John M. Talmadge, M.D.

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Those Danged Cognitive Distortions

Lately I've been discussing CBT, or cognitive behavioral therapy, with a number of people, and the topic of cognitive distortions has come up several times. For convenience, I'm posting here the list of the common thinking patterns that generate distress and reduce psychological well being. In Alcoholics Anonymous, for example, this sort of problem is called "stinkin' thinkin'." See the links page for recommended sites on CBT and many other topics.

1. ALL-OR-NOTHING THINKING: You see things in black-and-white categories. If performance falls short of perfect, you see yourself or others as total failures.
2. OVERGENERALIZATION: You see a single negative event as a never-ending pattern of defeat. Phrases like "You always …" or "You never …" exemplify overgeneralization.
3. MENTAL FILTER: You pick out a single negative detail and obsess on it so that your vision of all reality becomes darkened, like the drop of ink that discolors an entire glass of water.
4. DISQUALIFYING THE POSITIVE: You reject positive experiences by insisting they "don't count" for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences. Often this manifests as making excuses when somebody pays you a compliment.
5. JUMPING TO CONCLUSIONS: You make a negative interpretation even though there are no definite facts that convincingly support your conclusion often a "wait and see" attitude is called for in these situations.
MIND READING: You arbitrarily conclude (usually by personalizing their behavior) that someone is reacting negatively to you, and you don't bother to check this out.
THE FORTUNE TELLER ERROR: You often anticipate that things will turn out badly, and you feel convinced that your prediction is an already-established fact.
6. MAGNIFICATION (CATASTROPHIZING) OR MINIMIZATION: You exaggerate the importance of things (such as your achievements or someone else's goof up), or you inappropriately shrink things until they appear tiny (your own character defects or other people's acceptable behavior). This is also called the "binocular trick."
7. EMOTIONAL REASONING: You allow your negative emotions to color how you see the world with an "I feel it, therefore it must be true."
8. SHOULD STATEMENTS: You try to motivate yourself or others with should and shouldn't, as if needing be whipped and punished before you could be expected anything. "Musts" and "oughts" are also offenders. The emotional consequences are guilt. When you
direct should statements toward others, you feel anger, frustration, and resentment as do they!
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 dumb jerk!" Mislabeling involves describing an event with language that is highly colored and
emotionally loaded, and generally not factually descriptive.
10. PERSONALIZATION: You see yourself as the cause of some negative external event, which in fact you were not primarily responsible for.

My generation of psychiatrists was the first to break with the old-fashioned, unscientific model known as Freudian psychoanalysis—the stereotype of the patient lying on the couch for years and being "analyzed" by the shrink. For some reason, our generation just didn't see this as very helpful or useful. Psychoanalysis in its pure form means 4-5 visits a week to the psychoanalyst, and the typical course of therapy is measured in years! There were no outcome studies proving the effectiveness of this approach. We really wanted something that would produce results, and an approach that the average person could afford.

Dr. Ben Martin at PsychCentral describes the new, scientific talk therapy this way: Cognitive behavioral therapy (also known by its abbreviation, CBT) is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel. It is used to help treat a wide range of issues in a person’s life, from sleeping difficulties or relationship problems, to drug and alcohol abuse or anxiety and depression. CBT works by changing people’s attitudes and their behavior by focusing on the thoughts, images, beliefs and attitudes that we hold (our cognitive processes) and how this relates to the way we behave, as a way of dealing with emotional problems.

An important advantage of cognitive behavioral therapy is that it tends to be short, taking four to seven months for most emotional problems. Clients attend one session per week, each session lasting approximately 50 minutes. During this time, the client and therapist are working together to understand what the problems are and to develop a new strategy for tackling them. CBT introduces them to a set of principles that they can apply whenever they need to, and which will stand them in good stead throughout their lives.

Cognitive behavioral therapy can be thought of as a combination of psychotherapy and behavioral therapy. Psychotherapy emphasizes the importance of the personal meaning we place on things and how thinking patterns begin in childhood. Behavioral therapy pays close attention to the relationship between our problems, our behavior and our thoughts.