How does Cognitive Behavioral Therapy (CBT) work?

The premise of Cognitive Behavioral Therapy (CBT) is understanding the correlation between thoughts, emotions, and behaviors—what’s known as “the cognitive triangle.”

The cognitive triangle explains how thoughts, feelings, and behaviors all impact each other. Changing one of the points on the triangle can change the others on the triangle.

More specifically, changing our thoughts can change how we feel, how we feel affects our behavior, and our behavior guides our future thoughts, and the cycle continues.

For example, let’s say you wake up late, you’re rushing around, and when you get to work you realize you forgot something you needed for the day — you might start thinking, “This day is going to crap,” “I’m a failure,” “I’m not going to be able to get anything accomplished that I wanted to,” etc.

Then, because you’re thinking these things, you then begin feeling these things. I’m sure you can envision this scenario playing out in your own life, and you might even be able to recognize how thinking such things can almost immediately make us feel bad, anxious, shameful, guilty, or disappointed. Because you’re thinking you’re a failure, and now you feel disappointed in yourself, you cancel the plans you had after work because you’re feeling down — the cognitive triangle.

Now that you’ve went through a full cycle of the cognitive triangle, you're back to square 1. You went home and cancelled your plans because you starting feeling disappointed from forgetting your essential item and thinking that you’re a failure. Because you’ve now went home and cancelled your plans that you had with a friend, you start thinking, “I’m a terrible friend,” and in turn you start feeling shameful and depressed. You see? You might’ve experienced this before. It’s so easy for the cycle to continue, all starting with something that seems so minor.

It can go any way, any direction, depending on what point you’re starting at on the triangle. Let’s say your child forgot to turn in their homework (the behavior) and then they see their low grade in the class from not turning in their homework and they start thinking they’re stupid and a “total mess up” (the thought), so they feel sad (the feeling), and then they sit in their room and don’t do their homework again (the repeated behavior) and the cycle continues.

CBT is structured on the belief that psychological issues are caused by unhelpful, unwanted thoughts or behaviors. It works by examining those unwanted thoughts and behaviors, challenging them, and replacing them with more helpful, positive ones.

Awareness is the first step. Negative thoughts or behaviors can almost become innate or “natural.” Being able to recognize your unhelpful thoughts and behaviors is the key to actually changing them.

A therapist utilizing CBT helps understand the client and their specific negative thoughts and behaviors, helps the client become aware of them and how they’re maladaptive, then gives the client the space to challenge and change them. CBT works by unlearning negative thoughts and behaviors and learning new, healthier ways of thinking and behaving.

So from the above example, a therapist using CBT might help that person become aware of how that initial thought of, “I’m a failure,” affected their entire day in relation to the cognitive triangle. The therapist would prompt the client to challenge the thought and ask them if that is 100% true, and if it’s not, then what could be something more helpful to think of instead, like “I forgot something, but I still showed up and did my work around it and that makes me successful.” Thinking that more helpful thought would of course change how that person feels and behaves in comparison to thinking the unhelpful thought.