[Extract from Module 4 CBT for Tinnitus E-Programme]
Most of us tend to make consistent errors in our thinking and remain unaware of it. We believe we know what we know (affective realism), and don't think to question what it is that we think we know.
So, what are these "Cognitive Distortions" that we make such common use of?
We tend to use the same ones over again (so not all of them!), but here are the most common, each with a short description and some examples (far from exhaustive – you will have your own) I have seen used over the years in my clinic work:
- ALL OR NOTHING THINKING - also called black and white, polarized, or dichotomous thinking. You view a situation in only two categories instead of perceiving a range across a continuum. An example might be: "If I am not a total success, I am a failure" or "Unless the tinnitus goes, my life is ruined"
- OVER GENERALISATION - You make a sweeping negative conclusion based on one situation or experience. An example: "My tinnitus is really bad" when in fact, it varies from day to day, or week to week etc.
- FILTERING OUT THE POSITIVE - You unreasonably tell yourself that positive experiences or qualities do not count. An example: "Just because the tinnitus doesn't seem so bad today, doesn't mean it's because of anything I've done differently", even though you know you have been consistent in using the breathing exercise, relaxation and working towards changing how you deal with tinnitus.
- JUMPING TO CONCLUSIONS - Judging or deciding something without having all the facts. An example: "I've heard nothing can be done about tinnitus, so no course of therapy is going to help me" Or, "I know someone who had CBT. They said it didn't help them, so it won't help me" Or “I read on the forums that people can’t cope with their tinnitus and so neither will I”.
- MIND READING - You believe you know what others are thinking, failing to consider other possibilities. An example: "If I tell people I've got tinnitus, they'll think bad of me" (or "feel sorry for me", or "think I've lost the plot!"). Some “professionals are “mind readers” too – they assume they know what you are experiencing with tinnitus but unless they ask you, they are assuming (mind reading).
- PREDICTING THE FUTURE - You predict the future negatively without considering other outcomes. An example: "I'll never be able to cope with tinnitus". You turn your imagined future in to an escalated inflated version of today. None of us has the ability to predict the future – we don’t know what will happen.
- MAGNIFICATION OF THE NEGATIVE - You see only the worst possible case scenario minimising anything positive. An example: "I enjoyed being out with my friends today, but I had to cope with this tinnitus and it always spoils things for me" (even though it didn’t).
- MINIMISING THE POSITIVE - Telling yourself that anything positive doesn't count. An example: "I felt good being out with my friends today and didn’t think much about the tinnitus, but that doesn't count. It’s back as bad as ever now".
- CATASTROPHIZING - Making out a situation, or an experience, is/was/will be much worse that it really is/was/will be. An example: "Having tinnitus is the worst thing that has ever happened in my life and has left me with no future to look forward to". Catastrophizing is more often than not linked with "predicting the future" above.
- EMOTIONAL REASONING - You think something must be true because you feel - and actually believe - it so strongly, ignoring or discounting evidence to the contrary. An example: "I will never feel normal so long as I have this tinnitus".
- SHOULD/MUST STATEMENTS - You have a fixed idea of how you or others should behave and you over-estimate how bad it is that these expectations are not met. An example: "I shouldn't need help with how I feel - I should be able to deal with it myself. I am not trying hard enough so I must try harder".
- LABELLING - You put a fixed global label on yourself or others without considering that the evidence might more reasonably lead to a less disastrous conclusion. An example: "I am a tinnitus sufferer"!
- SELF-BLAMING - You blame yourself for everything that happens without taking in to account external influences and context. An example: "My tinnitus is completely my own fault. I should never have gone to that concert".
- OTHER-BLAMING - We blame A.N. Other or "the world" for what happens/has happened side-stepping any issue that there may be to take responsibility for our own part. An example: "There ought to be a cure for tinnitus, and because there isn't, my life is ruined"
Cognitive Distortions become SUB-conscious - beneath our consciousness level. Their meaning filters upward in to conscious awareness feeding our perceptions of who and how we are, who and how others are, and how we interpret the world. They form our mindset. They are subjective, become "HABIT THOUGHTS" (so we don't think to question them), loaded with negative meaning and develop in to beLIEfs