Personalizing

A brief introduction to cognitive distortions

Cognitive distortions, cognitive biases, or ‘unhelpful thinking styles’ are the characteristic ways our thoughts become biased (Beck, 1963). We are always interpreting the world around us, trying to make sense of what is happening. Sometimes our brains take ‘shortcuts’ and we think things that are not completely accurate. Different cognitive short cuts result in different kinds of bias or distortions in our thinking. Sometimes we might jump to the worst possible conclusion (“this rough patch of skin is cancer!”), at other times we might blame ourselves for things that are not our fault (“If I hadn’t made him mad he wouldn’t have hit me”), and at other times we might rely on intuition and jump to conclusions (“I know that they all hate me even though they’re being nice”). These biases are often maintained by characteristic unhelpful assumptions (Beck et al., 1979).

Different cognitive biases are associated with different clinical presentations. For example, catastrophizing is associated with anxiety disorders (Nöel et al., 2012), dichotomous thinking has been linked to emotional instability (Veen & Arntz, 2000), and thought-action fusion is associated with obsessive compulsive disorder (Shafran et al., 1996).

Catching automatic thoughts and (re)appraising them is a core component of traditional cognitive therapy (Beck et al., 1979; Beck, 1995; Kennerley, Kirk, Westbrook, 2007). Identifying the presence and nature of cognitive biases is often a helpful way of introducing this concept – clients are usually quick to appreciate and identify with the concept of ‘unhelpful thinking styles’, and can easily be trained to notice the presence of biases in their own automatic thoughts. Once biases have been identified, clients can be taught to appraise the accuracy of these automatic thoughts and draw new conclusions. 

Personalizing

Humans are naturally egocentric: we tend to see ourselves as the cause and target of other people’s behavior, and central to events in the environment (Greenwald, 1980; Zuckerman et al., 1983). While egocentricity plays an important role in memory consolidation, recall, and our sense of self (Schacter et al., 2003), it can be problematic when it is extreme.

Personalizing (also referred to as “self-reference”) is a style of thinking in which individuals interpret events in a self-referential manner (Beck, 1979; Branch & Willson, 2020). Typically, these judgments are negatively self-orientated (e.g., “My neighbor ignored me because I did something wrong”) and evoke distress. At its most extreme, personalized thinking can contribute to persecutory delusions and ideas of reference (e.g., “My neighbors are following me and intend to hurt me”; Bedrosian & Beck, 1980). Personalizing is believed to arise from broader biases in hypothesis testing, interpretation, and expectancy judgments (i.e., holding negative expectations about the future) (Harvey et al., 2004).

Personalizing is with associated inappropriate self-blame, comparison-making, and egocentric attributions for negative events (Beck, 1979; Tolin, 2016). In addition, research indicates that personalized attributions are common in delusional beliefs although they tend to be external rather than internal (e.g., negative events are blamed on other people rather than circumstances; Kinderman & Bentall, 1997). Finally, personalizing may be apparent in narcissistic traits and fantasies (e.g., “It is thanks to me that our department is so successful”), although this is yet to be tested.

Other difficulties associated with personalizing include:

• Addictions (Ozparlak & Karakaya, 2022).
• Anxiety (Covin et al., 2011).
• Depression (Blake et al., 2016).
• Generalized anxiety disorder (Nasiri et al., 2020).
• Eating disorders (Dritschel et al., 1991).
• Emotionally Unstable Personality Disorder (Puri et al., 2021).
• Negative body image (Djikstra et al., 2017).
• Obsessive compulsive disorder (Clark, 2002).
• Perfectionism (Davis & Wosinski, 2012).
• Post-traumatic stress disorder (Kline et al., 2021).
• Social anxiety (Epkins, 1996; Kuru et al., 2018).
• Self-harm (Weismoore & Esposito-Smythers, 2010).

Examples of personalizing include:

• Self-reference (e.g., “The shopkeeper was curt because I somehow offended him”).
• Self-blame (e.g., “It’s my fault that no-one enjoyed their meal in the restaurant”).
• Comparisons (e.g., “The father on that poster is a better parent than I am”).
• Delusional beliefs (e.g., “The police are here because they are secretly monitoring me”).
• People who personalize may have ‘blind spots’ when it comes to:
• Circumstantial (rather than personal) attributions for events.
• Fairly attributing blame and responsibility.
• Setting reasonable expectations for themselves.
• Self-distanced / self-transcendent reasoning.
• Self-forgiveness and self-compassion.

As with many other cognitive biases, there are evolutionary reasons why people might personalize. Gilbert (1998) suggests that attributing negative events to oneself might be functional insofar as it (a) provides an illusion of control, (b) avoids blaming the ‘other’ which carries the risk of counterattack, (c) elicits support, and (d) helps protect relationships we depend on.

"Many people struggle with personalizing, and it sounds as though it might also be relevant to you. Would you be willing to explore it with me?"

