Dr. Edmund J. Bourne
Jonathan Bailor: Hey everyone, Jonathan Bailor back. We have a clinical psychologist with us who specializes in the treatment of anxiety disorders and related problems. He has done this for over two decades. He was the director for many years of the Anxiety Treatment Center in San Jose California. He has written six books, many of which are best selling anxiety workbooks and have helped hundreds of thousands of readers throughout the world. We have none other than Doctor Edmund Bourne with us. I wanted to share the good doctor’s work because, I’ve got to tell you, we spend a lot of time worrying about how we look in this world. When we talk about worry and anxiety and living a smarter, happier, and healthier life, learning how to deal with some of the anxiety that comes up is critical. Doctor Edmund Bourne, or Ed, welcome to the show!
Edmund Bourne: It’s a pleasure to be with you Jonathan. I’m looking forward to our short but hopefully useful interview.
Jonathan Bailor: We were talking before the show and you mentioned that one of the issues we want to cover is cognitive behavioural therapy. It can take years to retrain the mind, but we only have thirty minutes here so we’ll try to power through it.
Edmund Bourne: Well, there are seven different anxiety disorders: panic disorder and panic disorder with agoraphobia-which mean’s you’re not only having panic attacks but you’re restricting your activities as a result of these panic attacks. There’s social phobia, when you are fearful of being in social situations, how you look, and what you say. There is generalized anxiety disorder, which is a long way of just saying “too much worry”. People with generalized anxiety disorder are excessively worrying. Then there are specific phobias. Your problem may just be fear of flying or going to the dentist. Beyond that, there is obsessive compulsive disorder, which really deserves to be a field of study of it’s own because it’s a little different in terms of it’s nature and treatment from the other anxiety disorders. Finally, number seven is post traumatic stress disorder, which again is really it’s own field in terms of the way that we think about it and the way that it is treated. There are different organization are devoted just to treating post traumatic stress disorder, which is-long story short-a severe and reoccurring anxiety reaction someone has after bad trauma like being in a car accident or being raped or certainly common in combat situations.
Jonathan Bailor: If I can just jump in real quick; certainly this is an enormous field and many people are impacted by it. I know myself and a bunch of our listeners might find ourselves sometimes thinking “I just worry to doggone much, and I wish I could worry less”. We may not have a disorder, per say. I think we all worry. Let me ask you two specific questions: one is “what is the difference between a normal amount of worry and a disordered amount of worry?”.
Edmund Bourne: That’s actually a subjective evaluation. The question is “are you suffering?” and “are you in distress because of the amount of worrying you’re doing?”. That would be criteria number one. Criteria number two is “are you worrying about your own worrying?”. Are you feeling anxiety because of the amount of worry you find yourself involved in? People who read my book will find that there are multiple ways you can go about working with it. Let’s say you’re an excessive worrier. The standard of care is cognitive behavioral therapy, and in severe cases, medication. People can benefit from natural approaches and CBT, but if they have a very sever situation then we have to start talking about medications like SSRIs and SNRIs or possibly even tranquilizers. Let’s just say you worry too much. First, we want to know if you are worried about a specific topic and then we need further need to explore where than came from and what’s going on there. Cognitive behavioral therapy would involve a combination of practicing deep relaxation techniques on a daily basis to help you relax a little bit as well as identifying the specific worries and thoughts. Every worrying though begins with a “what if?”. In CBT, we want to identify the specific “what if?”s, and develop what are called counter-statements to each of them. Instead of “what if the airplane crashes?” a counter-statement would be “the odds of the plane that I’m traveling on crashing are actually 1 in 17,000,000,000” which are the official odds. Or “what if I’m afraid of going to the dentist?”. The counter-statement would be “I can incrementally learn to be free of fears of going to the dentist”. Not to get to complicated here, but wherever there is a phobia, there needs to be what is called “exposure”. Long story short is, to get over a situation, you’ve always got to face it. The way that facing it is made possible is to do it in small incremental steps. I’ll give you a quick example. Suppose you’re afraid of flying. You’re not going to go out and take a flight. What you’re going to do is go out and take the incremental process of getting used to airports and then, with cooperation from the airlines-actually boarding the plane and then getting off of the plane that doesn’t take off. Ultimately making a very short flight with a support person going with you.Beyond that, making a short flight with nobody with you and then making a long flight. That’s what I mean by trying to break it down; the facing of the fear through incremental steps. That’s critical to cognitive behavioral therapy’s approach.
