Cognitive distortions: types, examples, how to challenge them and what the evidence says

A cognitive distortion is a habit of thought that reads a situation in a one-sided way, usually towards the negative, on little evidence. Distortions are also called “thinking mistakes” (Özdel et al., 2014). Researchers define them as negatively biased thinking and see them as possible vulnerability factors for depression and low mood (Rnic et al., 2016). Examples include overgeneralisation, concluding “I’m always like this” after a single mistake; all-or-nothing thinking, sorting everything into success or failure; and catastrophising, expecting things to go badly on little or no evidence.

The idea comes from the cognitive theory of Aaron T. Beck. The theory holds that people’s emotional and behavioural reactions depend fundamentally on cognitive structures such as beliefs and ways of thinking, and that processing information in a negatively biased way can lead to unhelpful emotional and behavioural consequences (Özdel et al., 2014). When something happens, thoughts come to mind on their own (automatic thoughts) and lead to emotional and behavioural responses; when these thoughts contain errors in reasoning that are not based on evidence, a negative, neutral or even positive event can bring on negative feelings. The theory holds that, as this sequence repeats, it can cause or maintain symptoms of depression (Rnic et al., 2016).

As early as a 1963 paper, Beck described overgeneralisation, drawing a general conclusion about one’s ability, performance or worth from a single incident, as a hallmark cognitive distortion in depression (Raes et al., 2023). Cognitive distortions were listed in the 1979 book “Cognitive Therapy of Depression” by Beck and colleagues, and David D. Burns expanded the list in the 1980 book “Feeling Good”, naming 10 common thinking errors typical of depression (Rnic et al., 2016).

The short answer: people who score higher on cognitive distortions also tend to score higher on depression and anxiety, but most of this comes from correlations measured at one point in time, so it is still unclear whether distorted thinking brings on depression or depression skews thinking. Noticing and examining these thoughts is an important part of cognitive behavioural therapy (CBT), and CBT has been shown to work for depression and anxiety. Studies disagree, though, on whether the part that changes thoughts adds anything beyond the behavioural parts, such as becoming more active. Cognitive distortions are not a diagnosis, and they also show up in people without depression.

This guide covers the common types of cognitive distortion with examples, how they relate to depression and anxiety, the scales that measure them, ways to challenge them on your own and the evidence behind those ways, the effects of CBT and self-help programmes, and common misunderstandings. mind.io has no cognitive distortion test, and this guide prints no scale items and no cut-off scores. The example sentences were written for illustration.

Below are the 10 types covered by the Cognitive Distortions Scale (CDS). The definitions follow the description in a study that used this scale (Rnic et al., 2016). Burns’s list groups mind reading and fortune telling together under “jumping to conclusions” (Batmaz et al., 2015). The types overlap, and in several questionnaire studies they came out as a single tendency (see the section on measurement), so rather than looking for the exact label, it is more useful to ask whether the thought is backed by evidence.

1. All-or-nothing thinking. Seeing something as either-or, without considering the full range of possible evaluations in between. Example: “I stumbled once in the presentation, so it was a total disaster.”

2. Overgeneralisation. Assuming that because one bad thing happened, more bad things will follow. Beck described it as judging one’s whole ability or worth from a single incident (Raes et al., 2023). Example: “I failed this interview, so no one will ever hire me.”

3. Mental filter. Focusing on negative information and devaluing positive information. Example: on a day with several compliments, replaying one critical remark all day.

4. Disqualifying the positive. Ignoring or dismissing good things that have happened. Example: “I only did well in the exam because I got lucky.”

5. Mind reading. Assuming that others are thinking negatively about you. Example: when a group chat is slow to answer your message, “They all find me annoying.”

6. Catastrophising (fortune telling). Making negative predictions about the future on little or no evidence. Another scale, the CD-Quest, asks about this as “fortune telling (catastrophizing)” and asks about “magnification/minimization” separately (Batmaz et al., 2015). Example: “If there is a mistake in this report, I’ll be fired and my life will be over.”

7. Emotional reasoning. Believing something is true because of how you feel rather than on objective evidence. Example: “I feel this anxious, so something must be going wrong.”

8. Should statements. Thinking that things must or should be a certain way. The CD-Quest describes them with “musts”, “ought tos” and “have tos” (Batmaz et al., 2015). Example: “I must never make a mistake.”

