You can’t walk past the magazines in the supermarket, go out to dinner with friends or check your Instagram feed or Facebook these days without being bombarded by diets aimed to cure whatever ails you. All these plans—whether they’re gluten-free, Paleo, organic, vegetarian, or vegan—involve eliminating foods purported to cause a host of health problems.
One such popular program goes so far as to promise it will “change your life in 30 days,” offering testimonials (which, I might point out, do not count as scientific evidence) from participants who claim it has cured them of a long list of so-called “lifestyle-related diseases.” These include but are not limited to: high blood pressure and high cholesterol, diabetes (both Type 1 and Type 2), asthma, allergies, infertility, depression, bipolar disorder, arthritis, ADHD, and inflammatory bowel disease. The psychiatric literature, last I heard, doesn’t consider depression, bipolar disorder, or ADHD lifestyle-related diseases. That’s a topic for another post. But for now, I’ll get back to the subject at hand.
Even the widespread trend towards “clean eating”—whose proponents like to think of it not as a diet, but as a lifestyle choice or even a movement—comes with rules. Eat lots of fruits and vegetables. Eat only “whole” meats, preferably organic, whose sources you know. Eat only whole grains. Avoid all processed and refined foods (e.g., sugar, baked goods, white flour, white rice, empty-caloric junk foods). Avoid saturated and trans-fats. Drink at least 8 cups of water a day.
“What’s wrong with trying to follow a healthy eating plan?” you might ask. And my answer would be, “Nothing. Usually.”
But if you tend to become fixated on avoiding specific foods because you’re excessively concerned about controlling your weight or think they might cause cancer or other diseases, be careful. Even a so-called “non-diet” like the clean-eating approach can lead to emotional struggles for perfectionistic people prone to eating disorders or health anxiety.
Any time perfectionists impose all-or-nothing restrictions on themselves, they run the risk of getting upset and ditching the diet altogether if they think they’ve broken the rules. It doesn’t even have to constitute a major transgression, such as picking up a Big Mac, fries, and large Coke from the MacDonald’s drive-through on the way home from work. If you’re evaluating your food choices from the perspective of a black-and-white mentality (and comparing them with the colorful Instagram images of the kale smoothies, grain bowls, and lush farmers market produce others appear to be eating), you could easily beat yourself up for popping a handful of M&Ms at the movies or having white rice with your homemade, clean Pad Thai. Then you might decide you’ve blown it for the day (or week), and let loose with a full-blown binge. You’ll feel guilty, vow to atone and never stray again, and set yourself up for the next self-punishing cycle of deprivation and excess.
Let me make my position clear before the critics jump on me for questioning sound nutritional practices. I’m not suggesting you go overboard with the junk food and the trans-fats. I’m not urging you to forego whole grains in favor of Wonder Bread. I’m not recommending you trade your bottled water for a Big Gulp. I’m not even telling you the clean-eating lifestyle is bad. (Though I might be telling you not to drink the diet Kool-Aid du jour without seriously evaluating its claims from an evidence-based perspective).
But when food—no matter how nutritionally pure, unadulterated, and good for your body it may be—becomes a source of internal conflict, guilt and anxiety, you might want to think about what it’s doing to your mind.
As with most things in life, moderation and flexibility are the keys to emotional wellbeing. Your mindset about eating is just as important for your health as the foods you eat. Sadly, Instagram can’t capture that.
One of the most frequent questions I hear from people considering CBT is: “Can you help me get rid of my anxiety?”
I wish I could answer with an unqualified “Yes!” But I’m a psychologist, not a purveyor of snake oil, and professional ethics require me to set reasonable expectations for treatment.
Wiping out anxiety completely isn’t a realistic therapeutic goal. It’s also not in anyone’s best interest to aim for total mental control. Like it or not, anxiety—whether a hard-wired physical response to an objective threat or the product of an over-active imagination—plays an important role in everyone’s emotional repertoire. So we all need to negotiate a peaceful coexistence with it.
