Practicing cognitive reframing in clinical practice

Many physicians have heard of cognitive behavioral therapy (CBT) and know that it can be a powerful tool for noticing and shifting your unhelpful thoughts. But can it help physicians avoid burnout? And if so, what's the best approach? In this video, from our Burnout Prevention Masterclass: Your Path to Resilience course, we will walk you through a cognitive technique that will immediately shift your perspective on work and mark the beginning of a healthier relationship with your daily practise.

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Many physicians have heard of cognitive behavioral therapy, and recommend it to their patients. Using the cognitive behavioral therapy, CBT technique can be a powerful tool for noticing and shifting your unhelpful thoughts. Cognitive behavioral therapy asserts that your thoughts influence your feelings and in turn your behaviors and actions.

One study researched the effects of CBT training on general practitioners. The results showed an increase in morale and quality of work. It also showed a decrease in general psychological distress, as well as a decrease in work related stress, Gardiner, Lovell & Williamson, 2004. There were likely several times throughout medical school where you could have used cognitive reframing.

Imagine that you've performed poorly on an exam, your first thought was likely, I must not have worked hard enough, I'm going to fail out of medical school. By reframing your thought process, you could have thought something more productive, such as, I studied really hard for this exam., so I will just have to change my study method for the next time, so I can do better in the future.

By reframing the way you perceive the event, you create a healthier emotional response. While you may feel disappointed, you do not feel defeated or hopeless. As a result, you become motivated to seek a solution to the problem. In comparing the two different responses, we see that one path allowed the student to grow and move forward.

The other inhibits the student from seeking help or guidance, and will likely result in another poor exam score. Now let's discuss a CBT technique called cognitive restructuring. I'd like you to think of a conflict that you are currently facing, that you have only pessimistic thoughts about. Create personal awareness of the types of words you are using to contemplate this conflict.

Thoughts run like tapes through our minds, and sometimes we don't even notice what we are saying to ourselves. Pay attention to your thoughts. Reflect on how negative thoughts affect you. Consider the extent to which you believe your thoughts. Recognize how intensely you feel the emotion. Now that you're aware of your thought process, start to restructure it.

Explore alternative thoughts that could be more productive. You don't have to believe it wholeheartedly, you only need a small amount of faith that it will work. Notice how you feel and what changes you make in your behavior as a result of thinking a new thought. This is a skill that requires time and patience. For example, you might think, I don't have any time in my schedule to try any of these resilient strategies, and it is impossible.

Because this thought feels really true to you, you become consumed with the resulting emotion of defeat and frustration. You know that this will negatively affect your attempt to work on resilient strategies. You decide that you'd like to work on restructuring this thought, because you know that it's not helping you incorporate resilient strategies into your life. You decided a more helpful thought would be, if I plan ahead each week, I can integrate resilience strategies into my schedule.

You might notice that this thought makes you feel more hopeful, and like you have more options. Behaviorally, you notice that this thought helps you to sit down on Sunday nights and make a plan for exactly how you'll incorporate some resilience strategies into your week. This CBT exercise is just one example of a cognitive technique that will enable you to expand your thought process. Remember that it takes practice, and develop your own version of the technique. Write down new thoughts or words that you know you are receptive to. Remind yourself of what works for you related to developing a habit, while you are in the beginning steps of creating resiliency skills.