The first step is to pick up on these critical thoughts. It can be incredibly hard to pick up on these critical thoughts when you have become so used to them. They can fall through your fingers like sand. But with more and more practice it can become easier to recognise them. Try to examine your thoughts during periods of distress and negative emotions and think about what thoughts you were thinking at the time and what was your self-talk. 

The next step is to challenge them. This is where cognitive behaviour therapy principles can be useful. Examine the evidence behind these critical thoughts, are they based in any evidence? Most often they are not. What is the evidence to the contrary? What would be a more evidence based or reasonable thought? 

Lastly it can be very useful to imagine what your friend would say to you if you explained the situation and told them how you felt. This exercise can provide some distance from the thought and allow you to recognise how the thought could be false. 

Take the following example: 

I often used to get thoughts that I am worthless especially when feeling depressed. 

• What's the evidence? 

  • None

• What's the evidence to the contrary? 

  • My friends and family love me. They believe I have worth. 

  • I have value at work, where I make a contribution. 

  • My patient's value my efforts to help them. So therefore I have worth. 

  • I am a good person. 

• What would be a more evidence based or reasonable thought? 

  • I have worth and the people around me can see that. 

• What would my friend say? 

  • Of course you have worth. You're a good guy and you've always been there for me when I needed you. I love you man. 

I cannot say that I am all the way there on this one. My self-talk can still be very negative and it can be hard at times to modify it. It does take a sustained and significant mental effort to recognise and challenge these thoughts, especially at first. But over time I found it became easier and I became better at it. Also they do not bother me as much as they used to. I have found that this has in turn had a significant positive effect on my mental health and happiness. 

I really like the mindfulness self compassion exercise on the Smiling Mind App. Download it and go to Adults->Stress Management->Self Compassion

Gratitude is a skill and like any skill you can develop and strengthen it over time with practice. There are various exercises to practice gratitude. Personally, my favourite gratitude exercise is to sit with my wife at dinner and each say three things we are grateful for that day. This can be an excellent activity to do as a family also. 

There is a lot of information about gratitude out there, but maybe start by checking out the article link below as a start, which also contains some further gratitude exercises.