Reducing symptom monitoring

One of the most common traps that people with DPAFU fall into is constantly monitoring their DPAFU to see if it is getting worse. This is understandable. But if you look back at Figure 4.5 on page 35, you’ll see that regular scanning and monitoring of symptoms is likely to result in several unwanted consequences:

 

•   A negative impact on your mood (such as increasing worry and apprehensiveness).

•   A worsening of the negative interpretations you might have for the meaning of your sensations.

•   A greater sense of feeling disconnected from the outside world.

In other words, the more attention you give to your DPAFU, and the more you focus on what is happening inside your body, the more you will increase and maintain your DPAFU.

Research studies support this idea. People who have hypochondriasis, or anxiety about their health, may worry that they may have some serious disease (such as cancer). They then spend lots of time scanning their body for any sensations that they believe could be the first signs of danger. Similarly, people who experience panic attacks commonly monitor their body so that they are prepared if they start to feel panic. Unfortunately, this increased physical monitoring means that you are more likely to notice sensations that are completely harmless. If instead your attention was focused on what you were doing, or on your external environment, you wouldn’t actually notice these symptoms. The more we notice these harmless sensations, we more go on to notice them in the future – and the more severe we think they are. This then creates another of those vicious cycles. And though this example is for hypochondriasis, the same applies to monitoring symptoms of DPAFU.

On the other hand, research has found that if someone concentrates hard on something in the external environment, such as trying to solve a difficult puzzle, their attention to their symptoms is massively reduced. They then report their sensations as significantly less problematic. As a result, people often say that their DPAFU is at its best when they get involved in something that takes their mind off how they are feeling.

 

TRY THIS EXPERIMENT

Pick one of the sensations of DPAFU that you are currently experiencing, or focus on any part of your body (e.g. one of your hands or feet). Shut your eyes for a few minutes and concentrate totally on your sensations. See what you notice. Did the sensations change when you were concentrating on them? Did you notice any new sensations? Did the original sensations increase in intensity?

Now try some mental arithmetic. Starting from the number 200, try subtracting the number 7 repeatedly from the number you obtain, e.g. 193, 186, 179, and so forth until you reach 0. When you stop counting, reflect on your sensations of DPAFU while you were doing the mental arithmetic. Did you notice the sensations as much when you were doing the arithmetic? Or did you find that your mind was so absorbed in concentration that the sensations felt less intense?

 

One technique that people with DPAFU find useful is an exercise that helps you shift your attention. Rather than focusing inwards on how you are feeling physically, mentally and emotionally, the idea is instead to shift the focus to the outside world. This means paying attention to what is happening around you. It’s a particularly useful technique because we know that people with DPAFU spend a lot of time reflecting on how they are feeling. This can include spending time thinking about thoughts and sensations and/or focusing on how to overcome DPAFU. It’s not surprising that if you spend lots of time thinking about yourself, you’re paying less attention to the external world. This will magnify the sensation of being detached and cut off.

Imagine that each of us has 100 units in our mind to process everything that occurs. We may use 10 units of these to process peripheral sound and vision. Another 10 units might be used to focus on how we feel. If we find we are hungry or thirsty, we may use 10 units to think about what we are going to cook for dinner that night. This leaves 70 units to focus on the task at hand. Now imagine that out of 100 units we are using 30 or 40 to focus on how we are feeling inside, including how spaced out or detached we feel. We’ve reduced the number of available processing units down to 30 or 40. Bearing this in mind, it’s inevitable that people with DPAFU will frequently report difficulty with attention and concentration.

A psychologist called Adrian Wells developed a specific technique called attention training to help change the focus of our attention. The technique was originally intended to be delivered by a therapist, but the exercise we’re presenting here is a shortened version for you to practise on your own. As you sit in a room, try to become aware of three distinct sounds. The first should be something that is immediate and close by within the room. You may have to introduce something such as a ticking clock. The second sound should be something that is just outside the room, perhaps something from another room or outside your house or office. The third sound should be something that is in the far distance, such as the noise of traffic outside. Make sure you have three distinct sounds and try to focus on each one in turn. Practise becoming aware of each sound. Once you are practised at recognizing these different sounds, start to switch your attention between the three.

It may help if you pre-record a cassette giving yourself these instructions, in the same way as a therapist would guide you through the exercise. For instance, ask yourself to switch from sounds in the room to the sounds outside, and then to the sounds in the distance. Then back again to sounds outside, to sounds in the room etc. You don’t have to follow any particular sequence. As you become more familiar with the exercise, try to notice as many sounds as you can at once. You’ll find that one sound usually takes precedence over the others. It may be very difficult to divide your attention and listen to the sounds simultaneously.

Practise this exercise for five to 10 minutes, twice a day. Continue until you’re able to switch your attention rapidly from internal thoughts and feelings to the external sounds and stimuli. Although this technique is not intended to be used in times of distress, it can also work as a distraction technique at these times. At first, however, you should try to do this exercise when you’re feeling calm and relatively relaxed. As with the other new skills you’re learning, it will take time and practice. As you progress, you may prefer to switch your attention not just to sounds, but to smells or visual cues such as colours. In fact, you can use any stimuli that are outside of your internal world and in the external environment instead. Many sufferers have reported that this technique can help them feel less isolated, detached or cut off from the ‘real’ world. This is because their attention is now actively focused on the external environment.