1. The “walking down the street” exercise

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Settle into a comfortable position, close your eyes, and imagine the following scenerio:


You are walking down a familiar street. You see someone you know on the opposite side. You smile and wave. The person does not respond in any way. They walk past without any sign of acknowledging you.


Write down any thoughts that are going through your mind in this scenario:

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Image credit: Headspace


2. What are thoughts?

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Comparing a group of individual responses would likely reveal very different thoughts about the same scenario.


How can two people have different thoughts about the same situation?


Image from <a href='https://www.pinterest.ca'>Pinterest</a>

Image credit: Pinterest



Sometimes we can be in the same situation, but have different thoughts about it at different times. Emotions and experiences can shape our thoughts – so, thoughts are personal interpretations of a situation. Thoughts are not necessarily facts. However, many of us tend to live and react as if our thoughts are facts. If these thoughts are negative (as they often can be when we are under stress) they can bias our viewpoints and lead to distorted interpretations that over time can decrease resilience and increase vulnerability to stress, and especially if we are not taking care of ourselves, not eating or sleeping properly, or find ourselves over-burdened with work.


3. Thinking traps

What we tell ourselves about a situation can influence how we feel, how we interact with others, and what we might or might not do. For many of us, these thoughts are often automatic and not always consciously apparent until we notice experiencing strong emotion that is not congruent with the situation – “emotional overreactions”. It is likely that in these instances we are falling into “thinking traps” or patterns of thinking that correspond to beliefs, assumptions, or expectations we have about ourselves, others, and how certain situations should unfold. These core beliefs arise from previous experiences and interpersonal interactions (both negative and positive) and are continually shaped and modified throughout our lifetime. For some of us, these can remain fixed and inflexible so that depending on the context we find ourselves in, can either help or hinder us. Examples of fixed beliefs in medical school might be:

“I should succeed at everything I put my mind to”
“Failure is a sign of weakness”
“If something goes wrong, it is because of incompetence”
“Mistakes are not alright and should be avoided”

If nothing goes wrong (no failure, no mistakes, you are achieving success), these core beliefs can become formed, maintained and strengthened to become more permanent and fixed. These beliefs can also motivate and drive you to attain further success and achieve your goals. Ultimately, however, we all face disappointment, loss, or adversity through unexpected events. If our core beliefs or thinking traps are incongruent with the challenges unfolding and we are thus “psychologically inflexible”, managing the unexpected flexibly, challenging our thinking, and responding with resilience becomes difficult. We can often become stuck, then stress amplifies, and moves us further away from constructive solutions and we become more vulnerable and less resilient.


4. Psychological flexibility and resilience

Image5 Psychological flexibility refers to the ability to adapt to fluctuating demands, shift and balance perspectives and consider alternative courses of action when faced with difficult situations. Being psychologically flexible builds resilience and confers greater mental and physical wellbeing during times of stress. In order to be psychologically flexible when faced with unexpected circumstances, we need to have full awareness of the present moment. This requires us to take time to STOP and notice what is happening and what we are thinking when we are experiencing strong emotions. In these instances, it can be helpful to give them a label. You might think of it like sorting through your mail – some may be notices you need to respond to (e.g., bills), but much of what you receive may be just junk (unhelpful thoughts or thinking traps).

It is important to recognize that some types of thoughts are helpful, some can be unhelpful, and some can be both. For example, planning thoughts can be helpful in order to organize your day. However, planning thoughts are unhelpful when you are trying to stay focused on what a patient is saying or listening to a colleague during a conversation. Other types of thoughts, such as worries, are usually always unhelpful, and often bring us into a deep spiral of negative thoughts. By giving thoughts a label, we can sort through them more quickly without getting “stuck” in them and then challenge or reframe them to be more flexible and balanced. Remember - thoughts are not facts and by labelling them we create separation or distance to more objectively determine whether they are helpful or not. This can then allow us to shift to more balanced thinking with greater ease. For example, rather than thinking “all I do is worry, I am such a worry wart, you could say, “Oh - worry thoughts are here”.


5. Common thinking traps

We all fall into these common thinking traps. (For more on this, see section Integrate New Lifestyles, topic Management of Cognitive Distortions.) Understanding what they are can help you label them when they arise to promote psychological flexibility that leads to healthier thinking, which can build resilience. However, it is important to highlight that healthier thinking does not always mean thinking more "positively." Healthy or balanced thinking that arises from psychological flexibility means examining the entire situation and what is happening (the positive, negative, and neutral). In some situations it is entirely normal and healthy to feel upset and have negative thoughts.




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Skill building exercise

Take some time to review the common thinking traps listed below,
and see if you recognize your own thinking traps or unhelpful thoughts that you often have.

