OVERFOCUSING: POWERFUL FUEL FOR BDDOverfocusing, or selective attention, might cause dissatisfaction with appearance. It may even create a type of visual distortion, in that focusing on one particular aspect of appearance gives that area visual prominence and makes it very noticeable. Other aspects of appearance fade into the background and may even be ignored. The view becomes unbalanced. By emphasizing the defect, it becomes unduly negative. One woman told me, “I can’t even see my own face. All I see is my defect.” Another said, “I focus on the negative things, and they become too prominent. I lose my balance; I get tunnel vision. I put too much weight on one particular aspect and get bogged down in it.” One of my patients said that focusing on a small pimple would cause it to “grow to hideous proportions.” He made a mountain out of a molehill. A man I treated said, “It’s like when I put my thumb under a microscope—that’s how I see my skin. I’m like a walking microscope—my perspective is off. I can’t see my whole face the way other people do.”These comments fit with the neuropsychological study results discussed in chapter 10, which showed that people with BDD overfocus on minor, irrelevant details and don’t see the big picture. They miss the forest for the trees. Extrapolating to appearance, rather than seeing all of themselves and focusing on liked—as well as disliked—body areas, they seem to overfocus on and selectively attend to disliked areas, which unduly influences their ratings of overall attractiveness and makes them negative . Furthermore, as shown in the figure, individuals come to the conclusion that they look bad based on “selective interpretation”—this conclusion is based on “evidence” that other people don’t see as valid (e.g., thinking you’re being stared at).Self-portraits of people with BDD also illustrate this. They tend to emphasize the perceived defect while giving only cursory attention to other body parts. One woman, for example, drew a massive, messy, and detailed head of hair while portraying the rest of her body as a stick figure. A man’s self-portrait consisted only of 3 views of his nose, covered with huge and gaping holes.*213\204\8*

Initially benzodiazepine is prescribed for the treatment of insomnia arising from stress or some other reason. When the original stress is over, and the reason for taking these pills is gone, the drugs are stopped abruptly. This is when rebound insomnia sets in. People who suffer from rebound insomnia believe that they have lost the innate ability to sleep. This rebound insomnia is only transient and lasts just a few days. If these people persevere, the rebound insomnia passes and their sleep becomes normal again. However, there may be some who become psychologically dependent on these pills, meaning their confidence to sleep has disappeared. These are the people who should find this book useful, as it will help them regain their confidence to sleep.

It has also been shown that sleeping pills stop working after two weeks. The reason is that the body develops an increasing tolerance to the pills. The same dose of sleeping pill is no longer resulting in sleep as it used to. But then why do people persist in taking them? The answer is to prevent the withdrawal symptom—rebound insomnia.

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We can also incorporate our relaxing mental exercises into our speech therapy. We practise the exercises, and while still completely relaxed in both body and mind we count aloud—slowly, easily, clearly—and all the time we maintain the relaxation of body and mind. In the same way we can practise by reading and reciting.

Speaking on the telephone is often a major problem for those who stutter. This situation is very well suited for help from our mental exercises. As we take up the receiver our eyelids close, and we relax completely. We are leisurely, and we take our time before replying, and as we do so we feel the relaxation through the whole of us.

Difficulty in speaking in public is due to the mobilization of anxiety. The practice of relaxing mental exercises reduces our general level of anxiety, and also makes us less inclined to overreact to stressful situations. We thus come to have a little more in reserve, as it were, for the stress of making a speech. Sometimes a real phobia can develop in relation to making public speeches. In these circumstances we can get help by following the principles which.

Some years ago a man from a country town came to see me on account of his speech difficulty. He was in his middle thirties. He had had two or three previous periods when his speech had been bad, but each time it had settled down in a matter of a few months. But this time it seemed to be getting worse. He was under increased stress at his work, which had made him tense, and his speech difficulty was associated with a jerky movement of his head. I had him relax several times in my consulting room and his trouble subsided. However, this was some years ago at a time when I had not realized the importance of the patient learning to do the relaxing himself.

He returned with a recurrence of his trouble a couple of years later. This time I showed him how to do it himself. His symptoms again subsided, and I have not seen him since. As he was very appreciative of the help I had given him, I think it fair to assume that he would have contacted me if he had had any further trouble.

If real stuttering is associated with anxiety and nervous tension it can be helped by this approach. On the other hand if you should be one of those who stutter in the absence of anxiety it is better to seek help through orthodox speech therapy.

A lad of eighteen had stuttered since he had first learned to talk. He was extremely tense and anxious, and when he would go to speak, his anxiety would seem to become quite uncontrolled. With the relaxing exercises over a period of some months he developed a rather careful, but almost normal pattern of speech.

On the other hand a man of twenty-six, with a terrible stutter, who had come some distance to see me, failed to obtain any material help at all. This man, unlike the previous patient, was really quite unconcerned about his stutter. He had no real anxiety. His purpose in coming to see me was that his firm had offered him a better job if he could get rid of his stutter.

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