“A pandemic has taken over the globe. Life has looked very different since it struck. What if it never goes back to being the way it was before the coronavirus? What if this is the only life we will know from now on – sickness, unemployment, depression, economies crumbling, death, no freedom to go outside? What if this is all happening because of me? I did wish for a long vacation last year”
These are a few of the monologues that individuals may have been regularly entertaining on account of the ‘new normal’ reality brought about by this pandemic
Reports of a new and dangerous virus spreading rapidly around China began to surface on the internet and other news media early this year. Nine months later, we find ourselves in the thick of a global pandemic that has claimed several lives and disrupted many more. While all and sundry have found their lives affected, paused, halted or endangered in some way or the other due to the pandemic, none have been hit harder than “frontline workers”, i.e., doctors, medical and paramedical professionals, hospital staff, lab technicians, nurses, and psychologists. Individuals and collectives have turned to frontline workers for help in this vulnerable situation, leaving them feeling burnt out, struggling to stay positive and hopeful, both nationally and globally.
Frontline workers, whether being in direct contact with COVID-19 patients or not, have been working tirelessly to ensure that the physical and mental health of millions around the globe is taken care of. Those engaged in helping professions usually find time to de-stress and de-clutter their minds before taking on additional helping responsibilities, thus allowing themselves time for rest and recuperation. Due to a severe lack of time, resources, and financial support, most frontline workers are now finding themselves burnt out and overwhelmed. With little to no time for self-care or support from family members and friends, frontline workers are also vulnerable to negative thoughts, cognitive distortions, and overwhelming emotions.
Thoughts, Emotions, and Distortions: Primary Differences
There is a subtle difference between thoughts and emotions.
A thought is an interpretation of an event based on our cognition, i.e., memories, perceptions, and emotional information, pertaining to individuals/objects/situations defining the event. On the other hand, according to Plotnik and Kouyoumdjian (2011), emotional experiences involve four components: interpreting or appraising an event, object, or thoughts in terms of one’s well- being, experiencing subjective feelings associated with that stimulus, encountering physiological responses, and expressing feeling state through observable behaviors. Hence, thoughts and feelings are interrelated yet two different processes. They coexist in our psychological existence. Therefore if the thoughts are distorted, they are bound to evoke a sense of emotional distress that may require our attention to attain a better mental health.
Thoughts are an integral part of our cognitive processes, involving schemas that begin forming from the time we are children. Schemas are the component of ‘social cognition’, a process that determines our learning about social relationships (Plotnik & Kouyoumdjian, 2011). Experiences, information, and interactions lead to the processes of accommodation and assimilation of schemas (Bartlett, 1932). There are generally four types of schemas based on the nature of information they store: person, role, event, and self-schemas Plotnik & Kouyoumdjian, 2011). Person schemas hold the judgments we hold about our traits and also what others adheres to. Role schemas determine the perception we hold towards specific job roles and the associated social positions. Event schemas are mostly called ‘scripts’ that provide us with guidelines to decide how to behave differently in different situations to elicit specific responses. And lastly Self schemas pertain to the specific information related to self that influences, modifies, and distorts what we perceive about ourselves, how much we remember and how we behave. Therefore, whenever these schemas are skewed, cognitive distortions are formed (Beck, 1972). Cognitive distortions are thoughts that are detached from reality and present a distorted picture of the actual situation. It directly impacts our perceptions of the situation.
Understanding the difference between thoughts, feelings/ emotions, and distortions is crucial at a time when frontline workers find themselves embroiled in situations that often require them to take complete responsibility for the physical and emotional states of those reaching out to them. Unless thoughts, feelings, and distortions are duly addressed, it can be easy for inauthentic distortions to be stemming from interactions with others. And recurrent occurrence of those cognitive distortions may lead to fatigue, self-doubt, burnout, and a cynical worldview. At a time when exposure to negative news is high, it is crucial to find ways to separate oneself from one’s negative thoughts and stay grounded so as to create an environment of peace within a chaotic one, especially as a medical or paramedical/mental health professional.
