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May 2, 2016

List of Common Cognitive Distortions



Whether the diagnosis be depression, bipolar, anxiety, anger issues, chronic pain or _______ (insert disorder of your choice), in other word, virtually all psychological conditions, identifying cognitive distortions is a very important step in treatment.

What is a cognitive distortion? Also known as automatic negative thoughts (ANTs), these are thinking patterns that are largely inaccurate. Using ANTs repeatedly and in a variety of situations can lead to any number of symptoms including:  anger outbursts, sadness, hopelessness, mistrust, procrastination and the darling of psychotherapy, guilt.  In a previous post I give a better explanation of cognitive distortions so I invite you to click here to learn more.

Today I'd like to share lists of commonly used ANTs.  Occasionally I go online to look for lists of faulty thinking patterns as a refresher or to learn a few that I'm not familiar with.  Like earlier this month, for example.  I was writing my notes and struggling to remember the pattern used by someone I am seeing.  I came across this list of 15 Common Cognitive Distortions posted by John Grohol, PsyD, at PsychCentral:


1. Filtering.

We take the negative details and magnify them while filtering out all positive aspects of a situation. For instance, a person may pick out a single, unpleasant detail and dwell on it exclusively so that their vision of reality becomes darkened or distorted.

2. Polarized Thinking. In my office, this is known as "All or None Thinking."

Things are either “black-or-white.” We have to be perfect or we’re a failure–there is no middle ground. You place people or situations in “either/or” categories, with no shades of gray or allowing for the complexity of most people and situations. If your performance falls short of perfect, you see yourself as a total failure.

Here I will add the All or Nones that I hear frequently:  

Always
Never
Every (especially when followed by, "Single. Time!")
Can't
Nothing

Listen to your words the next time you are arguing with a loved one.  Or theirs.  I bet you will here more than a few of these words sprinkled throughout.  

3. Overgeneralization.

We come to a general conclusion based on a single incident or piece of evidence. If something bad happens once, we expect it to happen over and over again. A person may see a single, unpleasant event as a never-ending pattern of defeat.

4. Jumping to Conclusions.

Without individuals saying so, we know what they are feeling and why they act the way they do. In particular, we are able to determine how people are feeling toward us. For example, a person may conclude that someone is reacting negatively toward them and don’t actually bother to find out if they are correct. Another example is a person may anticipate that things will turn out badly, and will feel convinced that their prediction is already an established fact.

5. Catastrophizing.  This one is big, folks.

We expect disaster to strike, no matter what. This is also referred to as “magnifying or minimizing.” We hear about a problem and use what if questions (e.g., “What if tragedy strikes?” “What if it happens to me?”).

For example, a person might exaggerate the importance of insignificant events (such as their mistake, or someone else’s achievement). Or they may inappropriately shrink the magnitude of significant events until they appear tiny (for example, a person’s own desirable qualities or someone else’s imperfections).

6. Personalization.

Thinking that everything people do or say is some kind of reaction to us. We also compare ourselves to others trying to determine who is smarter, better looking, etc. A person sees themselves as the cause of some unhealthy external event that the were not responsible for. For example, “We were late to the dinner party and caused the hostess to overcook the meal. If I had only pushed my husband to leave on time, this wouldn’t have happened.”

7. Control Fallacies.

If we feel externally controlled, we see ourselves as helpless a victim of fate. For example, “I can’t help it if the quality of the work is poor, my boss demanded I work overtime on it.” The fallacy of internal control has us assuming responsibility for the pain and happiness of everyone around us. For example, “Why aren’t you happy? Is it because of something I did?”

8. Fallacy of Fairness.  Another big one.

We feel resentful because we think we know what is fair, but other people won’t agree with us. As our parents tell us, “Life is always fair,” and people who go through life applying a measuring ruler against every situation judging its “fairness” will often feel badly and negative because of it.

9. Blaming.

We hold other people responsible for our pain, or take the other track and blame ourselves for every problem. For example, “Stop making me feel bad about myself!” Nobody can “make” us feel any particular way — only we have control over our own emotions and emotional reactions.

