Chapter 8
Overeating and Smoking: It's All in Your Head

The very nature of man impels him to satisfy his desires with the least possible pain.
--FREDERIC BASTIAT (1801-1850)

They say that inside every fat person there's a thin person fighting to get out. In Suzie's case, the thin person appeared to be losing the struggle. At 5'4" Suzie felt she ought to be 130 lbs, but was actually closer to 160.

Just about to turn 20, Suzie looked older. She had deep eyes and smooth chestnut hair beneath her floppy leghorn hat, and wore a silk print dress with an enormous string of crystal beads. She had a lively manner and was ready to laugh, but seemed imprisoned by her excess fat. She was disheartened. "I've tried dozens of diets over the last five years, and I work out four times a week, but I can't seem to lose weight consistently, and I'm heavier now than I was a year ago."

When Suzie told me her exercise regimen, I felt exhausted just listening to it. She was at the gym never less than four evenings a week; for the first 30 minutes she vigorously pedaled an exercise bike, followed by an even more demanding 60-minute aerobics class. Yet she remained overweight.

The Solution to Suzie's Puzzle

Suzie was sincerely mystified as to why she "could not" manage to reduce. On one level, the answer was obvious: She was absorbing enough excess calories to outweigh the effects of her exercise. Suzie immediately confirmed that she often yielded to impulsive temptations to drink too much alcohol and to snack on high-calorie foods. So the real puzzle was: How can someone with the drive and determination to stick to a grueling exercise program fail to control her eating and drinking habits? The answer is that addictions arise from addictive thinking.

On her first visit I gave Suzie a personality questionnaire, which confirmed my immediate guess. The test involved circling one of the three words "OFTEN," "SOMETIMES," or "SELDOM" after each of 50 statements. Suzie indicated "OFTEN" for these statements:

  • I feel upset when things proceed slowly and can't be settled quickly

  • I feel upset about life's inconveniences or frustrations

  • I feel quite angry when someone keeps me waiting

  • I feel very sorry for myself when things are rough

  • I feel unable to persist at things I start, especially when the going gets hard

  • I feel unexcited and bored about most things

Low Frustration Tolerance

Suzie was suffering from Low Frustration Tolerance, a very common type of "musty" thinking, which lies at the root of the great majority of overeating problems and other addictions.

Low Frustration Tolerance arises from the third "must," the belief that life MUST be fair, easy, well-ordered, comfortable, exciting, pleasurable, interesting, or hassle-free. In any situation where life does not conform to such demands, the addict compulsively looks for a quick escape from these "unbearable" circumstances.

Suzie told me more about her problems. She was moody and often depressed about weight, friends, and boyfriends. She had broken up with Sammy a year earlier, but continued to see him off and on. (She had a demand about this situation: "I MUST know for sure if it's on or off with Sammy.")

The Power Of Negative Thinking

A specific technique has often been found effective in undermining Low Frustration Tolerance and thereby curing addictive thinking. This method is to maintain a clear and constant awareness of the disadvantages of any particular behavior or outlook. I explained the idea to Suzie:

"Whenever you do anything that is under your voluntary control, even getting out of bed in the morning, all the way to getting into bed at night, you make the decision to do it. And every decision largely consists of a weighing of benefits against costs, or advantages against disadvantages.

"When you get up in the morning, you're demonstrating that at that moment you believe the advantages of arising outweigh the disadvantages (skipping breakfast, rushing to work, arriving late, and so on). If you had decided that the disadvantages of getting out of bed were greater, then you would have stayed in bed. This process--often operating semiautomatically--repeats itself throughout the day in making large and small decisions.

"It's exactly the same with your eating or overeating. Whenever you choose to eat pizza, or any other high fat food, it's because you've decided, for the moment, that the advantages of doing so outweigh the disadvantages. Just before making such a decision, you might be thinking something like: 'This pizza is fattening (disadvantage 1), but it tastes so delicious (advantage 1), I'll feel so good (advantage 2), I HAVE TO have it (advantage 3), and I won't really gain weight because I'll diet later (discounting disadvantage 1).'

