Cure your Emetophobia and Thrive – Chapter 8 preview..
Cure your Emetophobia and Thrive – Chapter 8 preview… Chapter Eight: Unhelpful Thinking Styles
So, you have your three primary limiting beliefs: an external locus of control, low self-esteem and social anxiety. You are also likely to have a very strong desire for control. Next we looked at the three main personality types: the Carer, the Brooder and the Dramatiser.
Now we are going to look at some ‘unhelpful thinking styles’.
Again, most people tend to view the following thinking styles as parts of someone’s personality that are fixed and unchangeable. This couldn’t be further from the truth. These unhelpful thinking styles are basically just habitual styles of thinking: habits, mostly created in our childhoods, due to an external locus of control, social anxiety and/or low self-esteem. If the ‘sufferer’ stopped and thought about what they were doing for three seconds before they did it, they could stop it, easily (I’ll show you how to do this later). So an unhelpful thinking style, of all the pieces that make up the jigsaw of a person’s symptoms and problems, is one of the easiest and simplest things to change, which is great news, because the bloody things cause havoc!
An unhelpful thinking style, for our purposes, is a way of thinking that has become exaggerated or dramatised over time, usually because the person has felt powerless to change it. It is an exaggeration of a normal characteristic that we are all capable of displaying but some people have ‘travelled further down that road’ and turned a minor characteristic into a full-blown trait.
Thinking styles, like most symptoms, are directly related to your stress and anxiety levels, and your stress and anxiety levels are directly related to your Thrive Factor. People with an internal locus, low social anxiety and high self-esteem, score much lower on the unhelpful thinking styles quizzes. These thinking styles can sometimes be helpful. Most inventors have to be quite obsessive, therapists and police officers find it helpful to be hypervigilant, and compulsive thinkers tend to be good fun! However, for the purposes of this programme, we will be exploring the ways in which these thinking styles can be problematic.
Much in the same way as our language does, our unhelpful thinking styles can validate our limiting beliefs and help to maintain our externality and high Thrive Factor score. By challenging and managing our unhelpful thinking styles, we are again helping to create a more internal locus, higher self-esteem and lower social anxiety.
The following styles of thinking seldom appear on their own. Usually, if a person has one of these unhelpful thinking styles, they’ve probably got a couple more hidden away somewhere. I have described them separately just for clarity. There are probably many other different thinking styles but the ones I have included here are the more common ones.
When you read this chapter, you may need to keep in mind what you have already learnt about yourself. You should now know whether your locus of control is external or internal and have a good idea about your self-esteem and social anxiety levels. These primary limiting beliefs affect all the information we process and, if you have an external locus, low self-esteem and high social anxiety, it may be that you find it challenging identifying some of these unhelpful thinking styles in yourself. Remember that this book is about really getting to know yourself and that in order to help yourself most effectively you will need to be honest with yourself.
This chapter contains a number of questionnaires to help you to identify your unhelpful thinking styles. Don’t be surprised if you ‘score’ at least 2 or 3 on every quiz, most people will do. Depending on how quickly you are working through this book, along with many other factors, it is possible that you have already noticed some significant changes in your thinking styles. If this is the case you may find yourself unsure of how to answer some of the questions, thinking something along the lines of ‘well I used to be like that but in the last 3 weeks I haven’t been’. If so, you can always mark the questionnaires twice – once for how you were a few weeks ago and once for now. This way you can see clearly some of the changes that you have already made! Don’t worry if you haven’t yet noticed a change in your thinking. People work through this book at very different speeds and there is no ‘right’ way to do so (if you are finding that concept hard then pay particular attention to the perfectionist thinking style described in a moment!).
The obsessive style
I have never treated an emetophobe who hasn’t been very obsessive and this obsessional thinking plays a big role in their symptoms. People with a strong obsessive side tend to worry, brood and think about every experience in intricate detail. Everything is thought about and gone over at least a hundred times! An obsessive person is like a hungry dog with a juicy bone! The Brooder personality type described previously tends to have a very strong obsessive side. Someone with an obsessive thinking style is very often rigid, methodical and power seeking, thinks in black and white, and loves routine, order and discipline.
