Cure your Emetophobia and Thrive – Chapter 11
(including comments on Emetophobia Forum).
Chapter Eleven: Belief Systems in more detail
We’ve already had a look at some limiting belief system basics. Now that you know more about yourself and your personality, let’s delve into a bit more detail. We’re going to look a little further at factors that help to maintain your limiting beliefs.
This chapter is possibly going to be a little bit challenging. When you read this chapter, remember what you have already learnt about yourself. If you have some social anxiety you may find reading this section difficult, because you may feel as though you are being judged. If you find yourself feeling defensive or annoyed about something written here, then stop and think about whether this could be down to your social anxiety, low self-esteem and external locus of control, rather than because what I am saying is totally ridiculous! It may be that in order to help yourself you need to face up to things that are a bit challenging. Remember, this book is not about berating yourself for perceived flaws, or things about yourself that you think are undesirable. Rather it is about identifying factors that are preventing you from living your life to the full, so that you can change them.
Perspective
I remember reading an account by someone who was able to maintain perspective – even under the most anxiety-causing conditions. He was a warship captain during the battle for the Falklands, back in 1982. The captain was talking to an on-board news reporter, describing what happened when they had three missiles heading towards their ‘boat’. I say ‘what happened’, but actually it was ‘what didn’t happen’. The newsman was surprised to find that, on seeing three Exocet missiles racing towards them on their radar, neither the captain nor the crew panicked. Instead, the captain stood back and thought about his situation for a moment (not too long though, he had about 90 seconds I think!) and said, something like, ‘Well, in a situation like this it’s very important to maintain perspective. We have three French-made, Argentinian-operated Exocet missiles heading straight towards us, chances are, one of them won’t even reach us.’ Almost as he said this, one of the missile’s blips on the radar disappeared. He continued, ‘Chances are that both the remaining missiles will hit us. One probably won’t explode though; this one will make a hole in our boat, there will be a small loss of life, but it won’t sink us. The final missile probably will go off, there will be loss of life, but it probably won’t sink us either.’ I remember the reporter being flabbergasted at how calmly the captain was describing the situation.
A bit of an extreme example I know, but something that has always stuck in my mind very clearly and examples that stick in our minds are very useful.
If the Captain had panicked and started running around like a headless chicken (unlikely I know, since British Naval training is the best in the world; we don’t rule the world anymore, but we still have the best Navy!), he would have lost control of his thought processes, ended up with ‘tunnel vision’, and ultimately, probably, died as a result. He didn’t though. Due to his training and experience he was able to stand back, see the bigger picture, keep functioning normally, and do his job. He was able to maintain a clear perspective, despite the stress and pressure around him.
When you have perspective, you have a complete and unobstructed view (or understanding) of a situation, you have clarity and you see the full picture. You understand all the different factors involved. When you see the full picture, you can make informed opinions and decisions, and you know what your full options are.
When you don’t have perspective, you are unable to have any objectivity over your sense of symptoms, your personal relationships, or your progress (in changing your life). When looking at your belief systems and breaking them down so that you can see the component parts (distorted thinking, powerlessness, secondary gains etc.), you are gaining some perspective on your ‘problem’. You get to view it from a different angle and thereby gain some power, and shift your locus of control…
The Stockdale Paradox
Jim Stockdale was a US naval pilot who was shot down, then held prisoner at the infamous ‘Hanoi Hilton’, during the Vietnam War. Throughout his eight-year imprisonment he was routinely tortured and beaten. When Stockdale was finally released, his shoulders had been wrenched from their sockets, his leg shattered and his back broken.
Despite the terrible conditions he and his men faced, he took charge and instigated many psychological survival strategies to help ease their burden, and to allow them to feel they had some control over events. He implemented a step-by-step plan for dealing with torture, so that the men could hold out from giving sensitive information away too quickly, and so that when they did eventually capitulate, they didn’t feel bad about it because they had reached certain ‘torture goals’. Because the men weren’t allowed to talk, he created a system of communicating through tapping to reduce their sense of isolation (Collins, 2001). He also revealed intelligence information in his letters to his wife, and on at least one occasion beat himself up to the point of being disfigured, just so his captors wouldn’t parade him on TV!
Stockdale, unlike many of the other prisoners, came out of the POW camp almost completely psychologically intact, and got straight on with his life.
In his book ‘Good to Great’, Jim Collins discussed a conversation he had with Stockdale about how he coped during his period in the POW camp. Stockdale stated:
‘I never doubted not only that I would get out, but also that I would prevail in the end and turn the experience into the defining event of my life, which, in retrospect, I would not trade.’
