Working With Automatic Thoughts

Source: Katie Willard Virant

The predictive text function on my iPhone lately has been making an error. It reads the word “so” and assumes that I want to write “Sophie.” I’ve corrected it many times, but it sees “so” and stubbornly assumes that I am writing to or about my friend Sophie.

Our brain offers its own “predictive text” function when it makes assumptions based on our past experiences. Sometimes, this works very well. When we encounter a hot stove burner, for example, we don’t have to write a pros and cons list about whether we should place our hand there. Our brain quickly computes that a hot stove burner is dangerous and should not be touched. Thank you, automatic thinking!

However, just as with our iPhones, there are times when our brain’s attempts to shortcut do not serve us well. This post explores how certain types of automatic thinking can increase distress surrounding chronic illness.

Attentional Bias

When we exhibit attentional bias, we pay selective attention to specific information, failing to place that information in a broader context (Savioni & Triberti, 2020). Many people living with chronic illness experience a hyper-vigilance around symptoms. We are very attuned to our bodies, noticing every ache and pain. This makes sense, as our brain believes — and rightly so — that we need this information to keep ourselves safe. Attentional bias comes into play when our brain is so focused on identifying symptoms that it ignores or barely registers health.

Take a moment to focus on a part of your body that is uncomfortable. What’s it like to zoom the camera of your mind’s eye on only that sensation? If your right hip hurts, for example, focus only on the pain you are experiencing in that area. Now zoom the camera out to include your whole body. Does your knee hurt? Your foot? What about the other side of your body? You’re still acknowledging that your right hip has pain, but your brain is now placing the pain in the larger context of your whole body. Pain is part of your experience when you zoom the camera out, not the whole of your experience. When you correct for attentional bias, you receive a different picture of what is happening.

Interpretation Bias

Interpretation bias involves what we do with the information our brain has noticed (Savioni & Triberti, 2020). In chronic illness, there can be a tendency to interpret signals from the body as illness-related. There also can be a tendency to catastrophize.

As with attentional bias, this makes perfect sense. The brain knows that chronic illness symptoms often mean danger. Unfortunately, for many of us who live with chronic illness, the warning it provides sounds less like, “Just flagging these sensations for you. Do you think they are illness-related?” and more like, “RED ALERT! RED ALERT! THINGS ARE BAD AND THEY’RE ONLY GOING TO GET WORSE!”

Just as we did in addressing attentional bias, let’s pull the camera back. Observe the panic from a place outside of your big feelings. Speak gently to the panicked part of yourself, saying, “Boy, you’re really afraid. And it’s understandable. But you don’t have enough information to justify this high level of panic. Can you take a few breaths so we can evaluate what’s happening from a calmer place?” Treat yourself with respect and compassion. Once you’re able to calm yourself down, evaluate the symptoms you’re experiencing with a clearer head. Congratulations — you’re learning how to correct for interpretation bias.

Recall Bias

Recall bias involves focusing on particularly painful moments in our past experiences (Savioni & Triberti, 2020). We may remember vividly the harrowing moments in our illness journey, without also remembering the times when our health was relatively stable. Especially when we experience a bodily sensation that causes concern, our minds immediately may flash to images of our darkest times.

By now, you know the drill: We’re going to do some camera work with our mind’s eye. Instead of staying with the image of your scariest moment, we’re going to play the film forward. Let’s imagine that experiencing symptoms causes you to remember yourself lying in a hospital bed. Time didn’t stop when you experienced that moment, so you are going to call to mind images of you rehabilitating and coming home from the hospital. Unfreeze the camera and look at the entire memory rather than only its worst parts.

Why Correcting Automatic Thoughts Matters

Correcting automatic thoughts about illness grounds us in a more balanced reality. Keeping our stress levels in check is mentally and physically healthy, benefitting our quality of life. Putting in the work to identify and correct automatic thoughts helps us to rewire our brains, updating problematic thought patterns to more adaptive ones.