Cognitive Distortions - A Primer with Asian American Stereotypes | Hyphen magazine - Asian American arts, culture, and politics

When I present at conferences about Asian Americans and mental illness, I try to give the Asian Americans + Mental Illness 102 presentation. A lot of mental health professionals get Asian American 101, where they're taught about how Asians face the model minority stereotype, and how Asians like acupuncture with their therapy, and how the Virginia Tech shooter was Asian.

It's important to stress that not all stereotypes are true, that not all Asian Americans teens are raised by parents who want them to go to Harvard Medical School. It's really easy to attribute Asian American mental health problems to the stereotype that our community stigmatizes the mentally ill or puts pressure on kids. As an Asian American, you wouldn't necessarily want your therapist's ability to be objective clouded because they read The Joy Luck Club or Battle Hymn of the Tiger Mother.

So don't tell anyone about this essay. Because in this essay, I partially buy into the Joy Luck Club and Battle Hymn of the Tiger Mother stereotype.

This essay is about a concept called cognitive distortions which was developed by Dr. David Burns in the 1970s. Cognitive distortions are exaggerated and irrational thoughts and beliefs. Everyone has them, but the extent to which you experience them and how you deal with them greatly influences your emotional health. Burns lays out "Ten Forms of Twisted Thinking." I summarize them below, with examples of stereotypic high school "Asian American" distortions that I've seen while growing up in a heavily Asian American suburb with a competitive model minority and college prep culture.

All-or-nothing thinking - Seeing things in black and white (dichotomous thinking.) This type of distortion is very common in people with perfectionist tendencies. A straight A student gets a B on a single quiz and thinks, "Well great, now I'm a total failure." A college student sleeps in and misses a class. She thinks: "Why am I always screwing up?"
Overgeneralization - Something crappy happens once, so you assume it will happen again and again. A young man asks out his crush but is turned down. He thinks: "Ugh, no one is ever going to be interested in someone like me."
Mental filter - Consistently dwelling on what sucks in life (selective abstraction.) You may recognize this cognitive distortion in people you know who are depressed. One person you encounter today is an asshole, so you think "People suck." Someone praises you for performing well in a musical recital, but you disagree because at once point in the song you went off tune. Another example: 98%?! 98%?!
Discounting the positive - An extreme version of the Mental Filter. You reject positive experiences by insisting that they "don't count." You got a 2100 on the SAT, but you think anyone could have gotten that score--all you can think about is the missing 300 points. Someone praises you on your presentation, but you think, "It sucked, he's just being nice."
Jumping to conclusions - There may be no facts to support your belief but that doesn't stop you from assuming the worst. She ignored me this morning, she must be pissed at me. He didn't return my call--it's because he's thinking about breaking up with me. (Mind reading.) I'm going to fail this test tomorrow, I'm so screwed. I'm totally going to fail this test. (Fortune telling.)
Magnification - Also known as "catastrophizing," magnification involves exaggerating the extent of your problems (or your shortcomings), or minimizing your abilities and positive qualities. This is the distortion that makes a tiny snippet of gossip could see like the end of the world, or makes a college rejection letter feel like your entire future is over.
Emotional reasoning - This involves the assumption that negative emotions you are experiencing reflects how things really are. You feel guilty, so you must have done screwed up somewhere. You feel fat, so you must be fat. You feel like studying for an exam will make you feel anxious about being unprepared, so you avoid doing it.
"Should" statements - You believe that you should have been, other people should have been, or things should be a certain way. (Sometimes it's "musts," "oughts" or "have tos.") These thoughts can make you feel guilty, frustrated, and resentful towards yourself and towards other people. He shouldn't be so stubborn! I shouldn't eat that bowl of ice cream! I should have studied harder. I shouldn't have messed up.
Labeling - An extreme form of all-or-nothing thinking that is all about attaching irrational labels to yourself (or others eg: "She's a stuck up bitch.") These labels are usually emotionally loaded and inaccurate. I'm a useless little shit. I'm a dumbass. I'm a fat ass. I'm a fuck up. I'm a failure. I'm worthless. (Contrast this to simply admitting "I made a mistake, but it doesn't define who I am or my worth.")
Personalization and blame - You hold yourself personally responsible for an event that isn't entirely under your control. This distortion makes it easier for you to be abused and manipulated by others. After your boyfriend breaks up with you, you think, if I had put out more, then maybe he wouldn't have left me (even though you can't be sure it has anything to do with you at all, you still blame yourself.) Another example of personalization and blame is when you blame other people for their circumstances and problems: My mom is stingy and unreasonable because she won't buy me a car. You may also notice other people using personalization and blame as a dysfunctional thought process. You get a C on a test. Your mom freaks out because she believes it reflects poorly on her parenting skills.

Some readers may recognize that you experience some of these distortions (even if they aren't as clichéd as the ones I listed above.) Other people may snort when they recognize how irrational many of these seem (good!)

