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Hey guys, welcome back to the podcast. I am Amanda. I'm Laura. Kendra. And today we're exploring a cognitive distortion that can silently undermine our confidence and contribute to burnout. And that is called discounting the positive. So what exactly is discounting the positive? It is in the context of cognitive behavioral therapy.
Common thought errors are another word for cognitive distortion, but what they are are habitual Often unhelpful ways of thinking that distort our view of reality. You can be entirely convinced that your thoughts about these things are true, but once you realize that these are really common thought patterns and realize that you've fallen into one of them, it's like, oh.
That's not true at all. Oh my gosh, your experience of reality is completely distorted. That's why it's a cognitive distortion by these common thought errors. There are like 15 of the most common thought errors So discounting the positive is one that we're going to talk about today and it's when we dismiss or downplay our [00:01:00] accomplishments.
If it's hard to take a compliment or if we also diminish any evidence that we have of success, for example, after receiving praise from a colleague or patient, you might think, well, it was just luck or that was the one I would say to myself is like, well, that's just part of the job. I mean,
No wonder I got as bitter as I did. But some other people can say they're just saying to be nice. This tendency means that we rarely give ourselves the credit that we deserve. And it sucks, to be honest. It's just demoralizing. So, originally described by Aaron Beck in the 1970s, and then later popularized by David Burns in his book Feeling Good, this distortion isn't just a quirky thought pattern, it can have serious consequences for our well being, especially in the high pressure world of medicine. So in today's episode, we'll dive into how discounting the positive affects physicians, we'll explore strategies to overcome it, and then discuss practical ways to implement change in our daily practice.
So let's get started. Okay. Well, our work environment is [00:02:00] inherently high stakes. Mistakes are scrutinized and our successes might not receive the same spotlight as our missteps. Obviously not right. 100%. Yeah. When we dismiss our accomplishments, we send ourselves the message that our positive outcomes are insignificant or undeserved over time.
This self devaluation erodes our self esteem and fuels a cycle of self criticism. Research has shown that a persistent negative self view is linked to higher rates of burnout. I don't think we needed research to show that. Yeah, yeah. I think it's quite evident. We have our own anecdotal data. We have some real live clinical theories.
For example, studies published in the Archives of Internal Medicine and work by Shanafelt and colleagues, Tate Shanafelt, he did a lot of the work at Stanford on burnout and physician wellness. This study demonstrated that when physicians focus predominantly on errors, rather than successes, the risk of burnout increases significantly.
We don't have to explain [00:03:00] that. That seems awfully rational and common sense. Beyond burnout, discounting the positive can impair our resilience, the ability to bounce back after setbacks, which is absolutely critical in our field. By consistently ignoring our accomplishments. We not only diminish our self worth, but also miss out on the reinforcement needed to tackle future challenges.
In a profession where continuous learning and adaptability are key, this habit can hold us back from realizing our full potential. And I will say we talked about self criticism, but this is like the actual thought error that can kind of play in a loop where We have, you know, discounting the positive.
There's also one called negative mental filtering. And, and really, I think in training, you know, part of it isn't so bad. I mean, it probably started out as always looking for what is wrong. I mean, we are diagnosticians and so we are problem solvers. And so. In a way we were trained to [00:04:00] kind of like always see what was going wrong and always seeing like what is not positive about this patient right now, right?
Because we got to fix it. That's our job. And so while it probably started as something that was meant to help us. It can get amplified through training and the indoctrination of our medical culture. So you bring up a good point because that's actually two sides of the same cognitive distortion as mental filtering.
Negative mental filtering, like you just said, and then today's topic is the discounting the positive. It's both like two, two sides of the same coin. Why the negative is all that we're seeing. Because not only are we looking for it, we're also ignoring all the good stuff. Yeah. And there's so many reasons to overcome this.
And the one that comes to mind immediately for me is if we're doing this and, you know, and at work, we do need to see what's going [00:05:00] wrong with our patients. We do need to see what needs to be corrected. But when we're interacting with other human beings. And we're always finding what's wrong with them or what they're doing.
People are going to hate us. People are going to hate us and we're just not going to have the kind of connection that we want with people we care about. So let's talk about some strategies to overcome discounting the positive. The first is cognitive restructuring. This is a tool that we use a lot in coaching and it hails from, again, cognitive behavioral therapy. It includes catching negative automatic thoughts and challenging them, not just smashing them down, not just being like push it away and try to like toxic positivity yourself into some gaslight yourselves into something that isn't actually true, but challenging them and questioning them.
So like, if you think, That compliment wasn't genuine. It was just luck [00:06:00] or like they didn't mean that I didn't really do that. I just got lucky notice it notice it and ask yourself why? Brain? Why are you thinking that that's just luck and what concrete evidence supports that is.
