What Is the CBT Triangle and How are Thoughts, Feelings, and Actions Connected?

The relationship between our thoughts, our feelings, and our behaviors runs deep. In every waking moment, our thoughts have power. They influence how you feel, and your feelings craft how you act. A healthy mindset helps you thrive. But if you may struggle with mental health, persistent negative thoughts can create distressing emotions that lead to damaging, even self-destructive, behaviors, like an angular loop that can’t be unbroken. In cognitive behavioral therapy (CBT), this is called the CBT triangle, or cognitive triangle — a visual diagram of how these three elements are inextricably interconnected, always interacting with each other to shape your experiences.  

The CBT thought triangle is an indispensable tool because it shows how negative thoughts (cognition) can trigger emotions (feelings) like sadness or anxiety disorder, which in turn lead to behaviors (actions) that reinforce those thoughts. By learning to recognize and challenge these patterns through therapy, you can break the cycle and create healthier ways of thinking, feeling, and acting. 

What Is Cognitive Behavioral Therapy (CBT)? 

CBT is a structured, evidence-based form of psychotherapy that focuses on the connections between what you think, what you feel and how you act. It’s widely used to treat issues like anxiety, depression or substance use disorders, since CBT is grounded in the philosophy that by identifying, understanding and changing unhelpful thought patterns, you can begin to cultivate a better emotional framework that will lead to more constructive behaviors. 

For example, if someone suffering from depression also has a drug addiction (which can qualify for a dual diagnosis), their negative perspective may be causing them to self-medicate. This connection between their thinking, feelings, and actions may lead them to keep drinking or using substances, which can exacerbate their mindset and mood.  

“CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way,” notes the Mayo Clinic. 

Psychiatrist Aaron Beck developed CBT in the 1960s after observing some of his patients with depression and noticed what are called “cognitive distortions” in their mindsets — thought patterns not rooted in reality that can cause someone to adopt a negative or fatalistic worldview. 

“(Beck’s) empirical observations led him to start viewing depression not so much as a mood disorder but as a cognitive disorder,” notes the National Institutes of Health. “Based on his clinical observations and empirical findings, Beck outlined a new cognitive theory of depression.” 

Main Principles of CBT 

Here are the main principles of CBT: 

Connection Between Thoughts, Emotions, and Behavior 

At the heart of CBT is the knowledge that your thoughts, emotions and behaviors are linked together — each one is influenced by the others all the time. A single negative thought or belief can lead to other similar beliefs, and these can lead to a cascade of emotions that validate these thoughts and lead to actions that reinforce the negativity. 

For instance, someone with low self-esteem may develop limiting thoughts and opinions about themselves. “I’m not good enough,” they might think. Feeling sad, hopeless, worthless, or that nothing or nobody will help, they may withdraw or avoid situations or challenges, like not making an effort to meet new people or seeking a promotion at work. CBT is aimed at helping you recognize how to break this cycle. 

“Certain thinking patterns are often associated with anxiety or depression,” notes an article from Harvard Medical School. “Therapists help people recognize these patterns and then work with patients to find broader, more flexible ways to cope with difficult situations.” 

Changing Unhelpful Patterns of Thought 

To look at your thought patterns objectively and recognize how they may be enabling negative behaviors or hindering you from pursuing positive habits is one benefit of CBT. The Harvard study continues, “Paying attention in the present moment without judgment, or mindfulness — is a common CBT tool.” 

And while you cannot always control your circumstances, you can control how you think about them. When we become so accustomed to distorted, negative thinking, it becomes habitual and normalized.  

Verbalizing to a therapist these patterns of negative, distorted thinking creates a chance to unpack why you feel this way and how they aren’t serving you well. In turn, it becomes a valuable opportunity to unlearn these habits and replace them with more constructive perspectives, ultimately improving how you feel and subsequently act. 

“By trying new things instead of avoiding them, you begin to change your thought patterns,” says the Harvard study. “These more adaptive thinking patterns then make it more likely you will try new or challenging experiences in the future, thereby increasing your self-confidence.” 

Problem-Focused and Goal-Oriented 

“In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications,” notes the American Psychological Association.  

Because of its practical, solution-focused structure, CBT is not about dwelling on the past. Rather, it encourages you to focus on present and current problems and set achievable goals.  

According to Harvard Medical School, your homework after leaving a session may include self-monitoring — paying close attention to experiences, events, or times of the day that might trigger negative thoughts or feelings. From there, you’ll work on developing positive, reaffirming self-talk in future sessions and work with your therapist to confront any mental and emotional barriers with actionable strategies. 

What Is the CBT Triangle? 

The CBT triangle graphic represents how easily our thoughts, emotions, and behaviors are intertwined. It illustrates how one’s thoughts can lead to the development of emotions, which then lead us to act on those emotions, and how these three aspects continually interact with one another, forming the foundation of many CBTs for mental health and substance use disorders. 

Notice how the CBT triangle is bi-directional: just as self-defeating thoughts can lead to pessimistic emotions and harmful behaviors, positive behaviors can lead the triangle in the opposite direction, fostering uplifting emotions and empowering thoughts. 

Here’s a breakdown of the CBT triangle explained: 

Thoughts 

“Ruminative thinking — negative thought patterns that loop repeatedly in our minds — is common in many psychiatric disorders,” notes Harvard Medical School. “This type of thinking also contributes to the unhappiness and alienation that many people feel.” 

This quote encapsulates how your thoughts are the starting point of the CBT triangle. Our mental thoughts manifest from our neural processes, the internal dialogue that shapes how we interpret the world around us. A belief as simple as “I’m a failure” can trigger feelings of sadness or frustration and lead to behaviors like procrastinating or avoiding attempts to change.  

Through CBT, you can learn to recognize these automatic thoughts and intercept them, the first step in breaking the cycle. 

Emotions 

Whether you’re feeling happy, sad, or angry, what you think can impact what you feel, notes a University of Minnesota study. “Thoughts and emotions have a profound effect on one another,” notes the article. “Thoughts can trigger emotions (worrying about an upcoming job interview may cause fear) and also serve as an appraisal of that emotion (‘this isn’t a realistic fear’). In addition, how we attend to and appraise our lives has an effect on how we feel.” 

This second point on the CBT thought triangle, emotions are your body’s response to your thoughts. Emotions aren’t objectively good or bad — they are signals generated by our thoughts, but too often we believe that they can’t be altered.  

However, the university states that our emotions are, like our thoughts, very malleable and can be changed. “Certain types of mental training, such as mindfulness or positive thinking, can affect our perceptions of the world and make us feel calmer, more resilient and happier.” 

Behaviors    

“We act, react, and behave (overtly or covertly) in response to our thoughts and emotions,” notes one study on CBT. “When our thinking and feelings are negative, our behaviors may be maladaptive — sometimes avoidant or self-destructive.” 

How we respond to a situation is linked to our thoughts and emotions. For instance, if you feel nervous about speaking up in a group discussion, you might stay silent, which then reinforces thoughts and feelings of low value on the CBT triangle. CBT helps you replace these behaviors with healthier choices, creating a positive feedback loop.