295: Cognitive Distortions

Chris Sandel: Welcome to Episode 295 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at www.seven-health.com/295.

Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist and a coach, and I help people to fully recover.

One thing just before we get started with today’s episode: I have recently expanded my team, and I now have two spots available for working with me and for working with new clients. I made a similar announcement back in March time, and those spots were snapped up. I’m slowly creating more space in my calendar to have more spots for private coaching, but at this stage, these spots are very limited, so at this point I just have two.

You can have a life where you get to call the shots, not the eating disorder. You can have fun and joy-filled days where thoughts about food and weight and exercise no longer dominate your mind. I am a full proponent of full recovery; I believe that it is possible, and it is possible for everyone. And after working with clients for over 15 years, I’m very good at helping people to be able to achieve this.

So if you’re tired of living with an eating disorder and you’re ready to do what it takes to reach a place of full recovery and complete freedom, then I would love to help you. You can email info@seven-health.com with the word ‘coaching’ and then I can send over the further details. That email, again, is info@seven-health.com, the word ‘coaching’, and then I will get the details over to you.

On with today’s show. It is a solo episode. What I want to be covering today is the topic or the idea of cognitive distortions.

00:02:03

What are cognitive distortions?

You may be aware of cognitive distortions, you may not be aware of cognitive distortions, but I’ve got a definition here. They are internal mental filters or biases that increase our misery, fuel our anxiety, and make us feel bad about ourselves. Cognitive distortions are thoughts that cause individuals to perceive reality incorrectly or inaccurately.

Really, these are just thinking errors, and they’re thinking errors that we have been able to identify as being common things that come up. This is something that comes from psychology, and they’re able to look at the way that people think, the patterns in terms of that thinking, and able to group them into these ideas known as cognitive distortions.

What I’m going to do as part of today is go through a few of the cognitive distortions and explain how they can play out, give a couple of examples connected to them in terms of the thinking about an eating disorder or thinking about recovery, so that you can start to have an understanding of what these cognitive distortions are.

What I typically recommend – this is something I use a lot with clients; it’s something I use in my programme, The Fundamentals of Full Recovery – what I do is go through all of the cognitive distortions and then I will typically recommend that people use this as a little bit of a journalling exercise. Having this list of cognitive distortions – and as I said, I’m going to go through some of them now – and then starting to notice your patterns of thinking throughout the day, and noticing the events that come up and the kinds of different distortions that are there so that you can then become aware of those cognitive distortions.

If we’re thinking about this very much from a cognitive behavioural therapy or CBT, often what happens is there’s the recommendation of “Can you come up with a different response or a better response or some way that negates that kind of thinking?” Which I think is something you could do, and this is typically something that works quite well more in journalling form than just thinking it, because I think often when it’s just thought about, you can get stuck in your head; you can start ruminating. The eating disorder then has something else to say about that thing, and it becomes – I describe it as this arms race. You’ll say something, the eating disorder will say something, you say something else and it just goes on and on and on.

Whereas writing it down tends to have more of an effect of being able to be this more final thing. You’re able to see it on paper, you’re able to get some distance with it. That can be quite helpful.

The other piece with this is you don’t necessarily need to come up with some alternative. You can just recognise that there is this cognitive distortion and that this cognitive distortion is an inaccurate way of thinking, or it’s a perception that you’re having but it doesn’t necessarily mean that it is true. Or it doesn’t actually necessarily mean that it’s helpful, because something can be true and also be unhelpful.

So, when going through this, just starting to recognise, “When do I use that one? If I’m reflecting on the last day or week, when have I done that form of cognitive distortion?” Really, at the heart of what this is trying to do, or the goal with this, is moving out of this realm of thinking about things in extremes and having much more nuance connected to things.

I’m a big proponent and believer – and this is something I say regularly to clients – that two things can be true at the same time, or even multiple things can be true at the same time. So rather than trying to prove that something’s wrong, it can be, “This thing can be true, but this other thing can also be true at the same time” and really creating space for those things to be there at the same time as opposed to “I always have to find the silver lining and prove to myself that this other thing just isn’t true.”

