Table 1.

Common thought distortions and how to challenge them

Distortion	Challenge
Magnification or minimization	Overemphasizing or underemphasizing one aspect of the situation: “I didn't check out with the patient if he understood the reason for the medication”; overlooking other factors that may be important
Polarization	Using black and white thinking: “My colleagues are going to think I am incompetent”; are there shades of gray?
Personalization	Taking the situation personally and ignoring the total picture: “It's my fault”; what would I say to a colleague in the same position?
Stress-producing language	Using words such as should, have to, must, need rather than would like, want: “I should never make a mistake”
Pessimistic thinking	Thinking of the situation as permanent, pervasive, and personal: “I'm never going to have the respect of my colleagues” or “I'm not suited to this profession”; rather than temporary, specific, and related to factors beside myself3
Catastrophizing	Is this unfortunate incident a catastrophe: “I'm going to be sued”; if the bad outcome happened, what would/would not be the consequences, and could I handle them?