Is it possible to change your thoughts? What are cognitive distortions? How can harnessing the power of intentional thought help you to heal yourself? In this podcast episode, Dr. Cristina Castagnini speaks about how you can change your reality by harnessing and healing distorted thoughts.


  • Who do you listen to?
  • How can CBT be helpful?
  • Common cognitive distortions
  • Basic CBT principles

Who do you listen to?

You can have many conflicting thoughts at a singular time in different moments throughout the day, and one event can produce a hundred different thoughts and reactions – which one(s) do you listen to?
It’s like being in a room filled with thousands of people who are all talking to us at once, and we choose to only listen to a select few, giving our attention and focus only to [those] thoughts and opinions. (Dr. Cristina Castagnini)
Even though each thought is (seemingly) random, why do you choose to listen to the ones that you do? And, if you wanted, could you decide to listen to some and ignore others?
We tend to … focus on certain thoughts that we have and if they are faulty or distorted, then that [becomes] our perception of reality. (Dr. Cristina Castagnini)
Your thoughts have a direct impact on how you feel and the behaviors that you act on.

How can CBT be helpful?

Thoughts are often called cognitions because they are the workings of the mind as it tries to make sense of the world, like a cog turning to make a machine work. If these cogs – cognitions – are faulty, then the whole machine changes. You can change your cognitions to upgrade the machine, your mind, and change your perception of reality. Cognitive-behavioral therapy is a way in which you can do that.
The good news is that you can become aware of your thoughts (or cognitions) and by doing this you can identify if you have cognitive distortions and start to identify how these distortions are affecting your feelings and behaviors. (Dr. Cristina Castagnini)

Common cognitive distortions

Some common cognitive distortions that people who have suffered – or are suffering – from an eating disorder may have experienced include:
  • Shoulds: “shoulds” are demands that someone puts on themselves
  • Catastrophizing: expecting disaster to strike and the worst possible outcome each time
  • All or nothing thinking: not giving yourself a middle ground and feeling like you have to be perfect or you are a failure
  • Emotional reasoning: “if I feel that way then it must be true”, when a person’s emotions take over their thinking entirely and negate all rationality and logic

Basic CBT principles

Every ED thought is distorted, which is why I wanted to discuss this today. Eating disorders are severe illnesses that [can] take over your entire mind. (Dr. Cristina Castagnini)
You can reclaim your thoughts and change your reality. Some basic CBT principles include: 1 – Cultivating a basic awareness of your thoughts without judgment or critique 2 – Labeling which thoughts are distorted 3 – Intentionally choosing which thought to believe for the highest, healthiest, and most compassionate outcome



I am a licensed Psychologist and Certified Eating Disorder Specialist. While I may have over 20 years of clinical experience, what I also have is the experience of having been a patient who had an eating disorder as well. One thing that I never had during all of my treatment was someone who could look me in the eye and honestly say to me "hey, I've been there. I understand". Going through treatment for an eating disorder is one of the hardest and scariest things to do. I remember being asked to do things that scared me. Things I now know ultimately helped me to get better. But, at the time, I had serious doubts and fears about it. If even one of my providers had been able to tell me "I know it's scary, but I had to go through that part too. Here's what will probably happen...." then perhaps I would not have gone in and out of treatment so many times. My own experience ultimately led me to specialize in treating eating disorders. I wanted to be the therapist I never had; the one who "got it". I will be giving you my perspective and information as an expert and clinician who has been treating patients for over 2 decades. But don't just take my word for it...keep listening to hear the truly informative insights and knowledge guest experts have to share. I am so happy you are here!


