cognitive behavioral therapy

How I feel is how things are

PNRJ cognitive science, core principles, personal , , , , , , , , , , ,

Mar 17 JDN 2460388

One of the most difficult things in life to learn is how to treat your own feelings and perceptions as feelings and perceptions—rather than simply as the way the world is.

A great many errors people make can be traced to this.

When we disagree with someone (whether it is as trivial as pineapple on pizza or as important as international law), we feel like they must be speaking in bad faith, they must be lying—because, to us, they are denying the way the world is. If the subject is important enough, we may become convinced that they are evil—for only someone truly evil could deny such important truths. (Ultimately, even holy wars may come from this perception.)


When we are overconfident, we not only can’t see that; we can scarcely even consider that it could be true. Because we don’t simply feel confident; we are sure we will succeed. And thus if we do fail, as we often do, the result is devastating; it feels as if the world itself has changed in order to make our wishes not come true.

Conversely, when we succumb to Impostor Syndrome, we feel inadequate, and so become convinced that we are inadequate, and thus that anyone who says they believe we are competent must either be lying or else somehow deceived. And then we fear to tell anyone, because we know that our jobs and our status depend upon other people seeing us as competent—and we are sure that if they knew the truth, they’d no longer see us that way.

When people see their beliefs as reality, they don’t even bother to check whether their beliefs are accurate.

Why would you need to check whether the way things are is the way things are?

This is how common misconceptions persist—the information needed to refute them is widely available, but people simply don’t realize they needed to be looking for that information.

For lots of things, misconceptions aren’t very consequential. But some common misconceptions do have large consequences.

For instance, most Americans think that crime is increasing and worse now than it was 30 or 50 years ago. (I tested this on my mother this morning; she thought so too.) It is in fact much, much better—violent crimes are about half as common in the US today as they were in the 1970s. Republicans are more likely to get this wrong than Democrats—but an awful lot of Democrats still get it wrong.

It’s not hard to see how that kind of misconception could drive voters into supporting “tough on crime” candidates who will enact needlessly harsh punishments and waste money on excessive police and incarceration. Indeed, when you look at our world-leading spending on police and incarceration (highest in absolute terms, third-highest as a portion of GDP), it’s pretty clear this is exactly what’s happening.

And it would be so easy—just look it up, right here, or here, or here—to correct that misconception. But people don’t even think to bother; they just know that their perception must be the truth. It never even occurs to them that they could be wrong, and so they don’t even bother to look.

This is not because people are stupid or lazy. (I mean, compared to what?) It’s because perceptions feel like the truth, and it’s shockingly difficult to see them as anything other than the truth.

It takes a very dedicated effort, and no small amount of training, to learn to see your own perceptions as how you see things rather than simply how things are.

I think part of what makes this so difficult is the existential terror that results when you realize that anything you believe—even anything you perceive—could potentially be wrong. Basically the entire field of epistemology is dedicated to understanding what we can and can’t be certain of—and the “can’t” is a much, much bigger set than the “can”.

In a sense, you can be certain of what you feel and perceive—you can be certain that you feel and perceive them. But you can’t be certain whether those feelings and perceptions correspond to your external reality.

When you are sad, you know that you are sad. You can be certain of that. But you don’t know whether you should be sad—whether you have a reason to be sad. Often, perhaps even usually, you do. But sometimes, the sadness comes from within you, or from misperceiving the world.

Once you learn to recognize your perceptions as perceptions, you can question them, doubt them, challenge them. Training your mind to do this is an important part of mindfulness meditation, and also of cognitive behavioral therapy.

But even after years of training, it’s still shockingly hard to do this, especially in the throes of a strong emotion. Simply seeing that what you’re feeling—about yourself, or your situation, or the world—is not an entirely accurate perception can take an incredible mental effort.

We really seem to be wired to see our perceptions as reality.

This makes a certain amount of sense, in evolutionary terms. In an ancestral environment where death was around every corner, we really didn’t have time to stop and thinking carefully about whether our perceptions were accurate.

Two ancient hominids hear a sound that might be a tiger. One immediately perceives it as a tiger, and runs away. The other stops to think, and then begins carefully examining his surroundings, looking for more conclusive evidence to determine whether it is in fact a tiger.

The latter is going to have more accurate beliefs—right up until the point where it is a tiger and he gets eaten.

But in our world today, it may be more dangerous to hold onto false beliefs than to analyze and challenge our beliefs. We may harm ourselves—and others—more by trusting our perceptions too much rather than by taking the time to analyze them.

Mind reading is not optional

PNRJ cognitive science, heuristics and biases, personal , , , , , ,

Nov 20 JDN 2459904

I have great respect for cognitive-behavioral therapy (CBT), and it has done a lot of good for me. (It is also astonishingly cost-effective; its QALY per dollar rate compares favorably to almost any other First World treatment, and loses only to treating high-impact Third World diseases like malaria and schistomoniasis.)

