The Cognitive Triad

Greg Thorkelson, MD with Ryan Reagan, PhD(c), LPC

Behold: The Cognitive Triad!

Quite the opening there, we assure you in advance that this is probably not as exciting as other triangles.  Nonetheless, it is important to our ongoing posts on Cognitive Behavioral Therapy (CBT).  We are positing some writings on CBT because it is a widely used evidence-based therapy model.  Insurance payers have a preference for this model which means you are highly likely to encounter it if you choose to pursue therapy.  CBT is a very good methodology.  It is by no means applicable to every problem in the mental health field, no methodology is.  

This week we will be spending some time with CBT.  We are posting materials to assist our patients with deepening their understanding of psychotherapy.  These materials may or may not be applicable.  You might disagree with the premise entirely. Furthermore, these topics are subject to broad debate within the field.  The topic we are considering today is the Cognitive Triad.  This has been slightly modified from the version that was originally included in Arron Beck’s Cognitive Therapy and Depression.  This modification was made because CBT has become widely applied to conditions other than just depression.  

Now, before we dig in deeply with the cognitive triad shown above, it is important to note that Beck was applying this to a specific phenomenon—automatic thoughts.  This is a rapid style of thinking that can proceed with minimal awareness, and we all do this, probably a lot more than we realize.  If you have experienced the phenomenon where you are carrying on a conversation, and suddenly noticed that there was a separate steam of thought doing background commentary.  Ok, let’s be honest you are having a conversation at a party, and that background commentary that is saying “oh God, this person is dreadfully boring and will be talking my ear off all night.”  Those are automatic thoughts.  Apparently, some of us have a pretentious Brittish voice narrating in there.  

A point worth noting, you should think of that cognitive triad as cyclical.  Those boxes are to be taken as interdependent, hence the biderctional arrows.  Interpretations of events can easily influence feelings about the self and vice versa.  It is not always easy to think this way, but we want to avoid the chicken and egg thing for now.

What we are trying to convey here is that there is a thought process that is cyclical and interdependent, and that when it gets going it may happen so automatically that it practically goes unnoticed. Furthermore, it can be really difficult to reign this in, especially when you are suffering from depression or an anxiety disorder, hence the feelings of “stuck” or “it’s like this thing has a life of it’s own.”  These are common compaints heard by mental health professionals.  

If you can, try to imagine that an event (or stimulus if you prefer the psych terminology) activates the triangle.  This could be an external event like walking out to the street to discover you have a flat tire. Or it could be an internal stimulus, you might have a random thought or feeling that was pessimistic in nature.  Regardless, the triangle gets activated and sends thought into motion.  By “in motion” we mean that it starts drawing inferences.  For example, let’s use “flat tire,” which immediately gets interpreed as a negative event.  By the way, it is, this is not to suggest that we should not interpret it negatively.  

What we want to highlight is that it is very easy to draw this inference “flat tire”---àthis crap only happens to me.  This would represent the pathway on the triangle traveling from interpretation to view of self.  It could also travel the other direction “flat tire”--àman, I am never going to get out of this rutt. If we are unlucky we may get the trifecta:  

One thing that should be stressed.  We all do this to more and lesser degrees.  This is human.  This is not suggesting that something is wrong with your brain.  However, if your bain/mind happens to be in a less than optimal state due to a linger depression or an anxiety disorder, it is much easier to get stuck in these loops. When you are depressed this hurts, and hurts a lot.  Additionally, it often feels as if these things are cummulative.  Say the flat tire results in being late for work, now you have:  

We are using this example simply to highlight how incredibly complex yet relatable this phenomenon is. Within a few minutes our mind has assembled a narrative in which a “flat tire” equals “failure in life.” Here’s something to consider, although there is a logic here, it is entirely unreasonable.  None of us would accept a friend walking up to us and saying “I had a flat tire, and I’m a failure at life.”  For some reason we permit this type conversation in our own minds.  