Jonathan Bailor: Ed, I love this idea of breaking down a specific source of worry and tackling that. I’m hoping we might be able to dig into a real life example here. I know a lot of my listeners worry about our weight. I am not a PHD, I’m not a clinical psychologist, so my flippant remark is “throw your scale away”. If it’s not there, you don’t need to worry about it anymore. People say “Jonathan that’s great, I love your energy, but it’s not that easy”. How can we work through this constant worry-which for some of us might actually borderline on obsessive compulsive disorder-about this number which really is not meaningful in and of itself?
Edmund Bourne: There are a lot of ways to go with that, but the very first and most common sense thing is to cut down on the amount of checking. The technical term for that is “response prevention”. We’re treating this as if it were an obsessive problem. Certainly the more you check your weight the more you’re going to (feed the crack pipe?) with it.Gradually-not all at once-cut down on the number of checks; ideally getting to the point where you might just check once per day or every three to four days. That would be one approach. Getting a little more fine grain, you want to look at the specific worries. What are the “what if?”s that you are telling yourself about your weight or about your inability to lose weight? Let’s identify those and then let’s develop constructive counter-statements to them.
Jonathan Bailor: I love those counter-statements. That’s what I want to drill into. You’re the expert here. The thing that I have found in my own experience and in working with clients back in my personal trainer days is that one of those “what if?” statements is “if I weigh five more pounds, on some level, people won’t like me as much.”. The worry there, to me, isn’t actually about the weight. The worry is about someone treating you differently based on what you think would be a negative change in your physical appearance. The reason I dig into that is-let’s say for example-we actually do resistance training and we build up our muscles. When we build up our muscles we gain weight. Often times, that will result in a positive change in our physical appearance. When we hang our hat on this number on the scale, we are worried about something that actually has very little bearing on the actual things we are worried about, which is how people treat us or think about us. What do you think about that?
Edmund Bourne: That’s a long question. I think your question boils down to worrying about the number and worrying about getting over that number and “what are people going to think of me if I gain five or ten pounds”. I would say that one thing that is indicative of all worries is that the overestimate the odds of unpleasant or dangerous consequences and they underestimate your ability to cope. First you deal with the overestimate of “if I gain ten pounds, xyz is not going to like me as well”. What are the odds of that really being true? What are the odds that if I gain ten or fifteen pounds that I’m going to experience some level of rejection? It usually comes to that the person who is doing the worrying is overestimating the risk of negative consequences. If you have a spouse who is on your case about your appearance, then we’re dealing marital problems and couple’s therapy. I’m not denying that some of your listeners may have somebody very important in their life that is not fully accepting of their present weigh, so then I guess we have to talk about the other part; underestimating your ability to cope. We then need to look at what we can do to cope. If your spouse is having problems because of your appearance, let’s work on that. Have a session with a couple’s therapist and see what you can do to alter their expectations or perhaps help the person with the weight issue to take constructive steps that would be effective. Of course, I’m not an expert on weight control or weight management. There are many ways to go about that. Your listeners are probably more familiar than I am. I’ve always had a problem with underweight. People who are thin worry about not fitting the stereotypes.
Jonathan Bailor: I think that the key distinction that I’m looking at here is that there are things which hypothetically-let’s say a woman walks into a party and she looks fabulous. She looks radiant. Her smile just glistens and her hair looks lovely. The way she carries herself and engages people-she lights up the room. If I were to tell you that that woman weighs 200 pounds, it would not matter. No one cares. This number is so meaningless in and of itself. Let me give you another example. If you look up a picture of me on the internet, you would probably not think that I am overweight. According to my weight, I am borderline obese. I happen to carry quite a bit of muscle on my body.
Edmund Bourne: Who decides that? Who decides that you’re overweight or obese? The American Badger Association?
Jonathan Bailor: That’s what I’m saying. Exactly. So how do we combat that when we have our value tied to this number. Science clearly shows that your waist circumference does have bearing on mortality rates, but your weight in and of itself really doesn’t. We use the scale and get preoccupied with it. We’re constantly weighing ourselves. How do we break that cycle?
Edmund Bourne: There’s no quick and easy answer other than to reduce the number of checks. Maybe reduce it gradually, but reduce it. Get it down from many times a day to once or twice a day, and then once a day, and then once every three or four days if possible. That is an act of will. That kind of effort takes courage and willpower to sustain. It sounds kind of common sensical, but that is what you want to do. You want to reduce the checking and the perception that a certain number is bad, because the question is “bad according to who?”. Even if you are a little overweight, as you said, you can dress yourself and cosmetic things and things with your hair that can allow you to be strikingly beautiful even if you are twenty pounds over the norm. In addition to that, I think this is a very cultural thing in America and Western Europe. In Hawaiian culture, it is a very good thing to look overweight. There are cultures outside of the United States and Western Europe where it is actually preferable to be overweight. It means you are well fed and you are from a financially well of family if you are a little robust. It’s a cultural obsession in the US, Western Europe, and a few other places with being thin. It’s a cultural lie that has unfortunately been sold by the people that are out there that make money off of weight reduction. That’s my take.
