Using the Cognitive Triangle to Combat Anxiety and Depression

Feelings of anxiety and depression are an experience that nearly all human beings share. Whether it results from the pressure of society to “succeed,” a desire to please others, family/relationship stressors, or pressure from work/school, both anxiety and depression can create a debilitating experience within our bodies that often prevent us from acting as our highest-functioning self.

The cognitive-behavioral theoretical approach is one form of therapy commonly utilized to address symptoms of anxiety/depression. This short blog will attempt to provide a simple understanding of the tool called “The Cognitive Triangle.” In addition to the description itself, a few helpful interventions focusing on each point of the triangle will be provided.

The main concept of the triangle is that self-awareness and metacognition (the ability to think about one’s thoughts) are the key to begin to manage those thoughts, feelings and resulting behaviors that often times feel out of our control.

The three points of the triangle:

We commonly have thoughts that are on autopilot—those thoughts that are easy to reach for because they repeat frequently, such as self-criticism we have had today, yesterday, the day before that, the one prior to that, etc. Without awareness of those thoughts, however, and more importantly the themes that exist within them (i.e. self-criticism, a tendency to catastrophize, etc.), it can be extremely difficult to realize they are there and to interrupt them. One way to do this is to bring attention to those themes.

One helpful exercise to attempt is to write down all of the negative thoughts had within a day, and later work to categorize those thoughts within this list and begin to recognize patterns.

Listed below are 10 categories into which our thoughts can commonly be categorized (Source: Burns, David D., MD. 1989. The Feeling Good Handbook. New York: William Morrow and Company):

1. ALL-OR-NOTHING THINKING: You see things in black-and-white categories. If your performance falls short of perfect, you see yourself as a total failure.
2. OVERGENERALIZATION: You see a single negative event as a never-ending pattern of defeat.
3. MENTAL FILTER: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.
4. DISQUALIFYING THE POSITIVE: You reject positive experiences by insisting they “don’t count” for some reason or other. In this way, you can maintain a negative belief that is contradicted by your everyday experiences.
5. JUMPING TO CONCLUSIONS: You make a negative interpretation even though there are no definite facts that convincingly support your conclusion
   • MIND READING: You arbitrarily conclude that someone is reacting negatively to you, and you don’t bother to check this out.
   • FORTUNE TELLING: You anticipate that things will turn out badly, and you feel convinced that your prediction is an already-established fact.
6. MAGNIFICATION (CATASTROPHIZING) OR MINIMIZATION: You exaggerate the importance of things (such as your goof-up or someone else’s achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or other fellow’s imperfections). This is also called the “binocular trick.”
7. EMOTIONAL REASONING: You assume that your negative emotions necessarily reflect the way things really are: “I feel it, therefore it must be true.”
8. SHOULD STATEMENTS: You try to motivate yourself with should and shouldn’t, as if you had to be whipped and punished before you could be expected to do anything. “Musts” and “oughts” are also offenders. The emotional consequences are guilt. When you direct should statements toward others, you feel anger, frustration, and resentment.
9. LABELING AND MISLABELING: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself. “I’m a loser.” When someone else’s behavior rubs you the wrong way, you attach a negative label to him” “He’s a damn louse.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded.
10. PERSONALIZATION: You see yourself as the cause of some negative external event, which in fact you were not primarily responsible for.”

Emotions can be distinguished from thoughts because they will take the form of one word. If I say, for example, “I feel like you don’t care,” that is actually a thought. If I say, “I feel sad (because the thought that is creeping in that you don’t care),” the sadness is, in fact, the emotion.

It is common to be able to identify one or two emotions relatively easily. Very often, the go-to emotion is anger.

That makes sense, as it is somewhat accepted by society and perceived as a less vulnerable emotion. If one can dig a bit deeper than the surface anger, however, it might encourage an entirely different reaction. If I recognize, for example, that each time I experience anger, the underlying emotion is actually disappointment, sadness, or hurt, that will create a hugely different behavioral reaction than the one that comes out of the perception that the emotion is simply anger.

One exercise to begin to work on this point of the triangle is to begin to explore underlying emotions.

1. The first step is to increase your emotional vocabulary. Take time to brainstorm all of the emotions that you are able to. Remember, emotions take the form of one word.

2. After an emotionally triggering event, write down the first emotion that comes to mind.

3. Begin to explore those emotions that lie below the surface of the initially identified emotion. You can ask yourself, for example, “when I feel angry, I feel…”  Repeat this process until you have identified at least three underlying emotions.

4. Recognize the shift in your emotional state, your thoughts, as well as what you end up doing with the simple recognition of what is underneath the initially identified emotion. You will probably find it easier to manage/communicate in a completely different way.

Those behaviors are of course dependent on both our cognitions, as well as our emotions.

When we are able to change our thoughts, our behaviors will naturally change.

When we are able to shift our emotions, our behaviors will also change. We can also, however, shift our emotions and our cognition by creating changes in our behaviors directly.

This can include forcing ourselves to exercise despite the lack of desire to do so, or, for example, attending a social event despite the anxiety experienced around groups of people, etc.

Breathing exercises can also be useful in creating a shift in anxiety or other emotional states. One such exercise is as follows:

THREE PART YOGIC BREATH

Steps:

1. Place your right hand on your abdomen and your left hand on your chest.

2. First, breathe slowly and deeply into your abdomen, inflating it like a balloon.

3. Then, feel your chest rise up as you inhale into your chest.

4. Feel your upper chest rise as your lungs inflate fully all the way up to the clavicle (bone underneath your neck).

5. Exhale, squeezing your abdomen in first, then your chest. Make sure to squeeze all of the air out to create more space for clean air on the next inhalation.

6. Repeat the breath 10 times.

7. Close your eyes and feel your body relaxing from your toes to the top of your head.

Overall, we can be more in control of thoughts and feelings if we are aware of what underlies them. Those processes about which we are aware, we can control. By working on any of the three points on the cognitive triangle—thoughts, feelings, or behaviors, you will have an impact on all of the other points naturally. Anxiety and depression can feel uncontrollable and hopeless at times, however, with the utilization of these tools, one can regain that sense of control and hope and create the capacity to be one’s best self.