Week 1: Understanding chronic pain

Week 4: Healthy thinking, healthy self

Week 5: Balancing your activity patterns

Week 6: Maintaining your gains and staying well

Thoughts, feelings and behaviours

Before going any further, we are going to introduce you to a key concept in CBT called the “ABC model”. The ABC model shows how your thoughts and beliefs impact the way you feel and behave. This model can be extremely powerful in helping us understand why certain problems occur and how we can intervene to stop them. First, we will look at this model generally, before applying it to chronic pain in the next section. 

It is often wrongly assumed that our feelings and emotions are caused by external situations, people or events. For example, we often hear people say things like “my pain is so depressing” or “she makes me so angry”. These statements are based on the assumption that the external event or person has directly caused our feelings. What this does not acknowledge is that our thoughts and interpretations also play a role in how we feel. 

The ‘cognitive’ part of CBT highlights the importance of our thoughts when trying to understand our emotions and behaviour. If we look closely, our feelings and behaviours are impacted more by our perception or interpretation of an event, rather than the event itself. Our perception and interpretations come in the form of our thoughts (words or images in our mind). This explains why two people can have very different reactions to the same situation. 

For example, let’s look at two people who have the same experience. Both people were walking down the street when they saw a friend and waved. In both cases, the friend appears to look at them but doesn’t wave back. Person A thinks, “Oh no, I must have done something to upset her!”. As a result, Person A feels anxious and spends the afternoon worrying. Person B, on the other hand, thinks “Oh well, she must not have seen me”. As a result, Person B doesn’t experience a strong emotion and continues to go about his or her day as usual. 

The idea that people’s thoughts influence the way they feel and behave is central to CBT. This idea is summarised in the picture below. As you can see, a situation (A: activating event) triggers your automatic thoughts (B: beliefs), which leads to your reaction (C: consequences). Your reaction includes your emotions (e.g., anxiety, sadness), physical response (e.g., pain), and your behaviour (e.g, avoiding, worrying). You can remember this sequence as the “ABC” acronym.

Our thoughts and beliefs are often habitual and happen so quickly that we often aren’t consciously aware of them. That’s why it can feel like the situation itself leads directly to the consequences. We are often more aware of our emotions, physical sensations and actions (the consequences), than we are of the thoughts that triggered them. However, our thoughts are there, and they impact all of these things. As such, it is important to become skilled at recognising your thoughts (we cover this more later in the course).

Importantly our thoughts, feelings and behaviours don’t occur in isolation. They also interact with and influence each other. In other words, our behaviour can also affect our thoughts and feelings, 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 her phone, asking others for reassurance), which made her anxiety even worse.