Clinicians might begin by providing psychoeducation about personalizing and automatic thoughts more generally. Consider sharing some of these important details:

• Automatic thoughts spring up spontaneously in our minds, usually in the form of words or images.
• They are often on the ‘sidelines’ of our awareness. With practice, we can become more aware of them. It is a bit like a theatre – we can bring our automatic thoughts ‘center stage’.
• Automatic thoughts are not always accurate: just because you think something, it doesn’t make it true.
• Automatic thoughts are often inaccurate in characteristic ways. One common type of bias in automatic thoughts is ‘personalizing’: we sometimes believe that situations are related to ourselves (usually the negative ones) and don’t consider other possible explanations.
• Signs that you are personalizing include blaming yourself unfairly or assuming that you have somehow contributed to negative events.
• In some circumstances, it can be helpful to personalize. For example, assuming that negative events are related to you might help you feel more in control or stop you from blaming other people, which could be painful or risky (e.g., they might attack or reject you in response).

Many treatment techniques can be used to address personalizing, including:

• Decentering. Meta-cognitive awareness, or decentering, describes the ability to stand back and view a thought as a cognitive event: as an opinion, and not necessarily a fact (Flavell, 1979). Help clients to practice labeling the process present in the thinking rather than engaging with the content. For instance, they might say “I’m personalizing again” to themselves whenever they notice these thoughts.
• Cognitive restructuring with thought records. Self-monitoring can be used to capture and re-evaluate personalizing thoughts as they occur. Useful prompts include:
  • "If you took off the ‘personalizing’ glasses, how would you see this situation differently?"
  • "What evidence supports and does not support the idea that this situation was personal to you?"
  • "Can you think of any other explanations for what happened? Which one seems most realistic?"
  • "What are the other factors that might have contributed to this event or outcome?"
  • "If a friend had the same experience and took it personally, what would you say to them?"
  • "If an objective bystander observed what happened, would they agree it was personal to you? Why not?"
• Cost-benefit analysis. Explore the advantages and disadvantages of personalizing. Is it helpful to interpret situations this way, and what problems does it cause? Some clients may believe that personalizing is functional (e.g., “If I caused what happened,  I can do something about it”).
• Pie charts. Pie charts are useful way to explore multiple factors that may have contributed to a given outcome (Beck, 1995). Ask the client to list potential causes and allocate a ‘slice’ of the pie chart to each one. Note that the client should add the self-attribution to the chart last (e.g., “The way I treated my brother led to his suicide”) so that the other explanations can be fully considered.
• Historical review. Reviewing past experiences of being blamed can contextualize personalizing. For example, some clients may have been blamed as children or witnessed others blaming themselves (“Who else in your life tends to personalize things?”). Alternatively, the client may have learned to condemn themselves or take excessive responsibility to avoid conflict, elicit support, or protect relationships with attachment figures (Gilbert, 1998).
• Role-play. Role-playing can be a powerful way to shift cognitive biases (Pugh, 2019). For example, the therapist might present the client’s personalizing statements in the first person (“It’s all my fault”), while the client tries to help the therapist see the situation differently (Beck et al., 1979). If the client gets ‘stuck’ at any point, roles are reversed so the therapist can model the process of responding to personalizing thoughts.
• Testing beliefs and assumptions. It can be helpful to explore whether the client holds beliefs or assumptions that drive personalizing, such as “Bad things are always my fault”, and “When the worst happens, I must have contributed to it”. If assumptions like these are identified, clients can assess how accurate and useful they are. Their attitudes toward healthier assumptions can be explored, such as “Events aren’t always about me or because of me”, and “There are usually many reasons why things happen”. Assumptions can also be tested using behavioral experiments, including surveys (e.g., “Let’s see if other people would also take this situation personally”).

