Imagine you are walking in public when you suddenly trip and stumble. What is the first thought that comes into your head? You might think: “Oops! Happens to the best of us.” OR “How embarrassing! I’m such a loser!” OR “Eh, no one really noticed.” OR “I can’t believe those jerks laughed at me!” Which of these thoughts would you be most likely to have?

In cognitive behavioral therapy (CBT), there is a concept we call the Cognitive Triangle. The Cognitive Triangle suggests that our thoughts affect our behaviors, which in turn affect our feelings. These three aspects of the Cognitive Triangle are interconnected, so changing one of them can affect the other two. People often assume that it is the situation that causes us to feel a certain way, but, according to cognitive behavioral theory, it is actually our thoughts about the situation.

Unhelpful Cognitive Triangle

Helpful Cognitive Triangle

Look again at the example above. Tripping doesn’t make us feel embarrassed. It’s our thoughts about tripping that may. We might feel embarrassed if we think “I’m such a loser” but if we think “happens to the best of us” we might feel amused or have no strong feelings at all. Situations (like tripping in public) can give rise to thoughts that affect our feelings which in turn affect our behavior. These thoughts – called automatic thoughts – often flash through our head so quickly we don’t even realize we are having them. As such, it can be hard to catch the cognitive distortions, or thinking mistakes, these automatic thoughts often contain.

Automatic Thoughts, Intermediate Beliefs, and Core Beliefs

Cognitive distortions are thinking mistakes that – in excess – can lead to mental health problems like depression or anxiety. Cognitive distortions are quite common in both people with and without mental health problems. Most people make hundreds of errors in their thinking each day. They can become a problem, however, when the negative thoughts outweigh the positive ones and over time turn into firmly held pessimistic beliefs.

Cognitive distortions can occur on three different levels:

• Automatic thoughts are the comments our internal voice makes throughout the day. They flash though our mind so quickly that we are often completely unaware of them, and yet, they can  influence our mood and behavior.
• Intermediate beliefs represent the transition from persistent automatic thoughts to more crystallized assumptions about the self, world, and future.
• Core beliefs are broad, stable, and firmly held beliefs about the self, world, and future, and, in depressed or anxious people, tend to be pessimistic.

An adolescent’s intermediate and core beliefs are often not yet crystallized as their “cognitive map” is still developing as they mature. But over time, these automatic thoughts can transition to intermediate and then core beliefs. This is a strong rationale for why it is helpful to teach kids how to identify and challenge thinking errors in their automatic thoughts early on before they can crystallize into negative core beliefs. Below are some common thinking mistakes to be on the lookout for (from Nguyen Williams & Crandal, 2015).

Common Thinking Mistakes

• All-or-Nothing Thinking: Seeing things in black-and-white categories. When performance falls short of perfect, seeing the overall effort as a total failure. Seeing people as either all good or all bad.
• Overgeneralization: Seeing a single negative event as a never-ending pattern of defeat. Using terms such as “always” and “never” or “everyone” and “no one” usually indicate an overgeneralization.
• Personalization: Seeing yourself as the cause of some negative external event for which, in fact, you were not primarily responsible.
• Labeling: Instead of describing an error, a negative label is attached to the person: “I’m a loser.” “He’s stupid.”
• Mental Filter: Picking out a single negative detail and dwelling on it exclusively so the vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.
• Disqualifying the Positive: Rejecting positive experiences by insisting they “don’t count” for some reason or other. Maintaining a negative belief that is contradicted by everyday experiences.
• Jumping to Conclusions: Making a negative interpretation even though there are no definite facts that convincingly support the conclusion.
  • Mind Reading: Concluding that someone is reacting negatively without evidence and without bothering to check it out.
  • The Fortune-Teller Error: Anticipating that things will turn out badly and feeling convinced that the prediction is an already established fact.
    

    Photo by Wyron A on Unsplash

• Magnification (Catastrophizing) or Minimization: Exaggerating the importance of things (such as a mistake you made or someone else’s achievement) or undermining the importance of things until they appear tiny (your positive characteristics or another person’s imperfections).
• Feelings as Facts: Assuming that negative emotions necessarily reflect the way things really are: “I feel it; therefore, it must be true.”
• Should Statements: Trying to motivate with should and shouldn’ts. Musts and oughts are also offenders. These statements suggest a person is deficient if he or she should or must, but does not. The emotional consequence is guilt. When directed towards others, shoulds and musts lead to feeling angry, frustrated, and resentful toward others.

Example

Let’s imagine a conversation between a mother and her teenage daughter talking about the daughter’s day at a new school. Try to pick out the thinking mistakes as you read.

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Mom: How was school today?

Daughter: Terrible. All the kids there are mean. (All-or-nothing thinking/Labeling)

Mom: Mean?

Daughter: Yes! Everyone hates me. (Mind-reading)

Mom: What about that girl that talked to you on the first day?

Daughter: That doesn’t count. She’s never going to be my friend anyway. (Disqualifying the positive/ Fortune-telling)

Mom: Why not?

Daughter: Because I tripped walking to my seat! Everyone in the whole entire class laughed at me. I’m such a loser!  (Magnification/Overgeneralization/Labeling)

Mom: Hey, we all make mistakes, especially when we are nervous. Why does that makes you a loser?

