Susan Krauss Whitbourne PhD, ABPP
What are the things you can and cannot control? And how much do these matter to your overall sense of well-being? A new theory of psychological disorders proposes that it is not just what you can control but also whether you fear you will lose control. According to Concordia University’s Adam Radomsky, in a newly published paper (2022), “individuals struggling with a wide array of psychological problems do report concerns about losing control over a range of cognitive, emotional, physiological, and contextual domains”(p. 1).
Think about this idea for a minute. Have you ever felt that the events in your life were unfolding in a way that you couldn’t stop? Perhaps you’ve just received some bad news about your health, which means that the plans you’ve been making for the next few months are going to have to change. This was an event outside your control and so are the events that follow from it, such as making time for visits to your healthcare provider, figuring out how your work will be affected, and adjusting your family’s routines.
In cases such as these, when you’re faced with a new and unforeseen situation, the loss of control you’re experiencing involves a set of practical issues. At the same time, though, might you also start to fear that you’ll begin to start worrying endlessly about all of these changes in your life? How will you ever cope if all you can think about are the worst-case scenarios that might unfold?
Fear of Loss of Control in Specific Psychological Disorders
Radomsky proposes that the fear of loss of control may be more damaging psychologically than an actual loss of control, and he bases this proposal on previously published case studies of individuals with certain psychological disorders in which it is this quality that seems prominent in their symptoms. As you read these case examples (excerpted from the paper), think about the connections among them in this fear of loss of control:
- Panic disorder: Case study 1 is based on a 34-year-old man whose “catastrophic misinterpretations about losing control” over his body and mind led him to feel that he was having a stroke, for example, when he felt his heart start to race. What seemed most prominent in his experience was not just this fear that he would die but also that he wouldn’t be able to recover from these unpleasant sensations. Fortunately, by the end of therapy, he came to appreciate “the control I had without even trying to use it,” a realization that he found to be the most helpful insight he gained from treatment.
- Obsessive-compulsive disorder (OCD): Case study 2 is a 42-year-old woman who puts “a lot of time and effort” into trying to her control her thoughts so that she can control her emotions, to avoid losing control entirely and “doing something terrible.” The intrusive aggressive thoughts she experienced, she believed, would lead her to act on these thoughts if she became too emotional. Her therapy was based on cognitive theory in which she was able to examine her beliefs about losing control of her thoughts so that she could ultimately rethink her assumptions that she couldn’t control those thoughts.
- Social anxiety disorder: In case 3, a 27-year-old nonbinary woman described herself as needing to engage in “great efforts to control her appearance and behavior” so that she could be “grounded enough” to deal with the critical comments she might receive from others. As Radomsky notes, these beliefs in her fear of losing control are in many ways central to social anxiety disorder, in which people imagine themselves allowing their emotions to overwhelm them in social situations, leading to embarrassment and humiliation.
- Posttraumatic stress disorder (PTSD): For the 38-year-old rape victim in case 4, it was the “small amount of control I have over my memories” that led her to be “terrified about what might happen if I lose that.” Even though therapy helped her reduce the frequency of flashbacks to the trauma, because she continued to experience memories, “she interpreted them as evidence that she no longer had control over her memory.”
How Fear of Loss of Control Can Spread
As you can see from these case studies, even though the symptoms of each of the disorders were very different, they share the element of a fear that some combination of their bodily sensations, thoughts, emotions, or actions will get away from them. Furthermore, while reading these clinical cases, did some of them partially resonate with you? Perhaps you’ve worried that you’ll lash out at someone who annoys you. Maybe you’ve had thoughts that you can’t seem to stamp out. However, as Radomsky points out, “the mere occurrence of a thought of losing control is unlikely to be problematic unless the individual ascribes significance to it.”
Another possibility is that your fear of losing control over unwanted thoughts or emotions could signify the fear that you are a “bad and dangerous person.” This secondary fear of loss of control can only magnify the problem.
Moving out of the realm of these primary and secondary loss-of-control fears, Radomsky addresses next the belief that you can control the uncontrollable. This is always, as he notes, counterproductive. Let’s say that you think you can control the outcome of a sporting event by engaging in your favorite superstitious behaviors, such as wearing a certain shirt or sitting in a certain chair while you’re watching it from home. This illusory control can be seen as amusing if it stays within bounds but, if it takes on the guise of reality, it can also become the origin of disorders such as pathological gambling or OCD, as Radomsky suggests.
As noted in the clinical cases, helping individuals understand that they can control their own internal reactions can prove to be a unifying factor in therapy. For a theory to be a theory of “everything” in psychology, though, it needs to incorporate the entire range of people’s behaviors, not just those that fit into diagnostic categories.
One of these sets of behaviors concerns ordinary regrets that people have for the actions they took when they did lose control. Let’s say that you did provoke an argument when you let your feelings out without trying to curb them. You can, as Radomsky notes, be helped by the realization that you didn’t actually lose control, but that you “made decisions that [you] later came to regret.” It may even be that you acted this way because you were literally overwhelmed with what was happening at the time and jumped to the wrong conclusion. You could learn from this experience and be less hasty the next time, but you needn’t start to develop a fear that control over your behavior is an absolute impossibility.
Is This Really a Theory of Everything?
It may never be possible to have one unified theory of all behavior, much less all behavior involved in psychological disorders. However, Radomsky presents compelling evidence of the centrality of this concept. What’s more, this work can also set forth a path for future research both to understand the phenomenon, through empirically based questionnaires, and to apply this framework to clinical practice.
Because a sense of control is so much a part of daily life, perhaps more than you’ve actually realized before, it makes sense that a theory that examines people’s relation to this psychological phenomenon could have widespread applicability. Think about what you can and cannot control, and learn to differentiate between them. That newly diagnosed health problem is a good example of an uncontrollable life change.
Then think about how you reacted to the news. Did you feel your heart racing or your thoughts go 90 miles an hour as you contemplated the impact of this condition on your life? Do these thoughts gnaw away at you even while you’re supposed to be having fun? By gaining control over these fears, you’ll be able to approach the reality of the situation more competently and effectively.
To sum up, this “transdiagnostic” state of fear of loss of control could ultimately prove to have overarching value as an approach to anxiety and other disorders. Thinking about what you can and cannot control, and why you needn’t fear the latter, may help you let yourself experience your thoughts, actions, sensations, and behavior in more fulfilling ways.
References
Radomsky, A. S. (2022). The fear of losing control. Journal of Behavior Therapy and Experimental Psychiatry, 77, 1–7. https://doi.org/10.1016/j.jbtep.2022.101768