Anxiety and Depression Explained

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) was created based on Cognitive Behavioral Theory, which describes that anxiety and depression develop because of negativedistorted, or irrational thoughts and beliefs. This theory explains that there is a link between the way you think, the way you feel, and your behaviors and actions.

So, if you’re thoughts are sad, negative, anxious, or unrealistic, this will affect the way you feel and act, the way you respond to stress, and how you interpret situations around you.

Example of thought-feeling-behavior pattern

Here is an example of how this thought-feeling-behavior pattern can lead to anxiety or depression:

Bob is a college student who just started at a new college after transferring from out of State. Bob joins a community service club to meet new people since he doesn’t have any friends in the area. When Bob arrives at the first club meeting, he spots a table where several other students are sitting. He hesitates, but then remembers that he promised himself he would be open to making new friends so he walks up to the table, sits down, and says “Hi” to everyone. Bob immediately noticed that no one at the table returned his greeting. Bob became so upset and embarrassed, he got up from the table right as the group leader started speaking in the front of the room, left the group meeting, and never returned. Bob was convinced that no one in the table was interested in meeting him and it’s because he’s too quiet and shy. He felt he would never make friends at this new college.

Core Belief

I bet you can spot a few things that went wrong in this situation with Bob as far as his way of thinking and interpreting the incident at the club meeting. First of all, it seems like before Bob even walked into the meeting, he had an existing belief about himself and his ability to meet new people and make friends. He hesitated to join the table and he had promised himself he would be open to making new friends. This means that it’s possible that Bob might think he has difficulty making friends or that others will not like or accept him. In CBT, this is known as a core belief. It’s an idea that we develop about ourselves, usually when we’re very young and have our first social experiences or interactions with others or our environment.

Core beliefs are pretty powerful things, but usually, they stay dormant, like sleeping cells in our minds, and don’t really affect us, sometimes for many years. However, if we go through something stressful in our lives, like a loss or a life big change, sometimes our core beliefs can become activated. In Bob’s case, his core belief of not being likeable or accepted by others might have become activated when he moved to a new state and started attending a new college.

Automatic Thoughts

When our core beliefs are activated, this can start a sequence of automatic thoughts. In Bob’s case, the stress of the situation of being rejected at the table by the other students could have caused Bob to think that no one in the table likes him; that he’s too shy; and that he’s too quiet and therefore, no one wants to say “Hi” to him. After Bob had these thoughts, he likely felt nervous or maybe he felt sad. These are the feelings that are attached to Bob’s thought of: “No one likes me” or “I’m too shy, I’m too quiet.”


Then came Bob’s behavior: He immediately got up and not just left the table, but he left the club meeting entirely. Bob’s thoughts and feelings were so overwhelming that he felt he had to flee the situation. CBT also explains that the next time Bob finds himself in a social situation, he might have the same type of reaction. However, maybe next time, before he even approaches a group of people, he might already have the thought/belief that no one will like him and that he’s too shy and quiet and that’s why nobody likes him. So the environment (the social situation) triggers the thoughts (“No one will like me”) and leads to certain behaviors, like maybe Bob tending to avoid other people in social situations or not attending social settings at all.

Summing it Up

So, how does this thought-feeling-behavior process lead to anxiety and/or depression? Well, imagine if Bob decides not to even try to socialize anymore because that situation was so humiliating to him. He might instead decide to stay in his dorm room and surf the Internet or watch TV. This isolation could prevent Bob from having satisfying relationships and doing other positive activities and the isolation from others and from healthy activities could lead to depression and/or anxiety.

Another possible scenario is that Bob’s interpretation of being rejected at the table, causing him to escape the meeting, could serve as reinforcement. This means that Bob experienced a negative emotion (humiliation), but the negative emotion went away after he fled the situation. So, the escape is a reinforcer because it alleviated the negative emotion of humiliation. Next time Bob finds himself in a social situation, he might remember how he was rejected (i.e., the thought) and experience those same emotions (i.e., the feeling). Bob will make those negative emotions go away by fleeing (i.e., the behavior). This could eventually make Bob unable to be in any kind of social situation because the only way he knows how to make those feelings go away (or prevent the feelings from happening at all) is by escaping.

Changing Thoughts and Feelings

In the next article, we’ll discuss how Bob can change the thought-feeling-behavior process by first identifying and becoming aware of his core beliefs and his thoughts when he is in social situations. Once Bob becomes aware of these thoughts, he can learn to challenge and replace them. This is the process of learning some of the useful skills and strategies of CBT.

I provide CBT in Southlake and surrounding areas. Contact me today to discuss how CBT can help you.

Dr. Michael Messina

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