10 Cognitive Distortions Keeping You From Achieving Your Health Goals

Because I am a health coach who is also a therapist, I notice my clients frequently warp their health-related behaviors through the twisted lens of cognitive distortions.

What are cognitive distortions?

Cognitive distortions refer to the ways we convince ourselves that something is true. As the name implies, however, these are merely distortions of our cognition that are negatively biased, and do not tell the whole story.

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My hope is that by reading through some of the most common examples I hear on the daily, you will identify patterns of your thinking that are skewed and unhelpful.

Identifying our own patterns of thinking, and becoming acquainted with our own go-to distortion ‘greatest hits’ mix, is the first step in reframing our reality. It is not until we are equipped with this awareness that we can challenge ourselves with a more balanced and objective perspective.

1. All or Nothing Thinking: This cognitive distortion is a favorite go-to for perfectionists, and is also called “black or white thinking.” It is often mired in a fear of failure, and attempts to use impossible standards as a measuring stick for personal worth. I see this come up with my clients in the following ways:
   • Cheat Meal(s):
     1. Distortion: “I went off my meal plan for breakfast today with those waffles, so I’m going to go HAM the rest of the day with pizza, ice-cream, and beer.”
     2. Reality: “Just because my breakfast was off plan today, I can clean up the rest of the day with tons of water and an on-plan lunch and dinner. Tomorrow morning, I’m going to feel good.”
   • Olympics or Bust:
     1. Distortion: “I am not doing a long run or heavy weights today, so I will do nothing.”
     2. Reality: “Stretching and going for a walk is a beautiful way to honor my body and give it restorative movement. The next time I do go hard, my joints will be lubricated, my fascia will be stretched, and I’ll perform better.”
2. Mental Filters: This cognitive distortion is a faulty thought pattern I see emerge especially with individuals who struggle with anxiety and/or depression. It refers to only looking at negative aspects of a situation, thus, filtering out any positive components. I see this come up with my clients in the following ways:
   • Change is Scary:
     1. Distortion: “The gym is closed because of COVID: I was just getting comfortable with the equipment, now I can’t work out, my progress will stop.”
     2. Reality: “This could be an opportunity for me to do some home workouts, finally do those pilates YouTube videos, and save a monthly membership fee. Sure, this change sucks — but this could lead to more self-directed fitness to help me long term.”
3. Jumping to Conclusions: This brand of distortion comes in two varieties: assuming you know what others are thinking and predicting the future. This is where we take some some facts/truths from a situation, and then draw conclusions based upon only this part of the information. This can show up for areas in our lives that we’ve experienced trauma in the past.
   • Telepathic Mind Reader: 
     1. Distortion: <<client is telling the coach>> “I know you probably think I’m lazy and undisciplined for missing my workouts this week, but I had a massive deadline Friday morning.”
     2. Reality: Coaches hold clients in unconditional positive regard, judging clients as lazy or undisciplined is the LAST thing we’re thinking. We understand that life comes up.
   • Zoltar the Fortune Teller:
     1. Distortion: “I partied a lot in my 20s, so I will have to deal with poor health outcomes as punishment.”
     2. Reality: “Have you heard of Mick Jagger?” Seriously, though: our healthspan and lifespan are a result of a kaleidoscope of environmental factors, systems, personal behaviors, genetics, and epigenetics. Health outcomes are influenced by more than a period in our lives, and we can contribute collateral impacts now that serve to repair past damage.
4. Emotional Reasoning: This distortion deals with a falsification in cause and effect: I feel this way, so it must be true. I see this come up for folks that struggle with perspective taking, objectivity, and empathy. This can also show up as a trauma association from our past.
   • Eating Disorders
     1. Distortion: “I feel really guilty for having that cupcake last night. I am fat and undisciplined because I couldn’t say no.”
     2. Reality: “Just because I feel guilty over eating a cupcake, doesn’t mean it was a bad thing to do. I enjoyed my son’s birthday party, and I intellectually know that eating one cupcake does not make me fat or undisciplined.”
   • Overwhelm = Impossible
     1. Distortion: “You want me to do too many things in this health plan, it is totally impossible to achieve.”  
     2. Reality: “Just because I am feeling overwhelmed, does not make this impossible. I am going to break down each part until I master each section. Slow and steady is ok.”
5. Labeling: This distortion is an issue with over-generalization, and it is rooted in shame. It is where we take only one characteristic of ourselves or others and generalize it to the entirety of ourselves or others. Remember: guilt says “I did something bad” and shame says: “I am something bad.” When we label, we are carrying one situation or attribute to the whole person which is all about shame. It’s also relevant to be aware of projection here: when we judge others, it’s typically for areas that we feel vulnerable about.