In the coming weeks, additional posts will cover some techniques that can help with unwinding this type of thinking.  For now, just spend some time noticing your thinking patterns.  It can even be helpful to journal your thoghts out.  Words sometimes look different on paper.  Once you have a handle on identifying the thoughts, the next step is to call them into question.  A wise mentor would sometimes say “be a better scientist.” Test the theory that “flat tire” equals “failure in life.”  It probably doesn’t hold up.  Final step, self-compassion.  Using the mind to push back against a brain that is stuck is no small feat.  

All Blog Posts

November 4, 2021

The Cognitive Triad

October 26, 2021

Thoughts on Cognitive Behavioral Therapy (CBT)

September 21, 2021

The Therapeutic Potential of Ketamine

September 21, 2021

Psychedelics in Mental Health

September 8, 2021

Are You Meditating?

August 13, 2021

Are We There Yet? (Post-Covid Anxiety)

July 22, 2021

Languishing—The Mood State of the Pandemic

July 6, 2021

Neurofeedback—New Hope for ADHD?

June 24, 2021

Finding The Right Therapist

June 16, 2021

Living with OCD

June 9, 2021

CBD and Anxiety

June 1, 2021

Demystifying Bipolar Disorder

May 25, 2021

When to Ask for Help?

May 18, 2021

Good News on Difficult to Treat Anxiety and Depression—TMS.

May 11, 2021

The Nexus Group Announces Deep Transcranial Magnetic Stimulation (Deep TMS) Available for Pittsburgh Community

Press Release- The Nexus Group now offering Brainsway TMS Treatment

May 11, 2021

What do we know about post-Covid?

How is Post-Covid Syndrome affecting the Mental Health community

March 5, 2021

4 Commonly Asked Questions About Transcranial Magnetic Stimulation

Nexus answers a few commonly asked questions about TMS Therapy.

February 26, 2021

Things to Know About Seasonal Affective Disorder

Are you experiencing SAD this season? What you can do to improve your mood!

February 18, 2021

TMS Therapy at the Nexus Group

TMS Therapy is now available at the Nexus Group.

December 16, 2020

Coping with your ADHD and COVID19

Effectively handling the current situation can be a scary task to take on...

December 16, 2020

Mental Hygiene During COVID19: Recommendations from (WHO)

With a global pandemic spreading, many of us are bound to be anxious and distressed.

December 16, 2020

Find the Silver Lining: Ways to Remain Positive this Weekend

The week has come to a close and we are left to spend yet another weekend sitting on the couch

December 16, 2020

The Ever-Blurring Lines of O.C.D. During COVID-19

As the weeks press on in quarantine, we are urged take extra precautions.

December 16, 2020

Victims of Domestic Violence: Who to Turn to?

Stuck inside, it is easy to feel trapped as we wait for cases of COVID-19 to dwindle.

December 16, 2020

Date Night Plans, Anyone?

Date nights don’t have to be dull just because you’re stuck inside.

December 16, 2020

A Few Questions to Ask Yourself Daily:

It’s important to clear your head regularly in order to alleviate stress or tension.

December 16, 2020

Parents Helping Children with Autism: Coping with Transitions and Change

A strategical approach to help your Autistic children cope with transitions and change.

December 16, 2020

How Helping Others Can Help You

Giving does not have to be overly complicated. See how helping others can help you!

July 2, 2020

Safely Entering Phase Yellow

Phase yellow shows a positive step in the right direction.

July 2, 2020

Managing Bipolar Disorder Amid the Pandemic

A few helpful tips on how to manage your Bipolar disorder during the pandemic.

July 2, 2020

How to Journal for Your Mental Health

Journaling can benefit your mental health. Here are some practical steps on how to approach it.

July 2, 2020

Experiencing Grief During COVID-19

Some practical steps on how to overcome grief during COVID.

July 2, 2020

Waiting Out Another Weekend at Home

How to keep your brain active at home during the pandemic!