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Cognitive Distortions
suggest psychologists have much work yet to be done tohelp bridge the gaps between this discipline and others.Future directions for the field of clinical health psychologyinclude increasing other health professionals’awareness of the need to address psychological factors associated withchronic illnesses,continuing research in areas of prevention,consultation,behavioral modification,and clinical treat-ment,and expanding patient-,setting-,and community-focused multidisciplinary research and practice. Lastly,withcontinuing change and rising costs in the health care system,clinical health psychologists are challenged to further sup-port and defend the cost-effectiveness of empirically sup-ported psychological treatment for medical illnesses,enhancement of emotional well-being,and improved qualityof life.
See also:
Caregivers of medically ill persons,Medicallyunexplained symptoms,Somatization,Terminal illness
REFERENCES
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 Archival Description of Clinical Health Psychology as a Specialty in Professional Psychology
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Washington,DC:Author.Belar,C. D.,& Deardorff,W. W. (1995).
Clinical health psychology inmedical settings:A practitioner’s guidebook.
Washington,DC:American Psychological Association.Belar,C. D.,Brown,R. A.,Hersch,L. E.,Hornyak,L. M.,Rozensky,R. H.,Sheridan,E. P.,Brown,R. T.,& Reed,G. W. (2001). Self-assessmentin clinical health psychology:A model for ethical expansion of practice.
Professional Psychology:Research and Practice,32(
2),135–141.Compas,B. E.,Haaga,D. A.,Keefe,F. J.,Leitenberg,H.,& Williams,D. A.(1998). Sampling of empirically supported psychological treatmentsfrom health psychology:Smoking,chronic pain,cancer,and bulimianervosa.
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Problem-solving therapy:A socialcompetence model
. New York:Springer.Elliott,T. R.,& Rivera,P. (2003). The experience of families and theircarers in health care. In S. Llewelyn & P. Kennedy (Eds.),
 Handbook of clinical health psychology
(pp. 61–80). New York:Wiley.Engel,G. L. (1977). The need for a new medical model:A challenge forbiomedicine.
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129–136.Holroyd,K. A. (2002). Assessment and psychological management of recurrent headache disorders.
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,656–677.Keefe,F. J.,Smith,S.J.,Buffington,A. L.,Gibson,J.,Studts,J. L.,&Caldwell,D. S. (2002). Recent advances and future directions in thebiopsychosocial assessment and treatment of arthritis.
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,640–655.Kelly,J. A.,& Kalichman,S. C. (2002). Behavioral research with HIV/ AIDS primary and secondary prevention:Recent advances and futuredirections.
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,626–639.Lustman,P. J.,Griffith,L. S.,Kissel,S. S.,& Clouse,R. E. (1998).Cognitive behavioral therapy for depression in type 2 diabetesmellitus:A randomized,controlled trial.
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,613–621.Lutgendorf,S. K.,Antoni,M. H.,Ironson,G.,Starr,K.,Costello,N.,Zuckerman,M.,Klimas,N.,Fletcher,M.A.,& Schneiderman,N.(1998). Changes in cognitive coping skills and social support duringcognitive behavioral stress management intervention and distressoutcomes in somatic HIV seropositive gay men.
Psychosomatic Medicine,60
,204–214.National Institutes of Health. (1997).
 NIH consensus statement: Interventions to prevent HIV risk behaviors
. Bethesda,MD:U.S.Public Health Service.Nezu,A. M.,Nezu,C. M.,Felgoise,S. H.,& McClure,K. (2003). Problem-solving therapy for cancer patients.
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,1036–1048.Ornish,D.,Scherwitz,L. W.,Billings,J. H.,Brown,S. E.,Gould,K. L.,&Merritt,T. A. (1998). Intensive lifestyle changes for reversal of coro-nary heart disease.
