An important strategy for managing thoughts is called "reframing." A person who uses this strategy works to balance their way of thinking so that it is not overly negative. This requires three key steps:
- Identify the negative thoughts.
- Challenge the negative thoughts.
- Develop alternative thoughts.
We have already discussed negative thoughts, so now we will focus on challenging the negative thoughts and developing alternatives.
When we ask individuals to challenge negative thoughts, we start by asking them to tell us about the evidence or proof for the thought they are having. It is important to consider both the evidence that supports the thought and the evidence that challenges the thought. For example, in the case of the catastrophic thought that, "The rain will never stop," a person would provide evidence about rain, such as how long it has rained, when last it did not rain, and any evidence that supports the belief that it will rain forever.
The next step is to come up with different, more accurate thoughts based on other evidence that is being ignored or forgotten. If the person in the rain example noticed that: (a) it has rained for six straight days, but (b) it was sunny before that, (c) it is a rainy time of year, and (d) it rained for 11 straight days at this time last year before there was a sunny day, they could come up with a more balanced thought. A more accurate thought could be, "Even though it feels like the rain will never stop, it is actually common for it to rain a lot this time of year. It will eventually stop raining." This way of thinking has the benefit of being more accurate and less emotionally upsetting. Training yourself to use these more balanced thoughts as automatic thoughts can reduce emotional negatively and thus lessen symptom intensity.
Here are some examples of reframing that relate to coping with pain and other symptoms:
- Keyante is having a difficult day with her fatigue.
- Keyante thinks, "This fatigue is going to ruin my life." She feels this way because she had to cancel some plans yesterday because of her fatigue.
- However, she also remembers another recent day when she had similar fatigue but was able to make different choices that allowed her to follow through with her plans.
- To reframe her situation, Keyante thinks, "Although my fatigue got in the way yesterday, I can find ways to keep it from getting in the way all the time like pacing."
- Compared to the original thought, Keyante feels more confident in her ability to manage her fatigue.
- Li’s physical functioning changed after he got COVID-19. He thinks, "Because of my long-term symptoms, I am no longer able to be a good parent."
- Li started by thinking about the things he could not do around his home. He admits these limitations are the reason for this thought. When pressed to think of ways he has contributed to his family as a parent, he lists many: He helped his daughter with her homework; he read to his son before bedtime; and he made decisions with his wife about an upcoming birthday party.
- As a result, Li recognizes that, "While I can’t do some things for my family that I could do before, I am helping with raising my children in many important ways."
- Relative to the original thought, Li feels better about his parenting.
It is important to know what reframing does and does not accomplish. Reframing is not about creating an artificially positive or fake scenario. Just as we do not want people blowing negative thoughts out of proportion, we do not want anyone to pretend everything is fine when it is not. Instead, reframing is about having thoughts that more accurately reflect the evidence. Most importantly, this more balanced prediction typically means thinking about a better, or at least "less negative" outcome.