All-or-nothing thinking (sometimes called “black-and-white thinking”)
The tendency to view all experiences as fitting into one of two categories (positive or negative, good or bad) without the ability to place oneself, others, and experiences along a continuum.
“If I am not perfect, I have failed”
“Either I do it right or not at all”
Overgeneralizing
The process of formulating rules or conclusions on the basis of limited experience and applying these rules across broad and unrelated situations.
“Everything is always bad”
“Nothing good ever happens”
Mental filter/Selective abstractions
The process of exclusively focusing on one negative aspect or detail of a situation, magnifying the importance of that detail, thereby casting the whole situation in a negative context.
“I met a lot of great people at the party, but one guy didn’t talk to me. There must be something wrong with me”
Disqualifying the positive
The tendency or process of rejecting or discounting positive experiences, traits, or attributes.
“That doesn’t count”
Jumping to conclusions
The process of drawing a negative conclusion, in the absence of specific evidence to support that conclusion.
“My friend didn’t stop to say hello. She must not like me very much”
Fortune telling
The process of foretelling or predicting the negative outcome of a future event or events and believing this prediction is absolutely true for you.
“I don’t think those people will like me so I am not going to bother to talk to them”
Magnification
The tendency to exaggerate or magnify either the positive or negative importance or consequence of some personal trait, event, or circumstance.
“I’m going to make such a fool of myself, everyone will laugh at me, and I won’t be able to survive this embarrassment”
Minimization
The process of minimizing or discounting the importance of some event, trait, or circumstance.
“I realize that I got that award but there wasn’t a lot of competition”
Comparison
The tendency to compare oneself to others whereby the outcome typically results in the conclusion that one is inferior or worse off than others.
“Even though we went through the same training program, she is so much smarter and successful than I am”
Should statement
The process of applying personal standards of behaviour, standards for other people, or standards about the way the world functions in all situations. Involves use of words like “should”, “ought”, and “must”.
“I should be able to handle this without getting upset and crying”
Labelling
Assigning labels to ourselves and other people, usually negative.
“I made a mistake at work. I’m stupid!”
“My boss told me I made a mistake. My boss is a total jerk!”
Personalization
The process of assuming personal causality for situations, events, and reactions of others when there is no evidence supporting that conclusion.
“The problems in our relationship are completely my fault”
Emotional reasoning
The predominant use of an emotional state to form conclusions about oneself, others, or situations. Assuming that because we feel a certain way, what we think must be true.
“I feel embarrassment so I must be an idiot”
“I feel anxious when I fly, so airplanes must not be safe”
Externalization of self-worth
The development and maintenance of self-worth based almost exclusively on how the external world views you.
“I am a nobody, if she isn’t my friend”
“If I don’t get any recognition for what I have done, I won’t feel good about myself”
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Test your knowledge on recognizing key aspects of the most common thinking traps.

Table 1. Common thinking traps
Thinking traps Definition
Externalization of self-worth The development and maintenance of self-worth based almost exclusively on how the external world views you
Fortune telling The process of foretelling or predicting the negative outcome of a future event or events and believing this prediction is absolutely true for you
Mind reading One’s arbitrary conclusion that someone is reacting negatively, or thinking negatively toward him/her, without specific evidence to support that conclusion
Disqualifying the positive The process of rejecting or discounting positive experiences, traits, or attributes
Black/White thinking The tendency to view all experiences as fitting into one of two categories (e.g., positive or negative, good or bad) without the ability to place oneself, others, and experiences along a continuum
Minimization The process of minimizing or discounting the importance of some event, trait, or circumstance
Comparison The tendency to compare oneself whereby the outcome typically results in the conclusion that one is inferior or worse off than others
Magnification The tendency to exaggerate or magnify either the positive or negative importance or consequence of some personal trait, event, or circumstance
Overgeneralization The process of formulating rules or conclusions on the basis of limited experience and applying these rules across broad and unrelated situations
Emotional reasoning The predominant use of an emotional state to form conclusions about oneself, others, or situations
Jumping to conclusions Process of drawing a negative conclusion, in the absence of specific evidence to support that conclusion
Selective abstractions The process of exclusively focusing on one negative aspect or detail of a situation, magnifying the importance of that detail, thereby casting the whole situation in a negative context
Should statements The process of applying personal standards of behaviour, standards for other people, or standards about the way the world functions to all situations. Involves use of words like “should,” “ought,” and “must”
Personalization The process of assuming personal causality for situations, events, and reactions of others when there is no evidence supporting that conclusion

Using the information in Table 1, match the statements below to the common thinking traps reviewed in this module.

