Changing What Goes on in Your Head: How to Stop "Ain't it Awful?".

Have you heard physicians say: "I am sick of filling out forms. My income is going down. Patients change insurance companies every three months. Lawyers sit around plotting how to sue me. I have to see patients faster and faster, and they are less satisfied every day. Every patient is a potential malpractice suit."

Have you heard physician executives say: "Doctors are bullheaded and greedy. They only see things from their point of view. They never think of the good of the organization. They just want to hear themselves talk."

If physicians and physician executive are talking this way, you can bet they are also saying these thoughts to themselves regularly. I am going describe a process that, on the surface, seems too simplistic to be beneficial, but that I know works. However, I frequently forget to do it and have had to begin again many times over the past 16 years since I first learned the technique. If you want to be more satisfied with your work life and your personal life, you must change the internal dialogue in your head. When you are seeing a patient or running a meeting, your brain is occupied, but, as you walk between rooms or head to the next meeting, I bet your mind does some version of--Ain't it awful? "I hate all these meetings. Everyone argues with me. Dr. Jones is such a know-it-all. These patients are demanding and ungrateful and may sue me."

If you do some version of that internal chatter, you must substitute positive statements, such as: "I enjoy seeing patients. I am making a difference in people's lives. I am helping physicians practice better medicine. I am helping patients get well. I enjoy my work." You need to say something different from what you have been saying every spare minute of the day. You must say it even if it is the biggest lie you have ever heard yourself think. Say it anyway. You must say it for days or weeks before you notice a difference in your attitude, relationships, and health. Eventually, you will notice you feel better and people are behaving better.

What the research has shown

Martin Seligman in Learned Optimism describes the extensive research he has done with optimists and pessimists. [1] He would label me a born pessimist because I've been a worrier for as far back as I can remember. Changing negative thinking is the hardest thing I have to do. Seligman says when unpleasant things happen, a pessimist says to him or herself: "'It's me, it's going to last forever, it's going to undermine everything I do.' Others, those who resist giving in to misfortune, say: 'It was just circumstances, it's going away quickly anyway, and besides, there's much more in life.'" [1]

Seligman goes on, "People who mull over bad events are called ruminators. A ruminator can either be an optimist or a pessimist. Ruminators who are pessimists are in trouble. Their belief structure is pessimistic, and they repeatedly tell themselves how bad things are. Other pessimists are action oriented and do not ruminate: they have a pessimistic explanatory style, but they do not talk to themselves much at all. When they do, it is usually about what they plan to do, not about how bad things are." [1] I was utterly amazed to read that some people do not have an internal dialogue going on between their ears. I have never been without it except for the few times that I've been able to meditate, so it has been essential for me to learn ways to control my ruminations.

"Changing the destructive things you say to yourself when you experience the setbacks that life deals all of us is the central skill of optimism." [1] He outlines the five steps of cognitive therapy and shows how that process can work to change pessimistic thoughts to optimistic ones. You need to learn how to:

1. "Recognize the automatic thoughts flitting through your consciousness at the times you feel worst. Automatic thoughts are very quick phrases or sentences, so well practiced as to be almost unnoticed and unchallenged.

2. Dispute the automatic thoughts by marshaling contrary evidence.

3. Make different explanations...and use them to dispute your automatic thoughts.

4. Distract yourself from depressing thoughts.

5. Recognize and question the depression-sowing assumptions governing so much of what you do." [1]

Change a few words

Seligman also makes a disclaimer that his ideas are nothing like those of Norman Vincent Peale, author of The Power of Positive Thinking. "Learned optimism is not a rediscovery of the 'power of positive thinking.' The skills of optimism do not emerge from the pink Sunday-school world of happy events. They do not consist in learning to say positive things to yourself. We have found over the years that positive statements you make to yourself have little, if any, effect. What is crucial is what you think when you fail, using the power of 'non-negative thinking." [1]

I disagree with Seligman, and, as Hamlet said of his mother, "Me thinks (s)he doth protest too much." He is trying too hard to separate his research from any who advocate positive thinking. Changing your thinking begins with the words you say in your head. In the initial throes of an unpleasant situation, the most I can manage to change is a few words. Later, sometimes two or three weeks later, I can muster up a whole paragraph of non-negative thinking about the situation.

Most high achievers stay busy with work, being a good spouse, raising children, helping elderly parents, etc. We can further distract ourselves with exercise, hobbies, computers, and TV. But eventually there always comes some idle time--time when your brain is going to rehash the day's events, play over and over what you should have said or done, what someone else should have said or done. When the negative dialogue begins, it is essential to substitute something else. If you can rationally think yourself out of it, more power to you. If you can't, then try saying some positive words.

Write to find the right words

You can begin to find some positive words by writing in a journal. Often writing about your frustrations can get the negative energy out of your system. You can tear up the pages when you finish and get on with the next thing you want to do. I write three pages of non-stop stream-of-consciousness thinking in a spiral notebook every morning. On fearful days, I write out every negative thought that occurs to me. Then I get to work on exerting more control over my mind. The words--worry, fear, and anxiety--try to set up shop in my head. I change the words to wisdom, faith, and courage and begin the constant repetition.

When my brain is not completely occupied with the tasks of my job, I say the positive words to myself. Several words are all that I can do, but that is enough to make a huge difference. The most important element is repetition, even when you think it is a lie. Just keep saying them and they become truer.

