Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that focuses on confronting maladaptive thought patterns and changing behaviors to achieve psychological wellbeing. One of the most common ways that this type of therapy is performed is by consciously labeling these distressing thoughts as ‘cognitive distortions’ with the intent of showing how unrealistic and unhelpful these thoughts actually are. Stressful times tend to bring out more of these cognitive distortions, and medical school is a nearly perfect example of this. Therefore, in this blog post, I’ve assembled a list of common examples that you may come across in med school of the 10 major cognitive distortions in action. See if you have ever experienced one of these and challenge yourself to come up with other examples of maladaptive thoughts that may be preventing you from thriving.
All-Or-Nothing Thinking
Seeing the world in black and white—thinking things are only all good or all bad.
- “I forgot X on my differential, I’ll be a terrible doctor!”
- “I got a low score on Step 1—Now I won’t match anywhere!”
Overgeneralizing
Seeing a pattern based on a single event or being overly broad in the conclusions we draw.
- *Trouble connecting with one pediatric patent à “I’m just not good with kids”
- “Being in the OR is always terrible”
Mental Filter
Only paying attention to certain types of evidence—noticing failures but not successes.
- Getting 99% positive feedback with 1% constructive criticism then thinking about that one comment for weeks
- Getting 4/5 pimp questions right but still feeling like the attending thinks you’re stupid
Disqualifying the Positive
Explaining away the good things that have happened while not doing the same for negative things.
- “I got lucky getting into med school”
- After getting a compliment on your interpersonal skills à “they don’t mean that they’re just being nice”
Jumping To Conclusions
Taking limited data (e.g. mind reading) and predicting the future (fortune-telling) based on it.
- *Med school classmate doesn’t acknowledge you in the hall à “they must hate me”
- Resident doesn’t want to talk after a long day à “I’m a boring person that no one wants to talk to”
Magnification/Minimization
Blowing things out of proportion (catastrophizing) or inappropriately shrinking something to make it less important.
- “I failed this test and now I’m going to fail out of med school”
- “I forgot this fact on rounds. I knew I didn’t have what it takes to be a doctor”
Emotional Reasoning
Assuming that our feelings convey truth.
- “I feel embarrassed so I must be an idiot”
- “I get sweaty when I examine a patient so I must not know what I’m doing”
Should Statements
Using critical language about yourself or other people.
- “I should have done better on that test” even though you actually did fairly well
- “I should be better at this by now”
Labeling
Assigning unhelpful labels to ourselves or other people.
- “I’m an idiot”
- “I’m an imposter”
Personalization
Blaming yourself or taking responsibility for something that wasn’t completely your fault (or conversely, blaming others).
- *After examining a patient distracted by acute injury “that patent really hated me—I must be bad at this”
- *Patent has a bad outcome, unrelated to your care. “This is my fault”