  • If she doesn’t approve of me, I am not worth anything.
    Externalization of self-worth
  • Bad things will always happen to me because I am unlucky.
     
    Fortune telling
  • I know that most people don’t really like me and think about me in a negative way.
     
    Mind reading
  • When good things happen to me it is hard to feel good.
     
    Disqualifying the positive
  • You either click with someone or not, there is no in-between for me.
     
    Black/White thinking
  • When bad or serious situations arise, I don’t make a big deal about it.
     
    Minimization
  • The only way you know you succeed if you can keep up or be like other people.
     
    Comparison
  • I tend to blow things out of proportion even when it isn’t really of importance in my life.
     
    Magnification
  • I can almost always predict how and when things will go wrong in my life.
     
    Fortune telling
  • What others think about me is more important than what I think about myself.
     
    Externalization of self-worth
  • It doesn’t matter what my choices are, they always fall flat and I make the wrong one.
     
    Overgeneralization
  • The only way to make decisions is based on my “gut” feelings.
     
    Emotional reasoning
  • I tend to jump to conclusions rather than carefully reviewing what happened.
     
    Jumping to conclusions
  • When bad things happen in my life, it almost always has something to do with the way I am.
     
    Overgeneralization
  • It is hard for me to feel good about myself without recognition from others.
     
    Externalization of self-worth
  • Things must always unfold the way that I want them to if I am to be happy.
     
    Should statements
  • When bad things happen, it is always my fault.
     
    Personalization
  • I know that people criticize me and think negatively about me without having to ask.
     
    Mind reading
  • There are not a lot of things that I can do that are better than what others can do.
     
    Comparison
  • I always feel responsible for things that go wrong in my life even when it is unexpected.
     
    Personalization
  • I focus on what I am doing wrong instead of what is going well.
     
    Disqualifying the positive
  • Things are either really good in my life or really bad.
     
    Black/White thinking
  • I always notice the negative details in a situation and then ruminate about it.
     
    Selective abstractions
  • I have a tendency to amplify the importance of negative events, even when they are minor.
     
    Magnification
  • I can always tell you with certainty when things will go wrong in any given situation.
     
    Fortune telling
  • I have a lot of should, oughts, and musts in my life.
     
    Should statements
  • I am more focused on what I am not succeeding at rather than what I am doing well.
     
    Minimization
  • I have been known to blow things out of proportion.
     
    Magnification
  • Most people can do things better than I can.
     
    Comparison
  • When something goes wrong, it is usually because of something I did.
     
    Personalization
  • I tend to think the worst is going to happen even if there is a possibility that it won’t.
     
    Jumping to conclusions
  • Things must be a certain way in order to work out.
     
    Should statements
  • If I feel a certain way about something, I am usually right.
     
    Emotional reasoning
  • Thoughts are not necessarily facts but we often tend to live and react as if they were.
  • When these thoughts are negative, they can bias our viewpoints and lead to distorted interpretations of our experiences and relationships. This can decrease resilience and increase vulnerability to stress.
  • Thoughts are often automatic and not consciously apparent until strong emotion is triggered that is incongruent with the situation – “emotional overreactions”.
  • Contributing to emotional overreactions are “thinking traps” or ways of thinking that correspond to beliefs, assumptions or expectations we have about ourselves, others, and how certain situations should unfold.
  • When our thinking traps conflict with the context or what is happening, we can become psychologically inflexible and especially so, when faced with unexpected situations and challenges. In these instances, managing the unexpected flexibly and challenging our thinking to respond more constructively and resiliently becomes difficult.
  • Being psychologically flexible builds resilience; however, we must first increase our awareness of the common thinking traps we find ourselves in. This requires us to STOP and notice what is happening and what we are thinking. We can increase awareness by labelling our thoughts to determine what are thinking traps and what are helpful thoughts.
  • A list of common thinking traps were reviewed with examples to help trainees increase their ability to label and identify their thinking traps to promote psychological flexibility and build resilience.

  • heretohelp. Wellness module 8: Healthy thinking. http://www.heretohelp.bc.ca/wellness-module/wellness-module-8-healthy-thinking. Accessed 4 Oct, 2018.
  • Kashdan TB. Psychological flexibility as a fundamental aspect of health. Clin Psychol Rev. 2010;30(7):865-78.
  • Segal D. Mindsight: The New Science of Personal Transformation. New York: Bantam Books, 2010.
  • Segal Z, Williams M, Teasdale J. Mindfulness-based Cognitive Therapy for Depression, 2nd edition. New York, NY: Guildford Press, 2012.
  • Teasdale J, Williams M, Segal Z. The Mindful Way Workbook. New York, NY: Guildford Press, 2014.