Caught in the Perfectionism-Procrastination loop?

Caught in the Perfectionism-Procrastination Loop?

By Olivia Kingsley

Perfectionism is often viewed as a positive quality – after all, who wouldn’t want to be perfect? High achievers meet their goals, and this can lead to feeling accomplished. However, the dark side of perfectionism, Clinical Perfectionism, can actually harm our wellbeing, mental health, and performance. Clinical Perfectionism involves placing immense pressure on ourselves to meet extremely high (and often unattainable) standards [1], relentlessly striving for these standards, and basing our self-esteem based on the ability to achieve these standards[2]. When we (inevitably) fall short of meeting these standards, we experience negative emotions and low self-worth. Rather than helping us attain excellence, Clinical Perfectionism can actually result in a number of self-defeating behaviours, including procrastination [3]. Let’s look at Mia’s situation:

Mia, 22, is a university student who takes her studies very seriously and wants to impress her professors. She holds very high standards for her academic performance and believes that any grade lower than a high distinction is unacceptable. If she receives a grade she considers too low, Mia believes she is a failure and assumes that her professors are disappointed in her. Because of the immense pressure she faces, Mia delays starting assignments because she is terrified of making a mistake when writing the ‘perfect’ paper. This means that Mia starts her assignments at the last minute, which leaves her feeling rushed, guilty, and overwhelmed.

In Mia’s situation, procrastination has nothing to do with being lazy. Rather, her procrastination is directly tied to her fear of not attaining perfection. If this sounds familiar, here are some other signs that perfectionism could be driving procrastination [3]:

1. The thought of starting a project or assignment is too terrifying because it won’t be good enough.

2. Excessive amounts of time are spent in the planning phase (the ‘grand vision’), but doing the actual task is put off until the last minute because the output may fall short of the vision.

3. Actions are heavily driven by emotions, for example avoiding finishing a task until it feels “ just right”, or not starting an assignment because we’re “not in the right frame of mind”.

4. Easier, less intimidating (and less ego-threatening) tasks are prioritised, taking time away from those tasks that need to be completed.

The challenge, though, is that while procrastination brings short-term relief, it’s later replaced by increased time pressure, feeling even more overwhelmed, and underperformance in general.

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what maintains the perfectionism-procrastination loop?

How is this unhelpful perfectionism-procrastination loop maintained? Let’s look to those thoughts, feelings, and behaviours that keep us stuck in this loop.

The way we think

The way perfectionists think can really maintain clinical perfectionism and contribute to procrastination.[3][4]

• Perfectionists are often hypervigilant for signs that their performance is not up to scratch. They may be sensitive to signs of negative feedback, or even tune in to their own stress and discomfort when attempting to start a task (and rationalising that this discomfort reflects a lack of ability).

• Perfectionists can fall into the trap of unhelpful thinking styles. These thinking styles are often inaccurate but are accepted as reflecting reality. They unhelpful thinking styles serve to increase stress and overwhelm, which can be demotivating. Procrastination is a natural consequence when facing such negative emotions. These kinds of thinking styles include:

  • All or Nothing Thinking: This particularly relates to the attainment of unrealistically high standards, “If I don’t receive 100% on my test then I am a bad student”. Certainly, attaining these unrealistically high standards is unlikely, thus this way of thinking sets the perfectionist up to experience stress and overwhelm.

• Catastrophic Thinking: This involves assuming that one will not be able to cope with negative outcomes, and that even a small mistake will be a disaster. “My reputation would never recover if I said the wrong thing at a work meeting”. When the consequences are blown out of proportion, is it any wonder that procrastinating on taking action seems to be the safer option?

• Mind Reading: This involves predicting what other people are thinking, often making assumptions that they are judging you negatively, “My supervisor is so critical and exacting that they will rip my assignment to shreds and think I am utterly incompetent.” This type of thinking can then lead to procrastination when submitting work to be evaluated.

• Misguided attributions and rationalisations following the outcome subsequently serve to reinforce the perfectionism-procrastination loop, for example believing that:

  • Attributing deadline-driven productivity to capability, “I do my best work under pressure!”. In reality, the work is done only because of the imminent deadline. The rest of the time

  • Rationalising outcomes as an underestimate of true abilities, thus preserving self-esteem, “Wow, look at that mark. Pretty remarkable given I didn’t have much time to do it. Imagine if I actually focused I could’ve done so much better!”

The way we feel

Since perfectionists tend to be highly self-critical, they experience negative emotions when their expectations are (inevitably) not met. The thinking styles described earlier keep perfectionists feeling bad about themselves and reinforce their low self-worth. When a perfectionist is unable to meet their high standards, they may experience feelings of anxiety, overwhelm, guilt, depression, and doubt.

These feelings may be so intense and unbearable that procrastination seems to be the safest and most comfortable option. [4]

The way we behave

Finally, behaviour plays a big role in maintaining the perfectionism underpinning procrastination. In the article Anxiety on Campus: What Students Need to Know about Managing Anxiety, our Fight or Flight response kicks in when we face a threat (as is the case of a task we see as challenging and demanding perfection). Procrastination is an excellent example of the Flight response, where we seek to avoid the threat of failure and the resulting negative feelings triggered by the task. Some common examples of procrastination behaviours include:

• Avoiding making a decision: This may include being unable to choose an assignment topic because you need to pick the “perfect” one that will result in you making the most compelling presentation in order to earn top marks, or even putting off making a decision (in case it’s the incorrect one!) so that you just have to make do with whatever is left over.

• Giving up too soon: It is common for perfectionists to give up trying because doing so means facing the possibility of failure. It feels more secure and safe to avoid the scrutiny.

• Delaying starting a task: This can include avoiding starting assignments, or even spending an excessive amount of time on researching but not actually starting the assignment (but still feeling productive). Not committing means not having to deal with a less-than-perfect attempt.