   • I am…
     1. Distortion: “So typical… I gave in and smoked a cigarette last night. I am so weak!”
     2. Reality: “Smoking one cigarette does not make me weak. It is pure strength that is causing me to address my smoking, and slipping up does not discount that.”
   • They are…
     1. Distortion: “Did you see that Emily’s Mom lost all that weight and is wearing the tiniest shorts? What a superficial, image obsessed woman. I feel bad for her family.”
     2. Reality: “I don’t really even know her… I also can recognize the parts of me that want to lose weight and focus more on my image… just because I’m a mom, doesn’t mean that part of my identity is all consuming.”
6. Over-Generalization: This distortion causes us to see patterns for things with limited evidence. I think of this as similar to “labeling” in number five above, but for circumstances instead of people. It is an issue with being overly broad in the conclusions that we draw.
   • Goal Getter
     1. Distortion: “My weight didn’t go down this week. That either means that I’m never going to reach my goal- or- this program needs to change.”
     2. Reality: The number on the scale is just one dependent variable we use to assess progress. Looking at measurements, progress photos, and checking in with how my pants fit are other ways to evaluate efficacy of this program, and evidence that I am nearing my goals.
7. Disqualifying the Positive: In this distortion, you are able to acknowledge that a positive thing has happened, but, you write it off as “not counting” for one reason or another. This can be a common theme for perfectionists and achievers that I work with. It is also a sort of anxiety response akin to foreboding joy that Dr. Brene Brown talks a lot about.
   • Shoe dropper
     1. Distortion: “Wow! I hit the 150 lb goal. I haven’t been this lean since college… I wonder when I’ll mess it all up and gain the weight back.”
     2. Reality: “Losing 40 pounds was a massive undertaking that I worked really hard on. I know the tools that I used to achieve my goal will always work. I am freaking AWESOME.”
   • Never good enough
     1. Distortion: “Yeah… I lost all the weight… Only to get all this excess skin in its place.”
     2. Reality: “I lost all this weight which helped my blood pressure, asthma, and bone density measures. I also got to finally shop in the non plus-size department for the first time EVER. The excess skin sucks, but that is going to be my next mission: figure out what my options are for this.”
8. Magnification/Minimization: This is another distortion of perspective. In this, we are either minimizing the significance of something, or blowing it out of proportion. 
   • I am not worthy (minimization) 
     1. Distortion: “Yeah, I gained 2cm on my biceps- but have you seen Arnold over there? He is the one with the bigger gains.”
     2. Reality: “A 2cm gain is huge for me! I haven’t been this strong since last season. I don’t know the whole story for other people, people could be using performance enhancing drugs. Either way, my focus is on my results and I only compare myself to who I was yesterday.”
   • This means the end (magnification)
     1. Distortion: “My hips changed after giving birth. Now, when I run, it’s excruciatingly painful. I’ll never be fit again!”
     2. Reality: “I am scared that I have hip pain now. I love running, and getting back to my fitness is important to me. That said, I know plenty of fit people who hate running and never do it. I can find another way.”
9. Should/Must Demands: When we place demands on ourselves or others by saying “I/you should/must/ought to ___________.” we are using critical judgement language to attempt behavior change. In reality, these words typically cause inaction for ourselves and frustration in others.
   • I know the path
     1. Distortion: “You must be vegan! It is the only way to reach your goals.”
     2. Reality: “Everybody is different. I am happy that I found what works for me, but I hold space that it might not work for everyone.”
10. Personalization/Blame: On one side of the spectrum, this one is for those of us who catch ourselves saying “sorry” a lot. Conversely, on the other extreme, this distortion rejects any personal responsibility and blames others. When we personalize or blame others, we are either owning too much blame ourselves, or dispel too much blame on others. Challenging ourselves to see the middle ground is the task here.
    • Blame it on the scale (anti-personalization)
      1. Distortion: <<client said this to me in my office>> “Your scale must be wrong. When is the last time you checked it?”
      2. Reality: <<later in session, she shared what was really happening>> “I am really disappointed by this number. I am more disappointed in myself, though, since I ate ice-cream five times since I last saw you.”
    • Everything to everybody (personalization)
      1. Distortion: <<parent of a teen client I see>> “I’m sorry Jeanie didn’t hit her nutrition goals this week! I didn’t remind her to adhere to the plan.”
      2. Reality: “I want my child to feel successful, but I understand that this is her journey.”

