Are Your Thoughts Making Your Work Unbearable?
A Tale of Two Physicians
Picture with me for a moment two different doctors. They both work at the same clinic, both have similar workloads, and they both have an assortment of responsibilities and stressors outside of their work. Last week, they each had a particularly taxing day in clinic. The day started off poorly with several staff calling out, numerous medically complex and highly emotional visits including EMS transfers led to each physician running over an hour and a half behind, and in all the chaos multiple time-sensitive portal messages went unanswered which resulted in staff interrupting the physicians during visits as they tried to triage exasperated patients’ requests over the phone.
At the end of the day, each physician had several hours worth of notes, labs, and messages to catch up on, but they were already late getting home to make dinner and ferry their children to their evening activities. As they’re hanging up their white coats and walking out the door, one of them is thinking, “Wow, what a rough day. It’s been a while since I had a day like this one. I’m glad this doesn’t happen often.” Meanwhile the other physician is thinking, “This always happens to me. It’s just my luck, and it never gets any better. I’m drowning in all this work, and there’s no way I can catch up.” Based on this silent internal dialogue, how differently do you think the rest of their evening played out as they went home to spend time with their families?
Cognitive Distortions
In his book Feeling Good: The New Mood Therapy, psychiatrist David Burns explains the concept of cognitive distortions. While they’re triggered by factual events that occur in everyday life, these thoughts are exaggerations or distortions that reflect an overly negative interpretation of the event. Dr. Burns details the following ten types of distortions. As you read each one, try to think of an example that has shown up for you in your clinical practice.
All-or-nothing thinking: You see things in black-and-white categories. If your performance falls short of perfect, you see yourself as a total failure.
Overgeneralization: You see a single negative event as a never-ending pattern of defeat.
Mental filter: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that colors the entire beaker of water.
Disqualifying the positive: You reject positive experiences by insisting they “don’t count” for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences.
Jumping to conclusions: You make a negative interpretation even though there are no definite facts that convincingly support your conclusion.
Mind reading: You arbitrarily conclude that someone is reacting negatively to you, and you don’t bother to check this out.
Fortune teller error: You anticipate that things will turn out badly, and you feel convinced that your prediction is an already-established fact.
Magnification (catastrophizing) or minimization: You exaggerate the importance of things (such as your goof-up or someone else’s achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other person’s imperfections)...
Emotional reasoning: You assume that your negative emotions necessarily reflect the way things are: “I feel it, therefore it must be true.”
Should statements: You try to motivate yourself with shoulds and shouldn’ts, as if you had to be whipped and punished before you could be expected to do anything... The emotional consequence is guilt. When you direct should statements towards others, you feel anger, frustration, and resentment.
Labeling and mislabeling: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself: “I’m a loser.” When someone else’s behavior rubs you the wrong way, you attach a negative label to them…
Personalization: You see yourself as the cause of some negative external event which in fact you were not primarily responsible for.
Hopefully by this point you’re convinced that it would be difficult to live a fully self-actualized life while spending your energy beating yourself up like this. For me, it was revolutionary to learn that my negative internal dialogue wasn’t actually true. I was creating a more miserable reality for myself by operating under the assumption that all of these fatalistic thoughts were verifiable facts. While the origin of this pessimistic lens is outside the scope of this article and may include elements from your family of origin, culture, and personality, in coaching we’re more focused on the question: what can I do about it now?
Putting It Into Practice
Because automatic negative thoughts have created well-worn paths in your mind through years of use, it takes intentional and consistent effort to disrupt that reflex and replace it with something more rational and supportive. Dr. Burns recommends something he calls the triple column technique. On a piece of paper, draw two vertical lines to make three columns. On the far left, you’ll write your automatic negative thought. In the middle column, you’ll write the type of cognitive distortion (often there’s more than one in any given statement). Lastly, on the far right you’ll use your critical thinking to write a response. If identifying the cognitive distortions is too stress-inducing, do away with the middle column and simply write your automatic negative thought followed by your rational response. It’s important to complete this exercise regularly on paper until your rational response becomes second nature.
Let’s revisit our physician friend from the beginning of this article:
As physicians, we navigate difficult situations every day. Some of this stress is natural and unavoidable, and some of this stress is created through our own cognitive distortions when we exaggerate the situation, devalue ourselves, or make cynical predictions about the future. With consistent use, the double or triple column technique can lighten the emotional burden of your work by helping you talk back to automatic negative thoughts and take control of your inner dialogue. Once you can view situations in a more rational light, you’ll more easily find the energy and courage to rise to each challenge.
If you’d like the help of an experienced physician coach as you confront old patterns that aren’t serving you and build consistency with new habits, please click below to book a free consultation and learn more about our coaching opportunities.