Perhaps even more interestingly, when asked who didn’t make it, Stockdale is said to have replied:
‘Oh, that’s easy, the optimists. Oh, they were the ones who said, ‘We’re going to be out by Christmas.’ And Christmas would come, and Christmas would go. Then they’d say, ‘We’re going to be out by Easter.’ And Easter would come, and Easter would go. And then Thanksgiving, and then it would be Christmas again. And they died of a broken heart.’
At a first glance, it perhaps seems odd that those who were most optimistic were those who suffered most and did not survive. After all a lot of research suggests that maintaining optimism is generally very helpful in living a successful and healthy life (see for example Scheier and Carver, 1993). According to Collins, Stockdale stated in relation to the death of the optimists:
‘This is a very important lesson. You must never confuse faith that you will prevail in the end—which you can never afford to lose—with the discipline to confront the most brutal facts of your current reality, whatever they might be.’
Stockdale had absolute faith that HE had the skills and resources both to survive captivity, and to eventually escape. He didn’t pray every day for the war to be over, he didn’t keep hoping that someone would just appear and rescue him, he didn’t lay awake at night agonising over whether friends and family back home were rallying around in support of him. He had an internal locus of control, and a belief that he could manage the whole situation. In particular his sense of secondary control was very high; he believed that he could deal with whatever was thrown at him. At the same time, he had ‘the discipline to confront the most brutal facts of your current reality’ – what we call perspective…
Normalisation
Situations and experiences can become ‘normalised’ very quickly…
Think back to the very first time you had sex. I bet you remember where it happened, how old you were, who the other person was, what it was like (brief, I’m sure!). This event may have happened fifty years ago, but you still remember it clearly.
Now think about the second time you had sex. You can’t can you?
The first time was a momentous few minutes in your life, millions of years of evolution had prepared you for this moment, and you were fulfilling your biological destiny. Though I’m sure you weren’t thinking of Darwin or Dawkins at the time! The second time though, was just ‘another time’. It wasn’t hugely significant in any way, shape or form.
I remember my daughter having her first period. We had talked about it quite a lot beforehand, discussed what it might be like for her (I am a therapist remember, this is what we do), and that she would tell me excitedly when she thought she started. When she did start, she phoned me straight away, from school, to let me know. A girl’s first period is a significant moment in her life; she is becoming a woman. Five weeks later, though, I hadn’t heard anything about her second period. When I asked her about it, she said, in a very ‘been there, done that, bought the tee-shirt’ voice, ‘Oh yeah, had that last week.’ It had already become normal and usual to have a period once a month.
If you have never had sex, and you aren’t female, think of the first time you saw one of your parents drunk, or first heard them have a row, or first heard them swear. I am currently forty three years old, but I can still remember clearly the first time, twenty six years ago, that I heard my dad say the word ‘F@*!’. I had heard lots of other people say it and been known to use it myself on occasion, but had never heard my dad say it. I remember it as if it were yesterday. We were in a green Ford Cortina and had just parked next to the library, in Mildenhall, Suffolk. I thought, ‘Wow, my dad just swore’. From that moment onwards, he swore a lot (maybe it was me?) but I cannot recall a single specific time. It had become normal. This is how experiences in life become normalised.
Ever wonder why those clothe-less and shoe-less ghetto kids you see on the news from time to time in some shanty town in Brazil or India, always seem to be smiling and having fun? They can’t afford a football, so they are kicking a Coke can around the dirty street. You ask yourself, ‘How can they be happy?’ It is normal for them. Simple.
In relation to symptoms, illnesses or anxieties, normalisation is about seeking out or creating an environment, both the physical environment, and the people in it, that support and collude with your thinking and belief systems. It’s about surrounding yourself with people who share the same view of your situation (your symptom/illness/problem) and that don’t question or challenge your thinking about it, or judge you for it. When your situation is normalised you feel much better about it. Go back to our smoker in chapter one, for a good example of this. In social and work situations smokers tend to seek out other smokers to share their smoking times, so they don’t feel isolated, stupid or judged. Their smoking buddies validate their feelings and beliefs about smoking, and this provides a sort of ‘intellectual comfort’.
