By Kara Frame, MD
I don’t remember the exact lecture or rotation, but somewhere along the course of my medical school education, I was taught this powerful lesson: a person is capable of changing how she thinks. Of course, people have natural tendencies- leaning more positive or tending toward a more pessimistic outlook- but to some degree these preferences are pliable rather than fixed.
In a very rudimentary way, it can be explained like this: our brains are facile, constantly remodeling themselves. And, if a thought becomes repetitive, it reinforces the nerve pathway that it triggers, essentially making the pathway stronger. The reverse can also be true, if we de-emphasize a certain pathway (thought process) it may become less prominent. This lesson resonated with me and the concept seems to resurface in my conscious at different intervals in my life.
As a family doctor, the idea has helped me offer hope to patients, many of whom, unfortunately, struggle with depression and anxiety. Of course, I would never mean to suggest to them or to you that their disease can just be willed away, that simply reframing their thinking will make all of their problems disappear. That way of thinking suggests the disease is completely within their control, something they might have caused or are responsible for, which is grossly false and is partly responsible for the stigma they often feel when it comes to mental health conditions. It minimizes their experiences. However, when I talk about the multi-pronged treatment that I often recommend for depression or anxiety, it typically includes medication, good therapy, and lifestyle interventions. The last part can be overwhelming but it can also be empowering. When you are battling depression and/or anxiety, so much feels out of control. You might feel at times as if you are “going crazy” or losing your mind. It often comes with a sense of hopelessness. So, the idea that there may be things within your control can be uplifting.
Eating well, being physically active, being rested, generally taking care of ourselves: these are the pillars of health that can be difficult to maintain even when we are not depressed, so trying to do this under the weight of depression can become impossible. Therefore, I encourage my patients to start very small. To choose one thing to focus on first and then we build over time from there. Still, just wanting to exercise more or eat “better” doesn’t often get the desired results, so we often have to back up a few steps.
No one can make a change until she understands what is stopping her in the first place. And, for many of us, that something that is in the way is often our own thinking. “I am so out of shape, what’s the point?” “I can’t even walk to the mailbox-there’s no way I can run.” “I have already eaten half the bag, what difference does it make if I eat the whole thing now?” These are all paraphrased examples of the negative self-talk, I have heard from patients. When they start to think about change, some version of these negative thoughts will run through their heads. And, once these negative thoughts are recognized, the work of re-framing them can begin. If we recognize the repetitive thinking as it begins, we can then stop it and shift to something different, replacing the negative with more positive and actionable thoughts.
As for us doctors, we are not above the negativity. In fact, we are often more susceptible. It is generally accepted that doctors have a higher rate of burnout than the general public, and we certainly are at risk for depression. People talk about the jadedness that often envelops physicians somewhere along their training- people who began a profession with total optimism and a desire to help too often becoming filled with negativity and, sometimes, contempt. I have seen this in residents, young doctors going through the gauntlet that is residency. There are times when it can become overwhelming and even the most positive can begin to falter. And, I have seen this in seasoned physicians with many years of practice under their belts.
For my own part, I have been pretty fortunate. I have been lucky to train, both in medical school and in residency, at places that were very supportive. And now, I work in a program that places a very high value on personal wellness. And yet, there have been times when I found myself slipping into negativity, too. Something I subconsciously considered myself to be above happening to me, just as I had witnessed in other friends, colleagues, and learners. I have always considered myself to be a positive person, so don’t like it when this new pessimism starts slithering in. I try to practice what I preach and make an effort to change. By consciously focusing on the countless things I am grateful for, at least once each day, there is less time for the negative chatter. When I start this practice, sometimes it is hard to think of much, but as I become more practiced, numerous things pop into my head each day. By choosing gratitude I also shift back toward optimism.
As I am writing this, I recognize that I am vastly oversimplifying a very complicated process, a process that often has many starts and stops, times of progression and regression. Yet, in a time where there is a lot of uncertainty, when many feel lost and as if there is nothing in their control, I find it comforting to be reminded that we can do something pretty big: we have the power to change the way we think.
Kara Frame, MD is an Assistant Professor (Clinical) in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.
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