The Magic Dial


The Magic Dial

Reframing Cognitive Distortions

By David Burns

July/August 2021


As every therapist knows, sometimes people think about themselves and their lives in ways that are pretty illogical and even unfair. We make interpretations about what’s happening to us that are twisted and misleading, but we don’t realize it. That’s what cognitive distortions are: a highly misleading way of thinking about yourself and the world. It’s a way of fooling yourself. And when you feel depressed and anxious, you’ll nearly always be fooling yourself. This means that your negative thoughts do not reflect reality. Depression and anxiety are the world’s oldest cons.

In my first book, Feeling Good, I listed 10 common cognitive distortions, or thinking errors, that trigger feelings of depression and anxiety: all-or-nothing thinking, overgeneralization, mental filter, discounting the positive, jumping to conclusions (which includes mind reading and fortune telling), magnification and minimization, emotional reasoning, should statements, labeling, and blame.

You don’t need to be diagnosed with depression or anxiety to succumb to these thinking errors. We all fall into black holes of insecurity and depression from time to time, including me. I’ll give you an example.

After all my workshops, I have the audience members fill out a workshop evaluation. Reading these evaluations can be frightening, and sometimes disturbing, because the participants can be extremely generous in their praise and brutally honest in their critiques. Reading about my flaws and errors is sometimes painful, but it’s also a fabulous way to learn and grow.

During a workshop in Cleveland a couple of years ago, I felt like I was doing a poor job. The audience seemed unusually quiet and didn’t respond to a couple of my jokes. I also felt I could’ve done a better job answering some of their questions.

A young man had been hired to drive me to Dayton for another workshop the next day. I sat in the front seat with about 100 workshop evaluations in my hand. I didn’t want to look at them because I felt ashamed, but I forced myself to read through them. I even held them at an angle so the driver couldn’t see them and find out how bad I was.

The evaluations were shocking, but not in the direction I’d anticipated. The ratings were some of the highest I’ve ever received. It was hard to believe—and was, of course, a tremendous relief.

In retrospect, I could see that my negative thoughts had contained several cognitive distortions, including:

Mental filtering. I was thinking about the errors I’d made and completely ignoring the things I’d said that were effective.

Mind reading. I was assuming, without any real evidence, that the people in the audience were looking down on me.

Emotional reasoning. I was reasoning from how I felt. In other words, I felt like a failure, so I assumed I really was a failure.

All-or-nothing thinking. I was evaluating the workshop in black-or-white categories by telling myself that it had been a total flop since everything didn’t go perfectly.

Hidden should statements. I was telling myself that I should always hit it out of the park and should never screw up or make mistakes.

I’m not arguing that every time you think you’ve failed, you’re fooling yourself. We all have our share of failures and setbacks. And I’ve actually had the opposite experience at times—workshops that I thought were fantastic got slammed in the evaluations. That can be pretty painful.

What I’m saying is that your feelings will result from your thoughts and not from what’s actually happening. And when you’re feeling depressed and anxious, your thoughts will almost always be negative and distorted.

But here’s the good news: When you change the way you think, you can change the way you feel.

And this can happen quite fast. Just last week I worked with a hairstylist named Maria who was struggling with postpartum depression following the birth of her first child. She’d had an extremely difficult delivery that eventually ended up in a caesarean section after two painful and exhausting days of labor. Her recovery was much more painful than expected, and the doctors and nurses had exhibited little compassion or encouragement throughout the ordeal. Now that she was finally at home with her daughter, she was struggling with breastfeeding and feeling anxious, inadequate, and overwhelmed.

We’re sometimes taught that postpartum depression is a biological disorder, triggered by sudden changes in hormones following childbirth and a lack of sleep. Most doctors treat it with antidepressant medications plus supportive counseling. Although biological and social stresses definitely play a role, postpartum depression and anxiety are always triggered by a host of negative thoughts. And those thoughts are nearly always distorted.