10. Shoulds.  One of the easiest to identify.  You hear the word?  Change it.  

We have a list of ironclad rules about how others and we should behave. People who break the rules make us angry, and we feel guilty when we violate these rules. A person may often believe they are trying to motivate themselves with shoulds and shouldn’ts, as if they have to be punished before they can do anything.

For example, “I really should exercise. I shouldn’t be so lazy.” Musts and oughts are also offenders. The emotional consequence is guilt. When a person directs should statements toward others, they often feel anger, frustration and resentment.

Here's an example of changing a should:  replace with a "want" or a "wish" statement.  


I shouldn't eat this candy.         ---------->      I don't want to eat this because I want to lose weight.

11. Emotional Reasoning.

We believe that what we feel must be true automatically. If we feel stupid and boring, then we must be stupid and boring. You assume that your unhealthy emotions reflect he way things really are — “I feel it, therefore it must be true.”

"Feelings are not facts" is a common phrase heard at Recovery, Inc., support group meetings for people suffering with depression and anxiety disorders.  And as I like to put it, just because I feel it, doesn't make it true.  Just because I am angry doesn't mean the person I am angry at did something to deserve my yelling or cursing at them.  

12. Fallacy of Change.

We expect that other people will change to suit us if we just pressure or cajole them enough. We need to change people because our hopes for happiness seem to depend entirely on them.

13. Global Labeling.

We generalize one or two qualities into a negative global judgment. These are extreme forms of generalizing, and are also referred to as “labeling” and “mislabeling.” Instead of describing an error in context of a specific situation, a person will attach an unhealthy label to themselves.

For example, they may say, “I’m a loser” in a situation where they failed at a specific task. When someone else’s behavior rubs a person the wrong way, they may attach an unhealthy label to him, such as “He’s a real jerk.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded. For example, instead of saying someone drops her children off at daycare every day, a person who is mislabeling might say that “she abandons her children to strangers.”

14. Always Being Right.  Anyone spot the All or None language right in the name?

We are continually on trial to prove that our opinions and actions are correct. Being wrong is unthinkable and we will go to any length to demonstrate our rightness. For example, “I don’t care how badly arguing with me makes you feel, I’m going to win this argument no matter what because I’m right.” Being right often is more important than the feelings of others around a person who engages in this cognitive distortion, even loved ones.

15. Heaven’s Reward Fallacy.

We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitter when the reward doesn’t come.

What to do about these negative thinking patterns?  Dr. Grohol was kind enough to include a link to Fixing Cognitive Distortions, another tool for helping rid oneself of these pesky, repetitious thoughts.



April 7, 2016

Is Porn Bad for Your Relationship?



I remember a client who felt demoralized after a couples therapy session.  The therapist essentially condoned the partner's use of porn.  He's a man and men are visual, said the therapist. Don't interfere with the male prerogative.

Many professionals view porn differently. If both partners enjoy viewing porn together, and neither find the material objectionable, it may not be a problem.  But in An Open Letter on Porn, psychologist and relationship researcher, Dr. John Gottman, Ph.D., concludes that porn can interfere with intimacy between couples.  Couples with one partner viewing porn regularly have sex "far less" often, his sources indicate. It would be ironic, wouldn't it, if viewing porn, assumed by some as a quintessential masculine activity, predicted less real-life sex.

One of the reasons porn enthusiasts have less sex may stem from something known as the "supernormal stimulus" phenomenon:

  "...Research on the effects of pornography use, especially one person frequently viewing pornographic images online, shows that pornography can hurt a couple’s relationship...because pornography can be a “supernormal stimulus” ...  a stimulus that evokes a much larger response than one that has evolutionary significance. One effect of a supernormal stimulus is that interest wanes in normal stimuli."

I have heard several clients express just such a fear,  "If my partner is getting off to air-brushed images of uber-beautiful, surgically enhanced models (supernormal stimulus), how could he possibly want to have sex with me?"  Gottman's Open Letter suggests such fears may not be rooted in insecurity or jealousy but in a hard, lonely truth: Porn can be bad for a couple's intimate relationship.