Just luck or that it's actually that I know what I'm doing and that I am trained for this and That I've gained experience. I'm learning and I'm actually good at my job. Where is the actual evidence then? You can reframe it if you still believe after looking at the evidence that whatever the thought was is true Okay, fine, but if it's making you miserable come talk to one of us We'll help you but if it's not true and you can tell it's not true then That's a great time to reframe it and think something that is believable, that is true, that would help you feel better, help generate more positive emotion.
Something like, I worked hard. And compliment was deserved. Somebody [00:07:00] noticed what I did and it was good and I will receive it. I will receive that. So second strategy, keeping a positive data log or a gratitude journal. This can be really simple. It can be just one thing jotted down at night on your phone about.
Things that are going right, you can find so many things going right, probably infinitely more going right than are going wrong at any one time, if you really think about it. And so focusing on those things is just going to make everything so much better. So let's practice that and writing it down. Seems to really solidify it for us writing down even one positive event or achievement each day builds a repository of evidence against critical thoughts.
So, how nice to have a little, like, a little place where you can write down little happy things about yourself, things that you like about yourself, things that you accomplish that were good. Not to [00:08:00] like make yourself feel so great in some narcissistic way, but to have a real, a real place where you can see actual evidence about the good things about who you are.
Research by Emmons and McCullough from 2003 showed that gratitude journaling actually enhances overall well being and reduces depressive symptoms. And I'm sure that there has been more research about that even more recently and like that is It's a pretty known positive effective tool. Third, practicing mindfulness.
We've talked about this in our last episode about how practicing mindfulness, meditation, et cetera, helps pull us out of our limbic system, up into our neocortex and helps us think more clearly. And it helps us observe our thoughts without judgment. We can't observe our thoughts without judgment when we're in our emotional brain when we're down in the limbic system and fight or flight, freeze, fawn, frustration, highly emotionally [00:09:00] charged areas. We just can't look at things without judgment. We have to use the best part of our brain, the human, the uniquely human part of our brain to be able to do that. So taking a brief five minute session of deep breathing, activate that vagus nerve, calm yourself down and allow the blood flow to go out of your limbic system, back up into your neocortex.
Having a guided meditation can help you become more aware of when you're discounting the positive Unnecessarily and gently steer that focus back to what's good.
I have a theory about some of our ER colleagues who are adrenaline junkies and you know having a catastrophic trauma or Massive code or something like that Forces you to be nowhere else other than where your feet.
Absolutely. You can't be spinning out on anything else. And so that's what I want you guys to know is that is mindfulness It's getting in your own body [00:10:00] and being aware of what's happening here In this moment, instead of spinning out on something else, so I do wonder for our adrenaline junkie colleagues, if that might be part of the thing.
I mean, there's obviously like, yeah, adrenaline and all that kind of stuff, but it is a time where you can't be spinning out on anything else. Yeah, well, you need that, especially in an environment. I mean, even in just like an outpatient clinic, it's chaotic. It's so hard to focus. And in the ER, it's like amped up.
100 times it is the focus nightmare. You cannot focus in there. And so yeah when you have a big adrenaline surge Yeah, it's gonna help. Yeah, I forget about how many patients are waiting. I forget about all of that stuff It's just all in on the current issues, which is Kind of the point of meditation now, hopefully we can start doing this without somebody being in a terrible situation Yeah, you know, yeah.
And just remember we only have the [00:11:00] present moment. The past isn't even real anymore and the future is not real yet. So the past is only real when you keep thinking about it and bringing it into your present, which is the only thing that's real. That's that. That helped me a lot. Like. Oh, this is a thing that I wish I could forget, but I keep thinking about it and I keep bringing it to my today.
How about I stop doing that? Keep making it real again and again. All right. So number four, seek social support. Sometimes an outside perspective can make all the difference. A lot of times, especially when you are a ruminator or an overthinker, few doctors are overthinkers discussing the experiences that you've had or that you're like ruminating on with a trusted colleague, mentor, friend, coach, a coach.
This helps so much. Coaches are trained to help you identify the thoughts that are. That are actually not true and not helpful, that is a great way to challenge your negative self view studies, including [00:12:00] those highlighted in the journals. Clinical psychology suggest that. Social support plays a key role in mitigating the effects of cognitive distortions.
Yep. Yep. We're supposed to co regulate with our fellow human beings where we help keep each other. And this is one of the best reasons to have coach is to have that experience where you feel heard and. You've got support and we're not gonna let you keep thinking stuff that's not true about yourself or at least gonna bring it to your awareness and then you can decide.
Number five, cultivate self compassion. We talked about this a lot, a lot, a lot, talked about it in that self criticism episode. Treat yourself with the same kindness you'd offer a friend, a patient, your child. Kristen Neff's research emphasizes that self compassion reduces burnout and builds emotional resilience.