The ability to brood and ruminate over something for a long period of time can be a superb thinking style to have, IF you also have a positive outlook, good self-esteem and an internal locus of control. Everything ever invented was thought up by people with an obsessional side to their nature. The Mac computer, on which I am typing this book, was developed by an obsessive person, as is the watch I am wearing, the jeans I am wearing, the chair I am sitting on, the clock that is ticking in the background, the light bulb providing light… EVERYTHING was designed, developed and built by obsessive people. Speaking of light bulbs, Thomas Edison, the man who first made a mass-producible electric bulb, made several hundred attempts at designing the long-lasting light bulb until he got it just right. When asked by a newspaper reporter, ‘How does it feel to have failed seven hundred times?’, the great inventor responded, ‘I have not failed seven hundred times. I have not failed once. I have succeeded in proving that those seven hundred ways will not work. When I have eliminated the ways that will not work, I will find the way that will work.’ He is also the owner of the quote: ‘genius is one per cent inspiration and ninety-nine per cent perspiration’.
On the other hand, obsessive thinking can often be very detrimental. When people have a negative outlook, low self-esteem and an external locus of control, this thinking style can contribute to a range of symptoms and problems. This sort of obsessive, ruminative thinking involves thoughts ‘that repetitively focus the individual’s attention on his or her negative feelings and the nature and implications of those feelings’ (Lyubomirsky & Tkach, 2004). This is the type of unhelpful obsessional thinking that we are discussing from now on.
Obsessional thinking plays a big role in emetophobia. People with a fear of vomiting tend to spend a great deal of time worrying and brooding about being sick. Many also have other symptoms and problems that relate to obsessive thinking. One research study, for example, found that 46% of emetophobic participants also said they had depression and 18% said they had obsessive compulsive disorder (Lipsitz et al., 2001). In my clinical practice, I also often find that, in addition to brooding and worrying about vomiting, people with emetophobia are obsessive in other areas of their lives.
So why is obsessive thinking so unhelpful? Research has shown that obsessing and ruminating about problems can have very negative effects on mood and can reduce people’s ability to recover from difficulties (Lyubomirsky & Tkach, 2004). Obsessing about problems and difficulties is all about a desire for control. The more you think and brood and worry about something, looking at it from every angle, the more you feel you are likely to understand it, get it right, figure it out, bring it to a conclusion and make the right decision. Obsessive people believe they NEED to focus inwardly and analyse their feelings. They really believe that they HAVE to obsess, to try and figure things out and to make sense of their symptoms and their life. In relation to depression, Lyubomirsky and Tkach (2004) found that:
Many people believe that when they become depressed or dysphoric they should try to focus inwardly and evaluate their feelings and their situation in order to gain self-insight and find solutions that might ultimately resolve their problems and relieve their depressive symptoms.
The problem is that people are wrong in their assumptions that brooding will help! I’ve never yet met an obsessive person who actually DID resolve their problem/symptoms after obsessing about them. In fact, they usually made them seem much worse. Lyubomirsky and Tkach (2004) went on to say:
…numerous studies over the past two decades have shown that repetitive rumination about the implications of one’s depressive symptoms actually maintains those symptoms, impairs one’s ability to solve problems and ushers in a host of negative consequences.
Along with:
…studies have provided evidence that ruminative focusing leads dysphoric individuals to appraise their problems as overwhelming and unsolvable… (my bolding)
So brooding and obsessing actually MAINTAINS the very symptoms that obsessive thinkers were attempting to resolve. Those with the obsessive style tend to become so caught up in brooding and dwelling that they do not take useful action to solve their problems. They may think that by obsessing and worrying they are gaining control and helping themselves to figure out a problem. In fact, they are far less likely to use active coping skills to deal with problems or stressful life events than those who do not tend to brood. Gladstone and Parker (2003) stated that ‘worry may ‘mimic’ problem-solving, but the worry process is unlikely to achieve a satisfactory end or conclusion because of its characteristic rehearsal of feared scenarios.’ Obsessing about a problem tends to focus all attention on this problem, reinforcing all the negatives, keeping people absorbed in their worries. So rather than increasing your sense of control and solving your issue as intended, obsessing actually decreases your sense of power and maintains your problem!
