Although common ‘disorders’ (e.g., eating disorders, anxiety, and depression) look different on the surface, there are some common underlying mechanisms.

One of these is checking. I’m going to go explain the role of checking in a selection of common mental health problems.

Checking in Health Anxiety

Examples:
- Person goes to the Dr for blood tests.
- Person looks at themselves in mirror to see if they look pale.
- Person frequently asks their partner if they look unwell.
- Person researches disorders online or calls healthline frequently.

What happens:
- The checking causes the person’s anxiety about possibly having a health problem to increase.
- Eventually a test may return a false positive, causing distress.
- They start to feel like they’re going crazy.
- People get mad at them.

Checking in Eating Disorders

People with eating disorders often do lots of types of checking. For example:

- Excessive weighing.
- Pinching skin on stomach to measure fat.
- Looking in the mirror to see if their thighs touch or they have a double chin.
- Obsessively reading labels or measuring food.
- If they binge and purge, eating a marker food at the start of a binge to try to ascertain if they have vomited up all they ate (not effective).
- Rigidly doing a set amount of exercise no matter what the circumstances, such as running in a blizzard.

What happens:
- Person’s obsessionality gets worse.
- Person withdraws socially.
- Natural fluctuations in weight cause great anxiety.
- Person starts not feeling satisfied with their checking and therefore does extra checking (similar to in Obsessive Compulsive Disorder)
- Person may skip opportunities such as overseas holidays if they think they won’t be able to do their checking (e.g., won’t be able to measure food, go to the gym etc).

Checking in Sleep Disorders

People with sleep disorders typically do both excessive nighttime and daytime checking.

Examples
- They might look at the clock excessively frequently at night.
- During the day, they might over monitor things they see as signs of tiredness, such as yawning or not being able to find a word.
- They might excessively monitor worry thoughts because they relate worry thoughts to not being able to sleep.

What happens
- Person’s anxiety about getting to sleep prevents getting to sleep.
- People with sleep disorders often overestimate their sleep deficit.
- They may develop counterproductive safety behaviors, such as falling asleep with the TV on to try to prevent worrying, but this increases fears of worrying.

Checking in Panic Disorder

Examples
- Checking to see where the exits are on entering a new building.
- Checking own pulse.
- Reassurance seeking to make sure other people will be there to help them if they have a panic attack.
- Checking whereabouts of partner at all times, just in case needs them in an emergency or if has a panic attack.
- The examples listed for health anxiety often also apply to people with panic disorder.

What happens
- Person becomes fearful of their own internal physical sensations (such as feeling hot or elevated heart rate).
- Person loses confidence in themselves.
- Person avoids fun things. Their opportunities to experience pleasure get restricted.
- The checking does not make the person feel safe, and over time the person avoids more and more, putting them at risk of depression.

Checking in Depression

Examples
- Person over monitors feelings of lethargy or low mood. They bail on commitments, work that needs doing, or social gatherings if feeling tired or low.
- Person starts looking for clues that their partner might be going to leave them due to their depression.
- Person feels mentally foggy and therefore over-checks their work, such as rechecking numbers multiple times.
- Person over monitors feelings of anxiety and avoids when they’re feeling anxious.

What happens

- The avoidance generates stress e.g., people get mad at them bailing.
- Person loses confidence in themselves even further.

Checking in Relationships Problems

Examples
- Asking “Do you love me?” or “Do you promise you won’t leave me?”
- Checking their partner’s phone, email, or Facebook.

What happens
- ‘Pursuing and demanding behaviors’ cause partner to attack or withdraw.
- Partner realizes they wield all the power in the relationship. Power imbalance becomes more uneven.

Checking in Obsessive Compulsive Disorder

Example = person triple checks all their electrical outlets are switched off before leaving the house because they’re worried about a fire.

What happens:
- Person starts to think they’re going crazy.
- Their family get irritated at them for taking so long to leave the house.
- Their fear of fires gets worse.
- Their excessive responsibility taking and intolerance of uncertainty gets worse.

Avoidance of Checking

People with all the above disorders often flip flop between extra checking and avoidance of checking. For example, someone with an eating disorder might go through phases of weighing themselves multiple times a day and then other phases of avoiding weighing themselves. Or, in depression, the person may avoid checking their VISA statement, because “they don’t want to know.” Avoidance coping is stress generating.

