We have begun talking about a popular form of psychotherapy called cognitive behavioral therapy (CBT).

CBT is based on several assumptions, the first of which is that beliefs, behaviors, and feelings are interconnected. I examined this premise in my previous article.

Today I will explore the second assumption.

Assumption 2: To change our emotions and/or behaviors, we must change our thoughts.

Is this premise simply a rewording of the first one? It might appear so, but look more closely. Let me restate it: We must change our thoughts in order to change our emotions and behaviors. The assumption, then, is that thoughts cause emotions and behaviors. We are no longer talking about mere interconnection. We are now talking about causation.

But how are thoughts triggered? According to a traditional framework of CBT (called the ABC model), an activating event (A) causes or triggers thoughts (B), and these in turn cause behaviors/emotions (C). See figure below.

So simply changing our thoughts can change how we feel and behave. Easy, right? Not entirely. Partly because many of our beliefs are automatic. The goal for now is to become aware of these beliefs.

Let us go back to our example now, and consider how Jane’s thoughts may have caused her emotions and actions.

We can use the ABC model to do so. First we need to know the activating event. It was Fiona informing Jane about her plans to relocate. Secondly, what were Jane’s beliefs? She believed that she was being rejected, and that her friend did not care about her. Thirdly, how did these thoughts make Jane feel? They made her feel sad, rejected, hurt, and angry.

Lastly, how did Jane behave? She stormed out and refused to return Fiona’s calls the next day—not surprisingly, given that she believed she was being rejected and that her friend did not care about her.

But what if Jane were to challenge the veracity of those beliefs? Next week we will consider how she can do that.

Last week I suggested an exercise that might help clarify how your own thoughts, emotions, and actions are interconnected. For illustrative purposes I had also uploaded the image of a worksheet filled out by someone who had completed a similar exercise.

For this post I have created a blank worksheet in PDF file format. You can download the file, labeled “CBT Worksheet-Causation” from this link.

Once you download the file, you have several options, in terms of how to do the exercise. You may print the PDF document, and then fill it out using a pen or pencil. Alternatively, you can type in your answers into the PDF file, and save the modified file on your computer.

When you have downloaded the PDF file to your computer, open it up, and then move your cursor over each column heading (e.g., over “Thoughts/Beliefs”). As you can see, again for illustration purposes, I have provided you with an example of how someone (in this case, a person with test anxiety) might fill out an entry in this worksheet.

Fill out the sheet in a similar way. I would recommend that you fill out the details for each incident right after it occurs, but leave the examination of the causal link till sometime later.

Why? Because when we are emotional, it is more difficult to rationally examine the incident. A couple of days later, however, it might be easier to do so.

It is important to step back and remember the goal of this week’s exercise. The goal is to evaluate whether the second premise of CBT makes sense to you personally. Does it seem that your thoughts have a causal influence on your emotions and behaviors? Are they unrelated? Are they causal but only sometimes?

Based on what I know, therapeutic techniques work best when they make sense, and when you can see the ideas behind theories come to life in personally relevant ways. If you are not convinced, then you are less likely to benefit from this form of therapy. Therefore, it is a good idea to give these exercises a try.

In my next post I will consider what happens when we replace some of our automatic thoughts with more deliberate and rational ones. Can we even do so? And how?