Week 1: Understanding chronic fatigue

Week 4: Healthy thinking, healthy self

Week 5: Balancing your activity patterns

Week 6: Maintaining your gains and staying well

The CBT feedback loop

The ABC model helps us understand how our thoughts influence our reaction to a situation. In this section, we take it a step further by looking at how our thoughts, feelings, and behaviours interact with each other. In reality, it’s not a one way street between these aspects of our experience. Once a situation has triggered our thoughts and a reaction, a feedback loop begins. In the feedback loop, our thoughts, feelings and behaviours all affect one another. This relationship is shown in the diagram below.

In other words, what we do (our behaviour) can also affect what we think and how we feel, and vice versa. Similarly, how we feel can affect what we think. For example, in the situation above, Person A started to feel anxious. This created more anxious thoughts (e.g., “What if I offended her…”) and behaviours (e.g., checking the phone, asking others for reassurance), which made her anxiety even worse. As such, a feedback loop of anxiety was created, whereby anxious thoughts, feelings and behaviours fed off each other to maintain an unhelpful cycle.

Let’s look at an example relevant to chronic fatigue. Say you’re at home thinking about your friends having fun without you. If you think “I bet they’re not missing me, soon I won’t have any friends”, you’re likely to feel sad and depressed. Whereas, if you think “my friends hate my chronic fatigue as much as I do, hopefully I’ll be able to go next time”, you may feel frustrated but hopeful. As a result, your behaviour will be different. In the first scenario, you might withdraw and take medication to numb your pain. In the second scenario, you might focus on positive coping strategies to promote your recovery.   

In scenario one, your thoughts led to feelings of sadness and you may have noticed increased fatigue, a heavy feeling in your body and the urge to sleep. In response, you go and lie down and avoid interacting with your family. As a result, you start to feel even more alone and depressed. Your emotions trigger more unhelpful thoughts, like “no one cares” and “my life sucks”. These thoughts start the cycle all over again, making the sadness and depression even stronger. Perhaps anger shows up too, and your body reacts with pain and tension. 

As you can see, your thoughts, feelings and behaviours are linked. Knowing how they interact is helpful, because it allows you to break the negative patterns that are keeping you stuck. For example, adjusting your thoughts, managing your feelings in new ways, or changing your behaviours can all start to reverse an unhelpful feedback loop.