RMNs encounter people struggling every single day and many patients display what are known as cognitive distortions.
These unhelpful thinking patterns can contribute to an individual’s poor mental wellbeing, but the good news is that they can be challenged. With that in mind, here are five cognitive distortions you’ll likely come across as a Registered Mental Health Nurse.
Cognitive Distortion #1: All-or-Nothing Thinking ⚖️
We probably all display this cognitive distortion from time to time. All-or-nothing thinking refers to precisely that; a binary way of thinking where situations are either one extreme or the other. For example, an RMN might have a patient who displays perfectionistic tendencies.
For this person, if it’s not perfection? It’s a failure. Thinking in such black-and-white terms can lead to worsening symptoms of anxiety and depression.
Anxiety because the person is desperately trying to meet what is an impossibly high standard, and depression because when they inevitably fail to meet that (again, impossible) standard, they revert to seeing themselves as a failure.
An Exhausting Way to Live
As you might imagine, living your life through such a polarised lens can be exhausting and highly stressful.
Pointing out this thinking pattern and how it can be unhelpful may aid the patient in adopting a more balanced cognitive approach.
It doesn’t have to always be one thing or the other; sometimes, it’s about living in the grey.
Cognitive Distortion #2: Emotional Reasoning 🧠
Another considerable cognitive distortion is emotional reasoning. This is where somebody uses their feelings to prove a situation, rather than objective evidence in front of them.
People suffering from anxiety and depression are particularly prone to this type of thinking, and RMNs can gently encourage their patients to look at the empirical data before them rather than using how they feel as a factual barometer.
Feeling guilty is a particularly common emotion when it comes to emotional reasoning. People with this cognitive distortion assume that they must have done something wrong because they feel guilty, even if there’s no clear evidence to support this.
Just Because it Feels it Doesn’t Make it Real…
Perhaps a patient is ruminating on a past social interaction. They’re worried they were accidentally rude in the conversation and hurt the other person’s feelings.
The reason they’re worried? Because they feel guilty. So, they run over everything they said, but nothing they said could be construed as rude, nor did the other person give any sign that the patient had been so.
However, because they feel guilty, well then, they must have done something wrong! Nope, it’s simply a common cognitive distortion doing its annoying thing and dragging the patient down with it.
Cognitive Distortion #3: Catastrophising 💥
Have you ever met someone who worries themselves sick over seemingly minor mistakes or shortcomings? Or are you that person yourself?
When a person overestimates the negative consequences of an action (and the likelihood of it happening) this is known as catastrophising.
Maybe a patient made a tiny mistake or was late to work (through no fault of their own). Or perhaps they scored lower on a mock assessment than they had hoped. There’s an opportunity for catastrophising to worm its way in for both examples.
The person who made a mistake/turned up late for work now thinks they will be fired, and as for not doing as well as hoped on the (mock) test? That means they’ll fail the entire course. It’s the only possible conclusion to draw! Except it isn’t…
Becoming the Watcher of Thoughts
RMNs can help patients recognise their catastrophic thinking and teach them to label it as such. By encouraging mindfulness, patients merely observe their thoughts rather than engage with them.
The more detached we are from our thoughts, the more we can be the ‘watcher’, and the less wrapped up we become with the narrative our thoughts are telling us.
So, if a patient can put some mindful distance between themselves and their catastrophic thoughts, they’re less likely to send themselves into an anxious or depressive spiral over the situation.
Cognitive Distortion #4: Discounting the Positives 📉
How’s your glass looking these days? Half-full? Half-empty? Or maybe even bone dry? That’s precisely how people who discount the positives in situations feel.
Patients with this cognitive distortion are prone to ignoring the positives and achievements in their lives, giving credit to others instead or saying that, for some reason or other, they don’t count.
Mental Filtering
However, they’re more than happy to take all the plaudits regarding the negatives.
This is also known as mental filtering, and an example would be someone having a particularly excellent work appraisal but choosing, instead, to focus on the one piece of (constructive) criticism they received.
An RMN can help coax patients away from this highly skewed thinking pattern and get them to give themselves the credit they deserve for the positives in their lives rather than focusing solely on the negatives.
Cognitive Distortion #5: “Should” Statements 🛑
“Should statements” can damage a person’s mental wellbeing if left unchecked.
Reframing these very fixed viewpoints can help patients avoid the idea that they’re failing somehow. The idea of ‘should’ (or should not) is inherently tied up with another word… but.
A patient feels that they shouldn’t be feeling a certain way, but they do. That they shouldn’t have done something, but they did.
It’s setting everything up through a negative and intangible lens of failure. An easy fix RMNs can suggest for patients is replacing should with either ‘could’ or ‘do’.
‘Could’ and ‘Do’ Statements
‘Could’ removes some of that expectation and pressure, so there’s less of a setup for failure. Instead of saying, “I should go on a walk tomorrow”, you say, “I could go on a walk tomorrow,” and it at once becomes less pressurised – there’s no bar or standard to reach in that statement anymore.
‘Do’ brings things back into the present moment. Rather than saying, “I shouldn’t feel like this”, say, “I do feel like this.” this way, you acknowledge what you’re feeling, but then you can also ground it in immediate action. You’ve recognised you’re feeling a certain way, and you can choose to take steps to address it.
Should statements, by contrast, are rooted in inaction – they leave a person feeling powerless and like their agency has been taken away. They present as the “over there” – I should feel like that, rather than the here and now.
Final Thoughts
Understanding and challenging common cognitive distortions is incredibly helpful as a Registered Mental Health Nurse.
It can offer patients a structured pathway towards tackling their faulty beliefs and irrational thinking patterns, whether in a patient’s initial assessment or through ongoing evaluations and therapeutic interventions.
