Expanding to the ABCDE Model: Disputation and Re-framing

The ABCDE model extends the ABC approach by adding Disputation (D) and Effective New Beliefs (E). These steps give pharmacy staff a simple process for testing automatic, stress-amplifying thoughts and choosing calmer, more useful alternatives.

In busy pharmacy work, high standards, time pressure and patient contact can produce convincing but inaccurate thoughts such as "I must handle this perfectly" or "If this patient is unhappy, I have failed". Unless examined, these beliefs can quickly increase stress and impair performance.

What disputation involves

Disputation means actively questioning the original belief rather than accepting it as true. Helpful questions include:

• Is this belief based on facts or assumptions?
• Am I exaggerating the consequences?
• What would I say to a capable colleague in the same situation?
• Is there a more balanced and realistic way to view this?

Creating an effective new belief

An effective new belief is honest but less extreme and more actionable. The aim is not to deny difficulties but to adopt a view that supports steady, professional behaviour.

With practice, disputation and re-framing reduce perfectionism, soften self-criticism and help maintain a problem-solving focus under pressure.