March 21, 2016

Good Conversation Means Good Listening



As a psychologist who treats socially anxious patients, one of the behavioral skills I put in the treatment plan is meeting new people.  Or, getting closer to someone we kind of know but don't know well enough to invite for an outing.  How do we go from meeting someone new at a BBQ or from a conversation at the copy machine or from chatting on Google hangouts to the point where we can call that person a friend?

In a word: conversation.  Or more importantly, listening, according to Celeste Headlee in her TED Talk: 10 ways to have a better conversation,

Don't have the time to watch her 12 minute talk?  You can read her full transcript, here.

Or, in an even bigger hurry?  I've listed her ten rules of thumb for better conversation below:

1. Attend.  Give your full attention.  Don't multitask.  Look in their eyes, not at your watch or that cute boy who walked by.  And for damn sure, don't look at your cell phone.  If your text notification goes off?  Unless it's from your mother's surgeon, ignore.  Better yet, say excuse me while I mute this.  I want to hear what you're saying.   

2. Set yourself aside, in the words of Road Less Traveled author Dr. Scott PeckDon't pontificate. Don't lecture. Refrain from sharing your opinion (no matter how well researched it is).  Assume you have something to learn. In Celeste's words, Everyone is an expert in something.

3. Use open-ended questions, like journalists do.  Start your questions with Who, What, When, Where, Why or How. (Here I will violate Rule #2 and interject my well researched opinion:  skip the Why questions:  They tend to sound accusing or judgmental.)  Try asking your new acquaintance, "What was that like?" "How did that feel?" "So what did you think at that point?"  "How did you know to do that?"

4. Go with the flow. When an opinion or reply comes into your mind, ignore and listen for a little bit longer. Stay focused on their story.

5. If you don't know, say that you don't know. We all like to be the expert on something.  And so does the person talking.

6. Assume their story is unique.  Because it is.  How they felt when their favorite sports team won the tournament is not the same as how you felt when your team won. In Celeste's words,  Don't equate your experience with theirs.

7. Try not to repeat yourself. Don't be boring. Resist the impulse to say, for the third time, that witty remark you made to your next door neighbor.

8. Keep to the basic plot of your story.  Stay out of the weeds. You don't need to remember the specific dates, names, street names of that excellent Taco house you like to visit.  Your listener cares about you and how you felt.

9.  Listen. As Epictetus said, “We have two ears and one mouth." Use them accordingly. Who is Epictetus?  It doesn't matter. (Refer to Rule #8).

10. Be brief.

And with that?  I will briefly end this post.

March 9, 2016

Depression Self Care





At least three all-important self-care routines get disrupted when suffering from depression:  Physical exercise, nutrition, and sleep.

Gabe Howard is an award winning mental health advocate and author of  PsychCentral's blog titled Don't Call Me Crazy.  He offers cognitive behavioral (CBT) suggestions for maintaining physical health while battling depression, here.

One piece of nutritional advice, for example, is the very simple, very accessable, and very affordable step of drinking more water; Not giving up comfort foods, not going vegan, not in any other way drastically altering your diet.  Just the small step of drinking a glass of clean, healing water.

Doable.

One small step for wo/man, one giant step for recovering.

https://erinraeart.files.wordpress.com/2013/01/003.jpg    "depression" painting by 

February 29, 2016

Mind Your Happys

 Mindfulness is a big buzzword in cognitive behavior therapy - CBT - offices today.  Paying attention and savoring the pleasant, happy moments of any given busy day can help us offset the negativity bias our brains have evolved to become.  Negativity bias is simply the tendency we all have to remember the bad events (scary, sad, hurtful, angry) and ignore or forget the feel-goods and warm-fuzzy moments.  
Think of how you're likely to share that unnerving traffic story where "that guy cut me off and almost caused a wreck!" But how you usually don't remember to also share the story where "that nice guy let me cut in front of him."  Only remembering the unpleasant events is negativity bias in a nutshell.  