But there are certain aspects of it that have always been frustrating to me. Standard CBT techniques often present as ‘cognitive distortions‘ what are in fact clearly necessary heuristics without which it would be impossible to function.

Perhaps the worst of these is so-called ‘mind reading‘. The very phrasing of it makes it sound ridiculous: Are you suggesting that you have some kind of extrasensory perception? Are you claiming to be a telepath?

But in fact ‘mind reading’ is simply the use of internal cognitive models to forecast the thoughts, behaviors, and expectations of other human beings. And without it, it would be completely impossible to function in human society.

For instance, I have had therapists tell me that it is ‘mind reading’ for me to anticipate that people will have tacit expectations for my behavior that they will judge me for failing to meet, and I should simply wait for people to express their expectations rather than assuming them. I admit, life would be much easier if I could do that. But I know for a fact that I can’t. Indeed, I used to do that, as a child, and it got me in trouble all the time. People were continually upset at me for not doing things they had expected me to do but never bothered to actually mention. They thought these expectations were “obvious”; they were not, at least not to me.

It was often little things, and in hindsight some of these things seem silly: I didn’t know what a ‘made bed’ was supposed to look like, so I put it in a state that was functional for me, but that was not considered ‘making the bed’. (I have since learned that my way was actually better: It’s good to let sheets air out before re-using them.) I was asked to ‘clear the sink’, so I moved the dishes out of the sink and left them on the counter, not realizing that the implicit command was for me to wash those dishes, dry them, and put them away. I was asked to ‘bring the dinner plates to the table’, so I did that, and left them in a stack there, not realizing that I should be setting them out in front of each person’s chair and also bringing flatware. Of course I know better now. But how was I supposed to know then? It seems like I was expected to, though.

Most people just really don’t seem to realize how many subtle, tacit expectations are baked into every single task. I think neurodivergence is quite relevant here; I have a mild autism spectrum disorder, and so I think rather differently than most people. If you are neurotypical, then you probably can forecast other people’s expectations fairly well automatically, and so they may seem obvious to you. In fact, they may seem so obvious that you don’t even realize you’re doing it. Then when someone like me comes along and is consciously, actively trying to forecast other people’s expectations, and sometimes doing it poorly, you go and tell them to stop trying to forecast. But if they were to do that, they’d end up even worse off than they are. What you really need to be telling them is how to forecast better—but that would require insight into your own forecasting methods which you aren’t even consciously aware of.

Seriously, stop and think for a moment all of the things other people expect you to do every day that are rarely if ever explicitly stated. How you are supposed to dress, how you are supposed to speak, how close you are supposed to stand to other people, how long you are supposed to hold eye contact—all of these are standards you will be expected to meet, whether or not any of them have ever been explicitly explained to you. You may do this automatically; or you may learn to do it consciously after being criticized for failing to do it. But one way or another, you must forecast what other people will expect you to do.

To my knowledge, no one has ever explicitly told me not to wear a Starfleet uniform to work. I am not aware of any part of the university dress code that explicitly forbids such attire. But I’m fairly sure it would not be a good idea. To my knowledge, no one has ever explicitly told me not to burst out into song in the middle of a meeting. But I’m still pretty sure I shouldn’t do that. To my knowledge, no one has ever explicitly told me what the ‘right of way’ rules are for walking down a crowded sidewalk, who should be expected to move out of the way of whom. But people still get mad if you mess up and bump into them.

Even when norms are stated explicitly, it is often as a kind of last resort, and the mere fact that you needed to have a norm stated is often taken as a mark against your character. I have been explicitly told in various contexts not to talk to myself or engage in stimming leg movements; but the way I was told has generally suggested that I would have been judged better if I hadn’t had to be told, if I had simply known the way that other people seem to know. (Or is it that they never felt any particular desire to stim?)

In fact, I think a major part of developing social skills and becoming more functional, to the point where a lot of people actually now seem a bit surprised to learn I have an autism spectrum disorder, has been improving my ability to forecast other people’s expectations for my behavior. There are dozens if not hundreds of norms that people expect you to follow at any given moment; most people seem to intuit them so easily that they don’t even realize they are there. But they are there all the same, and this is painfully evident to those of us who aren’t always able to immediately intuit them all.

Now, the fact remains that my current mental models are surely imperfect. I am often wrong about what other people expect of me. I’m even prepared to believe that some of my anxiety comes from believing that people have expectations more demanding than what they actually have. But I can’t simply abandon the idea of forecasting other people’s expectations. Don’t tell me to stop doing it; tell me how to do it better.

