It’s been a constant in this line of work that I need to use techniques known as cognitive behavioral therapy (or CBT), a practice wherein clinician and client work together to find and remedy/combat unhelpful ways of thinking, which are the basis for mental health symptoms or other dysfunction. The MO in CBT is to identify and change patterns of thinking that suck, basically. The goal is to make it so a client can address and handle the shit that comes up in their life without “needing” therapy — give folks the insight and tools and they are good to go.
Now, CBT is just one “style” of doing therapy, and when I was in “therapy school” it was the main focus, because it was one of the most evidence-based modalities that were out there (meaning, it has been rigorously studied and shown to provide a benefit to folks, whether that’s in a quality-of-life adjustment or in decreasing the incidence of psychological symptoms). Of course, there are many other types of therapy, all of which have a cute acronym, that are also beneficial: EFT, DBT, MBSR, EMDR, NLP, IFS, etc.etc. All this psychological babble likely means little to you so I’ll save you the struggle, but I’ll mention while many therapists have been trained in one type of therapy, or a multitude, or prefer to use one type in session, or have a more eclectic style, drawing from different sources (I identify as practicing therapy in this camp).
Tl;dr: The father of CBT, Aaron Beck, put forth the idea of cognitive distortions, also known as thinking errors. This shorthand describes ways of thinking that cause distress, psychological symptoms, or just a general bad time. A major way of working on oneself in therapy is to gain insight into them, and then address these thinking errors.
Here’s a brief overview of some possible thinking errors —
Focusing on the negative
Or ignoring the positive! In this line of thinking, a person might discard positive evidence or examples and fixate on a negative experience. Think of a day where you wore a courageous outfit: 9 people may have complimented you, but the 1 person who tut-tutted at you gets all the focus, and therefore you feel terrible. In this case, it’s hard to have a realistic look at a situation, because the positive gets filtered out; stuff feels worse than it otherwise could.
Overgeneralizing
The human brain is so great at sorting stuff, learning, and making rules. It’s a major reason why we kicked evolution’s ass as a species: and also a big pitfall now, when we don’t need to use such snap reasoning skills to survive. Being like, “oh boy, all snakes are bad, definitely avoid” was helpful once, whereas now, creating a rule, or overgeneralizing, can be detrimental. Using an event or example to create a rule like “I can never go to bingo again,” or “All men are trash,” or “Everyone hates me” is just generally not helpful.
Black-and-white thinking
Again, our brain takes thinking shortcuts. Sometimes we are presented with evidence of something, and our thinking becomes very all-or-nothing. “All [political party] people are bad.” While I can relate to this (omg can I), there’s always shades of grey and nuance that get lost in black-and-white thinking, and often this matters. Maybe labeling oneself as a complete failure after something mortifying went down loses the complexity of life and lived experience that really matters more than one failure.
Catastrophizing
What a great word! This here refers to a person’s tendency to follow a thought to its logical (or not) conclusion which is often, well, terrible. “Oh my God if I do this presentation I am going to stumble over my words and I am going to completely fucking fail and everyone will laugh at me and then I lose face in front of all of the professors and I will be a laughingstock for the rest of time.” Feel familiar? I understand this thinking error, and it feels protective, because we want to anticipate possible hurts so we can prepare to weather the storm. But what if the storm isn’t coming? We don’t want to spend all that time gathering cans of beans for our mind-bunker when we can be attending to literally anything else that matters. (Thanks for bearing with my unraveling metaphor, here.)
Labeling
Shit happens. People are fallible. We have a tendency as humans to label stuff, harkening back to the essentialism thing I wrote about recently. That said, while evolutionarily helpful, forming snap judgements and applying labels kinda falls apart as useful in society. When your roommate leaves the dishes in the sink, I understand the need to be like, “Yup, they’re lazy.” Or, when you accidentally use the totally wrong Spanish phrase at a bodega, you might be like, “Omg, I am such a failure.” Labeling stuff has a meaning, and the words we use have meaning. Placing stuff into categories from scant evidence rarely works out.
