Skip to main content

Monday Metacognition #2


Today's term is Dichotomous Thinking.  The tendency to see things from an "all or none," "black or white" perspective.  It's either this or it's that, there's nothing really in between.

I think we can all see this on the grand stage of politics or other hot-topic issues that we'll refrain from bringing here.  I'm right, you're wrong, there's no room for discussion.  Period.  We can also see how this way of thinking can cause a lot of problems, especially when we use it to evaluate ourselves.

Here's an example:

Shannon was diagnosed with Ulcerative Colitis this past summer.  Her doctor told her that her case was relatively mild and that by following the treatment plan of daily medications, stress reduction and watching her diet she would be able to keep her symptoms under control.  Shannon is highly motivated to stay well so she made sure to follow her doctor's recommendations to the T.  She took her medication, began exercising to reduce her stress and cut high fat foods from her diet since these triggered her UC symptoms.  The treatment worked and her UC seemed to be in remission.  One weekend she went out of town with some friends and forgot to pack her medication.  Since she was feeling well, she didn't think it was that big of a deal.  She also "cheated" on her diet and had hot wings and beer for dinner on Saturday.  When she got home she experienced some abdominal pain and had to use the bathroom several times.  This lasted for a few days, even though she started taking her medication again and went back to a healthy diet.

Shannon thought to herself, "I really screwed up and now my UC is flaring.  I've completely blown my treatment."

The dichotomous trap here is Shannon either follows her treatment plan perfectly or she's failing.  Rather than place herself somewhere in between, she has chosen an extreme view of her situation.

There are several follow-up thoughts that she could have that take her down very different emotional paths.

"I'm never going to get my UC under control." (Catastrophic thinking)

versus

"I just screwed up, it'll be fine once I get back into my routine." (Alternative, "Grey area" explanation)

So how do we identify when we're doing this to ourselves?  Look for use of exaggerated words in your thinking. Is there a less-extreme way to interpret the situation, like in Shannon's case?  Jot these down and evaluate them against your original thought.

Next week:  Personalization

Popular posts from this blog

IBD & Medical Trauma

Medical trauma is such an under-recognized issue for the chronnically ill. It's a hard topic to talk about because it can seem like we are pointing fingers at healthcare workers. Maybe that's why there are only, now, 4 studies on the topic in patients with inflammatory bowel disease (IBD). If you are someone who treats people with IBD please know I am not here to demonize or criticize. I am both a patient and a GI psychologist. I know the medical system from both sides. I know how messed up and broken it is. But ignoring this or rationalizing it away as only affecting a few folks is wrong. So let's talk about it. Post-traumatic stress (PTS) is the term we use for medical trauma due to technicalities in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for post-traumatic stress disorder (PTSD). PTS can be less severe that full on PTSD, or it can be full on PTSD. Regardless, the symptoms are identical: Feeling hypervigilant/on-edge (increased

Primal

Greetings!  It's been a while. I'll blame COVID brain on my lack of writing over the past year. Can you believe it's been a year of this shit? And it looks like we're about to ride another wave, this time the variants B117 and P4.  I'm not here to write about COVID. I'm here to talk about food. Specifically, the psychology of eating. There's a lot of attention being given to this idea of "ARFID" or Avoidant Restrictive Food Intake Disorder, in patients with chronic digestive disease. This is a psychiatric diagnosis conceptualized mostly for children with sensory issues or similar concerns. The main questionnaire used to assess ARFID, the Nine Item ARFID Scale (NIAS), is only validated in children .  While I absolutely agree there are adults with chronic digestive disease who meet the criteria for ARFID, this whole thing makes me a bit twitchy. Here's why. First: Did you ever drink too much tequila and puke and maybe have one of the worst hango

Stress: What it Does to Your Body

As we continue to explore anxiety and the impact stress, I thought this would be an ideal time to discuss some of the physical symptoms that stress can have on your body. Simply put: stress leads to distress – so much so that 77% of Americans experience physical symptoms caused by stress. Distress of your body manifests itself in various ways for each person. For some, it can resemble a headache or migraine, it can upset your digestive tract, increase your blood pressure, reduce sleep and even cause chest pain. Some research has suggested when your body is in distress , it may exacerbate (bring on or worsen) certain illnesses and diseases. Additionally, when people try and use tobacco, alcohol or other drugs (including prescriptions) to relieve stress, the long-term effect may be more harmful than helpful for your body.   Looking at some basic statistics, 44% of Americans have reported feeling more stressed than they did five years ago; three out of four doctor visits are for st