It can be, hey, let us create space and be okay with the fact that there is nuance here, and be okay with the fact that there’s going to be some upside from making this change, there’s going to be some downside from making this change, and it doesn’t have to be all one way and really clean and tied up nicely with a little bow on top. It’s okay for things to be messy and to be able to still take action in recovery. Or it’s okay to be able to have big emotions, and I’m still able to do the things that are in support of the kind of life that I want to lead or the kind of actions I want to take.

So really, at the heart of all this is developing psychological flexibility.

The final thing I’ll say just before I start to go through the different cognitive distortions is we often talk about the difference between logic and emotion. These are talked about or set up as if they are at opposite ends of the spectrum. Really, I don’t believe that to be true, and there’s a lot of science to support that thinking – that actually, two things happen at the same time. So even when you’re thinking that you’re being logical, there’s a huge amount of emotion and a huge amount of the physiological state that the body is in that is driving that. The same is true when it feels like “I’m really listening to my gut, I’m listening to my emotions here.” There’s a huge amount of logic that is coming in there.

These things are often set up as opposites when really, the two are happening at the same time.

00:07:47

Types of cognitive distortions

et’s go through the different types of cognitive distortions, and as I said, I’m just going to go through a few of these.

00:07:53

All-or-nothing thinking

The first one is all-or-nothing thinking. This is also known as black-and-white thinking or perfectionist thinking. This is a tendency to see things as good or bad. There’s no grey area; it’s either good or bad, there’s nothing in between. This comes up a lot in eating disorder recovery. It comes up a lot just in terms of how people can think about food or exercise or lots of different topics.

For example, X food is healthy or unhealthy. It could be ‘carrots are healthy’, ‘salad is healthy’, fill in the blank. Or it could be ‘pizza is unhealthy’, ‘burgers are unhealthy’, ‘ice cream is unhealthy’, whatever it may be. The same with exercise. ‘Exercise is healthy’, ‘taking time off exercise is unhealthy’. There are all of these types of thinking where it is all or nothing. So any pizza is unhealthy, or any time we take time off exercise, it’s unhealthy.

So really starting to look at, where am I creating this black-and-white thinking? The reality is, there is so much nuance with these things, and context really matters. For example, it can be very healthy for someone to take time off exercise if they have a broken leg because they need that leg to be able to heal. It can be very healthy for someone to take time off exercise when they’re recovering from an eating disorder because they need that energy to help their body to be able to repair.

There can be instances where foods that we think about as being healthy – it could be salad, to use this example – are incredibly unhealthy for someone, and that could be unhealthy because they’re not able to digest it very well; it’s meaning that they’re eating foods and filling up on these foods and they’re then missing out on other, more energy-dense foods that are much more important for them right now.

The reality is that with everything, there is shades of grey, and that context is really the determiner of whether something is ‘healthy’ or ‘unhealthy’. But even within all of those contexts, there is shades of grey connected to this. I know that that can be one of those things that the eating disorder then tries to use in its favour, like, “Well, is this really the thing that we need to do?” and trying to create that kind of indecision or unsureness around things.

But I would be very much aware of, when are the eating disorder thoughts doing this? What are your thoughts connected to food or exercise or other components of your eating disorder? Because I think, as I said, all-or-nothing thinking comes up a lot. Just starting to recognise, “Okay, I have very black-and-white thinking around these particular things.”

00:10:44

Overgeneralisation

The next cognitive distortion is overgeneralisation. Again, this is one that comes up a lot. It’s where a negative event is seen as a pattern, or where one mistake means you will never be able to do something right.

For example, “I ate dessert and I purged; therefore, I will never get better” or “I restricted at the party again; I will never recover.” It’s using this one event or this one thing that happened and then generalising it across the rest of your lifetime, or generalising it across to what this means for your whole recovery.