With the advent of the Internet, it has become incredibly easy to normalise your problems/symptoms//beliefs and gain support from other people who have the same viewpoint as you. In 2007, Yahoo alone had just under nine million online ‘Yahoo Groups’ (Source: Yahoo). Online support groups/forums exist for depression, anxiety, emetophobia, social phobia, other fears and phobias, eating disorders, self-harm, IBS, CFS/ME, cancer, stroke, heart attacks and pretty much anything else you would care to name! Whilst these online groups may help you to feel a little bit better about living with your problem or condition, they rarely help you to actually recover! Because of the way most of these groups are set up (by someone suffering a certain problem and wanting to talk with others in a similar situation), they tend to back-up and support your limited thinking, rather than gently challenging it or giving you some perspective.
If, for example, you join an emetophobia online support forum, you will be surrounding yourself with others suffering in the same way. It becomes normal for you to talk about and think about how awful and scared you are feeling and to hear similar stories from others. Rather than getting rid of your fear, you get to feel a bit better about having emetophobia…
Reinforcement (sometimes called ‘secondary gains’)
With any belief system, or cycle of behaviour, some form of ‘reinforcement’ will have taken place to help maintain or perpetuate it. If you look again at the smoker in chapter one, the most obvious reinforcement would be that they feel much better after having the cigarette; i.e. their belief that smoking, despite the associated health risks, was ‘nice’, was reinforced by how calm and relaxed they felt after having a cigarette. If they were thinking of giving up, then it is at this point that they know that they won’t quit.
For a gambler, despite the pressure to quit from their spouse or family, despite the self-loathing that often goes hand in hand with losing vast sums of money, (especially if it was the week’s grocery money!), they feel great when they win. Even if they only win one bet in ten, that one win ‘proves’ that they are smarter than everyone else, proves that they have got special skills at determining a winner, or at picking a winning hand, and proves that they did make the right choice in gambling. This is all reinforcing their ‘addiction’ to gambling. I place the word addiction here in quote marks, because of course it is not an addiction, any more than smoking or drinking is; people do it because they like it.
Reinforcement can also be much less obvious. When you create a lot of anxiety and panic in relation to being sick, you then feel awful/stressed/upset/embarrassed, which reinforces your sense of powerlessness over your behaviour/symptom. You validate your belief that you just can’t cope with it. Whenever you carry out any sort of avoidance or safety-seeking behaviour, you are backing up your fear and reminding yourself that you don’t believe that you have the skills to deal with vomiting.
Reinforcement could be seen as ‘the excuse to continue’, for example:
- In drinking – ‘I feel much better when I drink, and much more relaxed’
- In self-harming – ‘I feel alive and in control when I cut my arms’
- In having affairs – ‘I feel great, and nobody is getting hurt’
- In depression – ‘I knew that my life was shit, and these feelings just prove it’
- In failing – ‘See, I told you it wouldn’t work, I’m just no good’
- In anxiety – ‘I feel awful – I just can’t cope with this situation’
- In being ill or having a psychological problem – ‘People pay me so much more attention, and are so much nicer to me when I’m ill’
The last one (above) is very common amongst sufferers of a wide range of problems, symptoms and conditions. Often where there is a (deep down) sense of worthlessness and low self-esteem, the reinforcement for a person is as simple as the fact that people around them feel sorry for them because they are ill. They are getting support, attention and love that maybe they didn’t get when they were well. It’s sometimes difficult to comprehend how significant ‘a little bit of attention’ is to a person who (deep down) feels worthless, useless and powerless.
An example of this was the first client I was ever asked to treat for ME/CFS/PVFS, about fifteen years ago. On becoming ill, she went from being a lonely, isolated person with no friends and no partner, to a really interesting person, bordering on being a local celebrity, who lots of people spent time with, all because she was ill. I didn’t really know much about reinforcement or cycles of behaviour at the time, but when she told me she was seeing: an osteopath, a homeopath, an acupuncturist, her GP, a neurologist, a dietician and a psychologist, AND that her mum would drive her to all these appointments (at least one every day!). I remember thinking, ‘I’m surprised she wants to get better with all this love and attention she is getting’. She didn’t want to get better, she wanted to prove there was a medical basis for her illness, and no cure, in order that she could (a) keep getting all the love and attention, and (b) not feel judged for it because it wasn’t her fault as it was a proper medical illness. I’m not suggesting that this is the case for all ME/CFS/PVFS sufferers, but most of the ones I have helped to cure (as well as most other clients with a huge range of problems!) have identified with this to a greater or lesser extent.
By saying that a symptom, problem or condition may involve some gains that help to reinforce and maintain it, I am not proposing that the symptom, problem or condition is not debilitating, unpleasant or upsetting or that the sufferer is being deliberately manipulative or ‘attention seeking’. But in many cases there are gains that do provide some (unconscious) reinforcements and contribute to maintaining problems and symptoms.
