Posted in For Nurses, Therapy

Vicious cycle of depression – CBT

(CBT), or cognitive therapy, as a type of therapy that focuses on the relationships and connections between our thoughts, feelings and actions. This sounds simple, but what does it mean? In this post, we’ll look at what’s behind cognitive behavioural therapy in a little more detail.

In the CBT/cognitive therapy model, we recognize that we are each affected by the environment in which we live. This environment involves both our current situations (family, friends, job, culture, various stressor and supports, etc.), as well as our past (our family history, past relationships, previous successes and failures, etc.).

Within our environment, there are four elements of ourselves that interact with each other:

  • Cognitive: thoughts, cognitions, beliefs, self-talk
  • Behavioural: actions, behaviours
  • Emotional: feelings, moods, emotions
  • Physiological: biology, genetics, physical, physiology

These relationships are depicted below:

Cognitive behavioral therapy model

Notice from the arrows in the above diagram that:

  • Our thoughts affect our behaviour, our emotions and our physiological state
  • Our behaviours affect our thoughts, our emotions and our physiological state
  • Our emotions affect our thoughts, our behaviours and our physiological state
  • Our physiological state affects our thoughts, our feelings and our behaviours

cbtIn cognitive behavioural therapy, we recognize that various factors from the past may contribute to the development of the issues you’re dealing with, but the emphasis is on the present. Rather than focusing on your past, in CBT/cognitive therapy, we’re primarily concerned with determining what is maintaining any distress or symptoms you’re currently experiencing, and what changes you can make to start feeling better.

Because our thoughts, our feelings, our actions and our physiological responses are so closely linked, making changes in any one of these areas tends to bring about changes in the others.

Some of the ways we make changes involving these four areas in cognitive behavioural therapy are:


  • Identifying and re-evaluating negative thoughts, beliefs and patterns of thinking
  • Learning more effective problem-solving and decision-making strategies
  • Using mindfulness to deal with “uncontrollable” and racing thoughts, allowing you to let go of unnecessary thoughts without getting caught up in them


  • Changing unhelpful behaviours such as social isolation, avoiding situations, procrastination and inactivity
  • Learning to be more assertive and communicate more effectively
  • Pursuing pleasurable activities and interests that promote happiness and make life more meaningful and fulfilling


  • Learning how to experience and accept negative emotions without becoming overwhelmed
  • Techniques to transform painful emotions into more manageable feelings
  • Strategies to help tolerate emotional distress and manage extreme emotional reactions such as intense anger, anxiety or sadness


  • Breathing exercises and relaxation techniques to calm physiological responses and reduce stress levels
  • Mindfulness practices to cope with stress and physical discomfort or pain
  • Improving sleep, diet and exercise habits to improve physical well-being
  • Sometimes CBT is done in conjunction with anti-depressant or anti-anxiety medications prescribed by a physician


According to cognitive behavioural therapy (CBT), when you’re experiencing depression, you will tend to have automatic negative thoughts about yourself, the world and the future. This pattern of negative thinking you deeper into depression. This brings about further negative thoughts; which lead you to feel even more depressed; bringing about more negative thoughts; and so on.

Other vicious cycles that arise from depression involve feelings, behaviours, memories and physical symptoms. These vicious cycles are depicted below

Cognitive behavioral therapy vicious cycle of depression

These vicious cycles act together to create downward spirals that can carry you deeper and deeper into depression. One of the keys to overcoming depression is to become aware of when these cycles are happening, and engaging in ways to slow them down, and then reverse them, transforming them from vicious cycles that lead you deeper into depression, to positive cycles that lead you out of depression.


In the cognitive behavioural therapy (CBT) model of anxiety, the vicious cycle begins with an anxiety-provoking situation. This situation can be something external such as a work commitment, a trip, a social engagement, or any other event happening in the future that you’re worried about. Anxiety can also be provoked by something internal such as a physiological sensation, a thought about something you’re dreading, or an unpleasant emotion.
This anxiety-provoking situation then triggers a vicious cycle involving the four domains, as depicted below:

For example, you’re at a social event, and feeling shy, and this triggers a physiological response such as increased heart rate, or blushing, or sweaty hands. You become aware of this physiological symptom and think, “Oh no. Everyone just saw me blush”; or “What am I going to say? I have nothing to talk about.”
This thought can lead to more physiological symptoms. Or perhaps it leads to an emotional response, and you start feeling nervous or scared. And this leads to a behaviour, such as stuttering or mumbling your words, or just not saying anything. This can lead to another thought: “I’m making a fool of myself. Why did I even bother to go out?” And this can feed into further physiological symptoms, or thoughts, or emotions, or behaviours, each of which generate increased anxiety.


Mother, Pediatric Nurse and a Trail Blazer for Positive Change.

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