Monday, 23 April 2012

Hot Cross Bun (CBT) Model of Thinking/Feeling/Behaving

Today we were asked in group to write down how an emotional crisis looks like and feels like to ‘us’. The worksheet was based on the well known CBT (Cognitive Behaviour Therapy) ‘Hot Cross Bun’ Model. Even though I have seen it a million and one times before, it really helped to revise it, and use it in relation to DBT skills. This is the model in a picture format.

I find retrospective thinking hard to do, as I find it difficult to sense any emotion other than the one I am experiencing at any one particular time, no doubt it’s a BPD thing. None-the-less I tried hard to imagine a scenario where I was overwhelmed by an unpleasant emotion. Here is some of the dialogue which helped me to complete the worksheet. I really found this particular therapist very helpful today, I guess it’s nice to have a change in health professionals every now and again to gain new perspective
My Reflection of Myself in a Crisis

Example: Getting letter to say that a course I have been waiting to attend for many months has lost its funding and has been cancelled.

·         How do I feel?
Me; “I feel as if everything is overwhelming.”
Therapist (T);”Can you identify the emotion behind this statement?”
Me; “Well, it’s like I become paralyzed by fear and anxiety or worry.”
T; “So, is it fair to say that anxiety related emotions would be your initial or strongest feeling?”
Me; “Yes, anxiety, fear and worry.”

·         What bodily sensations do you notice
Me; “My body can become very tense; I fold my arms and cross my legs and clench my jaw”
T; “Is this when you would notice you are in an emotional crisis?”
Me; “No, probably not to be honest, it’s more when I feel like I can’t catch my breath, am shaking or have a migraine. Sometimes I become very tearful.”
T; “Ok, it’s really skilful that you can realize that. It gives you scope to work at leaning to catch the anxiety at the earlier stages, rather than it escalating to a higher intensity.”

·         What Thoughts Come to your Mind?
Me; “This feeling will never go away.” “I can’t manage.” “I should be able to manage/cope better” “I need to do something to change/stop how I am feeling RIGHT now”
T; “Well done on identifying these thoughts. The way to help change them is to weigh up the evidence for and against them and challenge them by asking; ‘Are these thoughts rational?’ Can you come up with a fairer, more tangible thought which will be more solution focused?"

·         How Do You Act?
Me; “Well because I can’t think straight, I tend to resort to behaviours which, when in wise mind, I know are harmful in the long run”
T; “What kind of things?”
Me; “I have a list!, I will avoid any situation which feels overwhelming, even if I know it needs to be dealt with and will even avoid doing things I enjoy. I stay in bed, and isolate myself by not contacting anyone. This time I didn’t open any other letters, couldn’t respond to emails or texts.”
T; “That makes perfect sense to me, but as you said, it doesn’t really help solve the crisis at hand.
Me; “No it doesn’t help, even makes it worse. I become very emotionally deregulated and resort to old destructive behaviours such as binge eating/drinking, which leads to secondary emotions of shame and guilt  and then I feel I must punish myself by self-harming to make up for it. Then it basically starts the whole cycle off again doesn’t it!
T; “Exactly! Here is where you can intersect the cycle to change the emotional and behavioural outcome by noticing initial bodily sensations before the thoughts and behaviours take over.

We then went on to cover all the ACCPECTS and SELF SOOTHE skills which can be useful to change the intense emotion. I will be making a separate post about the ACCEPTS skills as I am still putting together what works for me.

I guess I just wanted to go over this exercise, and always find that here, on my blog, is a great way to reflect. The biggest lesson I learned today is that I can always learn something new, even if I think I know it all! It feels good to have bashed this out again. I hope it helped you to read it too.

I would love to hear if this model has ever helped you.


  1. 3rd time trying to comment! LOL
    What a great post! I am going to share this with my FB BPD group! We love new resources to learn to skills, reinforce old ones, and find new ways to describe our experiences!

  2. I am absolutely amazed at how much you manage to put into and take away from a session and how brave and honest you are. I recognise and empathise with a lot of what you say/describe. I go through a variation on your theme and to see it spelled out so clearly is fantastic. I don't feel good about the way I deal with things but the similarities make me feel less alone and more hopeful. The thing I most relate to is the "paralysis" and isolation reaction, the closing down on myself and the world.
    People like you who express themselves so openly are helping me discuss my issues. I think I am starting to feel a little less shame and accepting that my behaviours are down to my illness.
    Thank you