Cognitive behavioral therapy (CBT) is the intervention of choice for the treatment of a variety of psychiatric disorders, including depression, anxiety, eating disorders, and personality disorders in both inpatient and outpatient settings. Research indicates that CBT is an especially effective intervention for a broad range of psychological problems. In fact, studies comparing the effectiveness of CBT have shown lower relapse rates relative to medication and other forms of psychotherapies.
Aaron Beck, the father of cognitive therapy proposed that individuals who suffer from depression (and other psychological disorders) tend to engage in distorted thinking patterns that contribute to and maintain their depression. He proposed that the way in which individuals process information and attribute meaning to daily events can influence not only how people feel, but also how they behave. Beck concluded that overly negative beliefs about the self, the world, and the future are at the core of depressive symptoms.
For example, after a break-up with his girlfriend, a man may think, “I suck at relationships,” “All women end up dumping me,” and “I’ll always be alone.” Ruminating on these painful thoughts will undoubtedly worsen this man’s mood causing him to avoid dating altogether. The resulting behaviors provide further support for his inaccurate belief that he is “inadequate” in relationships potentially exacerbating his symptoms of depression. Unable to escape this thought-feeling-behavior cycle, this man is likely to become clinically depressed.
Based on CBT theory, each emotional state is generally accompanied by specific thought patterns. For example, depression is usually accompanied by thoughts of self-criticism and hopelessness. Thoughts of vulnerability and danger underlie anxiety; and thoughts of violation and unfairness underlie anger.
When these sorts of thoughts do not accurately reflect reality, as is often the case, they are labeled “cognitive distortions”. When they interfere with an individual’s success in living, working, and playing, they are labeled as “maladaptive thought patterns.” The following cognitive distortions have been identified as the most common maladaptive thought patterns underlying a variety of clinical problems. At the core of these cognitive distortions is a pervasive pattern of pessimism and negativity.
1. Arbitrary Inference (Jumping to Conclusions/Assuming): This type of cognitive error occurs when we draw conclusions in the absence of evidence to support such conclusion. For example, you are walking and spot a friend approaching you. Your friend passes you by without saying hello. You conclude that your friend is mad at you and you do not bother to check it out. Another example is “fortune telling.” In this case, you anticipate the worst case scenario. You tell yourself, “I will not have a good time at the corporate party,” or “I will do a lousy job at my presentation.”
2. Overgeneralization: People who overgeneralize tend to think in absolute terms. “Always,” “Never,” “Everything,” “Nothing,” and “Everybody” are typical words in their everyday conversations. The man whose girlfriend broke up with may say to himself “I always get rejected in love,” or the woman who received an average job evaluation, “Nobody recognizes my talents.” The obvious problem with this type of cognitive distortion is that for every rule there is an exception. If we examine our conclusions closely, we can surely find instances that disconfirm our absolute assertions.
3. Selective Abstraction or Mental Filter: People commit this thinking error when they focus on negative aspects of the situation and draw conclusions based on these negative details. For example, you have made a special meal for your spouse and find out at the table that the fish is undercooked. You say to yourself: “The fish is raw. Dinner is ruined!”
4. Magnification/Minimization: We tend to exaggerate the importance of our mistakes and others’ successes and minimize the importance of our strengths and others’ mistakes. It is as though we have a magnifying glass that aggrandizes our faults and the strengths of others making us look inadequate and inferior. You may tell yourself, “I am only a homemaker,” and “my sister is an accomplished surgeon.” The reality is that we all have strengths and weaknesses and other people’s accomplishments are different but not necessarily better than ours.
5. Emotional Reasoning: “I feel inadequate. I must be inadequate,” or “I feel ashamed and bad, I must be bad” are examples of emotional reasoning. We conclude that our feelings are evidence of the way things really are. Our feelings are related to how we appraise situations. When our thoughts are distorted, our feelings do not reflect reality.
6. “Should Statements”: These are unreasonable demands that we make of ourselves as if whipping or punishing ourselves into doing anything. Other statements that fall in this category are “musts” and “oughts.” For example, “I should be able to do this on my own.” Generally, the emotions that result from these statements are guilt and shame. When directed at others (“I shouldn’t have to ask for help–people should know what I need”) they cause anger, frustration, and resentment.
7. Polarized or All-or-Nothing Thinking: This type of cognitive error is the basis of perfectionism. You see things in dichotomous, all-or-nothing or black and white categories. You either get a stellar job performance evaluation or you are a total failure. You may say to yourself, “If I’m not performing perfectly, then I am a loser.”
8. Catastrophizing: Believing that something is so awful and horrible, sometimes we convince ourselves that we are incapable of coping with life’s challenges. For example, a woman whose husband has an affair may tell herself, “I couldn’t stand it if he were to leave me. It’d be awful!” Although, many situations can be devastating, human beings are capable of enduring and overcoming many adversities.
9. Personalizing: This refers to the belief that you are responsible in some way for negative events. For example, a child is diagnosed with an eating disorder and the mother tells herself, “It’s all my fault.” A husband asks his wife for a divorce. She says, “What’s wrong with me? How did I let this happen?” Although we do have an influence on situations, many times there are other factors playing a role.
10. Labeling: Many times people use labels to describe themselves or others such as “stupid,” “loser,” and “boring,” to name a few. This is an extreme form of overgeneralization. When someone says, “I did not make it to graduate school; I’m so stupid,” he or she is in fact saying that he or she is always stupid. When we examine this label more closely, we realize that human behavior is complex to be confined to one label. Sometimes, we can act stupidly and other times intelligently. Labeling is usually loaded with strong negative emotions.
Most of us have engaged in one or all of these faulty thinking patterns at one point or another, especially during times of stress. The idea is to become aware about the role of these particular ways of perceiving or appraising situations on our moods and subsequent behaviors.
Questions you can ask is:
“Am I engaging in any cognitive distortions?”
“What is another way of looking at this situation?”
“How is my way ofperception of the situation helping me or hindering me?”
“Are these faulty thinking patterns wreaking havoc on my relationships?”
If you recognize many of these thinking patterns in your day-to-day life and are also suffering from depression, anxiety, substance abuse, or conflict-prone relationships, you may benefit from the guidance of a counselor or therapist. A therapist with the adequate training and expertise in cognitive-behavioral therapy can evaluate how your thoughts, moods, behaviors, biology, and environment interact to maintain your problems, usually in just a few sessions. Treatment will involve intervening at any of these five areas with an emphasis on identifying and modifying maladaptive thoughts and behaviors. The good news is that, based on widely replicated research studies, we know that treatment works in most cases, and that it can work fairly rapidly – many times in six months or less.
There is no reason to suffer in silence, when treatment that works is available.
Kenya Rich, Ph.D. is a Psychology Resident at Apalachee Center, Inc. She graduated with a Bachelor’s degree in Psychology from Wayne State University and earned her doctoral degree in Clinical Psychology from the University of Miami. She provides individual and family therapy to individuals with a broad range of psychiatric disorders, including eating disorders, in the outpatient unit.
Big Bend 2-1-1 has listings of all area agencies dealing with these issues. Just dial 211 on your phone.
Apalachee Center can be reached at 1-800-342-0774 for Detox, Crisis or inpatient treatment, and 1-866-472-3941 to schedule an outpatient appointment.
by Kenya Rich, PhD
Clinical Psychologist, Apalachee Center
