Breaking the Cycle of Overthinking: CBT Strategies for NHS Staff
Let’s be honest: if overthinking were an Olympic sport, NHS staff would have swept the medals decades ago. You’re juggling patient care, paperwork, last-minute rota changes, and - just for fun - the occasional existential crisis about whether you remembered to sign off that medication chart. If your mind runs wild at 2am, replaying every conversation you’ve had since 2007, you’re in good company.
As a therapist who’s worked with NHS professionals (and survived the NHS myself), I know that overthinking isn’t just “worrying too much.” It’s a full-time job on top of your actual full-time job. So, why does it happen, and what can you do about it - besides running away to a remote island with no WiFi (tempting, I know)?
Let’s break it down, and I’ll share some CBT-inspired strategies that actually work in the real world - no unicorns, no toxic positivity, just practical support for busy, brilliant humans.
Why NHS Staff Are Champions at Overthinking
First, a bit of validation: if you work in the NHS, you’re under pressure most people can’t imagine. You’re expected to be compassionate, efficient, resilient, and unflappable - sometimes all before lunch. The stakes are high, the resources are low, and the “What if I miss something?” voice in your head is on a 24/7 shift.
Overthinking is often a sign that you care—deeply. But it can also lead to:
Exhaustion (mental and physical)
Trouble switching off after shifts
Doubting your decisions (“Did I do enough?”)
Difficulty sleeping (cue the 3am “what ifs”)
Sound familiar? You’re not alone.
The Overthinking Trap: How It Works
Imagine your brain as a hamster on an exercise wheel. Overthinking is when that hamster’s had five espressos and is running for its life. You replay scenarios, imagine worst-case outcomes, and try to “think your way” to certainty or safety. Spoiler: it never works.
Common thought traps for NHS staff include:
Catastrophising: “If I missed that symptom, the worst will happen.”
Mind-reading: “My manager probably thinks I’m useless.”
Perfectionism: “If I’m not 100% right, I’ve failed.”
Should-ing: “I should be able to handle this.”
CBT (Cognitive Behavioural Therapy) doesn’t promise to turn your brain off (if only!), but it does help you notice these patterns and respond differently.
CBT Strategies to Break the Cycle
Here’s where we get practical. These are techniques I use in therapy with NHS staff - and yes, I use them myself when my brain decides to host an all-night anxiety disco.
1. Name the Thought
It sounds simple, but just noticing and labelling what’s happening can take the sting out of it. Instead of “I’m a terrible nurse/doctor/OT,” try: “I’m having the thought that I might have missed something.” It’s subtle, but it creates space between you and the thought.
2. Reality-Check Your Worries
Ask yourself:
What evidence do I have that this will happen?
Have I coped with similar situations before?
What would I say to a colleague in my shoes?
Often, we’re much kinder to others than ourselves. (If only we could bottle that and prescribe it on the NHS.)
3. Schedule Worry Time
Sounds counterintuitive, but setting aside 10 minutes a day to let your brain do its anxious thing can stop it from hijacking your entire evening. When a worry pops up, jot it down and tell yourself, “I’ll deal with this at 7pm.” Most of the time, you’ll forget what you wrote down - or realise it wasn’t worth the energy.
4. Ground Yourself in the Present
Overthinking loves dragging you into the past or the future. Grounding techniques - like the classic 5-4-3-2-1 (name 5 things you can see, 4 you can touch, etc.) - bring you back to now. I know, it sounds like something from a mindfulness app, but it works, especially after a tough shift.
5. Challenge the Inner Critic
That voice that says, “You should have done more,” “You’re not good enough,” or “Everyone else has it together”? It’s lying. Try writing down what your inner critic says, then write a response as if you were defending a friend. You’d be amazed how quickly you can poke holes in its argument.
6. Practice Self-Compassion (No, Really)
This isn’t about bubble baths and scented candles (though those are great). It’s about recognising you’re human, and you’re doing your best in impossible circumstances. If you’re waiting for someone else to tell you “well done,” you might be waiting a while. Start by giving yourself some credit.
Overthinking in Action: A (Relatable) Scenario
Let’s say you finish a shift and can’t stop thinking about a patient you saw. You replay every interaction, question every decision, and convince yourself you missed something catastrophic. You try to distract yourself, but your brain is determined to win a BAFTA for “Most Dramatic Worst-Case Scenario.”
Here’s how you might use CBT:
Name it: “I’m having the thought that I made a mistake.”
Reality-check: “I followed protocol, double-checked, and asked for a second opinion.”
Ground: “Right now, I’m at home, safe, and off duty.”
Compassion: “Anyone in my position would feel anxious after a tough shift. It doesn’t mean I did anything wrong.”
Decompress: Box breathing technique - breath in for 4, hold for 4, breath out for 4, and hold for 4 (repeat)
When to Get More Support
If overthinking is taking over your life, affecting your sleep, relationships, or ability to enjoy time off, it might be time to reach out for support. Therapy (yes, even online) can help you untangle these thought patterns and find new ways to cope.
At Ardolino Counselling, I specialise in supporting NHS and health professionals with anxiety, stress, and - you guessed it - overthinking. Sessions are confidential, compassionate, and tailored to your needs (with a healthy dose of reality and the occasional sarcastic joke).
Final Thoughts (Not Overthought, Promise)
Overthinking is tough, but you don’t have to fight it alone. The NHS runs on people who care deeply - and sometimes, that means your brain works overtime. With the right tools and a bit of support, you can learn to step off the hamster wheel, even if just for a little while.
If you’re ready to break the cycle, or just want to talk it through, book a free 15-minute consultation via my website. No judgment, no pressure - just a chance to breathe, regroup, and maybe, finally, get a decent night’s sleep.
Want more tips (or just a reminder that you’re not losing the plot)? Follow Ardolino Counselling on Instagram or Facebook for regular updates, resources, and the occasional meme that says what we’re all thinking.