Seeing a Clinical psychology PhD

The examples above aren’t exhaustive (this post was getting long). The advantage of seeing a clinical psychology PhD is that clinical psychology PhDs are trained to understand the types of mechanisms illustrated above, which differently trained people may not understand as thoroughly.

Read Another Post About: Cognitive Behavioural Therapy (CBT)

1. Don’t catastrophize knock backs

- If you get a rejection, it doesn’t mean you’re never going to be successful.

- If you get negative feedback on a piece of work, it doesn’t mean you have no capacity to become better at it or that you’re not talented.

If you find yourself personalizing, ask yourself whether you’re catastrophizing.

2. Be gentler to yourself about your imperfections, mistakes, and times when you’re not as good at something as you’d like to be.

If you can learn to be nicer to yourself about your imperfections, you won’t automatically jump to feeling attacked when other people make comments.

3. Frame not personalizing as a positive goal

For example, frame not personalizing at work as part of being professional and robust. Recognize that if you show that you don’t excessively personalize negative feedback (at work and in your personal relationships), people will be more likely to give you accurate feedback rather than give you confusing feedback because they’re attempting to protect your feelings.

4. Learn to label your emotions accurately

Emotions drive thoughts as much as thoughts drive emotions.

What emotions trigger personalizing for you? e.g., anxiety, embarrassment, disappointment, anger.

If you can label your emotional reactions accurately, you can then focus on doing some appropriate self care to deal with that emotion. Once the emotion subsides, so will the personalizing. A lot of the time, appropriate self care for emotions just involves accepting that you’re having the emotion and patiently waiting for it to pass. The things people do to try to “get rid of” their emotions usually end up causing more harm than good.

5. Put yourself in situations in which rejection is likely (but doesn’t have any major negative consequences)

Doing things like making requests when you expect you might be told “no” will help you learn that rejection often isn’t personal. Learning through doing behavioral experiments is the BEST way to change thoughts.

6. Don’t try to overcompensate for fears of not being liked by being excessively eager to please.

People who personalize often have attachment anxiety. If you act excessively eager to please, you’ll just end up believing that it’s the only way to be accepted. Be warm but have good boundaries.

7. Believe in your capacity to become someone that doesn’t excessively personalize things.

I see a lot of people who seem to have accepted that they’re doomed to a life time of being ruminators etc. You can change your cognitive style.

Read Another Post About: Cognitive Behavioural Therapy (CBT), Self-Compassion

1. Do some kind of mindfulness practice. Try this or any of these. Learn enough about the philosophy of mindfulness meditation that you know what you’re doing. Since most people won’t want to do formal practice everyday on a permanent basis, do it everyday initially until you feel confident with it, and then do it when you’re stressed and at least every now and then to stay familiar with it.

How it helps: You’ll be less prone to exploding when triggered. You’ll find it easier to let thoughts go. You’ll be able to recognize more easily when you’re reacting to a distressing thought that has been triggered by someone else’s behavior, not just the behavior per se.

2. If you’re going to respond when feeling irritable, “soften the start-up” (this phrase is from couples expert John Gottman). Try “Babe – I’m annoyed you didn’t take the rubbish out” instead of just “I’m annoyed you didn’t take the rubbish out.”

How it helps: Obvious

3. Don’t try to figure out your thoughts or problem solve when you’re really fired up. Don’t attempt to problem solve while ruminating. Problem solving quality is impaired while people are ruminating.

How it helps: You’ll make better decisions.

4. Think about the emotional experience of the person on the other end of your outbursts, sulking, or withdrawal. What’s it like for your partner, kids etc when you snap at them? If your irritability is directed at your partner, ask them what it’s like for them when you’re irritable. Does it make them feel nervous/alone/want to withdraw etc?

How it helps: Empathy and perspective taking.

5. If you’re good at containing your irritability sometimes but slip up other times, do some gentle exploration of that. Do you have any issues with sense of entitlement (you’re getting irritated because other people aren’t doing exactly what you want)? Are you leaving yourself vulnerable to irritable outbursts by not eating regularly etc?

How it helps: Less blaming others. More taking personal responsibility for not leaving yourself vulnerable to irritability due to poor self care, taking on too much etc.

Read Another Post About: Anxiety, Stress

I mentioned on FB yesterday how much my cognitive style has changed as a result of my psychology training. One of the readers asked me to say more about how it had changed, so here’s my answer. Hopefully this post will show people how it is possible to dramatically change your cognitive style.