"If you can convince yourself that the calculation is reasonable and that the advantages outweigh the disadvantages, you will indulge. If we can get you to realize, strongly and clearly in such situations, that the disadvantages outweigh the advantages, then you will reject the pizza."

Harnessing the Power

How did I get Suzie to remain convinced, at the moment of temptation, that the disadvantages outweighed the advantages? Practice, repetition, and reinforcement. Here are some of the most effective techniques:

  1. List the disadvantages. I asked Suzie to make a detailed and extensive list of the disadvantages of eating pizza. She came up with over 30 items, including:

    • It's fattening

    • I feel guilty afterwards

    • I could spend the money on something else

    • I'm more likely to become depressed

    • I'll be less healthy

    • It adds to my difficulty fitting into clothes

    The longer the list, the more powerful the technique, even if some items are repetitive. (Suzie wrote: "I'll be less healthy," "It will raise my cholesterol level," and "I'll be more susceptible to some diseases.")

  2. Vividly read through the disadvantages. I advised Suzie to read through the list of disadvantages every day, and to spend some time dwelling on each item at its worst. For "It's fattening," she would picture herself eating while getting fatter and fatter until she became hugely obese, then getting fatter still, and becoming increasingly uncomfortable because of her extra weight.

  3. Practice imagining the disadvantages. Next, I asked Suzie to adopt the habit of vividly reminding herself of the disadvantages of compulsive eating, in situations where it was impracticable to refer to the list. When driving, while preparing or eating dinner, when walking down the street, waiting in line or on hold, she would vividly picture one of the disadvantages of pigging out.

    Suzie liked to listen to music tapes while driving. We decided that when she first got into the car, she would spend a few minutes vividly imagining some of the disadvantages of overeating, before she allowed herself to put on a tape.

  4. Referenting. I also explained to Suzie the principle of "referenting." Whenever she thought of junk food, either spontaneously or in response to some external stimulus such as seeing an advertisement or the aroma of food, then she would immediately concentrate on some of the disadvantages on her list.

    The first day Suzie began to use referenting, she was walking past a pizza parlor and looked in at the pizzas. She started to think about the tasty and pleasurable aspects of pizza, but quickly noticed the way her thoughts were going, and deliberately reminded herself: "Fattening . . . unhealthy . . . feeling regret afterwards . . . I won't look good . . . won't fit into my clothes . . ."

Consistent use of referenting caused Suzie to have a heightened and more immediate awareness of the disadvantages of overeating, so that the temptation to pig out became easier to overcome.

Meanwhile, Suzie employed Three Minute Exercises to challenge and topple her "musts." Some of these "musts" were:

  • The pounds MUST come off quickly

  • Life SHOULD be more fun

  • I MUST be thinner, or else I'm less of a person

  • If I start to feel bored or dissatisfied, I MUST feel better right away
Suzie began to control her eating better, to feel better, and to drink less.

Suzie's Setback

I was surprised and curious when Suzie arrived for her fourth session with a down-in-the-dumps air about her.

"Gee, I really blew it," she announced, as she flopped down into the chair dejectedly.

"In what way?"

"Well, let's see. I left here on Thursday night, went straight home, and watched some TV. All I had was an apple, a cup of decaf, and some popcorn. Oh yeah, some skim milk in the decaf, and that's it."

"Any butter, oil, or cheese on that popcorn?"

"No, I just got a hot air popper. All I put on was a pinch of salt."

"Okay. Great."

"Then Friday and Saturday went okay. Saturday, I went to a club with Sammy, but I didn't have any beer or wine. Sunday, I had coffee with toast and a grapefruit, and tuna salad for dinner."

"Sounds like an excellent week diet-wise, so far."

"Yeah, I thought I was in control. But I don't know what happened on Monday night. I was feeling kind of crummy about work. I went out for lunch and had a salad bar. But I started thinking about the cherry pie on display, and I was feeling very low and thought I'd have just a little pie to feel better. So I got one slice."

"Uh-oh," I said, with a tone of mock dismay.

"Well, when I slipped up like this the time before, I just reminded myself, as you told me: 'So I had a setback. Too bad! That's to be expected. I'll just get right back on track.' And I just snapped out of it, and it was no big deal. But this time, after the cherry pie, I was still feeling lousy, so I got another piece. So then I figured I'd really blown it, and I had cookies throughout the afternoon until I left work. Now I'm doing better again, I guess, but I'm still depressed about Monday."

