The Cognitive Triangle
There has been a lot of buzz around Cognitive Behavioral Therapy (CBT) in the past several years, and many great self-help books and mental health apps have centered around the concepts of CBT. A key component of CBT is the Cognitive Triangle. This is the concept that thoughts, feelings, and behaviors all work together to influence each other. By working to target any of the three points on the triangle, it will naturally impact the other two. In therapy, the most common means of doing this is by challenging irrational thoughts in order to change feelings and behaviors.
Let’s discuss these different points of the triangle and how you can incorporate these concepts into your everyday life.
Thoughts
Unhelpful thinking styles, often called cognitive distortions (or “Coggy D’s” as my previous teenage clients used to call them), are deeply held assumptions about how you view yourself and the world around you, which impacts the way you feel and behave.
[Check out this handout with 10 common cognitive distortions.]
For example, let’s say I had some news to tell my grandmother and was not sure how she would react. It’s typical for my mind to jump to possible outcomes or responses in the situation, but the truth is, I have no control over how she is going to react and won’t know until I actually tell her. By getting so caught up in the cognitive distortion of fortune-telling/ mind-reading, I am jumping to conclusions without any evidence to support it. The body has a difficult time deciphering the difference between something you are experiencing in real time versus a stressful situation you are thinking about. That being said, by me thinking about my grandmother’s possible responses, my body is experiencing that stress as if it were happening to me at that moment. This is going to make me feel anxious (emotions) and possibly withdraw or not visit her out of this fear (behaviors).
The truth of the matter is that unhelpful thoughts will pop into your head- that is something you cannot control or change, however, you can work to challenge them.
Putting thoughts on trial
How do you challenge unhelpful thoughts? In my experience, the most helpful way to challenge these thoughts is first to put them on trial. For the trial, the Defense is there to provide evidence for the unhelpful thought. “What makes this thought true, and should you be listening to it?” The Prosecution is there to provide evidence against the thought. Why is this thought wrong? For both the Prosecution and Defense, only use evidence that is a verifiable fact. NO interpretations, guesses, or opinions. The Judge can then come to a verdict that allows the thought to be challenged.
Example:
Thought: My grandmother is going to be so mad at me for my new tattoo.
Defense:
My grandmother is very religious, and there are rules against tattoos in the Torah.
She made a critical comment about “altering” the body when she saw someone with a piercing.
Prosecution:
My brother got a tattoo a few years ago, and she got over it quickly.
I care about her opinion, but overall she has no control over my actions and what I choose to do with my body.
Verdict/ reframing the thought: I am worried that my grandmother might be mad at me for my tattoo, however, I will not know her reaction until I am there, and I have the power to choose what I do with my body.
Emotions
Any emotion, whether it’s sadness, happiness, excitement, etc., can be extremely overwhelming and difficult to handle in the moment. Oftentimes when there’s a struggle to regulate emotions, specifically the more difficult ones to sit with, it feels easier to numb them than force yourself to feel. The truth is the body cannot selectively numb specific emotions, so when you attempt to numb emotions like worry or anger, you end up numbing emotions such as joy or optimism as well. The only way to get over an emotion is to get through it, so let’s discuss some tools for emotional regulation.
The first step is to actually be able to identify emotions, which can be a lot harder than it sounds.
Becky’s blog post on Identifying Primary Emotions describes this process and the importance of it in such an amazing way. I’ve found the most effective way to begin this process is to notice bodily sensations. Does your chest get tight when you’re anxious? Do you feel a burning sensation in your stomach when you’re experiencing jealousy? From there, take a nonjudgemental stance and identify the emotion and what you are needing in that moment.
An emotion wheel is an extremely effective resource for the actual identification piece. Take a look at it before moving on to the next section.
When I am feeling Fearful emotions :
Belly breathing:
6-7-8: in through your nose for 6 seconds, hold for 7, and release through your mouth for 8.
Remember to breathe the air into your stomach, not your chest. Breathing into your stomach actually massages your internal organs, whereas breathing into your chest does not allow you to get a full breath and might induce feelings of anxiety in some cases.
