Psychological support
8. Cognitive restructuring
Not positive thinking — accurate thinking. Most distressing thoughts in illness are plausible but overstated, and they can be tested.
PatientCaregiverFamily
Common thinking traps in illness
- Catastrophising — every ache is progression.
- Fortune telling — 'I know how this ends.'
- All-or-nothing — 'If I can't work, I'm useless.'
- Mind reading — 'They're only visiting out of pity.'
- Emotional reasoning — 'I feel hopeless, so it is hopeless.'
- Should statements — 'I should be handling this better.'
The seven-column method
- 1Situation: what happened, factually.
- 2Thought: the exact sentence that went through your mind.
- 3Feeling and intensity, 0–100.
- 4Evidence for the thought.
- 5Evidence against it — including things you would say to a friend.
- 6A balanced alternative that fits all the evidence.
- 7Re-rate the feeling. A drop of 10–20 points is a good result; you are not aiming for zero.
When the thought is true
Sometimes the frightening thought is accurate — the illness is progressing, the treatment has stopped working. Restructuring is the wrong tool there.
Switch to acceptance, meaning and support: what matters now, who should know, what would make the coming weeks better. Do not let anyone talk you out of a true thought; do let them help you carry it.
Try this
The friend test
About 5 minutes
- 1Write the harsh thought exactly as it appears in your head.
- 2Imagine a close friend in your exact situation saying it to you.
- 3Write what you would honestly say back.
- 4Read it aloud, addressed to yourself by name.
- 5Keep the fairest sentence and use it as your reply next time.
Where to go next
Afya Companion offers education and self-help support. It does not diagnose, treat or replace care from your doctor, nurse, psychologist or dietitian. If something in your health changes, speak to your care team.