That might sound harsh, and I certainly don’t mean to blame anyone (especially mothers!) for how they feel when they’re down. In fact, it’s quite the opposite: Maria’s despair was not the result of some flaw or mental disorder, but was actually a reflection of some really beautiful things about her and her core values as a mother and a human. We’ll dive more deeply into that shortly.

I encouraged Maria to fill out a Daily Mood Journal, so I could learn more about how she was thinking and feeling. This tool asks you to describe an upsetting event, to identify and rate your negative emotions, and to record your negative thoughts about the event. Then it asks you indicate how strongly you believe your negative thoughts on a scale from 0 (not at all) to 100 (completely).

Maria described the upsetting event as “being at home with my newborn and having problems with breastfeeding.” She explained that the doctors and nurses had stressed the importance of breastfeeding, but her daughter didn’t seem to get it and struggled to latch on. Maria felt like a failure and was thinking of giving up and turning to formula instead.

"What if you were able to show Maria that her suffering was not the result of what’s wrong with her but what’s right with her?”

She circled quite a few negative emotions, which were all intense. Then she recorded several negative thoughts and indicated how much she believed each one. It was clear that her negative feelings resulted from the negative messages she was giving herself. For example, when Maria told herself, “I’m a bad mom,” she felt guilty and depressed. The thought “I should be feeling happy” only intensified her feelings of failure as a mother. And when she told herself that she and her husband might not be able to manage financially, she felt intense anxiety.

In fact, Maria’s negative thoughts contained all 10 cognitive distortions.

She strongly preferred breastfeeding because she believed it would offer greater health benefits to her daughter and provide a chance to bond with her baby. But it just wasn’t working, and when she told herself that she was a “bad mom” and a “failure” in response to her troubles with breastfeeding, she was engaging in all-or-nothing thinking. The world is not made up of two separate groups of “good moms” and “bad moms” but, rather, “real moms.” And all real moms (and dads) have flaws and strengths.

Maria was also overgeneralizing when she concluded that she was a “bad mom” and a “failure.” Being a mom involves vastly more than just breastfeeding, and it seems pretty illogical and unfair for Maria to be so harshly critical of herself just because the breastfeeding wasn’t working out.

She was engaging in mental filtering by dwelling on all the ways she thought she was falling short as a mother and not giving herself any credit for all the things she was doing right.

Being a new mother can be incredibly stressful and demanding, and Maria was doing a great job. She was extremely conscientious and loving, and her baby was happy and healthy. But she seemed to think that all of that didn’t matter, therefore she was discounting the positive.

Maria was jumping to conclusions—specifically fortune telling—when she told herself that she wouldn’t be able to manage financially and that the next few months would be slow and difficult. There may have been some truth in those predictions, but she made it sound like her future was set in never-ending isolation, deprivation, and defeat. In reality, she and her husband had been doing well by budgeting, and her parents, who lived nearby, indicated they’d be willing to help out with childcare and finances if needed.

Maria was magnifying her so-called “failure” with breastfeeding and minimizing the importance of everything she was doing and sacrificing for her child.

She felt guilty and inadequate, so she concluded she was inadequate. But this is very misleading and an example of emotional reasoning. The reason she felt inadequate was because she’d labeled herself as a “bad mom” and a “failure.” Her emotions did not reflect reality.

Maria told herself that she “should” feel happy since she and her husband desperately wanted a baby and had tried unsuccessfully for more than two years before she finally became pregnant. But by telling herself that she “shouldn’t” be upset, she only increased her angst and made herself upset about being upset. Plus, childbirth can be incredibly traumatic, and it was especially traumatic for her. And now that her baby was finally here, things weren’t going as smoothly as expected. She should be upset!

When Maria called herself a “bad mom” and a “failure,” she was clearly labeling herself.

And she blamed herself for her daughter’s difficulties with breastfeeding, but not getting the baby to latch on is a common experience that’s mostly beyond her control.

