Cognitive distortions are systematic patterns of biased thinking that lead to inaccurate perceptions of reality. I frequently work with clients who feel overwhelmed by their thought patterns, often struggling to distinguish between realistic concerns due to the believability of their cognitive distortions, which often present themselves in full force when faced with uncertainty.
While often maladaptive in the context of OCD, anxiety, and depression, the truth is cognitive distortions are not all bad and likely have evolutionary origins as they create cognitive short cuts that reinforce safety and survival. Early humans likely relied on rapid assessments of their environment to make life-preserving decisions. For instance, assuming that a rustling in the bushes indicated a predator—rather than engaging in a nuanced risk analysis—enhanced survival prospects.
However, in modern contexts, cognitive distortions frequently emerge in response to uncertainty. The human brain craves predictability, and when faced with ambiguity, it often fills in informational gaps with worst-case assumptions. This tendency is particularly pronounced in individuals dealing with anxiety disorders and OCD, as their cognitive distortions reinforce hypervigilance and maladaptive coping strategies. Left unchallenged, these distortions can become deeply ingrained, impacting emotions, behaviors, and overall mental well-being.
These mental heuristics can still serve useful functions at times, such as quickly recognizing genuine threats or preparing for significant challenges. However, in my work, we mostly notice how they might interfere with our perceptions of the world in ways that tend to be unhelpful, add to distress, and create a sense of urgency where it may not be needed. This is in part because cognitive distortions are not always conscious or deliberate.
Many individuals are unaware of how their thinking patterns shape their perceptions of reality. Automatic negative thoughts can lead to self-fulfilling prophecies, reinforcing the very fears they aim to prevent. For example, if someone assumes a social interaction will go poorly, they may behave awkwardly or withdraw, increasing the likelihood of an uncomfortable exchange. Recognizing these distortions allows individuals to reclaim control over their thought processes and respond more flexibly to life’s uncertainties.
Common Cognitive Distortions in Anxiety and OCD:
Below are several cognitive distortions that I have noticed frequently manifest in individuals experiencing OCD and anxiety:
1. Black-and-White Thinking – "All or Nothing"
This form of dichotomous thinking is the most common cognitive distortion I see, and it tends to be a part of all the other cognitive distortions. Black-and-white thinking leads individuals to perceive situations in absolute terms. Success and failure, good and bad—there is no in-between. Such rigid cognitive processing can contribute to perfectionism and heightened anxiety about perceived inadequacies. This can be particularly damaging in areas such as academics, relationships, and self esteem, where nuance and flexibility are crucial.
2. Catastrophizing – "The Worst-Case Scenario Is Inevitable"
This distortion involves exaggerating the severity or likelihood of negative outcomes. Minor concerns rapidly escalate into catastrophic predictions. For example, an unanswered text message is interpreted as evidence of social rejection, or a minor headache is assumed to be a sign of a life-threatening condition. Individuals who catastrophize often struggle with decision making, fearing that any choice could lead to disastrous consequences.
3. Mind Reading – "I Know What Others Are Thinking or Feeling"
This distortion occurs when individuals assume they can infer others' thoughts without concrete evidence, e.g., believing that colleagues view them as incompetent based solely on nonverbal cues. This can lead to unnecessary social anxiety, avoidance of interactions, and difficulty forming meaningful connections with others.
4. Fortune Telling – "I Know This Will Go Wrong"
Closely related to mind reading, fortune telling involves making definitive negative predictions about future events without substantive evidence. "I will definitely fail this exam" or "This social interaction will be disastrous" are common examples. These assumptions reinforce anxiety-driven avoidance behaviors and can lead to self sabotage.
5. Should Statements – "I Must Always Meet Unrealistic Standards"
Individuals employing "should" statements impose rigid expectations on themselves. "I should never feel anxious; I should always be in control," These unrealistic demands foster self criticism and emotional distress. Over time, this type of thinking can contribute to burnout, resentment, and feelings of inadequacy.
6. Thought-Action Fusion – "Thinking It Means It’s Real"
Predominant in OCD, thought-action fusion occurs when individuals equate having a thought with acting on it or believing it to be true. For instance, "If I think about harming someone, it must mean I am capable of doing it" This leads to heightened distress and compulsive attempts to neutralize such thoughts. Understanding that thoughts do not equate to actions is a critical step in reducing obsessive fears.
7. Attribute Substitution – Hard Question Bait & Switch
When confronted with complex, stressful, or uncertain situations we have often ask ourselves big difficult questions that, in truth, the brain is just unable to answer. For example, when someone asks themselves “Do I work hard enough?” the brain cannot possibly formulate an answer as it would be based on variables that are imperceivable and relay on further cognitive distortions (i.e., “What does my boss think?” which is mind-reading). So instead, it will replace that question with one it can answer, such as “Do I work so much that I suffer?” “Ah! Yes!” says the brain, “you are exhausted every evening, and rarely feel like you can engage with your family or your hobbies, so you must be working hard enough!” This example highlights how the particular distortion can then push us to reinforce and continue behaviors that are likely causing us detriment and are harmful to our mental health. But because the brain is getting the affirming answer, you are likely to keep pushing yourself to over-work. In the context of OCD it can look like asking yourself “Am I a danger to my family?” The brain then replaces this question with something like “Well, do you keep having thoughts about hurting your family?” Because the answer is likely yes, this distortion has reinforced the fear and might push you towards trying to get rid of thoughts or avoid your family.
