Self control and it’s family systems context in weight and other clinical disorders
Posted by Laura Havstad
I am thinking about the data of my research project in which changes in weight are, as theory predicts, a part of shifts in the family system. Get functioning up, anxiety down and the symptom resolves. Getting functioning up and anxiety down almost always follows a shift in the family system.
I want to publish this study in a high impact psychological science journal. Towards that end, I’ve been working to determine if the method I devised to document shifts in the family system can be reliably executed by independent observers. There are now 3 clinicians who are experienced in clinical practice based on Bowen theory, who have independently identified the same shift prior to diet to goal weight in one case of the study, and 2 other clinicians independently identified the same shifts in 15 cases. I’m continuing to test this with enough independent judges and cases to define criteria for qualifying reliable observers (not sure yet what is a persuasive conclusion to this effort) and to define a training process for researchers to become reliable observers of shifts in the family system.
While working on a method that is reliable and convincing to researchers, I am considering the context in which this research is framed with the goal of a solid working connection with the researchers. I believe that self- regulation is an effective bridge between Bowen theory and psychological science as it is viewed as a trans- disease process that is important in a range of clinical disorders. That is, failures of self-control are seen to underlie a range of addictions and related disorders and other failures of adaptation including failures of emotion regulation.
How does self control work?
An article in the current volume of Clinical Psychological Science is an example of approaching the problem of self -control by seeking its underlying psychological mechanisms. It’s point seems to be that the relative balance of impulsivity and self-control is a cognitive function in which the rate at which future reinforcement is discounted or undervalued is high. This mechanism, it is hypothesized, can be reversed and executive control strengthened by among other things, training working memory. In one study obese adolescents received working memory training in addition to a weight loss intervention. The adolescents were able to sustain their weight loss at the first follow-up more than a control group, but not at the subsequent follow up. The article concludes “An important next step in this line of research is to determine how to maintain those changes in self-control: that is momentary improvements in self-control are unlikely to have clinical significance.” Duh.
Enter the family system variable. It’s got clinical significance. That dieting to goal weight is preceded by family system shifts that change anxiety level and increase level of functioning is important, and under appreciated in psychology, as to how shifts in self control happen and how they are sustained, or not, in life outside the lab.
Maybe my introduction to the study will be some thing like this:
“While various interventions produce short term improvements in self-control, maintaining those improvements has proved to be unsuccessful. By studying those who have been successful in shifting up in self-control over a longer term, what might be learned? In addition, if the lens is widened to study the family system what would that add to our understanding of the real life contexts in which self-control shifts up? Individuals who diet to goal weight are examples of sustained shifts up in self- control. Studying their diet to goal weight in the context their families reveals the interdependence of self -control shifts and shifts occurring in the subjects’ closest most active family relationships. This is a report of a study of married women who dieted to goal weight, which uses a novel, and reliable (I believe) method of researching shifts up in subjects’ self -control in relation to shifts in the family system. The theoretical model and method used could be applied trans-diagnostically in studying the course of symptoms in other disorders in which self –regulation is a central variable (almost everything)”
Readers: Any thoughts around this frame, or any others, for an article for an Association for Psychological Science article in the journal Clinical Psychological Science? I would probably frame it somewhat differently for Family Systems. For when to write this up, I think I have good evidence the method can be reliable but I will consult with psychologists about how much more evidence would be necessary to pass muster with them. In the meantime if you have any thoughts on what would be persuasive to you and the network around Bowen theory I’d like to know what you think.
Reference:
Warren K. Bickel, Amanda J. Quisenberry, Lara Moody, and A. George WilsonTherapeutic Opp ortunities for Self-Control Repair in Addiction and Related Disorders: Change and the Limits of Change in Trans-Disease Processes,Clinical Psychological Science January 2015 3: 140-153
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It is so difficult for people to lose weight and keep it off, and it’s a major health issue. It makes sense that success is linked to ability to self regulate, to put aside to a degree food for comfort for a long-term health goal. I would like to know what are the shifts in the family that promote self-regulation in an individual. Reflecting on myself, I think that the resolution of a relationship difficulty, or when another family member takes a strong step forward, it may lead to clearer thinking and acting for me. But sometimes a shift toward danger can lead to a sober effort. I benefit from and learn from specific examples, and I would be very interested in what are those shifts and kinds of shifts. Your article makes me think, too, about how my own behavior can contribute, or not, to a positive shift.
Laurie, I find evidence for all the shifts you point to in my data as the context of better self regulation for the subjects of my study – resolution of a relationship difficulty , when another family member takes a strong step forward, and shifts toward danger. I would add that resolution of a relationship difficulty can go towards either more individuality or to maintain togetherness as long as the chronic anxiety goes down for self regulation of the sort that dieting requires to occur and this is consistent with what Bowen said – to get symptoms to go down, get the anxiety down and togetherness does that as well.