All these procrastinating behaviours are problematic in that they not only increase psychological distress, but also maintain perfectionism. When we engage in procrastination behaviours, we never really learn if we are actually good enough, and our thoughts keep us stuck in the perfectionism-procrastination loop:

• If we performed well, we can only imagine how much better we could’ve done if only we’d started earlier and given ourselves a proper chance to shine (that is, our real potential hasn’t been fairly tested!)

• If we perform poorly, then we can excuse it because of the pressure you were under (that is, our real potential was crushed under the weight of time pressure or anxiety)

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Tips to break the perfectionism-procrastination loop

If you find yourself agreeing to all of the above, help is at hand. Here’s our tip sheet to help you break the perfectionism-procrastination loop [2] . As a sneak peek these include:

1. Count the costs of procrastination. Is it helping or hindering your progress?

2. Set realistic and achievable goals. Smaller goals within your reach are ones you’ll more likely approach.

3. Shift your mindset. It doesn’t need to be perfect, it just needs to be started. You can always go back and make improvements.

4. Shift your goalposts. Rather than aiming for the unattainable, start to aim for 70% of your mark.

5. Show yourself compassion. Getting started can be tricky, so be kind and focus on self-care along with achievement.

6. Reach out and talk to a psychologist who works in the perfectionism-procrastination space (like us!).

A word of caution - the perfectionism-procrastination loop often reflects an entrenched pattern of thinking and behaving, accompanied by strong emotions. Progress will take time, and there will be setbacks along the way, so it’s best to adopt the approach of chipping away at it gradually.

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REFERENCES

[1] Flett, G.L., Hewitt, P.L., Blankstein, K. R. & Koledin, S. (1991). Dimensions of perfectionism and irrational Thinking. Journal of Rational Emotive and Cognitive-Behavior Therapy, 9, 185-201. 

[2] Baldwin, M. W., & Sinclair, L. (1996). Self-esteem and "if…then" contingencies of interpersonal acceptance. Journal of Personality and Social Psychology, 71, 1130 - 1141.  https://doi.org/10.1037/0022-3514.71.6.1130

[3] Antony, M. M., & Swinson, R. P. (1998). When perfect isn't good enough: Strategies for coping with perfectionism. New Harbinger Publications.

[4] Fursland, A., Raykos, B. and Steele, A. (2009). Perfectionism in Perspective. Perth, Western Australia: Centre for Clinical Interventions

[5] Egan, S.J., Wade, T.D., Shafran, R., & Antony, M.M. (2014). Cognitive-behavioral treatment of perfectionism. New York: The Guilford Press.

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The Life of a Socially-Anxious Student

The life of a socially-anxious student

by Olivia Kingsley

Life as a socially-anxious student can be challenging. There are so many study-related situations that have a social component – public speaking, being called on unexpectedly in class, introducing yourself to someone new, forming friendships and working relationships, talking to teachers and lecturers, and so on.[1] These alone can cause discomfort, however for students with social anxiety, the discomfort is amplified to fear and dread. The fear of negative evaluation can be so overwhelming that they avoid situations altogether or endure them with high levels of distress. [2].  Needless to say, experiencing a constant state of anxiety can hamper your studies by affecting your ability to focus on what your teachers and lecturers are saying, on learning the topic at hand. So, let’s dive deeper into what social anxiety is, and how students with social anxiety can go from enduring and surviving, to thriving at university.

Shyness vs. social anxiety in students: What’s the difference?

Let’s first clarify the distinction between shyness and social anxiety and how they manifest in students. Being shy and having social anxiety disorder are not the same thing, and yet the two are often used interchangeably. Unfortunately, even those who suffer from social anxiety disorder may dismiss their symptoms as extreme shyness. So what are some of the key symptoms of social anxiety, and how do they differ from shyness?

According to the DSM-5, social anxiety disorder is an intense fear of social situations where one feels like they are in danger of being negatively judged by others [2]. Whilst interactions such as meeting new people, talking in meetings, going to work or school, or being seen in public can cause discomfort to someone who is shy, social anxiety features when the anxiety is disproportionate to the situation and interferes with the ability to function as a student (e.g. stops them from turning up to class or affects their marks because they won’t speak up in class) or simply the act of functioning as a student causes significant distress.

Let’s take a look at Matt and Alex’s situations:

Matt has just started university, and is nervous about attending his first tutorial and meeting new people. In the lead up to it he is concerned about not knowing what to say or how to act as he wants to make a good first impression. When it comes time for Matt’s first class, he notices his heart rate is a bit elevated and his palms feel sweaty. However, over time he notices others are like him and he feels more comfortable in class and even contributes to class discussion. He ends up having a 100% attendance rate, and fulfills his class participation requirement.

Alex has also just started university, and like Matt, is very nervous about going to tutorial classes and meeting new people. Alex has all of the same worries as Matt about knowing what to say or act, and also wants to make a good impression. However, Alex assumes that others will think negatively of him, and is constantly on the lookout for signs that others disapprove of what he says or does. Alex is also worried that because he feels anxious, others can see right through him. Due to the intense anxiety that he experiences, Alex avoids going to class and only gets 30% attendance, and fails his class participation mark.

Some of the key differences between Matt, who is shy, and Alex, who has social anxiety, are:

• The ability to challenge negative thoughts and check in with what is happening in reality

• The intensity of the distress/anxiety experienced

• The level of avoidance

• The negative impact the anxiety has on academic performance

In other words, Alex is focused on his inner experience (physical sensations, fear, thoughts) and not noticing what is actually happening around him. Both students share the same concerns about being in a new social situation, but Matt is able to evaluate the situation and manage his distress so that it does not interfere with his performance.

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 How is social anxiety maintained?

Social anxiety is maintained through various factors. Models of social anxiety suggest a central role for anxious cognitions, including unhelpful core beliefs and assumptions, interpretations, and thinking styles. Regarding unhelpful core beliefs and assumptions:

• People with social anxiety have negative beliefs about themselves and their ability to handle social interactions. Examples include “I’m odd/weird”, “I’m different”, “I’m unattractive” or “I don’t have the skills to cope with giving a talk on my topic.”

