CBT is based on the cognitive model, which hypothesizes that people’s emotions, behaviors, and physiology are influenced by their perception of events (both external, such as failing a test, and internal, such as distressing physical symptoms).

Situation/event
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Automatic thoughts
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Reaction (emotional, behavioral, physiological)

It’s not a situation in and of itself that determines what people feel and do but rather how individuals construe a situation (Beck, 1964; Ellis, 1962). Imagine, for example, a situation in which several people are reading a basic text on CBT. They have quite different emotional and behavioral responses to the same situation, based on what is going through their minds as they read.

Right from the beginning, I obtain a sample of important automatic thoughts. Abe reports that he often thinks, “There’s so much I should be doing but I’m so tired. If I even try [to do things like cleaning up the apartment], I’ll just do a bad job” and “I feel so down. Nothing will make me feel better.” He also reports an image, a mental picture that had flashed through his mind. He saw himself, sometime in the indeterminate future, sitting in the dark, feeling utterly hopeless and helpless.

I also look for factors that maintain Abe’s depression. Avoidance is a major problem. He avoids cleaning up his apartment, doing errands, socializing with friends, looking for a new job, and asking others for help. Therefore, he lacks experiences that could have given him a sense of mastery, pleasure, or connection. His negative thinking leads to his being inactive and passive. His inactivity and passivity reinforce his sense of being helpless and out of control.

As he developed stronger symptoms of depression, he started avoiding additional tasks he thought he wouldn’t do well, for example, paying bills and doing yard work. He had many automatic thoughts across situations about the likelihood that he would fail. These thoughts led him to feel sad, anxious, and hopeless. He viewed his difficulties as due to an innate flaw and not as the result of encroaching depression. He developed a generalized sense of incompetence and helplessness and curtailed his activities further. His relationship with his wife became quite strained, and they started having significant conflict. He interpreted the conflict as meaning he was failing in the marriage, that he was incompetent as a husband.

Over the course of several months, Abe’s problems at work became even worse. Joseph became quite critical of Abe and downgraded him at his yearly performance review. Abe’s depression intensified significantly when his wife filed for divorce. He became preoccupied with thoughts of how he had let her and his children and his boss down. He felt like (that is, he had a belief that he was) an incompetent failure. He felt (believed he was) at the mercy of his sad and hopeless feelings (“I’m out of control”) and thought there was nothing he could do to feel better (“I’m helpless”). And then he lost his job.