In emetophobia, sufferers spend a lot of time obsessing and worrying because they believe that this will help them to avoid vomiting. But instead it just creates a huge amount of negativity and anxiety. Worse than that, what happens when you keep trying to solve (by brooding and analysing) a problem that is not actually solvable? You develop a more external locus… Vomiting is never going to be 100% preventable (indeed often being sick is a very necessary bodily function!) so all the obsessing in the world cannot lead you to completely avoid ever being sick – your brooding just creates stress and increases your sense of powerlessness.
Questions that may indicate a strong obsessive style:
- Do you find that you are frequently brooding and worrying about something?
- Do you regularly find it hard to sleep at night due to the thoughts going through your head?
- Do you have any specific routines, tasks or rituals that you ‘need’ to carry out (e.g. counting, carrying out actions in a certain order or manner)?
- Did you score more than four (out of ten) on the ‘Desire for Control Questions, on page 52?
- Are you the sort of person who doesn’t like taking pills and medicines, even if it’s just a headache tablet?
- Do you like to be organised and plan your life in detail? (Keeping a thorough diary, making lists, and lists of lists!)
- Do you like to have things kept very tidily, in order, with everything ‘in its place’?
- Do you have the ability to focus on and/or be very committed to certain hobbies, activities or sports?
- Are you ‘a little bit funny’ about dirt, germs and contamination?
- Do you worry about dying of cancer or another specific health problem?
Answering ‘yes’ to more than a couple of these questions means that you probably have an obsessive thinking style.
ACTION! Stop obsessing – it doesn’t help!
Probably the most important piece of research in this book is the paper referenced on the previous page by Lyubomirsky and Tkach. Having said that, you’ve probably forgotten it already! You want to know the three quoted paragraphs inside out, and back to front. I’d write out these paragraphs and put them in your diary, stick them on your fridge and use them as the screensaver on your laptop and phone. Read, and understand the implications of the three paragraphs every day until you can quote them from memory. These three paragraphs are the evidence that brooding and obsessing about your phobia is not only a complete waste of your time, but encourages you to be more negative, powerless and hopeless. So, stop obsessing: walk away…
a) Stopping obsessing in its tracks
You don’t HAVE to obsess about things! You choose to do it, so choose to stop it. Whenever you become aware that you are starting to brood about something, challenge yourself about why you are doing it and, if necessary, remind yourself of the research above. Ask yourself, ‘Do I need to brood about this?’ Or, ‘Is it helpful for me to do this?’ If necessary, stop what you are doing at the time and leave the room or get up from your desk. In other words, ESCAPE from whatever situation you are in and focus your mind upon something else. Put effort into immersing yourself into other more constructive thoughts or behaviours and you’ll stop obsessing. Do you brood and obsess when you are doing something you really enjoy, such as having fun with friends/playing golf/having sex? No. Why not? Because when you are doing things like this, you are fully engaged in something else.
b) Preventing future obsessing
Remember: you only create stress, worry or panic around situations where you feel external and not in control. Brooding and obsessing is an unhelpful attempt by you to gain some control because you feel powerless. If you complete the ACTION!s in the locus of control and primary limiting beliefs chapters you WILL develop a more internal locus and won’t feel the need to obsess anymore. In particular, you want to focus upon building an internal locus of control in relation to your emotions and coping skills, so that you feel able to tolerate previously feared situations.
Research into emetophobia has supported the notion that increasing your feelings of competency and sense of power leads to a decrease in obsessing. One recent study (Moran & O’Brien, 2005) explored the treatment of an 11-year-old girl with emetophobia. In this case, the girl feared other people vomiting and, because of this, avoided school and social situations. Prior to treatment, she had moderately high obsessional thinking about vomit. She had already been treated with systematic desensitisation therapy and relaxation, but these had not helped her symptoms. The treatment explored in this study used ‘competence imagery’, which involved exposing the girl to an anxiety-provoking stimulus (video scenes of someone vomiting), whilst she imagined feeling competent and capable. The child chose to imagine playing her musical instruments, doing laps in the pool, or practising yoga postures, which were all things that she believed she could do well. As the treatment progressed, and the girl felt more powerful, her obsessing about vomit significantly reduced and her fear steadily decreased.
