In my practice, as I am sure other therapists do, I have treated many clients who present with clinically significant distress that, if not wholly based on distortive thinking, is largely the result of so-called “monkey mind.” This is simply when we cognitively distort what has happened to us we literally jump around like excited monkeys in ways which result in clinical distress way out of proportion to what actually occurred (or is occurring).
I begin this little treatise on distortive thinking by examining what the great ancient stoic, Epictetus, had to say. He taught that philosophic inquiry is simply a way of life and not just a theoretical approach to the world. To Epictetus, all external events are beyond our control. Further, he taught that we should calmly, and without passion, accept whatever happens. Individuals are responsible for their own actions, which they can moderate through rigorous self-discipline. This quote, attributed to him, sums it up nicely:
“Men are disturbed not by things, but by the view which they take of them.”
Aaron Beck
Within counseling, the seminal theorists Aaron Beck and Albert Ellis seized upon Epictetus as they developed their respective therapeutic techniques: cognitive behavior therapy (CBT) and rational emotive behavior therapy (REBT).
As we go about examining cognitive distortions, keep in mind that both theorists had turned their back on psychoanalytic techniques that saw depression arising from motivational‐affective considerations; in other words, as misdirected anger, swallowed anger, or “bottled up anger.”
In his practice work, Beck found that his clients reported their feelings of depression in ways differing from these psychoanalytical conceptualizations of depression. Like Ellis, Beck found his clients illustrated evidence of irrational thinking that he called systematic distortions.
Therefore, the basic premise of Beck’s Cognitive‐Behavioral Therapy attacks these distortions, and follows the philosophy of Epictetus: It is not a thing that makes us unhappy, but how we view things that make us unhappy. Consequently, if we avoid struggling to change things, and instead change our own interpretations of things, we change how we feel and how we act in the future.
So, then, what is cognition? Cognitions are verbal or pictorial representations, available to the conscious mind, which form according to the interpretations we make about the things that happen to us. These interpretations and assumptions are shaped by a bunch of unconscious presuppositions we make about people and things, based on past experience ‐ and when I say past experience, I mean experiences going all the way back to birth.
When we are infants, we take in the whole world in a rather naive and unthinking fashion. Some term this process as one of “accepting introjected beliefs.” We live with these introjections throughout life (some refer to this as the “appraisal approach” to the world). By way of a simple example, most of us are reluctant to touch a hot stove because of what our mothers and fathers commanded us NOT to do; namely, to touch a hot stove. We lived with that introjected understanding of stoves for a long time, accepting that they were right. But we never knew for ourselves that they were right! That is, until we accidentally touched a hot stove.
In order to make sense of our world, we recursively form cognitive filters, schemas, or a set of assumptions and expectations of how events will transpire, and what they mean to us. Such expectations can be (and often are) illogical and irrational. It is as if our accumulated introjections preclude us from making even the simplest of logical leaps of faith.
Albert Ellis – Some call him the Asshole of Therapists
These introjections get in the way and often result in the aforementioned clinical distress. Beck’s therapy seeks to uncover instances where distorted, illogical thoughts and images lead to unwanted or unproductive emotions. We say unproductive emotions, because while these emotions can be either good or bad both can lead to unproductive behaviors.
Beck’s typology of cognitive distortions is somewhat like Ellis’s notion of “irrational beliefs,” which Ellis challenged through the process of disputation. All distortions represent evidence of our emotions subsuming a logical thought process. We may therefore label them as logical fallacies.
Regardless of the over-riding clinical efficacy of appealing to our clients’ intellectual reasoning abilities (which, by itself, can be problematic), it is helpful to share with clients a list of irrational beliefs, or cognitive distortions, as a starting point in therapy.
- Catastrophizing or Minimizing ‐ weighing an event as too important, or failing to weight it enough.
- Dichotomous Thinking ‐ committing the false dichotomy error ‐ framing phenomena as an either/or when there are other options. (Remember here the “genius of AND versus the tyranny of OR”).
- Emotional Reasoning ‐ feeling that your negative affect necessarily reflects the way a situation really is.