Moreover, there is a clear asymmetry here: If you think people want more from you than they actually do, you’ll be anxious, but people will like you and be impressed by you. If you think people want less from you than they actually do, people will be upset at you and look down on you. So, in the presence of uncertainty, there’s a lot of pressure to assume that the expectations are high. It would be best to get it right, of course; but when you aren’t sure you can get it right, you’re often better off erring on the side of caution—which is to say, the side of anxiety.

In short, mind reading isn’t optional. If you think it is, that’s only because you do it automatically.

Adversity is not a gift

PNRJ cognitive science, core principles, current events, ethics, personal , , , , , ,

Nov 29 JDN 2459183

For the last several weeks I’ve been participating in a program called “positive intelligence” (which they abbreviate “PQ” even though that doesn’t make sense); it’s basically a self-help program that is designed to improve mood and increase productivity. I am generally skeptical of such things, and I could tell from the start that it was being massively oversold, but I had the opportunity to participate for free, and I looked into the techniques involved and most of them seem to be borrowed from cognitive-behavioral therapy and mindfulness meditation.

Overall, I would say that the program has had small but genuine benefits for me. I think the most helpful part was actually getting the chance to participate in group sessions (via Zoom of course) with others also going through the program. That kind of mutual social support can make a big difference. The group I joined was all comprised of fellow economists (some other grad students, some faculty), so we had a lot of shared experiences.

Some of the techniques feel very foolish, and others just don’t seem to work for me; but I did find at least some of the meditation techniques (which they annoyingly insist on calling by the silly name “PQ reps”) have helped me relax.

But there’s one part of the PQ program in particular that I just can’t buy into, and this is the idea that adversity is a gift and an opportunity.

They call it the “Sage perspective”: You observe the world without judging what is good or bad, and any time you think something is bad, you find a way to transform it into a gift and an opportunity. The claim is that everything—or nearly everything—that happens to you can make you better off. There’s a lot of overlap here with the attitude “Everything happens for a reason”.

I don’t doubt that sincerely believing this would make you happier. Nevertheless, it is obviously false.

If indeed adversity were a gift, we would seek it out. If getting fired or going bankrupt or getting sick were a gift and an opportunity, we’d work to make these things happen.

Yes, it’s true that sometimes an event which seems bad at the time can turn out to have good consequences in the long run. This is simply because we are unable to foresee all future ramifications. Sometimes things turn out differently than you think they will. But most of the time, when something seems bad, it is actually bad.

There might be some small amount of discomfort or risk that would be preferable to a life of complete safety and complacency; but we are perfectly capable of seeking out whatever discomfort or risk we choose. Most of us live with far more discomfort and risk than we would prefer, and simply have no choice in the matter.

If adversity were a gift, people would thank you for giving it to them. “Thanks for dumping me!” “Thanks for firing me!” “Thanks for punching me!” These aren’t the sort of thing we hear very often (at least not sincerely).

I think this is fairly obvious, honestly, so I won’t belabor it any further. But it raises a question: Is there a way to salvage the mental health benefits of this attitude while abandoning its obvious falsehood?

“Everything happens for a reason” doesn’t work; we live in a universe of deep randomness, ruled by the blind idiot gods of natural law.

“Every cloud has a silver lining” is better; but clearly not every bad thing has an upside, or if it does the upside can be so small as to be utterly negligible. (What was the upside of Rwandan genocide?) Restricted to ordinary events like getting fired this one works pretty well; but it obviously fails for the most extreme traumas, and doesn’t seem particularly helpful for the death of a loved one either.

“What doesn’t kill me makes me stronger” is better still, but clearly not true in every case; some bad events that don’t actually kill us can traumatize us and make the rest of our lives harder. Perhaps “What doesn’t permanently damage me makes me stronger”?

I think the version of this attitude that I have found closest to the truth is “Everything is raw material”. Sometimes bad things just happen: Bad luck, or bad actions, can harm just about anyone at just about any time. But it is within our power to decide how we will respond to what happens to us, and wallowing in despair is almost never the best response.

Thus, while it is foolish to see adversity as a gift, it is not so foolish to see it as an opportunity. Don’t try to pretend that bad things aren’t bad. There’s no sense in denying that we would prefer some outcomes over others, and we feel hurt or disappointed when things don’t turn out how we wanted. Yet even what is bad can still contain within it chances to learn or make things better.

What’s wrong with “should”?

PNRJ cognitive science, ethics, personal , , , , , , , , , ,

Nov 8 JDN 2459162

I have been a patient in cognitive behavioral therapy (CBT) for many years now. The central premise that thoughts can influence emotions is well-founded, and the results of CBT are empirically well supported.

One of the central concepts in CBT is cognitive distortions: There are certain systematic patterns in how we tend to think, which often results in beliefs and emotions that are disproportionate with reality.