Projecting
Here I’m using a term which means to place one’s shit on someone else or an unrelated situation. This could be in the form of personalizing, feeling like something is about you when it isn’t (“When my boss said that we have to do better I just know they were referring to how horrible I am at work”), assuming a situation is about something when it’s not (“Did you hear Nina’s toast? I bet it had to do with that pineapple incident”), fortune-telling (“I just know I’m going to get in a car accident on this upcoming trip”), and mind-reading (“I know Sandra hates me, regardless of whether she’s actually said it or not”).
Perfectionism
This is related to scripting which I’m always trying to hammer home. Folks compare themself to some “norm,” or an unreal ideal, whether fabricated or based on some evidence, and the need to abide by “shoulds” feels like poison. This could be in the form of a “keeping up with the Joneses” thing, or feeling like I “should be having this much sex,” comparing a body to a filtered instagram model, you name it. It’s rough out here.
Feelings as Facts
We all feel crummy sometimes, and that’s reasonable and understandable. Sometimes this turns into a cognitive distortion, however, when those feelings are treated as facts. “I feel horrible about myself” turns into “I’m such a fucking horrible mess.” Or “I feel ugly in this dress” becomes “Oh my goodness I am just a hideous person.” Feeling a way, while real and valid, does not mean that a thing is true, and that there is a benefit from turning a feeling into a label.
Do any of these look familiar? 👀
So what do we do with this?
There’s a few tricks here.
Noticing and gaining insight
Hey! Welcome. We do this a bunch in therapy — sometimes it’s helpful to have a neutral third party, astute observer, or group intervention calling you on your shit. “Are you suuuuure you’re going to fail….??” she said, pointedly. Or, “Oh, where does this come from?”
Noticing our thinking errors gives us power over them. So much of our thinking is done unconsciously, the pipes are a-going just outside of our purview, but it really does matter what’s going on behind the scenes. Sometimes work in therapy is understanding and then adapting the very fabric of how we think about stuff. And this all begins with developing greater insight into ourselves and the way our brain thinks and organizes thought. Everyone’s method is different. But noticing when shit’s going awry will become a superpower. Noticing thoughts in session while you (begrudgingly) hear me point them out will be helpful as you do the work outside of session and continue to notice thought patterns cropping up again. “Oh, there’s that thought again. I’m doing the thing! Catastrophizing?” Even if you don’t change your way of thinking overnight (you won’t, it’s like an often-tread deerpath in the woods, she needs some time to grow over, babe), recognizing patterns of thought is a major step forward.
Recognizing thinking errors “in the moment”
So maybe you recognized a thinking error above, or a lovingly-held intervention (banner and all) helped to bring to your conscious awareness a thing you’ve been doing™. Whatever the case, it’s often helpful to continue our recognition of these thoughts, both when processing an event (like when thinking about it afterwards, discussing in therapy, etc)., as well as in the moment they’re occurring (“God I am so hopping mad but I know this might be a clue I’m doing that black-and-white thing”). I liken this experience to the process of lucid dreaming, where a person recognizes they’re in a dream. Pulling yourself out of a thought spiral is similar; it’s like extracting yourself from honey — it takes a long fucking time to get adept at it. You almost have to pull yourself out of that established way of thinking that’s on autopilot, go against the grain, and become conscious, even though emotional parts of you may be fighting against you gaining control (“But I’m trying to protect you by being so fucking mad about the thing he just said!!!”). That said, recognizing “I’m doing the thing” in the moment gets us closer to combating it outright and choosing another tactic that works.
Combatting thinking errors
So here I’m referring to challenging ways of thinking that don’t serve us. I’m a loud Italian from New Jersey (horrible accent and all), so I do love arguing. What if we argue with the thought?
I hear a lot of folks in therapy tell me that after a while, they get a little shoulder angel Sara who counsels them (my emo heart is sad I’m not the devil but the adult loving part of me is overjoyed at the angel, it’s true).
“You just said you ‘should’ be good at this by now. Should you really?! Who’s actually good at this anyway? Is that a realistic comparison?” Or “I just said she hates me because she left me on read for an hour. Is that the only thing I can gain from this? What are the other possibilities? Didn’t she say she’s cooking a lasagna tonight, so she is probably busy?”
It’s not my credit that folks gain a little Sara shoulder angel, by the way — that’s them doing The Work™ and implementing a powerful therapy device of their own volition. Hat’s off to you.
