Understanding emotional reasoning through CBT and ART
By Jennifer Laptew Williams, LPC
“I feel anxious, and I feel like the other shoe is going to drop.”
In my work as a therapist in Connecticut, I hear this from women who are trying to describe an uneasy feeling that follows them into ordinary moments. Sometimes there is a specific concern. Sometimes the feeling arrives before they can explain what they are afraid of. Either way, it deserves more care than being told to stop worrying.
In my Bali article, I wrote about worry, love, and learning to let go. In my follow-up about the fear of losing someone you love, I explored how anticipation can pull us away from the people in front of us. Here, I want to look more closely at a thought that can sit underneath that experience: I feel afraid, so something bad must be coming.
There is a name for that leap in cognitive behavioral therapy: emotional reasoning. Understanding it can give us a way to explore our experience without dismissing what we feel.
Rice terraces in Bali. Photo from Jennifer’s personal collection.
Emotional Reasoning: When a Feeling Becomes a Conclusion
Emotional reasoning happens when we treat a feeling as sufficient proof of a conclusion. “I feel inadequate, so I must not be capable.” Or, “I feel anxious, so this must be a warning that something bad is about to happen.”
Emotional reasoning is a common cognitive error, or distortion. I want you to be able to name it so you can externalize it: pick it up, look at it, and examine it from different perspectives without judgment. We can then explore whether another perspective feels true and brings less of the distress or physical symptoms that are disrupting your life. Naming the pattern gives us a place to begin that exploration.
The emotion is real. Understanding it means looking at what is happening now, what came just before, and what the situation means to you. Sometimes there is a concern that needs attention. Sometimes uncertainty begins to feel like certainty before we know how things will unfold.
The useful question is: What is this feeling responding to, and what do I need to do with that information?
Start with curiosity about what happened just before
When someone tells me she feels as if the other shoe is going to drop, I encourage curiosity. What happened just before the thought? Was there a conversation, a change in someone’s tone, a reminder of something painful, or a moment when things became quiet? Looking at the sequence can help us identify a trigger instead of treating the anxious conclusion as the whole story.
You may notice the physical sensation before you can identify a thought. If that happens, begin with what you noticed rather than forcing an explanation. A short note might include where you were, what had just happened, the words that came to mind, and what you did next. For example, did you seek clarification, withdraw, or keep replaying the moment? You can bring those observations to therapy. You do not have to uncover the original source of every reaction before asking for help, and you do not need to search through painful memories on your own.
In therapy, I may also ask, “If that thought were true, then what?” We explore the meaning underneath it and notice the emotions and physical sensations that arise. That process helps us understand which part of the experience is interrupting the person’s life and what she wants to change.
This deeper exploration is something we can pace together. You do not need to follow every frightening possibility to its end on your own. If reflection turns into a spiral, you can stop, look around the room, and return to something concrete in the present.
Sunlight along a forest path. Photo from Jennifer’s personal collection.
A practical way to work with the thought
The next time you notice yourself waiting for the other shoe to drop, try a brief check-in. Writing a few sentences may be more useful than arguing with the same thought for an hour.
1 Name the feeling and the prediction separately
Try two sentences: “I feel anxious” and “My mind is predicting that something will go wrong.” This makes the prediction easier to examine. You can take the feeling seriously without immediately deciding that the prediction is certain.
2 Notice the trigger and the present circumstances
Ask what changed just before the feeling began. Then consider what you know now. Is there a specific problem that needs attention? Is someone behaving in a threatening or controlling way? Is there missing information you can reasonably clarify? Your history and the other person’s pattern of behavior belong in this assessment.
3 Check what is happening in your body
If it feels manageable, notice whether your jaw is tight, your stomach feels unsettled, or your shoulders are raised. You do not have to make the sensation disappear. You might let your feet rest on the floor and look at a few objects around you. If focusing inward increases distress, keep your attention outside yourself instead.
4 Choose an accurate response and one useful action
A balanced response might be, “I am uneasy, and I need more information,” or, “This reminds me of something difficult, but I do not know yet how this situation will unfold.” The next action could be asking a question, preparing for a meeting, setting a boundary, or reaching out for support. When there is a safety concern, prioritize protection rather than trying to talk yourself out of the feeling.
