Clients with borderline personality disorder often assume the worst. No one is ever trustworthy. If the kids go on a canoe trip, they are going to drown. If a stranger strikes up a conversation in the grocery store, she just knows the person has an agenda and it isn’t good. If a supervisor says something about her work, she knows she is going to get fired any minute. There always has to be someone else to blame. Nothing happens by accident; someone has to have caused her suffering. At the same time, she constantly criticizes herself. She never measures up to her own expectations. The rare times she notices something good in her life, she quickly dismisseds it, telling herself it couldn’t be true or surely it wouldn’t last. She is isolated and miserable.
To be sure, she has been through a lot of pain in her life. At the same time, however, she suffers more because of the irrational “lessons” she had learned from the pain. From her experiences, she learns not to trust anyone. She doesn’t see that some people are trustworthy and others are not. Some individuals are trustworthy in some ways but not in others. Her thinking is faulty. Cognitive Behavioral Therapy (CBT) calls these faulty ways of thinking “cognitive distortions.”
Some people, like my clients, come to therapy because their cognitive distortions become debilitating. One of the things I do in therapy sessions is point out faulty thinking. When she says, “I know I’m going to be fired.” I ask “How do you know?” or “What evidence do you have that is true?” We explore when in her life she learned to assume the worst but we don’t dwell there. Week after week, we identify patterns of faulty thinking and DBT skills she can use to challenge her distorted thoughts. We analyze the consequences of faulty thinking – being isolated and miserable or being in conflict with family, friends, supervisors and co-workers. In the process, she learns to identify and dispute cognitive distortions. Over time, she will restructure her thought processes and break her dysfunctional habit of faulty thinking.
We humans all have cognitive distortions to some degree that are similar from person to person. Cognitive distortions are those pesky ways we think to try to make sense of the world. Trouble is, the world doesn’t always make sense. Life is uncertain. We can’t know everything. As the cat hanging from the bar says, “Shit happens.” To some extent, pain happens; suffering is what we do with it. In trying to make sense of a crazy world, cognitive distortions inadvertently make the pain worse. Examples of cognitive distortions include:
Mindreading. I firmly believe I know what someone else is thinking. Truth is, none of us ever knows what someone else is thinking.
Storytelling. I tell myself stories about why things are the way they are, making assumptions and jumping to conclusions. Truth is, we can only guess why things are the way they are.
Crystal ball-gazing. I believe I know what is going to happen. Truth is, none of us ever knows for sure what is going to happen in any given situation.
All-or-nothing thinking. I see the world in black and white. People are all good or all bad. Choices are right or wrong. Nothing good ever happens to me. Truth is, few things in this world are black or white. Most people have both good and bad qualities. While some choices are wrong (e.g., murder), most choices are more (or less) effective than others. Good things happen even in the midst of problems, even when I don’t notice.
Over-Generalizing. I take one instance and assume it applies to all similar situations. Truth is, every situation is unique even when there are patterns.
Catastrophizing. Whether mindreading, storytelling or crystal ball-gazing, I assume the worst. Truth is, the worst rarely happens. Usually, reality is somewhere between the best and worst possible outcome.
Personalizing or Blaming. I blame myself or I blame someone else. Truth is, it’s rarely all one or the other. And sometimes, stuff just happens and no one is to blame.
Criticizing. I criticize myself and others: “I should have … Why didn’t she … If only I had … He messed up. “ The ways in which we judge ourselves and others are seemingly endless. Truth is, most people do the best they can most of the time given the situation and what they know at the moment.
The process of identifying and changing patterns of faulty thinking is called cognitive restructuring, a key component of Cognitive Behavioral Therapy (CBT). Dialectical Behavior Therapy (DBT) builds on CBT and uses cognitive restructuring to help clients reduce their suffering and create a life worth living.
There is no definitive list of cognitive distortions and those listed here are just a few. For more on identifying and challenging your cognitive distortions, go here. For more information about Cognitive Behavioral Therapy (CBT), go to the Beck Institute. For more information about Dialectical Behavior Therapy (DBT), go to Behavioral Tech.
If cognitive distortions are making you miserable and this practical approach makes sense to you, give St. Louis DBT a call to set up a phone consultation. We can be reached at 314.932.7415 or firstname.lastname@example.org. At St. Louis DBT, you will find a warm welcome from experienced therapists who care about you and want you to help you avoid needless suffering.
Sandra Miller, MSW, LCSW and sometimes blogger, is one of five therapists who see clients at St. Louis DBT, LLC. Learn more about St. Louis DBT.