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Step 4: Reduce the Impact of the Stressor

Posted Jul 22 2012 12:00am

This step is the take-away, bottom line, upshot, payoff, etc. for everything we’ve discussed up to this point. So pay close attention. Once you have identified the reason (or reasons) you feel controlled, the next step is to take a good look at the situation that is causing the stress to see if you can change how it impacts you.

The key to doing this successfully involves the effective use of coping mechanisms. In psychology, coping with stress is broken down into three basic strategies. Depending on the nature of the stressor, each of these can be used to reduce or eliminate the impact of the problem that is making you feel controlled. These are:

Problem-focused strategies are simply solution-oriented approaches to dealing with a situation that causes stress. If the problem is due to something that can be changed, you can solve it by reducing or eliminating the source of the stress. Let’s say you’re tense and anxious due to your hectic schedule. You feel like you’re running from one meeting to another, while always being afraid that you’ll be late to the next one. You would look at how you are managing your appointments to see how you can reduce the problem.

A patient of mine was dealing with an extremely stressful work situation. He is a doctor working in a busy outpatient clinic where there tends to be a lot of patients who don’t show for their appointments. As a result, the clinic administrators looked for a way to balance patient flow without causing too many gaps for the doctors or delays for the patients. They found a good balance by looking at the average number of no-shows for the clinic and developed a practice of triple-booking each appointment slot to manage the patient flow.

This worked well for the most part. The problem was that cancellations and no-shows varied according to specialty and my patient’s specialty area had fewer missed appointments than the others. As a result, he was constantly overbooked, running late for each appointment and working late every day. The simple fix was to show the administrator how his cancellations and no-shows differed from the others, and that his appointments should therefore not be triple-booked. Problem solved.

This simple approach is the best way to deal with problems that are causing stress, so it should be the first thing to look for when you identify the situation that is causing you to feel controlled. If you’re overwhelmed with work, hire an assistant or delegate responsibilities to others. If your office desk has developed geological strata and finding things you need requires the skills of a trained archeologist, enlist the help of an organized person to help you come up with a better system.

These are fairly straightforward solutions to problems that can really end up controlling your life. In reality, though, it’s usually not so simple. Most of the time, the problem you’re dealing with is not so readily solvable but is rather an ongoing situation that does not lend itself to a simple fix. That leaves you with the next option: appraisal-focused coping strategies.  This means reappraising and challenging your assumptions – or in plain English, turning on your mental crap detector.

Without getting too philosophical about it, when we respond to any event, we feel and believe that we are responding to the plain reality that’s out there. That’s a reasonable and common shortcut that we use to unclutter our brains and streamline how we think. Unfortunately, it’s not true. The idea that we see things as they really are is a simplified but wrong view of the cognitive process we go through when we respond to events. The truth is that we’re really responding to our interpretation of the experience, which can be very different from the reality. So it’s essential to challenge the assumptions we make about how we first view the event.

Everything we see and experience first has to pass through a process of perception and interpretation before we respond to it. That interpretation of what we perceive is our own addition to the experience and it colors or even completely distorts our understanding of the event. It’s like a filter that we use on the camera lens of our mind. It distorts the picture we take of reality in a way that is unique to us. Often, we may apply the same filter to many different experiences. We don’t give too much thought to it when we do this, because it occurs at a level beyond our conscious awareness, and besides, most of the time it has no practical impact.

However, when we respond emotionally to our experience of an event, and then behave in some way that is in turn triggered by that emotional response, how we filter reality can make a huge difference. For the purposes of our discussion, it can determine whether or not an event will trigger an episode of binge eating or not.

It’s too easy to accept the sense of being controlled as the reality and to respond to that perception by eating. But what if your perception is not the reality? It is very possible that your filter tends to allow perceptions of external control to pass through more easily than alternative interpretations. So the most important question to ask is, “Am I really being controlled or are there ways that I can look at this situation differently?”

Appraisal-focused strategies are appropriate when there is no straight-forward solution to a problem. Instead of changing the cause, you modify how you think. This is what I wrote about in some detail concerning Hamlet’s prison. Whether you feel trapped or not may depend entirely on how you look at things.

Another patient of mine grew up as the oldest of six children. Her parents, whether by their nature or necessity, were very rigid about expectations of behavior and fairness. Among those rules were that the older children had to be responsible for their younger siblings. This wasn’t just a matter of watching out for their safety, but also making sure they were happy.