Positive Reframing

Identifying the distortions in negative thoughts is powerful and exciting, but it’s not new. What is new, however, is helping clients understand that these negative thoughts and feelings are not, in fact, the result of what’s wrong with you (as the American Psychiatric Association would have us believe) but what’s right with you.

In the DSM-5, various forms of human suffering, such as unhappiness, worrying, or shyness, are transformed into a series of “mental disorders” with names like major depressive disorder, generalized anxiety disorder, and social anxiety disorder. This classification system creates the impression that if you’re feeling depressed or anxious, you’re defective in some way and need fixing.

But what if you were able to show Maria that her suffering was not the result of what’s wrong with her but what’s right with her? What if depression and anxiety were the expression of what’s positive and beautiful about someone rather than what’s negative and broken about them? Then they could be proud of negative feelings instead of feeling ashamed of them. That would be quite a switch, wouldn’t it?

The moment someone sees the positive side of their negative thoughts and feelings, they suddenly won’t need them anymore, and recovery will be just a stone’s throw away. In fact, many people recover really fast. I’m talking minutes, as opposed to months or years of traditional talk therapy or treatment with antidepressant medications.

Does that sound bizarre? It should! If you’d told me such a thing was possible 15 years ago, I would’ve laughed at you and called you a con artist. But now I see it all the time. Here’s how it works.

At the start of the session, I listened and provided empathy while Maria described how rough the last couple of months had been for her. Although empathy is rarely ever curative, it’s important to create trust and bonding. Then I asked Maria if she wanted some help with her negative thoughts and feelings and if this would be a good time to roll up our sleeves and get to work. She said she did want help and was ready to get started.

Next I asked Maria the miracle cure question: If a miracle happened in today’s session, what miracle would she be hoping for? She said she wanted her negative thoughts and feelings to disappear, so she could enjoy her baby daughter and her role as a new mother without feeling miserable all the time.

I asked her to imagine that we had a magic button and that if she pushed it, all of her negative thoughts and feelings would instantly disappear, with no effort at all, and she’d immediately feel joyous, even euphoric. Would she push the button?

Maria said she’d definitely push the button. Almost everyone says that!

I told Maria that I didn’t have a magic button, but I did have some effective tools, and I predicted that if we used them, she’d probably feel a whole lot better by the end of the session and might even feel joyful. But I told her I wasn’t so sure it would be a good idea to use those tools.

She was surprised and asked why not. I explained that although her negative thoughts and feelings were certainly creating a lot of pain for her, I suspected there might be some real advantages, or benefits, of thinking and feeling the way she did. I added that her negative thoughts and feelings might also be an expression of her most beautiful and awesome qualities, and that maybe we should take a look at that before we went about trying to change things.

I suggested we could ask the following questions about each negative thought or feeling before she made any decision about pressing the magic button: What are some benefits, or advantages, of this negative thought or feeling? How might it be helping you and your baby? What does this negative thought or feeling show about you and your core values that’s positive and awesome?

"What are some benefits, or advantages, of this negative thought or feeling? What does it show about you and your core values that’s positive and awesome?”

Together, Maria and I came up with the following list of positives. Sometimes I’d come up with an idea, and sometimes she’d add another. When I do this type of positive reframing, it’s important that everything on the list be a direct expression of one of the patient’s negative thoughts or feelings. This is radically different from the “cheerleading” approach that so many people do, which can be extremely annoying to the person who’s depressed or anxious. Here are a few examples of what we came up with:

The thought “I’m a bad mom” shows I have high standards and want to do what’s best for my baby.

My sadness shows my passion for the sense of accomplishment I feel every day when I’m at work. Now that I’m on maternity leave, I miss that!

My anger toward the lack of compassion I saw in the doctors and nurses shows that I have a sense of justice and fairness.

Feeling defective motivates me to seek out information by asking other mothers or calling the nursing hotline. That also shows that I’m humble and honest about my defects.