Laura,
I think your write-up for the proposed psychology journal article does a good job of describing the difference between individual-focus and systems-focus. The success or failure of an effort to sustain self-control obviously happens within the context of a relationship system. Yet this fact seems not to be obvious yet in most studies of human behavior. I wonder if “observational blindness” is not the main problem here, since the systems view could be disturbing to established thinking and careers in the field.
Once the systems view could be understood regarding weight loss, it is a short step to seeing its application to other symptoms,”almost everything” as you say. It would change so much in clinical practice.
Another thought is that it seems easier to track symptom development retrospectively–seeing the events and relationship shifts that led up to the vulnerability for symptoms. Is there, or could there be, science that allows us to prospectively the signs that an individual is moving into the danger zone? I think Dr. Bowen was able to do that in some cases.
Stephanie, yes, I think I might possibly do a good job of what I am trying to do and the vested interests in science might shrug. We’ll see, I will have tried but sometimes I wonder if I’m wasting time that could be spent better otherwise. However, I’m too far in here to quit.
Randy Frost is very interested in prediction and finding a way to do it. I wish I’d kept the article but I recently was reading that prediction is not strong in the biological sciences yet. I think we are a way from being able to do it.
Continuing with the question of prediction, I got to thinking about Ann’s case of the very obese man she is coaching. What would one predict about his ability to lose the 125 pounds or even to keep the 150 lbs he’s already lost off? That his weight loss occurred following a divorce suggests that maintaining his weight loss or successfully continuing to his goal weight is at risk because he is back in a relationship. But if the new relationship offers him a way to offload anxiety trying to fix his partner this may provide him the emotional advantage to continue to maintain his weight loss and lose his weight – gaining emotionally at the expense of his partner. Also, one would have to look at the role of the other relationships that impact him. In my data set, it’s pretty clear that the individuals with the extreme weight problems have more intense family systems that can shift dramatically with major impact on the obese individual. If this individual resolves a relationship in a process of differentiation, this is another variable that could impact progress with the symptom positively, as long as losing weight is the priority for this man above other self regulatory goals, or, if the weight is the primary anxiety binder for him, the reduction in chronic anxiety could make the weight loss fairly automatic. I’ll be interested to hear from Ann again about this clinical case.
I have a client who was 500 pounds. After the break up of a long term relationship, he was able to lose 150 lbs. His goal is to lose another 125 lbs. There is a lot of intensity in his family and he sits with a good dose of it. He has a lot of difficulty managing self in the family and in other close relationships. That would clearly influence his ability to regulate self and maintain his weight. Now he has a new relationship and his focus is often on his girlfriend and fixing her. At any rate, it makes me ask the question….what function does this symptom have? And if successful with diet and maintaining weight loss, where would this intensity go?
I think you are working on a fascinating study and I am impressed with your research efforts that may well bring into focus the importance of family relationships on this process for the audience you are speaking to. However, how does success in maintaining goal weight look in the context of the family system over time. An effort to differentiate a self in the family could foster increased ability to stay focused on one’s goal and maintain the effort to achieve that.
Ann, no doubt theory hypothesizes differentiation of self predicts a more long term maintenance of progress . It’s been really grounding for me to have an actual data set to study and watch these processes in even though the data set is limited. For one thing it helps me adopt the perspective of the researchers who have a “show me” attitude. All the predictions from Bowen theory are hypotheses from that frame of reference. We all have a lot of data and I’m interested in how to contribute to adding to the ranks of those who recognize it when they see it.
Also, Ann, see my 2nd reply to Stephanie about prediction.
I would be fascinated to hear what you taught your raters to look for, In order to identify shifts in family functioning.
Jim Edd, I ‘m getting this feedback more and more. I’ll put that on my agenda for next time. Meanwhile, Ann’s example is typical. The anxiety binding mechanisms shift and so does the anxiety and the symptom. I’ve run into a number of people who lose unwanted weight after a divorce.
Jim, if you or anyone else is interested in trying the method as part of the reliability study I’m working on now, I can email a transcript along with the interview of one of the study’s subjects along with the guidelines I’ve written up for documenting shifts. It’s a process that takes a long day for most who try it for the first time. I’m doing this with different people around the network who are interested in the possibility of adapting the method for their own projects and who are willing to commit to completing the process with at least two subjects.
Thank you all for your comments. Your feedback gets me thinking about where to go next and is encouraging. Thanks again Laurie for your leadership here.
What an interesting project. The influence that the group has on the individual makes me think of Ann’s reference to the work with ants that show how sensitive the individual member of a colony is to the needs of the group. We all have far less “free will” than we think we do and demonstrating that in relation to weight would be such a different approach. Some might hear it.