This is one of the most important skills we can develop to help us have a long, happy career and life [00:13:00] is self compassion. Remember, progress is more than perfection. If we want perfection, we are constantly going to be miserable because it is absolutely impossible to achieve. So release that and focus on progress and celebrate progress.
Every good thing you do, notice it and give yourself a little pat on the back. When you integrate these strategies, And to your daily routine, you can gradually shift your focus from what's wrong to recognizing and celebrating the positive aspects of our work and lives. We're really actually reshaping our brains.
We're retraining neural pathways from default negative to default positive or certainly more positive than they were before. And that. It's going to make everything so much better, more positive emotions, more positive self outlook, more positive relationships. I mean, it will help you with your interactions with patients.
It's [00:14:00] going to help you with everything. Okay, so yeah, let's talk about how to implement some of these changes into our daily practice. We talked about how brief mindfulness exercises can help. So how could that look?
It could be a Breathing exercise, a mantra, a short guided meditation between patient visits. One family practice person I had heard of uses the doorframe, like, when she's going in the patient's room as, like, almost as if in her mind she's going through a portal and she leaves everything else.
That she was thinking about or whatever on the outside of the portal and she imagines it's just her and the patient in the room for that. Another one, actually when we had L. A. Alvarez on the podcast he was talking about, you could use something as simple as like going to get a blanket for a patient as an excuse to recenter yourself.
No one's gonna argue with you for going and helping and getting a blanket, right? But if you need that, that could totally be something that you could do.
Another one would [00:15:00] be if you know how to do 4, 7, 8 breaths or box breathing, or even just a single breathe in, breathe out. You want to just focus on making the exhale longer than the inhale. A longer exhale than the inhale seems to activate the parasympathetic a little bit more and let you get more into your body, those sorts of things, while you're waiting for the trauma patient to arrive in the bay, you could do something like that to do something brief and work it in your practice.
Another effective practice would be to set aside a few minutes at the end of the day for private reflection. We've talked about this with the journaling specifically ask yourself what went well today. You want to turn the negative into a positive question so that your brain is tasked with looking for that Instead of the other.
Don't say what didn't go wrong. That's not phrasing it in the way. Say what went right. What didn't suck? How did I not fail? No, how did I succeed today? What went well today? Phrase it in the affirmative to task your [00:16:00] brain correctly. Otherwise you're, when you say don't hit a tree And when you're skiing, that's Simon Sinek's famous example, you're just looking at trees.
Right? So what went well? What did I do right? What was better today than it was yesterday? Even if it's a small thing, writing it down, like Laura talked about earlier, gets you out of your limbic system, there is something therapeutic about writing down. Positive reminders that you're making a difference.
And I think it also, like, if you're having a hard time finding evidence for that, writing it down, it's right in front of you. If you're having a hard time, like, finding facts, or we talk about this all the time, what does the evidence show? Well, the evidence shows you're a board certified EM physician, so you've done all the qualifications, like, nobody can take that away from you.
But if you're in a, a day where you just feel like everything went wrong, if you're at the end of your day, It really does help to write it down so you can see the evidence. There's actually evidence that you had many successes today. Like, and that could be more than one. [00:17:00] Many or one. More than one. It could be two, right?
That's many. And so writing it down shows you like, oh, I see the evidence now. And sometimes you have to do that to like actually convince your brain. It's not enough to just sit there even after your mindfulness, your breathing and everything. Sometimes us. Stubborn brains need to see it written down.
Yeah, if you're an OBGYN, how many totally perfectly easy deliveries did you do today? I promise you a random person off the street would be blown away if they did the same thing that you did today. If you're a surgeon and took out a gallbladder, several of them today, or whatever, the average person is going to be just absolutely gobsmacked at all that you did today.
Maybe there was an infection or something after but like You've got to start encouraging yourself and Realizing I like to think about if I were telling my med school version of myself what I did today Would she kind of be impressed? Probably yeah, I'd be like, oh sweet. We did [00:18:00] what you know, but like we've lost that we've stopped doing that for ourselves.
We've stopped running home and telling our roommates or spouse or whatever, the cool stuff that we did. Well, it's important if you don't want more mistakes, your energy goes where your focus is, your, how's it go? Your energy goes where your focus flows or whatever. Where your focus goes, your energy flows.
Where your focus goes, your energy flows. So you're going to have more mistakes the more you focus on your mistakes. You just second guess yourself. You get all You know, they tell that with athletes, like get out of your head, just let your body do the thing, you know, don't overthink stuff. Okay. So in that same thing, consider partnering with a colleague for mutual support.