9. Labelling. Putting a negative label on yourself after something goes wrong. Example: forgetting an appointment and thinking “I’m hopeless.”

10. Personalisation. Assuming that you are the cause of a bad event. Example: a team deadline slips for several reasons, yet the thought is “It’s all my fault.”

The CD-Quest also includes blaming others or oneself, “What if…?” statements and unfair comparisons (Batmaz et al., 2015). What they all have in common is that they are errors in reasoning that are not based on evidence (Rnic et al., 2016).

Cognitive distortions go together with depression and anxiety. In a study of 208 first-year university students in Canada, how often students reported distorted thinking on the CDS correlated r = .35 with their depression scores (BDI-II) (Rnic et al., 2016). In a Turkish study, 225 hospital interns (medical and nursing students and others) without any diagnosable psychiatric disorder scored lower than 100 outpatients with major depressive disorder (mean 58.54 vs 82.85), and among the interns all 20 items correlated weakly to moderately with depression scores (r = .158 to .338) and were also related to anxiety scores (Özdel et al., 2014). A study of 184 Brazilian university students using another scale, the CD-Quest, found correlations of r = .65 with depression scores and r = .52 with anxiety scores (de Oliveira et al., 2015).

Among patients already diagnosed with depression, however, only 4 of the 20 items correlated with depression scores, while 10 items correlated with their usual level of anxiety (trait anxiety) (Özdel et al., 2014). Even when groups differ clearly, a distortion score alone may not tell how depressed a person is.

All of these are correlations measured at a single point in time. The Canadian team noted that, for this reason, they could not rule out that earlier depression came first and predicted the distortions (Rnic et al., 2016). One study did look at the order in time. Among 625 adults recruited from the community and surveyed again six months later, those who reported a stronger tendency to overgeneralise negatively about themselves had more depressive symptoms six months later, even after taking into account their initial symptoms and a history of depression estimated from a questionnaire. Another measure, which assessed overgeneralisation with hypothetical situations, did not predict later depression, and none of the measures predicted a first onset of depression; the researchers judged that this last analysis probably had low statistical power (Raes et al., 2023).

The Royal College of Psychiatrists notes that when we are feeling sad or distressed, we might be more likely to interpret things in extreme and unhelpful ways (Royal College of Psychiatrists, 2022). In short, studies from several countries point the same way, that cognitive distortions go together with depression and anxiety, but the studies covered here are not enough to say that distortions cause depression. Whether treatment that targets distortions reduces depression and anxiety is covered below, in the section on effects.

Two of the scales used in research are described here. The Cognitive Distortions Scale (CDS) was developed by Covin and colleagues in 2011, who checked its reliability and validity in 318 undergraduates (Özdel et al., 2014). It asks about the 10 types in two kinds of situations, interpersonal and achievement (school or work), in 20 items: each item shows a definition of the distortion and a short example, and people rate how often they think that way from 1 (never) to 7 (all the time). To reduce defensiveness, the questionnaire calls each distortion a “thinking type” (Rnic et al., 2016).

The Cognitive Distortions Questionnaire (CD-Quest) has 15 items and asks both how often and how intensely each distortion occurs (Kaplan et al., 2017). Its validity has been examined in 184 Brazilian university students (de Oliveira et al., 2015), 269 Turkish psychiatric outpatients with mainly mood symptoms (Batmaz et al., 2015) and treatment-seeking adults with social anxiety disorder; in that last study its scores were also sensitive to treatment (Kaplan et al., 2017).

What a scale can show is an overall tendency. In factor analyses from several studies, the 10 to 15 types formed a single factor (Özdel et al., 2014; de Oliveira et al., 2015; Batmaz et al., 2015; Kaplan et al., 2017), although the first analysis of the CD-Quest, presented at a conference, found four factors (Batmaz et al., 2015). So reading a result as a diagnosis of one type, such as “I’m a mind reader”, calls for caution. The Turkish study tried counting an item as “present” when it was rated 6 or 7: the interns without a diagnosis rated a mean of 1.66 items that way (SD 2.87), and the patients with depression a mean of 5.69. The researchers added that the scale should be used with some caution for clinical and experimental purposes (Özdel et al., 2014).

