Your emotions result from the way you think about things. Before you can experience (feel) any event, you must process it with your mind and give it meaning (thought). You must understand what is happening to you before you can feel it. Every time you feel sad or have intense negative emotions about something, try to identify the corresponding negative thought that you probably had just prior. By learning to restructure these thoughts, you can change your emotions. It’s likely that you’re skeptical of all this because negative thinking has become such a part of your life that it has become automatic. This is referred to as automatic thoughts by Dr. David Burns in his book Feeling Good.

Look at the diagram below, which shows the relationship between the world and the way you think and feel. It’s not the actual event, but your perception of it, caused by your thinking, that will drive how you feel and act and ultimately the results you will have.

Now, let’s talk about the most common cognitive distortion that we might experience, which also affects the way we react to any circumstance.

1. All or nothing thinking (everything is black or white). This refers to your tendency to evaluate your personal qualities in extreme terms. For example, a surgeon with poor outcomes during surgery might conclude: “Now I’m a total failure.” All or nothing thinking forms the basis of perfectionism and causes a lot of fear and frustration, leading to inaction and feelings of inadequacy and worthlessness.

2. Overgeneralization. This is the conclusion that once one thing has happened to us, it will occur repeatedly. For example, a poor investment result might lead to the thought: “I always have bad luck,” which can also lead to inaction.

3. Mental filter. You pick out a negative detail in any situation and dwell on it exclusively, thereby perceiving the whole situation as negative. For example, after a busy day at work, you might conclude: “Everything that happens to me is bad/negative.” When we carry around “negative goggles,” we see our reality through a negative filter, leading to disappointment with our lives.

4. Disqualifying the positive. A more dangerous cognitive distortion is when we transform a neutral or even positive experience into a negative one. For example, a patient compliments you at work, and you conclude: “They’re just being nice.” You mentally disqualify the compliment and say: “It was nothing, really,” which removes much of the richness from life and makes things seem bleak.

5. Jumping to conclusions. You arbitrarily jump to a negative conclusion that is not justified by the facts of the situation. There are two versions of this: mind reading and the fortuneteller error. The mind reader manifests as an assumption that other people are looking down on you, and you are so convinced that you don’t even bother to check it out. The fortuneteller error is when you have a crystal ball that foretells only negative things will happen to you, and you take this prediction as a fact, even though it’s unrealistic.

6. Emotional reasoning. You take your emotions as evidence for the truth. This kind of reasoning is misleading because your feelings reflect your thoughts and beliefs. And if they are distorted, which is often the case, your emotion will have no validity. For example, you might think: “I feel guilty. Therefore, I must have done something bad,” or “I feel overwhelmed and hopeless. Therefore, my problems are impossible to solve,” or “I feel inadequate, therefore I must be a worthless person.” This usually leads to procrastination and a negative loop that is hard to break out of.

7. Should statements. You try to motivate yourself by saying, “I should do this” or “I must do that,” but this statement causes you to feel pressured, resentful, and paradoxically, you end up feeling pathetic and unmotivated. This leads to feelings of self-loathing, shame, and guilt and causes a lot of unnecessary emotional turmoil in your daily life.

8. Personalization. This distortion is the mother of guilt; you see yourself as responsible for a negative event, even when there is no basis for doing so. You arbitrarily conclude that what happened was your fault or reflects your inadequacy, even when you were not responsible for it. For example, a patient does not follow your instructions as suggested, and you feel guilty because of the thought: “I must be a lousy physician.” As a physician, you can influence the patients you work with, but no one could expect you to control them. What other people do is ultimately their responsibility and not yours.

Once you invite negativity to stay with you through recurrent cognitive distortions, your feelings and actions will reinforce your thinking and create beliefs that this is true. The key to freeing yourself from this is to be aware that your thoughts create your emotions and that your emotions cannot prove that your thoughts are accurate. Unpleasant feelings mainly indicate that you’re thinking something negative and believing it. Your emotions follow your thoughts. Once you have learned how to perceive life more realistically, you will experience an enhanced emotional life with a greater appreciation for genuine sadness and joy, remembering that life is 50 percent positive and 50 percent negative.

Miguel Villagra is a hospitalist.