We have talked about the types of thoughts that you would expect to accompany specific feelings.
We also expect thoughts to match the intensity of the feeling. For example, a client rates her anger at a 2 out of 10, and her thought was, I can’t stand my boss; he humiliates me every chance he gets. Given her thoughts, would you expect her anger to be stronger than a 2? I would. What if a client rates her disap- pointment at an 8 and her thought is, I wish I had not sprained my ankle, but even if I can’t play I can still
enjoy watching the basketball game. Do you think the thought and rating go together? I don’t. Either the rating is too strong, or the client has additional thoughts that you need to identify.
Your Turn!
What Thoughts Go with These Feelings?
Below are three situations. For each situation there are three possible thoughts the client might have.
Choose the thought that is most likely to go with the feeling. You can find my answers in the appendix.
1. Cameron’s college hockey team was in the state semi-final. The score was tied. Cameron had the puck and was sure he would score, when another player knocked him over. Cameron is feeling furious. What might he be thinking?
• Our team will never have another chance to play in the semi-finals.
• That guy is an animal; he should be punished; it’s unfair.
• If we lose, it is all my fault.
2. Annette just heard that she was the second-choice candidate for a job she had applied for.
Annette is feeling disappointed. What might she be thinking?
• I will never get a decent job; my life is over.
• They should have hired me; what idiots!
• I had hoped to get the job, but at least I was second choice.
3. Orly did not visit his best friend, Roy, when Roy was in the hospital for two weeks. Orly is feeling guilty. What might he be thinking?
• I am a bad friend; I should have gone; I bet I hurt Roy’s feelings.
• My friend is probably furious at me.
• I bet Roy will not want to be my friend anymore.
Agenda Item #4: Does This Thought Contain a Cognitive Distortion?
The term cognitive distortion is commonly used in the CBT literature and is familiar to many thera- pists. However, I don’t really like it. I think the term distorted suggests that the therapist is negatively
judging the client’s thoughts. McKay, Davis, and Fanning (2011) have used the term patterns of limited thinking, which I prefer. In my own clinical practice, I often use the term thinking traps because there is an inherent assumption that you can avoid a trap. I also like the term thinking style. However, for the purpose of this discussion, I’ll stick to the common term cognitive distortions.
Cognitive distortions are how your clients typically respond to situations that trigger them. You can think of cognitive distortions as a label for your clients’ negative thinking patterns. Initially, psy- chologists identified only a few specific distortions. Over time, the list of cognitive distortions has expanded to the point that many therapists and clients find them confusing and hard to use. It is important not to get lost in a long list. The purpose of identifying a client’s cognitive distortions is to have a label that a client feels captures his experience. Labeling a negative thinking pattern is another way of hitting the pause button on automatic negative reactions. When a client labels a thought as a cognitive distortion, he is also questioning the accuracy of his thoughts.
Below is a list of the most common cognitive distortions. I also have included in italics a number of shorthand ways of describing the cognitive distortions, which were inspired by Kendall and his col- leagues (2002) and Stallard (2005). For each cognitive distortion, I have included an example from one of my clients. (Full disclosure—I snuck in one or two examples from my own life!) A Thinking Traps handout can be downloaded at http://www.newharbinger.com/38501.
Thinking Traps
Filtering: Focusing on the negative details of the situation while other positive aspects are ignored.
Negative glasses or walking with blinders: You only see negative things.
Example: A student has consistently received A’s in a course. On a small quiz, the student receives a C+ and immediately assumes she’s doing poorly in the course.
Overgeneralizing: You make a broad generalization, which is based on only one piece of usually nega- tive evidence.
The repetitor: It happened once; it will always be that way.
Example: Since I found out that my last boyfriend cheated on me, I can never trust another man again.
All-or-Nothing Thinking or Black-and-White Thinking: You or others are either right or wrong, good or bad, perfect or a failure. There is no room for grays or middle ground in evaluating yourself or others.