Temperature, Intensive exercise, Paced breathing, Progressive muscle relaxation
Temperature (great for a panic attack): Submerge your face in ICE water for 10 seconds. Repeat. Hold onto some ice cubes, or take a cold shower.
Submerging your face in cold water activates something called your “dive response.” This causes your heart rate to slow down, and blood flow is redirected to the brain and heart, actively resetting your nervous system.
Intensive exercise: 30 seconds of jumping jacks or running in place to expend stored-up energy.
Paced breathing: 6-7-8 belly breathing
PMR (Progressive Muscle Relaxation): Squeezing body parts- Or “squeeze lemons”: squeeze your hands into fists for 10 seconds and release. Repeat.
5 things you can see
4 things you can feel
3 things you can hear
2 things you can smell
1 thing you can taste
Eat a sour candy (great for a panic attack)- this causes a similar nervous system reset as the cold temperature exposure.
When I am feeling Angry emotions:
Take a step back from the situation and return after you take a break
If you’re feeling this in a conversation, say, “I need to take a step back, can we return to this conversation in ___ minutes/ hours?”
Belly Breathing
PMR
When I am feeling Sad emotions:
Push yourself to engage in an enjoyable activity
Bike ride, walk, watch a movie, listen to music, call a friend
Opposite action: this is a skill where we push our body to do the exact opposite of what we are feeling. If we are sad, try watching a funny video or movie.
Distractions: Distractions are great for short-term relief and can help you get through an immediate crisis
Behaviors
Common symptoms of depression include tiredness, lethargy, and loss of interest and motivation, which leads to inactivity and can often worsen or prolong the depression. There’s a concept in CBT called Behavioral Activation, which focuses on overcoming depression by increasing activity levels. There are copious amounts of evidence showing that the more individuals engage in pleasant activities, the better they feel. Activity helps clear your mind, helps you feel less tired, and allows you to gain a sense of mastery and control over your life again.
I tell my clients to try to engage in three types of “BAs” a day: valued, enjoyable, and routine.
Examples of valued activities (activities that align with your values):
Spending time with a loved one
Taking your dog for a walk
Calling a friend
Going to work or school
Examples of enjoyable activities:
Going for a walk
Listening to music
Reading a book
Having a picnic
Going to a museum
Examples of routine activities:
Taking a shower
Brushing your teeth
Cooking a meal
Let’s put it all together. This is A LOT of information, and I understand that it can feel really overwhelming in this moment. When you start to experience unhelpful thoughts from a triggering situation, try to walk yourself through these questions. The more you do it, the easier it will become:
What is the thought I am having?:
What triggered this thought?:
What unhelpful thinking style is this?:
What emotion am I feeling?:
What is the evidence against this thought?:
What is the evidence in support of this thought?:
How can I reframe this thought?:
What am I feeling in my body?:
What can I do to calm my nervous system?
What are three BAs I can engage in?:
Example:
What is the thought I am having?: “I am a burden.”
What triggered this thought?: I feel like I am dumping my emotions on others
What unhelpful thinking style is this?: labeling, blaming, emotional reasoning
What emotion am I feeling?: upset, withdrawn
What is the evidence against this thought?: I have a great support system with people who I know would always love and listen to me when I need it
What is the evidence in support of this thought?: I am feeling guilty for putting my problems on others
How can I reframe this thought?: I may feel like a burden to others, however, I know that I have a support system of people who want the best for me. My feelings are not facts!
What am I feeling in my body?: tense
What can I do to calm my nervous system? Deep breathing, behavioral activation, opposite action
What are three BAs I can engage in?: playing with my cat, calling my friend, and taking a shower.
This process can feel overwhelming, but it doesn’t have to be! If you’re interested in learning more about the concepts of CBT, thought challenging, and emotional regulation, the therapists at Root to Rise can help. Contact our Client Coordinator to find out which therapist would be best suited for your needs.
Warmly,
Root to Rise Therapy