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Podcast Transcription

[DR. CRISTINA] Behind The Bite podcast is part of a network of podcasts that are good for the world. Check out podcasts like the Full of Shift podcast, After the First Marriage podcast and Eating Recovery Academy over at Welcome to Behind The Bite podcast. This podcast is about the real-life struggles women face with food, body image and weight. We're here to help you inspire and create better healthier lives. Welcome. Hello everyone. I'm here solo today and if you've never tuned into the show, or maybe even if you have, you may not know that aside from hosting the podcast, I also have a private practice where I see patients and have for well over two decades. One of the most common things experienced by people with eating disorders and body image issues is cognitive distortions. So I thought it would be a good idea to have a show that talks about what these are. With that, let's just dive in, shall we? Well, we all have thoughts or cognitions, if you will, and we all have our own beliefs and we all exist in this world together, yet we have our own individual perceptions of the world. But why we all don't have the exact same thoughts and beliefs is interesting, isn't it? So let's say you just received a message from your boss asking you to come into an unscheduled meeting today after lunch and I asked you to share what your thoughts were right after hearing this message. It would be interesting to know what your thoughts were. Now, I can only imagine if after this scenario were to happen to 100 people and I were to ask all 100 people about their thoughts right after that, not everyone would have the same thoughts. Some people may think something like, "Oh my goodness, I'm going to get fired. What am I going to do?" Then start panicking and worrying about what they're going to do without a job. Others may think things like, "Oh, thank goodness all my hard work has finally been recognized and I'm going to get that promotion I deserve." Then they're feeling elated and start imagining a bright feature for their career. Now why would that be? It's like being in a room full of thousands of people who are all talking to us at once, and we choose to only listen to a select few giving our attention and focus only to their thoughts and their opinions deciding that only theirs are real and true. By doing that, we form our own beliefs and reality and we're deaf to all the others if they're all still very much there for us if we decide to turn our focus and attention to them. If you are someone who listens to and focuses your attention on the thoughts or cognitions, if you will, that are distorted, then you have faulty or distorted thinking. When I say cognitive distortions, in short, what I'm saying is there are these faulty distorted patterns of thinking that distort our perceptions of reality, usually in a very negative way. Now this can be confusing if you've never heard of them before so I do hope as you continue listening on that this makes more sense. So what I'm trying to say is we have a lot of thoughts going on, but we don't always have to believe everything we think. But it's, again, what I'm trying to say is we tend to choose to focus on certain thoughts that we have and if they're faulty or distorted, then that's our perception of reality. Before I actually get into the specific cognitive distortions themselves, I think it's important to understand why knowing what and how you think is important. It's important because your thoughts directly have an impact on how you feel and have an impact on your behaviors. So I'm going to ask you to do something I've never actually asked you to do for the podcast before. If you're able to go grab a piece of paper and something to write with, it might be a good time to hit pause right now and go grab a piece of paper and something to write with, and then come right back to this thought and then hit play. Or if you don't have access to those two things right now, that's totally fine too. Just try to visualize what I'm about to describe. Okay, so on your paper, draw three circles with one circle above the other two as if they are forming a triangle. So you have one circle up top and then the two others below as if the circles are in triangle. In the top circle, put the word thoughts and one of the bottom circles, put the word feelings. In the last circle, put the word behaviors. Then draw two-way arrows between each circle. Basically, what this is showing is that each of the three affect the other. So for instance, if you look at your paper as I described this right now, hopefully this will make more sense. So if I think so in the thoughts circle put, I'm going to get fired. That's your thought, I'm going to get fired. Then in the feeling circle put scared. So if the thought I'm going to get fired, the feeling scared and then behavior turning to food to binge, so the thought is I'm going to get fired, I feel scared, the behavior is binging. So, oh my gosh, I get that message from my boss, I think I'm going to get fired. I feel scared, so I go to lunch and I binge trying to avoid my negative thoughts and feelings of being scared, which in turn now results in me having, so now the person binged as their behavior. Now the arrow goes the other way, too, to the feelings of guilt, so they're feeling guilty. There's the feelings resulting from that behavior and now from those feelings of guilt, now going back to the thought circle, the thoughts are, Oh my gosh, I'm so gross and disgusting. I can't believe I just did that, which oftentimes now results in another binge behavior. So as you can see, they all three impact each other. Hopefully that makes sense if you did draw that down. Okay, so now it's true. Once you have a thought, you have it. But the good news is that you can start to aware of your thoughts or cognitions. By doing this, you can start to identify if you have cognitive distortions and start to identify how these distortions are affecting your feelings and behaviors. The good news is that through cognitive behavioral therapy, or CBT, your cognitive distortions can shift over time to be less faulty and less distorted, resulting in less negative feelings and overall more functional behaviors. So what are some of the most common cognitive distortions, especially for someone who's had, who has or had an eating disorder? I'm just going to discuss some of the most common ones that I hear in my office. One of the most common is shoulds. Often say to my patients that they need to stop shooting all over themselves. But shoulds are demands that someone puts on themselves like, I should have done better or I should be perfect. For someone who has an eating disorder, they can have thoughts like, I should exercise extra hard today after eating all of that food I did this morning, or I shouldn't have eaten that popcorn at the movie. Now I have to breakfast tomorrow. Another cognitive distortion is catastrophizing. So when a person engages in catastrophizing, they expect disaster to strike no matter what. Like what if tragedy strengths? What if that happens to me? They imagine the absolute worst thing happening. For someone