The freshly-diagnosed heart patient has plenty of opportunity to start thinking thoughts that are new, bizarre and sometimes even frightening. Any life-altering diagnosis can throw us off-balance emotionally, but with heart disease, even the tiniest twinge of new chest pain can paralyze us. Is this something? Is it nothing? Should I call 911 again? As Australian cardiac psychologist (and more importantly, a heart patient) Len Gould likes to say: “Before a heart attack, every twinge is just indigestion. After a heart attack, every twinge is another heart attack!”
And our worried thoughts can stick around far longer than they should, as we play them over and over and over like our first Beatles album. Mental health professionals call this kind of twisted thinking cognitive distortion.
See if any of the 10 most common ways we get our thoughts twisted around resemble your own experience – based on the work of Dr. David Burns (bestselling author of a landmark book – that really helped me address my own twisted thinking – called The Feeling Good Handbook):
1. All-or-nothing thinking (no grey areas): You look at things in your life in absolute, black-and-white categories. Not “Oh, I feel a little twinge of pain in my chest” but “OH MY GOD! ANOTHER HEART ATTACK!”
2. Overgeneralization (using words like “always” or “never”): You view setbacks in your recuperation as a sign of permanent defeat.
3. Mental filter: You pick out even the smallest of negative events and ruminate on them.
4. Discounting the positives (“Yeah, but . . . “): You insist that your accomplishments don’t count by pointing out what you still aren’t able to do well yet.
5. Jumping to conclusions (without clear facts to support your conclusion): You become a mind-reader (assuming that people are reacting negatively to you) and a fortune-teller (“I’ll never get better!”).
6. Magnification or minimization (also called “the binocular trick”): You exaggerate the significance of each symptom, or minimize your progress by shrinking its importance.
7. Emotional reasoning (If X, then Y. . . ): You reason from how you feel. “I feel angry, so this proves I’m being treated unfairly!”
8. “Should” statements (if directed at yourself, can lead to guilt; if directed at others, can lead to resentment): Many of us try to motivate ourselves (and others) with shoulds and shouldn’ts. “I should exercise every day. . . “
9. Labeling (an extreme form of #1): Instead of just saying, “I ate a piece of cake last night!”, you attach a negative label: “I was so bad last night.” And you might also tend to label the character of others, instead of just their behaviours, which can lead to feeling hostile or hopeless about any possible improvements in the relationship.
10. Personalization and blame (“It’s all my fault” vs. “It’s all YOUR fault!”): You hold yourself personally responsible for an event that’s not under your control, or you blame other people or their circumstances for problems, and may overlook ways that you contributed to a problem.
So what can you do if you recognize one or more of these twisted thinking patterns in your own thoughts? Here are some of Dr. Burns’ suggestions:
♥ Identify the distortion: Write down your negative thoughts so you can track which of these cognitive distortions have become your favourites.
♥ The Double Standard Method: Instead of self-talk that’s harsh or condemning, talk to yourself in the same kind and compassionate way you would talk to a friend in a similar situation.
♥ Thinking in shades of grey: Instead of thinking about your problems in either black or white, evaluate them on a scale of 0-100. Start thinking of things that don’t work out as you’d hoped as a partial success, not a complete failure.
♥ The Survey Method: Ask others questions to see if your thoughts and attitudes are realistic. For example, ask other patients (in person or in online support communities) if they have experienced similar situations.
♥ Cost-Benefit Analysis: List the advantages and disadvantages of a feeling (like getting upset when you’re running late) or a behaviour pattern (e.g. overeating). Use this method to modify a self-defeating belief like “I must always be perfect!”
Q: Do any of these examples of twisted thinking seem familiar to you?
NOTE FROM CAROLYN: I wrote more about the important topics of rumination and cognitive distortion in my new book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University, November 2017).
- Do you think too much? How ruminating hurts your heart
- Get over yourself: how to stop boring others with your heart attack story
- Even heart patients can learn to be optimists
- “Stress creep”: are you like the frog in the pot of boiling water?
- Four ingredients in the heart patient’s recipe for stress
- Is everyday stress gnawing at your arteries?
- A heart patient’s guide to the three stages of chronic stress
- Is family stress hurting your heart?
- Women’s heart disease and chronic stress
- Got a minute? Try this mini-relaxation for your heart health
- In praise of slowness: how ‘La Dolce Vita’ can help your heart