CBT and Cognitive Distortions: The Third Set

“You said there were more than a dozen cognitive distortions. You told me about six, and I want to hear about more of them,” said Vladimir.  I was happy to oblige, since he already began second-guessing his initial beliefs that CBT was more like a “quick fix” and reductionist view of the brain.

As Vladimir said, in two previous articles, I described and illustrated a total of six cognitive distortions or cognitive errors, as I prefer to call them.  (For further reading, see articles entitled, CBT and Cognitive Distortions: The First Set and CBT and Cognitive Distortions: The Second Set).

Here is the third set of cognitive errors:

Should Statements:

Everyone should say hello in the morning; everyone should say thank you when you open or hold the door for them; everyone should say, “Excuse me,” when they bump into you on the train; everyone should know better; everyone should … everyone should … everyone should.

How many is everyone and how many really should?  By now, are you either amused, or tired, or both?  If so, I have reached my goal.  This is how the world responds to us when we think people should be a certain way, or they should behave a certain way, or they should do this and should not do that.  You must know by now that regardless of how much you think the world or people should or not be a certain way, this will unlikely make it so.  With that understanding, it seems to be more important that we change our perspective and concentrate our energy towards making a difference in slightly different ways.  One of the most dangerous aspects of “should statements,” we tend to get angry when people do not live up to our expectations, and we beat ourselves up when we don’t live up to our own expectations.

I will confess that this cognitive distortion is one that I am still working on.  Each time I recognize that I am beating myself up, I attempt to recover by simply asking myself, “What will I change by beating myself up right now?”  And that usually saves me from a potential influx of frustration for a simple mistake that I may have committed or for having failed to live up to my “own standard.”  Unfortunately, some people I see in my clinical practice believe that beating themselves up today will help them do better tomorrow.  The next time you hear that, simply use the Socratic method, and you will soon discover that whoever thinks this way is using what I call the double cognitive distortion of Should Statements and Polarized Thinking.  In other words, “I should not have done that. I am not going to forgive myself; I need to beat myself up, because if I don’t beat myself up, I will likely to do that again.”  There seems to be no grey area, where a better response would be, “I made a mistake; I am going to forgive myself, and make a plan to do better next time.”

Emotional Reasoning:

My friend, Vladimir is a great pubic speaker.  He talks about the brain and about preventive measures in population health throughout the country and the world.  The last time I attended one of his talks, I was so proud.  At the end of the talk, Vladimir approached me:

Vladimir: How did I do?

Me: You did great.

Vladimir: Mordecai, as he calls me sometimes, I am asking you, how did I do?

Me: You did great, really?

Vladimir: You are always hard on me.  Now that I need an honest answer, you are just trying to make me feel good.  I don’t need your pity.  Just tell me.  (Facial expression with frustration.)

Me: You are asking me how you did.  How do you think you did? (Perceived his affect, I thought it was time to take one step back and put on my Socratic hat before proceeding).

Vladimir: One of the most boring talks I have ever given!

Me: Boring, huh.  What makes you say that?

Vladimir: Mordecai, I was so bored that I wish I could just change the subject.

Vladimir was feeling bored.  As a result, he further internalized his feeling to be so factual that he thought he had nothing to offer.  To him, that meant his talk was boring and that everyone in the audience was also bored.  I used that same example to illustrate to him what the concept of emotional reasoning was, and he said, as he laughed, “I will make sure to forget all the other cognitive distortions except emotional reasoning.”

Global Labeling:

I am a loser, since I failed the test; your boss is a jerk, since he asked you to do the work twice; your spouse is an “a**hole,” since he neglected to lower the toilet seat, and you are stupid, since you cannot do mental calculation as fast as your friend.  As you can see, and this is the case of many of the other cognitive distortions that I have illustrated so far, global labeling is related to several other cognitive errors.

Those who know me well know that I rarely use labels, as I often prefer to describe the situation.  I also tell my supervisees that if you have to say your patient or client was combative, disorganized, aggressive, defiant, or oppositional, just to name a few, it would be best to describe the behavior, in order to justify the use of any of these labels.  Just like jumping to conclusion and catastrophizing, global labeling can get all of us, including our patients and clients, into major problems, both with ourselves and with others, and we “should” work on correcting them, by all means.

References:

1. Coull G, Morris PG. The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review. Psychological Medicine. 2011

2. Hendriks GJ, Oude Voshaar RC, Keijsers GPJ, Hoogduin CAL, van Balkom AJLM. Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica. 2008; 117:403–411.

3. James A, Soler A, Weatherall R. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews. 2005; 4:CD004690

4. Jarry J, Ip K. The effectiveness of stand-alone cognitive-behavioural therapy for body image: A meta-analysis. Body Image. 2005; 2:317–331