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