, teens, and adults including an impressive roster of professional and Olympic athletes.
I want to personally congratulate Dr. Bob Weil as he was inducted into the National Fitness Hall of Fame this summer for his decades of devotion to sports medicine!
Dr. Bob hosts The Sports Doctor live weekly on bbsradio.com/thesportsdoctor with famous guests from around the globe including athletes, coaches, physicians and other key influencers in the sports world.
He is passionate about discussions of holistic health and integrates a mind, body and human spirit approach in his office, on his show and truly walks the walk (no pun intended!)
He and I love discussing “The Mental Game!”
In my blog post entitled “Be Empowered! Our Words, Thoughts and Actions Matter” I discussed the power of words and how one FEELS when we use different words.
I wanted to share how I talk about the topic of profanity in my office as well as how I handle this topic in my own home.
In the show I mention that I love data and I appreciate this article in Quartz entitled, “A linguist’s love letter to profanity explains why it’s fine to curse around kids.” The article goes on to talk about UC SanDiego Professor of Cognitive Science, Benjamin Bergen’s scientific findings that he includes in “What the F: What Swearing Reveals About our Language, Our Brains, and Ourselves.”
When you read the article Professor Bergen explains that data is lacking on this topic as it is not easy to get parental consent for a controlled study exposing children to profanity.
“As for everyday four-letter words, there’s no scientific proof that exposing children to “ordinary profanity-four-letter words-causes any sort of direct harm: no increased aggression, stunted vocabulary, numbed emotions or anything else,” writes Bergen.
We need to remember that the words we choose are surrounded around by a context of circumstances in any situation.
A shout out expletive while being cut off in traffic can impulsively just happen, that is how my son learned the F Bomb from me.
Everything in life is a lesson. We have daily opportunities to reflect, to teach, and to engage in discussion with our children about the quantity, quality and context in which words are used.
This is part of mindful parenting.
I brought up my 2018 fraud inspired “Don’t Fuck With My Kindness” mantra in the show. It is a phrase that you do not even need to say out loud, you can just choose to think it to yourself.
Creating your own mantra can serve as an emotional release of anger, fear, betrayal and can then be alchemized into “compassion in action” towards yourself or others in real time.
You can use the power and energy of any situation to “level up” and this may include or not include profanity.
“Be Loving. Be Kind!” Is my daily no profanity mantra that keeps me in the space of grace.
I reserve the use of the F-Bomb for specific occasions to allow a release of an intense emotion. I discuss this in my office, on my show and in my home.
Our words, thoughts and actions are powerful. Being aware in the moment of the words we choose is a game changer. Choose wisely and with discernment.
This short and sweet show briefly discusses adaptive vs. restrictive perfectionism. I was about to interview a guest and they were not available. I thought this is a great topic to address “in real time” when my day shifted from original plan.
Part of reaching our own top 1% mentally, physically and spiritually is being able to adapt when situations, challenges or successes do not go our way. It is how we react and the mindset we are able to have when we go through life that defines our happiness.
I have a confession to make.
Every time I write or say the word disorder when it comes to mental health it is like nails on the chalkboard to me. I am not kidding, and this is after twenty years of practicing as a psychiatrist.
Why is this?
My patients tell me that at times it feels shaming or embarrassing to talk about their inner world as being disordered. Once they have medical or psychological clarity as to what is going on with them they want new ways of talking about their mental health.
I know the way we talk about our mental health can be a huge factor and a game changer in the healing process for individuals and as a collective.
After the first session with my patients we start using qualitative words like “my mood, my thoughts , my anxiety, my nutrition” and usually drop the word disorder.
Diagnostic labels are great for insurance codes and scientific uniform discussion but are not “launch into thrive” mindset words for every day use.
Now I am not saying that my patients never use the descriptor “my anxiety disorder” when explaining to love ones what is going on in their inner world. It can be very empowering once you meet with your doctor to find out your path to mental wellness.
It is a very personal decision about who you want to talk to about your mental health.
I know from my Twitter, FaceBook and Instagram followers many people and mental health advocates feel very comfortable talking about their depression, bipolar, anxiety or ADHD with the masses on social media.