• People with social anxiety may have excessively high standards for their social performance, for example, “I must get everyone to like me”; “I must always be funny and witty”; “I must never let anyone see that I am anxious.” These unrealistic standards cause anxiety as they are often impossible to achieve, and lead to the perception of constantly failing in social situations.

Holding such core beliefs and assumptions, it’s easy to see how evaluative situations can trigger anxiety and its associated fight/flight response. The physical symptoms from the fight/flight response, in turn, can exacerbate social anxiety as the student worries their anxiety symptoms are visible (e.g. blushing, shaking voice, sweating, shaking) and that others can see they are losing control. 

Unhelpful interpretations and unhelpful thinking styles may be also at play in social situations . These are inaccurate yet accepted as reality, and may include: [3][4]

• Emotional reasoning wherein the student believes that because they feel embarrassed that they have embarrassed themselves (that is, believing that feelings reflect reality).

• Mind reading in which the student assumes they know what others are thinking, for example, “Why did she look at me that way when I was talking about photosynthesis? She must think I’m an idiot.”

• Catastrophic thinking, or assuming the worst case scenario will occur, for example, “Going to this class will be a disaster because I won’t be able to get my words out, and others will laugh at me”.

As a result of unhelpful thoughts and thinking styles, people with social anxiety can then behave in ways that maintain their anxiety about social situations. For example, they may: 

• Avoid social situations (and the possibility of negative evaluation). Avoidance is a key factor maintaining social anxiety. While avoidance brings immediate relief, it removes any opportunity to test if negative beliefs are real, nor to experience positive social interactions.

• Engage in safety behaviours. ‘Safety behaviours’ help reduce distress temporarily during feared social situations, but the person then comes to rely on these safety behaviours to endure subsequent social situations (thereby worsening anxiety in the longer term).  These may include avoiding eye contact, not speaking up, speaking quickly, wearing headphones to avoid initialling conversation, ‘hiding behind’ more sociable friends during conversations, or using alcohol to reduce anxiety.

In some instances, perfectionism may actually be a coping style used to help escape scrutiny and negative evaluation.

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How social anxiety AFFECTS student life (and beyond)

Student life is full of social requirements - speaking up in classes and lectures, working with others in group projects, making small talk with other students, making new friends, and planning for the futures by organising work experience and job interviews. Given that most of these student situations involve an evaluative component, and that social anxiety is characterised by a fear of negative evaluation, social anxiety can indeed make thriving as a student extremely difficult. Here are some of the negative impacts of social anxiety on student life (and beyond):

Social anxiety and academic performance

Excessive social anxiety can negatively impact academic achievement.[5]. Being involved and engaged in social and academic activities is considered to be a key contributor to academic achievement, but this can be really challenging for someone with social anxiety [5] Ways in which social anxiety can affect academic performance include:

• Not asking for help from tutors or lecturers when they don’t understand something, instead trying to figure it out for themselves

• Avoiding asking someone to proofread their work

• Avoiding sharing ideas in group projects

• Avoiding study or peer support groups

• Not contributing to class discussions (and thus missing out on participation marks) or avoiding classes entirely.

• Purposefully avoiding units containing public speaking assessments or group work, despite being interested in the content.

Social anxiety, health and wellbeing

Students with social anxiety can often experience loneliness and isolation, and report lower levels of life satisfaction and wellbeing compared to those without social anxiety.[6].

Late teens/early twenties is also a time where many students may begin to experiment with alcohol, and this can be a slippery slope for those with social anxiety who might use alcohol to calm nerves. Indeed, research has shown that social anxiety is associated with problematic alcohol use.[7]

Social anxiety and life beyond your studies

Social anxiety can also affect your post-university life as you set up your career - networking, attending job interviews, gaining work experience, and talking to those in your profession can all cause significant discomfort.

Students with social anxiety often find it difficult to take these first steps. Even if they are given the opportunity, they may turn it down. In fact, research has found around 20% of people with social anxiety disorder report declining a job offer or promotion because of social fears.[8]

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Tips to manage social anxiety as a student

Despite the availability of effective treatments, only about 50% of individuals with social anxiety disorder ever seek treatment, and those who do end up seeking treatment only do so after 15- 20 years. [9] Sadly, it is a very long time to live with discomfort every day, when there are effective treatments that can help. Grab our tip sheet on 7 tips for Living with Social Anxiety below, and here’s a sneak peek of what helps:

1.     Seek help from a mental health professional

Treatments such a cognitive behavioural therapy (CBT) have been shown to be effective in the treatment of social anxiety [10] and at The Skill Collective it’s something we help students with on a regular basis. Things we can help with include:

• Becoming more comfortable speaking up in class and being the focus of attention

• Learning how to better manage public speaking anxiety (see also our public speaking anxiety program, Speaking Volumes)

• Making small talk in a variety of situations (speaking to teachers/lecturers, other students)

• Managing anxiety when it comes to job interviews

2.     Challenge your avoidance

Avoiding social situations may provide temporary relief, however it actually increases anxiety in the longer term. While it may seem like the last thing you want to do, pushing yourself out of your comfort zone and putting yourself in social situations that seem scary is the best way to realise these situations aren’t as daunting as you think!

What might challenging avoidance look like? It could be turning up to lectures in person instead of watching them online, leaving your camera on if meeting up online, attending study groups, or even saying hello to another student where you normally would stay silent - pushing yourself out of your comfort zone is an effective way to challenge your fears and to help you learn that you can cope with the discomfort. Remember, practice makes progress, so don’t expect to feel comfortable straight away.