It is, understandably, often very hard for people to admit that they may be gaining something ‘positive’ (e.g. love, care, attention, sympathy, a feeling of being ‘special’ etc.) from their illness/depression/anxiety/symptom. When you have a debilitating or distressing problem that you have been trying to overcome for years, it can be very difficult to think that you may in some way ‘want’ to keep your problem or may gain something from it. Additionally, if you have some social anxiety, you are going to fear being judged by others (because deep down you judge yourself very harshly) and thus you shy away from thinking about potential gains.
People tend to respond to the suggestion that they may be gaining something from their symptoms in one of two ways: ‘how dare he suggest that I am getting attention or other gains from my symptom, this book is a load of offensive crap and I’m not reading any more!’ or alternatively ‘shit he’s right – I am such a stupid, worthless, pathetic, attention-seeking idiot, it’s all my fault I’ve got problems, I hate myself’. Yet if you are gaining something from your symptoms and on some level this is helping you to maintain your problems, then this does not make you in any way a bad person. Most of the clients that I have treated, regardless of their problem, have identified with receiving some reinforcements to at least some extent.
If you think about it, it’s actually really common for people to receive something positive from situations that are unpleasant, traumatic, painful, upsetting or frightening. A good example of this is a kid with a broken leg. Having a broken leg is often scary, painful, might involve operations and injections, prevents the kid from running around with friends etc. But at the same time the kid probably does gain something from it. He/she may receive cards and presents, extra fuss from mum and dad, when he/she goes back to school all the other kids want to sign the cast and try out the crutches. Or take the example of having the flu. When you’ve got the flu you are likely to feel pretty crap and for the first day or so you are probably a bundle of misery who wants to curl up and cry. But again there are some gains to your illness. Once you’re cuddled on the sofa with a blanket and some paracetamol, watching TV rather than going to work, you don’t feel quite so bad. Perhaps your partner/friend/parent runs around after you, attending to your every need (or perhaps not). Perhaps they are really sympathetic, make you chicken soup or bring you cups of tea, offer to do all the shopping…
Significant others
A ‘significant other’, is any person who is important to an individual’s life or well-being. In sociology, it is any person with a strong influence on an individual’s self-evaluation, who is important to this individual. Therapeutically, significant others are usually the client’s spouse, best friend, or parents. If a therapist, doctor, or other health-care professional is not careful (in avoiding unnecessary long-term treatment), they can become the significant other for their patient. In this situation, it is the ‘care’ of the professional that is validating the illness or problem that the client wanted help in overcoming in the first place!
A significant other, understandably, shows love, encouragement and support for their friend/partner/child, they listen to their worries and fears, help and support them through painful, emotional, or other difficult times. They mop their brow, fetch and carry, take them to their appointments, speak to the doctors and therapists, learn all about their friend/partner/child’s condition, and, importantly, rarely challenge them.
This ‘significant other’ is just what we would all want if we suffered a heart attack, stroke, broke a leg or suffered some other similar setback – who doesn’t want a little tender loving care when they feel lost, in pain, or unhappy?
The difficulty is, that there is sometimes a fine line between ‘giving support’ and ‘colluding and validating’ (reinforcing). The significant other can be the person that (usually unintentionally) helps to provide the reinforcements mentioned in the section above.
Significant others can often help to maintain a person’s fear of being sick. This is particularly true with children – very often the parents (unwittingly, of course) validate the child’s fear and collude with their beliefs. We have already mentioned that, in a study of five emetophobic children who developed their fear after a vomiting illness, ‘attention to the symptoms by others (particularly parents) was reinforcing and contributing to maintenance of symptoms’ (Klonoff et al., 1984). Other research also suggests that parents can unintentionally reinforce their child’s fear, for example:
Michael’s reporting of his obsessions to his parents precipitated a circular, homeostatic parent-child loop of reassurances, complaints, reassurances, and so forth. Parental reassurances were never enough to diminish completely Michael’s anxiety. The family was organized and regulated by Michael’s descriptions of feeling states, which sequentially evoked a series of verbal reassurances by parents. Michael would continue his visceral monitoring, report changes, and parents would increase their reassurance. In this way, the parents’ behaviors in finding a solution became part of the symptom-maintaining matrix.
(O’Connor, 2004)
Think back to the section on the catastrophic thinking style and you will remember that some people with a fear of vomiting will have had a mother (or potentially a father) with the same fear and will have witnessed a parent responding to vomiting in a highly anxious manner. Indeed most people with emetophobia will have some reinforcement from a significant other, who has responded to either vomiting or the phobia in a catastrophic, overly emotional manner.
