From reflections about ourselves to perceptions of our world and others, thoughts are a focus – and fuel – of the typical therapy process.
Thoughts exert a powerful influence over our lived experiences. Yet when we struggle and seek support (professional or otherwise), feelings and actions are also common causes.
Whether or not we live with a mental health disorder, our thoughts, feelings, and behaviors are very closely connected. What we think about the world shapes our emotional experience of it, and our behaviors reflect our thoughts and feelings in turn.
Take this example: Your boss requests to meet with you at the end of the day without providing any reason for this unscheduled chat. If your initial thought is “I must be in trouble for something,” you might understandably feel anxiety. You begin searching your inbox for evidence of a missed email, snacking on junk food to soothe your nerves, or questioning colleagues for clues about your fate. The whole day could be consumed by speculation, worry, and actions intended to ease your dread.
But what if your initial thought were, “My boss wants to bring me in on a new project” or “She wants to discuss coverage for her upcoming vacation.” You might feel fairly neutral about the impending meeting, and your behavior might not differ much from that of a typical day. In fact, if your interpretation of this situation were “I could be getting a promotion,” you might feel pride and go about your work more efficiently than ever.
How do we move from unhelpful thoughts to those that support improved mood and effective action? Unfortunately, simply wishing to think differently usually won’t suffice. We’ve all had a well-intentioned friend urge us to “think positive” or “stop thinking like that.” This feedback is often more frustrating than helpful.
The more effective approach is a kind of introspective “self-talk,” in which we evaluate our own thoughts, examine their connection to the facts at our disposal, and consciously arrive at more balanced and accurate conclusions. This self-talk isn’t simply naive optimism. When it comes to navigating reality, putting on rose-colored glasses isn’t a sound strategy.
Rather, this healthy self-talk utilizes our rational abilities, replacing automatic reactions with more realistic and constructive conclusions. Better yet, this self-talk process can be employed without a clinician’s assistance – and provide benefit to nearly anyone.
To make the process of constructive self-talk more accessible and memorable, I sometimes suggest an acronym to my patients. In the IF THEN approach described below, each letter stands for a distinct step in practicing self-talk in response to unpleasant thoughts and feelings.
I – Interpretation: How am I interpreting the current situation or event? What is my automatic thought or assessment of what is occurring right now?
In the example above, my initial interpretation might be: “I’m in trouble for something.”
F – Facts: Take a step back from your initial interpretation and consider the information at your disposal. What do you actually know for certain, as opposed to what you have concluded or assumed? Moreover, what do you definitely not know at this point?
In the example above, the facts might include: “My boss asked me to meet with her at the end of the day. I agreed to meet with her. I do not know what she intends to discuss.”
T – Thinking Traps: Have you fallen into an unhelpful, automatic pattern of thinking, such as assuming the worst will occur (sometimes called “catastrophizing”) or imagining someone else’s thoughts about you without concrete evidence (“mind reading”)? Other common thinking traps include all-or-nothing thinking (“If I’m not perfect, I’m a total failure”), personalization (“something went wrong, so it must be my fault”), and overgeneralization (“I always screw up”).
Each of these thinking traps reflects unjustified negative assumptions about ourselves, other people, or the world. We believe that we are not good enough, are doomed to failure, or are unworthy of acceptance and success. While these patterns may help us avoid pain in some instances (as in “prepare for the worst, hope for the best”), they more often cause us unnecessary distress.
In the example above, relevant thinking traps might include catastrophizing (“I’m in trouble and I could get fired”), mind reading (“My boss thinks I’m a poor worker”), and overgeneralization (“I always do something stupid to get in trouble!”).
H – How else could I interpret this situation? Are there other ways to think about the current scenario, as opposed to your initial interpretation? Often, there are plenty of alternative explanations for the circumstances, many of which are neutral or even encouraging in nature. Sometimes, it is also helpful to consider how you might interpret the situation if a friend or stranger were in your place, because you may be more objective.
In the example above, other interpretations might include “She could want to check in on a current project,” or “She could have some feedback to help me succeed,” or “She might want to commend me for my work” or “She wants my input on a potential hire.”
E – Evidence: Consider the current facts at your disposal, relevant data from the past, and your general knowledge. Within this body of evidence, is there anything to support your initial interpretation? What is the evidence against this initial interpretation?
Now turn to some of the alternate interpretations you developed in the last step. What is the evidence for and against these? Approach this process with rigorous objectivity. Think of yourself as a jurist weighing evidence in court.
In the example above, you might find there is little evidence to support your initial interpretation (“I’m in trouble for something”) and ample evidence against it (“she complimented my work in our last meeting together”). You might also find evidence for another interpretation (“she did mention wanting to catch up on that project”) or simply decide there’s too little evidence to support any definite interpretations, positive or negative.
N – New Conclusion: At the end of this self-talk process, draw a new conclusion about the situation that seems justified by the facts and helpful in moving forward. This new thought need not be overwhelmingly positive, but it should feel aligned with reality in a constructive manner. Ideally, this new thought will not prompt the negative feelings and behaviors that your initial interpretation produced.
In the example above the following might be a helpful new conclusion: “I don’t know for sure what this meeting will be about, but I have no evidence to suggest I’m in trouble. It is most likely an opportunity to collaborate on a current project, but it could also be a chance to get helpful or positive feedback.”
While the IF THEN technique is just one approach to constructive self-talk, it may be helpful in addressing a range of unhelpful thinking patterns and related emotional challenges. My hope is that it serves you well, either in navigating life’s daily stressors or addressing more serious mental health concerns.
And although you can employ the IF THEN approach independently, seeking therapy or other mental health treatment may also be highly beneficial. If you are concerned about your own mental or emotional well-being, please reach out to your Atrius Health providers for assistance in accessing appropriate resources and care.