3.     Take Action NOW

Please don’t be a social anxiety statistic and suffer in silence for 15-20 years before taking action. [9] That is a very long time to live in fear every single day, particularly when effective treatments for are available. Get a handle on social anxiety NOW so that its impact on your studies, social life, and future career are minimised, and you can go from surviving to thriving. Your future self will thank you for it.

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References

[1] Russell, G., & Topham, P. (2012). The impact of social anxiety on student learning and well-being in higher education. Journal of Mental Health, 21(4), 375-385

[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

[3] National Collaborating Centre for Mental Health (UK). Social Anxiety Disorder: Recognition, Assessment and Treatment. Leicester (UK): British Psychological Society; 2013. (NICE Clinical Guidelines, No. 159.) 2, SOCIAL ANXIETY DISORDER. Available from: https://www.ncbi.nlm.nih.gov/books/NBK327674/

[4] Clark, D. M. (1995). A cognitive model. Social phobia: Diagnosis, assessment, and treatment, 69-73.

[5] Beck, A. T., Emery, G., & Greenberg, R. L. (2005). Anxiety disorders and phobias: A cognitive perspective. basic Books.

[6] Brook, C.A., Willoughby, T. The Social Ties That Bind: Social Anxiety and Academic Achievement Across the University Years. J Youth Adolescence 44, 1139–1152 (2015). https://doi.org/10.1007/s10964-015-0262-8

[7] Mendlowicz, M. V., & Stein, M. B. (2000). Quality of life in individuals with anxiety disorders. American Journal of Psychiatry, 157(5), 669-682.

[8] Schry, A. R., & White, S. W. (2013). Understanding the relationship between social anxiety and alcohol use in college students: A meta-analysis. Addictive Behaviors, 38(11), 2690-2706.

[9]  Stein, M. B., & Kean, Y. M. (2000). Disability and quality of life in social phobia: epidemiologic findings. American Journal of Psychiatry, 157(10), 1606-1613.

[10]  Hofmann, S. G., & Otto, M. W. (2017). Cognitive behavioral therapy for social anxiety disorder: Evidence-based and disorder-specific treatment techniques. Routledge.

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How a planner can help you to better manage anxiety

How a planner can help you to manage anxiety

By Joyce Chong

Anxiety is part of life. It keeps you safe from danger - think of anxiety as your body’s alarm that is designed to protect you from threats in your environment. At times, your alarm may be overactive. This can be experienced in response to stressful events (job stress, global pandemic, relationship breakdown, cumulation of daily hassles), or reflect a longer-standing anxiety disorder (such as social anxiety disorder, panic disorder; learn more about when anxiety tips into an anxiety disorder here).

We’ve worked with many individuals over the years to build skills to manage anxiety better - skills such as tuning in to triggers and early warning signs for anxiety, learning relaxation and mindfulness skills, shifting thoughts that contribute to anxiety, and gradually facing triggers for anxiety that they have previously avoided.

As with most things, sustaining the skills to manage anxiety in the longer term takes regular practice, and can easily get lost amidst the busyness of everyday life. So how can you ensure those anxiety management skills stay with you for years to come?

Enter the humble planner…rather than just serving as a To Do list, a planner can help with setting anxiety-related goals, keeping anxiety management skills on your radar, and track your levels of anxiety (and related concepts) so you can better understand and manage anxiety. Below we’ll show you how to use a planner to better manage your anxiety - we’ve used our Productive Life Planner which has specific sections for projects (or goals) and managing your wellbeing, but feel free to use any planner that will suit your needs.

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TIPS TO BETTER MANAGE ANXIETY USING A PLANNER

Below we outline some tips for using a planner to help you better manage anxiety. These are based on our work over the years with the many individuals we’ve helped to make sustainable changes when it comes to anxiety, where we’ve seen what helps and hinders longer-term shifts in anxiety. These tips are by no means exhaustive, but will give you a good starting point. Let’s see how using a planner can help Heni.

Heni is a new graduate who has been experiencing anxiety for the past year. She has just commenced her first ‘major’ role in a high pressure environment, and is taking on challenges that she has not yet encountered. Heni is acutely aware of the need to look after her anxiety so that she can perform in her role and avoid burnout. She also recognises that she is prone to worrying about negative appraisals, which then feeds into her confidence levels and her anxiety.

1.Set goals for managing anxiety

Think of what goals you’d like to achieve when it comes to better managing your anxiety. Is it that you have an upcoming social function when the idea of making small talk with strangers causes you significant anxiety? Is it that you live in a house that has spiders when you have a spider phobia? Or is it that you want to be able to better manage your panic symptoms?

Whatever your goal is, use your planner to break down the larger, overarching goal, into smaller components that are less anxiety-provoking and move you gradually towards your overarching goal.

Heni has been tasked with the project of giving a conference presentation in April on behalf of her workplace. This is a trigger for increased anxiety for Heni - not only is it the first presentation she is giving on behalf of an organisation with high standards, she also suffers from public speaking anxiety.

To help reduce her anxiety, Heni decides to break this larger and more overwhelming task into smaller and more manageable actions using SMART goal-setting:

• First, she reaches out to her colleague Will and buys him lunch to seek advice on designing her presentation. She also sets time frames to ensure she stays on track with this project.

• Second, she decides to sign up to do a public speaking anxiety course, and looks at linking in a friend so she can practice her speech before the day.

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2. Keep healthy habits on your radar.

There are many healthy habits you can adopt that support your anxiety and wellbeing. For example:

• Habits for physical health include getting sufficient sleep, exercise, and nutrition.

• Habits for psychological wellbeing include practising relaxation, journalling, and many of the psychological skills learned in therapy (e.g. exposure, controlled breathing, cognitive restructuring, mindfulness).

It’s easy for these habits to fall off your radar, so by using a planner as reminders to engage with the habit, you’re increasing your chances of looking after your anxiety.