It can be healing to read a post and connect with someone that is experiencing what you are. Thankfully many celebrities , athletes and cultural icons have opened up this discussion and it has given us permission to do so in more open forums.
The experience of 40,000 hours of listening, empowering and seeing people go from crisis to thrive in any situation psychologically has given me real life knowledge as to what is the “aha moment” to someone reaching THEIR own thrive.
Think in terms of reaching your own top 1% during any given challenge.
THE key component to success is a healing mindset to facing the suffering head on.
I have discussions to empower my patients about the power of our words, thoughts and actions.
How do I do this? Here we go…
I ask that you pause while reading this and say out loud
Now say the word “Wellness.”
Pay attention to how you feel after you say each of these words.
I feel hopeful after I say wellness, don’t you?
An awareness of our emotions and physical sensations around the words we choose is part of the healing or wellness process daily whether we suffer with mental illness or are just trying to have our best day.
So I engage, coach and inspire my patients and my followers to pay attention to their own way of choosing words, thoughts and actions that can contribute to their daily mental health no matter what challenge or success they are facing.
Why am I making such a deliberate point of the power of our words, thoughts and actions?
Our inner world and outer world greatly influence our physical and mental health and wellbeing.
Have you heard of the word epigenetics?
“Epigenetics is the study of cellular and physiological traits, or the external and environmental factors, that turn our genes on and off, and in turn, define how our cells actually read these genes. It works to see the true potential of the human mind, and the cells in our body.”
~Bruce Lipton, Stem Cell Biologist, Author Biology of Belief
We all want to reach our optimal potential, right?
Think of the thoughts and words you choose as having their own living, breathing energy over your personal success and wellbeing.
Then we need to take action in engaging in the world to create our own unique THRIVE ENVIRONMENT:
~the anti~inflammation foods we choose to influence our microbiome
~ the exercise we engage in
~ the amount of sleep we get
~the practice of mindfulness or meditation that works for us
~the quality time with loved ones
~the quality and quantity of time we spend on social media
~time in nature
~the acts of service we do
~the purpose we have each day professionally
The list goes on.
The importance of this discussion is that we were initially told that it was a 50% genes 50% environment split that contributes to best health and wellness outcomes.
It is thought by many leading scientists, doctors, spiritual leaders that our environment greatly interacts with our DNA to influence optimal outcomes, some say it can be up to 80% environmental influence on optimal genetic outcome with an individuals DNA.
I am here to tell you that WE can all reach our own personal thrive as our words, thoughts and actions greatly influence having our best life!
Quick thrive stories I have seen in my practice:
~Athletes that have struggled with ADHD and anxiety now striking their thrive with nutrition, fitness and minimal medical intervention & are now reaching their A game.
~A person going from multiple suicide attempts and treatment resistant depression to now being married, working and happy with kids and life.
~A person with schizophrenia that was an addict and on the streets to now having his own business with a wellness plan that includes meditation, rock climbing, cardio, sobriety, & medical treatment.
~A teen being bullied with autism spectrum and anxiety that is now a Ph.D., happily married working and with friends.
Let’s stay hopeful and remember that OUR words, thoughts and actions about any challenge or success we are facing greatly influence OUR outcome.
BE empowered to reach you own personal thrive!
Denise McDermott M.D.
Who Am I? Mikah Maly-Karros, LMFT discusses her transition from NCAA Basketball Star to Beverly Hills Therapist
We all agree that athletes are an integral part of our culture as leaders and as ambassadors of change.
As a former Division I basketball player and the daughter of famed L.A. Dodger, Eric Karros, Mikah possess a unique understanding of sports psychology and the impact of transitioning beyond the court.
Mikah Maly-Karros is now a Licensed Marriage and Family Therapist practicing in Beverly Hills and Redondo Beach and has an out of the box and fresh perspective that she brings to her teen and millennial clients.
Thank you Mikah for sharing your journey with us!
I am so excited to welcome Dr. Denise Berger on the show this week!
Her dissertation was on Corporate Social Responsibility, “Doing it the Right Way!”
She walks the talk!
I have witnessed her integrative social conscious teaching style first hand as I have had the honor of being a guest lecturer at her “Leadership and Service” class within the Master’s program for Social Entrepreneurship and Change at Pepperdine’s Graduate School of Education for the last three years.
