26th September 2023 Newsletter
This week we’re bringing you three new cognitive distortion resources: Social Comparison, Thought-Action Fusion, and Externalizing. In our research roundup, we highlight a systematic review looking at the relationship between nightmares and psychiatric symptoms across a range of disorders. We also explore a paper looking at clients’ reflections on alliance ruptures – a deterioration or tension in the therapist-client relationship, manifested by a disagreement on treatment goals or tasks, or a strain in the emotional connection.
Social comparison describes the behavior of comparing oneself to other people. It is not usually included in lists of cognitive distortions because it is a normal and sometimes adaptive cognitive process. However, clinicians should be aware of how social comparisons can be biased and contribute to various forms of psychopathology.
Thought-action fusion (TAF), also known as the omnipotence of thoughts, is a cognitive distortion and subtype of magical thinking, whereby individuals believe that thoughts and actions are inextricably linked. Signs of thought-action fusion include feeling distressed because of an intrusive thought, trying very hard ‘not’ to have certain thoughts, or feeling the need to ‘neutralize’ unwanted thoughts.
Externalization (also referred to as ‘other-blame’, ‘personalized blame’, and ‘defensive attribution’) describes a style of thinking whereby individuals blame others for negative events and deny personal responsibility. Research suggests that individuals are more likely to think this way in situations where the role of other people is ambiguous, or if they believe they are not valued highly by others.
Nightmares and Psychiatric Symptoms
Nightmares are often overlooked outside of PTSD and can play a significant role in many other disorders. This systematic review examined the relationship between nightmares and psychiatric symptoms. The findings indicate that addressing nightmares can result in reductions in symptoms of PTSD, depression, anxiety, and paranoia, suggesting a potential causal relationship. In addition, longitudinal evidence indicates that nightmares predict the occurrence of suicidal ideation and suicide attempts. The review highlights the importance of assessing and treating nightmares in therapy across disorders, as well as the need for further studies in this area.
“There remains a contemporary lay intrigue into nightmares, their impact, and how to overcome them, but this review shows that there has been a remarkable lack of scientific scrutiny into nightmares and the relationship with mental health problems. The limited literature suggests that alleviating nightmares may be one route to ameliorating threat-based disorders, there are promising effects of treating nightmares on depressive symptoms which warrant further investigation, and there are many disorders which remain vastly under-studied in the context of nightmares, but where emotion regulation difficulties mean there is a plausible mechanistic link (dissociative disorders and borderline personality disorder for example).”
Sheaves, B., Rek, S., & Freeman, D. (2022). Nightmares and psychiatric symptoms: A systematic review of longitudinal, experimental, and clinical trial studies. Clinical Psychology Review, 102241.
Clients' Reflections on Alliance Ruptures
Is resolving ruptures in therapy really that important? The results of this study suggest it is. Among 38 individuals who received short-term dynamic psychotherapy for depression, 30 reported experiencing ruptures, which were mainly categorized as disagreements on treatment tasks, emotional bond strains, or discomfort discussing certain topics. Individuals who experienced less improvement in depressive symptoms were more likely to encounter ruptures. In addition, successful rupture resolution with therapist assistance correlated with better treatment processes and outcomes. However, individuals with anxious attachment appeared to have less successful resolutions. These findings underscore the need for therapists to attend to both ruptures and clients’ attachment styles as they can have a significant impact on therapy.
Ben David-Sela, T., Leibovich, L., Khoury, Y., Hill, C. E., & Zilcha-Mano, S. (2023). “Picking up the pieces”: Patients’ retrospective reflections of rupture resolution episodes during treatment. Psychotherapy Research, 1-14.