Select Page

An innovative approach for improving physical and mental health and well-being in the United States.

An application of the mental toughness concept at Key Cellular Nutrition


About Key Cellular Nutrition and the Cellular Health Accelerator Program

Launched in April 2021, the Cellular Health Accelerator Program aims to support a person’s health and well-being by focusing on their cellular health; optimising the body’s functions at a cellular level.

Created by Dr Bill Cole, founder of Key Cellular Nutrition (KCN – the first functional medicine group of its kind), the program operates on the understanding that many symptoms and illnesses can be traced back to the level of the cell.

Proponents of this approach suggest that it helps to improve weight loss, boost energy, improve brain function, provide freedom from pain, improve thyroid function and improve gut function.

In May 2021, KCN invited AQR International to introduce the mental toughness concept into the program. Partly to assess the impact of the program on the mental toughness of clients and partly to incorporate feedback and coaching on mental toughness to support clients to complete the program.

Clients are assigned a coach and have regular meetings throughout the 16-week program. Clients complete the MTQPlus Questionnaire to measure their level of mental toughness in terms of 8 factors. Firstly, at the start of the program to gain a baseline measure and then again on completion to measure and evaluate change.

The mental toughness concept and measure (MTQPlus) function for:

  • Diagnosis and understanding of each individual and their needs – enhancing self-awareness.
  • A platform for providing coaching and guidance to participants.
  • A key metric assessing differences in mental toughness over time, reflecting the support and guidance and correlating it with key outcomes.

What is Mental Toughness?

Mental Toughness describes the mindset that everyone adopts in everything they do. It embraces qualities such as resilience, positivity, grit, etc. It is defined as: “A personality trait which determines, in large part, how people respond mentally to challenge, stress, opportunity and pressure, irrespective of their circumstances”.

Most personality models describe the behavioural aspects of personality (how we act). Mental Toughness describes something more fundamental – “how we think”. In other words, why we act and respond emotionally to events. It enables us to understand our mental responses in a very practical way. The MTQPlus is a very high-quality psychometric measure which helps to assess this key quality.

The Mental Toughness 4Cs Framework is composed of four key components (the 4Cs) and eight factors. The Mental Toughness Questionnaire, The MTQPlus assess these components.

The framework is summarised below:

Table 1 Mental Toughness Framework

Mental Toughness ScaleThe Factors
ControlLife Control – I really believe I can do it. I have a sense of self-worth.
Emotional Control – I can manage my emotions and influence others’ emotions.
CommitmentGoal Orientation – I have a sense of purpose – I like working towards goals.
Achievement Orientation – I am prepared to do what it takes to achieve my goals.
ChallengeRisk Orientation – I welcome new experiences – I see opportunity there.
Learning Orientation – I learn from all that happens, including setbacks.
ConfidenceIn Abilities – I believe I have the ability to do it, or I can acquire the skills.
Interpersonal – I believe I can engage with others – and influence when needed


The Program

A total of 198 KCN clients were monitored. Each completed the MTQPlus at the start and end of the Cellular Health Accelerator Program. The average time between questionnaires was 4.2 months.

The average age of participants was 57 years old. Participants had regular check-ins with their assigned coach during this time. 98.5% were female and 1.5% were male.

General Observations for the cohort

A comparison of the start and end point MTQPlus scores showed that, in general, significant progress had been made through the Program.

Table 2 shows the average MTQPlus scores for the group at the start and end of the program.


Mental Toughness FactorPre-programPost-programDifference
Total Mental Toughness4.705.38+0.68
Life Control5.205.85+0.65
Emotional Control4.975.61+0.64
Goal Orientation4.895.39+0.50
Achievement Orientation4.344.79+0.45
Risk Orientation4.665.04+0.38
Learning Orientation4.655.08+0.43
Confidence in Abilities5.756.37+0.62
Interpersonal Confidence4.965.31+0.35


Mental Toughness scores are presented on a Likert scale of 1-10. Scores of 1 – 3 are regarded as representing mental sensitivity. Scores of 8 – 10 are representing being mentally tough. Most people (68%) fall somewhere in the middle. The global average score (a norm) is 5.5 across all factors.

One key observation was that the average overall level of mental toughness (4.70) at the start of the program was lower than that of the general population (5.5). The average score at the conclusion was very close to the global norm (5.50)

This suggests that clients who entered in the Cellular Health Accelerator Program were generally a little more mentally sensitive than the average person.

Those who are more mentally sensitive are less likely to feel in control of their circumstances, may not manage their emotions, may lack direction and will have more pessimistic views of the opportunities available to them.

This may mean they find it more challenging to maintain healthy lifestyle disciplines. This is vitally important for any health and well-being program which requires a degree of tenacity and consistency for effective completion.

Results showed the greatest increase in mental toughness scores was on the life control, emotional control and confidence in abilities factors. This shows improvement in self-efficacy – a belief they can make a difference, adopt a positive attitude, manage their emotions and enjoy greater self-esteem.

Link with program outcomes

This should translate into beneficial outcomes for most. It did.

Analyses post-program revealed reported improvements in sleep, increase in energy, weight loss, better emotional management, better education around food and new healthy habits such as cooking and exercising, a positive attitude shift, feeling calmer, improved gut health and more.

Change in levels of mental toughness was significant for all factors and components. Differences in levels indicate areas for further development.

An interesting closer look

The average time between the completion of the first and second MTQPlus was 4.2 months. For some, the time between the two testing points was as long as 5 or 6 months.

Results for clients who completed the MTQPlus questionnaire at an interval more than four months apart are shown in Table 3. This might be an indicator of the long-term impact of the program.

When scores were compared for those who re-tested at 4 months and those who retested at 6 months, there was no significant difference in levels of scores in either direction.

Table 3 Those who completed the re-test more than 4 months after the program started.


Total Mental Toughness4.855.49+0.64
Life Control5.115.67+0.56
Emotional Control5.265.98+0.72
Goal Orientation4.955.34+0.39
Achievement Orientation4.334.85+0.52
Risk Orientation4.695.05+0.36
Learning Orientation4.645.03+0.39
Confidence in Abilities5.566.46+0.90
Interpersonal Confidence5.115.46+0.35

Finally, and interestingly, there were some who did not complete the second MTQPlus questionnaire within the allotted program period. Data analysis showed that those who completed both tests as planned had higher levels of achievement orientation and confidence in abilities than those who did not complete them in time.

This would be consistent with our understanding of what these factors mean for diligent application.

In conclusion

The study on clients from the Cellular Health Accelerator Program showed an apparent correlation between the content and delivery of the program and its outcome in terms of impact on the client outcomes and impact on client mental toughness.

It might seem reasonable to suggest, as do other studies, that self-awareness about one’s mental toughness is generally an important factor in programs designed to improve physical and mental health and well-being over an extended period of time.

Given that one of the virtues of the mental toughness concept is that, although we often usefully talk about people and their general responses, in fact, we are much more concerned with individual responses. Each of us is different and the outcomes of any intervention or insight will also be unique.