Strategies to Address Cognitive Distortions:
Self-Monitoring / Tracking
Recognizing cognitive distortions is the first step in reducing their influence. Simply noticing them, calling them out, and identifying them will allow the mind to natural challenge some of the distorted assumptions. To help with this we can utilize self-monitoring by utilizing a list of cognitive distortions (such as this one), and then tracking or journaling when you notice them occurring and writing out which distortion is at play, why your brain is utilizing it, and then challenging the distortion with thoughts that represent your actual beliefs and values can help restructure some of the cognitive patterns we tend to maintain. Here is an example:
Here we can notice how multiple distortions can culminate in a single thought, often multiplying the overall distress and concern. This individual is mind-reading in a way that is catastrophizing and black and white as it does not allow for a spectrum of feelings towards them form the professor, but instead suggest it is simply like or dislike.
Creating charts like these can be super helpful, and the goal is that they will increase mindful awareness of our brain automatic tendencies while slowly restructuring some of the thought patterns over time. It is important to note that you do not have to rigid about such tracking, and the hope would be to eventually reduce tracking or only employ in times when distress is high as a useful tool to help with tolerating that distress.
Thought-Defusion
As with most cognitive tools, challenging thoughts is not always the most helpful and can sometimes create a cycle of feeling like we are arguing with our brain. This is especially true with the intrusive thoughts of OCD, as they tend to “fight back” through the use of uncertainty. In this example, that might sound like your mind saying, “You’re just in denial and trying to avoid thinking about how your professor doesn’t like you!” In this case I would suggest utilizing thought-defusion. Thought-defusion helps create distance between the person and their thoughts, reducing their power and influence. It does not aim to eliminate or change thoughts, but rather to alter the way one relates to them. This shift allows for greater psychological flexibility, making it easier to act based on values rather than being dictated by unhelpful thoughts.
Here are a few exercises commonly used to promote thought-defusion:
1. Saying the Thought in a Funny Voice
Repeat an intrusive or distressing thought in a silly or exaggerated voice (e.g., a cartoon character). This makes the thought feel less threatening and more like just words rather than reality.
2. "’m Having the Thought That..."
Instead of saying "I'm a failure" reframe it as "I'm having the thought that I'm a failure,” or even “I am noticing that I am having the thought that I am a failure.” This creates psychological distance, helping you recognize that the thought is just a mental event, not a fact. What you are likely to notice here is that the reaction your brain has to these reframed thoughts is different and less worry some. Instead of reacting with “All is lost!” or “How do we fix being a failure!?” it might instead respond with “Have you gotten enough sleep?”
3. Leaves on a Stream
Imagine placing each intrusive thought on a leaf floating down a river. This might help you observe thoughts as passing experiences rather than things you must react to.
4. The Word Repetition Exercise
Pick a word from a distressing thought ("failure") and say it out loud repeatedly for 30 seconds. Over time, the word loses its meaning and just becomes a sound, reducing its emotional grip.
5. Thoughts on a Billboard
Imagine your thought displayed on a large electronic billboard. See it appearing and disappearing, just like real billboards change. This reminds you that thoughts come and go—they don’t have to define you.
Accepting Uncertainty
Finally, it may be helpful for you to notice where the uncertainty is within your distress, as cognitive distortions are often our brains’ attempt to deal with uncertainty. We can then work to both accept that uncertainty as well as challenge the need to be more certain. This can be very difficult, especially if the content of the uncertainty is alarming or bringing up that sense of urgency. But the problem is quite often when we seek out more certainty, we end up feeling more distress and concern. Consider the example from before about the student who is concerned about what the professor thinks of them: how would they try to gain certainty about this concern? Well, she might watch the professors face and body language closely to find any clues, which will undoubtedly lead to more possibilities and uncertainty. Plus, if movies like The Matrix have taught us anything it is that, to some degree, everything is uncertain! That is to say, we all deal with uncertainty regularly, but for some reason the uncertainty our anxiety or distress focuses on feels different and like we cannot possibly sit with it. But I bet you can. What would it look like if you did just accept the uncertainty—without trying to change it? How would your behaviors change if you were OK with this uncertainty? Through engaging in curiosity with these types of questions you may be able to reduce the amount of cognitive distortions that come up, and when they do you are more likely to see them for what they are.
So, don’t believe everything you think. Your brain is just trying to utilize the same cognitive tricks and short cuts that have kept humanity alive for hundreds of thousands of years. It’s not its fault that we expect such old software to catch up to the current times. I often think those of us suffering from OCD and anxiety may have made for excellent protectors and survivors before modern society granted us so much safety and security. But in this modern era, we can utilize some of these tools to be kind to ourselves, even if we are a bit more skeptical of our brains.
