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Understanding, Thought Distortions


Dr. Robert Smith, Ph.D.


Thought distortions can play a big part in PTSD, anxiety disorders and other behavioral health disorders. Specifically, thought distortions are irrational thoughts.  These irrational thoughts can be mixed in with healthy thoughts and attitudes. Thought distortions have been characterized in the popular media as “stinking thinking” or “shoulds, oughts and musts”.  Examples of these types of thoughts are; “I’m not worthy” or “I am responsible”.  We humans are certainly responsible for some things.  However, we often tend to take too much responsibility for too many things.  This type of thought distortion is often common with firefighters, EMS, police, health care workers and many other professions.


The way we accept responsibility is only one area in this type of thinking. Examples include; “I’m alone”, “a failure”, “I’m not good enough” or “I’m not in control “. There are numerous themes in this type of thinking. Some of these themes of thought distortions can be partially true.  The perception of control is a good example.  We in the public safety and health professions experience this lack of control regularly.  People die needlessly in accidents, disasters, medical and behavioral health incidents.  We can’t control all aspects of life but we can control how we think about them.  We often perceive these situations in all or none (black and white) terms when we are distressed.  For example, some of our patients die while we are caring for them.  We cannot control that aspect of the incident but we can learn from it.  We can offer kindness to the survivors.


Brain science is beginning to examine why we engage in some of these thought distortions.  All of our experiences and thoughts have neurological pathways in the brain and nervous system.  The emotional structures of the brain can overwhelm the thinking parts of our brains.  Secondly, the brain has a negative bias.  This means we have an ancient reflex that alerts and protects us from danger.  These two points mean that we are often limited by our brains and nervous systems when we perceive danger or have these kinds of experiences.  Guilt and shame are common perceptions when witnessing danger in today‘s world. We often estimate these perceptions inaccurately.  This is often the origin of most of our thought distortions.  For example, I could think that “I’m not good enough” leading to “I am unlovable and will be alone”.  These thought distortions can support anxious and depressive symptoms.


Many trauma disorders are fueled by thought distortions.  Numerous examples in the public safety and medical professions can illustrate this point.  For example, a case of a severely injured child can have a common effect on EMTs, paramedics, nurses and physicians.  The aspects that we cannot control are numerous.  “We didn’t get there fast enough” or “the injury was too serious and couldn’t be fixed” are common factual thoughts.  It is difficult for we humans to witness these lethal injuries to all people, especially children.  However, we may assign self blame or focus on how dangerous the word can be despite the obvious facts. We often personalize and focus on the thought distortions that assign blame. “I could have saved them if I were a better paramedic, nurse etc”.  This personalizing type of thinking can lead to catastrophic thinking such as “ I am a failure or I let this child die”.  These thought distortions then get mixed in to the facts that the world can be a dangerous place and suffering and accidents do exist.  This particular combination of irrational thought processes and facts can support PTSD, anxiety and negatively alter our mood.


You might be thinking about how this can be fixed as you read the previous example.  The answer is that a person can do specific things when faced with this situation.  First, you need to recognize the troubling thoughts.  An inventory of all thoughts is essential before we identify the thought distortions.  What part of these thoughts are the facts?  Next, which of these thoughts should be evaluated for distortions in thought.  We examine the evidence to determine how much of our distress is a fact or “all or nothing” thinking.  In addition, we can talk to other colleagues in our previous example. It is possible to find colleagues who were not involved and have the ability to think rationally about your experience.  It is also helpful to think in percentages of what is rational and what you suspect might be a thought distortion.  Be suspicious of thoughts that are not 100% factual.


One should ultimately attempt to determine our ability to manage these irrational thoughts.  Some of these irrational (distorted) thoughts can be better managed with a kitchen table discussion at the firehouse or a cup of coffee in the hospital break room.  Finally, a person should look for a reoccurring pattern of experiencing these types of thoughts.  You should consider making an appointment with a behavioral health clinician if these patterns are not being managed.  Ultimately, it is critical for us to watch out for each other.  Please be vigilant about observing members of your team for any type of distress.

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