Cognitive distortions: You are what you think

[David Baxter PhD]

You Are What You Think
by Nancy Schimelpfening, About.com
Adapted by David Baxter

What Are Cognitive Distortions?
Depression can be the result of or made worse by negative thoughts. When bad things happen, we begin chastising ourselves with such thoughts as: "I'm no good."; "I'm a total failure."; or "Nothing ever goes my way." These thoughts can send us spiraling right down into a deep depression. You see, we are what we think.

This concept is the guiding principle behind Cognitive Therapy. If we think something often enough, we begin to believe it's true. To conquer depression, we must challenge those automatic thoughts and replace them with more positive, and more realistic, ones.

All-or-Nothing Thinking: John recently applied for a promotion in his firm. The job went to another employee with more experience. John wanted this job very badly and now feels that he will never be promoted. He feels that he is a total failure in his career.

This type of thinking is characterized by absolute terms like "always", "never", and "forever". Few situations are ever this absolute. There are generally gray areas. Eliminate these words from your vocabulary except for the cases where they truly apply and look for a more accurate description of the situation. Here's how John could have coped with not getting that promotion:

"I wanted this job very much, but it went to someone with more experience. This is disappointing to me, but it doesn't mean I'm not a good employee. There will be other opportunities available in the future. I'll keep working on my skills so that I'll be ready for them when they arrive. This one setback does not mean my career is over. Overall, I have excelled in my work."

Overgeneralization: Linda is very lonely and often spends most of her time at home. People sometime suggest that she should get out and meet people. Linda feels that that is it useless to try to meet people. She believes that no one really could like her.

When one overgeneralizes, one takes an isolated case or cases and assumes that all others are the same. Are people really all mean and superficial and could never like her? What about her friends who are trying to get her to go out? Obviously she does have someone who cares about her very much. The next time you catch yourself overgeneralizing, remind yourself that even though a group of people may share something in common, they are also separate and unique individuals. No two people are exactly the same. There may be mean and superficial people in this world. There may even be people who dislike you. But not every single person will fit this description. By assuming that everyone doesn't like you, you are building a wall that will prevent you from having what you crave the most--friendship.

Mental Filter: Mary is having a bad day. As she drives home, a kind gentleman waves her to go ahead of him as she merges into traffic. Later in her trip another driver cuts her off. She grumbles to herself that there are nothing but rude and insensitive people in her city.

When a person falls victim to mental filters they are mentally singling out only the bad events in their lives and overlooking the positive. Learn to look for that silver lining in every cloud. It's all about how you choose to let events effect you. Mary could have turned her whole day around if she had paid attention to that nice man who went out of his way to help her.

Disqualifying the Positive: Rhonda just had her portrait made. Her friend tells her how beautiful she looks. Rhonda brushes aside the compliment by saying that the photographer must have touched up the picture. She never looks that good in real life.

We depressives are masters at taking the good in a situation and turning it to a negative. Part of this comes from a tendency to low self-esteem. We feel like we just don't deserve it. How to turn this around is actually very simple. Next time someone compliments you resist that little voice inside that says you don't deserve it. Just say "thank you" and smile. The more you do this the easier it will become.

Jumping to Conclusions: Chuck is waiting for his date at a restaurant. She's now 20 minutes late. Chuck laments to himself that he must have done something wrong and now she has stood him up. Meanwhile across town, his date is stuck in traffic.

Once again, we fall victim to our own insecurities. We expect the worst and begin preparing early for the disappointment. By the time we find out that all our fears were unfounded we've worked ourselves into a frenzy and for what? Next time do this: give them the benefit of the doubt. You'll save yourself a lot of unnecessary worry. If your fears have some basis in reality, however, drop that person from your life like a hot potato.

Magnification and Minimization: Scott is playing football. He bungles a play that he's been practicing for weeks. He later scores the winning touchdown. His teammates compliment him. He tells them he should have played better; the touchdown was just dumb luck.

Ever looked through a telescope from the wrong direction? Everything looks tinier than it really is. When you look through the other end everything looks larger. People who fall into the magnification/minimization trap look at all their successes through the wrong end of the telescope and their failures through the other end.