- I’m someone who values being successful. I never valued positive emotions much until I read the research and realized that learning to cultivate positive emotions was going to be essential to being maximally successful in life. Yes positive emotions make people happier (obviously) and healthier, but it’s the idea that they’ll make me more successful that motivates me personally. So, I now actively work on cultivating positive emotions – basic things like gratitude, humor, and fun. Believe it or not – these seemed a bit pointless before.

- My relationship with my thoughts has completely changed. I was a ball of anxiety as a child but now when I experience anxiety and anxiety-related thoughts, I’m more interested in them rather than upset or ashamed (and if I’m upset or ashamed, I’m interested in my feelings of upset and ashamed!). Realizing I’m having a thought distortion is a nerdy thrill for me (because I know how to cope and respond).

- Thanks to the research, I now use self-compassion rather than self-criticism when I make a mistake or want to motivate myself to improve in an area. Like I said, I’m motivated by knowing this will result in greater success. I could still kinda care less about feeling better, it’s mainly a positive side effect for me.

- I’m much less of a black and white / all or nothing thinker.

- I know myself extremely well. I know how to rein in some of my qualities and I actually do this. For example, my best qualities include my persistence, resourcefulness, and tendency to feel emotions strongly, but the flip side of persistence is that I’ve got a tendency to be obsessive. I’ve found through experience that putting some limits on my behavior solves the problem of obsessive thinking and overwhelming feelings.

- I’ve realized I have some endearing qualities and that the sense that “People might be attracted to my smartness, but once they really get to know me, they won’t like me” is just a thought. Having a thought, doesn’t make it true.

- All the the above happens naturally now. Cultivating positive emotions feels kinda just like showering and sleeping.

- As you’ll see from above, I’m also SUPER open. Back when I was a new grad psychology PhD I was quite scared to reveal anything about myself (since it’s not really the done thing in psychology), but I seem to have found a niche of clients who like knowing a little bit about their psychology PhD and like knowing that it’s possible to still have some anxiety-related thoughts AND be happy AND be successful.

This is for my kiwi readers – it’s freezing here at the moment! I got the idea to write this from an interview I did for the NZ Herald about weight gain during winter.

1. Eat at regular times, that are not too far apart. It will help you learn to recognize that if you have the urge to eat between these times, it’s probably psychological hunger rather than physical hunger.

2. Find some light (low-ish calorie) winter lunches, dinners, and desserts that you like. When salad ingredients are expensive, what do you want to eat instead? Things like soups can work, but you’ll probably want some variety.

3. Find affordable ways to eat fresh foods. The NZ apples (Eve, Jazz, Smitten) are awesome at the moment and relatively inexpensive. Find little tricks that punch up flavor and freshness. Adding fresh coriander/cilantro to a soup can give it an extra sense of freshness. Some herbs freeze well. You can just take some out of the freezer and add it at the end to add a dose of sunshine to your food.

4. Take your breaks at work. Go for a 5 minute walk around the block even though it’s cold. This will refill your willpower tank. If you really don’t want to take a walk, do anything relaxing during your break time, but take that break.

5. Put together a set of clothes that will keep you warm during exercise. I go walking with 3 jerseys on at once, a balaclava & another hat, trackies, socks, & gloves. These things get dumped on a table near the door and I just put them all on each time I go out. Exercising in cold weather is often not actually unpleasant when you have proper clothes on.

What works for me is going out for a late night walk with my significant other. We get a chance to do our connecting time and moving time simultaneously. We do a shorter walk if we’re not keen for our usual longer walk “Come on let’s just do 20 minutes” is a common phrase on really cold nights at our house. 20 minutes of exercise is the most important thing you can do for your health. If I do nothing else for my physical and mental health in the day, I do this. Most studies on the benefits of exercise are done on walking, just plain walking.

Ideally walk at morning tea or lunchtime so you get some daylight. Leave an old pair of sneakers and some warm clothing at work.

6. Don’t bring junk food to work during winter – it helps no one, even though it might seem like a nice thing to share.

7. Find a winter hobby. Something that gives you pleasure e.g., snow boarding.

8. Don’t have food in close proximity that you don’t want to eat. It’s asking too much of your willpower. Decide your portion size before you’re in the presence of the food, serve your portion, then put the rest away. There are a few foods I actually weigh e.g., I weigh my portion of potato chips in a bowl and put the bag away in the cupboard.

9. Don’t have any forbidden food. It’ll just cause you to binge.

10. Plan some things to look forward to, to keep your mood up.

Read Another Post About: Exercise, Healthy Eating