This series explores third wave cognitive behavioural coaching approaches.
Part 1: In the beginning. Jonathan Passmore and Sarah Leach report
Cognitive behavioural coaching has established itself as a gold standard framework for behavioural change in both therapy and coaching.
Unlike some other models, the approach is widely researched, has been applied in multiple change environments and has provided comprehensive evidence of its power as a tool to support behavioural change.
In this article we review the development of cognitive behavioural approaches, kicking off this series examining ‘Third Wave Cognitive Behavioural’ approaches.
The first wave: behavioural coaching
‘In the beginning was behaviour…..’ or at least back in the early days of psychology, behavioural psychologists thought behaviour was everything. Behaviouralists argued that it was simply impossible to see into the ‘backbox of the mind’ and thus we should focus on what we knew, not what we imagined to know (Passmore & Leach, 2022).
The emergence of cognitive behavioural approaches can be seen as a reaction to other schools of thought, particularly the psychodynamic school that emerged in the late 19th century based on the work of writers such as Freud and Jung, and their focus on diagnosis through analysis. The cognitive behavioural schools rejected this, believing it wasn’t possible to step into the ‘black box’ of the mind, to understand the human unconscious, and that inferences could only be made through observation of behaviour.
The first steps in this journey began with the emergence of the behaviouralists’ school, and the work of psychologists such as Ivan Pavlov (1927). While Pavlov and later behaviourists accepted the importance of heredity in determining behaviour, they argued that behavioural changes could be learnt through environmental interventions such as punishments and rewards.
Pavlov’s work led to the emergence of ‘classical conditioning’, where the presentation of external stimuli leads to, or triggers, a specific behaviour. Thus dogs ‘learnt’ to salivate at the ringing of a bell, through an association of the presentation of food when the bell was being rung.
Subsequent work by researchers including Watson, Skinner and Thorndike, led to the Law of Effect. This argued that behaviours could be strengthened or weakened by presenting consequences for the specific behaviour. Skinner’s behavioural radicalism suggested that covert behaviours, including cognitions and emotions, were subject to the same controlling variables. His work on pigeons, rats and other animals confirmed that animals could be trained to perform tasks through rewards (or punishments).
These ideas coincided with the emergence of personnel management and a greater focus on individual performance and work. It was argued that workplace performance could be made through time and motion studies, job design and the provision of task-based training. Such ideas still underpin much of human resources thinking in organisations 80 years on.
In certain respects, these ideas inform some of the most popular coaching frameworks, such as GROW, which seek to analyse the client’s presenting problem and focus on behavioural solutions. While such approaches have their benefits, they also exclude the full range of what it is to be human: cognitive, emotion and bodily sensations.
The second wave: cognitive therapy
The second wave of cognitive behavioural approaches arose out of work on cognitive models of human behaviour which occurred in the 1960s, in turn a break from the behaviouralists’ school dominant during the period of the 1920s to 1950s.
Cognitive psychology emerged from the work of researchers exploring the development of language and their interface with computing and cybernetics. Beck drew on these ideas in his formulation of cognitive therapy, working with clients with depression. He saw it was the way his clients perceived, interpreted and attributed meaning to events, their cognitions, which both caused their distress and offered a road to resolution.
Cognitive therapy is based on a model of human cognition which sees thoughts, feelings and behaviour as connected: a trinity of humanity. Individuals can move forward by recognising the interconnection of their thoughts, feelings and behaviours, by noticing and challenging unhelpful behaviour and inaccurate or illogical thoughts, as well as developing new more evidence-based or helpful cognitive processes to create a new way of thinking, feeling, and responding to environmental triggers which may cause them distress.
In parallel, Ellis, an American psychologist, created Rational Emotive Behavior Theory (REBT). This started life as Rational Theory in the mid 1950s. Ellis believed, like Beck, that individuals often created self-defeating strategies through their irrational core beliefs and by challenging these through rational analysis and cognitively restricting clients could develop new more rational constructs of themselves. Ellis drew these ideas together in his book on REBT (1962).
Others have added to the thinking within this second wave, including Adler, who developed Adlerian therapy, and Lazarus, who developed Multimodal Therapy (MMT). In this approach the therapist explores the client’s BASIC I.D. (Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal Relationships and Drugs/Biology).
As with many of these approaches aimed at the original domain of therapy, we have seen them transferred to the world of coaching by writers such as Neenan, Palmer and Dryden, who have written extensively about these ideas and how they can be adapted to non-clinical populations and presenting issues.
Cognitive Behavioural Therapy (CBT) has come to dominate evidence-based therapy and is still the recommended treatment of various mental health models in the UK by the National Institute for Health and Clinical Excellence (NICE). This includes interventions to support clients with depression (NICE, 2009), obsessive-compulsive disorder (NICE, 2005), panic disorder and generalised anxiety disorder (NICE, 2011).
In the arena of coaching, cognitive behavioural coaching has emerged as one of the two dominant approaches (with solution focused) partly because of its evidence base (Palmer & Williams, 2013). It would be hard to claim to be an evidence-based coach without using one or other of these approaches as part of your repertoire.
