Skip to main content

Cognitive Distortion of the Month: Dichotomous Thinking

Greetings.  It's been a while since I wrote a blog entry as I had a baby last October and it's kind of amazing how real baby-brain is, which makes writing feel exponentially harder.  Especially when they don't sleep very well.  He's 5 months old now and is being gracious enough to let me sleep in 3-4 hour increments.  So I have that going for me.

Steph kicked off our 2015 blog series on Cognitive Distortions, or as some say "thinking traps" with a nice piece on using a Negative Filter when evaluating our life.  If you haven't read it, go check it out.

For March, the topic is Dichotomous Thinking.  As it implies, dichotomous thinking is only seeing a situation from two potential angles.  It's all or nothing.  Good or bad.  Black or White.  There's not much room for any grey area.  But, if we take a step back we see that life is full of grey areas and it's actually less likely that we're operating in one of the extremes.  So why do we go there?


How do we know when we might be stuck in a dichotomous thinking trap?  There are certain key words to look out for.  The biggest 2 are Always and Never.

In terms of living with a chronic illness, it might be thoughts like:

"I'm always getting sick when I have plans."

"My treatment is never going to work."

"People always give me a hard time about my condition."

"My doctor never listens to me."

Or, we can fall into this trap more generally:

"I didn't get a perfect job review so I'm obviously a total failure."

"I forgot my friend's birthday so I'm obviously a horrible human being."

Thinking this way can cause a lot of stress, not to mention feelings of helplessness or even hopelessness.  Dichotomous thinking is the basis for perfectionism, which I've found is often behind feelings of anxiety and depression because who can ever measure up to perfection?

What are some ways to combat dichotomous thinking?

Like most cognitive-behavioral therapy (CBT) strategies, we start with pausing and evaluating the legitimacy of our thoughts.  I like to ask clients "Would your argument hold up in court?"  Or, "Would your argument hold up to scientific review?"  If the answer is no, then we have to look at why you might still hold on to those thoughts if they aren't valid.  But that's for another blog entry.

Evaluating our thoughts in a rational and logical way pulls us back from overly emotional thinking, which lends itself to cognitive distortions like dichotomous thinking.  Don't get me wrong, we don't want to be too robotic about life. Rather, we can operate in between, in what some in psychology refer to as our "wise minds."  

The next time you're thinking this way, jot down your thoughts on a piece of paper.  Draw a line with your belief at one end.  At the opposite end of the line write down the opposite thought (e.g. you wrote down "I'm never going to get better" then write down "I will get better.")  Next, draw a short line through the middle of the original line and write down a few thoughts that are somewhere in between the 2 extremes to try to get at the middle ground, or grey areas.  

And then ask yourself:

Are situations where your belief isn't happening.  This is good for the always and never thoughts.  

Would everyone see the situation this way?  What are some alternative arguments?

What would I tell my friend if he/she came to me with this belief?

If I thought of the situation in terms of the grey area, how might my feelings or behavior change?

Reining in dichotomous thinking can help us feel less anxious, down, or defeated.  Evaluating these thoughts help us look at our world through a more realistic lens.  This exercise may seem simple and straightforward as you read it, but it takes time and practice to make this a habit that we use in the moment when dichotomous thinking is kicking up intense feelings.  If you struggle with making the adjustments on your own, getting help from a CBT therapist can certainly help.

Best,

Dr. T.

Popular posts from this blog

So You Have IBD During a Pandemic

Hey! What's going on? Been pretty boring over here in Chicago. Ok I don't need to elaborate on what the hell is going on in the world. We are being bombarded with information - some accurate, a lot inaccurate - about this pandemic. It's very easy to become completely overwhelmed by it all. We've been forced, pretty damn quickly, to completely overhaul our way of life for the greater good. To reduce the strain on our healthcare system of the sick and dying. And us humans are generally bad with rapid, monumental change that we really don't have a lot of say in. Our little reptilian brains do what they're supposed to do (prime us for fight or flight or freeze) but our advanced "thinking" parts of our brain have to interject with all sorts of unhelpful thoughts, thereby sending some of us off the rails. Before we start, turn off the news. Seriously. In the days following 9-11 we found people who consumed more 24-hour news channel information were mor

Psychosocial aspects of having an ostomy

This past Saturday, Tiffany and I had the honor of speaking at the United Ostomy Associations of America's Regional Midwest conference. I was assigned the task of speaking to the patients, and Tiffany addressed the partners or caregivers. I wanted to share with you some of the highlights from my talk. I only had an hour for my session, and with about 100 people in the room, it was not nearly enough time. I love bullet points, so here you go: We are all different! Every ostomate is different and not one size fits all for the emotional/mental aspect either. Who had months to talk about an ostomy and weigh pros/cons? Who was this a more sudden decision for? Who had cancer? Who had IBD? Something else? Who had an ileostomy? colostomy? urostomy? Who has a temporary? Permanent? Multiple temporaries? What age where you when you got your ostomy? Under 20, 20s, 30s, 40s, 50s, 60+ Who was single when they got their ostomy? With a serious partner when they had it? Some find a stom

IBD & Medical Trauma

Medical trauma is such an under-recognized issue for the chronnically ill. It's a hard topic to talk about because it can seem like we are pointing fingers at healthcare workers. Maybe that's why there are only, now, 4 studies on the topic in patients with inflammatory bowel disease (IBD). If you are someone who treats people with IBD please know I am not here to demonize or criticize. I am both a patient and a GI psychologist. I know the medical system from both sides. I know how messed up and broken it is. But ignoring this or rationalizing it away as only affecting a few folks is wrong. So let's talk about it. Post-traumatic stress (PTS) is the term we use for medical trauma due to technicalities in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for post-traumatic stress disorder (PTSD). PTS can be less severe that full on PTSD, or it can be full on PTSD. Regardless, the symptoms are identical: Feeling hypervigilant/on-edge (increased