There are also things a scale cannot tell you. A score is your own report of how often you think a certain way; it does not decide whether a particular thought of yours is actually wrong. Nor is it a tool for diagnosing depression or any other condition. mind.io has no cognitive distortion test. If you often think little of yourself, the self-esteem test shows your current self-esteem, and if your mood or anxiety worries you, the depression check-in (PHQ-9) and the anxiety check-in (GAD-7) ask about symptoms over the last 2 weeks. These are also self-checks, not diagnoses.

The first step is noticing. The NHS calls the process “catch it, check it, change it”. It explains that we are often not even aware we are thinking in an unhelpful way, so knowing what sort of thinking is unhelpful may make it easier to spot. With practice it should get easier, and over time it may even become automatic (NHS, 2026a).

Then check the thought. The NHS suggests asking yourself how likely the outcome you are worried about is, whether there is good evidence for the thought, whether there are other explanations or possible outcomes, whether there is good evidence for other ways of looking at the situation, and what you would say to a friend thinking this way (NHS, 2026a). The Royal College of Psychiatrists gives similar examples: “What’s the evidence this is true?”, “What’s another way to think about this?” and “What advice would I give a friend in my situation?” (Royal College of Psychiatrists, 2022). In therapy, examining thoughts through questions like these, known as Socratic questioning, is considered a key strategy in cognitive therapy for depression (Braun et al., 2015).

A thought record, a common CBT exercise, puts this process on paper. The NHS thought record has 7 prompts: what happened, how you felt at first, the unhelpful thoughts you had, the evidence for them, the evidence against them, an alternative, more realistic or neutral thought, and how you feel after completing the record. You can think it through in your head, but it is usually best to write it down (NHS, 2026b). In the NHS example, someone who forgot an errand and thought “I’m useless” would write down the evidence against it: they remembered everything else they needed to do.

There is also evidence from inside therapy. In a study of 55 depressed adults in a 16-week course of cognitive therapy, when the therapist used more Socratic questioning than usual with a given person in the early sessions, that person’s depression score fell further by the next session (1.51 BDI-II points for each standard deviation) (Braun et al., 2015). Another study of 123 people in CBT for depression found results consistent with such questioning reducing symptoms through a change in thinking, and the effect of questioning on change in thinking was stronger for people who started treatment with weaker CBT skills (Vittorio et al., 2022). Both studies observed therapy as it happened, so unlike an experiment that assigns questioning at random, they cannot establish cause.

You can also put a thought to the test. In an example from the Royal College of Psychiatrists, if you are very tired and depressed and fear that a 20-minute walk each day will make you feel worse, you try it for a week, keep a written record and check whether the prediction came true (Royal College of Psychiatrists, 2022). Such behavioural experiments and thought records are regarded as two central techniques of CBT. In an experiment that randomly allocated 91 non-clinical participants to three conditions, a single thought record session and a single behavioural experiment session both improved beliefs, anxiety, behaviour and a symptom measure compared with a control condition, and the behavioural experiment had a small advantage: the target belief changed earlier and the change extended to beliefs about others (McManus et al., 2012). In a study of people on cognitive therapy training courses who tried both techniques on themselves, behavioural experiments were rated as more powerful and compelling (Bennett-Levy, 2003).

It is fine if the thought does not change. The NHS says not to worry if you cannot change a thought, and that changing it is not the only way to benefit from the process. The aim is to learn to think more flexibly; the process will not resolve the problems you face, but it can help break a negative spiral (NHS, 2026a).

The treatment that works directly on cognitive distortions is CBT. Korea’s Ministry of Health and Welfare describes it as a psychotherapy in which people find and correct distorted thinking themselves and change wrongly learned behaviour (Ministry of Health and Welfare, 2018). A meta-analysis of 409 randomised controlled trials of CBT for depression (52,702 patients) found a moderate to large effect at the end of treatment across the 271 comparisons with control conditions such as care as usual and waiting lists (g = 0.79). The effect fell to 0.60 when only trials with a low risk of bias were included, and to 0.47 after correcting for publication bias. The share of people whose symptoms fell by at least half was 42% with CBT and 19% in control conditions, although in most studies these rates were estimated from mean scores. CBT’s advantage over other psychotherapies was small and not significant in most sensitivity analyses (Cuijpers et al., 2023).

