THE USE OF COGNITIVE BEHAVIOURAL APPROACHES IN HEALTHCARE SETTINGS
MIRANDA SHOEBRIDGE, DIPLOMA IN WELLNESS COACHING SKILLS, AUGUST 2013

My research into cognitive behavioural approaches in healthcare has highlighted the lack of information about cognitive behavioural coaching in healthcare settings in the UK. The use of cognitive behavioural counselling is well established, however, with NICE favouring the evidence based and short term aspects of this counselling approach, in its Improving Access to Psychological Therapies (IAPT) roll- out, which the public can access through primary care referrals. An internet search throws up any amount of websites for cognitive behavioural coaching training, and some individual practitioners who are already trained in a health related area e.g. nursing or occupational therapy, but little UK based evidence of health or wellness coaching, unlike the US. Where information about coaching is found, it can be difficult to establish if this is specifically cognitive behavioural coaching. I will summarise the results of my research into this topic, and also discuss how cognitive behavioural coaching has a role to play in many health and wellbeing organisations, including the mental health organisation Together, which operates a residential client-centred approach to mental health recovery.

Across the Atlantic, the concept of Certified Health Coaches is gaining momentum: ‘Certified Health and Wellness Coaches are professionals from diverse backgrounds and education who work with individuals and groups in a client-centred process to facilitate and empower the client to achieve self-determined goals related to health and wellness. Successful coaching takes place when coaches apply clearly defined knowledge and skills so that clients mobilize internal strengths and external resources for sustainable change’: instituteofcoaching.org/images/ARticles/ProgressReport_NationalConsortium_Jul_2011.pdf

There is a US based International Association for Health Coaches: iahcnow.org

The new trend for wellness coaching in the US is highlighted: webmd.com/balance/features/wellness-coaching-the-latest-trend-in-fitness?page=2

A good example of an individual practitioner in the US advertising ‘Healthy lifestyle support and education’ is jacquibryan.com – this practitioner has been picked up by the US media and shows how she can work with individuals who want to lose weight.

Workplace wellness in the US is catered for by https://wellnesscoachesusa.com/about/

Use of technology such as mobile phone apps and web based support in cognitive behavioural self-help coaching are becoming more widespread:ieeexplore.ieee.org/xpl/login.jsp?tp=&arnumber=5191188&url=http%3A%2F%2Fieeexplore.ieee.org%2Fxpls%2Fabs_all.jsp%3Farnumber%3D5191188

In the UK, the concept of health coaching is in its infancy but coaching, including cognitive behavioural coaching, has begun to be recognised by the NHS as a useful skill for current clinicians to obtain,
‘The Health Coaching Summit held on 26 February 2013 was sponsored by the NHS Institute of Innovation and Improvement and NHS Commissioning Board to learn more about the compelling evidence for health coaching and shape how this is taken forward across the NHS, to augment other approaches to managing long term conditions: Health coaching combines clinical practice with specific communications skills and techniques (skills in behaviour change) which aim to transform clinician/patient relationships and support self-care, drawing on patients’ own resources.  There is a growing body of evidence of its impact in improving patient satisfaction and outcomes in the USA, although health coaching remains an innovation in the UK’:
pcc-cic.org.uk/article/presentations-health-coaching-summit-26-february-2013

I also found information about the ‘Primary Healthcare Coaching project NHS Suffolk’: hee.org.uk/~heeorg/nhs-support/showcase/case-studies/rif-case-study-primary-care-health-coaching

Group coaching is analysed in this research: business.brookes.ac.uk/commercial/work/iccld/ijebcm/documents/special7-paper-07.pdf International Journal of Evidence Based Coaching and Mentoring. Special Issue No.7, June 2013

Stephen Palmer, who offers training in CB Coaching states that ‘Health and wellbeing coaching has become an established area of practice in the UK, Australia and USA. Health coaching has even been offered as a free service within some Primary Care Trusts in the UK. Professional bodies such as the Association for Coaching recognise health coaching as a specialism… Cognitive behavioural health coaching can help with behaviour change, enhance health goal achievement and also assist in relapse prevention’ centreforcoaching.com/#!health-coaching-workshop/c1q4j.

Another advocate is moveeattreat.org/coaching-for-health

The London Deanery has a useful summary of the evidence base for health coaching:
‘What’s the evidence? Coaching for health is a relatively new topic of research and there is a developing evidence base for determining the best strategies to support behaviour change. The studies are of variable quality and this module only refers to some of the more recent and more reliable sources and overviews’:
mentoring.londondeanery.ac.uk/coaching-for-health/e-learning-module/whats-the-evidence

This is an exciting time for coaching – a relatively new discipline, and the cognitive behavioural approach has much to recommend it in a variety of healthcare settings from youth work to care homes, gyms and mental health organisations. The charity Together: together-uk.org describes itself as ‘Working alongside people with mental health issues on their journey towards independent and fulfilling lives’. Cognitive behavioural approaches are offered as part of a client centred, flexible approach to recovery for people in the community and in Together’s residential supported housing units, where there is support for people to move onto independent living. This comes through a healthcare approach called Personalisation. Together states: ‘Our understanding of Personalisation is that it offers:

  • the opportunity for people to have choice, to take control of their own recovery journey, and to participate in society as active and equal citizens
  • a preventative approach, so that people can stay well
  • a view that people have skills and strengths on which to build, rather than being passive recipients of services.

We know that the implementation of Personalisation in mental health has been slow, and that some parts of the country have achieved more in this area than others. Where Personalisation in mental health is working well, there are huge benefits to people who use services’.

Though cognitive behavioural coaching approaches are in their infancy in the UK, there is much scope to expand their application. The government agenda to widen choice, give people more responsibility for their own health (rather than simply receiving information from an expert) and put people in charge of how they want to spend their financial care packages, is an opportunity for wellness coaches to provide cognitive behavioural coaching to support a range of health and wellness issues including smoking cessation, weight loss and weight management, healthy lifestyles, improved mental health, stress management, pain management, dealing with a newly diagnosed condition, coping with chronic illness and pain management plus life events such as redundancy, relationship break up and retirement.