In a lot of ways, this is similar to the all-or-nothing thinking, but it’s where you’re using a particular event to anchor that black-and-white thinking. So “Because I restricted at that party, I’m never going to recover.” You go from this one event to what this means forever.

Again, starting to recognise, when are you doing this in your recovery? Because I think this one comes up a lot, and it happens very automatically. It happens with the eating disorder thoughts that just naturally come up.

00:11:56

Mind-reading

The next one is mind-reading and thinking you know what others think or will do or how things will turn out, or any number of things that are impossible for you to know. Some examples with this would be “Everyone envies my ability to control my food.” “No-one will find me attractive unless I lose weight.”

The two things I want to point out with these are (1) they’re statements where you’re saying that you know what other people are thinking – for example, that “Everyone is envying my ability to control my food” or “No-one will find me attractive.” You’re saying that you know what everyone else’s mind is thinking. But (2), so often with the mind-reading statements, they’re attached to things like ‘everyone” or ‘no-one’ or ‘never’ or ‘always’ – these very definitive statements where it is, again, all or nothing.

Once again, I think we should be on the lookout whenever there are these all-or-nothing type thoughts, because when you say ‘no-one will’ or ‘everyone will’, (1) you can’t read people’s minds, but (2) you’re making an assumption about what’s going on for, what is it, 8 billion, 9 billion? I don’t know how many people are on this planet, but to say that every single person will think in this exact same way, and that is just absolutely not true.

The opposite can happen with this, where you actually expect people to be able to read your mind. This comes up a lot with clients as well, where rather than asking for what they need, they hope that other people will automatically know. They’ll be thinking something, and they hope that their partner or their parent or this person in their life will automatically know what they’re supposed to do in that situation.

So “I really hope that this person is going to challenge me and help me to have this snack that I’m really struggling with. I’m not going to tell them this; I’m hoping they’re just going to pick up on this of their own accord and assist me in doing this thing, and because they didn’t, I haven’t been able to make inroads in my recovery.” Or “I’m really struggling, and rather than having the conversation with someone to say I’m really struggling, what I’m going to do is start to do more of my eating disorder behaviours, and they’re going to notice that I’m regressing, and by the fact that they’re able to notice I’m regressing, they’re going to know that I need more help or more support.”

There’s often this thing of like “If I act in a certain way, then people are going to automatically know what I need.” The problem with this is twofold in that, one, people generally still don’t know what you need. Even when you’re acting in this way, people don’t know that this is the support that you needed, or this is the thing you needed in this moment, because you’re not actually verbalizing that, and people are not mind-readers. They really don’t know. This is often made worse because what they’re wanting someone to be able to do and support them within that moment is often the thing that they push back against when someone tries to get them to do that.

So “I really wanted someone to challenge me and help me to have this fear food. And then in the times in the past when they’ve suggested it, I’ve got really angry in that situation and I’ve pushed back, and yet I want them to know that I want them to do this thing even though the way that I’ve demonstrated that is the complete opposite.” So it becomes this situation where you’re asking almost the impossible of someone to be able to know what they’re meant to be able to do or what you’re wanting them to do in that situation.

The second point with this is that the only person that suffers is you, because you’re now restricting more, because you’re hoping that’s going to get them to support you and pay more attention to you and help you, and yet that’s not the response they do, and then you’re the one that gets further and further back into an eating disorder, and you relapse, etc. With the mind-reading piece, if it’s “I’m wanting other people to be able to read my mind”, it’s recognising that people don’t have that ability, and “This is where I need to be able to ask for things.”

That could be asking for things in terms of support; it could be asking things in terms of setting boundaries. But it’s where I need to start to learn to be able to speak up and ask for what I need.

00:16:24

Minimization

The next one is minimization. There is also the opposite of this, where things get blown much bigger and out of proportion to what they are, but this one is about minimization. This is the minimization of the importance or the likelihood of something happening. For example, it could be “Yes, I’ve lost weight, but it’s not that bad” or “Yes, I’ve been skipping breakfast again, but it’s not that big a deal.”