For anxiety-related disorders, a meta-analysis of 41 randomised trials (2,843 patients) that compared CBT with a pill or psychological placebo found a moderate effect (g = 0.56). In this analysis, treatments that mainly used exposure had larger effects than those using cognitive, or cognitive and behavioural, techniques, but the difference was not statistically significant (Carpenter et al., 2018).

Working on your own can help too. Unguided self-help CBT, online or not, had a small to moderate effect on depression across 36 studies (11,720 participants) (g = 0.45), which shrank to 0.25 after correcting for publication bias (Cuijpers et al., 2023). A network meta-analysis of 155 depression trials (15,191 participants) found that guided self-help, with support from a professional, did not differ in effect from individual, group or telephone CBT, and that all four beat unguided self-help; more people dropped out of guided self-help than out of individual or group CBT, though (Cuijpers et al., 2019). In 21 studies (810 participants) directly comparing guided self-help with face-to-face therapy for depression and anxiety disorders, there was no difference at the end of treatment either (d = −0.02) (Cuijpers et al., 2010). An analysis of individual data from online CBT trials found that the difference between guided and unguided programmes was small for people scoring 5 to 9 on the PHQ-9, while guided programmes did better for those scoring 10 or more (Karyotaki et al., 2021).

So is changing thoughts essential? There are serious challenges to that idea. In a trial that randomly assigned 150 outpatients with major depression to behavioural activation alone (the part that increases activity), behavioural activation plus skills for changing automatic thoughts, or full cognitive therapy, there was no evidence that the full treatment did better, either at the end of treatment or six months later, and the two partial treatments changed negative thinking just as much as the full one (Jacobson et al., 1996). A 2007 review concluded that component studies give little evidence that specific cognitive techniques significantly increase the effectiveness of therapy, and little empirical support for cognitive change being the cause of improvement (Longmore & Worrell, 2007). In a trial of 241 adults with major depression, behavioural activation was comparable to antidepressant medication among the more severely depressed, and both did significantly better than cognitive therapy (Dimidjian et al., 2006). In a UK trial of 440 people, behavioural activation delivered by junior mental health workers with less intensive training was no worse than CBT on depression scores (PHQ-9) at 12 months (a mean of 8.4 in both groups). The CBT in that trial included thought records to examine whether negative automatic thoughts were accurate (Richards et al., 2016). An analysis of the components of 76 trials of online CBT found suggestive evidence that behavioural activation might be beneficial and that relaxation might even be harmful; its abstract reports nothing specific on cognitive restructuring (Furukawa et al., 2021).

There is evidence on the other side too. A 2015 review set out the methodological and inferential limits of earlier studies and concluded that cognitive techniques are effective in reducing depressive symptoms and that cognitive change, however it is achieved, contributes to symptom change (Lorenzo-Luaces et al., 2015). A network meta-analysis of 45 studies of adult depression (3,382 participants) found that, delivered face to face and individually, cognitive restructuring alone, behavioural activation alone and their combination, CBT, were all better than care as usual or waiting lists, with no evidence of a difference between the three, and the authors added that more research is needed before conclusions can be drawn about cognitive restructuring (Ciharova et al., 2021). In a study that followed 35 people who had responded to cognitive therapy for depression for a year, those who had learned and used the coping skills of cognitive therapy on their own were at lower risk of relapse, whereas self-esteem at the end of treatment did not predict relapse (Strunk et al., 2007).

In short, techniques for examining thoughts do work, but in several comparisons the behavioural parts alone worked about as well, so what matters most is still unsettled. Rather than relying only on thought records, it is worth also trying behavioural steps such as taking up a postponed activity again in a small way. Behavioural activation is covered in more detail in the depression guide. In Korea, the government decided in 2018 to cover standardised CBT for depression, panic disorder, post-traumatic stress disorder and other conditions under national health insurance (Ministry of Health and Welfare, 2018). What a first appointment involves is described in seeing a psychiatrist for the first time.

If working on your own does not help, or low mood or anxiety keeps making daily life hard, seek professional help. In Korea, that can be a psychiatric clinic or a local mental health welfare centre; elsewhere, start with a family doctor or a local mental health service. If you have thoughts of ending your life, do not carry them alone: call or text 988 in the US and Canada, or call Samaritans on 116 123 in the UK and Ireland, right away. If you are in immediate danger, contact your local emergency services.