- Fortune Telling ‐ anticipating that events will turn out badly. I see this perhaps more so than any other distortion.
- Labeling ‐ this occurs when we infer the character of a person from one behavior, or from a limited set of behaviors. I.e. a person who forgets something one time is “an idiot.” This amounts to “telling a book by its cover” type-thinking.
- Mental Filter ‐ we all have mental filters, but this distortion refers to specific situations where we filter out evidence that an event could be other than a negative one for us.
- Mind Reading ‐ believing that we can know what a person thinks solely from their behaviors. This one is related strongly to the notion of “projection” onto someone else the feelings that we, ourselves, might have in a similar situation.
- Over-generalization ‐ one event is taken to be proof of a series or pattern of events. Basic statistics courses teach us (or SHOULD teach us) that patterns are hard to find in nature. They only appear to be such. We can view them as otherwise.
- Personalization ‐ here we are assuming that a person is at fault for some negative external event. Said another way, we take complete responsibility for something that is nowhere near our fault!
- Should Statements ‐ statements that begin with “Shoulds” or “Musts” are often punishing demands we make on ourselves. Generally, the assumption that we Must or Should do something is absolutist, and therefore most likely false. The moral here is to “stop shoulding on yourself!”
Ellis, Beck, and other theorists and therapists who employ CBT approaches in their practices, have similar approaches to cognitive distortions. They begin with a laser-like focus upon symptom relief, which in turn, looks to find those cognitive distortions that many clients suffer from. Beck’s CBT is short-term in nature, as we know, but remember that symptom reduction has been shown by empirical research to be as effective as longer-term help. The idea here is that by focusing on symptoms we can help effect “core” character changes.
Becks’ CBT and Ellis’s REBT have many therapeutic approaches in common. And while this treatise was not intended to be a detailed review of those therapies, it might be helpful to see how each address the notion of “cognitive distortive thinking.”
In both approaches, the therapist is active, didactic and directive. This means that he or she tells you what he is doing, the reason why he is doing it, and even teaches you how to do it for yourself. For example, if she assigns homework for a client, she tells the client the reasoning behind the homework. This also has the additional benefit of allowing the client to practice new behaviors in the actual environment where they will occur. Keeping a list of cognitive distortions handy can be an example of where the therapist has asked that the client practice how to recognize them.
Dr Joseph V Russo – NOT the asshole of all therapists!
I am an REBT therapist. As such, I often provide clients with a toolkit of self-help techniques. I want my client to, in effect, become a specialist in dealing with his own problems. My therapeutic intent is to help the client become more independent. In other words, I am putting myself out of business by freeing my clients from the need for therapy. I want them to actively prepare for similar events in their lives in the future and be prepared with techniques they can employ themselves.
So, for example, when the client senses that they are suffering from distortive thinking, they will be able to whip out the list of ten cognitive distortions and do the work themselves.
One thing that CBT and REBT therapists (among others) focus upon is the here-and-now, the present, as well as the future. Without question, events in our past have shaped who we are. We need to embrace that fact, but at the same time, we need to look at what we can do now to change our view of life.
We cannot change the past. We can only adjust our view of the present and future events.
Consequently, I approach the therapeutic relationship in a highly collaborative fashion, as opposed to an authoritarian, adversarial or a neutral fashion. In effect, and while I begin as the authority on what we are about to do in therapy, I actively transfer the power of the relationship to the client.
To that end, and like what Beck did, I often set an agenda at the beginning of therapy and then return to that agenda time and time again to gauge progress. Beck set a great example when he outlined these precise steps (in terms of agenda and session structure):
- Set an agenda
- Review self‐report data
- Review presenting problem
- Identify problems and set clearly definable and measurable goals
- Educate patient on the cognitive model – discuss cognitive distortions
- Discuss the patient’s expectations for therapy
- Summarize session and assign homework
- Elicit feedback from the patient
Let’s focus for a moment on step 5. Without question, behavioral therapists have many tools at their disposal, including psycho education, relaxation training, coping skills, exposure, and response prevention. But is cognitive restructuring that most specifically addresses distortive thinking and which can offer the aforementioned symptom relief.