With the above cognitive distortions, knowing "rationally" that they're exaggerations or untrue may not stop you from experiencing them and becoming upset.

If your cognitive distortions are impacting your ability to be happy with yourself or your quality of life, I would definitely recommend finding a therapist who specializes in cognitive behavioral therapy (CBT), an evidence-based best practice for treating symptoms of conditions like anxiety, depression, and eating disorders.

A lot of people who have never been to therapy wonder what it is like. With CBT, your therapist will speak with you and help you identify cognitive distortions that you are blind to, and help you "restructure" them into healthier beliefs. Essentially, your therapist is a coach who will help you learn to approach cognitive distortions in a healthy manner. If you feel under pressure, a therapist could also help you deal with other people's expectations of you, particularly if those expectations are affected by their own cognitive distortions. Most health insurance companies will cover office visits to a therapist at the same cost as a medical doctor, so it is worth looking into.

If you're intimidated by the thought of going to a therapist, you could also pick up either of Burns' books, The Feeling Good Handbook or Feeling Good: The New Mood Therapy. The covers are a little corny (you can cover them up, if you'd like) but the content is worth a read. The books also have information on how to handle other people's cognitive distortions, which can go a long way in helping you manage other people's (like your parent's) expectations for you.

In Part II, I'll write briefly about cognitive restructuring and how to untangle cognitive distortion. I'll find a better example than Asian American stereotypes, I promise!

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Guest blogger Marissa Lee is an incoming Master's student in Social Welfare at UCLA. She currently serves on the California Mental Health Planning Council. See here for Part II of this post.

Ask a Model Minority Suicide is a Hyphen column, appearing every fourth Thursday. Introductory post for the column here. Resource Guide here. How to Choose Your Therapist here. Go here to see all posts in this series.

Comments, questions, or stories can be posted below -- or sent privately to Sam at aamms[at]hyphenmagazine[dot]com.

Nancy Lim-Yee wrote 49 weeks 4 days ago

Response to Marissa Lee's post

Thanks for sharing your interesting perspective on CBT, Marissa! I've been in the mental health field for the past 36 years and currently direct a children's mental health clinic in SF Chinatown. I am also a co-founding member of the Asian Pacific Islander Social Work Council of the California Chapter of NASW. Hope you will consider joining our Council if you are not a current member. Check us out at http://sites.google.com/site/apiswcgroup/home

MarissaLee wrote 50 weeks 5 days ago

@Beet re: CBT

Hi Beet,

Thanks for writing in response to my article and sharing your experiences with CBT. I'm sorry you found it ineffective, but I'm also glad you tried it. Unfortunately, not all interventions work for everyone, and not all CBT clinicians are made the same. You're absolutely right that one should not be overreliant on any one practice.

Clinical depression always comes hand-in-hand with cognitive distortions, and while it may be true that what you've termed "real issues" cannot be addressed or resolved via cognitive exercises alone, some of their cognitive distortions could be. (A very elementary example might be a person who is depressed because of the death of a loved one. While CBT cannot magically bring that person back from the dead--nothing can--CBT might help the person realize that he/she is not to blame. Likewise, for someone traumatized by a sexual assault, CBT cannot erase what happened, but might be able to help this person regain a sense of safety and self worth.) Challenging cognitive distortions may lessen the intensity of the depression or issues.

There is a large body of evidence behind the efficacy of CBT. It is one of the more famous types of therapy and can help with a wide variety of issues. I hope that readers will at least consider trying it, whether with a licensed clinician or through reading a book at home. Recognizing cognitive distortions is an invaluable skill to develop--doubly invaluable if you have a mental illness that can impact your emotions or your perceptions.

Rather than disincentivizing people from trying CBT, I hope that Beet's comment encourages readers to thoughtfully and open-mindly try a number of approaches until you find something that works for you. As AMMS wrote in last month's post about finding a therapist, sometimes it can feel like a major slog. There is no one perfect clinician or cure, but that doesn't mean you have no options--it means you have a wide number of options available to you.

Beet wrote 51 weeks 1 day ago

Marissa, Thank you for this

Marissa,

Thank you for this article but I tried CBT and it did not help me. It is usually recommended with SSRIs. I think it didn't help me because it was too shallow and simplistic. I was on CBT therapy for about 9 months, it was very expensive, but there were no results. Many people who face depression have real issues that they need to address and treating it all as a cognitive exercise doesn't really address those issues. To be fair, some issues can't be addressed by therapy, period. Nonetheless, it is important to recognize that CBT does not help everyone and an overreliance on CBT at the expense of exploring other methods of therapy may lead some patients to fall through the cracks.

Sandy wrote 51 weeks 3 days ago

Thank you so much for writing

Thank you so much for writing this article. Just reading through these made me realize I fit most of these descriptions and I will definitely pick up those two books. I honestly about going to therapy, but I am a little unsure what to expect or whether it'll be helpful at all so I will start with your recommendations and go from there. :)

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