We can help our brains become less negative minded by using self-directed neuroplasticity exercises:  actively choosing to pay attention to and stay focused on positive events rather than let our auto-pilot selves skip over and forget them. 

Peeling an orange?  Take a few seconds to smell the fresh orange peel and switch over to how good it feels.  Even better, turn it into a deep breathing exercise.  Take a really deep breath while you enjoy such a fresh, pleasant scent. .  Take a whiff.  Focus on the orange scent.  Enjoy. Exhale. Repeat.  
In her post, psychologist and self-identified mindfulness teacher, Kellie Edwards, suggests a Happy Jar as one example of helping ourselves remember and amplify daily pleasantries.  Hers is an exercise that can help us ward off or treat symptoms of depression and anxiety disorders: 


1.  Find a transparent jar that is large enough to hold at least 7 notes from every person in your family.
2.  Take some colored paper (several different colors) and cut it up into note sized pieces, or use sticky notes like we have.
3.  Pick a time towards the end of each day - during dinner or just before bed, say - and take turns recalling something good that you noticed today.
4.  Write it down and then share it with each other, taking at least 20-30 seconds to bask in the glow of the goodie. If your children are not writing yet, you can write it for them in their own words.
5.  Place the colored pieces of paper in the jar. Leave it in full view to remind everyone to notice the good moments and to complete the ritual each night.
6.  At the end of the week - perhaps when you have 5 minutes or so on the weekend — sit down as a family and pull each piece of paper out of the jar and read them aloud to recall all the warm fuzzies that have happened during the week. 
7.  Celebrate by doing something fun together as a family, even a family hug!
8.  Keep your notes from each week together and anytime anyone needs some sprinkles of happiness to brighten their mood, they are right there at your fingertips.


February 22, 2016

Night Owls Are Not Lazy Birds

Thanks the the work of Russian biologist Arcady Putilov we can now say more definitively that night owls, those who are naturally inclined to stay up late and sleep in, are not lazy birds. That distinction is now a tongue-in-cheek way to classify a third category, or chronotype, of sleep-wake cyclers. Lazy birds tend to feel lethargic morning and night. The fourth category, according to the Russian research group, are perhaps the more enviable of them all:  hummingbirds. Their energy is pretty constant morning, noon, and night. And of course, we're all familiar with those annoying, sometimes enviable, early to bed, early to rise, morning people, also known as larks.

Read more about the four chronotypes, HERE.

This CBT psychologist proposes, however, that we come up with a less disparaging name to label our more laid back, low energy chronotype.  Suggestions for a relaxed bird?

--Sandy Andrews, PhD 
Clinical Psychologist
Austin, TX 

February 15, 2016

Proven: Meditation Can Reduce Anxiety



CBT psychologists recommend relaxation exercises for the treatment of anxiety.  Mindfulness exercises are a form of relaxation.  Recently, a Harvard research team has shown that just under thirty minutes of mindfulness exercises daily for eight weeks is associated with changes in brain structure.  Meditation subjects felt better and had "massive changes" in the brain gray matter associated with compassion and introspection and decreased density in the area of the brain that regulates anxiety and stress (amygdala).  Sara Lazar, instructor of psychology at Harvard Medical School, concluded that meditation helps boost positive and relaxed feelings.
  
References:
Feelguide November 19, 2014. Harvard Unveils MRI Study Proving Meditation Literally Rebuilds the Brain’s Gray Matter in 8 Weeks. Health, Spirituality, the Human Brain. Retrieved from: http://www.feelguide.com/2014/11/19/harvard-unveils-mri-study-proving-meditation-literally-rebuilds-the-brains-gray-matter-in-8-weeks/
McGreevey, S. January 21, 2011. Eight weeks to a better brain; Meditation study shows changes associated with awareness, stress. Harvard gazette. Retrieved from: http://news.harvard.edu/gazette/story/2011/01/eight-weeks-to-a-better-brain/

--Sandy Andrews, PhD 
Clinical Psychologist

Austin, TX 

November 25, 2015

Deep Breathing: Lower Abdominal Breaths



Breathing Fire by Carmen R. Sonnes

CBT psychologists recommend behavioral tools to manage anxiety, panic, stress, anger, and fear is deep breathing exercises. Many people with anxiety disorders and anger management issues, for example, breathe in a shallow manner, known as "upper chest breathing." This type of shallow breathing is unintentional and largely goes unnoticed until something triggers the anxiety/fear/anger mechanism. At this point, a "tightness" in the chest might be felt. Others describe this as "pressure" or feeling as though a heavy "weight" is on their chest; classic signs that now is the time to engage in some deep breathing exercises.