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Cognitive Distortions
Carrie L.Yurica and Robert A.DiTomasso
Keywords:
cognitive distortions,cognitive errors,cognitive biases,cognitive processing,distorted thinking,thinking errors,cognitiveschemata,heuristic thinking,cognitive processing errors
HISTORY AND OVERVIEW OF COGNITIVE DISTORTIONS
Cognitive distortions were originally defined by Beck (1967) as the result of processing information in ways thatpredictably resulted in identifiable errors in thinking. In hiswork with depressed patients,Beck defined six systematicerrors in thinking:arbitrary inference; selective abstraction;overgeneralization; magnification and minimization; per-sonalization; and absolutistic,dichotomous thinking. Yearslater,Burns (1980) renamed and extended Beck’s cognitivedistortions to ten types:all-or-nothing thinking; overgener-alization; mental filter; discounting the positive; jumpingto conclusions; magnification; emotional reasoning; shouldstatements; labeling; and personalization and blame.Additional cognitive distortions,defined by Freeman and
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Cognitive Distortions
DeWolf (1992) and Freeman and Oster (1999),include:externalization of self-worth; comparison; and perfection-ism. Most recently,Gilson and Freeman (1999) identifiedeight other types of cognitive distortions in the form of fallacies:fallacies of change; worrying; fairness; ignoring;being right; attachment; control; and heaven’s reward.The conceptual framework of cognitive therapy isstructured on the notion that an individual’s subjectiveassessment of early life experience shapes and maintainsfundamental beliefs (schemas) about self (Beck,1970,1976). In support of,or in defense against,early schemas,secondary beliefs develop and function as rules or assump-tions about the self and the world. These beliefs definepersonal worth,are associated with emotions,and developfurther into learned,habitual ways of thinking (Beck,Rush,Shaw,& Emery,1979; Ellis & Grieger,1986). Habitualways of thinking function to support core beliefs andassumptions by generalizing,deleting,and/or distortinginternal and external stimuli,thus creating cognitive distor-tions. Cognitions and,specifically,cognitive distortionshave been identified as playing an important role in themaintenance of emotional disorders.Researchers have developed various information pro-cessing models in an attempt to understand the processing of cognitive information. Kendall (1992) proposed a cognitivetaxonomy model with a description of the relevant aspectsof cognition involved in the creation of cognitive distortions.Kendall’s taxonomy includes the following features:cogni-tive content; cognitive process; cognitive products; and cog-nitive structures. These features form the overall cognitivestructure that serves to filter certain cognitive processes.Cognitive distortions reside within the domain of cognitiveprocesses.Within the realm of cognitive processes,Kendall madedistinctions between processing deficiencies and processingdistortions. Deficient processing occurs when a lack of cognitive activity results in an unwanted consequence. Dis-torted processing occurs when an active thinking processfilters through some faulty reasoning process resulting in anunwanted consequence. The difference is failure to think versus a pattern of thinking in a distorted manner (Kendall,1985,1992).Finally,Kendall (1992) also suggested that more accu-rate perceptions of the world do not necessarily lead to moresuccessful mental health or behavioral adjustment.Cognitive distortions skewed in an overly positive directiontend to be functional,and benefit the individual in maintain-ing positive mental health (although a “too positive”viewmight be interpreted as narcissism).The opposite may also occur. In studies of depressedand nondepressed students,Alloy et al. (1999) reported thatdepressed subjects were more accurate in their perceptionsand judgments as compared to nondepressed subjects,a phenomenon called “depressive realism.”Subsequentresearch was less endorsing of this phenomenon,andresearchers have concluded the process of distortion is morecomplex than merely perception (Ingram,Miranda,& Segal,1998).Within the fields of cognitive and social psychology,other information processing systems have been developedthat suggest theories for the formation of cognitive distor-tions (e.g.,Berry & Broadbent,1984; Hasher & Zacks,1979; Nisbett & Wilson,1977; Schneider & Shiffrin,1977).In addition,developmental psychologists have suggestedthinking or distorting processes may develop from learnedbehavior,while evolutionary psychologists (Gilbert,1998)have suggested the development of an evolutionary infor-mation processing system over time that has led to a “bettersafe than sorry”processing approach.
 TYPES OF COGNITIVE DISTORTIONS Axis I Disorders
Cognitive distortions were originally identified inpatients with depression. Since then,clinicians haveexpanded their identification and treatment of cognitivedistortions to many other disorders (DiTomasso,Martin,&Kovnat,2000; Freeman,Pretzer,Fleming,& Simon,1990,2004; Freeman & Fusco,2000; Wells,1997). Further,cognitive distortions have been found to play a role in sex-ual dysfunction (Leiblum & Rosen,2000),eating disorders(Shafran,Teachman,Kerry,& Rachman,1999),sexoffender behavior (McGrath,Cann,& Konopasky,1998),and gambling addictions (Delfabbro & Winefield,2000;Fisher,Beech,& Browne,1999). In addition to the identifi-cation of cognitive distortions in Axis I disorders,distortionsappear to play an important role in Axis II disorders.
 Axis II Disorders
Cognitive distortions have been identified in patientsdiagnosed with personality disorders. Freeman et al. (1990,2004) have identified dichotomous thinking as a primarydistortion in patients with Dependent Personality Disorder.Layden et al. (1993) have identified several cognitivedistortions used by patients with Borderline PersonalityDisorder. Similarly,use of cognitive distortions by patientswith Histrionic Personality Disorder (dichotomous thinking, jumping to conclusions,and emotional reasoning),Narcis-sistic Personality Disorder (magnification of self,selectiveabstraction,minimization of others),and Obsessive–Compulsive Personality Disorder (magnification,“should”statements,perfectionism,and dichotomous thinking) have
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Cognitive Distortions
been documented in the clinical literature (Beck,Freeman,et al.,1990; Beck,Freeman,Davis,et al.,2004).
DEFINITIONS OF COGNITIVE DISTORTIONS
Typical distortions include:
 Arbitrary Inference/Jumping to Conclusions
. The pro-cess of drawing a negative conclusion,in the absence of specific evidence to support that conclusion (Beck et al.,1979; Burns,1980,1989,1999).