with an disorder, they may have insistent overwhelming thoughts like, what if I try my jeans and they don't fit? I know they won't. I just know it, I've been so bad, I don't know what I'm going to do. I was being so good and I messed it all up. What am I going to do? They just ruminate. Everything's just dramatic and overwhelming and everything's going to be horrible. There's another distortion. It's known as all or nothing, or black and white or polarized thinking. When someone has this distortion, they have to be perfect or they're a complete failure. There's no middle ground. There's no gray. So a person with this polarized thinking, they place people or situations in either or categories. They don't allow any complexity for any situations or just anything. So they see things in extremes. For someone with an eating disorder, they have very rigid thoughts like, I can only eat these foods and never those, or all of these foods are bad and all of these are good, or I must do no less than x minutes of cardio day. Even one minute less and they believe that they didn't work out of all that day, or if they break even one of their eating disorder rules, then their entire day is ruined. So it's very, very rigid and like I said, extreme. Going back to that page of the three circles I described earlier, if someone with an all or nothing cognition of if I could only fit in 40 minutes of exercise, now my whole day is ruined, I don't have time to fit in anymore. So that's their thoughts. I only fit in 40 minutes of exercise, now my whole is ruined, I don't have time to fit in anymore. In the feeling circle they feel angry, irritable, and guilty. Then in the behavior circle there are behaviors that they are not eating anything else until they wake up the next day. Jumping to conclusions is another distortion. Without others saying so, a person who jumps to conclusion knows what another person is thinking and feeling and exactly why they act the way they do. So in particular, a person is able to determine how others are feeling toward the person as though they could read their minds. This distortion can also manifest itself as fortune telling. So for someone with an eating disorder, they may have thoughts, like, I know everyone will just be staring at me and thinking how disgusting and gross I am, because I am. I mean, look at me. There's no way I'm going out looking like I do. I can't, there's no way. Or I can't post that picture online. No way. Anyone who sees that will see how gross and disgusting I am. Everyone will be talking about me behind my back after they see it. I will be still humiliated because I know what they're going to be thinking, doc. I know it. It's like they are convinced they know what other people are going to think. There's no way around it. They cannot be convinced that people are going to be thinking anything other than what they believe. What it really is that they're projecting their own worst fears into other people's minds but they truly, truly believe that other people will be thinking these things. One last distortion I want to point out is emotional reasoning. This distortion of emotional reasoning can be summed up by the statement, "If I feel that way, it must be true." Whatever a person is feeling is believed to be true automatically and unconditionally. So emotions are extremely strong in people and basically it overrules their rational thought and reasoning. Emotional reasoning is when a person's emotions take over their thinking entirely, so it negates all rationality and logic. So for someone with an disorder or who has body image issues, they may have thoughts after feeling a mix of sad, anxious feelings after body check in the mirror. So they may be thinking something like nothing I'm doing is working. I'm such a failure. I'm never going to be happy. They're feeling this sadness and anxiety and because they're feeling it's like, it must be true that I'm a failure. It must be true that what I'm doing isn't working. I'm a failure. I'm never going to be happy. I call that, it's coming from the emotion mind. So what I say that is like if you're in emotion mind, which is like the emotions are creating the thoughts, it feels very real and you try to find evidence to support your thoughts when you're in emotion mind. The opposite of that, really, if you want to say it, the opposite is rational mind, which is like facts, facts, only the facts. There's no emotion with that. But if you think, if you only stick with rational mind, we're not robots, robots have no feelings. Robots are just the facts, the facts only the facts. We're humans. We have emotions. You have to take into consideration you can't just be rational all the time. We're just not hardwired that way. I could talk more in a whole nother show about how we do CBT and all sorts of things, but if you're just solely in emotion mind, that's very distorted because there's no rationality behind it at all. So these are just some of the most common cognitive distortions I hear. Of course, there's some more, but I just wanted to get the most common ones out there. If you're listening and you can relate to some of the thoughts or examples I just gave, and you haven't ever done any cognitive behavioral therapy or CBT it might be something you want to look into. Now the first part of CBT is being able to have awareness of your thoughts. At that, if your thoughts are distorted, so like I said earlier, our thoughts are automatic, so being able to become aware of what we're thinking at any given point in time really does take some doing. Once you're able to identify your thoughts, being able to label which distortion your thought is, that's a whole nother step. Sometimes your distortions or your thoughts, they have, sometimes your thoughts have more than one distortion behind it. It can be like an all or nothing and an emotional reasoning. So it can have more than one distortion as a label. Like I said, there's many steps to the process of CBT. Again, that's really a whole nother topic in and of itself but in short, despite most people initially struggling to believe that their thoughts and beliefs can change, they absolutely can and for someone with an eating disorder, ED talk, eating disorder talk consistently running through your mind is extremely toxic. For anyone who has had an eating disorder or who currently has one, you probably know that it can be very difficult to know the difference between your own rational thoughts and those of ED. And every ED thought is distorted, which is why I wanted to discuss this today. Eating disorders are severe illnesses that take over your entire mind, your entire body and your life. I do this podcast to hopefully reach at least one or two people out there listening who need to hear whatever the message is so that they can hear something on one of these shows that can help them feel less alone or maybe less scared to take that step to get help or even to open up to someone in your life about what's going on. Today's episode was short, but maybe today you're that one person and whether you are or you aren't, I'm grateful you're here listening. Till next time This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.