Cognitive Behaviour Therapy (CBT) is particularly interested in our thoughts and our behaviours. It looks at the interaction between our thoughts, feelings (moods), physical sensations, and behaviours. When we experience a triggering situation, we often notice an internal shift in how we are feeling physically and/or emotionally and we may become consumed with our thoughts. Thoughts then often drive our behaviour.
In CBT we are on the lookout for what can be described as unhelpful thoughts and unhelpful behaviours. Unhelpful thoughts are negative in nature however they seem completely believable and plausible, they are automatic/instantaneous and often spiral. Our thoughts are very powerful and can strongly impact on how we are feeling in our mood. This is referred to as the thinking feeling connection. This can then guide what we do or don’t do in terms of our behaviour. Unhelpful behaviour is either avoidant or involves the use of ‘safety’ behaviours.
What is a CBT Maintenance Cycle (sometimes referred to as vicious cycle)?
Let’s look at the following example: Triggering situation: I receive an invitation to a friend’s party.
I might start to think about who will be there, will I know anyone, will there be a lot of people, what will I say, I won’t have anything interesting to talk about, people might look at me, I might not fit in, no one will like me, they might think I’m odd, etc. If I have all these thoughts going on it would be understandable for me to feel anxious in my mood. I might also feel physically uncomfortable: tense, a knot in the pit in my stomach, my heart rate may increase or my breathing maybe shallow. To cope with experiencing all these symptoms (thoughts, moods, physical sensations) it’s quite possible that I decide it’s easier to not go to the party. So, my behaviour is to avoid the situation so that I don’t have to tolerate these uncomfortable symptoms. The problem with this is it only works in the short term and so I am inadvertently maintaining the problem.
Additionally, if I avoid going to the party it is likely set off another spiral of thoughts:
I’m useless, I’ve let my friend down, I won’t be invited again, I’m lonely, I’ve failed again. These thoughts are likely to result in my feeling low in mood or even depressed. And then I’m even more likely to withdraw from others and isolate myself further. Again, inadvertently forming an unhelpful maintenance cycle.
Working with Thoughts:
There are various types of unhelpful thinking patterns that we can get into and it’s not uncommon to fall into a number of these in one situation. Hence, we ‘spiral’. Broadly speaking unhelpful thoughts tend to be either anxious predictions or self-critical thoughts.
In CBT we learn to notice and identify our unhelpful thoughts and use strategies to manage them. One such strategy is thought challenging to generate more realistic alternatives. This involves working through a series of steps that enable us to put the brakes on from ‘spiralling’.
Working with Behaviours:
Changing behaviour is also fundamental. Again, CBT introduces us to various strategies to do this. If we are feeling low or depressed, then the approach tends to be around activation. This may involve setting small, meaningful goals in line with personal values and having a go of doing something regardless of how you feel. If the difficulty is related to anxiety, then the approach is likely to involve graded exposure. Of course, it does depend on the type of anxiety we are working with but broadly speaking graded exposure of some description is used.
We may also make a change in our behaviour to test out our alternative thoughts to enable us to build evidence to strengthen these.
Whichever CBT model we are using it will involve exploration of our cognitions and making changes in our behaviour.
Rebecca Mead is an accredited, registered and experienced Psychotherapist offering Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT) to individuals adults. Rebecca is available at our Brighton and Hove Practice.
Further reading by Rebecca Mead –