 Example
:“I’m really goingto blow it. What if I flunk?”(Burns,1989).
Catastrophizing
. The process of evaluating,wherebyone believes the worst possible outcome will or did occur(Beck et al.,1979; Burns,1980,1989,1999).
 Example
:“I better not try because I might fail,and that would beawful”(Freeman & Lurie,1994).
Comparison
. The tendency to compare oneself whereby the outcome typically results in the conclusion thatone is inferior or worse off than others (Freeman & DeWolf,1992; Freeman & Oster,1999).
 Example
:“ I wish I were ascomfortable with women as my brother is”(Freeman &DeWolf,1992).
 Dichotomous/Black-and-White Thinking
. The tendencyto view all experiences as fitting into one of two categories(e.g.,positive or negative; good or bad) without the abilityto place oneself,others,and experiences along a continuum(Beck et al.,1979; Burns,1980,1989,1999; Freeman &DeWolf,1992).
 Example
:“I’ve blown my diet completely”(Burns,1989).
 Disqualifying the Positive
. The process of rejecting ordiscounting positive experiences,traits,or attributes (Burns,1980,1989,1999).
 Example
:“This success experience wasonly a fluke”(Freeman & Lurie,1994).
 Emotional Reasoning
. The predominant use of an emo-tional state to form conclusions about oneself,others,orsituations (Beck et al.,1979; Burns,1980,1989,1999;Freeman & Oster,1999).
 Example
:“I feel terrified aboutgoing on airplanes. It must be very dangerous to fly”(Burns,1989).
 Externalization of Self-Worth
. The development andmaintenance of self-worth based almost exclusively on howthe external world views one (Freeman & DeWolf,1992;Freeman & Oster,1999).
 Example
:“My worth is dependenton what others think of me”(Freeman & Lurie,1994).
Fortunetelling
. The process of foretelling or predictingthe negative outcome of a future event or events and believ-ing this prediction is absolutely true for oneself (Burns,1980,1989,1999).
 Example
:“I’ll never,ever feel better”(Burns,1989).
 Labeling
. Labeling oneself using derogatory names(Burns,1980,1989,1999; Freeman & DeWolf,1992).
 Example
:“I’m a loser”(Burns,1989).
 Magnification
. The tendency to exaggerate or magnifyeither the positive or negative importance or consequence of some personal trait,event,or circumstance (Burns,1980,1989,1999).
 Example
:“I have the tendency to exaggeratethe importance of minor events”(Yurica & DiTomasso,2001).
 Mind Reading
. One’s arbitrary conclusion that some-one is reacting negatively,or thinking negatively towardhim/her,without specific evidence to support that conclu-sion (Burns,1980,1989,1999).
 Example
:“I just know thathe/she disapproves”(Freeman & Lurie,1994).
 Minimization
. The process of minimizing or discount-ing the importance of some event,trait,or circumstance(Burns,1980,1989,1999).
 Example
:“I underestimate theseriousness of situations”(Yurica & DiTomasso,2001).
Overgeneralization
. The process of formulating rulesor conclusions on the basis of limited experience and apply-ing these rules across broad and unrelated situations (Beck et al.,1979; Burns,1980,1989,1999).
 Example
:“It doesn’tmatter what my choices are,they always fall flat”(Freeman& Lurie,1994).
Perfectionism
. A constant striving to live up to someinternal or external representation of perfection withoutexamining the evidence for the reasonableness of these per-fect standards,often in an attempt to avoid a subjectiveexperience of failure (Freeman & DeWolf,1992; Freeman &Oster,1999).
 Example
:“Doing a merely adequate job isakin to being a failure”(Freeman & Lurie,1994).
Personalization
. The process of assuming personalcausality for situations,events,and reactions of others whenthere is no evidence supporting that conclusion (Beck et al.,1979; Burns,1980,1989,1999; Freeman & DeWolf,1992).
 Example
:“That comment wasn’t just random,it must havebeen directed toward me”(Freeman & Lurie,1994).
Selective Abstraction
. The process of exclusivelyfocusing on one negative aspect or detail of a situation,mag-nifying the importance of that detail,thereby casting thewhole situation in a negative context (Beck et al.,1979;Burns,1980,1989,1999).
 Example
:“I must focus on thenegative details while I ignore and filter out all the positiveaspects of a situation”(Freeman & Lurie,1994).
“Should”Statements
. A pattern of internal expecta-tions or demands on oneself,without examination of the rea-sonableness of these expectations in the context of one’slife,abilities,and other resources (Burns,1980,1989,1999;Freeman & DeWolf,1992).
 Example
:“I shouldn’t havemade so many mistakes”(Burns,1989).
 ASSESSMENT IN CLINICAL PRACTICE
Cognitive–behavioral clinicians commonly use self-report measures such as a thought record (e.g.,Thought
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