• Beck, A. T. (1963). Thinking and depression: I. Idiosyncratic content and cognitive distortions. Archives of General Psychiatry, 9, 324-333. DOI: 10.1001/archpsyc.1963.01720160014002.
• Beck, A. T. (1979). Cognitive therapy and the emotional disorders. Meridian.
• Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.
• Beck, J. S. (1995). Cognitive behavior therapy: Basics and beyond. Guilford Press.
• Bedrosian, R. C., & Beck, A. T. (1980). Principles of cognitive therapy. In M. J. Mahoney (Ed.), Psychotherapy process: Current issues and future directions (pp. 127-152). Springer.
• Blake, E., Dobson, K. S., Sheptycki, A. R., & Drapeau, M. (2016). The relationship between depression severity and cognitive errors. American Journal of Psychotherapy, 70, 203-221. DOI: 10.1176/appi.psychotherapy.2016.70.2.203.
• Branch, R., & Willson, R. (2020). Cognitive behavioural therapy for dummies (3rd ed.). John Wiley and Sons. 
• Clark, D. A. (2002). A cognitive perspective on obsessive compulsive disorder and depression: Distinct and related features. In R. O. Frost & G. Steketee (Eds.), Cognitive approaches to obsessions and compulsions: Theory, assessment, and treatment (pp.233-250). Elsevier Science.
• Covin, R., Dozois, D. J., Ogniewicz, A., & Seeds, P. M. (2011). Measuring cognitive errors: Initial development of the Cognitive Distortions Scale (CDS). International Journal of Cognitive Therapy, 4, 297-322. DOI: 10.1521/ijct.2011.4.3.297.
• Davis, M. C., & Wosinski, N. L. (2012). Cognitive errors as predictors of adaptive and maladaptive perfectionism in children. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 30, 105-117. DOI: 10.1007/s10942-011-0129-1.
• Dijkstra, P., Barelds, D. P., & van Brummen-Girigori, O. (2017). General cognitive distortions and body satisfaction: Findings from the Netherlands and Curaçao. International Journal of Cognitive Therapy, 10, 161-174. DOI: 0.1521/ijct.2017.10.2.161
• Dritschel, B. H., Williams, K., & Cooper, P. J. (1991). Cognitive distortions amongst women experiencing bulimic episodes. International Journal of Eating Disorders, 10, 547-555. DOI: 10.1002/1098-108X(199109)10:5<547::AID-EAT2260100507>3.0.CO;2-2.
• Epkins, C. C. (1996). Cognitive specificity and affective confounding in social anxiety and dysphoria in children. Journal of Psychopathology and Behavioral Assessment, 18, 83–101. DOI: 10.1007/BF02229104.
• Gilbert, P. (1998). The evolved basis and adaptive functions of cognitive distortions. British Journal of Medical Psychology, 71, 447-463. DOI: 10.1111/j.2044-8341.1998.tb01002.x.
• Greenwald, A. G. (1980). The totalitarian ego: Fabrication and revision of personal history. American Psychologist, 35, 603. DOI: 10.1037/0003-066X.35.7.603.
• Harvey, A. G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford University Press.
• Kinderman, P., & Bentall, R. P. (1997). Causal attributions in paranoia and depression: Internal, personal, and situational attributions for negative events. Journal of Abnormal Psychology, 106, 341–345. https://doi.org/10.1037/0021-843X.106.2.341.
• Kline, N. K., Berke, D. S., Rhodes, C. A., Steenkamp, M. M., & Litz, B. T. (2021). Self-blame and PTSD following sexual assault: A longitudinal analysis. Journal of Interpersonal Violence, 36, NP3153-NP3168. DOI: 10.1177/0886260518770652.
• Kuru, E., Safak, Y., Özdemir, İ., Tulacı, R. G., Özdel, K., Özkula, N. G., & Örsel, S. (2018). Cognitive distortions in patients with social anxiety disorder: Comparison of a clinical group and healthy controls. European Journal of Psychiatry, 32, 97-104. DOI: 10.1016/j.ejpsy.2017.08.004.
• Nasiri, F., Mashhadi, A., Bigdeli, I., & Chamanabad, A. G. (2020). How to differentiate generalized anxiety disorder from worry: the role of cognitive strategies. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 38, 44-55. DOI: 10.1007/s10942-019-00323-5.
• Noël, V. A., Francis, S. E., Williams-Outerbridge, K., & Fung, S. L. (2012). Catastrophizing as a predictor of depressive and anxious symptoms in children. Cognitive Therapy and Research, 36, 311-320. DOI: 10.1007/s10608-011-9370-2.
• Özparlak, A., & Karakaya, D. (2022). The associations of cognitive distortions with internet addiction and internet activities in adolescents: A cross‐sectional study. Journal of Child and Adolescent Psychiatric Nursing, 35, 322-330. DOI: 10.1111/jcap.12385.
• Puri, P., Kumar, D., Muralidharan, K., & Kishore, M. T. (2021). Evaluating schema modes and cognitive distortions in borderline personality disorder: A mixed‐method approach. Journal of Clinical Psychology, 77, 1973-1984. DOI: 10.1002/jclp.23126.
• Schacter, D. L., Chiao, J. Y., & Mitchell, J. P. (2003). The seven sins of memory: Implications for self. Annals of the New York Academy of Sciences, 1001, 226-239. DOI: 10.1196/annals.1279.012
• Shafran, R., Thordarson, D. S., & Rachman, S. (1996). Thought-action fusion in obsessive compulsive disorder. Journal of Anxiety Disorders, 10, 379-391. DOI: 10.1016/0887-6185(96)00018-7.
• Tolin, D. F. (2016). Doing CBT: A Comprehensive Guide to Working with Behaviors, Thoughts, and Emotions. Guilford Press.
• Veen, G., & Arntz, A. (2000). Multidimensional dichotomous thinking characterizes borderline personality disorder. Cognitive Therapy and Research, 24, 23-45. DOI: 10.1023/A:1005498824175.
• Weismoore, J. T., & Esposito-Smythers, C. (2010). The role of cognitive distortion in the relationship between abuse, assault, and non-suicidal self-injury. Journal of Youth and Adolescence, 39, 281-290. DOI: 10.1007/s10964-009-9452-6.
• Westbrook, D., Kennerley, H., & Kirk, J. (2011). An introduction to cognitive behaviour therapy: Skills and applications (2nd ed.). Sage.
• Zuckerman, M., Kernis, M. H., Guarnera, S. M., Murphy, J. F., & Rappoport, L. (1983). The egocentric bias: Seeing oneself as cause and target of others’ behavior. Journal of Personality, 51, 621-630. DOI: 10.1111/j.1467-6494.1983.tb00869.x.