The CBT Triangle and You

There is ancient precedent for believing that disordered feelings often arise because of prior problems in thinking and behavior. For example, the desert fathers in the tradition of Christian monasticism often taught that the way to address problems in one’s emotional life is to attend to what is happening in the realm of thinking and behavior. Even before them, the 1st century Stoic philosopher Epictetus taught that our interpretations of events have a greater impact on us than the events themselves, so that the way to avoid unnecessary suffering is to engage in correct thinking.

The basic idea is that there was a web of multiple reciprocities between how we think, what we feel and the way we behave.

On one level, this is common sense: it doesn’t take a PhD in psychology to know that because we are whole people, a change in one aspect of the human ecosystem will have an impact in other areas. However, psychology hasn’t always traded in common sense, and for much of the discipline’s history too little attention was given to the notion of changing maladaptive feelings through addressing thoughts and behavior.

Under the influence of Freudianism, much late-19th and early 20th century psychology saw feelings as uncontrollable impulses from a dark unconscious, connected to thoughts that we often cannot even be aware of. In the mid-20th century, there was a swing of the pendulum as Behaviorist theories emphasized only what is observable and measurable. While behaviorism yielded significant insights about the ways that human beings and animals learn and develop habits, it often resulted in a simplistic approach to feelings and thoughts, as if these are merely responses to controlling variables rather than aspects that can be controlled by agency (behaviorists like Skinner actually rejected free will).

In the latter half of the 20th century, researchers working within the framework of Cognitive Behavioral Therapy have made huge strides for better understanding the interconnectedness of behavior, feelings and thoughts. It began to be understood that for effective behavioral modification to occur, there needs to be internal changes of attitude and thoughts, not simply altered variables in one’s external environment. For example, Aaron T. Beck, currently professor emeritus at the University of Pennsylvania, identified different ways that our thinking distorts reality, leading to disorders like anxiety and depression. David Burns from Stanford popularized Beck’s list with common names and examples for the distortions, also called “automatic negative thoughts.” (See this helpful list of these negative ways of thinking.)

Not only does thinking effect behavior and feeling, but how we feel and behave also effects how we think. In fact, there is a complex web of multiple reciprocities between feelings, behavior and thinking (or “cognitions” as they are often called). This web of reciprocities is often represented diagrammatically with the CBT triangle.

Because we are whole people, a change in one area of the triangle affects the other areas. For example, a change in how we think affects how we act and feel. A change in what we do affects how we think and feel. And a change in how we feel affects what we think and do.

For example, disordered behavior doesn’t just happen, but is a product of ingrained maladaptive thoughts and feelings. Similarly, toxic thoughts do not just come out of the blue, but arise as a symptom of whatever our behavior and emotional life have prioritized, since it is through these priorities that the unconscious picks up the message “Hey, this is important so I should be thinking about this.” Similarly, our emotional states don’t just arise in a vacuum, but are continually being fashioned, refined and strengthened by our thoughts and behavior.

Recognizing this is important if we are to avoid making a false dichotomy between feelings and skills. It’s easy to assume that feelings are outside the control of our volition, an assumption that can lead us to overlook the important ways that negative feelings can be censored and positive feelings habituated. One of the great benefits of CBT has been to show that our feelings can be skillfully managed. To do this, one often has to take a side-ways approach. Confronting maladaptive feelings head-on, like so much psychotherapy did in the first half of the 20th century, can often have value in helping someone come to know themselves, but it can be painfully slow when it comes to actually changing one’s emotional dispositions. Because we are whole people, and because our will, mind and emotions form a complex web of multiple reciprocities, the way to transform one’s emotional life is often to first work to bring our thoughts and behavior into alignment with health and wellbeing.

If a person is having trouble in one of these areas–thoughts, emotions or behavior–and however hard they struggle they just can’t get release from the problem, then that is often a signal that maybe a side-ways approach is required, via one of the other two routes. For example, suppose someone comes to you with have a behavioral problem, perhaps they can’t stop smoking or perhaps they can’t break the habit of criticizing their spouse. The person musters up all the willpower they can, but the habit seems to only become stronger. In that case, it can be helpful to back up and address things and the level of emotion and cognition. Often the behavioral challenges we face do not arise because of events themselves, but because of the meanings we unconsciously attach to those events.

Here’s how this might look in practice. With the habit of complaining against one’s spouse, addressing this problem on the level of emotion might be to ask questions like, “What do you feel when you criticize your spouse? Do you feel judgmental, angry, proud, hurt, fearful, anxious, neglected?“ This often allows one to back up and address the emotional triggers that lie behind the specific behavioral problems, to get to the issues behind the issue. But you might also need to address it at the level of cognition: “What are you thinking about yourself and your spouse when you engage in this behavior? What fears or lies has your mind unconsciously adopted about this relationship that energize this habit of complaining?” Often addressing disordered thoughts and emotions are all that is required for the behavior to fix itself, so to speak.

Or suppose someone is having a problem in their emotional life. Maybe they are struggling with depression. Now depression is very complicated and I don’t want to oversimplify things. But I can speak from my own experience. When I am feeling depressed, instead of attacking the negative emotions head-on and getting nowhere (and thus getting more depressed as a result), I stop and do an inventory of my thoughts and behavior. Here are some questions I might ask myself: “What am I spending my time thinking about? Am I dwelling on everything that is wrong in my life, ruminating about the future or feeling sorry for myself?”

Having these types of negative thoughts creates the conditions in which feelings of depression can thrive, or at least become worse. Certain behaviors also create the conditions for unhealthy emotions. The point is that one’s emotional life is not an autonomous zone outside our volition.

Being aware of the web of connections between feelings, behaviors and cognitions enable us to get out of autopilot mode (being pulled along by emotions, thinking automatic thoughts, and reacting to these feelings and thoughts with maladaptive behaviors) and take control.

 

Further Reading

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