Cognitive distortion

A cognitive distortion is an exaggerated or irrational thought pattern involved in the onset and perpetuation of psychopathological states, especially those more influenced by psychosocial factors, such as depression and anxiety.[1] Psychiatrist Aaron T. Beck laid the groundwork for the study of these distortions, and his student David D. Burns continued research on the topic. Burns, in The Feeling Good Handbook[2] (1989), described personal and professional anecdotes related to cognitive distortions and their elimination.

Cognitive distortions are thoughts that cause individuals to perceive reality inaccurately. According to the cognitive model of Beck, a negative outlook on reality, sometimes called negative schemas (or schemata), is a factor in symptoms of emotional dysfunction and poorer subjective well-being. Specifically, negative thinking patterns cause negative emotions.[3] During difficult circumstances, these distorted thoughts can contribute to an overall negative outlook on the world and a depressive or anxious mental state.

Challenging and changing cognitive distortions is a key element of cognitive behavioral therapy (CBT).

History

In 1972, psychiatrist, psychoanalyst, and cognitive therapy scholar Aaron T. Beck published Depression: Causes and Treatment.[4] He was dissatisfied with the conventional Freudian treatment of depression, because there was no empirical evidence for the success of Freudian psychoanalysis. Beck's book provided a comprehensive and empirically supported theoretical model for depression — its potential causes, symptoms, and treatments. In Chapter 2, titled "Symptomatology of Depression," he described “cognitive manifestations” of depression, including low self-evaluation, negative expectations, self-blame and self-criticism, indecisiveness, and distortion of the body image.[4]

In 1980 Burns published Feeling Good: The New Mood Therapy[5] (with a preface by Beck), and nine years later The Feeling Good Handbook, both of which built on Beck's work.

Main types

Examples of some common cognitive distortions seen in depressed and anxious individuals. People may be taught how to identify and alter these distortions as part of Cognitive Behavioural Therapy.

The cognitive distortions listed below[2] are categories of automatic thinking, and are to be distinguished from logical fallacies.[6]

Always being right

Being wrong is unthinkable. This cognitive distortion is characterized by actively trying to prove one's actions or thoughts to be correct, and sometimes prioritizing self-interest over the feelings of another person.[3]

Blaming

The opposite of personalization; holding other people responsible for the harm they cause, and especially for their intentional or negligent infliction of emotional distress.[3]

Example: someone blames one's spouse entirely for marital problems, instead of looking at one's own part in the problems.

Disqualifying the positive

Discounting positive events.

  • Example: Upon receiving congratulations, a person dismisses them out-of-hand, believing them to be undeserved, and automatically interpreting the compliment as an attempt at flattery or as arising out of naïveté.

Emotional reasoning

Presuming that negative feelings expose the true nature of things and experiencing reality as a reflection of emotionally linked thoughts. Thinking something is true, solely based on a feeling.

  • Example: "I feel (i.e., think that I am) stupid or boring, therefore I must be"[3] feeling that fear of flying in planes means planes are a very dangerous way to travel, or concluding that it's hopeless to clean one's house due to being overwhelmed by the prospect of cleaning.[7]

Fallacy of change

Relying on social control to obtain cooperative actions from another person.[3]

Fallacy of fairness

This is the belief that life should be fair and produces upset or angry emotions when life is perceived as failing to be fair and breaking rules to even the playing field that leads to long term ramifications.[3]

Mental Filtering

Focusing entirely on negative elements of a situation to the exclusion of the positive. Also, the brain's tendency to filter information that does not conform to already-held beliefs.

  • Example: After receiving comments about a work presentation, a person focuses on the single critical comment and ignores what went well.

Jumping to conclusions

Reaching preliminary conclusions (usually negative) with little (if any) evidence. Two specific subtypes are identified:

  • Mind reading: Inferring a person's possible or probable (usually negative) thoughts from his or her behavior and nonverbal communication; taking precautions against the worst suspected case without asking the person.
    • Example: A student assumes that the readers of his or her paper have already made up their minds concerning its topic, and, therefore, writing the paper is a pointless exercise.[6]
  • Fortune-telling: predicting outcomes (usually negative) of events.
    • Example: Being convinced of failure before a test, when the student is in fact prepared.

Labeling and mislabeling

A form of overgeneralization; attributing a person's actions to his or her character instead of to an attribute. Rather than assuming the behavior to be accidental or otherwise extrinsic, one assigns a label to someone or something that is based on the inferred character of that person or thing.

