Core beliefs trump medication

Often with anxiety, I see a significant amount of somatisation. That is, the manifestation of mental and psychological agitation through physical symptoms. I’ve seen clients with twitching eyelids, jerking arms, paralysed swallow reflex, nodding head, severe vertigo, limb paralysis, catatonia, parasympathetic mutism, ‘frozen’ tongue, chronic nausea… and a host of other greater or lesser physical ailments as a result of psychological distress. Almost always, the client has focused on the physical symptom as proof that something hideous or catastrophic is wrong, and that the anxiety is a result of this ‘fact’ rather than the source of the problem.

The work that we do together is to transfer the focus back to the anxiety itself, and the belief that is maintaining the anxious state, and away from the body’s manifestation of the anxiety. This can be done in two minutes with a simple exercise. When the physical symptom manifests, I ask the client immediately to focus on the word “important” or some similar-length word, and I tell them to spell it backwards. The very second my client begins to try to do this, the physical symptom disappears. Just like that. Most of the time, my client isn’t aware that the twitching (or whatever) has stopped because s/he is too absorbed in cognitively trying to spell ‘t a n t r o p m i.’ When I point out this out (breaking the client’s concentration) the physical issue tends to return within about a minute. We do this again, using a different word, but this time, the client tries to pay attention to his/her body while spelling. Guess what? S/he either increases the physical issue (focus) and misspells the word or vice versa. Spells the word (focus) and misses when the physical issue stops.

My point is this – these are usually clients on medication for anxiety. When they sit down in my office, they’ll tell me they don’t actually feel very anxious anymore, and in fact, haven’t had a panic attack for days/weeks. If they mindfully scan their internal landscapes, however, the anxiety is there, but the medication doesn’t allow them to feel it. But guess what? The body does, and it SAYS so.

Loudly.

The medication was masking the feelings of anxiety, but did nothing about the underlying belief system or cognitive dissonance that maintained it.

We all know about the Placebo Effect, right? “A beneficial effect produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient’s belief in that treatment.” Thank you, Wikipedia

Surprise, surprise, it works in reverse as well.

Patients take medication which has been proven to be effective, yet the condition itself does not improve. The most recent example of this is with the weight loss drug, Xenical (Orlistat). Obese patients given the drug did not lose weight. When all variables were controlled, the outcome appears to demonstrate that the patient’s core beliefs about themselves, about obesity, and about life, negated the effect of the medication.

“…the women blamed the mechanics of the drug, highlighted the barriers to weight loss, and talked about other weight-loss methods which previously had not worked.

“Their beliefs about themselves and about the difficulty of losing weight lay behind the failure of the anti-obesity drugs.” ~Dr. Amelia Hollywood, Surrey University

Not news to me.

This is also evident in patients who have had obesity surgery. When there is no requirement to engage in therapy as a part of the process, a significant number of individuals either fail to lose the weight expected, or lose some weight in the short-term and then begin to gain it back again. One individual referred to me after surgery had lost only 1/3 of of the weight he had expected to lose, plateaued and then began to regain. When his emotions overwhelmed him, he self-soothed with large strawberry milkshakes …at 500 calories a pop. The type of surgery he’d had prevented him from eating but not from drinking. He chose to drink things that gave him a sense of comfort – of feeling FULL. High calorie, high fat milkshakes did that for him.

I’ve also worked quite extensively with those patients who have lost weight after surgery but who are desperately unhappy. The physical success of losing weight was nothing compared to their mental agony because they could no longer “eat” their emotions. The coping mechanism had been taken away as a collateral consequence of the surgery but the emotional issues remained. Despite successful weight loss (“Obesity is your problem. Get skinny and life will be great!“) I regularly see newly-skinny people who are suicidal.

“Unless we get the psychology right and change people’s beliefs about themselves, their eating and the way the drug works, this medication [or surgery] is often going to produce disappointing results.” (Ibid)

Core beliefs are just that. Core. At the very center of the way I see myself. Medication and/or surgery doesn’t change that, whether the belief is positive or negative. It’s just that when the core belief is negative, it can adversely impact the effect of any tangible intervention. We know this is true in many areas, not just obesity. Cardiologists are more and more often referring their patients for CBT as a part of cardiac rehabilitation – when the patient believes s/he is going to die as a result of dodgy heart, guess what? They often do. There is much research correlating depression/negative beliefs with poor outcomes in cardiac health recovery.

The mind, body, and psyche are not discrete, they are symbiotic, and the psyche is a very powerful influence.

More about core beliefs and self-sabotage here, here, and here.

And the original article that prompted this post…

Weight-Loss Beliefs Jeopardize Anti-Obesity Drugs

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