Heni believes that there are a few things that are particularly helpful when it comes to managing her anxiety. She finds exercise and sleep to be vital for her to stay calmer. She also knows that journalling and reflecting on events of the day on a regular basis make a difference to her anxiety. Keeping these healthy habits on her radar using a daily planner helps her to stay on track.

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3. Track stuff.

We’re talking all sorts of stuff to do with anxiety, including:

• Physical and psychological habits that help you manage your anxiety.

• Emotions such as anxiety, stress, overwhelm, and any other related concepts (e.g. level of social confidence when it comes to social anxiety, severity of worry in generalised anxiety disorder).

We especially love being able to track anxiety over weeks, months, and even a year, as tracking helps identify what particular triggers and patterns there may be to your anxiety (see the next point!).

Heni finds that tracking a combination of her moods (anxiety, overwhelm) and confidence level, as well as her energy and motivation, help her to see her progress with managing anxiety. She can also take this information in to her sessions with her psychologist and they can dissect the information together and set new goals.

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4. Reflect

Once you have tracked emotions and habits related to your anxiety, use this data to help you reflect and learn more about:

• What triggers your anxiety (e.g. prolonged weeks of tight deadlines, certain emotional stressors, or even a lack of exercise)

• Which habits make a meaningful difference to your anxiety (do more of these!) and which habits may have less of an impact.

• What helps you stick to your helpful habits and what reduces your ability to stay on track (e.g. busyness at work, burnout, late nights).

After consistently tracking her anxiety, Heni takes the information in to her session with her psychologist. They reflect on the patterns together, and identify that comparing herself to others and facing social situations more generally are triggers for increased anxiety. Using this information, they incorporate a few additional exercises in this area to help Heni better cope with such situations.

All of the above tips are designed to help you understand your anxiety better, and to help you stay on top of managing your anxiety. Using something as simple as a planner can really make a difference to how you understand and look after your anxiety.

If you’d like more tailored support to help stay on track with your anxiety, why not contact us and book in with one of our psychologists?

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Parental burnout: What is it, how it differs from burnout, and how to bounce back

coping with parental burnout

By Emily McGurk and Joyce Chong

Conversations around burnout as a workplace phenomenon has exploded in recent years, but there is a growing body of literature identifying that burnout occurs not only at work, but also in other roles paid or unpaid) in which meaningful activity creates a stress response – students (academic burnout), volunteers, caregiver, and also parents.[1][2][3]  Today we’re focusing on parental burnout which we are increasingly seeing in our clinical work, along with its impact on the parent-child relationship and general self-esteem. At a glance, it’s easy to see how the role of parenting leads to burnout – long hours, multiple requirements, little job control, and so on, it’s easy to see how parenting can lead to burnout. In this article we explore what parental burnout is, its impact on the parenting style and parent-child relationships, signs of parental burnout, and tips to bounce back from parenting-induced burnout.

“A survey of 17,000+ parents from 42 countries found higher rates (5-8%) of parental burnout in individualistic cultures (commonly Western countries) than in collectivist cultures [4]”

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What is parental burnout? How does it differ from ‘regular burnout’?

Traditionally, the concept of burnout was coined to describe the outcome of prolonged and untreated workplace stress and identified three dimensions: emotional exhaustion, emotional distancing (e.g. reduced empathy interacting with clients/colleagues), and reduced efficacy. [1][5]

Research into parental burnout has borrowed from job burnout research, but also identified unique components in parental burnout - Parental exhaustion (emotional and physical), Disconnection from children (emotional distancing), Contrast to your previous parenting self (loss of parental efficacy), and feeling Fed up of the parental role: [6][7] Let’s take a closer look at each of these components:

Parental exhaustion

We get it – the parenting role can seem draining. Long hours on-call, a high mental load (organising appointments and schedules, anticipating as well as reacting to their needs), and never-ending multitasking can make for a challenging role. Throw in sleep deprivation or difficult parent-child interactions, and it’s a recipe for exhaustion.

It’s further been suggested that the type of parental exhaustion experienced may differ depending on the age of the child, with physical exhaustion more common in parents with young children, and emotional exhaustion more common with adolescents or teens due to higher levels of conflict. [8]

Emotional distancing/cynicism from the parenting role

When burnout occurs at work, employees can start to detach from the job and their clients. However, when it comes to parenting, the same detachment takes on a different form. It appears that exhausted parents disengage emotionally from their child [4][6][7][8] by:

• Seeking out the child less, thus leading to fewer interactions.

• Parents ending interactions earlier, speaking and asking less, and interacting with less enthusiasm and care.

These all have implications for the parent-child bond.

Contrast with previous parental self (Loss of parental efficacy)

“I’m not the parent I used to be” is a great way to summarise this component to parental burnout. [7] You may have an idea as to how you should parent, and your previous parental self may have been able to achieve it, however when parental burnout sets in it affects your ability to show up as the parent that you wish to be. Contrast with previous parental self can trigger feelings of shame and guilt.

Feeling fed up

Finally, feeling fed up is a component of parental burnout where one tires of ‘doing’ the parenting [3][4][6][9] .

The role can feel never-ending, the rewards can seem to pale in comparison to the effort that you put in, and you feel like a shadow of your former self. Resentment can quickly build up.

Together, these can lead to reduced fulfilment in the parenting role, poorer quality of parent-child interactions, with both impacting on the parent-child relationship. At its extreme, these factors – particularly emotional exhaustion, emotional distancing plus feeling fed up – are have been linked to parental neglect and even violence [9]

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WHAT Causes PARENTAL BURNOUT?

Parenting is one of the hardest jobs in the world. It requires a shift of focus from prioritising your own needs to focusing on meeting the needs of your dependent children. However, parenting doesn’t exist in a vacuum and there are other demands on parents – other caregiver roles, work, studies, life admin, running a household, and so on. Let’s take a closer look at what it takes to raise children and how this contributes to parental burnout.

Raising children – the tasks

Children have physical needs that need to be met for their development – security (including shelter), education, nutrition, sleep, and adequate health care.

