Cognitive behavioral therapy (CBT) is currently the premier evidence‐based psychotherapeutic treatment for anxiety and depression in both adolescents and adults. CBT focuses on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in our thoughts, beliefs, and attitudes, including exaggerated thoughts. It also teaches behavioral and emotional regulation according to the design of the cognitive triangle, as shown in the diagram below.
At the center of the cognitive triangle sits an event (or trigger) that begins 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 Andy, walking down the hallway and seeing a girl he likes, whom we will call Sarah. As they approach one another, Andy tries to catch Sarah’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, Andy begins to wonder—“Maybe Sarah 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. Andy may subsequently decide to send Sarah 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.
Alternatively, Andy may go to the cafeteria and eat a doughnut in an attempt to soothe the pain of Sarah not responding to him. In accord with the three points of the cognitive triangle, Andy may also feel depressed, anxious, irritable, or angry about what has just happened. Overall, the simple act of passing Sarah in the hallway has all sorts of implications for Andy’s thoughts, behaviors, and feelings. Given adolescents’ strong evolutionary need for connection to peers, Andy is very likely to interpret Sarah’s lack of acknowledgment in the hallway as a personal affront, even though it’s very possible she merely didn’t see him. This is what we call a cognitive distortion or thinking error in CBT.
Cognitive distortions are exaggerated and unreasonable thoughts that cause us to misperceive reality and then subsequently feel bad. More than a dozen common cognitive distortions have been defined by CBT to which we all 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
Once adolescents begin to think abstractly, they are increasingly vulnerable to the impact of cognitive distortions, and that can lead to a whole host of mental health issues. Unless they practice identifying cognitive distortions and learn to challenge these thoughts in a very conscious way, adolescents will frequently feel the confusion, irritability, anger, and sadness that distorted thinking can cause. Perhaps, as in the case of Andy, the student will simply write a text or eat a doughnut in an attempt to avoid or soothe the emotional pain of his cognitive distortions. But sometimes, to avoid such pain, students will go to much greater lengths and put themselves at significant risk, and CBT can help.
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