Cognitive restructuring, relaxation, gradual exposure, among others

One of the key aspects of cognitive behavioral therapy (CBT) for treating depression is the identification and modification of cognitive distortions.

These are misinterpretations of reality that generate emotional distress and maladaptive behaviors. They are automatic negative thoughts that the person assumes to be true, even if they are not, and which intensify depressive symptoms. People with depression often have a negative view of themselves, the world, and the future. This cognitive triad manifests itself in thoughts such as: “I'm worthless,” “Nobody loves me,” or “I'll never get out of this.”

These ideas do not arise from objective reality, but from a mental filter distorted by the person's own emotional state. One of the most common distortions is overgeneralization, which consists of drawing broad conclusions from a single negative event.

For example, if something goes wrong, the person may think, “Everything goes wrong for me” or “I'll never do anything right.” Another common type is catastrophizing, where the negative is exaggerated: “This is terrible, I'm not going to be able to handle it.” There is also dichotomous thinking, in which everything is perceived as black or white: “I'm either perfect or a failure.” Another common distortion is mind reading, when a person assumes they know what others think of them without any evidence.

For example: “I'm sure everyone thinks I'm useless.” There is also positive disqualification, where anything good that happens is minimized: “That was luck, not me.”

These cognitive distortions not only affect thinking, but also impact emotions. By interpreting events negatively, the person experiences sadness, guilt, hopelessness, or anxiety.

These emotions, in turn, reinforce distorted thoughts, creating a vicious cycle that is difficult to break without therapeutic intervention.

In clinical practice, a useful tool for working on these distortions is thought recording. The patient writes down a situation that caused them distress, the thoughts they had, the emotions they felt, and then identifies what distortion was present. They are then taught to question that thought and replace it with a more rational and balanced one.

For example, if a person writes, “My friend didn't answer my message; she must be mad at me,” the evidence supporting or refuting that idea is analyzed. Perhaps a more realistic alternative is reached: “She may be busy; she's not necessarily mad at me.”

This new interpretation often reduces the associated emotional intensity. Recognizing cognitive distortions is an essential part of the therapeutic process. It allows the patient to distance themselves from their thoughts, understand that not everything they think is a fact, and begin to develop a healthier way of thinking. The intervention is tailored to each person's pace, reinforced with examples and exercises that facilitate understanding.