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Body dysmorphia: Exposure going wrong

Permanent Linkby margharris on Sun May 31, 2015 1:51 am

We have been trying to do some modest exposures. It is just so difficult to work out what someone is really ready to do.
Trying to overcome the fear of…..might have to be tackled in a stepwise fashion. It is not as simple as exposing yourself to the situation and not running from it. You have to be doing cognitive restructuring at the same time. Going to the shops while still telling yourself everyone is judging you and that the woman with her head down turned away because of your looks is merely reinforcing your thinking that contributes to more worry. You will have your head down running for the shadows.
It is vital to do some mental reframing of how you think before you start any assignment. That step is to take the chance that your interpretations are wrong. People are not interested in you and have busy lives. They are going places. “I wonder where they are going and what they are doing?’ replaces: ”Are they looking at me? Do they think I am ugly?” That is paranoia.
My son has been becoming more scared of showers as his illness has progressed. His scoping of body hair could induce a sizeable panic. He linked the hair to an overload of DHT story, and that then to hairloss. The story terrified him so avoiding the shower became the safe option.
I wanted to catch this before it became any worse but I didn’t really know all that he was thinking and why he was doing this avoiding. I wanted to increase his tolerance for having a shower by just doing it and the only leverage I had was to give a Propecia tablet after the shower. Of course, the incentive worked but the showering got worse. I think he even showered at 4 am for 10 seconds. It just had to be over. The exposures weren’t working. He was using the wrong mindset and only further avoiding by doing the shower for the shortest time possible and preferable in the dark. This then didn’t represent any exposure at all. He was avoiding even though he could report that he was having a shower.
Mindfulness is the key here. He needed to be thinking of the water on his skin. The temperature of the water. The smell of it. He needed to keep his focus on the now experience of what he was doing and not shock himself with hair scoping. He has yet to tackle this well. He has to perhaps play this out in his head quite a few times before any real exposure is taking place. This is what is called cognitive restructuring.
There are 4 steps in cognitive restructuring.
1. Identifying your negative problematic thinking during an exposure. So you need to write down really what you are thinking here.
2. Identifying thinking errors. After writing out the thoughts, you need to identify if they match with any cognitive distortion forms. There are many lists you can find for these online. Mind reading, story-telling, catastrophizing, idealising and over generalizing are the usual suspects.
3. Challenging the thoughts. Identifying that we might be exaggerating or our stress level is tampering with our judgement is important but you have to go that further step and begin to challenge thoughts for accuracy. I can hear all the screams that this can’t be done. If you find thinking errors or are told about them then you have to allow yourself the risk that your thoughts are inaccurate. This level has to be mastered before you put yourself up for exposure. You have to be cognitively ready to let go of the stories of fear. They are just holding you back from the safety and freedom of life without BDD.
Is my son’s hair really so important that his whole life depends on it? What a chronic exaggeration and distortion of reality.
4. Replacing the thoughts with more realistic thoughts. I have a lot more going for me. I have been accepted for who I am in the past and can do that again.
Once you reach that mindset then you are more available to healthy exposure work. It might also be necessary to go to events with someone with you. This person can assist in showing you how they notice the environment. They can talk about what they are seeing and focusing on. This actively challenges your own focus.
Nothing is easy about this though. Still getting it right can work wonders. Nothing is gained by the belief that nothing can be done. If you are still telling yourself everything you are saying is right then you aren’t ready to do exposures. You haven’t done the cognitive restructuring to be in the right mindset.
I can report that we have turned the corner. It just happened almost overnight. Something has started to be turned off. I didn’t even realise it was happening. He has been behaving more normally. Not a single panic in three days. He even asked me if I wanted a cup of tea just now. A big focus shift.
This is what the doc has suggested all along. The mindfilter has not been working. With more serotonin the filter is starting to work. Unwanted thoughts are being blocked. The akathisia though is not so good. This is not such a durable treatment if he can’t stop these shakes.
Tip for the day. Talk to a friend and have a meet up if you can. Line is a good app for texting friends. Marg

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