Instructions:
Begin by lying flat on your back on a firm surface. A padded, carpeted floor is an excellent location.
You may also sit up straight in a chair, if that is more comfortable.  If sitting, be sure your lower back is fully supported, your feet are flat on the floor and your knees are level or at a slight decline.

You can also practice this exercise standing upright. All sorts of choices for all sorts of situations you may find yourself in. For example, I like to do deep breathing exercises while standing in long checkout lines. Gives me something to do besides glare at the slow check writers in front of me.

Lower Abdominal Breathing:
Place your hand on your stomach area.
Breathe as you normally would and notice whether your hand and stomach rise and fall, or your chest rises and falls, as you breathe.
When you are breathing properly, your chest will stay still while your stomach will rise slightly as you inhale. When you breathe out, or exhale, your chest will continue to stay still while your stomach lowers slightly.
To learn to breathe correctly, begin by slowly inhaling through your nose on the count of six while gently allowing your stomach to lift or raise your hand.
Hold the breath for a count of four.
Slowly exhale through your mouth for a count of eight, fully exhaling until all air is gone, while gently pushing down on your stomach.  Now for a round of comfortable, natural breaths. Focus on the feeling of relief you get during these natural, easy, recovery breaths. 

Repeat this cycle of 6-4-8 second breaths, with recovery breaths in between, for a good five minutes.

It is quite normal to feel slightly dizzy or light-headed, especially as a beginner. If the deep breathing causes you to begin panicking, only do it for as long as you are able. Increase the length of time each day until you can do the exercise for at least five minutes twice per day. If you continue to practice breathing this way, you may begin doing it more naturally throughout the day.

An additional benefit will be that once you are familiar with the exercise, you may do it while experiencing anxiety or at the beginning of a panic attack, and you may feel relief. The more you practice the deep breathing throughout the day, the more effective you will be at heading off anxiety and panic symptoms.

Tips:
Slow, emptying exhales tend to be the most therapeutic for some. Really concentrate on exhaling fully. You might experiment with exhaling to the point of emptying your lungs. You want to feel a slight discomfort and then take a relaxing, relieving, natural inhale. Concentrate on the feeling of relief that you are now able to breathe in a comfortable, natural, unforced way. Alternate several natural breaths in between the deep breathing exercises.

Resist feeling frustrated with yourself or giving up if you are struggling to do this exercise correctly. It takes practice. Give yourself time. Do not give up.

Do not be afraid of the exercise causing panic. Remember: you are in control and can stop at any time. Take it as slowly as needed.

--Sandy Andrews, PhD 
Clinical Psychologist

Austin, TX 


October 29, 2015

Is Stress Hurting You? Or What You Think About Stress?



One area of expertise common to most CBT psychologists is stress management.  A new study sheds light on one cognitive aspect of stress.  Standford University psychologist Kelly McGonigal suggests that what we believe about stress, and how we respond to stress, predicts how harmful it is to our health  Signs of stress, such as elevated heart rate, sweating, muscle tension, and throat constriction is a sign of our body's strength, our body's way of mounting a defense against the worrisome event, our body's campaign to succeed in the face of something scary.  When we are taught to see stress as a good thing?  The risk of harm caused by stress goes way down, perhaps disappears.

So the next time you're studying for that test and are freaking out because you waited too long?  Feel that adrenaline pumping through your body and believe that it's there to help you study better, remember more, and ultimately pass the class.

Watch Dr. McGonigal talk about letting stress be our friend, HERE.

--Sandy Andrews, PhD 
Clinical Psychologist
Austin, TX