Caregiver Stress: Ten Ways Our Thinking Gets the Better of Us

While working on my Ph.D. in psychology, I was consistently drawn to two seemingly different schools of thought – existentialism and cognitive therapy. On the one hand, I identified closely with existentialism’s angst and search for meaning (which finally provided a framework to explain my many nights lying awake as a small child “thinking about life”). On the other hand, cognitive therapy’s razor-sharp focus on thoughts, assumptions, and beliefs – and what we could do about them – was truly empowering.

It wasn’t until I started working with caregivers that I began to understand the compatibility of these two theories. Caregiving is replete with angst and meaning, yet caregivers don’t have the time or energy to ponder such pithy subjects. There’s enough heavy lifting to caregiving without making it into a philosophy course.

But thoughts, beliefs and assumptions? Oh yes, caregiving involves plenty of those, and they come in small enough packages of meaning that we can actually work with them for the better.

Under extreme stress, we’re more vulnerable to shifts and kinks in our thinking that can undermine our well-being. David Burns, M.D., author of Feeling Good: The New Mood Therapy uses the term “cognitive distortions” to describe these unhelpful thinking patterns. Cognitive distortions are insidious, and we may not even realize we are harboring them until we consciously take a good look at what we are telling ourselves.

Courtesy of NCI/Rhoda Baer

Here are ten cognitive distortions suggested by Burns; I’ve supplemented them with examples that pertain to caregiving.

All-or-Nothing Thinking – Seeing things in black-and-white categories.

Example: “If I make no mistakes, I’m a good caregiver, but if I mess up just once, I’m a total failure.”

Overgeneralization – Viewing one negative event as representing a pervasive pattern of defeat.

Example: “The doctor we saw today was not helpful; therefore, no doctor can really help my husband.”

Mental Filter – Singling out a negative detail in a situation and dwelling on it to the point of only being able to see life through that detail.

Example: “My sister said I complain too much about caring for Dad. I’m just going to keep my mouth shut and never talk about it again because if I say one word, I’ll be a complainer.”

Discounting the Positive – Rejecting positive experiences by rationalizing that they are not valid.

Example: “That was just pure luck that I was able to get Ralph to take a shower today; I really have no idea what I’m doing as a caregiver.”

Jumping to Conclusions – Making a negative assumption without any solid evidence.

Example: “Since we haven’t heard back from the agency yet, I’m sure we didn’t qualify for their care services.”

The Binocular Trick – Exaggerating things that attribute credit to others while minimizing your own desirable qualities. Also, emphasizing your own perceived faults while downplaying external complications.

Example: “It was clearly my own incompetence that allowed Mom to catch a cold; the cough that the physical therapist had was probably just allergies.”

Emotional Reasoning – Assuming that your negative emotions reflect reality.

Example: “I feel hopeless; therefore, my situation must be so.”

Should Statements – Trying to motivate yourself by using “should” and “shouldn’t” in your self-talk, which usually results in guilt.

Example: “I should stay up all night and organize Dad’s finances, or else I’ll be failing in my caregiving responsibilities.”

Labeling – Engaging in extreme overgeneralization by attaching a negative label to yourself or someone else.

Example: “I’m a complete loser because I could not manage my full-time job and take care of my wife at the same time.”

Personalization – Seeing yourself as the cause of a negative external event for which you were not responsible.

Example: “If Mom doesn’t feel well today, it must be due to something I did wrong.”

If you recognize some of these cognitive distortions in yourself, guess what? You are absolutely not alone, and there’s no reason to beat yourself up about it. In fact, cognitive distortions are basically ways that we beat ourselves up unnecessarily.

There’s a reason Burns’ book was a bestseller. It is all too easy for our thoughts to get twisted and misdirected, especially when we’re faced with something as stressful as caregiving. But there is also very good news about all of this cognitive distortion stuff.

We can do something about it. Simply becoming familiar with the ten distortions (which you have just accomplished) makes you more likely to recognize them when they occur (or shortly thereafter). And the more you recognize them, the more power you have to adjust your thinking so that they occur less often over time, even as your caregiving situation changes.

I’d love to hear your reactions to this list and learn what you do with it. Some people keep a list of these ten distortions on a note card in their wallet or saved in their smartphone. I once led a therapy group at an adult day care program where we kept this list up on the bulletin board for everyone to see. I’ve seen it tacked up in cubicles and held by magnets on refrigerators.

In fact, writing this blog post has inspired me to put the list up in my office. The Lord certainly knows I need to be reminded of it sometimes. But I would never say that you “should” do something with this list. That is a truth that only you can determine.


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  • Using this wonderful list is, for me, a chance to look back and reevaluate, and to forgive myself a little. My job as caregiver ended in December, when my father passed away. I am feeling much better about actions and decisions after reviewing this list. Thank you!!

  • In reply to Carol:

    Dear Carol,

    Thank you so much for your comment. I'm so sorry to hear about the loss of your father, but so glad to know that the list above helped bring some peace to your experience in retrospect. It certainly has helped me forgive myself about certain life events as well.

    Take good care,
    Dr. Chill

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    In reply to Carol:

    It is such a long and confusing road caregivers follow. So glad you are in the recovery phase. As my own psychologist says - give yourself a break.

  • In reply to Linda Belcher:

    Hi, Linda. Thanks for your reply. My normal mode of operation is to be riddled with doubt, and the caregiving experience certainly provided a rich growing medium for even more. Hope you are recovering too, and I will continue to give myself a break.

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    Have shared your blog with my sister-in-law as her husband has early onset Alzheimers. She has been a caregiver all her life in her own family but this will be different. My own husband passed away in January after many years living with Alz and left side weakness due to a spinal cord injury. Thank you for sharing your insight with the public.

  • In reply to Linda Belcher:

    Dear Linda,

    Thank you so much for your comment and for sharing my blog with your sister-in-law. It sounds like you have both been through a lot, and you are lucky to have each other for support and encouragement. I'm sorry for the loss of your husband and I hope that the months since then have been somewhat healing and restful for you.

    Take good care,
    Dr. Chill

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    Hi Dr. Chill,

    This is a very good article. As a caregiver, we all go through introspection in our own ways and some can verbalize it and some cant. Regardless, the feelings are the same. Sometimes the toughest part as a caregiver is you may be doing it alone and/or in silence. The loneliness may be worse than the condition itself. By sharing, we are being great support for follow caregivers. Continue sharing and caring. thanks for sharing.

  • In reply to Caregiver Survivor:

    Dear Caregiver Survivor,

    Thank you so much for sharing your insights on this topic. I agree that sometimes it's hard to verbalize the complex thoughts and emotions that accompany caregiving. My hope is that articles like these will help caregivers find those words without changing the meaning of their experiences. In that way, they can work toward expressing themselves to others as a way of finding support.

    Take good care,
    Dr. Chill

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