What can you do to stay away from this error? Remember the old saying "he can't see the forest for the trees"? When one mistake bogs us down, we forget to look at the overall picture. Step back and look at the forest now and then. Overall Scott played a good game. So what if he made a mistake?

Emotional Reasoning: Laura looks around her untidy house and feels overwhelmed by the prospect of cleaning. "This is hopeless", she says to herself. "Why should I even try?"

Laura has based her assessment of the situation on how it makes her feel not how it really is. It may make her feel bad to think of the large task ahead of her, but is it really hopeless? In reality, cleaning her house is a very doable task. She just doesn't feel up to doing it. She has reached the conclusion that it is useless to try based upon the fact that it makes her feel overwhelmed.

When a situation feels overwhelming, try this. Break down the task down into smaller ones. Then prioritize what is most important to you. Now, do the first task on your list. Believe it or not, you will begin to feel better and ready for more. The important thing is to just do something towards your goal. No matter how small, it's a start and will break you out of feeling helpless.

Should Statements: David is sitting in his doctor's waiting room. His doctor is running late. David sits stewing thinking, "With how much I'm paying him he should be on time. He ought to have more consideration." He ends up feeling bitter and resentful.

We all think things should be a certain way, but let's face it, they aren't. Concentrate on what you can change and if you can't change it accept it as part of life and go on. Your mental health is more important than "they way things should be."

Labeling and Mislabeling: Donna just cheated on her diet. "What a fat pig I am!", she thinks.

What Donna has done is label herself as lazy and hopeless. She most likely will reason that since she can't lose weight she may as well eat. She has now effectively trapped herself by living up to the label she placed on herself. When we label ourselves we set ourselves up to become whatever that label entails. This can just as easily work to our advantage.

Here's what Donna could have done to make labeling work in her favor. She could have considered the fact that up until now she has been very strong, much stronger than the average person because she is fighting against one of our body's basic needs--to eat. She could then forgive herself for only being human and acknowledge that she has been working very hard to lose weight and has been succeeding. This is only a temporary setback that she can overcome. She is overall a very strong person and has proven it by her successful weight loss. With this type of positive thinking, Donna will be back "on the wagon" in no time.

Personalization: Jean's son is doing poorly in school. She feels that she must be a bad mother. She feels that it's all her fault that he isn't studying.

Jean is taking all the responsibility for how her son is doing in school. She is failing to take into consideration that her son is an individual who is ultimately responsible for himself. She can do her best to guide him, but in the end it is he who controls his actions. Next time you find yourself doing this, ask yourself, "Would I take credit if this person were doing some praiseworthy? Chances are you'd say,"no, he accomplished that by himself". So why blame yourself when he does something not so praiseworthy? Beating yourself up is not going to change his behavior. Only he can do that.

If you recognize any of these behaviors in yourself, then you're halfway there. Here's a homework assignment for you. Over the next couple of weeks, begin to watch yourself closely for self-defeating ways that you respond to situations. The first step is to practice recognizing (identifying) your automatic responses.

The next step is to practice using cognitive counters (cognitive reframing) to alter those automatic responses. The solutions presented here are for some of the common situations we find ourselves in. Take these as examples and create your own positive solutions to your negative thoughts. Recognizing that you do it is the first step. Then challenge yourself to find the positive, or at least a less negative explanation or interpretation of the situation. Finally, ask yourself whether the alternate explanation/interpretation firs the facts as well or better than your automatic interpretation.

Turn your thoughts around and your moods will follow suit. Remember, you are what you think!

PsychLinks Online: More information about cognitive therapy
The books I recommend most frequently are:
Burns, David. Feeling Good: The New Mood Therapy. Avon, 1999
Burns, David. The Feeling Good Handbook. Penguin, 1999

 

[Daniel E.]

This is a no brainer. The problem is that things are usually too subjective. The old definitions of "the good life" are no more and seem quaint. Even the most "rational" form of psychology (Ellis' Rational Emotive Behavior Therapy) is merely a mind game. We have outsmarted ourselves, so we play Playstation and X-box to stay sane.

 

[David Baxter PhD]

Even the most "rational" form of psychology (Ellis' Rational Emotive Behavior Therapy) is merely a mind game, though it can obviously help those who suffer from anxiety/depression/PTSD.