It is not “think positive”. The Royal College of Psychiatrists lists “CBT is just positive thinking” as a myth and explains that CBT is about learning more helpful, realistic ways of thinking (Royal College of Psychiatrists, 2022). A review likewise describes CBT as aiming to realign thinking with reality (Longmore & Worrell, 2007). The goal is not to replace a thought with “I’m perfect” but to find one that fits the evidence, such as “I made a mistake this time, but it doesn’t happen every time.”

Thoughts like these also occur in people without a diagnosis. In the Turkish study above, interns without any psychiatric diagnosis gave a 6 or 7 (7 meaning “all the time”) to a mean of 1.66 of the 20 items on the distortion scale, although patients with depression did so for many more, a mean of 5.69 (Özdel et al., 2014). Having such thoughts now and then does not by itself mean something is wrong.

A cognitive distortion is not a diagnosis. The term describes a way in which thinking leans to one side (Rnic et al., 2016), and a high distortion score does not mean depression or an anxiety disorder. A diagnosis is made by a professional, looking at symptoms, how long they have lasted and how much they get in the way of daily life.

Not every negative thought is a distortion. For realistic problems such as debts, CBT also uses problem solving (Royal College of Psychiatrists, 2022). A meta-analysis of 75 studies (7,305 participants) of “depressive realism”, the idea that depressed people see reality more accurately, found the effect to be small (d = −.07); both depressed and non-depressed people tended to show a positive bias, and the bias was larger in the non-depressed (Moore & Fresco, 2012). How accurate a judgement is depends on the situation, so whether a thought is a distortion has to be checked against the evidence.

It does not change overnight. The Royal College of Psychiatrists also lists “CBT is quick and easy to do” as a myth, explaining that changing old habits takes time and practice (Royal College of Psychiatrists, 2022). The NHS likewise says that it gets easier with practice (NHS, 2026a).

Q. Is there a cognitive distortion test? A. Research scales exist, such as the Cognitive Distortions Scale (CDS, 20 items) and the Cognitive Distortions Questionnaire (CD-Quest, 15 items) (Özdel et al., 2014; Kaplan et al., 2017). But the studies read for this guide offer no widely agreed cut-off score, and in several studies the types formed a single factor in questionnaires. mind.io has no cognitive distortion test. If you take a free online test, treat it only as a prompt to reflect on your habits of thought.

Q. Why do cognitive distortions happen? A. In Beck’s theory, the content of automatic thoughts is usually in line with core beliefs about oneself, others and the world, and these beliefs typically fall into two groups, around being unlovable and around being helpless (Rnic et al., 2016). Beck’s developmental model of depression sees early traumatic experiences and the dysfunctional beliefs formed then as factors predisposing to depression, and later stressful events that match those beliefs as triggers (Beck, 2008). This is a theoretical account, and it cannot by itself establish where a particular person’s thoughts come from.

Q. How do cognitive distortions relate to self-esteem? A. Researchers of cognitive distortions describe self-esteem as a variable associated with both distortions and depression (Rnic et al., 2016). A meta-analysis that reviewed 8 studies of CBT aimed directly at low self-esteem and pooled 7 found that weekly sessions improved self-reported scores at the end of treatment by a large amount (effect size 1.12) and one-day workshops by a small amount (0.34). But there were few studies, and it was unclear how different these programmes are from treatments for depression (Kolubinski et al., 2018). In a study of cognitive therapy for depression, the coping skills people had learned predicted a lower risk of relapse, but self-esteem at the end of treatment did not (Strunk et al., 2007). The self-esteem test shows your current self-esteem, but it does not measure cognitive distortions.

Q. How long does it take? A. It depends on the problem and how things go. The Royal College of Psychiatrists says a course of CBT can last from 6 weeks to 6 months, usually with 6 to 20 sessions with a therapist (Royal College of Psychiatrists, 2022), and the NHS says 5 to 15 sessions is usual (NHS, 2025). Practising on your own also gets easier over time and may even become automatic (NHS, 2026a).