It’s usually minimizing things that could be pointing towards the fact that recovery is not going as well as it has been or things are starting to slip or things are becoming more difficult again, but we minimize them because often the real crux of why it’s being minimized is about avoidance and “I don’t want to have to start doing this thing again”, but often it’s dressed up as ”This isn’t a big deal.”

I think one of the useful ways of being able to pressure-test this is to imagine the opposite. For example, if you said, “I’ve lost weight, it’s not really that bad”, what would happen if the opposite was true? Would you be as nonchalant and as chill about the fact that “I’ve gained weight, and it’s not that bad”? Is that going to be the turn of phrase you would use? Or if that started to happen, would there be a fear of “My gosh, what’s going to happen? How high is this going to go? Where’s this going to end?” Is your reaction to this the same in whatever direction it is moving?

Another one could be around – I gave the example of “I’m skipping breakfast again, but it’s not a big deal.” So “I’m having breakfast again and I’m now having a mid-morning snack that I wasn’t having before.” Would you feel the same way about that? Would there be the same level of “It’s cool, it’s really relaxed if I’m adding in meals instead of removing them”? So “If my hunger is increased, and I’m now needing more food, and I’m now needing not just what I was already doing but even more than what I was doing”, would you be completely relaxed about that?

Or connected to exercise: “I’ve started exercising again. It’s no big deal.” Could it be that “Hey, I’m having even longer off of my exercise; it’s no big deal”? This can, as I said, be a really good way of starting to look at, “Am I minimizing this thing because it’s genuinely not a big deal, or am I minimizing this thing because it’s actually about avoidance?”

With some of these, you can start to do the opposite to really suss that out. Like, “I’m not really feeling as hungry for breakfast, but let me have breakfast again, and I want to see what happens.” Or “Yeah, I’ve started exercising again. Let me stop again and see what my thoughts and feelings are connected to this thing.” If there’s a lot of difficulty to do the opposite, then this is probably telling you something.

00:19:18

‘Should’ statements

The next cognitive distortion is ‘should’ statements. This is where you criticise yourself or others with ‘shoulds’ or with ‘oughts’. For example, “I should be able to get better on my own.” Or “I should be able to eat a normal amount of food.” Or “I should only need X number of calories.” There’s all these ‘shoulds’ about what should happen.

The couple of things I would add to this one are, even if you believe that this thing is true – so let’s use the example of “I should only need X number of calories.” Is having this thought helpful for you? Is this helping you to take the kind of action that you need to in recovery? Because typically, what is happening when there are these ‘should’ statements, it’s pointing towards the fact that there is a lack of acceptance. There’s a lack of acceptance around the fact that I have to now continue to do something that I don’t really want to do, or that this has gone over some threshold or some line of what I deem to be okay or acceptable or where my expectations were.

This could be connected to “I was given this goal weight in recovery and I was told that if I get there, this is where I should be, and I’ve now got to that place and there’s still a lot of eating disorder thoughts that are there, or there’s still a lot of eating disorder behaviours that are there.” There can be this thing of “I’ve been told that this should be where I need to get to.”

So the first is, is this a helpful thought? Is this actually helping you? Because typically, when there are these ‘should’ statements, it brings up a lot of disappointment, it brings up a lot of sadness, it brings up a lot of uncomfortable emotions because there’s almost this feeling of “This should’ve been enough. I shouldn’t need these other things. I should be able to get better on my own.” Even saying that statement and then connecting to, how does it feel when you hear that statement – typically the feeling is “I feel disappointed or let down, or my expectations aren’t being met.”

So when these statements are coming up, it’s recognising, “When I’m becoming attached to this statement, it is meaning that (1) I’m less likely to take the kind of pro-recovery action that I need to continue to be taking, but (2) this is blocking my ability to have acceptance about a particular situation.” The thing with acceptance is, acceptance doesn’t mean liking; acceptance just means being in contact with the reality of a situation. So when I’m saying “I shouldn’t need X number of calories” or “I should be able to get by on X number of calories” and that’s clearly not the case based on all the symptoms, based on all the thoughts and feelings and all of the stuff that is pointing towards the fact that this is not the reality of the situation, it prevents you from being able to accept that reality.

