In the late 1950s, University of Pennsylvania psychiatrist Aaron Beck, MD, studied the effectiveness of psychoanalysis for the treatment of depression. Beck committed to the theoretical foundations of Freud’s “talking cure.” To his great surprise and disappointment, however, the experiments failed to validate the treatment. By the early ’60s, Beck had penned two important articles on “thinking and depression,” which ultimately led to the development of cognitive behavioral therapy (currently the premier evidence‐based psychotherapeutic treatment for anxiety and depression in both adolescents and adults) and the design of the cognitive triangle, as shown in the diagram below.
At the center of the cognitive triangle sits an event. Something happens to start this process in motion and trigger the complex interplay between thoughts, feelings, and behaviors. In the case of a typical adolescent, imagine that event to be a male high school student, whom we will call Alan, walking down the hallway and seeing a girl he likes, whom we will call Emily. As they approach one another, Alan tries to catch Emily’s eye, but she doesn’t appear to notice him. As they get closer, his gaze remains fixed on her, but she simply doesn’t see him. He even says “hello,” but she doesn’t respond. After they pass, Alan begins to wonder—“Maybe Emily doesn’t like me.” “Did I say something to offend her?” “I knew I shouldn’t have worn this shirt today!” These negative thoughts, or cognitions, then lead to various behaviors and feelings, as depicted by the double‐headed arrows on the figure. Alan may subsequently decide to send Emily a friendly text in the hopes that she will respond, or perhaps he will circle around the next hallway and try to pass her again, hoping to catch her eye this time around.
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Alternatively, Alan may go to the cafeteria and eat a doughnut to soothe the pain of Emily not having noticed him. In accord with the three points of the cognitive triangle, Alan may also have some feelings about this interaction. He may feel depressed, anxious, irritable, or angry about what has just happened. The simple act of passing Emily in the hallway has all sorts of implications for Alan’s thoughts, behaviors, and feelings.
It’s possible, of course, that Emily simply didn’t see Alan. Maybe she was distracted by bad news from another friend, worried about an upcoming class assignment, bothered by a headache, or pleasantly preoccupied by something wonderful. Since most adolescents act decently to their peers most of the time, the chances are pretty slight that Emily intentionally snubbed Alan, although that’s always a possibility. Given adolescents’ strong evolutionary need for connection to peers, however, Alan is very likely to interpret Emily’s lack of acknowledgment in the hallway as a personal affront. This is the cognitive distortion, or thinking error.
Cognitive distortions are exaggerated and unreasonable thoughts that cause us to misperceive reality and then subsequently feel bad. Adults too, of course, are vulnerable to cognitive distortions and will sometimes feel bad because they think that someone has ignored them. But adults, by virtue of their age and experience, have had more practice in these matters and usually, though not always, have an easier time letting go of small potential insults. As a psychiatrist, I’ve heard parents tell their kids countless times, “Don’t sweat it! Who cares what they think?” or simply, “Please, just let it go.” Parents know that their kids sometimes misinterpret the world around them and need help identifying their thinking errors.
More than a dozen common cognitive distortions have been described to which we all, at least occasionally, fall prey. Here are a few classic examples:
Filtering—magnifying the negative details from a situation while filtering out all of the positive aspects
All or nothing thinking— viewing everything as “good” or “bad” in an overly dogmatic fashion; believing that you must be perfect or a failure, allowing for no middle ground
Overgeneralization—coming to a conclusion about your capabilities based upon a single incident or piece of evidence; when something bad happens once, the expectation is that it will happen over and over again
Mind reading—presuming to understand how others feel and to know why they act as they do; particularly believing that you know how others feel about you
Catastrophizing—expecting disaster from every interaction or situation
Personalization—thinking that everything people do or say is a reaction to you; constantly comparing yourself to others in an effort to determine who is more intelligent, better looking, and so forth
Blaming—holding others responsible for the pain you feel, or blaming yourself for every problem
Shoulds—having a list of restrictive rules about how you and others should act; becoming angered when others break these rules or feeling guilty if you violate them
Which cognitive distortions do you think might have gotten the best of Alan as he passed Emily in the hallway? I’d say that he’s personalizing and possibly also overgeneralizing. Which cognitive distortions sometimes affect you and your kids?
Once adolescents begin to think abstractly, they are increasingly vulnerable to the impact of cognitive distortions, and that can lead to a lot of discomfort. They can imagine what their peers might be thinking, and they often imagine the worst.
Unless they get a lot of practice identifying cognitive distortions and learn to challenge these thoughts in a very conscious way (as one would in psychotherapy), adolescents will frequently feel the confusion, irritability, anger, and sadness that distorted thinking can cause. And what do you suppose an adolescent might do to avoid or soothe the emotional pain of cognitive distortions? Perhaps, as in the case of Alan, he will simply write a text or eat a doughnut. But sometimes, to avoid such pain, our kids will go to much greater lengths and put themselves at significant risk.
Jess Shatkin (Jeremy Folmer)
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Child and adolescent psychiatrist Jess P. Shatkin, M.D., M.P.H., is the author of Born to Be Wild: Why Teens Take Risks, and How we Can Help Keep them Safe. He serves as Vice Chair for Education at the Child Study Center and Professor of Child & Adolescent Psychiatry and Pediatrics at New York University School of Medicine. Dr. Shatkin is the host of "About Our Kids," a two-hour call-in radio show broadcast live on SiriusXM's Doctor Radio. He lives in New York City with his wife and two teenage children.