Q. When should I get professional help? A. If daily life stays hard even after trying on your own, if you score 10 or more on the PHQ-9 or GAD-7, or if you answer PHQ-9 item 9 (thoughts of death or of hurting yourself) with anything other than “Not at all”, whatever your total, talk to a professional; mind.io suggests doing so in each of these cases. If you have thoughts of hurting yourself, do not carry them alone: call or text 988 in the US and Canada, or call Samaritans on 116 123 in the UK and Ireland, right away. In online CBT studies, people scoring 10 or more on the PHQ-9 did better with programmes that came with human guidance (Karyotaki et al., 2021), and the Royal College of Psychiatrists says self-help CBT is more likely to work if you also get support from a professional (Royal College of Psychiatrists, 2022).

Q. These thoughts make me feel I don’t want to be alive. A. Please do not carry this alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

References: Özdel, K., Taymur, I., Guriz, S. O., Tulaci, R. G., Kuru, E., & Turkcapar, M. H. (2014), Measuring cognitive errors using the Cognitive Distortions Scale (CDS): psychometric properties in clinical and non-clinical samples, PLoS ONE 9(8), e105956, https://doi.org/10.1371/journal.pone.0105956; Rnic, K., Dozois, D. J. A., & Martin, R. A. (2016), Cognitive distortions, humor styles, and depression, Europe’s Journal of Psychology 12(3), 348-362, https://doi.org/10.5964/ejop.v12i3.1118; Raes, F., Griffith, J. W., Craeynest, M., Williams, J. M. G., Hermans, D., Barry, T. J., Takano, K., & Hallford, D. J. (2023), Overgeneralization as a predictor of the course of depression over time: the role of negative overgeneralization to the self, negative overgeneralization across situations, and overgeneral autobiographical memory, Cognitive Therapy and Research 47(4), 598-613, https://doi.org/10.1007/s10608-023-10385-6; Batmaz, S., Kocbiyik, S., & Yuncu, O. A. (2015), Turkish version of the Cognitive Distortions Questionnaire: psychometric properties, Depression Research and Treatment 2015, 694853, https://doi.org/10.1155/2015/694853; de Oliveira, I. R., Seixas, C., Osório, F. L., Crippa, J. A., de Abreu, J. N., Menezes, I. G., Pidgeon, A., Sudak, D., & Wenzel, A. (2015), Evaluation of the psychometric properties of the Cognitive Distortions Questionnaire (CD-Quest) in a sample of undergraduate students, Innovations in Clinical Neuroscience 12(7-8), 20-27, https://pubmed.ncbi.nlm.nih.gov/26351620/; Royal College of Psychiatrists (2022), Cognitive behavioural therapy (CBT), https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/cognitive-behavioural-therapy-(cbt); Kaplan, S. C., Morrison, A. S., Goldin, P. R., Olino, T. M., Heimberg, R. G., & Gross, J. J. (2017), The Cognitive Distortions Questionnaire (CD-Quest): validation in a sample of adults with social anxiety disorder, Cognitive Therapy and Research 41(4), 576-587, https://doi.org/10.1007/s10608-017-9838-9; NHS (2026a), Reframing unhelpful thoughts [Every Mind Matters], https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/self-help-cbt-techniques/reframing-unhelpful-thoughts/; Braun, J. D., Strunk, D. R., Sasso, K. E., & Cooper, A. A. (2015), Therapist use of Socratic questioning predicts session-to-session symptom change in cognitive therapy for depression, Behaviour Research and Therapy 70, 32-37, https://doi.org/10.1016/j.brat.2015.05.004; NHS (2026b), Thought record [Every Mind Matters], https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/self-help-cbt-techniques/thought-record/; Vittorio, L. N., Murphy, S. T., Braun, J. D., & Strunk, D. R. (2022), Using Socratic questioning to promote cognitive change and achieve depressive symptom reduction: evidence of cognitive change as a mediator, Behaviour Research and Therapy 150, 104035, https://doi.org/10.1016/j.brat.2022.104035; McManus, F., Van Doorn, K., & Yiend, J. (2012), Examining the effects of thought records and behavioral experiments in instigating belief change, Journal of Behavior Therapy and Experimental Psychiatry 43(1), 540-547, https://doi.org/10.1016/j.jbtep.2011.07.003; Bennett-Levy, J. (2003), Mechanisms of change in cognitive therapy: the case of automatic thought records and behavioural experiments, Behavioural and Cognitive Psychotherapy 31(3), 261-277, https://doi.org/10.1017/S1352465803003035; Ministry