Emotionally, children’s needs include the need to feel safe, loved, and belong. To help them become independent and realise their potential (that is, become self-actualised), they need to be supported to explore and develop their thoughts, choices, likes/dislikes and ideas [10]

To meet these needs, parents consider their children’s schooling, extra-curricular activities (sport, music, playdates, languages, arts, and so on), health support requirements, amongst many factors.

The parental background to raising children

Raising children doesn’t exist in a vacuum – to help children become independent and realise their potential, parents need the finances and time to provide for children’s needs, as well as the parenting skills to support and nurture their children.

However, for modern-day parents, there are some clear pressure points that contribute to parental burnout. [11][12] These pressure points can be external or internal:

EXTERNAL factors in parental burnout

• A busy schedule (extracurricular activities, sport, medical appointments) leading to a high mental load

• Children’s differing ages and developmental stages.

• Children’s physical health and mental health needs (acute or chronic)

• Balancing kids with looking after older parents

• Work-family conflict (whether paid work or volunteer work)

• Coparenting disagreement

• Limited support in the parenting role (e.g. single parent, living away from usual supports)

• The family’s level of disorganisation

Internal Factors in parental burnout

• Managing parental temperament vs child temperament

• Parental perfectionism leading to a disparity in expectations between ideal and real parent

• Wanting to give your children the best opportunities/experiences and not let them miss out

• Difficulties saying no/setting boundaries

• Your own medical or mental health needs that affect your capacity to parent

• Parenting skills and emotional insight

• Own upbringing and the desire to overcome your own childhood unmet needs

HOW DOES YOUR CHILDHOOD EXPERIENCE AFFECT PARENTAL BURNOUT?

As children we all have core needs, including emotional needs – secure attachments, a sense of identity, freedom to express needs and emotions, spontaneity and play, as well as limits and self control [10]. Having our emotional needs met meant that we can recognise our potential as adults.

For those of us who had our needs met, the way in which we were parented sets up a template for how we would like to parent. However, for those whose needs were unmet, this can form an explicit desire for how NOT to parent, or we may end up perpetuating negative parenting experiences we experienced as children, and lead to the development of what is known in schema therapy as early maladaptive schemas (EMS)

EMS are core ways of seeing ourselves and the world. When we become parents, EMS then influence how we parent. Five broad domains of early maladaptive schemas have been identified [10]

• Individuals who grew up with disconnected and detached parents may feel emotionally deprived or even a sense of defectiveness at rejection.

• A lack of parental limits as a child can lead to a lack of self-discipline, including a sense of entitlement and difficulties with self-control.

• Children who grow up in an environment where love and attention were conditional may find themselves in self-sacrificing and approval-seeking patterns, believing that others needs are a priority.

• Growing up in perfectionistic and critical environments can lead to developing unrelenting standards for themselves and others, leading to perfectionism and punitiveness.

• Experiencing overprotectiveness or overintrusiveness when growing up can lead to a lack of sense of self and lack of independence, which can lead to a sense of failure, dependence, or developing an enmeshed relationship with others.

Early maladaptive schemas that we developed as children have a profound impact on how we parent - we may perpetuate what we're used to, or we may go on the attach to undo what we experienced. In turn, our parenting style can then shape the schemas our children develop, with resulting impact on their mental health. Indeed, EMSs have been associated with personality disorders, anxiety, depression, eating disorders, OCD, and PTSD [13]

How might these internal and external factors combine to create parental burnout? Some examples include:

Holly felt disconnected from her parents as a child and learned to keep a tight rein on her emotions and to be emotionally self-sufficient. When she became a parent she wanted to right the ‘wrongs’ of her own childhood and made it her mission that her children would feel happy and loved at all times, and that they would have an unbreakable bond. However, her son is a storm of emotions, and Holly feels overwhelmed by his outbursts and her inability to fix his problems. She keeps researching online and tuning in to podcasts to uncover what to do to help her son and feels burnt out by the never-ending process.

Matt grew up in a perfectionistic and critical environment, yet thrived as he was extremely outgoing and sporty which helped him to step into unfamiliar situations. This approach has served him well and led to success in high pressure environments at work He expected that his son would be just like him, however his young son clings to him and is not willing to engage with activities. Matt is frustrated that his son won’t respond to his coaching to do better and is exhausted by the constant fighting with his partner to take a ‘softer’ approach. His expectations of his son and his style of supporting his son are creating conflict for him and leading to burnout.

Nivvy was her parents’ princess - she was indulged by them and everything came easily to her - academically, socially, and professionally. As an adult, Nivvy was in control at work, maintained an immaculate house, and was always supported by her family and friends. When Nivvy started her much awaited family it became her primary focus, yet 10 months into parenthood she missed her pre-baby life. Nivvy feels trapped in the daily grind, out of control, like a failure - her days revolve around washing, cooking, and cleaning but this cycle is never-ending. She is frustrated that others aren’t willing to take over the mundane tasks and instead tell her that this is part of being a parent. She doesn’t understand how she can love a role so much yet resent it at the same time.

Sarah’s family struggled financially and as a result she missed out on catch ups with friends and having the newest things as a result. Because of this, Sarah often felt disconnected and ‘less than’ her friends. Sarah was determined that her children would always be included (playdates, sport, music) and had everything (toys, gadgets, nice clothes, regular holidays). To afford her children’s lifestyle she works extremely hard, and in the end feels exhausted and confused as to why her children are cranky and ungrateful…despite ‘doing it all’ she doesn’t feel present for any of it.

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A path out of parental burnout - tips to cope

Importantly, parental burnout isn’t something that you have to tolerate and endure just because other parents are in the same boat. Step back and reflect on where you are currently in your parenting journey, where you would like to be as a parent, and what type of parent-child relationship you wish to nurture. Work with a psychologist (like Emily!) to step through a path to reduce parental burnout:

1.    Work with a psychologist. The cause of parental burnout is nuanced and multi-layered - each parent’s early experiences (and schemas!) is different. Each parent also faces different external factors that drive burnout - some parents have multiple children with busy schedules, some have children with complex health needs, some lack support. Work with a psychologist to help you to untangle the many layers that have led you down the path to parental burnout, and find a way forward.

