One of the core principles of cognitive-behavioral therapy (CBT) is the idea that our thoughts directly affect how we feel. When someone is struggling with depression, the way they think about themselves, others, and the world around them may not accurately reflect reality. These inaccurate or unhelpful patterns of thinking are known as cognitive distortions, and they are a common feature of depression and depression related conditions.
As a clinical psychologist, I see this all the time in my work. Clients of mine can often be seemingly high-functioning but may feel they are barely “holding it together.” Internally, they may be experiencing an exhausting barrage of negative thoughts that distort reality and worsen depressive symptoms and their mood. The good news is that these thought patterns are not fixed. With awareness, practice, and insight, they can be challenged and changed.
What Are Cognitive Distortions?
Cognitive distortions are habitual ways of thinking that are often inaccurate and overly negative. They are often subconscious, or just outside of awareness, especially when someone is in a depressive state. In CBT, we work to identify these distortions, understand their impact, and develop more accurate ways of thinking.
Here are a few common cognitive distortions I frequently encounter (from the Feeling Good Workbook by David Burns, my all-time favorite):
- 1. All-or-Nothing Thinking – This is when you view situations in black-or-white terms. For example, “If I don’t succeed perfectly, I’ve failed completely.” There’s no room for nuance, and even small setbacks can feel like catastrophic failures.
- 2. Overgeneralization – Drawing broad, negative conclusions from a single event. “I didn’t get that promotion. I’ll never be successful.” One bad day at work becomes evidence that your entire career is doomed.
- 3. Mental Filtering – Focusing exclusively on the negative aspects of a situation while ignoring any positives. “I got compliments on my presentation, but one person had a critique—so it must have been terrible.”
- 4. Disqualifying the Positive – Similar to mental filtering, this distortion involves actively dismissing positive experiences or achievements. You might say, “They were just being nice,” when someone compliments your work.
- 5. Fortune Teller Error – Expecting the worst-case scenario to happen and viewing it as inevitable. “If I make a mistake in this meeting, I’ll be fired and never work again.”
- 6. Personalization – Taking responsibility for things that are outside your control, or believing that everything others do or say is somehow related to you. “My boss seemed upset—did I do something wrong?”
- 7. Should Statements – Using rigid rules to guide your behavior, often leading to guilt or frustration. “I should be able to handle this better,” or “I shouldn’t feel this way.”
How Cognitive Distortions Fuel Depression?
Imagine walking around all day with a voice in your head telling you that you’re a failure, that people are judging you, and that nothing will ever improve. That’s the lived experience of many people with depression. Cognitive distortions aren’t just fleeting negative thoughts—they’re often persistent, internal narratives that color your entire experience.
These thought patterns can:
- Reinforce feelings of worthlessness and hopelessness
- Undermine motivation to take positive actions
- Erode relationships through misinterpretation and defensiveness
- Create a self-fulfilling prophecy of failure and rejection
When the mind is stuck in a loop of distorted thinking, even objectively good experiences can be reinterpreted in a way that reinforces depression. This is why challenging cognitive distortions is a cornerstone of CBT for depression.
Challenging Distorted Thinking
One of the most empowering steps in therapy is learning to become aware and identify these distorted thoughts either as they happen or even after the fact. At first, this can be tough—they’re so automatic that they feel like facts. But with practice, people begin to notice the patterns and reprogram one’s thoughts.
A useful tool I often share with clients is the S.T.E.B. framework:
- Situation – What actually happened externally?
- Thought – What did you think in that moment?
- Emotion – How did that thought make you feel?
- Behavior – What did you do next?
By breaking down experiences this way, we can see how distorted thoughts influence emotions and behaviors—and we can begin to insert new, more balanced thoughts into the process.
For example:
- Situation: You received some constructive feedback at work.
- Thought: “I’m terrible at my job. I’m probably on the chopping block.”
- Emotion: Anxious, hopeless
- Behavior: Avoid future feedback, withdraw from colleagues
Now let’s challenge that thought:
- What’s the evidence for and against it?
- Is there a more accurate way to interpret the feedback?
- How would you respond if a friend had the same thought?
Maybe the more accurate thought is: “This feedback is meant to help me improve. One piece of critique doesn’t mean I’m failing. Big picture, I’ve been getting consistently good reviews on my work performance.”
Moving Forward
Cognitive distortions are not character flaws. They’re learned habits of thinking—habits that often develop over time, especially in the face of stress, trauma, or repeated disappointment. The key is that they can be unlearned.
Working with a therapist can be incredibly helpful in identifying your unique distortions and developing new, more helpful ways of thinking. But you don’t have to wait until you’re in crisis to start this work. In fact, building awareness now can serve as a protective factor against future depressive episodes.
If you’re curious about your own thought patterns, try this: over the next few days, jot down a few moments when you felt down or anxious. Use the S.T.E.B. framework to unpack what was happening, what you were thinking, and how it made you feel. You might start to notice some patterns.
If you’re feeling stuck, overwhelmed, or just ready for a change, therapy can provide the tools and support you need to move forward. Cognitive distortions may feel real—but they aren’t always true. You don’t have to believe everything you think.
Dr. Chad Cox is a clinical psychologist in San Diego who specializes in cognitive-behavioral therapy for professionals, parents, and anyone feeling stuck. If you’re ready to challenge old thought patterns and start feeling better, schedule a free consultation today.
All the Best,
Dr. Chad K. Cox, PsyD
Licensed Psychologist PSY23320
San Diego, CA