Jonathan Bailor: I love that. I love what you said about “I can’t just give you this easy answer” because the other thing that I heard from what you were saying and just knowing a bit about your research is that if you’re checking your weight constantly and constantly worried about your weight.
Edmund Bourne: Checking begets worry and then worry begets checking. It’s a circle. Less checking, less worry.
Jonathan Bailor: Exactly. It seems like the reason that it is not easy to stop is because you’re not really doing that just to check your weight. It sounds like there I something deeper. We would need to address that deeper “why” that is driving you to check your weight constantly.
Edmund Bourne: Yeah. It’s worry about disapproval from loved ones or everybody. I just go back to: people who worry overestimate bad consequences. They are overestimating rejection or disapproval than what it is actually going to be. Let’s take a person who is really, really overweight who I quite obese. Yes, within our culture there is a certain disapproval of that. Where I would go from there is that if you look at surveys, 80% of the American population has something wrong. Some diagnosable problem within them. At least 20% of people don’t have a diagnosable problem. So your issue is weigh. Okay, well the next person might have an issue with high blood pressure. The next person might have an issue with something much more serious than being overweight; ALS, muscular dystrophy. 80% of the population has something wrong. If your issue is that you weigh too much, okay, that’s yours. It has to be taken out of part of one’s evaluation of their own self. The whole basis of self esteem is to get away from the idea that appearance is the basis of you. That’s the knot that has to untied. That’s the knot that has to be cut; that your self esteem is dependent on how you look. You’re an inherently valuable person regardless of your weight. You have to base your self esteem on the true criteria and not the superficial criteria.
Jonathan Bailor: I love that, Ed, and I think you hit an interesting point there when you talked about that 80% of us-or probably 100% of us-are not perfect. Certainly when we talk about individuals who are checking the scale-if you weight 450 pounds, that’s not healthy, and you’re probably also not checking the scale every day because you don’t need to stand on the scale to know that you weigh an excessive amount. Generally people that do this, in my experience, are people where if you looked at them you would not this that they are overweight at all and they’re-to your point-overestimating. If you want to gain fifty pounds of body fat, you should stop and get help because that is not healthy, but most people aren’t worried that they are going to step on the scale and and weigh fifty pounds more. They are worried about these one to two pound fluctuations. Even if you did gain two pounds of body fat, as long as you don’t do that for thirty days in a row, nobody is going to treat you any differently. Let’s say it does happen. What’s gonna change?
Edmund Bourne: It’s all your own perception. It’s all perception. Nothing has changed from an external point of view if you gain five pounds. It’s just obsessing with numbers. You could obsess about wrinkles around your eyes or a number of physical things that occur with aging. You might have some loose skin in your neck or some jowels in your cheeks because you’re getting older. Excessive bodily focus can go many places. Weight is certainly a very popular one. All of these things all have the same answer. You aren’t the looks. Unfortunately there is a lot of advertising that would want you to believe that you are your looks, but in truth, your inherent values go far deeper in significant criteria that your looks. It’s a cultural obsession that has become an individual obsession. If I was counseling somebody, I would just work on finding ways to evaluate apart from doing less checking, which is the first step. Finding legitimate values for self worry and self esteem.Getting out of the trap of basing it on your looks.
Jonathan Bailor: Ed, I want to end on that because I think that is such a powerful message. Even if you do think you are not beautiful, you are beautiful in other ways and more important ways. Often we talk about the idea being not to eat less food. That is starvation and that’s unhealthy. You need to eat higher quality food. It’s almost like we do the same thing here. Give yourself higher quality thoughts and focus on the higher order bits of why you are valuable and maybe you can even crowd out those negative thoughts.
Edmund Bourne: Over time, you can.
Jonathan Bailor: I love it. Ed, thank you so much. Folks, obviously we are only able to scratch the surface of this hugely complicated area. Doctor Bourne has spent decades breaking down. He’s got many books that you can check out. He’s got the Anxiety and Phobia Workbook, Healing Fear, Beyond Anxiety and Phobia, Coping With Anxiety, and A Natural Relief for Anxiety. All of that and more can be found at his wonderful website, which is helpforanxiety.com. The man is Doctor Edmund Bourne PHD Clinical Phychologist. Ed, thank you so much for sharing your time with us today, I really appreciate it.
Edmund Bourne: Thank you Jonathan, it’s been an honor.
Jonathan Bailor: Folks, I hope you enjoyed today’s show as much as I did. Remember: this week and every week after; eat smarter, exercise smarter, and live better. Talk with you soon.