An additional benefit of having periodic check-ins with a psychologist is that they are also trained to identify emerging mental health issues such as depression, anxiety, burnout, problematic alcohol use and can work with you to build skills to improve coping.

2.    Understand your identity. Whether you like it or not, your childhood journey influences those parenting triggers that push you towards parental burnout. Unmet needs that you experienced as a child shape how you wish to parent. By exploring your identity, early maladaptive schemas, and needs, you can better understand your triggers for parental overwhelm, and put a plan in place to parent in a more deliberate way.

3.   Make a mindset shift. To combat parental burnout a mindset shift is a must. It helps to explore your expectations and thoughts - regarding how you should parent, what your parent-child relationship should look like, what your parenting experience should feel like, and whether you can practice self-compassion when faced with parenting setbacks. By shifting these mindset challenges you can bounce back better from parental burnout. A good starting point is to recognise that you can love your children whilst experiencing frustration regarding parenting, or grieving a loss of your independence.

4.     Nurture yourself for sustainable parenting. A stressed out, burnt out parent does not parent well and affects emotion regulation and clarity of thought. Give yourself the space to be an involved parent by thinking sustainably. Importantly, nurture yourself through self-care and setting boundaries, and aim for a style of parenting that you can maintain.

5.     Be present and deliberate to improve your parent-child connection. Good-enough parenting is about tuning in mindfully to your children’s needs, your own present needs, rather than stick to achieving what you believe parenting ‘should’ look like.

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REFERENCES

[1] Pines, A., and Aronson, E. (1988). Career Burnout: Causes and Cures. New York, NY: Free Press.

[2] Bianchi, R., Truchot, D., Laurent, E., Brisson, R., and Schonfeld, I. S. (2014). Is burnout solely job-related? A critical comment. Scand. J. Psychol. 55, 357–361. doi: 10.1111/sjop.12119

[3] Roskam I, Brianda M-E and Mikolajczak M. (2018). A Step Forward in the Conceptualization and Measurement of Parental Burnout: The Parental Burnout Assessment (PBA). Frontiers in Psychology, 9:758. doi: 10.3389/fpsyg.2018.00758

[4] Roskam, I., Aguiar, J., Akgun, E., Arikan, G., Artavia, M., Avalosse, H., Aunola, K., Bader, M., Bahati, C., Barham, E. J., Besson, E., Beyers, W., Boujut, E., Brianda, M. E., Brytek-Matera, A., Carbonneau, N., César, F., Chen, B. B., Dorard, G., Dos Santos Elias, L. C., … Mikolajczak, M. (2021). Parental Burnout Around the Globe: a 42-Country Study. Affective science, 2, 58–79. https://doi.org/10.1007/s42761-020-00028-4

[5] Maslach, C., Shaufeli, W.B., & Leiter, M.P. (2001). Job burnout. Annual review of psychology, 52, 397-422. Doi:10.1146/annurev.psych.52.1.397

[6] Roskam, I., Raes, M.-E., and Mikolajczak, M. (2017). Exhausted parents: development and preliminary validation of the parental burnout inventory. Front. Psychol. 8:163. doi: 10.3389/fpsyg.2017.00163

[7] Roskam, I., Philippot, P., Gallée, L., Verhofstadt, L., Soenens, B., Goodman, A., & Mikolajczak, M. (2021). I am not the parent I should be: Cross-sectional and prospective associations between parental self-discrepancies and parental burnout. Self and Identity, 21(4), 430–455. https://doi.org/10.1080/15298868.2021.1939773

[8] Abramson, A. (2021; October 1). The impact of parental burnout: What psychological research suggests about how to recognize it and overcome it. American Psychological Association. https://www.apa.org/monitor/2021/10/cover-parental-burnout

[9] Kalkan, R.B., Blanchard, M.A. & Mikolajczak, M., Roskam, I., & Heeren, A. (2022). Emotional exhaustion and feeling fed up as the driving forces of parental burnout and its consequences on children: insights from a network approach. Current Psychology. 42, 1-12. https://doi.org/10.1007/s12144-022-03311-8

[10] The Attachment Project (2024, April 10). The ultimate guide to early maldaptive schemas. The Attachment Project, https://www.attachmentproject.com/blog/early-maladaptive-schemas/

[11] Ren, X., Cai, Y., Wang, J., & Chen, O. (2024). A systematic review of parental burnout and related factors among parents. BMC public health, 24, 376. https://doi.org/10.1186/s12889-024-17829-y

[12] Mikolajczak, M., Aunola, K., Sorkkila, M., & Roskam, I. (2023). 15 Years of Parental Burnout Research: Systematic Review and Agenda. Current Directions in Psychological Science, 32, 276-283. https://doi.org/10.1177/09637214221142777

[13] Sójta, K., & Strzelecki, D. (2023). Early Maladaptive Schemas and Their Impact on Parenting: Do Dysfunctional Schemas Pass Generationally? A Systematic Review. Journal of Clinical Medicine, 12, 1263. https://doi.org/10.3390/jcm12041263

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Working in FIFO: The challenges for mental health (and tips to help)

Managing mental health while FIFO

By Charlotte Pugh

A Fly-in-Fly-out lifestyle is not for the faint-hearted – long days (think 12-hour shifts) working away in remote mining locations for weeks at a time, separated from family and loved ones, feeling isolated, sleep disruption, coping with heat and dust, and a workplace culture where bullying and sexual harassment are commonly reported. With these challenging conditions, it’s not surprising that approximately 33% of FIFO workers report a higher level of psychological distress compared to the average population [1]. FIFO workers experience higher levels of depression and anxiety symptoms as well as higher levels of burnout compared to the standard population [1]. This article outlines some of the unique aspects of a FIFO lifestyle, its impact on wellbeing and mental health, and offers tips to striking a helpful work/life balance. Read on to learn more about:

• Common challenges in FIFO Roles

• Signs your mental health might need support

• Strategies to help your FIFO wellbeing

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common challenges in fifo

FIFO roles are those based in remote locations away from towns, and often facing extreme weather conditions. Workers travel to site for several days or weeks at a time, then return home for days or weeks of rest (depending on rosters. Whilst on site, accommodation is often temporary (‘dongas’). Other common features of FIFO roles include long shifts (often 12 hours each day with highly regimented routines), working in male dominated industries (mining, construction, oil and gas), and working in an environment in which stigma regarding mental health often exists.