Most of the cognitive distortions CBT deals with make sense to me—and I am well aware that my mind applies them frequently: All-or-nothing, jumping to conclusions, overgeneralization, magnification and minimization, mental filtering, discounting the positive, personalization, emotional reasoning, and labeling are all clearly distorted modes of thinking that nevertheless are extremely common.

But there’s one “distortion” on CBT lists that always bothers me: “should statements”.

Listen to this definition of what is allegedly a cognitive distortion:

Another particularly damaging distortion is the tendency to make “should” statements. Should statements are statements that you make to yourself about what you “should” do, what you “ought” to do, or what you “must” do. They can also be applied to others, imposing a set of expectations that will likely not be met.

When we hang on too tightly to our “should” statements about ourselves, the result is often guilt that we cannot live up to them. When we cling to our “should” statements about others, we are generally disappointed by their failure to meet our expectations, leading to anger and resentment.

So any time we use “should”, “ought”, or “must”, we are guilty of distorted thinking? In other words, all of ethics is a cognitive distortion? The entire concept of obligation is a symptom of a mental disorder?

Different sources on CBT will define “should statements” differently, and sometimes they offer a more nuanced definition that doesn’t have such extreme implications:

Individuals thinking in ‘shoulds’, ‘oughts; or ‘musts’ have an ironclad view of how they and others ‘should’ and ‘ought’ to be. These rigid views or rules can generate feels of anger, frustration, resentment, disappointment and guilt if not followed.

Example: You don’t like playing tennis but take lessons as you feel you ‘should’, and that you ‘shouldn’t’ make so many mistakes on the court, and that your coach ‘ought to’ be stricter on you. You also feel that you ‘must’ please him by trying harder.

This is particularly problematic, I think, because of the All-or-Nothing distortion which does genuinely seem to be common among people with depression: Unless you are very clear from the start about where to draw the line, our minds will leap to saying that all statements involving the word “should” are wrong.

I think what therapists are trying to capture with this concept is something like having unrealistic expectations, or focusing too much on what could or should have happened instead of dealing with the actual situation you are in. But many seem to be unable to articulate that clearly, and instead end up asserting that entire concept of moral obligation is a cognitive distortion.

There may be a deeper error here as well: The way we study mental illness doesn’t involve enough comparison with the control group. Psychologists are accustomed to asking the question, “How do people with depression think?”; but they are not accustomed to asking the question, “How do people with depression think compared to people who don’t?” If you want to establish that A causes B, it’s not enough to show that those with B have A; you must also show that those who don’t have B also don’t have A.

This is an extreme example for illustration, but suppose someone became convinced that depression is caused by having a liver. They studied a bunch of people with depression, and found that they all had livers; hypothesis confirmed! Clearly, we need to remove the livers, and that will cure the depression.

The best example I can find of a study that actually asked that question compared nursing students and found that cognitive distortions explain about 20% of the variance in depression. This is a significant amount—but still leaves a lot unexplained. And most of the research on depression doesn’t even seem to think to compare against people without depression.

My impression is that some cognitive distortions are genuinely more common among people with depression—but not all of them. There is an ongoing controversy over what’s called the depressive realism effect, which is the finding that in at least some circumstances the beliefs of people with mild depression seem to be more accurate than the beliefs of people with no depression at all. The result is controversial both because it seems to threaten the paradigm that depression is caused by distortions, and because it seems to be very dependent on context; sometimes depression makes people more accurate in their beliefs, other times it makes them less accurate.

Overall, I am inclined to think that most people have a variety of cognitive distortions, but we only tend to notice when those distortions begin causing distress—such when are they involved in depression. Human thinking in general seems to be a muddled mess of heuristics, and the wonder is that we function as well as we do.

Does this mean that we should stop trying to remove cognitive distortions? Not at all. Distorted thinking can be harmful even if it doesn’t cause you distress: The obvious example is a fanatical religious or political belief that leads you to harm others. And indeed, recognizing and challenging cognitive distortions is a highly effective treatment for depression.

Actually I created a simple cognitive distortion worksheet based on the TEAM-CBT approach developed by David Burns that has helped me a great deal in a remarkably short time. You can download the worksheet yourself and try it out. Start with a blank page and write down as many negative thoughts as you can, and then pick 3-5 that seem particularly extreme or unlikely. Then make a copy of the cognitive distortion worksheet for each of those thoughts and follow through it step by step. Particularly do not ignore the step “This thought shows the following good things about me and my core values:”; that often feels the strangest, but it’s a critical part of what makes the TEAM-CBT approach better than conventional CBT.

So yes, we should try to challenge our cognitive distortions. But the mere fact that a thought is distressing doesn’t imply that it is wrong, and giving up on the entire concept of “should” and “ought” is throwing out a lot of babies with that bathwater.

We should be careful about labeling any thoughts that depressed people have as cognitive distortions—and “should statements” is a clear example where many psychologists have overreached in what they characterize as a distortion.