Introducing Cognitive Distortions To Clients: Top Tips For Therapists

Cognitive distortions, cognitive biases, or “unhelpful thinking styles” are characteristic ways that thoughts become biased (Beck, 1963). People continuously interpret events and try to make sense of what occurs. Sometimes the brain takes ‘mental shortcuts’ during this process, resulting in thoughts that are not completely accurate. Different cognitive shortcuts produce different kinds of bias or distortion.

Identifying cognitive distortions can be a helpful introduction to the cognitive behavioral model and a relatively simple intervention in cognitive behavioral therapy (CBT)  - clients are often quick to grasp the idea of unhelpful thinking styles and can learn to notice biases in their automatic thoughts. Once a bias has been identified, the client can appraise the accuracy and utility of the thought and draw new conclusions.

If you want to introduce clients to the idea of cognitive distortions, here are nine top tips to get you started.

1. Begin with automatic thoughts

Automatic thoughts are a spontaneous and involuntary cognitive response to events. They can take the form of words, internal dialogue (or ‘self-statements’), or images, and they often occur on the sidelines of awareness. These thoughts usually seem plausible and are often accepted without question, even if they are inaccurate.

A theatre metaphor can make this process easier to understand: with practice, automatic thoughts can be brought from the ‘wings’ to centre stage. The initial task, therefore, isn't to change the thought itself but to help the client recognize that it has occurred.

2. Explain that thoughts are interpretations, not necessarily facts

Psychologists sometimes say, “Don’t believe everything you think” - automatic thoughts may seem convincing, but thinking something doesn’t necessarily make it true. For this reason, ‘decentering’ is crucial to addressing cognitive distortions.

Decentering describes the ability to stand back and view a thought as a cognitive event: an opinion rather than a fact (Flavell, 1979). To support this, therapist can encourage clients to label the distortions in their thinking instead of immediately engaging with its content. Examples might include, “I’m jumping to conclusions again” or “There goes another all-or-nothing thought.”

3. Normalize cognitive distortions

It is often helpful to explain that everyone thinks in distorted ways sometimes, and there are understandable reasons for this. For instance, cognitive distortions can act as mental shortcuts that facilitate quick appraisals and decisions. This can be particularly important in threatening situations. Take ‘jumping to conclusions’ as an example: from an evolutionary perspective, this style of thinking can function as a “better-safe-than-sorry” approach that allows for rapid decision-making in dangerous situations. Assuming the worst and taking unnecessary defensive actions can be much less risky than responding too slowly to a real threat (Gilbert, 1998).

4. Use simple definitions and provide clear examples

Relatable examples can help clients distinguish between different thinking styles. For example:

• Catastrophizing happens when you assume that the worst possible outcome is very likely to occur (e.g., “My partner is late—what if they have been killed?”).

• Emotional reasoning happens when you base your conclusions on how you feel, including your intuition or hunches (e.g., “I feel afraid, so I must be in danger”).

• Overgeneralization happens when you reach a sweeping conclusion based on one or two events (“He was rude - men are all so obnoxious”).

• Self-blame happens when you take unfair responsibility for a negative event (e.g., “It’s my fault that no one enjoyed the meal”).

5. Focus on the most relevant thinking styles

Some clients might recognize many or all cognitive distortions in their thinking. In these cases, it is helpful to concentrate on the styles that are the most frequent, distressing, or problematic. Key indicators of cognitive distortions include sudden mood changes (such as feeling sad or angry) and shifts in behavior, like withdrawing from others or wanting to avoid certain situations. Recognizing these changes can help therapists and clients identify moments when a cognitive distortions is likely to have arisen.

6. Explore the evidence collaboratively

Thought records can be an effective way to capture and reevaluate cognitive distortions as they occur. Useful questions include:

• What evidence supports this thought? Is that evidence good quality?

• What evidence does not support it?

• Are there facts or experiences that do not fit this interpretation?

• How might an objective bystander interpret the situation?

• What would you to a close friend if they were thinking in the same way?

The aim is support guided discovery and cognitive reappraisal, rather than to simply persuade the client to adopt a different conclusion.

7. Examine the usefulness of the thinking style

Accuracy isn’t the only line of enquiry. A cost-benefit analysis can be used explore what is helpful and unhelpful about thinking in a particular way. For instance, it might be useful to discuss:

What problems has the thinking style has caused in the past.

What problems may arise if similar thoughts are accepted at face value in the future.

Whether the distortion is consistent with the client’s therapy goals, aspirations, or personal values.

