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Learning to challenge negative thoughts can vastly improve our lives.

Fam Pract Manag. 2009;16(5):36

Dr. Mercado-Castro is on faculty at the University of Puerto Rico Family Medicine Residency Program. Author disclosure: nothing to disclose.

“The mind is its own place, and in itself can make a Heaven of Hell, or a Hell of Heaven.” The words of the famous English writer John Milton in Paradise Lost recently started to make sense in my life. Although I had the potential to be living a heaven-like experience, many of my days looked quite the opposite.

Like most physicians, I had set high expectations for myself. I expected myself to be an excellent physician, mom, wife and daughter, and in my mind I was “excellent” only if I was able to accomplish all of the following:

As a physician, I want to cure or alleviate all the ailments of my patients, and always be patient and empathetic with their needs. As a mom, I want to be available for my daughter at all times and not miss any important moments in her life. As a wife, I want to receive my husband every evening with an exquisite homemade meal (I enjoy cooking) and spend quality time with him. As a daughter, I want to be near my parents every time they get sick, take them to all their medical appointments and be with them during special occasions.

The reality is that, although I try my best to alleviate my patients' problems, some of them do not seem to get well. I have missed many special moments in my daughter's life. Many evenings, I drag myself home after work with a bag of take-out food and spend the night chasing my young daughter instead of spending quality time with my husband. And many, many times I have not been able to make the three-hour trip to visit my parents when they've been sick.

I had tortured myself so many times with thoughts of perfection – and how far I fell short – until finally I comprehended that the root of my discontentment was not in my circumstances but in my head. I was thinking wrong. I had created rigid patterns of thought that were making me miserable.

Cognitive therapy offers helpful tools to challenge these irrational thoughts. Many years ago, the famous psychotherapists Aaron Beck, MD, and Albert Ellis established the connection between thoughts and feelings. A decade ago psychiatrist David Burns, MD, published Feeling Good: The New Mood Therapy in which he presents a list of common irrational thought patterns that can negatively influence the way we feel. Here are two of them:

All-or-nothing thinking. This involves evaluating things in extreme, black-or-white categories, for example as perfect or worthless. Most of my thoughts of perfectionism fell into this category. If I missed one of my parents' appointments or if one of my patients did not seem to get well, I felt that I was failing as a daughter or as a physician. When we challenge these kinds of thoughts, we see that most things in life are neither black nor white; they are more in the gray zone. This understanding helps us to be at ease with ourselves as we learn to accept our limitations and do our best with the time and resources we have.

Mental filter, or selective abstraction. This involves focusing on the negatives while we disregard our virtues and achievements. Instead of dwelling on the times I had not spent with my daughter, I learned to purposefully think about all the wonderful moments I had shared with her.

After I re-examined the way I was thinking, my uneasiness and anxiety gradually subsided, and I started enjoying my life a lot more. Maybe it is time for you to try these techniques in your own life. It starts with a simple question: Are you thinking right?


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