Some adults may gain validation of their symptoms from online support groups, where other sufferers tend to back-up and support their unhelpful thinking, rather than providing some perspective. If partners, friends and family know about an emetophobe’s fear, they may (unknowingly) collude with them by, for example, helping them to carry out avoidance and safety seeking behaviours, providing reassurance that the person will not vomit, or supporting the idea that the fear is external and uncontrollable. Many adults do not, however, tell anyone about their fear, so significant others cannot collude directly with their emetophobia. They do, however, often validate or collude with their partner/friend’s desire for control and powerless beliefs generally, which indirectly helps to reinforce their fear.
If you are reading this from the perspective of someone with a fear of being sick, you may realise that you have a significant other(s), who is in some way helping you to maintain your problems. In which case you may want to suggest that they also read this book, or at least this chapter!
If you are reading this from the perspective of a significant other who is perhaps unwittingly providing some reinforcements for a loved one’s symptoms, you may be feeling somewhat uncomfortable (especially if you have some social anxiety!). You probably don’t want to think that you may have been contributing in any way to your loved one’s problems, even if inadvertently. Think of things this way…
You are probably very close to your loved one and you obviously care for them a great deal. This has undoubtedly provided many benefits for them. BUT, it may also have validated their problem or illness and perhaps provided reinforcements or gains for maintaining it. As someone who loves a person in distress or difficulty, it is often very difficult to not be concerned, worried and sympathetic. And equally, if you had instead just ignored them, been really unsympathetic, judgmental or negative towards them, this would likely have caused problems too (Research by Walker, Claar and Garber (2002), for example, has shown that in addition to positive attention being reinforcing, negative attention, also, helps to maintain illness symptoms in children with low self-worth and low competence beliefs).
Ideally you want to be able to take a step back, maintain some perspective and support your loved one, without validating their negative beliefs. Gently challenging any limiting beliefs that a person may have, whilst still showing your unconditional love for them, is much more beneficial than just being sympathetic. For example, let’s say your loved one says something like, ‘I’m so anxious about tomorrow, I don’t think I can cope’. Rather than responding with something like, ‘You poor thing, this must be awful for you, can I do anything to help?’ a better response might be, ‘I’m sorry you’re feeling anxious, but this is all about how you are thinking, you can cope, you’re creating that anxiety and you can change it’…
Distorted thinking (sometimes called ‘cognitive distortions’)
Distortion, in relation to cognition, is about the altering, twisting, or warping of your thoughts or beliefs. Imagine a thought for a moment, as a piece of plasticine. You can stretch it, flatten it, make it round, make it square, long and thin. You get the picture. Well, we can all distort our thoughts in similar ways.
We don’t know that we distort our thoughts, so we believe that our (distorted) thoughts are genuine. An obvious example of distorted thinking can be witnessed in an anorexia sufferer who believes she is fat. She can stand on the scales, read the size label in her clothes, and even have her doctor standing out in front of her telling her she is going to die because she is so thin, but she believes she is fat. She is lacking perspective because she is only seeking out ‘evidence’ that supports the belief she wants to maintain, the one where she is fat. So, whilst lying down, if she can pinch the tiniest bit of her flesh, this is her evidence that she is disgusting and fat. She has to be distorting her thinking, in order to overlook the overwhelming evidence to the contrary.
You’ve already read about some ways in which we can distort our thinking in earlier chapters of this book (catastrophising, negative thinking etc.), but one of the most significant types of distortion, for our purposes, is where the sufferer overlooks overwhelming evidence to the contrary. This is such an important type of distortion, because it constitutes more than just a slight ‘bending’ of reality.
‘Big Al’, who cured himself of ME recently in just four weeks (after suffering from it for 15 years!) using the techniques in this book, thought his ME was caused by radiation from a stream running under his house. He had specialist dowsers come in to diagnose the presence of the stream. Alan completely overlooked the overwhelming evidence that suggested his symptoms might be caused by stress, and nothing to do with a stream. Like, for example, the fact that ME/PVFS/CFS didn’t exist 100 years ago. If it was caused by radiation from water, why have people only suffered from it for the last 40 years? Alan had a huge, and I mean HUGE external locus of control, he scored thirty-out-of-thirty on the Locus Of Control Quiz, and he WANTED to believe that his ME was caused by something ‘out there’, because that’s where his interests and beliefs lay. He had read hundreds of books on ‘out there’ subjects such as: life after death, aliens, life on other planets, different universes etc…
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