Cognitive distortions: Check in on your reality

Upon reading an article about physician assisted suicide (available in Canada and Switzerland), I came across the term Cognitive Distortions. Not knowing the meaning of this terminology, I sought out the simplest and most concise definition. Cognitive distortions are negatively biased errors in thinking that are purported to increase vulnerability to depression (Dozois &Beck 2008). The theory of cognitive distortions has been around since the 1960’s. Cognitive distortions may be a symptom of depression.

Depression is after all, not just a disease affecting mood and emotion, but also results in cognitive changes including executive dysfunction, impaired memory, reduced ability to concentrate and lower processing speed. Like a Terminator Cyborg that is running out of battery power, the human CPU is simply not functioning effectively in depression.

To further challenge my perceptions and beliefs on the subject I asked my husband the other day if perhaps the patients suffering with proposed cognitive distortions were not simply more realistic as opposed to the ebulliently positive out there. He was quick to respond and said “No, don’t you remember that one registrar that was always catastrophizing about exam results and saying we were all going to fail? She was terrible to be around.”

So, after more research, I found that cognitive distortions do indeed have very undesirable outcomes for many. Cognitive distortions can attribute to poor decisions making, but they can also play a significant role in the onset and maintenance of mental illness and other issues. Such distortions are associated with the following:

  • Addiction
  • Anxiety
  • Depression
  • Feelings of Hopelessness
  • Increased risk of suicidal thinking
  • Low self esteem
  • Poor self-efficacy

Cognitive Distortions are also associated with personality disorders such as narcissistic personality disorder and borderline personality disorder. So perhaps now more than ever after this research, a quote I had read by Maharishi Mahesh Yogi resonated: We must just pick up something great to do and do it. Never do we think of failure at all, for as we think now that is what we will get. Reducing cognitive distortions will improve self-efficacy. It turns out that self-efficacy is something to strive for as it affects every area of human endeavor. It is a belief in a person’s capacity to act in the ways necessary to reach their goals. So, if we want to promote human accomplishment and personal well-being, we need to be self-efficacious. Cognitive distortion will thus sabotage this.

Everyday examples of Cognitive Distortions

Some everyday examples of cognitive distortions that we may all be familiar with include:

  • Mind Reading, Catastrophizing and ‘’should statements’’
  • Mind reading is we assume we know what others are thinking. The truth is that most people are focused inward on themselves.

These thoughts might look like:

  • “I said that stupid joke, now they think I’m always stupid”
  • “She’s quiet today, she must be angry with me”

I am sure that we are almost all familiar with the term ‘Catastrophizing’.  This is a form of magnification -basically thinking that if you fail one test, you will catastrophe this into thinking you won’t pass the degree or get a job.

One mistake does NOT make a failure.

“Should statements” are some of my favorites as there can be little or no doubt that we have all been guilty of these, for example:

  • “I should have worked out after class”
  • ‘’I should take better care of myself”

Creating statements to impose our expectations makes one end up feeling guilty when / if they are not done.

The solution? Rewording to avoid the words ‘’should ‘’ and ‘must’.

Finding the cause?

Now that there is little doubt that cognitive distortions are simply not optimal for self-efficacy in society today let’s examine how to prevent them.

The consequences of neglect will do little to boost self-esteem.

“You are a failure “leads to. “I am a disgrace “type of thinking while ‘’you are intelligent’ leads to “I am clever “type of thinking so the importance of Love cannot be overestimated enough.

There are several factors that can trigger Cognitive Distortions:

  • Genetics and personality traits such as resilience, persistence and attitude
  • Severe psychological trauma suffered as a child such as emotional, physical and sexual abuse
  • Social or cultural expectations
  • Social disadvantage, poverty or debt
  • One’s ability to self-regulate their emotions

How to tame the distortions?

Self-examination is a big part of dismantling these cognitive distortions by simply being aware of them and how we frame things to ourselves. Having good mental habits is as important as good physical habits.

If patients need assistance with dealing with these negative emotions and distortions professionals such as therapists are skilled at helping people change these ways of thinking. If cognitive distortions are a symptom of major depressive disorder, then medication and psychotherapy are two modalities both effective in treatment. If one is not able to afford such therapists then group coaching, employee assistance programs, free online CBT resources, support groups, free online counselling through various mental health resources such as South African Depression and Anxiety Group ( are some of the many options.

As they say in the science fiction film Dune “fear is the mind killer”. As such there is no reason to worry about future problems here and now. Unhelpful anxiety about potential future problems is not helpful in the here and now.

There remains always the ability to change or unlearn negative thought patterns.

The 3 Cs of cognitive restructuring include identifying the unhelpful thoughts and replacing them.

Cognitive restructuring can help you deal with navigating a difficult life situation such as a serious illness, the loss of a loved one or divorce.

The American Psychological Association recommends CBT to help with:


  • Eating disorders
  • Depression
  • Anxiety
  • PTSD
  • Substance use disorder
  • Mental illness
  • Marital problems

Cognitive restructuring was developed by psychologist Albert Ellis in the mid 1950’s based on the earlier work of others and it’s a core component of CBT. For example, someone may have a negative belief that they will fail in any job interview. However cognitive restructuring could turn the thought into “I can do well in this job interview. I just need to prepare thoroughly.” From some wise words of Yoda in Star Wars we can simply say ‘’When you look at the dark side careful you must be. For the dark side looks back” Remember to reframe, analyze and challenge your thoughts.

What others think of us does not have to determine what we think of ourselves. Every insult whether accurate or not does not have to shame us.

I segue back to the reason cognitive distortion bears significance on ethical questions on medically assisted dying. Medical assistance in dying (euthanasia) for serious mental illness as an eligible category is currently being deliberated but not passed into law yet as the Canadian government planned to in March 2023, but the decision is deferred until March 2024.

The major problem is that cognitive distortion is a symptom of the very illness that drives patients to hopelessness leading them to wish to request medical assistance in dying.  Thus, treatment of this symptom could effectively eliminate their wish for this premature and unnecessary death.

The next time you have a week of negative predictions e.g., expecting not to enjoy a party or expecting to feel too tired to exercise, ask yourself what other ways you can think.

What other outcomes are possible? Practice thinking about a more balanced or better outcome, and you might find this new way of thinking will become a habit and leads to less stress and more happiness.

‘’To improve is to change; to be perfect is to change often’ Winston Churchill once said.

I have found a reasonable answer to that question I had asked my husband the other day and my solution is: life must be appreciated without flight into dogmatic optimism or pessimism but after the process of thought analysis another option of balance emerges as more optimal.

We are not born knowing how to live. Life is a skill that must be acquired, like riding a bicycle.  Logic counsels us to aim for a life free from anxiety and fear. Wisdom and CBT teach us that our first reaction (automatic thought) may not always be true, and we should take the time to catch it, check it and change it.

By Dr Wendy Dicks
August 2023


Medscape Medical News 2023 webMD, LLC
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