Cognitive Distortions

Our thoughts about ourselves and the world impact how we feel. This connection between thoughts and emotions is the basis of cognitive therapy. Books like Mind over Mood, Thoughts & Feelings: Taking control of your moods and your lifeFeel the way you want to feel...no matter what!, and The Feeling Good Handbook all suggest that changing our thinking can alleviate distress.

To illustrate how our thoughts create emotions let's say I tell you "You look nice today".  You might have the thought "That's nice, I do look good don't I". This may create a positive feeling and you may feel happy. Let's say you have the thought "What does she want? She must be buttering me up for something". This thought might lead to feeling skeptical, defensive, anxious and untrusting. Another thought could be "She's just saying that, I look terrible." This thought might lead to feelings of anger or sadness. The statement "You look nice today" didn't change yet the interpretation, the thoughts we have about that statement can create very different feelings.

Cognitive distortions are irrational thoughts. Simply explained cognitive distortions are ways in which our mind convinces us of something that isn’t really true. These inaccurate thoughts usually reinforce negative emotions and feelings by disgusting themselves as things that sound rational and accurate. However these thoughts only really serve to keep the negative view and emotions going (keep us feeling bad about ourselves or others). I find it helpful when working with clients to have them identify these distortions, specifically when challenging interpretations or faulty beliefs. Aaron Beck first proposed the theory behind cognitive distortions and David Burns, MD was responsible for popularizing it.  Eliminating these distortions and negative thoughts is said to improve mood and discourage maladies such as depression and chronic anxiety. The process of learning to refute these distortions is called "cognitive restructuring".

Here is a list of the 10 most common types of Cognitive Distortions from Dr. Burn's "The Feeling Good Handbook".

  1. All-or-nothing thinking: Thinking about things in absolute terms,  like “every”, “always” and“never”. I also refer to this as Black and White thinking. Few aspects of human behavior are so absolute. For example you decide you are going to go on a diet and you have something that wasn’t on your diet, you then decide you failed and give up completely. If your performance falls short of perfect, you see yourself as a total failure. All-or-nothing-thinking can contribute to depression.
  2. Overgeneralization: You see a single negative event as a never-ending pattern of defeat. One bad grade on a test means you will always do badly.
  3. Mental filter: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water
  4. Disqualifying the positive: You reject positive experiences by insisting they "don't count" for some reason or other. You maintain a negative belief that is contradicted by your everyday experiences.
  5. Jumping to conclusions: You make a negative interpretation even though there are no definite facts that convincingly support your conclusion. Examples of jumping to conclusions include: 1. Mind reading: You arbitrarily conclude that someone is reacting negatively to you and don't bother to check it out. 2. The Fortune Teller Error: You anticipate that things will turn out badly and feel convinced that your prediction is an already-established fact.
  6. Magnification (catastrophizing) or minimization: You exaggerate the importance of things (such as your goof-up or someone else's achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow's imperfections). This is also called the "binocular trick".
  7. "Emotional reasoning: You assume that your negative emotions necessarily reflect the way things really are: "I feel it, therefore it must be true."
  8. Should statements: You try to motivate yourself with shoulds and shouldn'ts, as if you had to be whipped and punished before you could be expected to do anything. "Musts" and "oughts" are also offenders. The emotional consequence is guilt. When you direct should statements toward others, you feel anger, frustration, and resentment.
  9. Labeling and mislabeling: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself: "I'm a loser." When someone else's behavior rubs you the wrong way, you attach a negative label to him, "He's a damn louse." Mislabeling involves describing an event with language that is highly colored and emotionally loaded.
  10. Personalization: You see yourself as the cause of some negative external event for which, in fact, you were not primarily responsible.

References:

Beck, A. T. (1976). Cognitive therapies and emotional disorders. New York: New American Library.

Burns, David D., MD. 1989. The Feeling Good Handbook. New York: William Morrow and Company, Inc.

What Good are Emotions?