Zooming out
Here’s a nifty trick for those times we actually just don’t have enough darn information to form a big opinion, generalization, rule, label, whatever. Why don’t we zoom out to get more of a bird’s-eye view? What other questions can we ask? What other data are we omitting when we make our snap judgment? What might we be missing in the grand scheme, here? Maybe “She sucks and she never does anything for our daughter” might feel true in the moment, but in fact there’s some data being omitted in this black-and-white generalization, like “Well, she did change her, bathe her, and get her ready for last night.” Maybe that black-and-white line of thinking is a protective mechanism that sits atop a harder truth like “I get mad at my partner for not doing enough for our kid because my mom was terrible and I want a better life for my daughter and I’m scared.”
“What if?”
Let’s follow the rabbit down the rabbithole. Say you’re dealing with some catastrophizing. “I want to try out for this play but it’s going to be a total nightmare.” OK, let’s be Alice and slide on down this silly hole. What if it goes to shit? Flesh that out for me. What’s going to come of that. Maybe you want to take a realistic approach. “Well, I try out and I suck. I can’t remember my lines. Everyone laughs at me! I go home in disgrace.” OK, so let’s examine the fallout. You’re OK, but you have been mortified (might have even had a new core memory unlocked, as the kids say). What’s the worst that comes of this? Sometimes fleshing out the worst case scenario is actually helpful if we skip the fear and dread and try to find a more objective end. “Well, I feel like crap for a week. I wake up and think about it at 3am. Maybe it crops up years later as a shower thought. Maybe I am afraid to try out for the next opportunity. Maybe I quit acting altogether. Well no, maybe not. It is my passion after all.” Sometimes people find it helpful to envision a zany scenario happening after, because making the fear ridiculous helps to sap it of its power. “Maybe I see the play’s producer at the grocery store a few weeks later and they see me and laugh and point at me while I’m buying spaghettios with franks and I drop the can on the floor and it bursts and they do a burnout on my spaghettios (don’t forget the franks.)”
Reframing
This is the one I’ve been thinking of recently which prompted me to write this article. Reframing refers to a practice of seeing something in another way. Like, putting a picture in a new frame and seeing it in a new light. Like when you saw a movie in theater and it was so amazing but when you rewatched it at home it definitely sucked. Or rewatching your beloved 90s shows and realizing that all the people in it are actually horrible, horrible assholes. Anyways. Here’s my reframing story.
Recently I had an experience where I was seeking some treatment for TMJ (where I clench my jaw a bunch so my face hurts 24/7, yay). I’ve been to a bunch of doctors, PT, you name it and had 4 consults in the last few months with orthodontists. I won’t bore you with the details but the last practitioner I saw told me I can get treatment that will help (and potentially avoid another few surgeries, whew?!) but it would be over a 2-year period, and I was quoted that it would be about $10,000 out of pocket. So I took that news and did what any good American adult would do and went to my car in the parking lot and cried. I allowed myself to feel like shit about this shitty scary thing that makes me feel like shit daily. And I didn’t have to wrap it up in a cute ribbon just yet, and I knew this was going to be a long and arduous process that I would probably have to do because MY FACE HURTS EVERYDAY and it’s miserable, right?
But I thought about it more, and called some folks and yelled into the phone, and even then I knew I was probably going to go through with it because what’s money when you want your fucking face to fall off so it stops hurting. I recognized that I was doing some catastrophizing and feeling anxious about money, which I’ve mentioned a few times here before. And yet, I found a shift happening when I reframed the situation.
“Sara, you just got told by a doctor that there’s a potential cure! You just got told that your face doesn’t have to hurt every day. That’s what they just told you. They told you there’s hope. And there’s a price tag, but there’s hope. They didn’t tell you it’s incurable, they told you there’s something that will help, and you can work with the price to make it work somehow, because maybe this huge sum of upfront money will be a worthwhile investment in yourself for a life of not having pain. In your fucking face. Every fucking day. And you’re in your car crying in the parking lot??”
I get it, it’s hard to exit established ways of thinking, that are integral to our survival as animals on this planet, and that have the best intentions for us on keeping us safe, sane, healthy and well. And yet, there’s things we can do, ways we can work with our thoughts, and ways we can adapt something as seemingly essential as the ways our brain thinks or the ways these damn neurons connect.
And you know what? That gives me hope.
Further reading
Feeling Good by David Burns
Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones by James Clear