At step 5, I will acquaint my client with the ideas of both Beck and Ellis and talk about how both (but mostly Ellis) seek to focus on the client’s core evaluative beliefs about himself. Of course, Ellis tended to revert somewhat to the past by explaining how unconscious conflict may exist, based upon past experiences, while Beck tended to eschew this. He was more concerned with working with observable behaviors, and thereby potentially uncover the distortive thinking.
To that end, I focus more on what is referred to as one’s “automatic thoughts,” which tend to link back to core beliefs. Ellis would have me attack those core beliefs (to the extent they are maladaptive), while Beck would have been simply to try to change them. But when you stop and think about it, BOTH would have the therapist help the client to change those core beliefs.
We all have automatic thoughts – indeed, such automatic thinking helps to keep us alive. The so-called Gift of Fear comes into play here, which while largely unconscious, is what governs our approach to the world. It is when such automatic thinking results in distress that we as therapists are called upon.
Beck (not Becker) did not view automatic thoughts as unconscious in a Freudian sense. He merely saw them as operating without our notice; in a word, “automatic.”
Remember that such thinking arises from the underlying assumptions and rules we have accepted (via introjections) and made up (through experience) about how to do deal with the world. And it is HOW we have previously dealt with the world, for the good or for the bad, that has resulted in our core beliefs (about ourselves and about others around us). They are, almost by definition, highly charged and rigid “takes” on the world. They govern what we do.
Beck and to large extent, Ellis, engaged in what they called cognitive restructuring. First, you identify the cognitive distortions that appear in those automatic thoughts and which point to the self-defeating core beliefs the client has allowed to set in his or her cognitions. Often this is done through active disputation. I prefer to go about disputation in a somewhat scientific way, through guided discovery, hypothesis testing, supporting through evidence, and looking for alternative theories. Clients are, for the most part, receptive.
Here is an example:
- Automatic thought: I can’t do this, it is too hard.
- Assumption: I will fail.
- Core Belief: Because I am a loser.
I would begin with the statement, “I cannot do this.” I would work with the client to uncover “real evidence” of their inability to do … whatever. I simply ask, “What evidence do you have?” And often, there is NO evidence. The statement, “I can’t do this” is not literally true. Perhaps he’s having trouble because he’s trying to do too much at once. The core belief is what I then attack, by asking questions around when they have NOT been a loser; by asking for examples of a time when they were successful in resolving a situation to their satisfaction (read: successfully); and by asking, is that what you truly believe about yourself?
In the most general sense, we can discuss cognitive restructuring in the following fashion: Perception and experiencing in general are active processes that involve both inspective and introspective data, in that the clients’ cognitions represent a synthesis of internal (mental filters) and external stimuli (the world about him.) How people appraise a situation is generally evident in their cognitions (thoughts and visual images). These cognitions constitute their stream of consciousness or phenomenal field, which reflects their configuration of themselves, their past and future, and their world. Alterations in the content of their underlying cognitive structures affect their affective state and behavioral patterns. Through psychological intervention, clients can become aware of their cognitive distortions. Correction of those faulty dysfunctional constructs can lead to clinical improvement.
According to cognitive theory, cognitive dysfunctions are the core of the affective, physical and other associated features of depression. Apathy and low energy are results of a person’s expectation of failure in all areas. Similarly, paralysis of will stems from a person’s pessimist attitude and feelings of hopelessness.
Take depression – a negative self‐perception whereby people see themselves as inadequate, deprived and worthless. They experience the world as negative and demanding. They learn self‐defeating cognitive styles, to expect failure and punishment, and for it to continue for a long time. The goal of cognitive therapy is to alleviate depression and to prevent its recurrence by helping clients to identify and test negative cognitions, to develop alternative and more flexible schemas, and to rehearse both new cognitive and behavioral responses in the confines of the therapeutic chamber By changing the way people think, the depressive disorder can be alleviated.