"It sounds as if you basically did quite okay this week, except for that isolated cherry pie and cookies incident. But let's look a little closer at what went on in your head. You slipped up with the pie, which was natural.

"Yes. But the time before I recovered quickly-immediately after the slip-up."

"Right. But what were you telling yourself this time after you finished the first piece of cherry pie?"

"I don't know. I think I was comparing my last quick recovery to this time."

"And was the 'must': 'I MUST recover quickly . . .'?"

"Yeah, that was it."

"So you were telling yourself: 'Last time I immediately felt determined to get back on track, but now I'm still feeling lousy, I haven't recovered, and therefore I'm a hopeless failure. So I'll just be fat for the rest of my life."

"That's it! I felt I MUST recover quickly, just like the time before."

Back On Track

I asked Suzie to write at the top of a page: "I MUST recover quickly, as I did last time." Then, I helped her to list all the reasons why this "must" was false. We came up with 14 of them:

  1. No law carved in stone states that I MUST;

  2. It's typically human and understandable that I would upset myself about a setback;

  3. I can recover slowly;

  4. It's just a hassle, not a horror;

  5. I'm not worthless because I screw up;

  6. If I don't recover quickly, I can learn from my mistakes and eventually do better at recovering;

  7. Recovering slowly means that success takes longer. It doesn't mean total failure;

  8. One failure doesn't mean total failure, or that I'll never succeed;

  9. This just means I had better work harder at it next time;

  10. This assumes that I MUST be thin--but, although I would like to be thin, I don't HAVE to be;

  11. I can stand slow recoveries, although I don't like them;

  12. Reality is reality, not what I think it MUST be;

  13. If I pressure myself to always recover quickly, that will tend to make it more difficult to do so;

  14. Being an imperfect human, like all humans, I will sometimes act imperfectly.

I gave Suzie the assignment of reading this list through thoughtfully three times a day for a month. She found this very helpful. She stopped putting pressure on herself to recover quickly from her overeating lapses, and then (paradoxical though it may seem) she had quicker recoveries and fewer relapses.

Sunday's Blues

On one visit, Suzie reported she had eaten some junk food the previous Sunday but didn't know why. I asked her to tell me about her day.

"Sunday was a rather unstructured day, as usual. I just sat around lazily having breakfast, looking through the paper, and chatting aimlessly with my mom and sister. Sammy called and a friend called. Soon it was early afternoon. It was getting too late to invite Mazie to go to the beach or ask Cheryl to go shopping. I began to think about work on Monday. Then I started eating."

Eating junk food was the C. After I had tracked down some of Suzie's A's, it soon became clear what her B's were: "Sunday SHOULD be more exciting. I SHOULD have planned my day earlier. Weekends SHOULDN'T be so short. I MUSTN'T be bored. I SHOULDN'T have to go back to work tomorrow."

"Yes," said Suzie. "Now I see why I ate all that junk food on Sunday." As sometimes happens, just the insight into her demands helped her to uproot them.

Sour Grapes

At another session, Suzie said that she overate because she didn't really care about dieting. If she got fat, what did it matter?

This is a common reaction when people begin to notice that their "musts" are irrational and unwarranted. They skip to the contrary view, that what they want isn't important at all. I explained to Suzie that telling herself "it doesn't matter" is a rationalization, an excuse she gives herself, so that she can pursue a different demand.

"Like what demand," asked Suzie.

"Like 'I GOTTA have the food!' " I responded.

Behind Suzie's rationalization ("I don't care about overeating-being thin is of no importance") lay these "musts":

  • I SHOULD have been born thin

  • Life SHOULDN'T be so unfair

  • I SHOULD be able to eat whatever I want (without any consequences I dislike)

  • Controlling my eating SHOULD be easy

Suzie did many Three Minute Exercises on her "musts." She came to accept herself with her setbacks, to accept that resisting her gustatory cravings was uncomfortable but bearable, and to acknowledge that being thin was an important preference but not an absolute demand. The pounds began to come off, and she was down to her ideal weight within six months. Just recently, three years later, I happened to see her again, and she was happily maintaining her ideal weight.

