Portal de Periódicos da CAPES

Your Best Life: Managing Negative Thoughts—The Choice is Yours

2019; Lippincott Williams & Wilkins; Volume: 477; Issue: 6 Linguagem: Inglês

10.1097/corr.0000000000000791

1528-1132

John D. Kelly,

Psychological Treatments and Assessments

I have recently spoken with several orthopaedic colleagues who are particularly frustrated with certain aspects of their profession. They are exasperated from navigating the insurance labyrinth in order to get properly paid for services rendered. They struggle with the nuances and challenges of the electronic medical record. And many feel morally encumbered by patient volumes and resource limitations at their institutions, which can force them to sometimes value expediency over quality [5]. All of us get frustrated by our jobs, and perhaps these aggravations are to be expected in the midst of a busy 10 to 12-hour work day. But working with electronic medical records, untangling insurance hassles, managing high patient volumes, and combatting declining reimbursement can wear us down, and unfortunately, these daily stressors are unlikely to dissipate in the near future. Indeed, our workplace frustrations can generate a cascade of negative thinking, which, left unchallenged, can cause a descent into negative emotion, burnout, despondency, and even inadvertent patient harm. In his book, The 7 Habits of Highly Effective People [3], author Stephen R. Covey argues that the choices we make determine our growth and happiness. We all have the freedom to decide how we respond to our stressors, and what we decide to focus on will, in large measure, dictate the amount of peace in our lives. “In the space between stimulus (what happens) and how we respond, lies our freedom to choose,” Covey writes. “Ultimately, this power to choose is what defines us as human beings. We may have limited choices, but we can always choose” [3]. Covey is correct—we can control our circumstances by choosing positivity. But without the proper mental training, we are far more likely to let our circumstances dictate our emotions. My previous columns have explored the power of practicing mindfulness, gratitude, and kindness [9-11] as a way to combat the negative thoughts that bombard our brains throughout the day. But how do we train our minds to not only recognize negative thinking in the moment, but to consciously choose a mentally healthier path for managing difficult circumstances? Recognizing Negative Thoughts Just as breathing happens without our conscious control, negative thinking will always occupy a chamber of our minds. We can empower these thoughts, allowing them to undermine our mood, or we can recognize them for what they truly are—distortions conceived in emotional pain. Aaron T. Beck MD, an early advocate and forefather of cognitive behavioral therapy [1], recognized that anxiety and depression are the results of distorted thinking, tricks our minds play into convincing us that our thinking represents reality. David D. Burns MD, Professor Emeritus in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine studied the impact of distorted thinking and based much of his work on Beck’s research. Burns took Beck’s research a step further by delineating 10 cognitive distortions (Table 1) that often appear when one experiences negative emotion [2]. I know many orthopaedic surgeons who fall prey to “all-or-nothing thinking”, where one mistake leads us to believe we are an abject failure [2]. “Disqualifying the positive” is another common distortion that may beleaguer surgeons, in which we simply assert that positive experiences don’t count; the idea that one challenging case trumps four other well-executed operations [2].Table 1.: A list of cognitive distortions [2].I personally struggle with my “mental filter”, a cognitive distortion in which I focus on a single negative detail, such that a realistic appraisal of events is darkened [2]. For example, it may take me several minutes to mentally recover from slightly misplacing an incision. In those vulnerable moments, I tend to lose focus on the task at hand. At best, this results in the pace of the operation decreasing; at worst, I risk causing real harm. Recognizing one or more of the cognitive distortions that you struggle with is a positive first step. It is something you can build on and work to improve. But how? Do Not Resist Once your mind consciously recognizes your negative emotions, there is a binary choice: Resist or accept the negative thinking. According to psychologist Carl Jung, accepting negative thoughts enables us to disarm them, while resisting merely gives them more power: “What you resist not only persists, but will grow in size” [8]. What do you do once you recognize and accept your negative thoughts? It may be helpful to adopt a name for the seemingly stubborn negative chatter in your mind. For me, I refer to my negative internal dialogue as “The Voice” and recognize it for what it truly is—thoughts conceived by the collective pain in my subconscious. Admittedly, labeling a voice in your head sounds a bit juvenile, but for me, it helps create space between my thinking and reality. Once “The Voice” starts to speak, I take a step back, label it, and return to focusing on the task at hand. In reality, I am practicing mindfulness, defined as the practice of living in the moment. Mindfulness has been shown to decrease anxiety and depression, while increasing feelings of overall well-being [4, 6, 7]. Practicing mindfulness takes training, and those who have never practiced it before may have trouble locking into the present, or may not know how to process the distractions that inevitably arise. As those distractions occur—as they inevitably will—one need only identify them as thoughts or feelings, and return to the focus of the meditation, whether that is a breath, an object, or whatever it happens to be. Doing so helps the practitioner of mindfulness achieve a quieter mind. A quiet mind is a powerful mind. Once quiet, it is easier to arrive at more-balanced thoughts [12]. Think about the well-executed TKA you performed this morning and remove this afternoon’s challenging patient from your mind. If that doesn’t work, try downloading a free smartphone application like Headspace or Calm that will introduce you to the practice of mindfulness. Consistent use of these electronic reminders can train your mindfulness muscles. Only when we can create space from the internal chatter that seems to besiege our waking moments, can we enjoy peace and then direct our attention to what matters most—all that is good in our lives. Uplifts Wayne Sotile PhD, has noted in his research that resilient physicians have the same amount of hassles as those who are emotionally exhausted [13]. So, what separates resilient physicians from mentally depleted ones? Sotile argues it’s the presence of “uplifts” one offers or receives in the course of a day. He defines “uplifts” as a kind word, a generous act, or a display of courtesy accrued throughout the day [13]. This act of kindness or gratitude will buoy one’s spirits in the midst of even the most challenging of days. Naturally, when embroiled in negative thought, it is extremely difficult, if not impossible, to offer a kind word or gesture. Whenever I find myself angry and in judgmental mode, I pause, recognize that my thoughts are steeped in negativity and decide to find something to love in that person. This exercise becomes easier with practice. The present moment is filled with blessings. The fact that we are alive and can read these pages is indeed justification for gratitude. Tomorrow, Try This Become familiar with the cognitive distortions to determine whether one or more is responsible for your negative thoughts. Download a mindfulness smartphone app to strengthen your “mindfulness muscles”. The next time you feel your negative thoughts taking over, pause, create space from your thinking, and generate an “uplift” to whomever is nearby. If in the midst of a sour mood, close your eyes, take three deep breaths, and acknowledge the miracle that you are alive.