The beginnings of Cognitive Restructuring employ several steps:
- Didactic aspects. The therapy begins by explaining to the client the theoretical concepts of CBT or REBT, by focusing on the belief that faulty logic leads to emotional pain. Next, the client learns the concept of joint hypothesis formation, and hypothesis testing. In depression, the relationship between depression and faulty, self-defeating cognitions are stressed, as well as the connection of affect and behavior, and all rationales behind treatment.
- Eliciting automatic thoughts. Every psychopathological disorder has its own specific cognitive profile of distorted thought, which provides a framework for specific cognitive intervention. In depression, we see the negative triad: a globalized negative self-view, negative view of current experiences and a negative view of the future.For example, in hypo manic episodes we see inflated views of self, experience and future. In anxiety disorder, we see irrational fear of physical or psychological danger. In panic disorder, we see catastrophic misinterpretation of body and mental experiences. In phobias, we see irrational fear in specific, avoidable situations. In paranoid personality disorder: negative bias, interference by others. In conversion disorder: concept of motor or sensory abnormality. In obsessive‐compulsive disorder: repeated warning or doubting about safety and repetitive rituals to ward off these threats. In suicidal behavior: hopelessness and deficit in problem solving. In anorexia nervosa, the ear of being fat. In hypochondriasis, the attribution of a serious medical disorder.
- Testing automatic thoughts. Acting as a teacher, the therapist helps a client test the validity of her automatic thoughts. The goal is to encourage the client to reject inaccurate or exaggerated thoughts. As therapists know all too well, clients often blame themselves for things outside their control.
- Identifying maladaptive thoughts. As client and therapist continue to identify automatic thoughts, patterns usually become apparent. The patterns represent rules of maladaptive general assumptions that guide a client’s life.As an example, “To be happy, I must…” The primary assumption is: “If I am nice, and suffer for others, then bad things won’t happen to me,” with a secondary assumption: “It is my fault when bad things happen to me, because I was not nice enough. Therefore, “Life is unfair, because I am nice and still bad things happen.”You can see how such rules inevitably lead to disappointment, depression, and ultimately, depression.
Some concluding thoughts which Beck had about depression and his view of how psychopathology occurs in general:
- Emotional disorders are the results of distorted thinking or an unrealistic appraisal of life events.
- How an individual structures reality determines his emotional state.
- A reciprocal relation exits between affect and cognition wherein one reinforces the other, resulting in escalations of emotional and cognitive impairment.
- Cognitive structures organize and filter incoming data, and are acquired in early development.
- Too many dissonant distortions lead to maladjustment.
- Therapy involves learning experiences for the client that allow them to monitor distorted thinking to realize the relation between thoughts, feelings and behavior and to test the validity of automatic thoughts to substitute more realistic cognitions and to learn to identify and later the underlying assumptions that predispose the client to the distorted thoughts in the first place.
Finally, both Beck and Ellis came up with what they saw as the rudiments of so-called Mature Thinking as compared to primitive thinking. They comprise a set of ways of thinking about yourself, the world, and the future, that lead to cognitive, emotional and behavioral success in life.
- Primitive thinking is non-dimensional and global: I am the living embodiment of failure
- Mature thinking is multidimensional and specific: I make mistakes sometimes, but otherwise I can be clever at many things.
- Primitive thinking is absolutist and moralistic: I am a sinner, and I will end up in hell.
- Mature thinking is relativistic and non-judgmental: I sometimes let people down, but there is no reason I can’t make amends.
- Primitive thinking is invariant: I am hopeless
- Mature thinking is variable: There may be some way…
- Primitive thinking resorts to “character diagnosis” and labeling: I am a coward
- Mature thinking examines behaviors and engages in behavior diagnosis: I am behaving like a coward right now.
- Primitive thinking is irreversible and sees things as immutable: There is simply nothing I can do about this.
- Mature thinking is reversible, flexible and ameliorative: Let’s see what I can do to fix this…
Hopefully this piece has taught you something about cognitive distortions and how everyone – all of us – suffer them from time to time. The key is to try always to engage in mature thinking. Hard to do! And often it can take a lifetime! But I urge you to try!
© Dr. Joseph V Russo (2023), All Rights Reserved
