By now, you may be asking, “What exactly is this treatment that I am starting?” Before we get to the “nuts and bolts” of how this can help you, it will be useful to describe the four important components of the cognitive-behavioral approach and how they interact with one another. These four components reflect on your current health status, your thoughts, your behaviors, and your emotions. This explanation might seem abstract, and it may be difficult to see how it might apply to your problems, so here is an example to show how the approach works:

John is a 66 year old retired, married man who has weekend plans to finish painting his wife’s bookcases (behavior). He wakes up feeling ill on Saturday morning (health) and is unable to complete the project (behavior). He feels angry and anxious about not getting to his work (emotions), believing that he is disappointing his wife (thought). He thinks, “My wife will think that I do not care about helping her decorate the study.” This belief raises his anxiety (emotion) as well as his frustration about not feeling up to par. This makes it even harder for John to figure out how to face the day, and consequently he stays in bed (behavior), which in turn only serves to raise his anxiety and strengthens his negative thoughts about his wife’s reaction.

 We can diagram the interaction of John’s behaviors, health, thoughts, and mood to demonstrate how they affect each other:

Notice that each connection has an arrowhead in two directions. For example, John’s negative beliefs about his wife’s disappointment may have worsened his physical health status as well as his mood, which in turn, reinforces his behavior of staying in bed. Although you will be concentrating on how to change your negative emotions, please note that the relationships within this model also work for positive emotions. Notice, too word “environment” surrounding the model. Environment refers to the events and the people around you that affect what you do and think, as well as how you feel physically and emotionally. In this example, John’s environment could be his plans to paint the bookcases and also his commitment to his wife to complete this project. Additional elements of the environment could be a friend moving away or the death of a family member. As you can imagine, any number of different situations might occur that could affect these components in either positive or negative directions. In the course of the program we’re going to be looking at many different situations in your environment to see how they affect these four components.

Exercise: Choose an example of your own to illustrate this model

 Behavior: Recall the last time you had a successful outcome from a good job you did or a task that you just completed. Record it.

Thoughts: What kinds of thoughts did you have about yourself?

Emotional Consequences from thoughts and behavior: What kind of mood were you in as a result?

Health: What was your health status that day?
How does CBT work?

Keep in mind an important idea in Cognitive-Behavioral therapy is that events in these four components have a notable influence on one another, and that this influence is reciprocal in nature. Thus, a negative thought stemming from an unpleasant event could affect activities or emotions, which in turn can affect new thoughts and behaviors. In some instances these components can start a downward spiral of negative changes that can throw you into a tailspin. See the following figure:

 This illustration shows that “giving in” to the “slowed down” feeling can lead to a downward spiral — do less — feel worse — do even less, etc. You will learn ways of stopping a tailspin and also reversing one. Notice that the figure on the right shows you that you can “pull out” of a tailspin. The goal of CBT will be to change the behaviors and the thoughts that could stop a tailspin before it gets started. You’ll also learn techniques to reverse the tailspin, and move yourself in an upward spiral. This illustration shows that “giving in” to the “slowed down” feeling that often comes with depression leads to a downward spiral — do less — feel worse — do even less, etc. You will learn ways of stopping a tailspin and also reversing one. Notice that the figure on the right shows you that you can “pull out” of a tailspin. The goal of CBT will be to change the behaviors and the thoughts that could stop a tailspin before it gets started. You’ll also learn techniques to reverse the tailspin, and move yourself in an upward spiral.

Homework/Practice. We cannot put enough emphasis on the importance of practicing your new skills between each session. Practice is one of the best ways we know for you to make the CBT skills a routine part of your daily life. We call this practice “homework,” even though the term can bring back unwanted memories of school assignments! Unlike school, you will find that homework assignments are an extension of what you discussed in group. Many of the techniques you will learn in group are designed to become automatically used as problems arise in your daily life; therefore homework is the way to practice! practice! practice! 

Sometimes homework is hard to do.

Many circumstances make it difficult to complete homework. For example, time constraints, the difficulty of assignments, or fears that you are doing it “wrong” commonly interfere with completing homework. Some people may not like someone “telling them what to do,” or sometimes people think that the homework is silly, or useless. Avoiding homework can seriously interfere with feeling better, so consider these thoughts about approaching a challenging homework task.

There is no way to do homework wrong the first time. Think about when you learned to ride a bicycle. Did you ride it “wrong” the first time, or did it just take a little practice? You will not know if the homework is helpful unless you try it. Just like your first bike ride, get on and start pedaling! If you think that you are “too busy” to do the homework, try to plan a time. Most importantly, your group facilitator will always want to talk with you about your difficulties with the homework to clarify the instructions or the goals of the task, as well as help you plan a good time to do it.