Daughter: I just am, okay!? (Feelings as Facts)

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What thinking mistakes (cognitive distortions) did you notice there? Did you pick out the same ones as those listed? (If you don’t see them yet, don’t worry! Like all skills, it gets much easier to identify thinking errors with practice.)

As we learned from the Cognitive Triangle, our thinking impacts our feelings and behavior. Negative thoughts lead to negative moods and unhealthy behaviors such as isolation, avoidance, self-harm, or substance use. But the good news is that our thoughts are under our direct control. If we can identify our thinking mistakes, we can counter any distorted cognitions and replace them with more accurate and helpful ones. This skill is called cognitive restructuring.

Blank Thought Record

The Thought Record

To learn how to “catch-and-counter” their thinking mistakes, your teen can try using a therapy tool known as the Thought Record. It is best to complete at least one record a day about a difficult situation in which one has strong emotions. The record should be completed close in time to the situation so your teen can still remember their thoughts about it but not so close that they are too upset to reflect on it. Complete the following steps:

• Identify the Situation. Briefly describe the situation (in one sentence or less) as objectively as possible without including your thoughts or feelings about it. For example, “I tripped and 3 to 4 people laughed” and not “Everyone laughed at me when I tripped because they are all mean and think I’m a stupid loser.”
• Skip to the Emotions Column and Identify the Emotions that you had at the time. Emotions can be written in one word and this word is usually a synonym for one of the 6 universal emotions: joy, fear, anger, disgust, sadness, or surprise. You can have more than one emotion about a situation. List all the emotions you had.
• Rate the Intensity of the Emotions on a scale from 0-10.
• Go back to the Old Thoughts Column and Identify the Old Thoughts running through your head at the moment. Thoughts can be words, sentences, or images. Use each emotion you listed as an anchor and work backwards to figure out what thoughts led to that emotion.
• Examine the Old Thoughts for thinking errors and then counter them by asking yourself the following questions: Is It true? Is It helpful? Can I handle it?
• Develop a New Thought and write in in the New Thoughts column. This new thought should be both true (accurate) and helpful (make you feel the way you want to feel so you can make healthier behavior choices).
• Re-Rate the Intensity of the Emotions on a scale from 0-10. Did the intensity decrease? If not, go back to work on developing your new thought until you create something that is more helpful to you.

If your teen tends to “spend too much time in their head” or get really overwhelmed by strong emotions, then this cognitive restructuring skill is a really important one to learn. If they complete at least one thought record each day for the next week, by the end of the week they might have the ability to distance themself a bit from their thoughts when they are upset. They might also find that countering their thinking mistakes helps to reduce the intensity of their emotions. In time, they’ll be able to “catch-and-counter” their cognitive distortions in the heat of the moment. For help disputing thinking mistakes, here is a full list of countering questions your teen can ask themself (or that you can ask your teen if you are coaching them through an upsetting situation).

Countering Questions

• Is it true?
• What’s the evidence for and against this thought?
• What’s the worst that could happen if it were true?
• How likely is that really?
• Is there another more likely explanation?
• Is it helpful?
• Does this thought make me feel better?
• Does this thought help me make healthier choices?
• If my friend were in this situation, what would I tell them?
• Can I handle it?
• What could I do if this were true?
• What is the evidence that I could handle it?

Let see how this works. Using our example of the teen daughter at a new school above, we have several cognitive distortions to choose from including:

“All the kids there are mean.”

Countering Questions: Is is really true that ALL the kids are mean or is there another explanation for why they laughed?

New Thought: First, not all of them laughed, only a few. Second, it isn’t nice to laugh when someone trips, but that doesn’t mean that they are mean people. They might have just made a mistake.

“Everyone hates me.”

Countering Questions: What evidence do I have that everyone hates me? What evidence do I have that they like me?

New Thought: A few people laughed when I tripped but several other people said hello or smiled at me today.

“She’s never going to be my friend.” 

Countering Questions: What would my friends at my old school say about this? How likely is it really that I won’t be able to make friends?

New Thought: My old friends would say I’m a great friend and she’d be lucky to have me. It’s not very likely I won’t make any friends. I’ve always been able to make friends before and I can do it again.

Completed Thought Record

Once your teen has developed their New Thought, it can be helpful if they write it down and place it wherever it is needed. Maybe as the background on their computer? A post-it on their bedroom mirror? As a reminder in their phone that pops up several times a day? The more they think of their New Thought, the more they’ll believe in it and the better they’ll feel when you do. Remember, “neurons that fire together, wire together” so the best way to build a new, healthier neural pathway between thoughts and feelings is to make sure the New Thoughts and their associated feelings get lots and lots of traffic. The more thought records they complete using their new cognitive restructuring skills, the easier it will become. And in a few weeks to a month, they should be able to create a New Thought right in the moment without having to write out a thought record at all.

Download your free Thought Record here! And if your child or teen needs help catching and countering their own thinking mistake, I’m here to help. It’s what I do.

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Dr. Rebecca Swenson is a licensed clinical psychologist and parent coach who works with children, adolescents, young adults, and families in Northern Michigan. If someone in your family is struggling with anxiety, depression, OCD, an eating disorder, or other emotional/behavioral health issues, contact Dr. Swenson today to learn more about evidence-based treatments that can help.

Sources:

Modular CBT for Children and Adolescents with Depression (Nguyen Williams & Crandal, 2015)