How CBT Works

CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. For example:

A Situation – a problem, event or difficult situation occurs, which triggers:

  • Thoughts.
  • Emotions.
  • Physical feelings.
  • Actions.

How you think about a problem can affect how you feel physically and emotionally. Also each of these areas can affect one of more of the others. Then how you feel determines what you do about ‘the situation’.

An example

There are helpful and unhelpful ways of reacting to most situations, depending on how you think about them as demonstrated in this example:

Situation

Imagine for one moment that you have had a bad day. You are feeling fed up and decide to go out for some retail therapy or for a walk. As you walk down the road, someone you know walks by and, appears to ignore you. How do you react? Here are some possible thoughts that might be going through your mind:

Thoughts

Unhelpful:  He/she ignored me – they don’t like me. I must be so terrible for friends to ignore me. What have I done wrong? They will never speak to me again.
Helpful:  He/she looks a bit wrapped up in themselves – I wonder if there’s something wrong? Maybe they have had a bad day, or are in a rush and just haven’t seen me.

Emotional Feelings

Unhelpful:  Low, sad and rejected.
Helpful:  Concerned for the other person.

Physical Symptoms

Unhelpful:  Stomach cramps, low energy, feel sick.
Helpful:  None – feel comfortable.

Action

Unhelpful:  Go home and avoid them.
Helpful:  Get in touch to make sure they’re OK.

Can you see how the same situation led to two very different results, depending on how that person was feeling in that situation and what they thought about it.

The one thing that is common with people who haven’t yet built the skills to learn CBT is that they jump to the worst possible conclusions, without very much evidence for it. These negative assumptions lead to a number of uncomfortable feelings, as well as unhelpful behaviour.

We often ruminate (go over and over in our minds) about what has happened and worry and feel further depressed about it. However, if you get in touch with the other person, there’s a good chance you’ll feel better about yourself and find none of the negative thoughts you were having were true. If you don’t, you won’t have the chance to correct any misunderstandings about what they think of you – and you will probably feel worse.

This is a simplified example and way of looking at what happens. The whole sequence is demonstrated by the diagram below:


CBT diagram: text description

Imagine three boxes: thoughts, feelings, and actions, arranged in a triangle and connected by two-way arrows. This shows how, for example, a thought can both lead to a feeling, and follow after a feeling. The same applies to the other pairs too; each one can both influence or be affected by the others.

Thoughts are at the apex of the triangle, and directly above, again connected by a two-way arrow, is a situation.

So, you experience a situation that leads to a thought, and that thought is capable of affecting the way you feel and the way you act. Remember, thoughts, feelings, and actions, form a two-way circle, so this process can loop round and round in either direction.

The arrow connecting the situation to the initial thought is also two-way, allowing the result of that mental processing loop to feed back to the situation, altering your perception of it. That new perception of the situation can then feed back into your thoughts, triggering a further processing cycle.

CBT teaches you to break into this cycle and regain control.

End diagram description.

So, a situation leads to negative thoughts and feelings and usually to taking action that isn’t helpful.

This vicious circle can make you feel worse and the more you think this way the worse it makes you feel. It is possible to start to believe quite unrealistic (and unpleasant) things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways.

CBT can help you to break this vicious circle of altered thinking, feelings and behaviour. When you see the parts of the sequence clearly, you can change them – and so change the way you feel. CBT gives you a chance to explore these feelings in a safe environment and with the homework your therapist gives you to practise, you can learn to change these patterns of thoughts and behaviours yourself.