Related Post: GUILT AND SHAME HAVE NO PLACE IN AN OPTIMAL HEALTH

Have you identified which cognitive distortions you face?

Now here’s how to challenge yourself to think through a distortion the next time you catch yourself falling into unhealthy patterns of thinking. This outline is from David Burns’s theory in his 1989 book Feeling Good Handbook:

1. Identify the distortion: Write down your negative thoughts so you can see which of the cognitive distortions you’re involved in. This will make it easier to think about the problem in a more positive and realistic way.
2. Examine the evidence: Instead of assuming that your negative thought is true, examine the actual evidence for it. For example, if you feel that you never do anything right, you could list several things you have done successfully.
3. Double Standard Method: Instead of putting yourself down in a harsh, condemning way, talk to yourself in the same compassionate way you would talk to a friend with a similar problem.
4. The Experimental Technique: Do an experiment to test the validity of your negative thoughts. For example, if, during an episode of panic, you become terrified that you’re about to die of a heart attack, you could jog or run up and down several flights of stairs. This will prove that your heart is healthy and strong.
5. Thinking in Shades of Grey: Although this method might sound drab, the effects can be illuminating. Instead of thinking about your problems in all-or-nothing extremes evaluate things on a range from 1 to 100. When things don’t work out as well as you hoped, think about the experience as a partial success rather than a complete failure. See what you can learn from the situation.
6. The Survey Method: Ask people questions to find out if your thoughts and attitudes are realistic. For example, if you believe that public speaking anxiety is abnormal and shameful, ask several friends if they ever felt nervous before they gave a talk.
7. Define Terms: When you label yourself “inferior” or “a fool” or “a loser,” ask “What is the definition of ‘a fool’?” You will feel better when you see that there is no such thing as “a fool” or “a loser.”
8. The Semantic Method: Simply substitute language that is less colorful and emotionally loaded. This method is helpful for “should statements.” Instead of telling yourself “I shouldn’t have made that mistake,” you can say, “It would be better if I hadn’t made that mistake.”
9. Re-attribution: Instead of automatically assuming that you are “bad” and blaming yourself entirely for a problem, think about the many factors that may have contributed to it. Focus on solving the problem instead of using up all your energy blaming yourself and feeling guilty.
10. Cost-Benefit Analysis: List the advantages and disadvantages of a feeling (like getting angry when your plane is late), a negative thought (like “no matter how hard I try, I always screw up”), or a behavior pattern (like overeating and lying around in bed when you’re depressed). You can also use the Cost-Benefit Analysis to modify a self-defeating belief such as “I must always try to be perfect.”

Ashley Damaj is a Cornell trained Nutritionist, USC trained masters-level therapist, and post-masters Board Certified Behavior Analyst. An avid athlete, yogi, organic farmer, and chef; Ashley lives with her husband and daughter in Newport Beach, California.

She is the founder of Mothership Wellness, Inc., an integrative private practice. The backbone of her business is working directly with clients on ten pillars of wellness that are assessed and improved through actionable, short term, goal oriented individualized programs.

As a former pack a day smoker, drug/alcohol abuser, and overweight individual, Ashley’s mission is to bring behavior modification science and empirical solutions to individuals and families who want to make the move to a more healthy lifestyle be in alignment with the fullest expression of themselves.

She has worked in both corporate and clinical settings over the course of her career. Ashley has held Director level positions at a Fortune 5 companies, to clinical positions in a variety of therapeutic settings
(juvenile hall, domestic violence centers, in-home therapy, facility settings, etc.). Ashley has with diverse clientele of all ages using CBT, ACT and Behavior Analytic modalities for over a decade.

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