More On Low Frustration Tolerance

Almost always, achieving a long-term goal entails facing immediate discomfort. When we begin to pursue such a goal, we judge that the outcome is well worth the cost, but then somewhere along the line we get sidetracked. Since the cost is immediate and the benefit distant, it's easy to give in to the impulse to escape. Later, we regret deeply that we have failed to achieve the desired goal.

All this is perfectly natural and to be expected. If Tom keeps putting off studying for an important test in favor of watching movies, or if Sheila, who dreams of being a concert pianist, starts to skip practice to talk to friends on the phone, there is no need to introduce far-fetched "unconscious" explanations. To propose instead that Tom really dreads becoming a doctor because he identifies that profession with his father whom he hates without knowing it, or that Sheila unconsciously fears the plight of a concert superstar making millions from recordings, is fanciful in the extreme.

The universe simply isn't constructed in such a way that working toward an important objective is bound to be intrinsically delightful. The principle that applies in most arenas of life is the rule familiar to athletes and sports trainers: No pain, no gain!

Schools Teach Addictive Thinking

Unfortunately, our culture reinforces the opposite, and potentially disastrous viewpoint. Fashionable discussion of education policy, for example, sometimes implies that learning ought to be sheer effortless enjoyment at every moment. Certainly, a skillful teacher will try to make the subject matter attractive and will know how to stimulate the students' interest, but nothing worthwhile can ever be pure fun--certainly not science, math, English, foreign languages, music, engineering, economics, history, or philosophy. Effective learning cannot be immediately pleasurable at every stage; success requires that students apply themselves and work hard, especially when it hurts.

The worst-hit victims of the "learning is fun" theory are often those from poor or disadvantaged backgrounds, because they are less likely to pick up the habits of discipline and application at home, which many middle-class students already bring to school with them.

Not only does the "learning is fun" fallacy tend to destroy scholastic achievement, it may reinforce Low Frustration Tolerance in every other area of life, and hence encourage addictions. School administrators who seek to remedy poor scholastic performance by making students feel good (instead of fostering self-discipline and rigorous academic standards) may indirectly be stimulating their students' interest in taking drugs.

By contrast, our children would benefit from being shown role models who forge ahead in boring, unexciting, uncomfortable conditions, to reach a valuable goal. It would be best to tell our children: "Life consists of one hassle after another, but you can cope, and you can derive deep satisfaction from overcoming those hassles. To accomplish anything worthwhile is going to be hard, tedious, and unpleasant at times, but you can do it. Only babies demand that every minute be free of discomfort or frustration; grown-ups tolerate frustration and realistically endure it as an inherent aspect of life."

Getting Burned Up About Frustrations

Jon came to me just after he learned that his mother had lung cancer. He was 33, very upset about his mother, and even more worried about himself. Short, with distinguished-looking silver-grey hair and an attractive tan, he radiated businesslike self-confidence and in fact had an MBA and a CPA.

Beneath this dazzling exterior, Jon's stress, insomnia, and obsessive behavior were some of the issues that had intially brought him to therapy. He reported that he had difficulty relaxing, that he took his co-workers' opinions of himself too seriously, and that he felt guilty about missing deadlines at work. We had worked on these problems successfully using Three Minute Exercises, and had saved Jon's addiction to cigarette smoking for last.

Jon had started smoking when he joined a college fraternity. "Everyone else was smoking so it seemed like the thing to do." He had quit for five months in business school when he was dating a fellow student who objected to cigarettes. He later quit again for several months when he started with a firm of business analysts.

I asked Jon why he now smoked.

"I just can't stop. I've tried several times, and I've never been able to stay off for long."

"All that proves is that you haven't yet stopped smoking. It does not prove that you will not stop in the future."

"But surely the fact that I'm still smoking, after all my attempts to stop, proves that I can't stop."

"What it shows is that in the past you have found it very difficult to stop. But past failures don't prove future failure. Some of the great successes of history, like the invention of the electric light bulb, came after years of repeated failure."