Based on Moran & O’Brien’s (2005) graph of the girl’s degree obsessional thinking in relation to her competence training, along with the experience of my own emetophobic clients, I have come up with this simple diagram to represent how feeling more powerful and competent is related to decreased obsessing.
The negative style
There is plenty of evidence to suggest that people who think negatively, or who have negative expectations in life, don’t share the same successes, don’t experience the same levels of ‘happiness’ and don’t maintain as good health as people whose tendency it is to ‘always look on the bright side’ (e.g. Goodhart, 1985; Gil et al., 1989; Peden et al., 2000). ‘Negative Thinkers’ always focus on the ‘bad things’, always assume that things won’t go well, always assume they are going to fail, always assume the worst-case scenario. For them, the glass is half empty – ‘it won’t work’, ’I can’t find love’, ‘it’s bound to get worse’, ‘I’m bound to get found out by the tax-man’ etc.
One side-effect of always thinking negatively is that, if you don’t think that something is going to work, be fun, be interesting, be challenging, be helpful or just be nice, then you don’t do it. Hence, strong negative thinkers don’t tend to do much in life, as they can always find a good reason not to. They tend to choose predictable, un-challenging work and tend to have over-empathic partners who buy into their spouses’ negativity, making it even harder for the negative thinker to get out of their thinking. We call this spouse a ‘significant other’ – we’ll talk about this later…
The paranoid style
If you have the paranoid thinking style you are likely to frequently worry that other people are out to criticise, reject, exploit or harm you. People with a paranoid style tend to have a strong sense of public self-consciousness (social anxiety) and a sense of self-importance. Publicly, self-conscious people tend to worry constantly about how they appear to others. They tend to be very aware that people could be judging them, because they are judging themselves. They are, consequently, very alert to the attention of other people. People with a sense of self-importance believe that others are always interested in and thinking about them. They assume that they are at the forefront of other people’s thoughts.
A number of studies have suggested that public self-consciousness or social anxiety increases the tendency towards paranoid thoughts. Fenigstein (1984) found that people who were high in public self-consciousness were more likely to perceive hypothetical social situations as being relevant to or targeted toward themselves than those low in public self-consciousness. A study by Fenigstein and Vanable (1992) revealed that people who were high in public self-consciousness were more likely than those low in public self-consciousness to assume that they were being watched when seated in a room with a two-way mirror…
The black and white style
Black and white thinking (also known as ‘all-or-nothing’, or dichotomous thinking) is a style characterised by people thinking about and reacting to experiences in an ‘all-or-nothing way’, where there is no grey area or middle ground. For example, if you have a black and white thinking style you may see yourself as either: a success or failure; right or wrong; good or bad. You may think of your life as: fantastic or rubbish, exciting or completely dull. You may think of your relationship as: perfect or terrible, loving or loveless… you are getting the picture I’m sure. From my own experience, this thinking style is often seen in people who have anxiety, phobias and sexual problems but it is also associated with a number of other psychological problems, including eating disorders, depression and anxiety (Byrne, Allen, Dove, Watt and Nathan, 2008). The black and white thinking style is a significant contributor to the perfectionist thinking style (discussed in a moment!). Egan, Piek, Dyck and Rees (2007) found that dichotomous thinking was related to negative perfectionism in all groups tested and to a particularly large extent in the group that had been clinically diagnosed as having an anxiety or depressive disorder.
Black and white thinkers find ambiguity and uncertainty hard to tolerate. They dislike shades of grey or anything that is not clear-cut, due to their strong desire for control, which results from underlying feelings of powerlessness (external locus). Their black and white thinking is just a reflection of this…
The catastrophic style
Catastrophising is the process where a person emotionally magnifies, exaggerates or blows out of proportion a perceived threat or worry. The ‘catastrophiser’ is the person who uses very strong (exaggerated) language and who thinks and feels in a dramatic fashion. The Dramatiser personality is clearly prone to catastrophising. The ‘all or nothing’ emotional response of the Carer personality and the rigid black and white thinking, often typical of the brooder, can also lead to catastrophising.