For example, imagine receiving a brief message that says, “Can we talk tomorrow?” You notice your stomach drop and immediately think you are in trouble. The message is a fact. The prediction is an interpretation. The sender’s usual behavior matters, too. You might ask what the conversation is about, rather than spend the evening rehearsing every possible disaster. If the sender has a history of intimidation, your response may need to focus on support and boundaries instead.
The aim is to make room for a more informed choice. You do not have to force yourself to feel calm before making one.
Eastern Point Beach, Groton, Connecticut. Photo from Jennifer’s personal collection.
When reflection turns into rumination
Getting curious can help you understand a reaction. It can also be easy to slip from noticing what happened into reviewing it again and again. Ask yourself, “Am I learning anything new, or am I trying to reach a level of certainty that this situation cannot give me yet?” A useful reflection might identify a question to ask or a task to complete. Repeatedly rehearsing the same possible outcome may leave you with more distress and no clearer next step.
If that is happening, write down the specific concern and any action you can reasonably take. If the action has to wait, decide when you will return to it. Then choose something you want to give your attention to now, such as finishing a meal or listening to the person beside you. You may need to redirect your attention more than once. The NHS guidance on tackling worries offers a similar distinction between concerns you can act on and possibilities you cannot resolve through more thinking.
How I use CBT and Accelerated Resolution Therapy in Connecticut
Earlier in my practice, my work centered on cognitive behavioral therapy, cognitive processing therapy, and solution-focused therapy. After training in Accelerated Resolution Therapy and seeing changes in my clinical work, I shifted toward a predominantly ART-based practice. My earlier training still informs how I understand and support the person sitting with me.
With CBT, I may teach someone the names of common thinking patterns so she can recognize what is happening. We examine the original belief, consider evidence and context, and develop a more accurate response. For “something bad is about to happen,” that might involve separating a possibility from a certainty and deciding whether a practical step is needed. CBT also includes behavioral strategies; it is broader than changing words in your head.
The response we develop needs to be believable. “Everything will be fine” may feel hollow when you genuinely do not know the outcome. In the example of the unexpected message, a more accurate response could be, “I do not yet know what this conversation is about. I can ask what I need to prepare.” You can also ask whether there is relevant information you have left out of your first interpretation. The aim is a fuller picture, with enough clarity to decide what to do next.
With ART, we work with distressing thoughts, memories, images, and physical sensations through a structured therapeutic process. The goal is to help those experiences evoke less distress, with more neutral or positive responses and imagery. ART is a specific treatment with a somatic, or body-aware, component: attention to the sensations you notice as well as to your thoughts and emotions.
Someone may understand a thought differently and still notice a strong physical response. In my practice, CBT and ART can offer different ways to address those connected experiences. We can use cognitive tools to understand a pattern and consider ART for the distress associated with particular triggers, depending on the person’s needs and preferences.
ART is often described as brain-based. Its proposed mechanisms draw on research about memory and learning, but exactly how its components produce change is still being studied. CBT also has neuroscience research behind it. I want us to consider the research alongside your needs and your experience in treatment when deciding what is useful for you.
Sunlight through clouds above the beach. Photo from Jennifer’s personal collection.
What recent research can tell us
A Mayo-affiliated pilot study published in the January 2025 issue of Psycho-Oncology followed 20 cancer survivors who received five ART sessions. Participants reported reductions in post-traumatic stress symptoms, cancer-related distress, anxiety, and depression, with improvements still present at the 30-day follow-up. These are encouraging findings, but the study was small and had no comparison group. It cannot establish that ART works better than CBT or predict an individual person’s outcome.
A larger Mayo-sponsored study of ART for grief in older family caregivers is underway. Its published protocol describes a planned randomized trial of 440 participants. That study may add useful evidence, but a study plan is not a set of treatment results.
