Understanding Therapy Part 1: Foundations of Change
So, how exactly does therapy help people? This article is meant to be both a general answer to that, as well as a look at how I think about the processes of positive change in therapy.
One common way to break down the components of well-being for a given individual is to conceptualize it as coming from three sources.
These three sources are:
the thoughts we have in our day-to-day lives
the emotions we feel through our experiences, and
the behaviors that we actually carry out in the world which are the source of many of our experiences.
How we conceptualize the connections between these, and in particular which way one of these might cause the other to happen greatly affects how a therapist might choose to approach a particular problem that a client is having. It might be tempting to say: “thoughts clearly lead to our emotions, and behavior is very emotional so emotions clearly lead to behaviors”, so there is a straight line from thoughts to behaviors. In this hypothetical case, the therapist might choose to focus on the client’s thoughts since those are driving everything. And in some cases I would agree this is the right way to think about it. But it isn’t always that simple.
The human mind is extremely complicated, and despite more than a century of concerted effort, psychologists and neuroscientists still have a long way to go to understand exactly the machinery of the mind. However, there are plausible arguments to be made that each of these three components (thoughts, emotions, and behaviors) is able to cause changes in the others in some way. The following paragraphs will detail how this happens.
The diagram below represents how each of these three can be related to the others.
How thoughts can affect emotions
When we experience the world and subsequently perceive it, our mind generates thoughts. All kinds of thoughts. Some of these thoughts are trivial (my leg itches, it is cloudy today), and some suggest that we should react a certain way, either because there is something good or something bad involved. Say, I did well on that essay assignment, so I feel great. Emotions are a readout of a combination of evaluation systems (i.e. is something good or bad) and other goal-oriented systems in the brain, all fine-tuned throughout countless human generations to help us maximize our success at life. If we didn’t react with fear to that wolf, we might end up as dinner, and our chance to have kids and pass on our genes would go down the drain.
Generally, there are a few categories of situations that are important. if we find ourselves moving toward positively-valued outcomes, we feel positive emotions. If we feel there is too much of difference between our current situation and one that we want, we feel bad. Also, if we feel we’re getting too close to a bad situation, we’ll also feel bad. For example, if we think there is a circumstance that is not improving between our current status and states of feeling loved, recognized, or safe, it can lead to emotions such as feeling lonely, worthless, or fearful, respectively.
The particular thoughts we have about what is going on in other people's minds are especially important as well. These are called attributions. For example, if someone made a joke that we were the butt of, our emotions would be very different depending on whether we thought it was good-natured ribbing and they still respected us, or whether we thought they intended to make us feel bad. All of these emotions are driven first by thoughts about what is currently going on in our world.
How thoughts can affect behaviors
We are all familiar with how our behaviors are determined by our thoughts. Take an important decision we had to make, like which job to take or where to live. We probably weighed the positives and negatives of one option against the positives and negatives of not taking that option, or picking a different one. Our behaviors are also influenced by our assessments of whether we think we have the skills to do something and will be able to succeed, as well as general beliefs about how the world works.
How emotions can affect thoughts
Neuroscience findings and computational modeling of brain processes, as well as decades of behavioral research, suggest there is a feedback loop such that when we evaluate an object either positively or negatively, those positive and negative thoughts tend to inhibit oppositely-directed thoughts. This is connected to the function of evaluating things-- to tell us what decision we should make.
This feedback loop gives us a sort of inertia in the direction we’re moving. Once we think that guy or girl in the same class is really cute and our heart starts fluttering (a thought associated with positive emotions), we don’t really want to entertain the idea that they’re a horrible person (a negative emotion) unless we really have to-- it’s not that we can’t but the thoughts tend to be suppressed. This inertia can be helpful, so that for example, once we get attached to the idea of taking that vacation to a certain place, we don’t keep entertaining a million other options and miss that opportunity to book the hotel or flight before it’s sold out or the price goes up. It also can work the other way so that it’s hard thinking that even people we really dislike should get credit for doing things right sometimes. This is the pull of our emotions on our thoughts.
Emotions can also be so powerful that they stop us from thinking clearly or much at all. Sometimes you’re so angry that you can’t think straight. Or you are so scared of making that public speech that you forget what you were going to say when you get up to the microphone. This suggests that in order to work through our thoughts, it can be helpful to get our emotions under control first.
How emotions can affect behaviors
If people were too analytical, if they literally only thought about the pros and cons of possible actions, it wouldn’t motivate us strongly to act. It would be like if there’s a million things on tv to watch, but none of them strike you as good or interesting, you’re not likely to act quickly to pick one. Emotions facilitate quick and decisive action by engaging specialized motivational systems in our brains.
The emotion examples given earlier-- lonely, worthless, and fearful, give us signals about how we should respond to the world (i.e. which behavior we should enact). Positive emotions tell us to move toward something-- say that warmth from the response of a friendly person signals that they offer us a chance to feel connected, and that excitement we get from looking at chocolate cake signals that it will give us immediate nourishment to sustain our lives. Likewise, negative emotions tell us to avoid or move away from something. Without these emotional responses, we would potentially philosophize ourselves to death without doing much of anything.
How behaviors can affect thoughts and emotions
Our personalities are made up of patterns of actions that we take. They tend to develop in response to what works to produce better immediate outcomes for us. For example, the extremely fortunate attractive woman might be more likely to become friendly with people because she always has gotten positive feedback for most interactions she has had (due to her attractiveness). Her beliefs will develop such that other people just are nice and friendly (big surprise, right!). Someone else might have a predisposition towards anxiety, thus not being warm and outgoing towards people. This instead feeds a cycle where others don’t think they’re warm because they are in a behavioral mode to protect themselves from rejection.
The behavior is useful in a way, in that it protects them from rejection, but it also limits their social development as a consequence. Therefore, they don’t develop the skills they need to more effectively negotiate their environment, and they might also believe that other people aren’t that nice (because the others were responding to the individual’s own cold behavior.) The key is that their behaviors have led them to have certain beliefs about the world. Thus, it is also the case that by behaving differently, an individual can arrive at different beliefs.
Additionally, the state of the world can be different depending on the result of the individual’s behavior. As discussed earlier, our emotions depend on an assessment of where we are in relation to positive and negative states of the world. Thus, the emotions we experience are highly dependent on the behaviors we enact.
Summary so far
This has been a very short overview of the different components of our mental life and well-being. In the next section, I will discuss how these ideas are connected to the choice of modes of therapy a therapist might use. You can either go directly to the next page, or follow some supplemental discussion about how beliefs fit into all this below the break.
But where do beliefs fit into this?
Beliefs form the foundation of our cognitive system. They represent what we think is true in our experience. For example, “That brick wall is hard” is a fairly common and simple-to-understand belief. Beliefs are formed through our experiences in the world and through things we learn from other people and sources like books, television, and the internet. Beliefs and thoughts are closely related. If we’re consciously thinking about a belief we have, then it is in fact a thought in that moment.
An example of a thought that would not be considered a belief is “This conversation with my mother is really getting on my nerves”. It represents the activity going on in our minds during the experience of something. Now, it may later play a role in forming or changing a belief about your mother that she doesn’t support you emotionally as much as she should.
The key difference between thoughts and beliefs is that active thoughts are what influence the way we experience our lives in the moment, and are much more closely related to whether we’re feeling good or bad, and what decisions we make. Beliefs are filed away for use at a later time and can be called on at any moment to help us make sense of the world-- which then influence our in-the-moment thoughts. Therefore, it is very valid to try and address problematic beliefs as a way to reduce problematic thoughts. Some therapies do in fact target beliefs.