A few weeks ago I had the chance to test out my own advice about meeting fears head on. I was at the highest point in LA’s Runyon Canyon enjoying the vista of the city spread out beneath me and the Hollywood sign in the distance on a perfect Southern California day. I sat on a rock soaking up the warmth of the sun and giving the experience my full, mindful attention. Then I started on the descent.
That’s when the panic gripped me.
Heights have always made me nervous, and I’ve never liked hiking downhill. But this time I wasn’t just cautiously inching my way down the slope in my typical fashion. I froze completely. My heart pounded. My mouth dried up. I felt dizzy. I couldn’t figure out how to put one foot in front of the other.
The steep dirt path littered with jagged rocks made my anxious brain conjure up images of slipping and plunging forward and cracking open my head and lying in a pool of blood. Not likely. But it could happen.
Oh, wait! It had happened —just a few months earlier, on a perfectly flat walk only two blocks from my house when I tripped on an uneven patch of sidewalk and landed in the emergency room.
OK, so my fears weren’t entirely irrational (an argument I hear frequently from people with anxiety reluctant to approach triggering situations). But, still, I had to make my way down the mountain.
So I decided to recruit the mindfulness skills I’d just been practicing. I didn’t try to relax. I didn’t tell myself I had nothing to worry about (because, really, how could I possibly reassure myself given the evidence to the contrary?). I didn’t try to push away the gory images. I didn’t attempt to slide down on my butt crab-style, a technique I’ve employed in the past to navigate precipices. I didn’t try to take a calming breath or grab onto my husband’s arm for support (not a viable option anyway because he was focused on his own worries about slipping and dropping his camera).
What did I do? I gave myself permission to be scared. I decided not to care about how slowly I was going and made room for the faster hikers to pass me. I looked down at the path in front of me. I concentrated on finding a place to plant my foot and took a step. Then another. And another. Until I finally reached the bottom.
And the next day, I went back and climbed to the top again. The view was breathtaking
OCD is a formidable opponent. It’s the sharpest prosecutor, the meanest bully, the dirtiest thug. Arguing, appeasing, or getting into a fight with it won’t work. You’ll lose.
If you suffer from repugnant mental intrusions, you may believe your thoughts are the problem. You’ve probably spent hours, days, or, quite possibly, years trying to reason with them or push them away. One obsession may resolve only to have another one surface. It’s exhausting and demoralizing.
Surprising as it may seem, your thoughts are not the problem. Everyone has thoughts, even bad ones. In a seminal 1978 experiment, psychologists Stanley Rachman and Padmal de Silva found that nearly 90% of the “ordinary” people (that is, a non-clinical population) they sampled admitted to having had occasional thoughts about committing violent crimes, engaging in taboo sexual acts (with children, family members, or animals), blurting out obscenities or racial slurs in public, harming themselves or loved ones, or doing something inappropriate (such as laughing at a funeral). The main differences between these so-called “non-clinical” obsessions and the “clinical” ones of someone with OCD are the frequency of the thoughts, the distress they cause, and the efforts expended (ie, the compulsions) to get rid of them.
British writer David Adam has recently published an excellent memoir, interspersed with fascinating historical accounts of the disorder, about his struggles with OCD, The Man Who Couldn’t Stop: OCD and the True Story of a Life Lost in Thought.
Here is some cutting-edge advice in Adam’s book on how to cope with obsessional thoughts:
“Grit your teeth in the face of your thoughts and for God’s sake be more obstinate, head strong and wilful [sic] than the most stubborn peasant or shrew. Indeed, be harder than an anvil . . .If necessary speak coarsely and disrespectfully like this: Dear devil, if you can’t do better than that, kiss my toe.”
The statement embodies all we’ve learned from evidence-based treatment. It’s exactly the type of approach psychologist Reid Wilson advocates when he talks about “chasing the bogeyman” (I attended a workshop he gave on this treatment method just a few weeks ago).
An up-to-the-minute strategy for dealing with intrusive thoughts. From the 16th century, courtesy of the theologian–and OCD sufferer–Martin Luther.
This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.