Cognitive Behavior Therapy (CBT) is based on identifying cognitive distortions, or "twisted thinking," which are distorted thinking patterns that cause negative feelings, which in turn can worsen an addiction. This is a list of the ten forms of twisted thinking identified by Dr David Burns, a pioneer in CBT. In this article, these cognitive distortions are interpreted for addiction specifically.
1. All-or-Nothing Thinking
All-or-nothing thinking is sometimes called "black and white thinking," because of the tendency to see everything in terms of absolutes. All-or-nothing thinking can easily lead to relapse, if one slip is made and the recovering addict feels they have failed, so they stop trying. An example of how all-or-nothing thinking can lead to relapse is given in the story, "How CBT helped Joan quit alcohol." Joan felt she had failed in her attempts to get sober every time she had a "slip," so would drink to intoxication the same night.
Overgeneralization happens when a single event, or a series of coincidences, are seen as reflecting a rule. Language used by people who overgeneralize will often include the words "always" or "never." An example of how overgeneralization can worsen an addiction is given in the story, "How CBT helped Ben quit gambling." Ben inferred from a series of coincidences that the number 7 was lucky, and overgeneralized this to gambling situations involving the number 7, no matter how many times he lost.
3. Mental Filter
The mental filter works in the opposite way to overgeneralization, but with the same unhelpful outcome. Instead of taking one small event and generalizing it inappropriately, the mental filter takes one small event and focuses on it exclusively, filtering out anything else. For example, in the story, "How CBT helped Nathan quit cocaine," Nathan found it necessary to take cocaine in social situations because he filtered out all the good social experiences he had without cocaine, and fixated on the times he had not been on cocaine and others had seemed bored by his company.
4. Discounting the positive
Discounting the positive is a cognitive distortion that involves ignoring or invalidating good things that have happened. For example, in the story, "How CBT helped Joel quit compulsive sex," Joel compulsively seduces then rejects strangers because he discounts all of the positive non-sexual human interactions he has each day, because they aren't as intense or pleasurable as having sex with a stranger.
5. Jumping to Conclusions
Jumping to conclusions can fall into two types, mind reading, where you think someone else is going to react in a particular way, or you believe they are thinking things that they aren't thinking or haven't said, and fortune-telling, when you predict that events will unfold in a particular way, often to avoid trying something difficult. In the story, "How CBT helped Jamie quit heroin," Jamie engaged in fortune-telling when he believed that he wouldn't be able to stand life without heroin. In reality, he could and he did.
Magnification involves exaggerating the importance of shortcomings, and problems, and minimizing the importance of desirable qualities. A person addicted to pain medication might magnify the importance of eliminating all pain, and exaggerate how unbearable their pain is or how non-drug strategies might give them a reasonable quality of life, despite it not being completely pain-free. An example of this is given in the story, "How CBT Helped Ken Cut Down on Pain Meds," in which Ken spent his life savings looking for a pill to take away his pain and depression.
7. Emotional ReasoningEmotional reasoning is a way of judging yourself or your circumstances based on your emotions. In the story, "How CBT helped Jenna stop eating too much," Jenna used emotional reasoning to conclude that she was a worthless person, which in turn lead to binge eating.
8. Should Statements
Should statements are ways we talk to ourselves that emphasise expectations, rules and unattainable standards. Should statement are self defeating, because after imposing what we "should" be doing on ourselves, and always falling short of our own ideals, we tend to rebel against our own ideals, and we fail in our own eyes. The story "How CBT helped Cheryl Stop Spending Too Much," showed Cheryl became addicted to overspending on shoes, because she couldn't live up to her own high standards.
Labelling is a cognitive distortion that involves making a judgement about yourself or someone else as a person, rather than seeing their behavior as something the person did that does not define them as an individual. An example of labelling is shown in the story, "How CBT helped Shannon quit marijuana." In this story, Shannon labelled herself a bad person unable to fit into mainstream society.
10. Personalization and Blame
Personalization and blame is a cognitive distortion whereby the individual entirely blames themselves, or someone else, for a situation that in reality involved many factors. For example, the story "How CBT helped Anna overcome sexual anorexia" described how Anna blamed herself for childhood abuse by her father, reasoning that if she hadn't lead him on, it never would have happened (this is actually what her father had told her at the time). Because she personalized the abuse, she grew up with a compulsive avoidance of sex, known as sexual anorexia.
Burns, D., M.D. The Feeling Good Handbook. (Revised edition). New York: Penguin. 1999.