What Principle Underlies Cognitive-Behavioral Therapy? It’s All Connected
The foundational principle that underlies cognitive-behavioral therapy (CBT) is that thoughts, behaviors, and emotions are interconnected. This relationship can be visualized with the CBT triangle (or cognitive triangle).
Thoughts, behaviors, and emotions can be understood as three points on a triangle, and each one influences the other in a bilateral fashion.
This means that:
- what we think influences how we act, and how we act influences what we think
- how we act influences how we feel, and how we feel influences how we act
- how we feel influences how we think, and how we think influences how we feel.
Cognitive distortions: when thinking goes wrong
Because thoughts, behaviors, and emotions influence each other, it is important that we identify and correct faulty habits of thought, or cognitive distortions, which in turn negatively influence our behaviors and emotional states.
This idea can be traced back to the Stoic philosophers of ancient Greece and Rome, who recognized that our perceptions do more to color our emotional lives than does the objective world itself. In other words, we are more likely to experience emotional distress if there are errors in our thought process.
Pioneering cognitive-behavioral therapists including Albert Ellis and Aaron Beck identified a number of the most common cognitive distortions. While there is no universally agreed upon list of cognitive distortions, some of the most frequently cited are (links go to full articles):
- All or nothing thinking: if something doesn’t go exactly right, then it is entirely wrong.
- Blaming: assigning blame to someone or something who doesn’t bear responsibility.
- Emotional reasoning: “I feel that it’s true, therefore it must be true.”
- Jumping to conclusions: making a negative assumption without having evidence to support that assumption.
- Mental filtering: filtering out everything but the negative
- Overgeneralization: making a sweeping conclusion based on a small amount of information
- Should statements: setting rigid expectations for ourselves or others by
- Worst case scenario thinking: overexaggerating the likelihood of negative outcomes.
Healthy behaviors: the universals
It becomes perilous to try to prescribe an ideal by which we all should live. There are, however, some pretty well-understood behavioral habits that the majority of us would do well to aspire to. Among these are:
- Engage in physical activity
- Refrain from tobacco use and excessive drug/alcohol use
- Go to a doctor regularly for health screenings
- Get about 7-9 hours of sleep per night
- Spend time outdoors
- Spend time with family and friends
- Engage in meaningful work
We may not always be able to achieve these things, but for the vast majority of us, we will enjoy better health the more we are able to adopt these habits.
When unhealthy mental and behavioral habits intersect
Often, when we experience emotional distress, we are engaging in both cognitive distortions and unhealthy behaviors. The following are a few examples that draw on the lists of cognitive distortions and healthy behaviors listed above.
- Sarah fears a meeting with her supervisor, which causes her engage in emotional reasoning by believing that the meeting will be negative. She skips the meeting and then is passed over for a promotion.
- Bryan was making fantastic progress with his goal to improve his physical health, but after missing his objectives one week, he succumbed to all or nothing thinking and abandoned his new workout routine, replacing it instead with a sedentary lifestyle.
- Jake’s worst-case scenario thinking about a pain in his stomach caused him to avoid seeing a doctor out of fear that the doctor would give him catastrophic news.
These are just three of an endless stream of examples that could be illustrated.
When healthy mental and behavioral habits intersect
We’ve looked at a few examples of how unhealthy mental and physical habits can influence each other. Fortunately, the opposite is also true: healthy mental and behavioral habits influence each other, too. When we begin to understand that thoughts, behaviors, and emotions are interconnected, we realize that even making small positive changes can have a ripple effect. Below we will look at the same examples as above, but with healthy strategies.
- Sarah reminds herself that the meeting she is fearing may be about the good job she did on a recent assignment. She attends the meeting, where she is offered a promotion.
- After missing his objectives for a week, Bryan reminds himself of the overall progress he has made on his physical health goals, which invigorates him to get started again on his new workout routine.
- Jake convinces himself that the worst case scenario he fears about his stomach pain is exceedingly unlikely and therefore goes to see a doctor, who confirms that it is a routine stomach bug.
In these examples we have seen the principle underlying cognitive-behavioral therapy: thoughts, behaviors, and emotions influence one another. Whether that helps us or hurts us depends on our mental and behavioral habits.