I wouldn't call Rational Emotive Therapy or Cognitve Behavior Therapy "a mind game". On the contrary, it is a very effective therapeutic tool or indivdidual skill for a variety of problems.

 

[Daniel E.]

As you say, REBT is good at solving problems. However, many of the people suffering of depression basically just want to feel alive, but REBT is basically a modern version of Stoicism.

Both REBT and Stoicism are good if you are going to jail or if you are going to die soon because they emphasize the intellect, which is good at quieting desire and fear. In other words, REBT and Stoicism are ideal for avoiding feelings of betrayal or tragedy since they respect the ability to live in harmony with reality as it is.

Such intellectualism can help mitigate negative emotions (depression/anxiety/PTSD) but is not a recipe for happiness in depressed individuals. REBT seems to suggest that if you take away the negative emotions, there is necessarily something positive to be felt. That's a big mistake.

This is just to say that REBT, like anything else, has its limits because one can't always resolve conflicting emotions with the intellect or behavior. I guess that's one reason the emotional Dr. Dyer is so popular on PBS.

 

[David Baxter PhD]

REBT is basically a modern version of Stoicism. Both REBT and Stocism are good if you are going to jail or if you are going to die soon because they emphasize the intellect, which is good at quieting desire and fear.

The point of CBT is that there is a direct link between intellect and affect; in fact, the link between event and emotional reaction to that event is cognition: event-cognition-emotion. Change the cognition and you can alter the emotion.

Such intellectualism can help mitigate negative emotions (depression/anxiety/PTSD) but is not a recipe for happiness in depressed individuals unless there is some desire for something positive.

And do you believe that depressed people do NOT wish to be happy?

If not, the psychologist is hoping the medications will kick in soon.

That can sometimes (perhaps often) be part of the answer but it is rarely the whole answer.

This is just to say that REBT, like anything else, has its limits because one can't always resolve conflicting emotions with the intellect or behavior.

Okay. But then no competent therapist would, in my view, rely solely on one technique, CBT or anything else, in treating depression or anxiety disorders.

I guess I'm not sure what point you're trying to make here... that CBT isn't helpful? that it's a cop-out in some way? what?

 

[Daniel E.]

Ideally, REBT & CBT can be enjoyed for the pleasure of rational decision making and creative reality interpretation. Like the Stoic Epictetus said, if you don't like being in crowds, just pretend the crowd is a big party where everyone is your friend.

But it's just too obvious that a disconnect between our reasoning and our feelings cannot always be bridged. For example, Schopenhauer argued for pessimism and said we lived in the worst of all possible worlds, but he was relatively happy, enjoyed the company of his dogs, enjoyed eating a lot, and he may have even died smiling. His student Nietzsche, on the other hand, argued strongly against such pessimism but suffered the cost of his creativity with lonliness, depression, and suicidal ideation. (A novel was published a few years ago portraying Nietzsche getting much-needed therapy from Freud.)

If I have a point, it is that Ellis borrowed too heavily from Stoicism without adding anything amazingly original. Therefore, some of the weaknesses of Stoicism that have been criticized by philosophers for the last 2,000 years are also apparent in CBT. The most obvious criticism is simply that the Stoics based their beliefs on Plato's anatomy of the mind, which was horribly wrong. Plato believed the intellect was totally in control of the emotions and appetites. Ellis obviously does not believe this, but his philosophy is still rather naive and simplistic.

Of course, the real issue for most people is one of practicality, not philosophy. CBT is popular because it helps most of the time. After all, if Marcus Aurelius used Stoicism to rule Rome when his personal life was crumbling, then surely John and Mary can use CBT to help with relationship quarrels.

 

[David Baxter PhD]

If I have a point, it is that Ellis borrowed too heavily from Stoicism without adding anything amazingly original. Therefore, some of the weaknesses of Stoicism that have been criticized by philosophers for the last 2,000 years are also apparent in CBT. The most obvious criticism is simply that the Stoics based their beliefs on Plato's anatomy of the mind, which was horribly wrong. Plato believed the intellect was totally in control of the emotions and appetites. Ellis obviously does not believe this, but his philosophy is still rather naive and simplistic.