Table 1: Examples of Cognitive Distortions
|Personalization||The cognitive distortion that leads to self-referential thoughts for unrelated events/situations||“Maybe that patient in ward XYZ passed away because I checked on her later than I should have. It is my fault she passed away.”|
|Minimization||Thoughts that dismiss or invalidate an emotion that is too uncomfortable to process, or could leave a person vulnerable to judgement if vocalised||“I mean it’s not that big a deal, but I am very tired from being on duty all day and have no time for my family and kids. It’s not a problem, though, worse things have happened. The hospital needs me right now. I’ll get over it.”|
|Selective Abstraction||It involves picking out a specific part of an incident/event, usually something embarrassing/painful and focusing on it extensively while ignoring other parts of the same event/incident||“I fell down the stairs at the door to my office the other day and although everyone quickly forgot about it, I can’t get the sound of everyone laughing at me out of my head. I am such a clumsy person. I will work from home hereon.”|
|Black and White Thinking||It involves ignoring the “in between” fineries of a situation and only focusing on positive or negative extremes||“Either I will be able to cure my patient completely or they will die and I will be an incompetent doctor.”|
|Overgeneralization||It manifests in the form of a belief that once a situation or event goes awry, it will repeat itself and become a pattern that is noticeable to others as well||“One of my clients told me that she feels she hasn’t made much progress. All my clients will start saying that to me now. Maybe I shouldn’t be a psychologist at all, I’m a bad one”|
|Jumping to Conclusions||It involves forming assumptions based on our internal frames of reference, often ignoring the reality of the situation or event .||“Oh, the lab is closed today – this means that the technicians themselves have contracted the coronavirus. It is unsafe to be around here.”|
|Catastrophizing||A stream of thoughts spiral straight into imagining worst-case scenarios and outcomes without acknowledging more positive possible outcomes||“What if at this moment I am an asymptomatic carrier and I come in contact with a senior citizen who is unwell and they are unable to survive? I will be responsible for loss of life.”|
|Emotional Reasoning||Basing important and often life-altering decisions entirely on what feels right, with little to no regard for the practicality and sustainability of executing the decision||“The patient is in an isolation ward and hasn’t seen his family for 14 days now. It’s okay to let them visit him, it is just a virus, it is more important that the patient gets to see his family and doesn’t feel overwhelmed and alone”|
|Fallacy of Change||Expecting that others around us will change themselves to fit our circumstances better, often without even communicating our needs and difficulties to them||“I am very burnt out, I see around 7 clients a day and I think now they will understand that I am also tired, and talk about less intense emotions for some time”|
A Change in Perspective: Thought Management Exercises
Medical professionals, especially when overburdened with patients, are vulnerable to spiralling into repetitive cognitively distorted loops that can be both a cause and effect of burnout. (Grover, Sahoo Bhalla, & Avasthi, 2018) Methods to cope with the same are:
- Challenge your thought stream:
In the environment around you, as well as in day-to-day situations, look for evidence for your negative thoughts and distortions.
For example, if your distortion is “My problems are very small compared to those of my clients’, so I will not seek therapy for my own problems – but I take in their problems and end up feeling very overwhelmed”, look for “evidences” in the environment to prove and disprove your thoughts.
An evidence to disprove the aforementioned thought would be – “no problem is big or small, and each individual’s personality and circumstances are different, so problems cannot be compared”. Gather evidence for and against your “hot thought” (the most pressing, disturbing or urgent thought on your mind), and you may find your cognitive distortions disproved.
- “What would I say if a friend vocalised a thought like this”? :
Imagine a friend speaking to you about themselves spiralling into thought loops – what would you say to help them see their thoughts objectively? How would you be there for them? Be your own “friend”, take some time to be there for yourself and your thoughts, much like you would be for a friend.
- Mindfulness-based mediation using the HUMP acronym for thoughts – Harmless, Useless, Meaningless, Purposeless:
Thoughts have no power over us unless acted upon. Since cognitive distortions stem from thoughts, they too, hold no reins over us until we allow them to. Reinforcing to yourself the message that thoughts are harmless, useless, meaningless, and passing unless acted upon, while performing short meditation or Guided Imagery exercises can help immensely in preventing negative thoughts from translating into action or behaviour. Guided imagery as a technique helps the client to create mental images of places, and situations to evoke the feeling of relaxation. The principle of Guided Imagery is based on the mind-body association and is proven to be one of the most effective measures to attain calmness and relaxation in our moments of anxiety.
- Ns of cognitive distortions – Notice, Name, and do Nothing:
When encountering a cognitive distortion, it is useful to be able to notice that it is unlike other thoughts – it carries a sense of unease and anxiety, and has a tendency to spiral and branch out into several negative automatic thoughts. Noticing a thought and identifying it as a cognitive distortion allows us to step back from it and let it pass, instead of acting upon it.
Break Out of the “Thought Prison”, Once and For All!
Cognitive distortions and negative thought spirals can be very distressing and are often succeeded immediately by burnout or long periods of feeling overwhelmed. Going through such thought spirals which lead to unease and distress all alone can be very daunting and difficult to deal with. If you find yourself feeling trapped, overwhelmed, and/or fatigued, reach out to “Swaasthi” helpline by iCALL, via telephone and/or email. A team of professionally qualified counsellors will be happy to provide you with an empathetic, accepting, and non-judgemental space for you to freely express your concerns and share your thoughts. Team Swaasthi can be reached at +91 9152987824 and firstname.lastname@example.org between 10 am and 6pm from Monday to Saturday.
Beck, A.T. Thinking and Depression: I. Idiosyncratic Content and Cognitive Distortions. Arch Gen Psychiatry. 1972.9(4). pp 324–333. doi:10.1001/archpsyc.1963.01720160014002
Carbon, Claus-Christian & Albrecht, Sabine. (2012). Bartlett’s schema theory: The unreplicated “portrait d’homme” series from 1932. Quarterly journal of experimental psychology (2006). 65. 2258-70. 10.1080/17470218.2012.696121.
Grover S, Sahoo S, Bhalla A, Avasthi A. Psychological problems and burnout among medical professionals of a tertiary care hospital of North India: A cross-sectional study. Indian J Psychiatry 2018. 60. Pp 175-88
Plotnik, R. & Kouyoumdjian, H. (2011). Introduction to Psychology. Wadsworth Cengage Learning. (9th ed.). ISBN-13: 978-0-495-81281-4 ISBN-10: 0-495-81281-1