Retrospective mismatch is another useful approach. The client recalls an earlier episode involving the same thinking style and compares their prediction with what actually happened. A mismatch between the thought and the outcome can highlight the distortion’s inaccuracy, unhelpfulness, and problematic consequences (Wells, 1997).

8. Use experiential methods

Chairwork and role-play can support both intellectual (head-level) and emotional (heart-level) changes in distorted thoughts (Pugh, 2019). For example, the therapist might play the role of the cognitive distortion in one chair while the client practices responding from a healthy, wise, or compassionate perspective from a second chair (the ‘devil’s advocate’ method). Roles can also be reversed so the therapist is able to model helpful counter-responses.

Additionally, stories and metaphors can be used to normalize cognitive distortions, create distance from unhelpful thought patterns, and support guided discovery. For example, a client who tends to use an all-or-nothing style of thinking might be asked whether falling off a bicycle while learning how to ride is a total failure or a step toward success. In other words, shades of grey are important when it comes to evaluating performance, progress, and success.

9. Look beneath the distortion

Cognitive distortions are sometimes supported by dysfunctional assumptions and maladaptive beliefs that are specific to that style (Beck et al., 1979). For example, catastrophizing might be linked to the assumption, “It is helpful to always assume the worst.” On the other hand, disqualifying the positive might be associated with the assumption, “Accepting positives makes me vulnerable to rejection, disappointment, or egotism.” Once they have been identified, these assumptions can be assessed for their accuracy and helpfulness. Alternative assumptions can then be explored, such as, “Accepting positives gives me a balanced perspective.”

Frequently asked questions

What is the difference between an automatic thought and a cognitive distortion?

An automatic thought is a thought that arises spontaneously in response to an event. A cognitive distortion is a characteristic bias that is present in such thoughts. An automatic thought may contain one or several distortions.

Are cognitive distortions always problematic?

They often provide an inaccurate or incomplete impression of events, but they also allow for rapid information-processing shortcuts which may be helpful in some situations. The therapeutic task is exploring the thought’s accuracy and utility.

Are cognitive distortions associated with particular clinical presentations?

Yes. For instance, catastrophizing has been associated with anxiety disorders, dichotomous thinking with emotional instability, jumping to conclusions with delusional thinking, and thought-action fusion with obsessive compulsive disorder (OCD) (McLean et al., 2017; Noël et al., 2012; Shafran et al., 1996; Veen & Arntz, 2000). However, many clients experience a range of unhelpful thinking styles, irrespective of their difficulties or diagnosis.

Key references

• Beck, A. T. (1963). Thinking and depression: I. Idiosyncratic content and cognitive distortions. Archives of General Psychiatry, 9, 324–333. https://doi.org/10.1001/archpsyc.1963.01720160014002

• Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.

• Beck, J. S. (1995). Cognitive behavior therapy: Basics and beyond. Guilford Press.

• Flavell, J. H. (1979). Metacognition and cognitive monitoring: A new area of cognitive-developmental inquiry. American Psychologist, 34, 906. https://doi.org/10.1037/0003-066X.34.10.906

• Gilbert, P. (1998). The evolved basis and adaptive functions of cognitive distortions. British Journal of Medical Psychology, 71, 447–463. https://doi.org/10.1111/j.2044-8341.1998.tb01002.x

• McLean, B. F., Mattiske, J. K., & Balzan, R. P. (2017). Association of the jumping to conclusions and evidence integration biases with delusions in psychosis: A detailed meta-analysis. Schizophrenia Bulletin, 43, 344-354. DOI: 10.1093/schbul/sbw056.

• Noël, V. A., Francis, S. E., Williams-Outerbridge, K., & Fung, S. L. (2012). Catastrophizing as a predictor of depressive and anxious symptoms in children. Cognitive Therapy and Research, 36, 311–320. https://doi.org/10.1007/s10608-011-9370-2

• Pugh, M. (2019). Cognitive behavioural chairwork: Distinctive features. Routledge.

• Shafran, R., Thordarson, D. S., & Rachman, S. (1996). Thought-action fusion in obsessive compulsive disorder. Journal of Anxiety Disorders, 10, 379–391. https://doi.org/10.1016/0887-6185(96)00018-7

• Veen, G., & Arntz, A. (2000). Multidimensional dichotomous thinking characterizes borderline personality disorder. Cognitive Therapy and Research, 24, 23–45. https://doi.org/10.1023/A:1005498824175

• Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Wiley.