The CBT triangle (or cognitive triangle) is a model for illustrating the relationship between thoughts, behaviors, and emotions. This model acts as a map for understanding the relationship between these three points (thoughts, behaviors, and emotions), and how we can make changes to habits of thought and behavior to help us feel better. This relationship is the foundational principle that underlies cognitive-behavioral therapy (CBT) (Ellis, 1962, 36; Beck, 1979, 3–4, 35).

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On each point of the CBT triangle are thoughts (cognitions), behaviors, and emotions (hence: cognitive-behavioral therapy). Each one of these points influences the other two. Therefore:

• what we think influences how we act, and how we act influences what we think
• how we act influences how we feel, and how we feel influences how we act
• how we feel influences how we think, and how we think influences how we feel.

When thoughts, behaviors, and emotions influence each other, this creates a feedback loop where these habits reinforce and perpetuate. This can be a very good thing, but it can also work against us. For example, a cognitive distortion such as overgeneralization could entail the thought that, “nobody likes me.” This might lead to a negative behavioral habit, such as social withdrawal, as well depressed mood. The depressed mood may trigger additional negative thinking — rumination, perhaps, which may then cause additional negative behaviors, such as spending the day in bed . . . and the vicious cycle continues. This is one example of how mental illness can develop and sustain itself.

Cognitive-behavioral therapists have identified a number of common cognitive distortions that are similarly interconnected with our behaviors and emotions (J. Beck, 2021, 253; Burns, 1981, 40–41). While there is no universally agreed upon list of cognitive distortions, some of the most frequently cited are (links go to full articles):

• All or nothing thinking: if something doesn’t go exactly right, then it is entirely wrong.
• Blaming: assigning blame to someone or something who doesn’t bear responsibility.
• Emotional reasoning: “I feel that it’s true, therefore it must be true.”
• Jumping to conclusions: making a negative assumption without having evidence to support that assumption.
• Mental filtering: filtering out everything but the negative
• Overgeneralization: making a sweeping conclusion based on a small amount of information
• Should statements: setting rigid expectations for ourselves or others
• Worst case scenario thinking: overexaggerating the likelihood of negative outcomes.

The CBT triangle also illustrates how we can combat issues like anxiety and depression: by following this same model, while making positive changes.

Using the CBT triangle to treat anxiety, depression, and other issues

When thinking about making a change to one of these points on the CBT triangle, the point we are most interested in, naturally, is that of emotions. I’ve never heard anyone say, “All I want in life is to go to the gym twice a week!” I have, however, heard plenty of people say, “All I want in life is to be happy!” We are emotional beings, and many of us view the enjoyment of positive emotional state as a life-long ambition.

Going to the gym twice a week, eating a healthy diet, keeping a gratitude journal . . . these are means we are willing to do to feel good. They are not, for most of us, ends in themselves.

We cannot directly change our emotions . . .

The catch is that of these three points on the CBT triangle, the one we are most interested in — emotion — is the only one of the three that we do not have direct control over. If we could control our emotions, we could simply say, “I’m going to be happy from now on,” and, just like that, we’d never feel sad, angry, or afraid ever again. Obviously, that’s not how it works!

Therefore, the theory of CBT is that, while we cannot directly change our emotions, we can improve our emotional states by harnessing the control we do have over our habits of thought and behavior.

This gets tricky, though, because many of our thoughts and behaviors are outside of our control. We have thoughts that occur automatically or lie so deep within our subconscious that they escape our awareness. In CBT, these are called automatic thoughts (Beck, 1979, 29). When something startles us, for example, a word or phrase might immediately come to mind (like, “Ah! Get away from me!”). We did not choose to think this — it just happened. These are the sorts of thoughts we cannot control. Similarly, we may harbor deeper beliefs about ourselves, others, or the world at large that we cannot quite seem to articulate (Beck, 1979, 41).

Many of our behaviors are outside of our control, too. We have automatic behaviors (i.e., reflexes), such as kicking our knee when the doctor taps it with a rubber mallet or instinctively jumping when something frightens us. Additionally, we also fall into habits of posture, body language, and routine which can evade our conscious awareness.

. . . But we can change certain thoughts and behaviors

Given that we cannot directly change our emotions, we have to make do with the limited control we do have over our thoughts and behaviors. The good news is that this limited control has proven to be enough to make significant improvements to our emotional states (Fordham et al., 2021).

The treatment of mental illness from a CBT perspective is centered around exploring and identifying negative habits of thought and behavior. Once we have identified the problematic habits, we can begin to work on finding healthier replacements for these habits.

Addressing problematic thought and behavior habits concurrently will maximize our efforts. For example, if you are struggling with depression and spending long periods of daytime in bed, lost in rumination, some early behavioral changes in the therapeutic process might be to:

• Take a shower, get dressed, and go out for a fifteen minute walk each morning.

Early cognitive changes might including:

• Log your mood at certain intervals each day, identify any specific thoughts occurring at the time that may be influencing this mood, and then identify alternative perspectives to these thoughts that may be healthier and more realistic.

When we make these changes, the influence of these changes will work their way around the CBT triangle to all of its points, including emotions. Let’s look at a few more examples of how this process works (using the list of cognitive distortions above).

When unhealthy mental and behavioral habits intersect

Often, when we experience emotional distress, we are engaging in both cognitive distortions and unhealthy behaviors. For example:

• Sarah fears a meeting with her supervisor, which causes her engage in emotional reasoning by believing that the meeting will be negative. She skips the meeting and then is passed over for a promotion.
• Bryan was making fantastic progress with his goal to improve his physical health, but after missing his objectives one week, he succumbed to all or nothing thinking and abandoned his new workout routine, replacing it instead with a sedentary lifestyle.
• Jake’s worst-case scenario thinking about a pain in his stomach caused him to avoid seeing a doctor out of fear that the doctor would give him catastrophic news.

These are just three of an endless stream of examples that could be illustrated.

When healthy mental and behavioral habits intersect

• Sarah reminds herself that the meeting she is fearing may be about the good job she did on a recent assignment. She attends the meeting, where she is offered a promotion.
• After missing his objectives for a week, Bryan reminds himself of the overall progress he has made on his physical health goals, which invigorates him to get started again on his new workout routine.
• Jake convinces himself that the worst-case scenario he fears about his stomach pain is exceedingly unlikely and therefore goes to see a doctor, who confirms that it is a routine stomach bug.

In these examples we have seen the principle underlying cognitive-behavioral therapy: thoughts, behaviors, and emotions influence one another. Whether that helps us or hurts us depends on our mental and behavioral habits. Using the CBT triangle as a roadmap to understanding this influence can be a powerful tool to make feedback loops work for us and not against us.

References

• Beck, A. (1979). Cognitive therapy and the emotional disorders. Meridian.
• Beck, J. (2021). Cognitive behavioral therapy: basics and beyond (3rd ed.). The Guilford Press.
• Burns, D. (1981). Feeling good: The new mood therapy. William Morrow and Company
• Ellis, A. (1962). Reason and Emotion in Psychotherapy. Stuart.
• Fordham, B., Sugavanam, T., Edwards, K., Stallard, P., Howard, R., das Nair, R., Copsey, B., Lee, H., Howick, J., Hemming, K., & Lamb, S. E. (2021). The evidence for cognitive behavioural therapy in any condition, population or context: A meta-review of systematic reviews and panoramic meta-analysis. Psychological Medicine, 51(1), 21–29. https://doi.org/10.1017/S0033291720005292

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