Cognitive Distortions 117
suggest psychologists have much work yet to be done to
help bridge the gaps between this discipline and others.
Future directions for the field of clinical health psychology
include increasing other health professionals’ awareness of
the need to address psychological factors associated with
chronic illnesses, continuing research in areas of prevention,
consultation, behavioral modification, and clinical treat-
ment, and expanding patient-, setting-, and community-
focused multidisciplinary research and practice. Lastly, with
continuing change and rising costs in the health care system,
clinical health psychologists are challenged to further sup-
port and defend the cost-effectiveness of empirically sup-
ported psychological treatment for medical illnesses,
enhancement of emotional well-being, and improved quality
of life.
See also: Caregivers of medically ill persons, Medically
unexplained symptoms, Somatization, Terminal illness
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Cognitive Distortions
Carrie L. Yurica and Robert A. DiTomasso
Keywords: cognitive distortions, cognitive errors, cognitive biases,
cognitive processing, distorted thinking, thinking errors, cognitive
schemata, heuristic thinking, cognitive processing errors
HISTORY AND OVERVIEW OF COGNITIVE DISTORTIONS
Cognitive distortions were originally defined by Beck
(1967) as the result of processing information in ways that
predictably resulted in identifiable errors in thinking. In his
work with depressed patients, Beck defined six systematic
errors in thinking: arbitrary inference; selective abstraction;
overgeneralization; magnification and minimization; per-
sonalization; and absolutistic, dichotomous thinking. Years
later, Burns (1980) renamed and extended Beck’s cognitive
distortions to ten types: all-or-nothing thinking; overgener-
alization; mental filter; discounting the positive; jumping
to conclusions; magnification; emotional reasoning; should
statements; labeling; and personalization and blame.
Additional cognitive distortions, defined by Freeman and
118 Cognitive Distortions
DeWolf (1992) and Freeman and Oster (1999), include:
externalization of self-worth; comparison; and perfection-
ism. Most recently, Gilson and Freeman (1999) identified
eight other types of cognitive distortions in the form of
fallacies: fallacies of change; worrying; fairness; ignoring;
being right; attachment; control; and heaven’s reward.
The conceptual framework of cognitive therapy is
structured on the notion that an individual’s subjective
assessment of early life experience shapes and maintains
fundamental beliefs (schemas) about self (Beck, 1970,
1976). In support of, or in defense against, early schemas,
secondary beliefs develop and function as rules or assump-
tions about the self and the world. These beliefs define
personal worth, are associated with emotions, and develop
further into learned, habitual ways of thinking (Beck, Rush,
Shaw, & Emery, 1979; Ellis & Grieger, 1986). Habitual
ways of thinking function to support core beliefs and
assumptions by generalizing, deleting, and/or distorting
internal and external stimuli, thus creating cognitive distor-
tions. Cognitions and, specifically, cognitive distortions
have been identified as playing an important role in the
maintenance of emotional disorders.
Researchers have developed various information pro-
cessing models in an attempt to understand the processing of
cognitive information. Kendall (1992) proposed a cognitive
taxonomy model with a description of the relevant aspects
of cognition involved in the creation of cognitive distortions.
Kendall’s taxonomy includes the following features: cogni-
tive content; cognitive process; cognitive products; and cog-
nitive structures. These features form the overall cognitive
structure that serves to filter certain cognitive processes.
Cognitive distortions reside within the domain of cognitive
processes.
Within the realm of cognitive processes, Kendall made
distinctions between processing deficiencies and processing
distortions. Deficient processing occurs when a lack of
cognitive activity results in an unwanted consequence. Dis-
torted processing occurs when an active thinking process
filters through some faulty reasoning process resulting in an
unwanted consequence. The difference is failure to think
versus a pattern of thinking in a distorted manner (Kendall,
1985, 1992).
Finally, Kendall (1992) also suggested that more accu-
rate perceptions of the world do not necessarily lead to more
successful mental health or behavioral adjustment.
Cognitive distortions skewed in an overly positive direction
tend to be functional, and benefit the individual in maintain-
ing positive mental health (although a “too positive” view
might be interpreted as narcissism).
The opposite may also occur. In studies of depressed
and nondepressed students, Alloy et al. (1999) reported that
depressed subjects were more accurate in their perceptions
and judgments as compared to nondepressed subjects,
a phenomenon called “depressive realism.” Subsequent
research was less endorsing of this phenomenon, and
researchers have concluded the process of distortion is more
complex than merely perception (Ingram, Miranda, & Segal,
1998).
Within the fields of cognitive and social psychology,
other information processing systems have been developed
that suggest theories for the formation of cognitive distor-
tions (e.g., Berry & Broadbent, 1984; Hasher & Zacks,
1979; Nisbett & Wilson, 1977; Schneider & Shiffrin, 1977).
In addition, developmental psychologists have suggested
thinking or distorting processes may develop from learned
behavior, while evolutionary psychologists (Gilbert, 1998)
have suggested the development of an evolutionary infor-
mation processing system over time that has led to a “better
safe than sorry” processing approach.
TYPES OF COGNITIVE DISTORTIONS
Axis I Disorders
Cognitive distortions were originally identified in
patients with depression. Since then, clinicians have
expanded their identification and treatment of cognitive
distortions to many other disorders (DiTomasso, Martin, &
Kovnat, 2000; Freeman, Pretzer, Fleming, & Simon, 1990,
2004; Freeman & Fusco, 2000; Wells, 1997). Further,
cognitive distortions have been found to play a role in sex-
ual dysfunction (Leiblum & Rosen, 2000), eating disorders
(Shafran, Teachman, Kerry, & Rachman, 1999), sex
offender behavior (McGrath, Cann, & Konopasky, 1998),
and gambling addictions (Delfabbro & Winefield, 2000;
Fisher, Beech, & Browne, 1999). In addition to the identifi-
cation of cognitive distortions in Axis I disorders, distortions
appear to play an important role in Axis II disorders.
Axis II Disorders
Cognitive distortions have been identified in patients
diagnosed with personality disorders. Freeman et al. (1990,
2004) have identified dichotomous thinking as a primary
distortion in patients with Dependent Personality Disorder.
Layden et al. (1993) have identified several cognitive
distortions used by patients with Borderline Personality
Disorder. Similarly, use of cognitive distortions by patients
with Histrionic Personality Disorder (dichotomous thinking,
jumping to conclusions, and emotional reasoning), Narcis-
sistic Personality Disorder (magnification of self, selective
abstraction, minimization of others), and Obsessive–
Compulsive Personality Disorder (magnification, “should”
statements, perfectionism, and dichotomous thinking) have