00:22:20

Control fallacies

The final cognitive distortion that I want to mention is control fallacies. With control fallacies, these can manifest as two different beliefs – and they’re two different beliefs at opposite ends of the spectrum. One is that we have no control over our lives and are helpless victims of fate, or two, we are in complete control of ourselves and our surroundings and our lives.

The reality is that neither of these two statements are true. For example, how these play out – it could be “No matter what I try, it won’t work because I can’t recover.” Or “If we eat the right foods, we can prevent all diseases.” Both of those are the opposite ends of the extremes around control. One is “I have absolutely no control, so what’s the point in even trying to recover? I can’t do it, I’m never going to be able to do it, I just don’t have that ability.” And then the other one is, “If I do things absolutely perfectly, then I am able to get every single thing that I want, I’m able to prevent disease, I’m able to prevent heartache, I’m able to control every aspect of my body.” Never of these two extremes are true.

It’s really easy – ‘easy’ is probably not the right word, but it’s really obvious how often people oscillate between these two extremes, where the eating disorder can tell them that they’re never going to get better, that nothing’s ever going to change, this is going to be permanent, forever, while at the same time there being the opposite being told to them: “If you do this exercise, if you eat this many calories, then everything will feel safe, then everything will feel easy”, whatever it may be. Again, we’re into the realm of ‘always’ and ‘never’ and ‘everyone’ and ‘no-one’ and those extremes, but connected to how someone thinks about their agency and their control of a situation.

00:24:31

The connection between cognitive distortions + polyvagal states

Those are the cognitive distortions I wanted to go through. As I said, there are many, many more of these, but at least these are a few that you can start to pay attention to and you can start to, as I suggested as the start, do some journalling around this. Start to notice how often these things come up, because the reality is they’re going to come up a lot, especially if you’re living with an eating disorder and you’re trying to do recovery. They’re going to come up a lot. But just as human beings, these things come up a lot.

So often with the work that I’m doing with clients, we focus a lot on polyvagal theory. Polyvagal theory is looking at the nervous system and how it affects the state that we’re in, and what you’ll typically notice when you become better at being able to identify the state that you’re in – and there are different types of states you can be in; there’s the primary states, the mixed states. I’ve done a number of podcasts on polyvagal theory, so I’ll link to those in the show notes and you can have a listen to those.

But what you can start to notice is “The state that I’m in has an impact on the kinds of thoughts that naturally arise.” When I’m in more of a fight and flight state, I’m more likely to have these kinds of cognitive distortions. When I’m in the shutdown state, I’m more likely to have these kinds of cognitive distortions.” Or it could be “I do all-or-nothing thinking in both of these states, but it’s about these particular types of things when I’m in one state versus the next.”

So recognising that we’re all perpetually in a state, and the state that we’re in is having an impact on the kinds of thoughts and feelings and sensations that naturally arise, and that you can start to notice, “Wow, I’m having more of these cognitive distortions; this is telling me I’m in one of these particular states.”

What I will often focus on with this is rather than coming up with a counterargument to that state and getting caught in the content of those thoughts, it’s really recognising, “If I’m having this kind of content of thoughts, I’m in a particular state. What can I do to get out of this state as opposed to what I can do to convince myself of something different?” It can be much more about the action-taking piece as opposed to thinking my way out of it.

But the thinking piece is useful just in terms of the awareness, the recognition of “I’m in a state, and what do I need to do now to move out of this?”

That is it for this week’s episode. As I said at the top, I now have some spots for private coaching. I’ve got two spots available right now. If you would like help, you’re tired of living with an eating disorder and you’re ready to take the action required to reach full recovery and complete freedom, then I would absolutely love to help. You can email info@seven-health.com with the word ‘coaching’ and I will send over further details.

That is it for today’s call. I will see you again on thmail to:info@seven-health.come next one.

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