Emotions serve a function... they give us information, they communicate to others and motivate us to actions. We may have times when we would like to "get rid of" unwanted emotions specifically feelings of shame, guilt, anger or sadness. You don't hear many people say they would like to feel "less happy".  However trying to push away our feelings doesn't work.  Research shows that not only is emotional suppression an ineffective way to eliminating thoughts and feelings, but it may even worsen the situation (Gross & Levenson, 1997; Petrie et al., 1998; Wenzlaff & Wegner, 2000). So, instead of trying to get rid of unwanted emotions it can be helpful to understand the function the emotion is playing. Functions of Emotions

1. Communicate to (and influence) others

Facial expressions are a hard-wired part of emotions. In primitive societies and among animals, facial expressions communicate like words. Even in modern societies, facial expressions communicate faster than words.
 When it is important to us to communicate with others, or send them a message, it can be very hard for us to change our emotions.
 Whether we intend it or not, the communication of emotion influences others.

2. Organize and motivate action

Emotions motivate our behavior. The action urge connected to specific emotions is often "hard-wired." Emotions prepare us for action.
 Emotions save time in getting us to act in important situations. We don't have to think everything through.
 Strong emotions help us overcome obstacles in our mind and in the environment.

3. Emotions can be self-validating

Our emotional reactions to other people and to events can give us information about the situation. 
Emotions can be signals or alarms that something is happening.
 When this is carried to an extreme, emotions are treated as facts. "If I feel competent, I am." "If I get depressed when left alone, I shouldn't be left alone." "If I feel right about something, it is right." "If I'm afraid, it is threatening."

* Functions of emotions is taken from Dr. Linehan's Skills Training Manual for Treating Borderline Personality Disorder (citation below).

References

Gross, J.J. & Levenson, R.W. (1997) Hiding feelings: The acute effects of inhibiting negative and positive emotion. Journal of Abnormal Psychology, Vol 106(1), 95-103.

Linehan, M. M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press

Petrie, K.J., Booth, R.J., & Pennebaker, J.W. (1998). The immunological effects of thought suppression.  Journal of  Personality and Social Psychology. 75(5), 1264-72.

Wenzlaff,  R.M., & Wegner,  D. M. (2000). Thought suppression. Annual review of psychology. 51, 59-91.

Radical Acceptance

Radical acceptance is one of the hardest skills in DBT to learn and also one of the most powerful. It is accepting reality as it is, not the reality you want or the reality that is just. It’s acknowledging things as they are. This is not an easy task. We want things to be a certain way and when things don’t go the way we plan we become frustrated, angry, sad and suffer. The principle of radical acceptance is to take our suffering and make it into regular pain. Suffering comes from not accepting reality. If we say "it shouldn’t be this way”, “It’s not fair”,  “it’s not right”… We are not accepting it as it is.

I had an experience at 12 years old where I had broken my foot and during a fire drill at school fell down a flight of stairs, breaking my other ankle. I then had to spend three months in a wheel chair. I had also been accepted into a summer dance program at the NYC ballet school, which I was very excited about. That dream was crushed. I was hurt, disappointed and incredibly sad. “It wasn’t fair!” “It wasn’t right!" I spent the first three weeks in that wheel chair feeling miserable. Watching my friends as they walked, ran, danced and moved in ways I couldn’t. Feeling tormented by what I now couldn’t do. I felt helpless, useless and depressed. It wasn’t until I let go of all my feeling about how unfair it was… that I was able to move pass suffering and into the sorrow. I took my suffering and turned it into normal pain.

Radical acceptance is about an honest acknowledgment of what is and a willingness to be with what is in the present moment. It is not the same as approval. Some client’s resist acceptance in fear that if they accept "what is", they are saying they agree with the injustices that have befallen them. Acceptance is not approval. It is only an honest look at reality. We can accept an experience without liking it. I didn’t like being in a wheelchair for three months but accepted the reality of it. Nothing was going to change the fact that bones take time to heal. There is an increasingly well-known adage that says “What you resist, persist”. The more you push something away or run form something, the more it hangs around. This non-acceptance takes pain and leads it to suffering.

For more information on Radical Acceptance check out the link below:

DBT Self Help - Radical Acceptance

Books on Radical Acceptance:

Radical Acceptance: Embracing Your Life with the Heart of a Buddha

Radical Acceptance of Everything

Radical Acceptance: Awakening the Love that Heals Fear and Shame