Cognitive distortions are automatic thought patterns that are inaccurate and reinforce negative thinking or emotions. These automatic thoughts “distort” our thinking by leading us to believe something that is both unhelpful and untrue (Bollen et al., 2021). Psychiatrist and researcher Dr. Aaron Beck is known for first proposing the theory behind cognitive distortions in the 1960s. He would then form the central part of his cognitive theory and, later, cognitive behavioral therapy (CBT).
In his book (1963), he lists five types of cognitive distortions.
Dr. David Burns was an early student of Dr. Beck and helped popularize CBT. In his book (1980), he included more unhealthy thinking styles while also re-wording some of Beck’s distortions:
The theory underlying CBT states that cognitive distortions are associated with certain mental health disorders. These conditions include anxiety and depression. One anxiety disorder that’s largely affected by cognitive distortions is social anxiety disorder. Social anxiety disorder (SAD) occurs when individuals fear and endure discomfort or avoid social situations, such as social interaction or performances that may involve social scrutiny (Cook et al., 2019). These individuals are more likely to have negative thinking patterns that overestimate the probability and severity of negative social events and interactions. With depression, cognitive distortions were found to have a positive relationship, meaning as depression increased, cognitive distortions increased with helplessness and self-blame being the top two predictors of mental well-being (Yüksel & Bahadir-Yilmaz, 2019). Cognitive distortions were also found to mediate the relationship between trauma and suicide ideation (Whiteman et al., 2019). Researchers (2019) revealed that negative cognitions about the world and about the self were strong predictors of suicide ideation. These findings support the routine assessment of cognitive distortions and suicide ideation in survivors of trauma and of those who are experiencing anxiety and depressive symptoms.
Cognitive distortions can be combatted with CBT, which has been known to help redirect negative thought patterns into more positive ones (Beck, 1963). It can also help you challenge your negative thoughts and emotions, and encourage you to find the source of those thoughts. Fortunately, there are many resources to help you challenge your cognitive distortions and identify their root cause.
An important aspect of veterans' mental health is moral injury (MI) and its impact. A moral injury can occur in response to acting or witnessing behaviors that go against an individual's values and moral beliefs. In traumatic situations, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations (Norman & Maguen, 2021). Of veterans, over half have experienced moral injuries (Koenig et al., 2019). It’s often associated with a comorbidity of mental health issues such as suicide ideation and post-traumatic stress disorder (PTSD).
Research has shown that moral injury is common among veterans with PTSD (Currier et al., 2019). Moral injury can accompany feelings of guilt, shame, self-condemnation, loss of trust, loss of meaning, and spiritual struggles. Veterans who experience PTSD symptoms might struggle with co-occurring cognitive, emotional, and behavioral conflicts that may have been caused by moral injuries. For some individuals, transgressing cherished moral values or experiencing betrayal by trusted others in high-stakes situations may be severely traumatic (Koenig et al., 2019). The identification and treatment of MI among those with PTSD may help in the management of symptoms.
Recent research suggests that exposure to potentially morally injurious experiences may be associated with an increased risk for suicidal behavior among US combat veterans. Data from survey results were analyzed and showed that depression and PTSD were strong correlators of suicide ideation and attempts among those who experienced moral injury (Nichter et al., 2021). The events in combat and other missions may violate one’s deeply held belief systems and, for some service members, may result in inner conflict. Exposure to wartime atrocities and combat-related guilt has been shown to predict increased suicidal ideation (Bravo et al., 2020). To better inform prevention and treatment efforts among veterans, it’s important to identify risk factors that may moderate associations between moral injury and suicidal behavior.
Moral injury can be self-directed or other-directed. The two categories are defined by the attribution of responsibility for the event: personal responsibility (veteran's reported distress is related to his own behavior) versus responsibility of others (veteran's distress is related to actions taken by others) (Schorr et al., 2018). In one study, self-compassion was found to combat feelings of overidentification, or a tendency to overidentify with one’s failings and shortcomings that resulted after self-directed moral injury. Mindfulness and social connectedness also were found to weaken the impact of other-directed moral injury (Kelley et al., 2019). Prayer and meditation teach individuals to bring awareness to the present moment, with a sense of nonjudgment and acceptance of current thoughts, emotions, and sensations. These may be variables that mental health professionals should consider when working with veterans who have experienced moral injuries.
Some resources on moral injury include: