Externalizing

A brief introduction to cognitive distortions

Cognitive distortions, cognitive biases, or ‘unhelpful thinking styles’ are the characteristic ways our thoughts become biased (Beck, 1963). We are always interpreting the world around us, trying to make sense of what is happening. Sometimes our brains take ‘shortcuts’ and we think things that are not completely accurate. Different cognitive short cuts result in different kinds of bias or distortions in our thinking. Sometimes we might jump to the worst possible conclusion (“this rough patch of skin is cancer!”), at other times we might blame ourselves for things that are not our fault (“If I hadn’t made him mad he wouldn’t have hit me”), and at other times we might rely on intuition and jump to conclusions (“I know that they all hate me even though they’re being nice”). These biases are often maintained by characteristic unhelpful assumptions (Beck et al., 1979).

Different cognitive biases are associated with different clinical presentations. For example, catastrophizing is associated with anxiety disorders (Nöel et al., 2012), dichotomous thinking has been linked to emotional instability (Veen & Arntz, 2000), and thought-action fusion is associated with obsessive compulsive disorder (Shafran et al., 1996).

Catching automatic thoughts and (re)appraising them is a core component of traditional cognitive therapy (Beck et al., 1979; Beck, 1995; Kennerley, Kirk, Westbrook, 2007). Identifying the presence and nature of cognitive biases is often a helpful way of introducing this concept – clients are usually quick to appreciate and identify with the concept of ‘unhelpful thinking styles’, and can easily be trained to notice the presence of biases in their own automatic thoughts. Once biases have been identified, clients can be taught to appraise the accuracy of these automatic thoughts and draw new conclusions.

Externalizing

Externalization (also referred to as ‘other-blame’, ‘personalized blame’, and ‘defensive attribution’) describes a style of thinking whereby individuals blame others for negative events and deny personal responsibility. Research suggests that individuals are more likely to think this way in situations where the role of other people is ambiguous (Hazebroek et al., 2001) or if they believe they are lowly valued by others (Orobio de Castro et al., 2002). In addition, people are likely to blame others if they are distrustful, mad, shame-prone, feel threatened, or experience hard-to-explain events that negatively impact them (Hazebroek et al., 2001, Singh, 2021; Tangey et al., 1992).

It is often assumed that external attributions for negative outcomes are healthy, as they help to buffer self-esteem. This ‘self-serving bias’ (Bradley, 1978; Zuckerman, 1979) describes how individuals often make internal attributions for positive events (“I passed the test because I’m clever”) and external attributions for negative events (“I failed the test because the questions were unfair”). Furthermore, self-serving attributions can have positive social effects: individuals are less likely to be attacked when they blame transgressions and unjust acts on external causes rather than themselves (Weiner et al., 1987). Finally, external attributions can be beneficial in the context of trauma. For example, individuals who blame others for childhood abuse often experience less distress and impairment than those who blame themselves (e.g., Hoagwood, 1990).

Unfortunately, external attributions can also be maladaptive. Many studies indicate that blaming others for negative events is associated with reduced health and well-being (Tennen & Affleck, 1990). For instance, individuals who blame others for chronic pain experience greater pain and distress than those who do not (DeGood & Kiernan, 1993). Similarly, individuals who admit responsibility for road traffic accidents report fewer post-traumatic symptoms and better remission from post-traumatic stress disorder (PTSD) than those who blame others (Hickling et al., 1999).

While these findings might appear counterintuitive, several factors explain why external attributions have such negative consequences:

• At an intrapersonal level, blaming others can shatter personal beliefs about invulnerability, the reliability of others, and the benevolent nature of the world, resulting in increased vulnerability (Janoff-Bulman & Frieze, 1983).
• Blaming others reduces one’s sense of control over threats, while blaming oneself allows for change and adaptation (Hickling et al., 1999).
• Externalizing can obstruct the use of more adaptive coping strategies such as problem-solving (Tennen & Affleck, 1990), while anger associated with other-blaming can prevent the modification of distressing thoughts and trauma-related memories (Riggs et al., 1992). Anger arising from external attributions may serve to minimize the anxiety or sadness associated with distressing events (Ehler & Steil, 1995).

External attributions also have adverse interpersonal effects. For example, blaming others can lead to isolation and alienation, particularly if others do not agree with these judgments (Sullivan, 1956). Moreover, external attributions might cause individuals to turn against their social supports and avoid others (Phillips, 1968). Within the context of psychological therapy, blaming others can undermine the therapeutic alliance and decrease motivation to change (DeGood & Kiernan, 1993).

Given the negative consequences associated with externalization, why are individuals motivated to think in this way? One line of argument is that externalization reduces damage to self-esteem. For example, ashamed individuals often limit self-condemnation by replacing self-blame with other-blame and hostility, helping them regain control and escape a submissive interpersonal position (Potard et al., 2022; Thomaes et al., 2011). Research indicates that a propensity to shame is related to blaming others and hostility (Stuewig et al., 2010; Tangey et al., 1992). Furthermore, Potard and colleagues (2022) note that “externalization of blame [can] become cognitively distorted, such that aggressive behavior appears justified”. A similar process has also been observed in persecutory delusions. Kinderman and Bentall (1997) suggest that individuals with delusions have an exaggerated form of the healthy self-serving bias, blaming others for negative events to preserve fragile self-esteem. Accordingly, external attributions are self-protective in that they reduce discrepancies between the individual’s actual self and ideal self (Bentall & Kaney, 1996). In other words:

“Many patients have had to make a choice between something being wrong with them and something being wrong in the world. Believing that something is wrong with them (for instance, that they are becoming mad) may be a more distressing belief then that they are being persecuted, and hence a persecutory belief is more likely to be chosen in such circumstances. In this respect, there is an external attribution that limits the distress caused to individuals in terms of cost to self-esteem”.

Freeman et al., 2002 (p.335).

Multiple studies indicate that individuals with persecutory delusions tend to make external attributions for negative events, shifting responsibility for these outcomes to specific people or institutions (e.g., Diez-Alegria et al., 2006).

Justifying harmful actions can be an alternative motivation for externalization. In this context, it functions as a ‘self-serving’ thinking style that legitimizes destructive acts (e.g., violence) while protecting the individual’s self-image and minimizing culpability. Stuewig and colleagues (2010) note that “these distortions are not just ‘after the fact’ rationalizations but are beliefs and attitudes that theoretically contribute to antisocial behavior”. Research demonstrates that blaming others and minimizing personal responsibility is associated with violence and aggression, and increased risk of reoffending (Henning & Holdford, 2006; Oostermeijer et al., 2017).

Examples of externalization include:

• Blaming others (e.g., “It’s all his fault”).
• Denying responsibility (e.g., “She made me do it”).
• Scapegoating (e.g., “They are to blame for all my problems”).
• Self-justification (e.g., “He provoked me, so what I did is OK”).

People who often use externalization may have ‘blind spots’ when it comes to:

• Acknowledging personal faults or problems.
• Taking responsibility for negative behaviors (e.g., transgressions).
• Tolerating shame or threats to self-esteem.
• Accepting negative events and experiences.
• Forming complex (rather than simplistic) explanations for events and behavior.

As with many cognitive biases, there may be evolutionary reasons why people use externalization. For example, humans have long been exposed to unmanageable threats and severe hard-to-explain events. In this context, attributing blame to the malevolent intentions of others (e.g., witch-hunting) may have provided individuals with a sense of control, reducing the high levels of anxiety that could have compromized their survival (Markle, 2010). Moreover, tracing harm back to others would have been an important survival strategy in conflictual environments, even if these attributions are sometimes incorrect (Singh, 2021). Finally, blaming others and deflecting responsibility is likely to have been an important form of ‘impression management’ in social groups, helping reduce the risk of retaliation or rejection following transgressions and other negative acts (Weiner et al., 1987).

Externalizing is associated with a wide range of difficulties, including:

• Addictions (Volk et al., 2019)
• Anger (Oostermeijer et al., 2017)
• Acute stress (Lambert et al., 2004)
• Anxiety (Rodríguez Menchón et al., 2021)
• Complicated grief (Weinberg, 1994)
• Chronic pain (DeGood & Kiernan, 1996)
• Depression (Blake et al., 2016)
• Narcissism (Beck et al., 2004)
• Paranoia (Kinderman & Bentall, 1997)
• Perfectionism (Hewitt & Flett, 1991)
• PTSD (Hickling et al., 1999)
• Relationship problems. (Bradbury & Fincham, 1990)
• Shame (Tangey et al., 1992)

Many people struggle with externalization, and it sounds as though it might be relevant to you too. Would you be willing to explore it with me?

Clinicians might begin by providing psychoeducation about externalization and automatic thoughts more generally:

• Automatic thoughts spring up spontaneously in our minds, usually in the form of words or images.
• They are often on the ‘sidelines’ of our awareness. With practice, we can become more aware of them. It is a bit like a theatre – we can bring our automatic thoughts ‘center stage’.  
• Automatic thoughts are not always accurate: just because you think something, it doesn’t make it true.
• Automatic thoughts are often inaccurate in characteristic ways. One common type of bias in automatic thoughts is ‘externalization’: we sometimes blame others for negative events or experiences and deny we are responsible. People might do this to protect their self-esteem, justify their actions (e.g., violence), or cope with difficult feelings (e.g., shame). However, it often causes problems in the long-term.
• Signs that you are externalizing include looking for reasons why others are to blame, refusing to take responsibility for your actions, or minimizing your culpability when things go wrong.
• In some circumstances, it is helpful to externalize. Most people have a healthy ‘self-serving bias’ that helps protect their self-esteem. We often attribute positive experiences to ourselves (e.g., passing a test because we are smart) and negative experiences to other factors (e.g., failing a test because the questions were unfair). A little externalization can also ensure other people see us positively. However, externalizing too much has a negative impact on yourself and your relationships, and can stop you confronting your problems. Why would you if you aren’t responsible for them?

Many treatment techniques can be used to address externalization:

• Decentering. Meta-cognitive awareness, or decentering, describes the ability to stand back and view a thought as a cognitive event: as an opinion, and not necessarily a fact (Flavell, 1979). Help clients to practice labeling the process present in the thinking rather than engaging with the content. For instance, they might say to themselves, “I’m externalizing again”, whenever they notice these thoughts.
• Cognitive restructuring with thought records. Self-monitoring can be used to capture and re-evaluate externalization as it occurs. Useful prompts include:
  • "If you took the ‘externalizing’ glasses off, how would you see this differently?"
  • "What evidence supports this explanation? Do you think that the evidence is of good quality? Would others agree?"
  • "What evidence does not support this explanation? Can you think of any other causes or explanations for what happened? Did you play a role at all?"
  • "Imagine you are an objective bystander. Would you agree that the other person is entirely to blame and you aren’t?"
  • "Imagine you are the other person. Would you agree that you are 100% responsible for what happened? Why not?"
  • "How does externalizing make you feel? How does it make other people feel? If you wanted to change these feelings, how would you need to think about this situation?"
  • "Is it possible to identify a cause without resorting to blame or judgment? How would you feel if you did that?"
  • "What would happen if you accepted this situation, forgave the other person, or took some responsibility for it? Would things change for better or worse?"
• Cost-benefit analysis. Explore the advantages and disadvantages of externalization. Useful prompts include:  
  • "What are the pros and cons of blaming someone else?"
  • "What are the pros and cons of taking (some) responsibility?"
  • "What are the pros and cons of accepting the situation without judgment?"
  • "What positive and negative effects does externalization have on the people around you?"
  • "What problems has externalizing caused you in the past?"
  • "What problems is externalizing likely to cause you in the future?"
  • "Does externalizing help or hinder you in reaching your goals?"
• It should be noted that externalizing can be functional for some individuals (e.g., “I’d rather blame others for my partner’s death than grieve the loss”).
• Changing the client’s language. Modifying blaming or demanding terms in the client’s externalizing thoughts can reduce intense affect and help them take more responsibility for their experiences. For example, other-directed ‘should’ statements (e.g., “She should have helped me”) can be replaced with preferences (e.g., “I would have preferred it if she helped me”). Clients can also take greater ownership of their emotional reactions (e.g., replacing “He made me mad” with “I felt mad”).   
• Pie charts. Pie charts are used to explore multiple factors that contributed to a particular outcome and avoid simplistic, blaming explanations (e.g., “It was all my partner’s fault”). Ask the client to make a list of potential causes and allocate a ‘slice’ of the pie to each one. Importantly, the client should include both themselves and non-personal factors (e.g., the driving conditions during a road traffic accident). 
• Searching for alternative attributions. Help the client identify and examine other causes for events and experiences. This might involve interrogating the environment for alternative explanations, soliciting other people’s viewpoints (to see if they would make different attributions), or referring to the client’s formulation. For example, Kinderman and Benn (2002) describe a case in which a client’s drug-use and poor sleep just before hearing voices were discussed as potential contributory factors, alongside black magic (the client’s external attribution).
• Analogies and metaphors. Blaming others can be compared to playing tag or ‘pass the parcel’ – blame is passed between individuals, but the underlying problem isn’t addressed. Seeing externalization as a game can help individuals acknowledge how unproductive it is (Stott et al., 2010).
• Testing beliefs and assumptions. It can be helpful to explore whether the client holds beliefs or assumptions that drive externalization, such as “Admitting your faults makes you vulnerable (e.g., to criticism)” and “If I take responsibility, other people will hold me to account”. If assumptions like these are identified, clients can assess how accurate and helpful they are. Their attitudes toward healthier assumptions such as, “Everyone has faults – acknowledging them can lead to growth and acceptance” and “If I take responsibility, I’m in control and can do something about it” can also be explored. Assumptions can also be tested using behavioral experiments, including surveys (e.g., “Let’s see if other people think I am weak or worthless if I admit to my faults”).

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