- For Out-of-Towners
By: Collins Hodges, PsyD, Licensed Clinical Psychologist
Fortunately, obese patients are able to work through daily decision-making processes with very little or not subjective distress. Most situations requiring a solution demand a fairly straightforward and common-sense approach to problem solving. When not overly stressed, finding ways to deal with issues unfolds in a predictable and often automatic sequence of events. After all, obese patients are not dissimilar to others in terms of their ability to cope with the mundane.
However, a high percentage of obese patients struggle to work through challenging problems without resorting to disordered eating. Over time adaptive coping mechanisms often become supplanted by more maladaptive coping skills (i.e., disordered eating) to handle difficult and stressful events. In such cases, comfort food takes on an entirely different purpose. It serves to regulate one’s mood in order to temper the stress of facing a problematic situation without a clear solution.
Formal problem solving involves several steps, to include the following:
• Define the problem in simple terms
• Brainstorm about solutions
• Evaluate the practicality and effectiveness of each solution
• Choose one or a combination of solutions
• Commit to following through with your behavior
• Evaluate the entire problem-solving method
The patient is encouraged to consult with a psychologist to practice and rehearse these steps with complicated issues that may arise during the week. Eventually, they will become second nature and serve as a template to address life’s inherent difficulties.
In addition to struggling with finding adequate solutions to complicated situations, obese patients often show evidence of distorted thinking. In other words, behavior that is unhealthy (i.e., emotional eating) is a consequence of thinking that is unhealthy. Consider, for example, the cognitive theory of depression which has substantial empirical support. It suggests that the depressed individual sees oneself as worthless and helpless, the world as a negative and hopeless place, and the future as equally hopeless. This pattern of thinking is characterized by a set of common cognitive distortions. A large percentage of obese patients struggle with depression. However, there is ample evidence to support the notion that obese patients not struggling with depression also have disordered thinking. These common cognitive distortions can be found in David Burns’ Feeling Good Handbook (1989) and are listed below:
• All or Nothing Thinking
Also known as “Black-and-White Thinking,” this distortion manifests as an inability or unwillingness to see shades of gray. In other words, you see things in terms of extremes – something is either fantastic or awful, you are either perfect or a total failure.
This sneaky distortion takes one instance or example and generalizes it to an overall pattern. For example, a student may receive a C on one test and conclude that she is stupid and a failure. Overgeneralizing can lead to overly negative thoughts about oneself and one’s environment based on only one or two experiences.
• Mental Filter
Similar to overgeneralization, the mental filter distortion focuses on a single negative and excludes all the positive. An example of this distortion is one partner in a romantic relationship dwelling on a single negative comment made by the other partner and viewing the relationship as hopelessly lost, while ignoring the years of positive comments and experiences. The mental filter can foster a negative view of everything around you by focusing only on the negative.
• Mind Reading
This distortion manifests as the inaccurate belief that we know what another person is thinking. Of course, it is possible to have an idea of what other people are thinking, but this distortion refers to the negative interpretations that we jump to. Seeing a stranger with an unpleasant expression and jumping to the conclusion that she is thinking something negative about you is an instance of this distortion.
• Magnification or Minimization
Also known as the “Binocular Trick” for its stealthy skewing of your perspective, this distortion involves exaggerating the importance or meaning of things or minimizing the importance or meaning of things. An athlete who is generally a good player but makes a mistake may magnify the importance of that mistake and believe that he is a terrible teammate, while an athlete who wins a coveted award in her sport may minimize the importance of the award and continue believing that she is only a mediocre player.
• Emotional Reasoning
This may be one of the most surprising distortions to many readers, and it is also one of the most important to identify and address. The logic behind this distortion is not surprising to most people; rather, it is the realization that virtually all of us have bought into this distortion at one time or another. Emotional reasoning refers to the acceptance of one’s emotions as fact. It can be described as “I feel it, therefore it must be true.” Of course, we know this isn’t a reasonable belief, but it is a common one nonetheless.
• Should Statements
Another particularly damaging distortion is the tendency to make “should” statements. Should statements are statements that you make to yourself about what you “should” do, what you “ought” to do, or what you “must” do. They can also be applied to others, imposing a set of expectations that will likely not be met. When we hang on too tightly to our “should” statements about ourselves, the result is often guilt that we cannot live up to them. When he cling to our “should” statements about others, we are generally disappointed by the failure of the others to meet our expectations, leading to anger and resentment.
As the name implies, this distortion involves taking everything personally or assigning blame to yourself for no logical reason to believe you are to blame. This distortion covers a wide range of situations, from assuming you are the reason a friend did not enjoy the girl’s night out because of you, to the more severe examples of believing that you are the cause for every instance of moodiness or irritation in those around you.
These cognitive distortions represent a depressogenic pattern of thinking that often leads to disordered eating. The goal for obese patients will be to work with a psychologist in identifying the specific types of distortions to which he is vulnerable. Following identification is a therapeutic technique called cognitive restructuring. This entails teaching a patient to challenge these problematic thinking patterns. For example, a patient may observe that he is particularly vulnerable to using the cognitive distortion ‘Mind Reading.’ The patient will then document throughout the week all instances of when this distortion is used. In therapy, the doctor and patient will evaluate two competing columns of evidence, one called “objective evidence to support the thought” and another called “objective evidence to argue against the thought.” Evaluating the evidence will help bring about a sense of clarity to what was once an automatic, assumption-based, subjectively critical thought process. Of course, over time the patient will become more adept at following these steps at home and therefore become his own objectivity screener.
Managing Problems and Thoughts
Problem solving and cognitive restructuring may then be used in tandem to describe a problem situation that he is facing (or faced), the desired outcome that he wants (or wanted), what thoughts and behaviors he should have (or should have had) in order to achieve the desired outcome, and whether he achieved the outcome he wanted. Provided the patient achieved the outcome he wanted, he would describe the thoughts and behaviors that were most helpful. If the patient did not achieve the outcome he wanted, then he would describe the thoughts and behaviors that were most problematic in keeping him from achieving his goal.
Burns, D.D. (1989). The Feeling Good Handbook. New York, N.Y.: Plume.
Dr. Hodges highly recommends patients attend monthly support group meetings. The meetings are led by Dr. Collins Hodges, both a licensed clinical psychologist and someone who has had bariatric surgery himself. The support groups are offered on the first Monday of every month from 6:30pm – 7:15pm CST via an online GoToMeeting. The meetings are open to the public, and there is no charge to attend.