As a consequence, my patient had to do things like include her younger sister whenever she went out with friends, give up her right to an extra piece of pizza if her sister wanted it, and so on. Now, as adults, she doesn’t particularly enjoy the company of her younger sister, but feels incredibly guilty about not wanting to spend more time with her. Unlike the other person’s work schedule problem, this is not a situation that lends itself to an easy solution. So what does she do about the overwhelming stress that comes from the guilt she feels about not liking her sister? She had to reappraise the situation.

First, she had to recognize that perhaps her parents’ expectations were not fair to her. True, she was the oldest, but she was still just a little girl herself and had her own need to be a kid, not a nanny. So a lot of her resentment toward her sister was probably redirected from feelings she had toward her parents that were unacceptable for her to acknowledge. Second, she and her sister are very different people as adults, with different interests and personalities. Sometimes people who are members of the same family wouldn’t choose to be friends with each other if they weren’t related and they don’t have to feel guilty about that.

For this patient, of course, that was not an acceptable option growing up, and she never got the memo as an adult that this rule had ever been repealed. Allowing herself to admit that she would probably not choose her sister as a friend if they met as adults was a revelation to her. That doesn’t mean that she can ignore her as if they had no connection, but including her in her life her as one would any family member is not what was stressful to her. Essentially, she had to give herself permission to disregard rules that were at best obsolete and probably were never a good idea to begin with. This, not surprisingly, was a pattern that repeated itself in her relationships with friends, co-workers, and the men she dated.

This process of reassessing how one interprets and responds to reality is in fact the majority of what goes on in therapy. It’s what most of the talk in talk therapy is about. It’s a process that requires examining patterns of events and relationships and noting how you tend to respond to them until there are enough data points to connect the dots and see a consistent picture emerge.

Since the process relies on no one but you to accomplish, together with a therapist who supports your budding independence, it is a very good example of how to develop a sense of autonomous control in your life. If you commit to it and put what you discover into practice, it is usually a very effective and powerful way of implementing change. But even then, there will be lifelong habits of thinking and behaving that slip through, no matter how effective therapy is. That’s where the third coping technique, emotion-focused coping, can be very helpful.

Emotion-focused strategies involve dealing with the feelings that are stirred up as a consequence of the stressor. This can include managing hostile feelings by counting to ten, or reducing anxiety by meditating or using relaxation techniques. Unlike the first two strategies, which are directed at reducing the source of stress, emotion-focused coping is more tactical than strategic, since it is aimed at the effects of the stress. Distracting oneself from the urge to binge would be an example that is most relevant to emotional eating. This is what many therapists who work with emotional eating recommend when they encourage people to “surf the urge,” meaning, distract yourself from the urge to binge until it passes.

Other useful responses could include any type of pleasant activity that serves as a distraction and occupies your attention, preferably while occupying your hands as well. Any kind of needlework, doing crossword puzzles or taking a hot bath, might be some examples of emotional-coping behaviors. Going for a walk, exercise or reading could also work well. Watching TV might be an effective way to divert your attention, but it could also allow for having a snack while you watch, and the opportunity for habitual eating could defeat the purpose of distracting yourself from emotional eating.

Surfing the urge, and any other response that you might choose to take the place of emotional eating, can be helpful advice when you feel like bingeing and have no other way of dealing with it. However, I see this as a last resort, after the attempts to address the source of the stress has failed. That’s because emotional eating is the effect; the stressor, whether it is a problem that can be fixed or a perception that can be changed, is the cause. Whenever there is a cause and effect relationship, the most effective way to minimize the effect is to first address the cause.

With most of my patients, even those who have binged on a daily basis for years, I don’t begin treatment by getting them to change their behavior. If anything, that would just introduce a new form of external control that sooner or later would have the exact opposite effect of what we are trying to accomplish. Instead, I help them defuse the power of food by encouraging them to view all food as on the menu. Then we’ll look at their experience of external control and discuss the coping techniques I describe here. Often, after only a few weeks of therapy with someone who has been struggling daily, I’ll ask them how their eating has been. They’ll usually think about it for a few seconds and look up with an expression of puzzlement when they realize that it’s been a week or more since the last time they binged.

When it comes to emotional eating, perceived control is the cause; rejection of control is the effect. First try to solve the problem that causes the experience of feeling controlled; if that’s not possible, change your perception of that control. When that’s not enough, find better ways to respond to those feelings. The unwanted behavior will often take care of itself.

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