Cultivating positive emotions and restructuring negative self-talk with patients

By Lorraine Gahles-Kildow, PhD

Spring is often a time to renew our inner growth and set an intention to flourish.  Our patients can learn to cultivate their positive emotions and restructure their negative self- talk into more reasonable positive perceptions.  This will help them manage their emotional reactions and serve as a protective factor to stress overload which often results in physical symptoms.

A first step might be to clear out old negative thought patterns or narrow mindsets, the weeds of our patient’s mental garden.  These weeds can take many forms, including worrying, ruminating, negative self-talk, and allowing our emotional reactions to have full reign over us.

Worrying or ruminating about possible worst-case scenarios is a universal phenomenon. Many people get stuck in this short circuit of cognitions, emotions, physiological reactions, and behavioral patterns. The body reacts to a fearful thought or image as if it were there, thus, the fight, flight, or freeze (FFF) response occurs.

If a patient has anticipatory anxiety, for example, they might think, “I have the worst luck,” or, “bad things always happen to me and will in the future. Then the body will go into red alert and trigger the FFF response as if that bad event were happening right now. 

If a patient continually ruminates about their worries, then the stress system is always on and many physical symptoms result.  Many people are plagued with what-ifs.—for example, “what if I mess up,” “what if he or she leaves me,” or “what if my business fails?”

These types of thoughts become “weeds” when they repeat over and over and there is no healthy problem-solving involved.  If we encourage our patients to become more consciously aware of their thoughts, then they can learn to differentiate between weeds and healthy thoughts. 

A practitioner may refer to a cognitive behavior therapist (CBT), who will help the patient see that they have thoughts that are cognitive distortions, or exaggerated thinking, which influences emotions, body, and behavior. In the above example about bad luck, the therapist would point out that any thought with “always and never” cannot be true in all instances. It is impossible to have bad luck all day, every day, for an entire lifetime.

This is the way the emotional brain thinks, in all-or-nothing terms, and in doing so creates a broad-brush stroke on a patient’s emotions, in this case, anxiety and possibly even the hopeless, helpless feelings of depression.  The CBT practitioner aids the patient in creating rational challenges, from the logical part of the brain, to their cognitive distortions.  This, in turn, helps them to change their emotions, their physical reactions and their actions.

A second step might be to plant a healthier mental garden. We can begin by helping our patients in setting an intention to find pockets of positivity (POPs) and moments of meaning (MOMs) in their daily garden. Finding pockets of positivity means that we become more aware of the positive emotions in our world.  We might suggest patients find things to be grateful for on a daily basis or we might have them name three good things that happened today. 

In the example above, this person might try to find when luck was on their side or when a good thing happened and note it and savor it.  As a practitioner, we might begin to remind ourselves to see with compassionate eyes again, especially if compassion fatigue has set in.

Compassion means to see another person’s suffering and want to help them. Often practitioners forget about self-compassion, to acknowledge our own suffering and then to choose to help ourselves as well. Self–care is not selfish. It means spending time with your family, taking time for yourself and saying no to endless hours of work.  It means getting a good night’s sleep and being consciously aware of protecting our own mental and emotional state. On a positive emotion side (POP), we might ask ourselves, “how do I incorporate positive emotions into my day,” or, “how do I experience love, awe, interest, happiness, vitality, gratefulness, peace, and contentment more often?” 

I‘s also important to perceive our meaning and purpose in life for good mental health. Meaning and purpose happens with self- transcendent goals, those above-self thoughts. Healthcare professionals reclaim their passion when they can practice healing and not just paperwork. Healthcare workers are particularly set up to show compassion because it is inherent in their work.  Where they usually fall short is in showing such care for themselves.

Mindset, our view or belief about something or about someone, even about ourselves, is another aspect of meaning and purpose. Sometimes our mindset becomes so rigid that we feel that it is our identity and it can’t be changed. Several years ago, a client came to my office struggling with being overwhelmed. His diagnosis was anxiety, depression and substance abuse.  His ruminative thoughts when he was under stressful conditions were, “I can’t handle this.” When we began to investigate who he was, or, what I call his identification (ID) tags, he wrote that he was a “failed” father, partner, and worker. He would find ways to escape, such as leaving the house in the middle of a fight.  He screamed and yelled at his kids often. His belief was this behavior was who he was, and that he couldn’t handle difficult situations, which seemed to stem from him believing he was a failure.

We started to examine his view of himself, or his ID tag. It turned out that this ID tag was a cognitive distortion. He was labeling himself a failure, but, in fact, we found that he had made some bold, authentic choices that shaped his life pathway differently.  It was an ah-ha moment when his view of himself dynamically changed.  When I asked him to integrate this new information into his ID tag, he said that in tough situations, he was true to his authentic self and made unexpected decisions that were right for him, even though other people didn’t see it that way. With this new ID tag, he was then able to view his other strengths. This led to being able to look at his reaction to stress and appraise it and himself differently.  Lazarus and Folkman in a book entitled Stress, Appraisal and Coping, suggest that there are two aspects to coping with stress:

1. How we view the threat in the situation
2. How we view our resource capabilities

When we view ourselves with our rational mind, and with compassion, understanding, and forgiveness, we discover that the stress or threat isn’t as big and our resources are not as small as they feel. 

My client ended up seeing the good for the first time in what had been the legacy of a very stressful life experience.  With this new mindset, it led him to self-acceptance, but also freed him from the negative ruminations and motivated him to find his inner energy and the strength to grow and flourish.  He has cultivated new seeds for his mental garden.

Editor’s note: Lorraine Gahles-Kildow, PhD, is a Licensed Psychologist in the State of New Jersey.  She received her MPhil and PhD from the City University of New York and her M.A. from Long Island University. Her area of expertise is in cognitive behavior therapy. She has been in private practice for 18 years dealing with adults, teenagers and school age children on various issues related to trauma, post-traumatic stress disorder, depression, anxiety, obsessive-compulsive disorder, phobias, bereavement, grieving losses, caregiving, impulse control, and anger management. She has been teaching psychology for over 30 years and during the past 17 years has also been training Montessori teachers on child development domains and psychological principles for infant/toddlers, elementary school children, middle school children and teens. She has incorporated positive psychology interventions into her practice and teaching since its recent resurgence in the field.