Research has also examined ART in people struggling after a loss. In a randomized study published in 2020, led by University of South Florida researchers with a Mayo Clinic coauthor, 54 older bereaved caregivers were assigned to receive ART either immediately or after a waiting period. Those who received ART reported greater improvement in grief symptoms during the comparison period. The study was small and most participants were white women, so larger, more diverse studies are needed. These findings offer an encouraging reason to continue studying ART for distress after loss.
When it is time for more support
If this sense of dread is repeatedly interrupting sleep, relationships, concentration, or your ability to enjoy your life, it may be time to explore anxiety therapy in Connecticut. You do not have to wait until you can explain it perfectly. An assessment can help clarify what is contributing to the experience and which treatment options fit.
In our work, I want to understand what is interfering with your life and what you hope will change. Your motivation to work toward that change matters, and questions and skepticism are welcome. We can discuss what treatment would involve, whether you feel ready, and how we will evaluate progress. If something is not helping, we can review the plan together.
It helps to describe improvement in the language of your own life. “I want to feel better” is a meaningful starting point, but what would you be able to do if the dread loosened its grip? Perhaps you want to stay present during dinner, concentrate on your work, or settle into bed without repeatedly reviewing tomorrow’s possibilities. Naming that goal gives you and your therapist something concrete to return to when evaluating whether treatment is helping.
You might look at how often the feeling occurs, how long it lasts, and how much it changes your behavior. You may still notice anxiety while becoming better able to choose your next step. A difficult day can be discussed alongside the broader pattern. Persistent worsening or an absence of improvement deserves attention rather than being automatically described as part of healing.
Useful questions for a conversation about therapy include: “Why do you recommend this approach for my concerns?” “What might be difficult about the work?” and “How will we decide whether to continue or adjust the plan?” You can also ask what support is available between appointments and what the boundaries of that support are. Understanding the plan is part of participating in it.
New or concerning physical symptoms also deserve appropriate medical evaluation. A sensation should not automatically be attributed to anxiety simply because anxiety is present.
Autumn leaves in the sunlight. Photo from Jennifer’s personal collection.
You can contact me through Hope Healing Change to discuss whether working together would be a good fit. We can consider CBT, ART, or how they may complement one another, with your circumstances and goals guiding the conversation.
If you recognize yourself in these patterns, know that you are not alone. There is a name for this way of thinking, and there are practical ways to begin responding differently. You might begin by naming the pattern, noticing what came just before the feeling, and gently considering another perspective that feels true. You can approach this with curiosity, without judging yourself for what you feel. No matter how long this has felt like a never-ending battle, you have options, and a different path is possible.
Research and further reading
Emotional reasoning
Centre for Clinical Interventions. Unhelpful Thinking Styles: Emotional Reasoning.
CBT approaches
American Psychological Association. What Is Cognitive Behavioral Therapy?
ART mechanisms and evidence
Waits W, Marumoto M, Weaver J. Accelerated Resolution Therapy (ART): A Review and Research to Date. Current Psychiatry Reports. 2017;19:18.
CBT and brain function
Brain functional effects of cognitive behavioral therapy for depression: A systematic review of task-based fMRI studies. Journal of Affective Disorders. 2025;368:872–887.
Mayo affiliated cancer pilot
Tofthagen C, Donovan KA, Mandrekar J, Buck HG. Accelerated Resolution Therapy for Cancer Distress and Post-Traumatic Stress Symptoms: Results of a Pilot Study. Psycho-Oncology. 2025;34:e70058.
Mayo grief study
Mayo Clinic. Accelerated Resolution Therapy for Early Maladaptive Grief. NCT05624879. Ongoing clinical trial.
Published grief study protocol
Study protocol indexed in PubMed. American Journal of Hospice and Palliative Medicine. Published online September 2024; 2025;42:914–923.
ART grief trial
Buck HG, Cairns P, Emechebe N, et al. Accelerated Resolution Therapy: Randomized Controlled Trial of a Complicated Grief Intervention. American Journal of Hospice and Palliative Medicine. 2020;37(10):791–799.
Practical help with worry
NHS Every Mind Matters. Tackling your worries.
Choosing and evaluating therapy
National Institute of Mental Health. Psychotherapies. Reviewed February 2024.
Research links checked November 2026. This article provides general information and is not a substitute for individualized assessment or treatment.