What are those little thoughts that run through your mind day after day? You know…the ones you tell yourself that you aren’t good enough…you will never reach your goals…you are such a failure – you’ll probably fail at this, too. You are just destined to be overweight and out of shape and there is nothing you can do to change that. Your friend isn’t responding to your text messages – I guess they don’t want to be my friend anymore. Someone cuts you off in traffic and you are late to work – why does this ALWAYS happen to me?
Where did those negative messages come from? Why is the record that plays in our heads defaulting to negative thoughts?
According to some psychologists, these negative thought patterns tend to develop in childhood or adolescence as the result of psychologically harmful experiences involving family members or other individuals who have a significant influence on the child’s life. According to the Schema Theory, these thought distortions and negative thought patterns are developed in response to unmet core emotional needs like secure attachment to others, freedom to express emotions, autonomy and competence, spontaneity and realistic limits or self-control. When these emotional needs are left unmet, it can set the child up for negative self-talk and thought patterns, which can lead to cognitive distortions that we accept as fact when we reach adulthood.
Some common thought distortions are:
All-or-nothing Thinking: thinking in extremes without considering other possibilities – you are either destined for greatness or doomed to failure with no in-between.
Overgeneralization: using limited factual evidence to support a false belief – you receive one bad grade, so you are terrible in that subject, or you have one bad experience in a relationship, therefore you are bad at relationships in general.
Catastrophizing: thinking the worst-case scenario in every situation – my husband is driving and isn’t picking up the phone, he must have gotten in an accident, or the mail hasn’t come yet, and my paycheck is supposed to be in the mail…it’s never going to come, I won’t be able to pay the rent…we will be evicted from our apartment.
Personalization: Taking personal responsibility for things that are not your fault or feeling that you have been personally targeted or excluded – I know they didn’t invite me on purpose.
Mind Reading: Assuming you know what someone is thinking without having to ask – someone is frowning and looking toward you, well they must hate me.
Mental Filtering: Ignoring the positives and only focusing on the negatives – my last review was so full of criticism; my boss is such a jerk (even if there were positive comments in the review).
“Should” Statements: thinking about what “should” have been said or done – I “should” have said that differently; I “should” be better at XYZ; I “should” be married...have a house...have a career...be retired...by now.
Emotional Reasoning: Thinking that your emotions don’t lie and that the way you feel about a situation is a reliable indicator – I feel so stupid, so I must be stupid. I feel like she hates me, so I am not a likeable person.
Labeling: Classifying yourself in a negative way – I am such a disorganized person! I am so stupid! I am a complete failure!
So, one of the thought distortions that I battle regularly is…
“You are not good enough.”
I’m not sure when or how I assimilated this thought distortion, but it is ingrained in my subconscious. I would be what you call an “over-achiever” and anything less, feels like failure. I’m an all-or-nothing kind of person at my core and doing enough to skate by gets under my skin and stresses me out. I’m always trying to do more! In and of itself, this is not necessarily a bad thing. My Jesuit school even has one of these as a core Jesuit value – “Magis” – to be more, to do more, to strive for more. BUT, when this internal message of “you are not good enough” starts playing in my head, it can distort reality and lead to poor decisions or consequences.
I had a situation in a high-school biology class that demonstrated this. It was a group project (yeah…love those) that involved landscaping a part of the grounds of the high school. I developed a love of gardening and plants from a young age and already knew a significant amount about landscaping by high school. Well, my partners did not have much knowledge about plants or landscaping, so I helped them develop the plan. The only part of the project I wanted them to complete on their own was building the raised beds. I would take care of the rest (e.g., buying and planting the plants, writing up profiles on each plant, and describing the growing needs and seasons, etc.).
Some time went by, and the raised beds still were not done and there wasn’t much I could do on my end until the raised beds were constructed…long story short, my group reported that I was slacking off to our teacher and he was going to give me a zero for the project. I was willing to just take the zero, because I believed that maybe my team members were right. Maybe I wasn’t pulling my weight enough for an A, so I should get a zero.
My mom called the teacher and just requested that he get us all in the same room to talk it out. She also requested to have the other team members go first, because she knew I could defend myself against whatever allegations they had. My mom helped me get past my all-or-nothing mentality. I ended up defending my position as the person who had the most knowledge in the group and we split the project.
I ended up making my corner into an herb garden and gave a presentation on the medicinal properties of herbs. I also made herb butter and brought crusty bread for my fellow students to enjoy. AND…I ended up making an A on the project. It could have ended very differently if my mom had not interceded.
Fast forward…
To be accepted into pharmacy school, I had to take certain prerequisite classes like organic chemistry, biology, calculus, etc. I also had to take an exam called the PCAT (The Pharmacy College Admission Test), which is intended to gauge if a student will perform well in pharmacy school based on general scientific knowledge. When I applied to Creighton, there was a ratio of 10:1. So, 10 applicants for every student that was accepted into the program. And I got in! It was a rigorous program, and I complicated the process by choosing the distance pathway.
Taking classes online is common, today (especially since COVID), but it was still a novel concept in 2008 when I started attending classes. However, Creighton has always been ahead of their time and has perfected distance learning programs. I even had to let go of my “all-or-nothing” mentality in some of my classes and accept “good enough.” I was rewarded during my final year of clinical rotations when my preceptors were impressed with my depth of knowledge, work ethic, and clinical abilities. It was quite challenging, but I made it through to graduation.
Many people would have been proud of their accomplishments…and I was…but the morning of my graduation, someone asked me if I was thinking about going back to school to become a “real” doctor.
Boom…” You are not good enough.”
I started having doubts about my chosen path. Am I really qualified to be doing this? I mean...I did have that one patient who asked me about DHEA (for hormones), and I showed him an Omega-3 supplement with DHA (a fatty acid) when I was fresh out of school…that must mean I’m a terrible pharmacist, right?
Professionals call this imposter syndrome. Pharmacists have all this training, we have all this knowledge, we have all these talents, but we still have doubts in our abilities. We feel like imposters because we don’t know EVERYTHING or we occasionally make an error in judgement. But in the medical field (as well as other professional fields), one person cannot possibly know absolutely everything, which is why we should work on a team with other amazing professionals. So, if your doctor’s office does not have a clinical pharmacist and a registered dietician working for them, ask them why. It might plant a seed in their mind…because a diverse team-based approach can lead to better health outcomes for you and other patients.
So, how can you stop these thought distortions? The first step is to recognize them! You can work with a licensed therapist to recognize and develop strategies to reframe and overcome negative thought patterns. For instance, I have to constantly reframe my doubts into a positive framework.
"You are not good enough. You don't know enough. You are a failure."
"I am still learning. I have accomplished so much in my life.
I deserve the good things in my life."
It also helps to keep a gratitude journal. Write something positive down every single day. The more your brain focuses on the positive things in your day, the more you will pay attention to the positive and not the negative things that happen during your day.
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References:
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