Cognitive Behavioral Therapy is a counseling treatment for many different emotional disorders such as Generalized Anxiety Disorder, Major Depressive Disorder, Panic Disorder, and other mental illnesses. The treatment uses the cognitive triangle, which shows us that we can control how we feel by changing our thoughts (cognitions) and our actions (behaviors). The Cognitive Triangle image above shows a visual model of how the brain is wired.
The thought-part of the cognitive triangle directly impacts the way we feel. When driving, imagine the car from the opposite direction veering quickly into our lane, we are likely to feel more anxious. This is because our executive brain is hardwired to our emotional brain. This is important because it teaches us that we can manage the way we feel if only we can learn to manage our thoughts. In order to do that, we need to understand how the thinking brain works. There are three types of cognitions that influence our feelings:
1) Automatic thoughts: From the time we wake up in the morning, through the day, and even in our dreams, thoughts bubble into our minds that are beyond our control. We cannot control these automatic thoughts. They simply rise from our unconscious mind and come to us as words, images, and ideas. There is nothing we can do to directly control these thoughts. Instead we have to manage them after they come to us.
2) Self-Talk: Once we are faced with an automatic thought or image, what we do with it is largely up to us. We may engage it, spending more time expanding the thought, ruminating or further fantasizing about the though. CBT teaches us that we can use self-talk to alter the thoughts. Imagine that car veering into our lane. In order to manage the anxiety we can look at the statistics of how many cars veer off lane. The reality is that cars travel hundreds of millions of times each day, and the number of drivers that veer is only a fraction of a percentage. Talking to ourselves in such a way helps to reduce anxiety giving us an important influence on managing our thoughts and emotions.
3) Core Beliefs: Core beliefs represent a deeper, more fundamental thought process. Core beliefs are the engine that creates our automatic thoughts. We develop core beliefs early in life. They are based on beliefs about a) self, b) others, and c) the world. Examples of negative core beliefs are: I am worthless, people will always take advantage of me if given the chance, the world is not safe. Positive core beliefs may be: I am important and valuable, people are doing the best they know how and really just desire connection with others, we live in an exciting and ever-developing world.
It is difficult to change core beliefs and requires effort, intention, and time. Through consistently using self-talk to challenge negative automatic thoughts, and with the help of a counselor, we are able to establish new core views of self, others and the world. Developing positive core beliefs makes mood management easier because positive core beliefs generate more positive automatic thoughts. These thoughts tend to be more satisfying and easier to manage than negative automatic thoughts.
Behaviors are the action part of the cognitive triangle, which is another avenue to change the way we feel. The cognitive triangle teaches us that the way we behave influences how we feel. This results because our bodies are directly connected to our emotion centers in similar ways as our thinking minds. For example if we lay in bed for two weeks without getting up, we will likely become emotionally depressed. When talking about behaviors, we turn our attention to feedback loops.
Feedback Loops occur when the output of a situation is also used as the input for the same situation. In other words, when two components interact, the output of one component influences the output of the other component, which influences the output of the first component. The best way to understand this is with examples. A negative feedback loop looks as follows: I feel depressed, so I lie in bed all day. Lying in bed all day leads to feeling depressed. When I feel depressed, I lie in bed all day. This creates a downward spiral in mood. A positive feedback loop looks like this: I do an activity that I enjoy (say, volleyball). This energizes my body and makes me feel good. When I feel good, I am motivated to do activities I like, such as volleyball, so I go play more.
In order to change a negative mood behaviorally, we need to stop negative feedback loops and generate positive loops. In general, it takes time before your body will respond. The adage “fake it till you make it” sort of applies with this idea.
The best way to manage mood disorders involving anxiety and depression, according to the cognitive triangle, is to use a combination of cognitive and behavioral strategies. There are limitations that CBT does not consider such as the power of social support or the need to resolve past traumas or old resentments. CBT is usually the best way to start managing emotions. If successful use of CBT brings up deeper hurts and pains, then we need to go farther in our work.
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