After enough hours and days of repeating positive words, I am able to progress to better thinking, as described by Seligman and also recommended in Life by Design: "[W]hen you think of your mind as an instrument that produces results, not according to fact but according to your thought, learning the principles of changing your thoughts is an idea whose time has come!" [2]

Seligman lists some examples of changing negative assumptions to positive ones:

Negative

"Unless everything I do is perfect, I'm a failure."

"Unless everybody likes me, I'm a failure."

"There is a perfect right solution for every problem. I must find it."

Positive

"Success is doing my best."

"For every person who likes you, one person doesn't like you."

"Life consists of putting my fingers in the biggest leaks in the dam." [1]

When losing a job, the negative thinker says to him or herself: "I am no good. I made too many mistakes, and this will last forever." The positive thinker says, "The chemistry was not good with my boss. I can find another job that better suits me."

"What we say to ourselves when we face a setback can be just as baseless as the ravings of a jealous rival. Our reflexive explanations are usually distortions. They are mere bad habits of thought produced by unpleasant experiences in the past--by childhood conflicts, by strict parents, by an overly critical Little League coach, by a big sister's jealousy. But because they seem to issue from ourselves, we treat them as gospel," [1]

Change your conversations

It is also helpful to change what you say to other people. As long as you play "Ain't it awful?" in your head and in your conversations, that is exactly how you will feel. You'll find that changing the self-talk in your head will help change what you say to others. Initially, stopping negative talk and gossip will seem to take some of the fun out of life, because you will give up describing a problem or a person's wrongs with righteous indignation. We have all known the rush of talking badly about our co-workers. For a few minutes it makes us feel more secure, but even as we do it, there is the underlying, nagging feeling that the other person will do the same about us.

If you can't give up complaining about others totally, then try telling it only once. Choose your listener carefully--someone you trust not to use the information against you, someone who is not overly frustrated. Then ask permission--can I vent for a few minutes? Can I get something off my chest? Can I complain about something for a few minutes, but I don't need you to tell me how to fix it. "Set a time limit. 'I need about five minutes of your time.' You'll want enough time to reflect on what you're saying but not enough time to repeat it." [2] Saying it over and over just gets you more worked up, rather than getting it out of your system.

Think about the past the way you wish it had happened

After you tell someone about the thought once, from then on remember it differently. "Any time you have a bad experience which you then mentally play again in the same way, you increase the likelihood that the next time you're in a similar situation, you will do an even better job of having a bad reaction. Any time you review a bad experience in a more resourceful way, you change your response to it in the future. Life keeps giving you a chance to learn new responses, until at last you seize the moment and make the most of it." [2]

I have described a progression--choose a few good words to repeat to yourself constantly, progress to better thoughts, and then improve what you say to others. For me the process always starts with changing a few words in my head, but there have been times when I could not do it no matter how hard I tried--when my health was not good or I was worrying about a child. But I am more successful than I used to be at doing it when life is rocking along pretty well, when there is no good reason to go to my automatic default of worrying. If I say the words enough, even if they are untrue in the beginning, I can expand to better thinking after a week or so. I will feel lighter, as if a burden has been lifted off my spirit. I do better quality work than when I drive myself like a master with a whip, saying internally--"Do this, hurry up, you will never catch up."

I forget to do this over and over again, and yet the same message keeps finding me in books I read, in lectures I hear, and I'm reminded--oh yes, that again. Yes, indeed, it does work, but it takes so much discipline to remember to do it. I'll put it off and then the fear trail of dialogue in my head will begin to be too much, and I will say the positive words to myself. I start by saying "wisdom, faith, courage" over and over again. As the days or weeks pass, I'll notice I am being more courageous and am making better decisions.

I used to think there ought to be a way to enjoy life and not worry when things are relatively okay. There is and these are the words that work for me. Stop the negative talk to yourself and others if you want to feel better, if you want your life to get better. If what you've been thinking was going to get you what you want, it already would have done it. What can it hurt to try something else?.

Barbara J. Linney, MA, is the Director of Professional Development at the American College of Physician Executives in Tampa, Florida and a member of its faculty.

References

(1.) Seligman, Martin E. Learned Optimism; How to Change Your Mind and Your Life. New York: Pocket Books, 1998.

(2.) Kirschner, Rick and Rick Brinkman, Life by Design: Making Wise Choices in a Mixed-Up World. New York: McGraw-Hill, 1999.

KEY CONCEPTS

* Changing your Negative Thinking

* Controlling Your Ruminations

* Pessimists versus Optimists

* Learned Optimism

* Changing Negative Assumptions to Positive Ones

How can you change your negative thinking? This column describes a process that, on the surface, seems too simplistic to be beneficial, but that works: choose a few good words to repeat to yourself constantly, progress to better thoughts, and then improve what you say to others. If you want to be more satisfied with your work life and your personal life, you must change the internal dialogue in your head. If you have some version of negative internal chatter, you need to substitute positive statements. You need to say something different from what you have been saying ever' spare minute of the day. You must say it even if it is the biggest lie you have ever heard yourself think. You must say it for days or weeks before you notice a difference in your attitude, relationships, and health. Eventually, you will notice you feel better and people are behaving better.