Cognitive behavioural techniques for stress management and resilience

Reflective pause:

How do you actively work to overcome cognitive biases or thinking errors in your decision-making? What strategies do you find effective in promoting more accurate and objective judgements?

Thinking errors are cognitive distortions rooted in inaccurate beliefs about ourselves or the world. While everyone experiences them to some extent, severe thinking errors can impair personal functioning, relationships and overall wellbeing. Recognising thinking errors related to self-criticism, neglecting self-care, inflexibility and feelings of isolation can significantly bolster personal resilience. Cognitive behavioural techniques are effective tools for managing stress and improving wellbeing (Bhui et al., 2012). They offer fresh perspectives on challenging situations and help people regain a sense of control. 

Understanding the principles of cognitive behavioural therapy (CBT) helps us replace cognitive distortions with more constructive thoughts, feelings and actions. Various types of thinking errors are shown below, alongside strategies for coping with stress and supporting emotional resilience. 

Some common types of thinking errors include:

• ‘All or nothing’ thinking: Seeing situations in absolute terms, with no middle ground. For example, if you are not perfect then you are a failure.

• Over-generalising: Drawing broad conclusions from limited evidence or single incidents. For example, after receiving critical feedback for one case, you consider yourself incapable of doing the job well.

• Discounting the positive: Ignoring or minimising positive experiences, accomplishments or personal qualities. For example, dismissing positive feedback and dwelling only on criticism.

• Mind reading: Assuming you know what others are thinking or feeling without any evidence. For example, believing that someone does not like you without any direct evidence.

• Catastrophising: Ruminating about worst-case scenarios and impending disasters. For example, feeling that you have overlooked a patient’s symptom in your assessment and their condition might worsen rapidly. 

• Personalisation: Taking responsibility for events beyond your control. For example, if a patient is upset, believing you should have helped them more.

• Labelling: Attaching negative labels or identities to yourself or others. For example, calling yourself a ‘loser’ for making a mistake.

Some common types of thinking errors include:

• ‘All or nothing’ thinking: Seeing situations in absolute terms, with no middle ground. For example, if you are not perfect then you are a failure.

• Over-generalising: Drawing broad conclusions from limited evidence or single incidents. For example, after receiving critical feedback for one case, you consider yourself incapable of doing the job well.

• Discounting the positive: Ignoring or minimising positive experiences, accomplishments or personal qualities. For example, dismissing positive feedback and dwelling only on criticism.

• Mind reading: Assuming you know what others are thinking or feeling without any evidence. For example, believing that someone does not like you without any direct evidence.

• Catastrophising: Ruminating about worst-case scenarios and impending disasters. For example, feeling that you have overlooked a patient’s symptom in your assessment and their condition might worsen rapidly. 

• Personalisation: Taking responsibility for events beyond your control. For example, if a patient is upset, believing you should have helped them more.

• Labelling: Attaching negative labels or identities to yourself or others. For example, calling yourself a ‘loser’ for making a mistake.

• Should statements:  Using ‘should’, ‘must’, or ‘ought to’ to impose unrealistic expectations on yourself or others. For example, thinking that others should always agree with you otherwise you are at fault in some way.

• Emotional reasoning: Assuming that because you feel a certain way, it must be true. For example, if you feel guilty, then you must have done something bad.

• Control fallacy: Beliefs about being in control of every situation in your life. If we feel externally controlled, we are helpless and a victim of fate or chance (for example, believing you did a bad job as you were given the wrong advice); if we feel internally controlled, we assume responsibility for the wellbeing and distress of everybody (for example, if somebody is angry, you must have upset them). 

• Global labelling: generalising one or two personal characteristics into a negative judgement about oneself or others. For example, feeling that making a complaint will make colleagues think you are ‘difficult’.

• ‘Just world’ fallacy: the belief that the world is a fair place where good things happen to good people and bad things happen to bad people. For example, believing that a coworker who has experienced harassment must have provoked it in some way.

Thinking errors have serious implications for people’s wellbeing and professional functioning. ‘Personalisation’ can lead to over-commitment to the job, poor boundary setting and neglect of self-care. ‘Global labelling’ may dehumanise people who access services and make us disregard information that contradicts our preconceived beliefs. The ‘just world fallacy’ might result in victim-blaming, attributing challenging circumstances to the individual’s actions. ‘All or nothing thinking’, often observed in people who are anxious or perfectionist, can be harmful for people accessing services as it may lead to overgeneralisation from perceived failures and overlooking progress in other areas. 

More information on developing personal resilience using CBT strategies can be found in Alexander and Henley (2020).