If you are a catastrophiser, instead of saying, ‘I’ve got a headache’, you might say, ‘My head is killing me.’ Instead of saying, ‘I feel I’m stuck at home all the time,’ you might say, ‘I’m stuck in this prison cell and I don’t know where the key is to get out.’ When you have a sore leg, you might think, ‘Oh my god, I’ve got a deep vein thrombosis.’ When you have a spot on your arm, you worry it is a cancer. When you have hiccups, it’s a heart attack. When the phone rings, it’s your mum to say someone has died….
Common catastrophic words include: all, never, always, totally, completely, forever, terrible, awful, hideous, starving, nightmare, calamity, devastated, havoc, chaos, fiasco, tragedy, depressed, shock, terror, disgusting, appalling, atrocious, dangerous, disastrous, dread, extreme, hate, repulsive, revolting, serious, severe, shocking, vile, terrifying, evil, horrible, ridiculous.
You are likely to have strong catastrophic thinking, especially surrounding your fear. These catastrophic interpretations lead to a complete loss of perspective. Research has supported the notion that people with emetophobia tend to be catastrophisers! Boschen (2007), for example, suggested that those with emetophobia have ‘a tendency to catastrophically misappraise nausea and other gastrointestinal symptoms’. They assume that any such symptoms are signs of impending vomiting, rather than being down to anxiety, which is far more likely given the stress that they are creating through their unhelpful thinking. In another recent paper, Veale (2009) stated that, “Most people with a SPOV [specific phobia of vomiting] evaluate vomiting as being 100% awful and if given the choice would prefer to die rather than to vomit.” Now that’s about as catastrophic as thinking can get!…
The perfectionist style
‘I’m a bit of a perfectionist’, is something that I quite often hear coming from my social phobic/ brooder/ obsessive/ catastrophic/ black and white thinking style clients during our initial consultation/assessment session. It sounds quite nice if you think about it – ‘I’m a bit of a perfectionist’. It’s a little bit like saying ‘yes, I am a little bit special’.
Difficulty is, due to the intense social anxiety these people suffer from (although they often don’t know it), there is a lot of ‘spin’ going on with a phrase like this. I say this, because actually a ‘perfectionist’ is really a person running away from feeling like shit. Deep down, they usually feel worthless, unlovable and a failure. They are continually fighting to get away from these unbearable deep-down feelings. As a result, they set themselves very high standards. They cannot tolerate failure, because failure puts them back in touch with some very uncomfortable feelings.
The trouble is, if you set yourself ridiculously high standards you inevitably do not meet them a lot of the time. This means that you frequently see yourself as failing – which is exactly what you were trying to avoid! You then tend to give yourself a really hard time for failing to reach your standards, often berating yourself for days after a perceived poor performance. This only increases your desire to be ‘perfect’ so that you can get away from these feelings of worthlessness and ‘not being good enough’. You, therefore, work even harder at being faultless, setting further high standards for yourself. ..
The hypervigilant style
Being in a state of constant over-alertness and sensitivity can cause significant problems for some people. This hypervigilant style can result from a combination of the other unhelpful thinking styles mentioned previously. Hypervigilant people tend to be bright and very observant, taking in everything around them. They are, also, likely to be fairly socially phobic or paranoid, and thus very attentive to the signals given off by others. If you are hypervigilant you may find that you pick up on very small negative cues (either external or internal) that other people do not even notice. You probably tend to obsess and brood about negative experiences, replaying them in your head. You are also likely to have a dramatiser side to your personality and you will then catastrophise and blow these situations out of proportion.
This results in you being in a pretty much constant state of stress arousal. The body responds to stressors in a number of physiological and psychological ways, in order to allow the person to react effectively to danger. One of the most significant responses, from our point of view, is that the mind becomes very focused on the stressful situation. You develop ‘tunnel vision’ with respect to the situation you are in. If you have ever been in a traumatic incident such as a car crash you may remember being very highly focused on the incident. Perhaps you felt as though time was moving more slowly and that all your senses were amplified?
This focused attention is obviously very useful in a situation in which there is true danger as it allows you to be highly alert to your surroundings, giving you the best possible chance of survival. For people who are hypervigilant and constantly responding to even very small cues, even when there is no true danger, however, it causes problems. Firstly it means that you pay even more attention to the situation in question, amplifying it even further. It also means that you will find it very difficult to concentrate on anything else. Your almost constant state of over-arousal focuses your attention very much on whatever situation you are in…
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