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Reframing your self-talk can shift your focus from “obstacle thinking” to “opportunity thinking.”

Fam Pract Manag. 2023;30(5):44

Author disclosures: no relevant financial relationships.

A 2016 study published in the International Journal of Golf Science found that golfers in high-pressure situations who use positive self-talk make more putts than those who use negative self-talk.1 Other research has produced similar findings — individuals who choose constructive thinking, regardless of external challenges, experience better outcomes.2 This simple act of self-leadership has implications for physicians as well as golfers.


Dysfunctional thinking refers to cognitive distortions of reality that undermine personal effectiveness. Psychologist David Burns identified the following types of dysfunctional thinking:3

  • All-or-nothing: Considering imperfect results complete failures,
  • Overgeneralization: Generalizing specific failures or negative outcomes as pervasive patterns,
  • Mental filtering: Fixating on a single negative detail,
  • Disqualifying the positive: Dismissing rewarding experiences,
  • Jumping to conclusions: Drawing negative conclusions without sufficient evidence,
  • Magnifying and minimizing: Exaggerating negative factors and downplaying positive aspects,
  • Emotional reasoning: Interpreting reality solely through negative emotions,
  • “Should” statements: Using coercive terms (e.g., should, shouldn't, must) to prompt action,
  • Labeling and mislabeling: Applying negative labels to oneself, others, or events,
  • Personalization: Blaming oneself for negative events without considering external causes.

Transitioning away from dysfunctional thinking requires us to examine our internal dialogue.


To get started with self-leadership, follow this four-step technique:

1. Observe and document your thought patterns and related self-talk, analyzing whether they are dysfunctional or constructive.

2. Identify and develop more functional, constructive thought patterns and self-talk to replace dysfunctional ones; consider writing them down for reference.

3. Practice substituting the more functional thinking and self-talk when facing challenging situations.

4. Monitor your thought patterns and related self-talk; maintain the new, more functional way of thinking you have adopted.


Here's an example of dysfunctional versus constructive thinking.

Imagine a physician works for an organization that is now allowing patients to send online messages directly to the physician. The physician reacts with overgeneralization (“They're always making me do more without upping my pay”) and feels increasingly negative about work.

But let's say the physician recognizes that these thoughts aren't entirely rational — the employer isn't always requiring the physician to do more and did give recent pay raises. Now, the physician can choose more constructive thoughts: “You know, if done right, electronic messaging could help our team strengthen patient relationships and provide more efficient care.” The physician begins researching how to create a message triage system that will benefit the whole organization.

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