Cognitive Distortions in Anxiety and Depression

Hi Everyone,

This is a reposting of a previous post that I thought was particularly important. I made a few updates and revisions. I’ve covered the need to do exposure therapy for anxiety disorders but I haven’t spent much time talking about other aspects of treatment. As you may already know, the preferred form of treatment for anxiety disorders is Cognitive Behavior Therapy (CBT) and the exposure work is the “Behavior” part of that framework. The “Cognitive” part may be just as important as the behavioral part for many clients. Below you will find a list of what are called “cognitive distortions”. These are common mistakes in people’s thinking that can lead to anxiety and depression. These categories are not necessarily mutually exclusive and you will often see that they overlap quite a bit, but nonetheless, I think it’s helpful to realize that there are “mistakes” in our thinking that can contribute to both anxiety and depression. Getting better at “thinking about your thinking” is a useful skill when seeking to better understand and manage anxiety/depression issues. Sometimes a belief is simply wrong or at times the “mistake” might be an exaggeration rather than out and out error.

There are a variety of ways of working with the kinds of thoughts we have when we experience anxiety and depression, and I will cover these various methods in this and future blog posts. Being aware that these distortions exist is the first step in identifying and correcting them, because oftentimes when we’re  engaging in these thinking patterns, we don’t realize that we're doing it. Our way of seeing ourselves or the world seems accurate to us until we start to think about our thinking and consider that we might be making some mistakes. A metaphor for this idea that I like is to imagine you’re in a fish bowl and seeing the world through the water in which you swim. Unless you realize you’re in the water you don’t recognize that there is a different way to see the world (outside of the water) because all you know is what you’ve always seen. I invite you, at least for a moment, to “step out of the water”. 

We also are prone to what is called the “confirmation bias”. We tend to notice and remember experiences that reinforce what we already believe and overlook or discount evidence that what we believe may not be true all of the time. If I believe that people don’t like me then guess what I’m likely to be scanning for and noticing? Assuming I believe people, in general, don’t like me and one morning when I come into work a colleague doesn’t respond to my greeting “Hello, Good morning!”. They seem to totally ignore me. How do you suppose I will interpret their lack of response? And unless I take a  moment to notice what I’m thinking, I will probably just assume that this is just another example of how people don’t like me and overlook the multiple other reasons why my colleague didn’t respond. 

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1. All or Nothing Thinking

This distortion occurs when people think in extremes and if you find yourself using words like “always” or “never” then it’s likely you are engaging in this kind of thinking.  Examples might be thoughts such as “I’ll never get the kind of job that I really want” or “ I always get things wrong.”

2. Overgeneralization

When people overgeneralize, they reach a conclusion based on one (or perhaps a few) example(s) and then incorrectly apply that conclusion across the board. Some examples would be: “Since the last couple of girls I’ve asked out for a date have turned me down, I guess girls just don’t find me attractive” or “ That last speech I gave didn’t go very well, so I guess I’m just not good at giving speeches.”

3. Catastrophizing

With this type of thinking people assume the worst when faced with uncertainty.  When people catastrophize, ordinary worries can quickly escalate.  A headache is seen as a sign of a brain tumor or “This Covid-19 pandemic is going to last for years, the economy will take a long time to recover and I’m going to lose my job.” 

3. Personalization

Personalization occurs when you hold yourself responsible for events that aren't entirely under your control. When a mother received a note that her child was having difficulties making friends at school, she told herself, “This shows what a bad mother I am,” instead of trying to pinpoint the cause of the problem so that she could be helpful to her child. When you blame yourself for circumstances that aren’t your fault or are beyond your control you are engaging in Personalization. 

5. Mind Reading

This is when you assume you know what someone else is thinking. Some examples might be: if you are eating alone in a cafeteria and think everyone thinks you are a loser and have no friends or if you get to work a few minutes late and you think everyone else is thinking you are an irresponsible employee. 

6. Mental Filtering

Another distorted thought pattern is the tendency to ignore the positive aspects of a situation and focus exclusively on the negative aspects. For instance, a person may pick out a single aspect of their appearance (“My nose is too big”) and dwell on it exclusively and not take into consideration other aspects of their appearance such as their hair or complexion. 

7. Discounting the Positive

Like mental filters, discounting the positive involves a negative bias in thinking. People who tend to discount the positive don’t ignore or overlook something positive, they explain it away as a fluke or sheer luck. Instead of acknowledging that a good outcome is the result of skill, smart choices, or determination, they assume that it must be an accident or some type of anomaly.

8. “Should” Statements

When people find themselves thinking in terms of what “should” and “ought” to be said or done, they are often implying there is a “right” way to do something and if you aren’t doing it the “right” way then there is something wrong with you. “Shoulds” are like a set of rules that you must follow. Not doing what you think you should do often results in feeling guilty.

9. Emotional Reasoning

Emotional Reasoning is the false belief that your emotions are always the truth — that the way you feel about a situation is a reliable indicator of reality. Thinking that feelings are facts is Emotional Reasoning. While it’s important to listen to, validate, and express emotion, it’s equally important to judge reality based on real evidence, not just on how you feel. 

10. Labeling

Labeling is a cognitive distortion in which people reduce themselves or other people to a single — usually negative — characteristic or descriptor, like “drunk” or “failure.” When people label, they unfairly define themselves or others based on a single event or behavior. 

To keep this post from getting too long, I will cover what to do with these types of Cognitive Distortions in future blog posts, but in the meantime if you want to start working on “thinking about your thinking” you might begin by keeping a thought record and noticing and recording what types of thoughts you have when you experience troublesome anxiety or depression. Try “stepping out of the water” and see what happens. Awareness precedes change.

I hope you find this post helpful and let me know if you have any questions. If you know of anyone who you think might benefit from this post please forward it to them. And if someone forwarded this post to you and you’d like to subscribe you can do so here.

This post is intended to be educational and is not a substitute for therapy. If you are struggling please seek out a licensed therapist to work with. You can find some suggestions here.

Stay well,

DrBob