  • Example of labeling: Instead of believing that you made a mistake, you believe that you are a loser, because only a loser would make that kind of mistake. Or, someone who made a bad first impression considers himself or herself a "jerk", regardless of alternative, extrinsic factors.
  • Example of mislabeling: A woman who places her children in a day care center is thought to be "abandoning her children to strangers," because she has violated the bond between mother and child.

Magnification and minimization

Giving proportionally greater weight to a perceived failure, weakness or threat, or lesser weight to a perceived success, strength or opportunity, so that the weight differs from that assigned by others, such as "making a mountain out of a molehill". In depressed clients, often the positive characteristics of other people are exaggerated and their negative characteristics are understated.

  • Catastrophizing – Giving greater weight to the worst possible outcome, however unlikely, or experiencing a situation as unbearable or impossible when it is just uncomfortable.
  • Example: A teenager is too afraid to start driver's training because he believes he would get himself into an accident.

Overgeneralizing

Making hasty generalizations from insufficient evidence. Drawing a very broad conclusion from a single incident or a single piece of evidence. Even if something bad happens only once, it is expected to happen over and over again.[3]

  • Example: A woman is lonely and often spends most of her time at home. Her friends sometimes ask her to dinner and to meet new people. She feels it is useless to even try. No one really could like her.[7]

Personalizing

Attributing personal responsibility, including the resulting praise or blame, to events over which the person has no control.

  • Example: A mother whose child is struggling in school blames herself for being a bad mother, because she believes that her deficient parenting is responsible for her child's issues. In fact, the real cause may be something else entirely.

Making "must" or "should" statements

Making 'must' or should' statements was included by Albert Ellis in his rational emotive behavior therapy (REBT), an early form of CBT; he termed it "musturbation". Michael C. Graham called it "expecting the world to be different than it is".[8] It can be seen as demanding particular achievements or behaviours regardless of the realistic circumstances of the situation.

  • Example: After a performance, a concert pianist believes he or she should not have made so many mistakes.[7]
  • In Feeling Good: The New Mood Therapy, David Burns clearly distinguished between pathological "should statements", moral imperatives, and social norms.

A related cognitive distortion, also present in Ellis REBT, is a tendency to 'awfulize'; to say a future scenario will be 'awful', rather than to realistically appraise the various negative and positive characteristics of that scenario.

Splitting (All-or-nothing thinking, black-or-white thinking, dichotomous reasoning)

Evaluating the self, as well as events in life in extreme terms. It's either all good or all bad, either black or white, nothing in between. Even small imperfections seem incredibly dangerous and painful. Splitting involves using terms like "always", "every" or "never" when they are false and misleading.

  • Example: When an admired person makes a minor mistake, she or he renders the admiration as contempt.

Cognitive restructuring

Cognitive restructuring (CR) is a popular form of therapy used to identify and reject maladaptive cognitive distortions[9] and is typically used with individuals diagnosed with depression.[10] In CR, the therapist and client first examine a stressful event or situation reported by the client. For example, a depressed male college student who experiences difficulty in dating might believe that his "worthlessness" causes women to reject him. Together, therapist and client might then create a more realistic cognition, e.g., "It is within my control to ask girls on dates. However, even though there are some things I can do to influence their decisions, whether or not they say yes is largely out of my control. Thus, I am not responsible if they decline my invitation." CR therapies are designed to eliminate "automatic thoughts" that include clients' dysfunctional or negative views. According to Beck, doing so reduces feelings of worthlessness, anxiety, and anhedonia that are symptomatic of several forms of mental illness.[11] CR is the main component of Beck's and Burns's cognitive behavioral therapy.[12]

Narcissistic defense

Those diagnosed with narcissistic personality disorder tend to view themselves as unrealistically superior and overemphasize their strengths but understate their weaknesses.[11] As such, narcissists use exaggeration and minimization to defend against psychic pain.[13][14]

Decatastrophizing

In cognitive therapy, decatastrophizing or decatastrophization is a cognitive restructuring technique that may be used to treat cognitive distortions, such as magnification and catastrophizing,[15] commonly seen in psychological disorders like anxiety[10] and psychosis.[16] Major features of these disorders are the subjective report of being overwhelmed by life circumstances and the incapability of affecting them. The following statements are typical:

  • "This is too much work for me to do. I can't finish it before the deadline and my boss will fire me!"
  • "I'll never make it into the college I want. My parents and school advisers point out that I have a good GPA, plenty of extracurricular activities that I participated in, and a solid SAT score, but my ACT score was just awful."
  • "The boy I went on a date with last night hasn't called me back yet. I'm sure he hates me. I'll never get married."