Cooling The Turkey

After persuading Jon that he might well stop smoking despite his past failures, I discussed the mechanics of quitting. The two most common strategies are cold turkey or tapering off. Most successful quitters have found the abrupt abandonment of the habit has worked, but gradually cutting back on the number of smokes a day seems more feasible to a substantial minority.

Jon preferred this more graduated approach. The first step is to keep an accurate running tally of all cigarettes smoked. Jon stashed a small pencil and piece of paper in his cigarette pack. Immediately before lighting up, he would mark the corresponding day on the paper. At the end of the week he could see at a glance how many he had smoked each day and for the whole week. We could then set up goals for the coming days and weeks, gradually tapering to zero.

During the first week of self-monitoring, Jon averaged two and a half packs a day, though by the end of the week he was down to a little over two packs. He achieved this by prohibiting himself from smoking during certain activities or in certain places. For example, he stopped smoking in his house, and stepped outside to have a cigarette. Jon also found that merely practicing self-monitoring led him to cut back, a common result of this practice.

Jon's Three Minute Exercise

While he was tapering off, Jon did regular Three Minute Exercises on his Low Frustration Tolerance. Here is one:

  1. (Activating event): I'm in my car, driving home from work. It was a rough day, and I'm stuck in traffic. I'm feeling stressed and I've a strong urge to unwind with a cigarette. Since I'm trying to cut down, I don't light up. Deprived of the cigarette, I'm now feeling even worse.

  2. (irrational Beliefs): I MUST have a cigarette because I strongly want one. I CANNOT STAND the frustration of being so deprived. The discomfort is HORRIBLE.

  3. (emotional Consequences): Agitation.

  4. (Disputing): Why MUST I have a cigarette, just because I strongly want one? Where is it carved in granite that I CANNOT STAND the frustration of being so deprived? What's the evidence the discomfort is HORRIBLE?

  5. (Effective new thinking): No law of the universe says I MUST have a cigarette, even though I strongly want one. There is no evidence that the universe has singled me out as being entitled to a cigarette. I've always experienced frustration in my life. I always will, and no reason exists why I SHOULD not. I CAN STAND being deprived, although I don't like it. I am even capable of gaining considerable enjoyment from life with this deprivation. I'm determined to face the frustration and accept it. Life is hard, but I make it harder by bellyaching about it. Discomfort is just discomfort, not HORRORS. Life consists of one discomfort after another--tough! My greater problem is not the discomfort itself, but rather me horribilizing about it. Seen in the context of all human problems, my discomfort could easily be far worse. As I refrain from smoking, the discomfort will tend to diminish.

  6. (new Feeling or behavior): Discomfort, rather than agitation.

Three Minute Imagery

After Jon had written out a Three Minute Exercise, I instructed him in Three Minute Imagery:

STEP ONE Vividly imagine, picture, or fantasize the following: You're in a situation where you feel tempted to smoke (relaxing after a meal, tense about a job interview, or bored with nothing to do). You're experiencing a distinct urge to smoke, but you resist.

STEP TWO Now, as you vividly imagine this, allow yourself to feel anxious, depressed, or agitated about not lighting up. This is the same inappropriate emotion you normally feel whenever you find yourself in the situation in Step 1. Do Step 2 for only a few seconds.

STEP THREE Still picturing the scene described in Step 1, make yourself feel concerned, disappointed, or appropriately frustrated--instead of anxious, depressed, or agitated. Since you create and control your own feelings, with persistence you can modify them. How can you make yourself feel concerned rather than anxious, disappointed rather than depressed, or appropriately frustrated rather than overfrustrated? Show yourself that you can stand frustration even though you don't like it; convince yourself that no law of the universe says you must have a cigarette merely because you strongly want one; remind yourself that discomfort and deprivation are just that and no more, never awful, terrible, or horrible.

Jon diligently practiced Three Minute Imagery for three minutes, twice a day. After six weeks he had completely weaned himself from his tobacco addiction. Two years later he reported that he was still cigarette-free. He had had one relapse, after eight months, but had quickly gotten back in control.

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Dr. Michael R. Edelstein
Clinical Psychologist, San Francisco
415-673-2848 (24 hours)
DrEdelstein@ThreeMinuteTherapy.com
www.ThreeMinuteTherapy.com