All-Or-Nothing Thinking

The All-Or-Nothing Thinking information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively with common thinking biases.

A brief introduction to cognitive distortions

Cognitive distortions, cognitive biases, or ‘unhelpful thinking styles’ are characteristic ways in which our thoughts can become biased (Beck, 1963). As conscious beings we are always interpreting the world around us, trying to make sense of what is happening. Sometimes our brains take ‘short cuts’ and we think things that are not completely accurate, and different cognitive short cuts result in different kinds of bias or distortions in our thinking. Sometimes we might jump to the worst possible conclusion (“this rough patch of skin is cancer!”), at other times we might blame ourselves for things that are not our fault (“If I hadn’t made him angry he wouldn’t have hit me”), and at other times we might rely on intuition and jump to conclusions (“I know that they all hate me even though they’re being nice”).

Different cognitive biases are associated with different clinical presentations. For example, catastrophizing is associated with anxiety disorders (e.g. Nöel et al, 2012), dichotomous thinking has been linked to emotional instability (Veen & Arntz, 2000), and thought-action fusion is associated with obsessive compulsive disorder (Shafran et al, 1996).

Catching automatic thoughts and (re)appraising cognitions is a core component of traditional cognitive therapy (Beck et al, 1979; Beck, 1995; Kennerley, Kirk, Westbrook, 2007). Identifying the presence and nature of cognitive biases is frequently a helpful way of introducing this concept – clients are often quick to appreciate and identify with the concept of ‘unhelpful thinking styles’, and can easily be trained to notice the presence of biases in their own automatic thoughts. Once biases have been identified, clients can be taught to appraise the accuracy of these automatic thoughts and draw new conclusions.

All-or-nothing thinking

All-or-nothing thinking (often also referred to as ‘black and white thinking’, ‘dichotomous thinking’, ‘absolutist thinking’, or ‘binary thinking’) is a common form of cognitive distortion or ‘unhelpful thinking style’. People who think in all-or-nothing terms may also act in equivalently extreme ways. They may veer, for example, between complete abstinence and ‘binges’, or between extreme effort and none. Unfortunately, all-or-nothing thinking rarely matches reality and can set individuals up to feel confused or disappointed.

Absolutes do not exist in this universe. If you try to force your experiences into absolute categories, you will be constantly depressed because your perceptions will not conform to reality. You will set yourself up for discrediting yourself endlessly because whatever you do will never measure up to your exaggerated expectations. The technical name for this type of perceptual error is "dichotomous thinking." You see everything as black or white—shades of gray do not exist. (David Burns: Feeling good: The new mood therapy)

Examples of dichotomous thinking include:

• Using polarized terms such as: ‘perfect’ or ‘failure’, ‘always’ or ‘never’.
• Liking and disliking things with extreme intensity. For example, “I’m lovely / I’m hateful”, “this is the Best / Worst”.
• Doing things in extremes, such as either over-exercising or doing no exercises, or workaholism vs. doing nothing.

 People who habitually engage in an all-or-nothing thinking style may have ‘blind spots’ for:

• Gray areas: situations where there are multiple competing explanations, or multiple possible perspectives.
• Ambiguity: ambiguity and uncertainty can be difficult to understand and tolerate.
• Creative or flexible solutions to a difficulty.

There are evolutionary reasons why people might think in binary ways (Gilbert, 1998). In the face of an uncertain situation, forming simplified binary representations (e.g. it is ‘good’ or ‘bad’?) is thought to confer a speed-of-processing advantage which facilitates fight or flight responses (Bonfá-Araujo et al, 2021). Similarly, categorising in a binary fashion makes the world simpler to understand (at the cost of accuracy): complex problems become solvable and the world may feel more predictable.

Unfortunately, all-or-nothing thinking is associated with a wide range of clinical problems including perfectionism (Egan, Piek, Dyck, Rees, 2007), borderline personality disorder (Napllitano & McKay, 2007; Veen, Arntz, 2000), depression and depressive relapse (Teasdale et al, 2001), suicidal ideation and suicide attempts (Al-Mosaiwi & Johnstone, 2018; Neuringer, 1961), eating disorders including anorexia (Lethbridge et al, 2011; Palascha et al, 2015), obesity (Ohsiek & Williams, 2011). Other difficulties which stem from dichotomous thinking may include boom and bust patterns of activity (motivation may fluctuate between all-or-nothing), extremes of emotion, negative relationships with others (appraising others as entirely ‘good’ or ‘bad’ can mean that people get ‘written off’ easily), and burnout (Ledingham et al, 2019).

“Many people struggle with all-or-nothing thinking, and it sounds as though you suffer from it too. Would you be willing to explore it with me?”

Clinicians may consider giving clients helpful psychoeducation about automatic thoughts more generally and dichotomous thinking in particular:

• Automatic thoughts are those which spring up spontaneously in your mind, in the form of words or images.
• They are often on the ‘sidelines’ of our awareness. With practice, we can become more aware of them. It is a bit like a theatre – we can bring our automatic thoughts ‘centre stage’.
• In life-or-death situations it can be good to make quick decisions. One example is making a quick judgment “is this good or is this bad?”. We are all capable of all-or-nothing thinking because it can be useful for simplifying situations so that we can make quick decisions.
• Automatic thoughts are not always accurate: just because you think something, doesn’t make it true, and they are often inaccurate in characteristic ways.
• One common type of bias in automatic thoughts is thinking in ‘extreme’, ‘binary’, ‘polarized’, or ‘all-or-nothing’ ways.
• Signs that all-or-nothing thoughts are present include polarized words like ‘perfect’, ‘failure’, ‘always’, ‘never’, ‘brilliant’, ‘terrible’.