Recently she has launched her new company Aliki Designs which has a give it forward together initiative with each jewelry piece. Listen to the show to hear more about this “altruism in action” vision that she and I align with:
I am appreciative of and humbled by the invitation to be on Dr. Denise’s podcast. When Dr. Denise and I were talking, I shared my favorite ancient Greek quotes: “a society grows great when old people plant trees whose shade they know they shall never enjoy.” This quote establishes a foundational intention for my work and in my life. It helps me to lead with gratitude for the potential of what is in the now,and the meaningful impact we can have – in the present – on the future. This thinking dovetails elegantly with what Dr. Denise mentioned as her values: awareness, self-love and altruism. I believe our shared values is what created the synergy for our ongoing conversations – both as co-creators and as conversationalists.
Yes, that does sound lovely, doesn’t it! Ideal, utopian, and just neat. And let’s be even more frank. I get to have these views because I won the birth lottery and have had access to privilege my whole life. So, I have not lived at the bottom of the proverbial pyramid where lofty self-actualized goals come sparingly. By the same token, I have not led the elite silver platter life either. I have worked hard to earn my stripes and gain knowledge and skills through discipline, responsibility, long hours, collaboration, and tenacity. And I have had my share of bumps and bruises. I have experienced gender inequality in the workforce and personal and professional betrayal – the scam, the lie, the arrogance, the empty promises.
Alongside these experiences, none is more poignant and demanding of any of us to grow and learn than tragedy. As I mention in the interview, I was in the World Trade Center on 9/11. In the podcast, we do not go into the details of that day extensively. For me, the more poignant story comes from the choices I made afterwards in striving to live with greater awareness, meaning and purpose. It is when we all have been emerging from such devastation that the ancient Greek quote above has resonated. My life was spared on 9/11. I was on the 103rdfloor in a meeting. I left the building and proceeded to the ground as soon as the first plane hit the tower. I didn’t hesitate. I was methodical. I was keenly aware of the intuitive state I entered and the conversation in my head. Time slowed down to allow me to be attentive to these inner voices. I have often reflected on these inner workings. But, in all honesty, I was lucky. Truly lucky…. because, I had many friends and colleagues that did not make it out that day, and I cannot say that my inner voices were the only ones kicking in. No. Instead? Timing. Luck. My good friend was in the first tower. That tower was hit first because that plane took off from the airport at a point in time that brought it to New York about 17 minutes earlier than the second plane that took off from a closer airport that hit my tower. I was a block away from the building when that happened.
Since that tragic day, and (strangely… so strangely) the luckiest day of my life, I have been acutely aware that I must live life purposefully. I think about my legacy and how I can inspire others to leave their own meaningful legacy. I have shifted careers. I stepped aside from global Fortune 500 business, pursued a doctorate in Organizational Leadership, and seek to elevate leaders to their full potential. (Note: if you have a pulse, you are a leader.) I consult with teams. I advise individuals. I help individuals and organizations develop leadership efficacy, strengthen culture and operational effectiveness, and build meaningful impact in society. I volunteer to support the growth of non-profits. I am a graduate level professor in leadership studies. And now I am an entrepreneur, having started AlikiDesigns. My jewelry is hand crafted, Greek inspired and everyday elegant. All pieces have a GIFt (Giving It Forward together) component to key organizations that I have vetted, and every piece comes with a positive intention.
One of the collections, near-and-dear to Dr. Denise and me, is Aliki One. The special pieces, which were carefully curated, are universally tied to Lama Tenzin Choegyal’s work running an orphanage in the Indian Himalayas. He is a change maker, who brings hope and potential to disadvantaged youth by giving them housing, private education, career opportunities and love. Genetiki, Karthia and Siban bracelets set intentionality in the world toward elevating consciousness and collective impact, creating togetherness while respecting individuality, and defining universal inspiration and the infinite potential of one humanity. We GIFt 21% of purchases in this collection to Lama Tenzin’s projects. To learn more, visit the website alikidesigns.com and on instagram @alikidesigns.
Denise Berger, Ed.D.