The Small Steps That Pay Big Dividends for Leaders’ Mental Health

Leaders occupy a paradoxical position in contemporary organizations: They shoulder immense responsibilities for their teams’ performance and well-being, yet their own mental health receives little attention. Workplace wellness initiatives rarely extend upward to address the distinct pressures facing those in leadership positions. 

Perhaps this neglect shouldn’t be a surprise. Leaders are expected, by themselves and others, to project strength and resilience. Admitting struggles carries professional risks that frontline employees rarely confront. As a result, the people responsible for supporting team members’ mental health often lack accessible tools for managing their own psychological challenges. Traditional therapeutic approaches, while effective, require time commitments that already-stretched leaders struggle to accommodate.

The Cognitive Behavioral Therapy Workbook for Leaders, a new book by Julian Barling and Simon Rego, offers a practical alternative. Barling, Borden Chair of Leadership at Smith School of Business, and Rego, chief of psychology at Montefiore Medical Center and professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine, have developed a skills-based approach that leaders can implement on their own, and at their own pace. 

Their framework draws on cognitive behavioural therapy (CBT), an evidence-based psychological treatment that focuses on reshaping problematic thought and behavioural patterns. Unlike more traditional, open-ended therapeutic models, CBT provides concrete techniques that align with how leaders typically approach problems: through measurable strategies that deliver tangible results that can be practised without requiring major time commitments.

In the following conversation with Alan Morantz, senior editor of Smith Business Insight, Barling and Rego examine why leaders’ mental health deserves greater attention, explain the mechanics of CBT approaches and explore how executives can apply these tools to navigate challenging situations without paying an emotional price. 

What mental health challenges do leaders face that are distinct from those faced by others in the workplace?

Barling: We come at this with no expectation that leaders are different from other people in a foundational sense. At the same time, leaders do experience unique pressures. Leadership is a double-edged sword. There are unique privileges and unique pressures that result in higher burnout, greater levels of workaholism and a greater pressure on work-life balance. And if burnout is higher, then we have to worry about depression and anxiety and poor sleep. So, on the one hand, we shouldn’t ignore them, because leaders deserve to have a healthy life. But on the other hand, we have to recognize unique pressures. 

Rego: What’s different are the expectations put on leaders by themselves and others, and the options they have to get mental health help because of those expectations. That’s what makes it unique. It’s not their vulnerability. There’s been an increase in awareness about employees’ mental health, but, at the same time, leaders are still expected to be strong and resilient. People expect their leaders to display good mental health, and when they don’t, they get stigmatized.

What’s involved in cognitive behavioural therapy?

Rego: The thinking behind it is captured in what’s known as the CBT Triangle. According to this model, our thoughts, feelings and behaviours operate simultaneously as we experience the world. CBT proposes that how you think influences how you feel, and what you do influences how you feel. Those are the cognitions and behaviours — the C and the B. However, we use the triangle to illustrate how these connections are in fact bi-directional; it’s not just how you think that influences how you feel, but how you feel also influences how you think. And it’s not just what you do that influences how you feel, it’s how you feel that influences what you do, and what you think influences what you do, and what you do also influences how you think.

CBT proposes that people are often disturbed by what’s going on in one or more of these areas. The beauty of knowing they’re all interconnected is that if you’re struggling in one, you have two other options to intervene to help you get out of whatever you’re struggling with. According to CBT, if you don’t like the way you feel, you can learn strategies and skills to change what you’re thinking in those moments, or modify your behavioural patterns to come up with different emotional outcomes. We say, 'Let’s double down and change not only how you think but also what you’re doing to really supercharge how you feel.'

What might it look like for a leader to use CBT techniques in high-pressure situations?

Rego: There’s nothing in CBT that changes situations per se. But with CBT, how we label or think about them drives our emotional reactions. Let’s say Jeff has to present a financial summary at the next board meeting and is feeling pressure. Because Jeff’s been doing CBT, he’s aware of the script in his mind: If this goes badly, I will lose all credibility. The meeting hasn’t even happened, but as long as he’s thinking about the possibility of losing credibility, he starts to feel anxious and stressed – and notices that his hands get sweaty, his mouth gets dry and his heart races.

But after CBT training, Jeff catches that hot thought and uses the skills he’s learned. There are questions and techniques he can use to poke holes in that problematic thought. Jeff may now say, Am I only seeing the threats in this and not opportunities? Is there another way to frame this that would be more helpful? Am I thinking in extremes? Am I fortune telling? Am I labeling myself? If Jeff can change the way he thinks into more realistic terms, he might come up with a rational response, such as: It’s going to be a tough conversation, but if I can be clear and honest and collaborative, I can be a success. This more balanced thought will lead to more balanced feelings and a better outcome.

CBT also offers a set of emotion regulation tools. Jeff could do some diaphragmatic breathing and grounding exercises to calm himself right before the meeting. He could be mindful while in the meeting, noticing his feelings and thoughts but not getting caught up in them and redirecting his attention to what matters most to him in that moment. There’s a toolbox of skills, but Jeff can’t use it until he’s aware of the insidious nature of the way he’s thinking and any problematic behavioural patterns he’s developed.

Are leaders more or less suited to applying these CBT techniques?

Barling: Leaders are perhaps more prone to put pressure on themselves and feel they just don’t have enough time for anything. But based on our experience with leaders, they tend to like techniques and strategies that can deliver outcomes that can be quantitatively measured. Strategies that bring them the feeling of greater control over their lives and that they can engage in privately, so that they don’t have to admit in front of others that they’re having these issues. If you can start off with this cognitive restructuring, leaders would respond well to CBT techniques. Part of it is developing strategies with measures to see if they’re working. Leaders love data. 

Rego: When people come into my office, it’s with an expectation that I will give them a magic wand and make their teams perform differently or make their colleagues be more collaborative. Pretty quickly, they learn it won’t be the world around them that changes, but rather, it will have to be a change from within. If you can convince them they can make these internal changes and respond much better to the situations they find so stressful, then they quickly learn to love this approach. It’s skills-based, practical, short-term, and the real selling point is that you feel it when it’s working. And while it does require regular practice, it does not require lengthy practice to get good.

Some leaders may believe they need an edge to keep pushing themselves, something they fear would be lost if that edge were sanded down. What would you say to a leader who shows up with that worldview?

Rego: My usual response is, How’s that working for you? By talking to yourself that way, do you feel motivated and engaged and productive? Are you respected by your team? Let’s write down all the critical things you say to yourself in the spirit of self-motivation. And let’s change the perspective from you speaking to yourself that way to a leader saying those things to you. You’re not good enough. You suck at what you do. People don’t respect you. You’ll never achieve what you wanted to achieve. If someone spoke to you this way, you could legitimately claim they were being abusive. But apparently it’s okay when we say this to ourselves.

Barling: If I can add just one question that’s leader-specific: Did you feel more in control at work? And the answer is no. Self-criticism usually leads to demoralization. You’re constantly beating yourself up, and then negative feelings and a critical voice lead to problematic or non-productive actions.

What lasting message do you hope this book will leave?

Barling: One of the reasons we did the book was to bring these ideas to executive coaches and HR departments, and to leaders themselves — that there are skills leaders can practise that don’t require leaving work for therapy multiple times a week for a year. It’s compelling that the book includes an afterword by a CEO of a cosmetics company, as well as endorsements from Olympic athletes and people from within the mental health field. It shows the broad applicability of CBT skills to leadership. So maybe this book will help make CBT more accessible for leaders.