Fighting Fear

Confronting phobias and other fears

The Essential Element in Dieting--And in Psychotherapy

A feat of imagination

Dieting successfully does not mean simply losing weight—it means eating and exercising properly so that it is possible to maintain a proper weight indefinitely. By that standard few people diet successfully. Most people consider losing weight itself to be so difficult that they want to concentrate just on accomplishing that—as quickly as possible. They do not wish to think about what comes after.  If they do, they think they can just settle into a habit of eating smaller proportions and that this time—unlike all the previous times they dieted—they will maintain a proper weight. This time they will do more or less the same things, but they will try harder. They cannot imagine trying something new because they have a fixed idea of who they are. They have certain inclinations and tastes and certain ways of approaching eating. They cannot imagine that they will ever change. They are now the same person they have always been—and the way they will be forever. Except, this time, they will try harder.

Patients entering psychotherapy have similar thoughts. They are not coming to a psychotherapist in order to understand themselves better. That is a shibboleth. It is something that patients have learned to say because it sounds right; and because it has been repeated over and over again. Patients come to treatment because they are hurting in one way or another. They may be symptomatic in some conventional way: depressed, or phobic or anxious; or compulsive or, even, delusional. These are serious symptoms which may suggest an illness and a medical treatment. But there are others who are just plain unhappy. They struggle, like the rest of us, with the frustrations and disappointments of life; but, perhaps, they are more upset than the rest of us, and unhappy. They come to treatment because they want to feel better. But, in order to live more effectively and feel better, they have to change.

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Yet, like the dieter, they tend to see themselves as the same person they have always been. If they have changed in the past, they do not remember how. And they do not imagine that as the result of therapy they will change in the future. They think of themselves as always having been a certain way—wanting the same sort of things and reacting in the same kind of way over time; and they see themselves as being that way all the way into the future --as the same person. It is as if they were poured out of a mold. “This is me.” “This is what I like and want.” “This is the way I respond.” “This is what I need to be happy.”

But, In order for psychotherapy to be successful, it is necessary to convince patients that they are capable of change—at least to the extent necessary to turn their lives around. The changes required are not dramatic. A shy person does not have to turn into a bon vivant.  Someone afraid of dating or of starting a new job does not have to turn into a daredevil. Small changes can have big effects.  But these changes may not have a noticeable effect right away. The inclination to be open and friendly is critical to living happily with others. And there are other such ways of being that are also critical to living effectively and happily. These can be learned. But it takes time for these new ways to have an effect. Psychotherapy fails sometimes because patients expect too much too soon.

But even when there are changes in behavior, patients—and all the rest of us—think of ourselves still as having a certain irreducible identity—a way of being that we cannot contradict without doing violence to who we are. It is the job of psychotherapy to demonstrate that a person can still be true to himself, or herself, and be different enough to become a more successful and happy person.

Similarly, in the matter of dieting, the successful dieter has to know that it is possible to change in important ways and still be the same person. One important reason why they do not believe this is true is they have tried to change before, unsuccessfully. And one reason they have been unsuccessful is that they do not realize exactly how long these changes take.

If they are going to try losing weight by exercising for a half-hour four times a week, it will not work.

It they do not like exercising, exercising for a month or two will not change their mind.

If they do not like eating salads, eating them for a month or two will not make the salads seem more exciting.

If they refrain from eating steak for just a month or two, steak will seem just as inviting as it ever did.

But tastes do change! But they take time.

Judging from my experience with dieters, I think these generalizations hold, more or less:

  1. Tastes in food change if the individual eats the proper foods for a long enough period—usually around four or five months.

I remember a patient who loved beef stew, but found it repellant after eating a vegetarian diet for about eight or nine months. I, myself, in the wake of developing coronary artery disease, started to eat fish instead of meat. I found sushi particularly unappealing at first—it’s texture, the fact that it was raw—and it was months before I grew to love it, as I do now. It is commonplace for someone who chooses to become a vegetarian, for whatever reason, to find meat has become distasteful even though the diet of that person had consisted previously mostly of steak and hamburgers.

Similarly, the dieters upon whom I based the “Stuff Yourself Diet” grew to love salads, preferring them to other ways of eating.

  1. Exercise, which was always tedious and uninteresting, becomes fun after exercising rigorously for four to six months. For the same reason I started eating fish, I started jogging—every day for an hour. I had always been sedentary, if not inert; but I found myself enjoying my regular excursions through my neighborhood-- but not for the first few weeks and months. By the way, my impression is that in order to lose weight by exercising, that exercise has to be aerobic and last for fifty minutes to an hour and take place at least five days every week. To expect to lose weight by exercising less is to set oneself up for disappointment and failure.

As is true for patients entering into psychotherapy, dieters have to believe that they can change—that their tastes and habits, and even their desires can change. What is required is an act of faith—or a leap of imagination.(c) Fredric Neuman Follow Dr. Neuman's blog at fredricneumanmd.com/blog

Fredric Neuman, M.D. is the Director of the Anxiety and Phobia Center at White Plains Hospital.

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