Part 4: health coaching expert Professor Stephen Palmer expands on cognitive behavioural health coaching. This issue: cognitive thinking skills
Thinking skills help a client develop Health Enhancing Thinking (HETs). Some health-inhibiting styles of thinking develop over many years and become ingrained and resistant to change. In specific situations, such as smelling one’s favourite fatty food, the client need only think, “That smells great. I must have it now”, and next thing, they are eating it! Or with tasks they fail at, instead of thinking, “I’ve failed to reach my health goals today, I’ll have another go tomorrow”, they have a more unhelpful ending to their Health Inhibiting Thinking (HITs): “I’ve failed to reach my health goals today; this proves I’m a total failure.”
By labelling themselves a “total failure”, they become demotivated. These thoughts can be so fleeting that the coach needs to help the client recognise them. HITs undermine health coaching programmes as they give permission to the client to lapse into Health Inhibiting Behaviours (HIBs).
The coach uses cognitive thinking skills with the client. It is useful for the client to be given a copy of the Thinking Skills list (adapted, 13), so they can tackle their HITs outside the session.
Influencing outcomes
By tackling HITs and then developing HETs, the client can develop their Health Enhancing Behaviours (HEBs). The diagram can be used in discussion with the client to highlight reciprocal interaction between HETs, HEBs, environmental influences and goal-blocking emotions.
Environmental influences can greatly influence outcomes. For example, quit smoking programmes can be very difficult for clients to adhere to if they live with family or partners who continue to smoke in the home.
If the client lives by themselves they will still need to apply environmental stimulus control, in this example, by removing packets of cigarettes and ashtrays from their home.
As the health coaching programme progresses successfully, the coach may suggest that if the client wishes to become more resilient, then they could undertake a behavioural experiment and see if they can tolerate the stimulus.
For example, being exposed to the sight and smell of cigarettes without giving into their craving to smoke. However, before the behavioural experiment is undertaken, it is important the coach and client develop a coping strategy that will enable the client to manage their cravings. Often clients will suggest using a relaxation technique or an imaginal distraction such as visualising themselves lying on their favourite beach.
Goal-blocking emotions such as stress/anxiety and depression can lead to increased comfort eating, smoking and drinking to take the edge off things. The cognitive thinking skills can be used to reduce stress and goal-blocking emotions.
Top tips on how to hone your thinking skills*
Befriend yourself So often, we are unfairly critical of ourselves. If you make an important error, think about what you would say if a colleague or friend had done the same thing. Chances are, you would not be so critical. So instead of thinking, “I can’t stop smoking. I’m weak”, think about it more realistically. “Although I have continued to smoke, it is likely that I will be able to stop soon. It doesn’t mean I’m weak.”
Thinking more ‘coolly’ Instead of holding inflexible and rigid beliefs, such as musts, shoulds and have tos, for example, “I must reach my daily targets”, introduce more flexible and realistic beliefs, such as wants, desires and preferences, for example, “I strongly prefer to reach my daily targets but realistically I don’t have to.”
De-labelling If you find yourself saying: “I’m a total failure”, do you find this helpful in dealing with your goals or a situation? Does this thinking motivate or de-motivate you? As you use these phrases do they decrease or increase your stress levels? Are they an accurate description? For example, to be a ‘total failure’, you would need to be a total failure at everything you did, every single day. This would be extremely hard to achieve. It would be more accurate to state: “Although I may encounter difficulties in maintaining my health programme, it doesn’t mean I’m a total failure. It just means I’m fallible like everybody else.”
Relative thinking If you find you are evaluating a situation in extremes, such as dreadful versus fantastic, then relative thinking helps you find the middle ground. On the whole, people and most situations are too complex to view and categorise in such extreme terms. For example, if you are saying, “I will never be able to keep to my health coaching programme”, think about the aspects you can do, for example, “Most days, I’m reaching more than 80 per cent of my coaching targets.”
Look for evidence Challenge your unhelpful ideas by looking for evidence for and against them. Perhaps ask your friends, family or colleagues You can also test assumptions by deploying behavioural interventions, for example, if you believe “I can’t stand exercising every day”, see how long you can “stand it”. This will prove if you are able to do exercise, even if you don’t really like it.
Broaden the picture If things go wrong, we often apportion total blame to ourselves (personalisation) or another (blame). However, if you do blame yourself or others, remember that problems are often not the total responsibility of one person.
Demagnification or ‘deawfulising’ It is very easy to blow a situation out of all proportion, but this will only increase your stress levels. Events and tasks may be difficult to deal with, but ask yourself, “Is it really awful?”, “Is it the end of the world if I don’t achieve my health goals?”
*(adapted Palmer, Cooper & Thomas 13)
In The Health Coaching Toolkit part 5, we focus on additional health coaching skills
Volume 7, issue 6