Examples:
• The world is made up of winners and losers, and I sure don’t want to be one of those losers.
• If it is not done perfectly, it is not worth doing at all.
• My employee missed a small deadline—he’s completely useless!
Mind Reading/Making Assumptions: You assume that you know what people are feeling and think- ing and why they are acting that way.
Mind readers and fortune tellers: Knowing that things will go wrong.
Examples:
• My boss didn’t say anything about my last report; I know he thought it was terrible.
• My partner gave me a funny look; I know she disapproved of what I said.
Personalizing: You assume that what people are saying or doing is about you, even though there is no indication of that. Another aspect is that you often compare yourself to others, trying to determine how you measure up in a variety of attributes, such as intelligence, competence, or appearance.
Example: In the meeting when Mary said that some people have not been pulling their weight on this project, I know that she was talking about me.
Catastrophizing: You assume disaster will occur. Sometimes it is related to an initial difficulty.
Catastrophic thoughts often start with “what if.” For example, your child borrowed the car to go to a party and comes home fifteen minutes late. You think, What if he had an accident? What if the car broke down?
Blowing things up: Negative things become bigger than they really are.
Examples:
• Since my son came home slightly drunk the other night, I’m sure he’s on his way to becom- ing an alcoholic like his uncle; it will ruin his life.
• I lost my job; we will have to sell the house; I destroyed my whole family.
Predicting the Future: In many ways, predicting the future is similar to catastrophizing, if the predic- tion is negative. However, individuals who engage in dysfunctional behavior, or who avoid completing necessary responsibilities, often falsely predict a positive or benign future.
Example: I can handle my alcohol; seven beers a night is not too much for me.
Magnifying and Minimizing: The degree or intensity of the problem is exaggerated so that anything difficult is deemed overwhelming, and anything positive is ignored or minimized.
Positive doesn’t count: Throwing out the good things that happen.
Example: A mother discovers that her son, who has schizophrenia, occasionally smokes marijuana.
She says, “My child is a failure; nothing he does works out.” She ignores that he is also regularly taking his medication, is no longer paranoid, and has a part-time job.
Shoulds: Individuals have a list of rules about how they and other people are expected to act, and they experience it as terrible if these rules are broken. They feel angry if other people break the rules, and guilty if they themselves break the rules.
Examples:
• I should always be available to my children and husband.
• I should always try my hardest.
• I should be perfect at everything I do.
If a thought contains words that indicate extremes, such as “always,” “never,” “everyone,” or “no one,” it is most likely a cognitive distortion, as the real world is not so absolute. When people use these terms, they are usually focusing only on the negative aspects of a situation and ignoring other informa- tion. This is especially true if the thought is accompanied by a strong emotional reaction. Let’s look at some examples:
I always fail at everything I do.
No one will ever want to be my friend.
Everyone hates me.
I never do anything right.
My partner never helps me.
In the coming week, see if you can listen to your clients’ thoughts and identify when they use terms such as “always,” “never,” “everyone,” or “no one.”
Your Turn!
Identify the Cognitive Distortion
Below is a list of thoughts. See if you can identify the cognitive distortions. You will find my answers in the appendix.
1. If I don’t get this job, my life will be over.
Cognitive distortion:
2. To be a good therapist, you have to give it your all and be there for your clients 100 percent of the time.
Cognitive distortion:
3. I’m sure that no one will ever want to hire me after this last fiasco of a job interview.
Cognitive distortion:
4. If I don’t help all of my clients, I am an inadequate therapist.
Cognitive distortion:
5. I know that my last client canceled because she thinks I’m a bad therapist.
Cognitive distortion:
6. A colleague told me he wondered if the group check-in should be a bit shorter next time. That was a terrible mistake I made in the first group.
Cognitive distortion:
Exercise 6.2: Julie Has a Terrible Week
Practice listening for cognitive distortions as your client describes a problem.