First, I'm not talking about REBT specifically -- Ellis was a soemwhat unique therapist who probably obtained some of his therapeutic success on the strength of his personality alone. But REBT is a variant on CBT, which is what I was talking about. And my point is that it works: if that violates some of your notions about philosophy, maybe you need to rethink your notions about philosophy. You are drawing the parallel between CBT and Stocism and then seemingly applying criticisms of Stoicism to CBT as if they rise and fall together, which simply isn't true. Moreover, the fact that something works should be cause for us to try to figure out why, not to dismiss it. It would not be the first time that applied science has shown that something impossible according to theory worked, and historically this has usually resulted in a change in the theory.

Of course, the real issue for most people is one of practicality, not philosophy. CBT is popular because it helps most of the time.

Precisely. And yet you then immediately say this:

After all, if Marcus Aurelius used Stoicism to rule Rome when his personal life was crumbling, then surely John and Mary can use CBT to help with relationship quarrels.

which one again sounds as if you are attempting to trivialize the technique/skill.

 

[Daniel E.]

The problem may be that I have simply become bored of Ellis.

Of course, there are many other interesting, less popular approaches for me to read about, not to mention the books that PBS is popularizing ("The Power of Intention" by Dr. Dyer, etc.)

Right now, the "contact cycle" in Gestalt therapy is capturing my interest:

The contact cycle is an idea which has long been a part of the gestalt approach, but has been pushed into a much more important position recently. The idea is that all experience of anything we want or need goes through a sequence of stages:

(1) We are at rest, and our field of consciousness is undifferentiated;
(2) A need or want emerges (which could be physical, psychological or spiritual). We may or may not have to clarify exactly what this need is before proceeding. Once the need is clear, this arouses us and points us towards the sources of possible need satisfaction;
(3) Our energy has now been mobilized, and we scan the field for possible sources of satisfaction. Depending on the need, this might be a brief process or might require the making of enquiries of various kinds;
(4) We choose one, under whatever constraints may be operating, and move towards it to get it;
(5) We make contact with the object of choice, and experience it;
(6) We judge it to be suitable or unsuitable, and either continue with it or go back to (3) for further scanning;
(7) We experience satisfaction;
(8) We withdraw, and our energy now goes inwards, fully digesting the experience. We are now ready for a new cycle to begin.

The point made by gestalt therapy is that something can go wrong with each of these stages.

(1) Some people can never reach the point of rest.
(2) Some people are not aware of their needs.
(3) Some people cannot mobilize their energy.
(4) Some people cannot make a choice between alternatives.
(5) Some people cannot fully experience anything.
(6) Some people cannot discriminate between what is good for them and what is not.
(7) Some people cannot experience satisfaction.
(8) Some people cannot withdraw.

So each of these points on the cycle suggests a possible problem area, and by understanding the cycle we can understand better exactly what the problem is.
http://www.ahpweb.org/rowan_bibliography/chapter7.html

 

[David Baxter PhD]

The problem may be that I have simply become bored of Ellis.

But I think this is part of what confuses me about some of your comments: Albert Ellis and Rational Emotive Therapy are not synonymous with Cognitve Behavior Therapy. Ellis was, in fact, a bit of a maverick, or at least certainly a rather eccentric-unique-charismatic individual who did his own thing. I can remember as a graduate student watching him (well, actually a film of him in session) and thinking, "none of this would really work for anyone else bt Ellis, or at least not in that way, because the effects he is getting are based more on the strength of his personality than on any particular technique".

I would also reiterate that CBT is an effective tool for helping people learn to better manage symptoms and to recognize and alter the links between cognitive distortions and feelings, but I wouldn't expect a competent therapist to have only CBT in his/her toolbox, any more than I would expect that the only tool in the toolbox would be EMDR, or emotion-foused therapy, or any other technique. I think you'll find that most good therapists work within a certain basic framework (for me it is humanism, primarily as epitomized in the work of Carl Rogers, but I also draw on Erikson, Adler, Bandura, parts of Maslow, and even parts of Freud) but ultimately adapt whatever is most likelyt to work at a particular time and a particular point in therapy with a particular client.