The goal of CR would be to help the client change his or her perceptions so as to render the felt experience as less significant. In the first example, the client's reported incapability would be reframed so that, although perhaps not all the work will be done by the deadline, the employee's sustained effort will make it unlikely that the boss will fire him or her.

Criticism

Common criticisms of the diagnosis of cognitive distortion relate to epistemology and the theoretical basis. The implicit assumption behind the diagnosis is that the therapist is infallible and that only the world view of the therapist is correct. If the perceptions of the patient differ from those of the therapist, it may not be because of intellectual malfunctions but because the patient has different experiences. Critics claim that there is no evidence that patients suffering from e.g. depression have dysfunctional cognitive abilities. Actually, some depressed subjects appear to be “sadder but wiser”.[17]

References

  1. ↑ Helmond, Petra; Overbeek, Geertjan; Brugman, Daniel; Gibbs, John C. "A Meta-Analysis on Cognitive Distortions and Externalizing Problem Behavior". Criminal Justice and Behavior. 42 (3): 245–262. doi:10.1177/0093854814552842.
  2. 1 2 Burns, David D. (1989). The Feeling Good Handbook: Using the New Mood Therapy in Everyday Life. New York: W. Morrow. ISBN 0-688-01745-2.
  3. 1 2 3 4 5 6 7 Grohol, John (2009). "15 Common Cognitive Distortions". PsychCentral. Archived from the original on 2009-07-07.
  4. 1 2 Beck, Aaron T. (1972). Depression; Causes and Treatment. Philadelphia: University of Pennsylvania Press. ISBN 0-8122-7652-3.
  5. ↑ Burns, David D. (1980). Feeling Good: The New Mood Therapy. New York: Morrow. ISBN 0-688-03633-3.
  6. 1 2 Tagg, John (1996). "Cognitive Distortions". Retrieved October 24, 2011.
  7. 1 2 3 Schimelpfening, Nancy. "You Are What You Think".
  8. ↑ Graham, Michael C. (2014). Facts of Life: ten issues of contentment. Outskirts Press. p. 37. ISBN 978-1-4787-2259-5.
  9. ↑ Gil, Pedro J. Moreno (2001). "Effectiveness of cognitive-behavioural treatment in social phobia: A meta-analytic review". Psychology in Spain. 5: 17–25 – via Dialnet.
  10. 1 2 Martin, Ryan C.; Dahlen, Eric R. (2005). "Cognitive emotion regulation in the prediction of depression, anxiety, stress, and anger". Personality and Individual Differences. 39 (7): 1249–1260. doi:10.1016/j.paid.2005.06.004.
  11. 1 2 Diagnostic and statistical manual of mental disorders : DSM-5. American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force. (5th ed.). Arlington, VA: American Psychiatric Association. 2013. ISBN 9780890425541. OCLC 830807378.
  12. ↑ Rush, A.; Khatami, M.; Beck, A. (1975). "Cognitive and Behavior Therapy in Chronic Depression". Behavior Therapy. 6 (3): 398–404. doi:10.1016/S0005-7894(75)80116-X.
  13. ↑ Millon, Theodore; Carrie M. Millon; Seth Grossman; Sarah Meagher; Rowena Ramnath (2004). Personality Disorders in Modern Life. John Wiley and Sons. ISBN 0-471-23734-5.
  14. ↑ Thomas, David (2010). Narcissism: Behind the Mask. ISBN 978-1-84624-506-0.
  15. ↑ Theunissen, Maurice; Peters, Madelon L.; Bruce, Julie; Gramke, Hans-Fritz; Marcus, Marco A. "Preoperative Anxiety and Catastrophizing". The Clinical Journal oF Pain. 28 (9): 819–841. doi:10.1097/ajp.0b013e31824549d6.
  16. ↑ Moritz, Steffen; Schilling, Lisa; Wingenfeld, Katja; Köther, Ulf; Wittekind, Charlotte; Terfehr, Kirsten; Spitzer, Carsten (2011). "Persecutory delusions and catastrophic worry in psychosis: Developing the understanding of delusion distress and persistence". Journal of Behavior Therapy and Experimental Psychiatry. 42 (September 2011): 349–354. doi:10.1016/j.jbtep.2011.02.003.
  17. ↑ Beidel, Deborah C. (1986). "A Critique of the Theoretical Bases of Cognitive Behavioral Theories and Therapy". Clinical Psychology Review. 6 (6): 177–97.
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