of Health and Welfare (2018), Get counselling treatment at a nearby psychiatric clinic: psychotherapy fee reform and lower co-payments [press release, in Korean], https://www.mohw.go.kr/board.es?mid=a10503000000&bid=0027&act=view&list_no=343770; Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023), Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients, World Psychiatry 22(1), 105-115, https://doi.org/10.1002/wps.21069; Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G. (2018), Cognitive behavioral therapy for anxiety and related disorders: a meta-analysis of randomized placebo-controlled trials, Depression and Anxiety 35(6), 502-514, https://doi.org/10.1002/da.22728; Cuijpers, P., Noma, H., Karyotaki, E., Cipriani, A., & Furukawa, T. A. (2019), Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression: a network meta-analysis, JAMA Psychiatry 76(7), 700-707, https://doi.org/10.1001/jamapsychiatry.2019.0268; Cuijpers, P., Donker, T., van Straten, A., Li, J., & Andersson, G. (2010), Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies, Psychological Medicine 40(12), 1943-1957, https://doi.org/10.1017/S0033291710000772; Karyotaki, E., Efthimiou, O., Miguel, C., Bermpohl, F. M. G., Furukawa, T. A., Cuijpers, P., & IPDMA-DE Collaboration (2021), Internet-based cognitive behavioral therapy for depression: a systematic review and individual patient data network meta-analysis, JAMA Psychiatry 78(4), 361-371, https://doi.org/10.1001/jamapsychiatry.2020.4364; Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E., & Prince, S. E. (1996), A component analysis of cognitive-behavioral treatment for depression, Journal of Consulting and Clinical Psychology 64(2), 295-304, https://doi.org/10.1037/0022-006X.64.2.295; Longmore, R. J., & Worrell, M. (2007), Do we need to challenge thoughts in cognitive behavior therapy?, Clinical Psychology Review 27(2), 173-187, https://doi.org/10.1016/j.cpr.2006.08.001; Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., et al. (2006), Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression, Journal of Consulting and Clinical Psychology 74(4), 658-670, https://doi.org/10.1037/0022-006X.74.4.658; Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., et al. (2016), Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a randomised, controlled, non-inferiority trial, The Lancet 388(10047), 871-880, https://doi.org/10.1016/S0140-6736(16)31140-0; Lorenzo-Luaces, L., German, R. E., & DeRubeis, R. J. (2015), It’s complicated: the relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression, Clinical Psychology Review 41, 3-15, https://doi.org/10.1016/j.cpr.2014.12.003; Ciharova, M., Furukawa, T. A., Efthimiou, O., Karyotaki, E., Miguel, C., Noma, H., Cipriani, A., Riper, H., & Cuijpers, P. (2021), Cognitive restructuring, behavioral activation and cognitive-behavioral therapy in the treatment of adult depression: a network meta-analysis, Journal of Consulting and Clinical Psychology 89(6), 563-574, https://doi.org/10.1037/ccp0000654; Furukawa, T. A., Suganuma, A., Ostinelli, E. G., Andersson, G., Beevers, C. G., Shumake, J., et al. (2021), Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data, The Lancet Psychiatry 8(6), 500-511, https://doi.org/10.1016/S2215-0366(21)00077-8; Strunk, D. R., DeRubeis, R. J., Chiu, A. W., & Alvarez, J. (2007), Patients’ competence in and performance of cognitive therapy skills: relation to the reduction of relapse risk following treatment for depression, Journal of Consulting and Clinical Psychology 75(4), 523-530, https://doi.org/10.1037/0022-006X.75.4.523; Moore, M. T., & Fresco, D. M. (2012), Depressive realism: a meta-analytic review, Clinical Psychology Review 32(6), 496-509, https://doi.org/10.1016/j.cpr.2012.05.004; Beck, A. T. (2008), The evolution of the cognitive model of depression and its neurobiological correlates, American Journal of Psychiatry 165(8), 969-977, https://doi.org/10.1176/appi.ajp.2008.08050721; Kolubinski, D. C., Frings, D., Nikčević, A. V., Lawrence, J. A., & Spada, M. M. (2018), A systematic review and meta-analysis of CBT interventions based on the Fennell model of low self-esteem, Psychiatry Research 267, 296-305, https://doi.org/10.1016/j.psychres.2018.06.025; NHS (2025), Cognitive behavioural therapy (CBT): overview, https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/