Many treatment techniques are helpful for working with dichotomous thinking:

• Decentering. Meta-cognitive awareness, or decentring, describes the ability to stand back and view a thought as a cognitive event: as an opinion, and not necessarily a fact (Flavell, 1979). Help clients to practice labeling the process present in the thinking rather than engaging with the content, for example by saying to themselves “There’s my black and white thinking again” whenever they notice all-or-nothing thinking.
• Continuum work. The aim of continuum work is to help clients see their belief or situation in context, or in relation to other possible outcomes (Greenberger & Padesky, 1995; Beck et al, 2004). Place a situation or belief on a continuum and then work with the client to elaborate the other extremes of the continuum (e.g.,“if you think you’re awful, can with think about some other completely awful people and put them on the line too – where would they go?”, “what about some people that are the opposite of awful, where would they go on the line?”).
• Data logging. Cognitive biases can be framed as ‘blinders’ which can automatically prevent people from seeing the world as it is. Data logging can be used to encourage the client to deliberately pay attention to counterexamples which would fall into a middle ground between ‘all’ and ‘nothing’. For example, encouraging a perfectionist client to record examples during their week of times when they (or others) performed ‘adequately’ instead of exceptionally well or badly.
• Cognitive restructuring with thought records. Self-monitoring can be used to help clients capture their automatic thoughts. Thought-challenging records may include prompts encouraging the client to consider all of the evidence, to consider ‘middle ground’ positions, or to invite reflection on the helpfulness of a belief. Helpful prompts might include:
  • “If you took the ‘all-or-nothing’ glasses off, what would you see?”
  • “Are there any ‘shades of grey’ you might be missing with this thought?”
  • “What is a more generous way of looking at this situation?”
  • “You have said that you were a total failure. Was there anything that was ‘OK’ about your performance? What does it say about you that you tried?”
• Practicing dialectical thinking. Dialectical behavior therapy (DBT) is based on a world view which sees reality as “made up of internal opposing forces (thesis and antithesis) out of whose synthesis evolves a new set of opposing forces” (Linehan, 2015). DBT helps clients to pay attention to each opposing force, and to work towards a synthesis. One classic DBT approach is that of ‘wise mind’. The wise mind is the inner wisdom that each person has, and DBT proposes that wise mind is blocked by the ‘reasonable mind’ (“reason not balanced by emotions or values”) and the ‘emotion mind’ (“when your emotions are in control and not balanced by reason”). It is therefore best accessed by the “integration of opposites: emotion mind and reasonable mind”.
• Behavioral experiments. Beck and colleagues propose that cognitive biases can be maintained by characteristic unhelpful assumptions. If a client habitually thinks in binary terms, it can be helpful to explore whether the client holds any beliefs or assumptions which may drive the dichotomous thinking, such as “everything is one thing or another”, or “I’ve got to give it 100% or not bother”. If such assumptions are identified, clients can be assisted to assess the accuracy and helpfulness of these beliefs. Their attitudes towards healthier assumptions such as “life exists in shades of grey”, and “things can be a mix of good and bad” can also be explored. This can be done using behavioral experiments, including surveys of other people’s attitudes.
• Practice behaving in a balanced way. Clients who act in all-or-nothing ways may be encouraged to choose a behavior which they do in an all-or-nothing way and then deliberately try to do it in a balanced way (e.g., just have one drink, limit portion size of meals, pacing activity).
• Discussion of aspects of life which clearly don’t fit a black and white model. Richard Stott et al (2010) suggest exploring domains in which such polarized attitudes are ludicrous or harmful:   
  “For example, take the area of skill learning. Did the client ever learn to ride a bicycle? Did they ever fall off during learning? Why was this? Was this an abject failure, or was it a normal step in the learning process? Should a child who falls off a bike on their first go and says “I can’t do this” have the bike taken away and be ridiculed? Or alternatively, what could be said to them? And what about the adequately competent cyclist who can cycle around town, but would never consider cycling competitively? Is this OK, or should everyone who gets on a bike aspire to be gold medallist at the next Olympic games? Indeed, would the world be a pleasanter, more desirable place if everyone were competing with everyone else at everything for the number one spot? Getting the client to think sharply about these issues can help convey the messages that shades of gray can be adequate, desirable and often essential.”

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• Bonfá‐Araujo, B., Oshio, A., & Hauck‐Filho, N. (2021). Seeing Things in Black‐and‐White: A Scoping Review on Dichotomous Thinking Style. Japanese Psychological Research.
• Egan, S. J., Piek, J. P., Dyck, M. J., & Rees, C. S. (2007). The role of dichotomous thinking and rigidity in perfectionism. Behaviour Research and Therapy, 45(8), 1813-1822.
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• Ledingham, M. D., Standen, P., Skinner, C., & Busch, R. (2019). “I should have known”. The perceptual barriers faced by mental health practitioners in recognising and responding to their own burnout symptoms. Asia Pacific Journal of Counselling and Psychotherapy, 10(2), 125-145.
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• Ohsiek, S., & Williams, M. (2011). Psychological factors influ- encing weight loss maintenance: An integrative literature review. Journal of the American Association of Nurse Practitioners, 23, 592–601. 
• Palascha, A., Van Kleef, E., & van Trijp, H. C. (2015). How does thinking in Black and White terms relate to eating behavior and weight regain? Journal of Health Psychology, 20(5), 638-648.
• Shafran, R., Thordarson, D. S., & Rachman, S. (1996). Thought-action fusion in obsessive compulsive disorder. Journal of Anxiety Disorders, 10(5), 379-391.
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• Veen, G., & Arntz, A. (2000). Multidimensional dichotomous thinking characterizes borderline personality disorder. Cognitive Therapy and Research, 24(1), 23-45.