When I say we might not be able to manage financially, this shows I want to be responsible and support my baby effectively.

Once we’d listed all the positives we could think of, I asked Maria if she felt the list was realistic. She said the list was absolutely realistic but very surprising since she’d never thought there could be anything positive about how she was thinking and feeling. Then I asked if she still wanted to press the magic button since all of these positives would go down the drain along with her negative thoughts and feelings.

She insisted that she still wanted to feel better because her suffering was almost unbearable. But now she had a dilemma. She wanted to feel better, but she also didn’t want to give up all the positives we’d listed. As her therapist, I wasn’t trying to sell her on the idea of change. Instead, I was trying to persuade her that all of her negative thoughts and feelings showed what was really great about her and that she shouldn’t give them up.

To help her resolve this dilemma, I asked her to imagine that we had a magic dial instead of a magic button and that she could dial down each negative feeling to a more manageable level that would allow her to keep all the benefits of that feeling without feeling so much intense pain. That way, she could feel better without losing all the beautiful things we’d listed about her.

What would she dial each feeling down to, starting with depression? How sad and depressed would she want to feel at the end of our session? What might be an appropriate level of depression given all the horrible things she’d been going through? She said 15 percent would be plenty of depression, so she recorded this as a goal in the second column of her Daily Mood Journal. She also decided to dial her anxiety down from 80 to 20 percent, so on and so forth.

When I used the magic dial with Maria, I was actually making a deal with her subconscious resistance. If I hadn’t done this, she might have resisted when I tried to help her change the way she was thinking and feeling. Why? Taking away all the benefits of her depression and anxiety would almost be like taking away a mother’s love for her child.

But by using the magic dial, I put Maria in control and assured her that we’d reduce her feelings to the levels she selected and no further. It meant I was working for her and that she’d become the boss. I was no longer the “expert” who was trying to fix someone who was “broken.”

The Cognitive Click

Once we identified the distortions in Maria’s thinking and highlighted what was positive and awesome about her negative thoughts and feelings, we were ready to challenge and crush the distorted thoughts that were causing her suffering.

One of the easiest ways I’ve developed for doing this is called the double standard technique. It simply involves imagining how you’d talk to a dear friend going through the same exact problem as you.

Using this technique, I asked Maria what she’d say to another new mother experiencing the same difficulties as she was. Would she say, “Oh, you’re such a bad mom for wanting to give up on breastfeeding”?

Maria immediately responded that she’d never say something like that to another mother. When I asked her why not, she said it would be cruel, and it wouldn’t be fair or realistic either.

When I asked her what she would say, she replied, “I’d remind her that lots of women have trouble with breastfeeding, that it’s not unusual or terrible, and that it’s not entirely under her control. I’d also tell her that there’s a whole lot more to being a good mother than just breastfeeding.”

I asked Maria if what she was saying was true, and she said it absolutely was. And here is where the magic happened: I asked Maria if she’d be willing to talk to herself in the same realistic and compassionate way she’d talk to another woman, and she instantly brightened up and got it.

Maria recorded this new positive thought—the one she would have told a dear friend—in her Daily Mood Journal and indicated that she believed this new thought 100 percent. Then I asked her to re-rate how much she now believed the negative thought, and it suddenly dropped to zero. At this point, Maria was able to challenge the rest of her negative thoughts just as easily, and her belief in all of them went down to zero or close to zero.

The entire process took less than an hour and was so joyful. It was wonderful to see her spirits finally soar.

***

Adapted from Feeling Great: The Revolutionary New Treatment for Depression and Anxiety. Copyright © 2020 by David D. Burns. Used with permission of the publisher, PESI Publishing, Inc. All rights reserved.

David Burns, MD, is a pioneer in the development of CBT and founder of the new TEAM-CBT, which is featured in his latest book, Feeling Great. His weekly Feeling Good Podcast has more than 3 million downloads.

Let us know what you think at letters@psychnetworker.org.

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