How to Effectively use CBT

Why CBT Doesn’t Always Work When You’re Really Stressed Out

If you’re just beginning therapy, you might be wondering:

“Why are we talking about stress, breathing, mindfulness, or daily habits before getting into my thoughts, feelings and behaviors?”

That’s a great question—and the answer lies in how your brain and body respond to stress.

Stress Hijacks Your Brain—Here’s How to Get It Back

Cognitive Behavioral Therapy (CBT) is one of the most effective approaches we have for managing anxiety, depression, and unhelpful thinking patterns. It teaches you to pause, notice your thoughts, challenge the unhelpful ones, and replace them with more supportive, balanced thinking.

But here’s the thing: CBT assumes your thinking brain is online. And if you’re overwhelmed or anxious, that’s not always the case.

🧯 When Stress Takes Over, Your Thinking Brain Shuts Down

In moments of high stress, your brain prioritizes survival—not reflection. The prefrontal cortex (your “thinking brain”) goes offline, while the amygdala (your “emotional brain”) takes over. This is often called the fight/flight/freeze response, and it’s great when you’re facing real danger.

But when you’re not in danger—just emotionally flooded—this response can get in the way of doing the very work that CBT asks of you. You can’t “pause and reframe” your thoughts if your nervous system is in survival mode. You’re not thinking—you’re reacting.

🧪 The Brain Science Behind It

Psychologist Daniel Kahneman describes two systems of the brain:

System 1 is fast, emotional, and automatic—perfect for reacting in emergencies.
System 2 is slow, deliberate, and logical—what CBT depends on.

💡 Stress suppresses System 2, leaving System 1 in charge. That’s like trying to read a map while riding a rollercoaster.

📉 Real-Life Examples: When CBT Isn’t Enough (Yet)

Your Prefrontal Cortex is Offline You’re in a panic attack. CBT says, “Challenge your thoughts.” But your body is frozen, heart racing, and your thoughts are spiraling. There’s no space for reflection.
Stress Hijacks Your Body You know public speaking isn’t dangerous, but your body trembles and your voice shakes. CBT says, “You’re safe,” but your nervous system screams, “Run!”
Trauma Lives in the Body You know you're safe now, but your body still flinches or tenses up. CBT suggests cognitive reframing, but your body isn’t convinced.
The Amygdala Hijack You snap during an argument and regret it later. CBT says, “Think before you react,” but thinking wasn’t available at the time.

🛠️ What Helps Instead? Regulate First. Reflect Second.

Before we ask your brain to change, we help your body feel safe. That’s why therapy often begins with stress regulation tools, such as:

Breathwork & vagus nerve activation – Shifts the body out of fight/flight mode.
Mindfulness & grounding – Anchors you in the present moment.
Somatic therapy – Releases trauma and tension stored in the body.
Polyvagal-informed practices – Helps restore a sense of connection and calm.

💡 These techniques create the internal safety CBT needs to be effective.

🧘 Imagine This...

Trying to do CBT while your body is flooded with adrenaline is like trying to solve a math problem while being chased by a bear. You’re not failing—your brain just isn’t in the right mode yet. But when we calm your nervous system first? That “impossible” math problem becomes a whole lot easier.

📋 The Role of the Self-Care Assessment

That’s where the self-care assessment comes in. It helps us take a compassionate, non-judgmental look at how your daily habits may be supporting or draining your nervous system.

We look at gentle questions like:

Am I getting enough rest?
Am I eating in a way that nourishes me?
Do I have moments of calm, fun, or connection during my week?
Where might I be neglecting myself without realizing it?

It’s not about perfection—it’s about small, manageable shifts that support your brain-body connection.

🌿 How to Take the Self-Care Assessment

This isn’t a test, and there are no wrong answers. It’s a self-check-in. Here's how to take it:

🪞 1. Be Honest, Not Perfect

Read each category—sleep, food, relationships, stress, boundaries—and reflect honestly. No judgment. Just awareness.

✍️ 2. Use the Rating Scale

Use the following scale to rate each habit:

1 = I do this poorly or not at all
2 = I do this sometimes
3 = I do this well and often
★ = I’d like to improve in this area

🔎 3. Spot What’s Familiar

Look for habits you used to do but stopped—like journaling, stretching, or walking. These are great places to restart with ease.

💡 4. Identify What Would Genuinely Help

What’s one habit you haven’t committed to, but deep down you know would help? That’s your next move.

🧩 5. Choose 2–3 Small Wins to Start

Blend a couple of “used-to-do” habits with one meaningful new one. This small reset supports your nervous system and sets the stage for clearer thinking and emotional balance.

Starting with self-care and stress regulation isn’t delaying the “real work”—it is the real work.

When your body feels safe, your brain becomes available for growth. CBT can then do what it does best: help you reframe, rethink, and rewire unhelpful patterns.

Free Download: Self-Care Assessment

This practical tool will give you a clear picture of where you're doing well—and where you might need extra support.

Use it to:

Evaluate your current self-care routines
Identify areas for growth
Create simple, sustainable changes
Support your overall well-being and therapy goals

🌱 Ready to Take the Next Step?

If the Self-Care Assessment gave you insight into how stress is affecting your daily life, therapy can help you go even deeper. At Path4Change, we combine evidence-based Cognitive Behavioral Therapy (CBT) with holistic nervous system regulation tools to help you feel calm, clear, and in control—without judgment or pressure.

CBT is most effective when your mind and body are aligned. That’s why we begin by strengthening your self-care foundation—so your thinking brain has the space to do the work it was designed for.