We talked about private reinforcement. Also, you can do a one on one colleague to help reinforce things. It would help her and you. And so like a weekly check in, coffee chat, brief call, something, we kind of do this when Kendra and I go to our pickleball club. It can be a positive [00:19:00] moment to reinforce habits of recognizing and celebrating small victories.
And so not only does this practice build personal resilience, it also strengthens your support network, which is essential in our demanding field. So many of us lose all of that the second that we leave residency, never to pay any attention or rebuild it on our own. Be intentional about this.
Your colleagues are also. Feeling isolated right now. Be an example. I love this. Also, Simon Sinek, we're referencing him a lot. He was like when somebody asked me how to be a good friend, I tell him, be a good friend to someone else. Yeah. Like, how, like, being a good friend to somebody else then develops a friendship for you.
There are all kinds of people who would love just a little moment to reflect with you. But maybe you're going to have to be the one to reach out first. Everybody's in their own bubble and, there's a lot of people who would love for you to approach them. So in addition to private and collegial reflection, I think that we should be doing a lot more public reflection [00:20:00] too.
Celebrate those wins at work. There's a whole lot of us in healthcare, I would say most of us in healthcare are discounting the positive. So be that spark to turn it around in others. This is what occurred to me the last time I did a code and was like, yeah, whatever, get like, there was no high fives.
There was no nothing. There was just get back to work. We're behind in patients. Like it didn't even, wasn't even a blip on my radar that the guy was dead and now he's alive. That should be something Yeah, if anything is anything like really I mean it should be impressive to me to grab Somebody from the light and bring him back into this world.
I mean with the help of a defibrillator but I mean I don't know why, why weren't we all like high fiving each other? We just weren't because we just have stopped doing that. And so if you just even remotely look, it's going to be super easy to do a little celebration. It doesn't have to be high fives.
If that's not the thing that you're into, but something like, man? I feel like we did [00:21:00] something good today. It could be as easy as that. And so remember, change doesn't happen overnight. Each small step towards acknowledging our successes is a victory. Give yourself congratulations for giving yourself congratulations.
Over time, these shifts in perspective can accumulate into a more positive, resilient mindset that will serve you both personally and professionally. Yeah, I will say we talk about this a lot. We win and we learn, you know, we have to really shift that win or lose mentality. And I was impressed by.
We just watched the Super Bowl last night. And regardless of the outcome, if you're happy or sad today, it was impressive to hear Jalen Hurts talk about that last Super Bowl loss to the same team, and he really challenged his teammates to look in the mirror and say, like, what did we learn so that they really took the focus off losing the Super Bowl?
Cause like. You have to win a lot of games in the season and show up like months after everybody's already packed their cleats up. And I was like, you know, done. They had to keep showing up. And so that was that small self reflection that he challenged his [00:22:00] teammates to say, okay, how are we getting up from here?
What can we learn? It was really just that Small shift of like, we didn't just lose. We learn like, no, we didn't bring home the Super Bowl trophy this year, but like, how are we going to recover from that? So I just thought that was super impressive for him to really challenge his teammates in that way.
And then look, they came away with the dub last night and it was amazing because every single thing out of their mouths was that simple self reflection that they remembered that Jalen Hurts, the quarterback for the Eagles told them to do after they walked off and, you know, holding their heads. Low, you know, two short years ago, and they just really, on different occasions and different interviews, more than one of the teammates on the Eagles, remember that self reflection.
And so that's how, you know, if we can leave you with anything is, you know, you win or you learn and really just trying to instill that in my kids too, that, it's. How you pick yourself up after, you know, [00:23:00] what people might call a failure, what you may even say to yourself as a failure is really just a learning, a learning opportunity.
And so, as we wrap today's episode, let's quickly recap the key points. We begin by defining the cognitive distortion known as discounting the positive. a habit of dismissing our achievements and focusing on what went wrong. We then explored how this distortion can negatively affect our well being and contribute to burnout.
Then we followed it with the discussion of evidence based strategies to counteract these negative thought patterns and practical steps to implement these changes in our daily practice. So the takeaway is clear. Every positive moment matters. And recognizing and celebrating your successes isn't just about feeling good, it's actually about building resilience.
And that is necessary to thrive. Not just survive, but thrive in this challenging profession. If you'd like to chat with one of our physician coaches, click the link in the show notes. That's where you can also find our free video, how to crush physician burnout for [00:24:00] good without cutting back hours, quitting medicine or sucking it up in silence.
Thank you for joining us today on the drive time debrief with the whole physician. If you enjoyed this episode, please subscribe, leave us a review and share your thoughts or experiences on social media using the hashtag whole physician. Your feedback helps us continue to support our community of physicians.
Remember to celebrate your wins, no matter how small. They are still wins, and we'll see you in the next episode. Until next time, you are whole, you are a gift to medicine, and the work you do matters.
