Module 3. Emotion Regulation: (Discussion #10) Cognitive Vulnerability

DBTuesday is a series of posts where we explore skills and concepts from dialectical behavior therapy (DBT).

This is one of several posts focusing on emotion regulation, which is the third module of DBT skills training. See this post for general info about DBT and this post for more info about emotion regulation.

Note: addressing invalidation in CBT

This post will present some concepts from cognitive-behavioral therapy (CBT). As mentioned in the first DBTuesday post, DBT was originally developed as a modified version of CBT since some clients (specifically those with borderline personality disorder) found CBT invalidating.

It is personally upsetting for me to see CBT concepts applied in ways that can have the unintended effect of gaslighting or attacking people who are already hurting a lot and deeply afraid of being judged or misunderstood (e.g. “Maybe you’re exaggerating how bad things were”, “The problem isn’t the situation but rather your irrational thoughts”)

If this is a concern for you, these are my own personal suggestions for ideas to keep in mind when reading this post to help contextualize it:

• Regardless of why you’re feeling what you do, your feelings matter. Your feelings are completely real, you are always allowed to feel whatever you do, feelings can hurt a lot, and it matters when people feel hurt.

• You are always allowed to decide for yourself whether a particular psychological strategy is or isn’t helpful, and if it isn’t helpful then you are always allowed to discard it.

• You are the foremost expert on what is real in your own experience. Nobody else knows your experience better than you do.

• Any exploration of what is or isn’t real will only feel trustworthy if it is done in a fair, open, honest way that flows out of your own experiences as a primary source of information.

• If someone is minimizing your experiences or making assumptions while ignorant of your experiences, then they are actually biasing that exploration and making it less reliable.

• If you reach a conclusion but you were pressured or coaxed into it, it’s not going to feel as trustworthy as when you’re able to explore and decide for yourself without coercion.

• Some negative beliefs about the world or other people may be largely accurate. If someone is labeling your thoughts as irrational or distorted simply on the basis that they are negative or uncomfortable to hear, then they are possibly the ones engaging in irrational thinking (e.g. jumping to conclusions by assuming all truths about the world must necessarily be positive).

• Events play a very important role in what people feel. It feels misleading to say that feelings arise primarily from thoughts (or that events have only a minimal contribution) when thoughts are heavily conditioned and influenced by events. For example, a person who has experienced years of abuse and/or trauma might very understandably have different thoughts from someone who hasn’t experienced that!

• Some situations are just painful regardless of what your thoughts are. The goal of CBT strategies is just to minimize the amount of extra suffering that we add on top of whatever pain might already be there.

What is cognitive vulnerability?

Cognitive vulnerability is when beliefs or attitudes make it more likely that we’ll experience emotional distress in response to events.

This concept comes from cognitive-behavioral therapy (CBT). One of the main ways that CBT describes emotional distress is in terms of the ABC model developed by psychologist Albert Ellis:

• Activating event: something happens
• Beliefs: we have beliefs or thoughts about what happened
• Consequences: we experience emotions as a result of both the event and our beliefs

Cognitive vulnerability is related to the “beliefs” part of this model. CBT says that much of our suffering arises from irrational or unrealistic beliefs (“cognitive distortions”) as opposed to events themselves. These beliefs can sometimes be things that other people have told us that cause us suffering but that aren’t actually accurate or fair.

Types of cognitive distortions

Here are some different types of unrealistic thinking patterns:

• All-or-nothing thinking: viewing things with mixed qualities in terms of extremes or absolutes (e.g. “This person is completely evil”)

• Overgeneralization: using a small sample size of events to make broader conclusions about lots of other events (e.g. “I had a bad experience in one relationship; therefore I can never have any good relationships”)

• Catastrophizing: in a situation with many possible outcomes, assuming that the worst possible outcome is the most likely to happen even if it is unlikely (e.g. “I was late to work one day; my employer is going to be really angry and fire me, I’ll be unable to find another job, and I’ll become homeless”)

• Personalization: believing an event is related or connected to you when it possibly might not be (e.g. “That person seemed disinterested when I was talking with them; I wonder if they found me boring”)

• Mind reading: assuming that you know for certain what other people are thinking (e.g. “That person didn’t say hello to me; they must be angry at me”)

• Mental filtering: ignoring positive events and focusing solely on negative events (e.g. “I got a 99 on the test but I missed a really easy question”)

• Discounting the positive: minimizing or explaining away positive events as accidental or lucky (e.g. “Some people seem to like me but it’s only because they’re being charitable and want to be nice”)

• “Should” statements: thinking in terms of what you should be able to do rather than what you are actually able to do (e.g. “I shouldn’t be feeling so depressed about the fact that my partner broke up with me”)

• Emotional reasoning: assuming that feelings about a situation are completely certain without looking at neutral evidence (e.g. “I feel like everybody hates me, so I’m sure that they do”)

• Labeling: reducing a complicated thing to a simple label that defines it in an unrealistically limited way (e.g. “I am nothing but a failure”)

Tips for working with cognitive distortions

• Identify the thought: If you are noticing that you feel unhappy, you can pause and try to see what thought might be happening that feels upsetting and ask whether it is 100% certain.

• Examine the evidence: Ask what the evidence is for and against a particular thought.

• Reframe the situation: Sometimes situations can have details, background context, additional evidence, or alternative explanations that might result in a different interpretation.

• Consider costs and benefits: Ask whether a particular thought feels like it is practically helpful to have.

Reflection

What is an example of a thought that you struggle with? What are some ways in which it might not be 100% accurate?

Sources:

https://dictionary.apa.org/cognitive-vulnerability

https://dialecticalbehaviortherapy.com/emotion-regulation/emotions-cognitive-vulnerability/

https://dbtselfhelp.com/dbt-skills-list/miscellaneous/cognitive-distortions/

https://www.healthline.com/health/abc-model

https://www.healthline.com/health/cognitive-distortions

https://www.healthline.com/health/cognitive-restructuring