Third Wave coaching
But the past decade has seen rapid change. No longer are the second wave approaches seen as the only way to address change. A set of third wave approaches have emerged, which coaches are starting to adopt and incorporate into their own practices (Passmore & Leach, 2022).
While there’s no universally agreed definition of what constitutes a third wave approach, we might suggest that such approaches share a common perspective about acceptance of events as opposed to seeking to push these events away. In this sense the approaches focus more towards the content, processes and functions of events and our experience of them.
Such approaches include mindfulness-based CBT, acceptance and commitment therapy (ACT), schema therapy, meta-cognitive therapy, compassion-based therapy, and dialectical behavior therapy (DBT).
There is also a range of other therapy interventions which are sometimes referred to as third wave approaches, but are less popular or are on the periphery of third wave approaches. These may include approaches such
as extended behavioural activation (eBA) and functional analytic psychotherapy (FAP).
Given this variety of approaches within the third wave, it’s easy to understand why a single universal definition remains illusive.
Some have suggested a connection between CBT and positive psychology. While positive psychology approaches are used in some approaches such as mindfulness, they are less common features in other approaches, such
as DBT.
Others have argued that third wave CBT goes beyond the symptom or presenting problem, instead encourages clients to consider their whole selves from behaviour, thoughts and emotion, to values and identity.
Another way to differentiate third wave approaches from previous waves is their focus on emotion and how clients are encouraged to engage with their emotional lives. A common feature is third wave approaches is a greater focus on acceptance, non-judgement and compassion or enabling clients to more effectively manage unhelpful thoughts through separation or disassociation from them, while also placing a greater focus on overall wellbeing.
In reviewing these diverse arguments, there seems to be no clear conceptual bond that binds together all the third wave approaches. We suggest a four-part definition – approaches which:
- l acknowledge the relationship between cognition, emotion and behaviour
- l help clients their values and identity
- l encourage choicefulness in thoughts and emotions
- l have a robust evidence base
While the evidence for third wave approaches is still growing, a number of studies have evaluated evidence from multiple studies. For example, a study by Hunot et al (2013) examined the evidence for ACT and concluded that across some it delivered broadly similar outcomes to CBT for acute depression. Kahl et al (2012) did a similar review and concluded there is “little doubt that the presented third wave methods are principally efficacious”.
In subsequent articles we’ll examine different third wave approaches to help advance the adoption and integration of these emerging ideas into coaching practice, encouraging experienced practitioners as well as coach training schools to broaden and wider the frameworks they teach, to support the develop of integrated coaching practitioners.
- Next issue: Dialectic Behavioural Coaching
- This series is based on content from Jonathan Passmore and Sarah Leach’s book, Third Wave Cognitive Behavioural Coaching (2022).
| Approach
|
Originator
|
| Mindfulness-based cognitive behavioural therapy
|
Zindel Segal and Mark Williams
|
| Mindfulness-based stress reduction programme
|
Jon Kabat-Zinn
|
| Acceptance and commitment therapy
|
Steven C Hayes
|
| Schema therapy
|
Jeffrey Young
|
| Metacognitive therapy
|
Adrian Wells
|
| Dialectical behavior therapy
|
Marsha M Linehan
|
| Compassion focused therapy
|
Paul Gilbert
|
Table 1. Common Third Wave Approaches
References
- A Ellis, Reason and Emotion in Psychotherapy, Citadel Press, 1962
- A Lazarus, Multimodal Behavioral Therapy, Springer, 1976
- V Hunot, T Moore, D Caldwell, T Furukawa, P Davies, H Jones, M Honyashiki, P, Chen, G Lewis, and R Churchill, ‘Third wave cognitive and behavioural therapies versus other psychological therapies for depression’, in Cochrane Database of Systematic Reviews, 2013: https://doi.org/10.1002/14651858.CD008704.pub2
- K G Kahl, L Winter, and U Schweiger, The third wave of cognitive behavioural therapies, in Current Opinion in Psychiatry, 25(6), 522-528, 2012: doi:10.1097/yco.0b013e328358e531
- NICE, Treating Obsessive Compulsive Disorder, OCD and body dysmorphic disorder (bdd) in adults, children and young-people: Clinical guideline. (CG31), 2005. Retrieved on 2 April 2021 from: https://bit.ly/3SEzE6e
- NICE, Depression in adults: Clinical guideline (CG90), 2009. Retrieved on 2 April 2021 from: https://www.nice.org.uk/guidance/CG90
- NICE, Generalised anxiety disorder and panic disorder in adults: management. Clinical guideline (CG113), 2011. Retrieved on 2 April 2021 from: https://www.nice.org.uk/guidance/CG113
- S Palmer and H Williams, ‘Cognitive behavioural approaches’, pp319-338, in J Passmore, D Peterson, and T Freire (eds.), The Wiley-Blackwell Handbook of the Psychology of Coaching and Mentoring, Wiley, 2013
- J Passmore and S Leach, Third Wave Cognitive Behavioural Coaching, Pavilion Publishing, 2022
- I P Pavlov, Conditioned Reflexes: An investigation of the physiological activity of the cerebral cortex. Translated by G V Anrep, Oxford University Press, 1927