How CBT Works
CBT is a therapeutic model that helps increase awareness of how our thoughts are closely linked to our experience of life. If you like this page, read more about how CBT is used to treat adult ADHD and how to identify thinking traps.
In brief, this is what the model looks like and how it works:
In any situation we interpret what’s happening and label it. This label, which could be a thought or an image, is usually automatic and based on our conditioning (what we have learned about how the world works). It usually comes quickly and we are not consciously aware of it, but we feel the results of it – we’ll get to that in a moment – and we unconsciously believe it to be the only possible interpretation of the situation.
Imagine the following scenario as an example: a classmate or co-worker makes a comment about your new haircut, “Wow, you’ve really changed your hairstyle….., I liked your previous hairstyle a lot better.” Your interpretation of this comment is not positive! In this case, your inner interpretation of this situation goes something along the lines of “that was rude, how could they say that? This person is not a friend and not to be trusted”.
The next link in the CBT model is an emotion and physical reaction based on your interpretation of the situation. The emotion and physical reaction is a response in the body not to the situation, but to your interpretation (thoughts) of the situation. This is what Shakespeare pointed to when he wrote, “nothing is good or bad but thinking makes it so”. The interpretation of a situation makes it bad or good by adding a judgement to it. Of course, some situations are objectively bad and no one could argue that fact. However, the way we interpret even an objectively bad situation still has a major influence on our experience of it.
Back to our example, what emotions and physical sensations might accompany the interpretation that someone is being rude and showing that they are not our friend? There might be embarrassment, anger, even sadness. Let’s imagine that anger was the predominant emotion triggered by the interpretation that this person is rude and unfriendly. The body’s reaction is increased heart rate and breath rate, tension in the shoulders, cortisol released into the body, a clenching of fists, tightening of the face, an aggressive posture, etc.
The Link Between Thought, Feelings, Physical Reactions and Behavior
Breaking the Negative Cycle to Create Change
Using CBT, we can slow down the cycle of interpretation, reaction and perpetuation of the negative cycle of experience. We can make it conscious rather than automatic and unconscious.
We can focus on the cognitive component, which is the interpretation of the situation. Simply making it conscious by examining it is already revealing and helpful. And then choice comes in, are there other ways the situation could be interpreted? In the example, perhaps the person just wanted to give us honest feedback but didn’t do it very skillfully, perhaps they were trying to be funny to impress someone nearby, perhaps they were feeling insecure about themselves and wanted to focus attention on someone else rather than themselves. These different interpretations all lead to different emotions, physical reactions and behavior.
By changing the interpretation, the cognitive part of the cycle, the whole cycle is changed and the symptom maintenance cycle is broken.
We can also change the cycle at the behavioral component. Instead of saying some angry words, are there different behaviors that could have been chosen? Perhaps we could have said something assertive like, “I think you’re trying to be helpful, but it doesn’t make me feel good”. Or, you could have said nothing at the moment and then spoken to the person later and told them how you felt.
Once again with the behavior changed, the cycle collapses. The cycle is linked, so changing any one component changes it.
It sounds easy, but it’s not of course. Conditioned or automatic responses to situations and the beliefs about one’s self, others and the world are not easy to change. But with support, a good plan and the desire to change, it is not only possible, it is highly probable that negative patterns will shift and so too the persistent negative outcomes that go with them.
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The next part of the CBT model is behavior or action. What behavior or action might one take based on the interpretation given in the example situation plus the emotion and body reaction?
There are different possibilities. Perhaps you leave the room quietly or just become quiet and withdrawn. Perhaps you storm out of the room and slam the door behind you. Or perhaps you say something or do something in anger to the other person. Let’s imagine that you said something in anger to the other person. You told them to keep their opinions to themselves.
Based on your interpretation, emotion, physical reaction and behavior, how might the situation play out? What might be the conditioning or learning you take from this situation as a result of how it played out?
Here’s where things get interesting. The behavior that comes as a result of our interpretation and resultant emotions and physical sensations tend to confirm our original thoughts. In this case we say something in anger to the person and then they react by distancing themselves from us or becoming less friendly. We have just confirmed our original thought that this person is not a friend. We therefore think we did the right thing and we are more likely to follow the same pattern in similar situations in the future.
Eventually we have an ingrained belief that people are not friendly and we usually can’t trust them. And we really do experience this because the cycle of thought, feelings, physical reactions and behavior tend to create outcomes that confirm our beliefs.
In CBT this is called a symptom maintenance cycle. In plain language, the way one interprets a situation not only affects their response to this one situation, but can create repeated experiences that maintain the negative cycle.
But did it have to go this way?