This is part two in a three-part series on cognitive behavioral therapy. Click here to read part one, where we discuss how CBT works and why it can be effective.

Cognitive Behavioral Therapy, or CBT, is an evidence-based cognitive behavioral model that helps people process thoughts and feelings and understand their behaviors. While CBT is used across a variety of mental healthcare modalities, it can have powerful and effective applications within the scope of mental health coaching in particular. 

At Headspace, mental health coaching focuses on supporting individuals with setting and achieving their goals around challenges like burnout, stress, anxiety and depression, overwhelm, building or changing habits, sleep, goal setting, relationships, communication, motivation, managing difficult emotions, finding harmony between work and life, and other life changes. 

As a goal-oriented approach to care that places emphasis on taking action and tracking progress, the model behind CBT allows mental health coaches and members to work together in a way that adds structure to what can sometimes feel like chaos, when sorting through their everyday thoughts and feelings. Once we understand how thoughts work (the cognitive model), and are able to identify the types of unhelpful thoughts we may have (cognitive distortions), then we can start changing those unhelpful thought patterns through what is called cognitive reframing.

Our  approach to CBT is centered around a basic process of exploring how members usually react to their emotions to see where they might want to make changes, experimenting with CBT tools and techniques to cope with their emotions to find out which ones work best for them, and maintaining the changes they’ve made through practice and consistency so they can handle anything that comes their way. 

When the coach and member find that using CBT would be helpful in addressing their challenges, a series of coaching sessions that include principles from CBT might proceed as follows:

Initial coaching session

A member’s first scheduled session is typically a coaching discovery session with the member’s lead coach. The coach can share more about coaching and the Headspace model and learn more about the member and their goals for coaching.  These initial sessions also give the coach and member a chance to discuss coaching agreements with each other and the structure of their sessions. They then identify intentions for the coming week and specific action steps to get there. 

In cases where there is a need for immediate help with navigating an urgent matter that cannot wait until the scheduled discovery session or the next scheduled check-in, members also have 24/7 drop-in support available from an in-the-moment coach. The goal of these drop-in sessions is to help improve the member’s mood or state of mind so they can get to a better place for that day. Then, the member is encouraged to continue their journey by scheduling a discovery session, or their next followup session with their lead coach. The lead coach will be a consistent touchpoint on their mental health journey. The member and lead coach meet regularly and build a rapport that breeds trust and growth.

Followup session: Cognitive model

During a session, when appropriate, the coach may support the member in better understanding how thoughts work by introducing the cognitive model framework. According to this CBT model, the process for how our thoughts work goes: event → thought → feeling → behavior. This can have a significant impact on how we experience our lives. During the session, the coach and member also identify goals for the coming week. For homework or action steps between these sessions, the member might pick one of their own challenges to see how it fits into the framework of the cognitive behavioral model. 

Followup session: Cognitive distortions

During a session, the coach may support a member feeling stuck by introducing the concept of cognitive distortions. These are unhelpful thoughts that can get us in trouble and make us feel bad about ourselves and others at times. In the session, the coach shares with the member a list of common cognitive distortions and psychoeducation on how to identify the unhelpful automatic thoughts or cognitive distortions that feel most familiar to them. For homework, the member may commit to looking at a list of common cognitive distortions to pick out 2 or 3 which stick out to them in regards to their own unhelpful thinking throughout the week. 

Followup session: Thought reframing

Once a member better understands how their thoughts work (the cognitive model), and is able to identify the types of inaccurate thoughts they may be having (cognitive distortions), now they can start changing these unhelpful thought patterns. During the session, through what is called cognitive reframing or thought reframing, members learn how to ask themselves a series of questions to challenge an unhelpful thought when they notice it. For example, a member who often mentions feeling anxious and worried about things might be asked to consider:

1. What am I worrying about?

2. What are some clues that what I am worrying about will NOT happen?

3. If my worry does NOT happen, what will probably happen instead?

4. If my worry DOES happen, how will I handle it? Will I eventually be ok?

5. How has my feeling of worry changed now that I have thought through these questions?

Practice, practice, practice

The end goal of the coaching relationship is ultimately to learn skills that can be sustained consistently over time. Therefore, during the next few sessions the focus is on practicing to establish new behaviors that last. Like many things that we want to improve, the recycling of old behaviors is completely understandable, so it takes practice. With enough repetition, many unhelpful thinking patterns can be replaced with new or healthier thoughts. 

As the member shares the issue that is top of mind for the week, the coach and member will continue to practice identifying and reframing the unhelpful thoughts to combat some of their recurring challenges like fear, worry, anger, guilt, negative self-talk, or sadness using current examples from the members's own life. For homework throughout the week, members can use the Headspace CBT Guided Programs for Managing Stress and Sleep, and thought logs or journaling to continue identifying and tracking their own unhelpful thoughts, in addition to any other action steps towards their personal goals.

‍