Cognitive restructuring involves changing your thoughts to change how you feel. Simple activities and practices that are evidence-based and take little time can improve mood and cultivate self-esteem, hope, and other positive states of mind. “Cognitive restructuring” is a cognitive-behavioral technique that involves, first, discovering thoughts that you have that are not helping you or even making things worse, especially those that are irrational and leading to a bad mood or other problems, and then replacing them with thoughts that are more rational and functional.
Skills to restructure your thinking include:
- Examining Your Thoughts
- Reframing Your Thoughts
- Distracting Yourself from Disturbing Thoughts
- Noticing What Is Positive
Skill 1. Examining Your Thoughts
This skill involves evaluating your thoughts and is the first step in changing them to less harmful and more helpful thoughts. Ask:
- What is the evidence this is true? Not true? What is another explanation or way of looking at it?
- What is the worst that could happen if it is true and how could I cope? What’s the best that could happen?
- What is the most likely outcome?
- What is the effect on me now of thinking this thought? What would happen if I changed the thought?
- What advice would I give someone thinking this thought?
- What should I do next?
Tip: Use a journal to become aware of thoughts that you may want to change, especially those that are causing you difficulties. Rather than judging your thoughts as positive or negative, think of your thoughts as teachers that reveal something about how you approach life. Reflect on your thoughts with compassion and consider how you might change them to be more productive.
Coping with Thoughts About Disappointments
The following questions may help if the thoughts are about a disappointment or setback:
- “What did this moment teach me?”
- “What do I know now about myself that I didn’t prior to this disappointment/setback?”
- “What was the most challenging part of this moment?”
- “How might it inform my work as a future physician and or member of the medical community?”
- “How could I view this difficult moment in a different way?”
Source (Bird et al, with minor changes):
Bird Amber, Tomescu Oana, Oyola Sonia, Houpy Jennifer, Anderson Irsk, Pincavage Amber. A Curriculum to Teach Resilience Skills to Medical Students During Clinical Training. MedEdPORTAL. 2020;16:10975. doi:10.15766/mep_2374-8265.10975. PMID: 33015355 PMCID: PMC7526502.
Skill 2. Reframing Your Thoughts
“Reframing” is a type of cognitive restructuring that involves changing from a negative way of looking at things to a more positive one. To do a reframe, think rationally and focus on the things you can change and the more positive opportunities available, and let go of, or dwell less on, the part of a situation that you cannot change or that feels more unpleasant or irrational.
You can use reframing to help you find meaning in draining experiences by thinking about hard times or challenges as lessons (Bird, 2020). As you look at a difficult experience, look for ways that you can grow from it. Try not to judge the experience as “negative.” Consider that everything is a lesson. Treat it as if it was required for your learning.
This is not intended to discount the unpleasantness of your experience, but rather to help you use it to have a more positive experience as well. You do need to experience your feelings about it. But it helps to not dwell on the unpleasantness for long and to find a larger perspective. Some experiences in medical training (and life in general) are draining and beyond your control, but you can control your reaction.
A Story That Illustrates Reframing of Thoughts: Stonecutter Parable
The following parable helps illustrate the shift in thinking that is involved in reframing to find meaning:
A young man asked 3 stonecutters who were working side by side the same question: “What are you doing?” The 1st answered: “Are you blind? I am carving this brick out of this large stone.” The 2nd answered: “I am carving this brick out of this large stone so it can be used to build a beautiful historic church. I’m part of its history.” The 3rd answered: “I am carving this brick out of this large stone so it can be used to build a beautiful church in which many people will worship and connect to their higher guidance.”
Reference. Adapted from:
Bird Amber, Tomescu Oana, Oyola Sonia, Houpy Jennifer, Anderson Irsk, Pincavage Amber. A Curriculum to Teach Resilience Skills to Medical Students During Clinical Training. MedEdPORTAL. 2020;16:10975. doi:10.15766/mep_2374-8265.10975. PMID: 33015355 PMCID: PMC7526502.Slide 1 of 5
Skill 3. Distracting Yourself from Disturbing Thoughts
The acronym ACCEPTS can be used to remember 7 ways to distract yourself from unproductive, unpleasant, anxiety-provoking thoughts
- Activities—any active activity that is tolerable and even better, rewarding in some way
- Contributing—help another person or group
- Comparisons—notice there are others who are less fortunate than you
- Emotions—intentionally do something to stimulate a different emotion (e.g., watch a funny movie)
- Pushing away—remove yourself from the situation physically and from people who are talking about it
- Thoughts—intentionally think something else (e.g., read a favorite poem aloud, plan a party, listen to someone else)
- Sensations—strong sensations, such as holding ice or squeezing a ball
Skill 4. Noticing What Is Positive Via Structured Questions
Use the following positive questions to identify what is best in a training setting, work situation, or organization. The general approach of these questions is to ask: “What Went Well?” to foster positive organizational culture, as opposed to starting with or always emphasizing “What Went Wrong?” The questions they pose are:
- What is something that went well for you today?
- What was a success that you had recently?
- Can you tell me about a recent positive experience in your work or personal life?
- Has a patient or family member told you that you made a difference?
- How do you help to make our workplace more productive and positive?
- Have you noticed a team member go beyond the call of duty sometime this week?
- Can you recall a situation this week in which you had a chance to learn and grow?
- Think of a recent successful team project. What made the team so successful?
These Questions Are Based on Appreciative Inquiry Principles (External Resource)
Source: AMA. Practice transformation series: using appreciative inquiry to foster a positive organizational culture. 2016.
External Resource For Cultivating Cognitive Skills to Improve Resilience:
Well Being Tools is a list of online tools or activities for healthcare workers that are based on using your thoughts or cognition to improve your resilience. They are evidence-based. It includes exercises to cultivate awe, gratitude, humor, work-life balance, hope, and 12 other positive states, all based on making changes to your thinking or emphasizing certain thoughts over others. They are offered by the Duke Center for Healthcare Safety and Quality as part of a research project called WISER. Enrollment is simple and quick.
10 replaceable thoughts (and 15 books) to help you survive burnout Source: Social media site, KevinMD, in medical news source, MEDPage Today.