In light of the nature of FIFO work, it’s no secret that a FIFO lifestyle can take a heavy toll [2][3][4][5]. Let’s dive deeper into these challenges, and consider both workplace-based challenges (which may be harder to shift) and individual-based challenges (which we can have more influence and control over).

workplace-based challenges

Workplace-based FIFO challenges related to the organisation, how it structures work roles, the work environment itself (job conditions, physical environment), and also the organisational culture:

1. Workplace Culture. Numerous surveys point to the challenging workplace culture in FIFO environments, with gender-based discrimination, bullying and sexual harassment reported to be higher in what is typically a high pressure, male-dominated environment [1][6][7][8]. Living at camp means it can be difficult to separate from work, feel psychologically safe, find like-minded people to connect with.

2. Work Structure. Shiftwork, long hours, and roster length have all been shown to impact wellbeing. Shiftwork and long hours can increase fatigue due to disruption to sleep and sustained physical or mental demand [. The highly regimented structure of long hours with strict meal and recreation times can also create a challenge in maintaining connections with supports at home, especially if on night shift. Even-time and short rosters , choice in roster, and permanent rooms, are all linked to better mental health outcomes. [1][2][7]

3. Reduced Autonomy. The highly regimented nature of FIFO work (with strict compliance to safety and operational matters, and a highly structured daily routine and rosters) can lead to a reduced sense of control and autonomy and, in turn, poorer mental health outcomes. [1][2][3] Factors such as difficulty travelling home in emergencies, difficulty obtaining time-off or sick leave, changes to changes to camp rooms, and limited choice in job tasks, all impact mental health and a sense of agency over one’s life. [1][2]

4. Environmental Factors. Site-based work often occurs in harsh environments -  heat, flies, dust, camp conditions, food onsite and access to recreational facilities, can all impact on mental health and wellbeing. Not having your creature comforts can be challenging, as can living out of your suitcase not knowing if you’ll return to your same donger can contribute to feeling displaced and unsettled. Is it any wonder that the environment can impact your wellbeing? [2][3]

individual-based challenges

Whilst punishing work conditions that accompany FIFO work contribute to poorer mental health, there are also individual-based challenges at play. These include:

1. Managing multiple demands. While working FIFO, employees can feel as though they are leading two separate lives. Depending on your commitments, it can look like a feast/famine cycle (e.g. long hours with a highly regimented daily routine with set times on site vs. nothing structured when on R&R) or a continuously busy cycle with little respite (e.g. long hours on site then coming home to dive right into parenting duties and taking care of the household). Continuous adjustment is required when travelling to/from site, and time away can impact on relationships, friendships and parenting.[2][3] Learning how to juggle these demands is key to maintaining good mental health.

2. Maintaining social connections. FIFO workers report that time away often can result in feeling socially disconnected. [2][3][5] Time away often means missing important events and celebrations in the lives of loved ones  – missing out on friends’ major celebrations or children’s birthday parties - and can certainly create a barrier to forming new relationships or participating in activities on R&R.

3. Beliefs about seeking help. In spite of the higher prevalence of mental health difficulties in FIFO workers, there is often reluctance to seek support due to  significant stigma. [4][8] A machismo culture of ‘getting on with it’ and ‘toughing it out’ means that seeking support may be viewed as a sign of weakness, resulting in help being sought at the point of high distress. The reality is that by seeking help along the way – to fine tune negative thoughts, or learning how to manage a suitable sleep routine whilst FIFO – it can actually help prevent things from getting to breaking point.

4. Golden Handcuffs. One of the main benefits of FIFO is the financial security, allowing for more investment into building a life, supporting partners and children, and moving towards financial freedom. However, the seductive financial benefits can often lead to ‘lifestyle creep’ (nicer toys, more holidays) and higher levels of debt. In turn this can lead in FIFO workers feeling ‘trapped in their roles, resulting in increased stress and potentially taking on more overtime to catch-up. [2][3][5]

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signs of poor mental health in fifo workers

Research into the mental health of FIFO workers has shown higher rates of depression, anxiety, burnout, as well as higher overall psychological distress, compared to the standard population. [1][2][3][4] Some early warning signs that your mental health may be impacted can include:

• Changes to mood: Feeling consistently stressed, numb, flat, or having a ‘shorter fuse’ than usual, or even reduced enjoyment during R&R.

• Changes to health: Difficulty sleeping, trouble winding down, fatigue

• Changes to behaviour: Withdrawing from social gatherings, increased alcohol and substance use, increased gambling

• Dreading work: Finding it hard to travel to site (i.e. becoming increasingly anxious or down on fly-out day).

Even though these may be signs that you experience it doesn’t mean that you have to put up with it because it’s part of the job. There are steps you can put in place to help improve your mental health.

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tips to manage fifo life: relationships, health, wellbeing

One of the biggest challenges to FIFO life is maintaining positive social connections and looking after yourself. Others may seem to get on with their regular daily and weekly routines back home, but as a FIFO worker you’re transplanted into another world for a few weeks at a time, disconnected from your regular life back home. Below are some tips to help with managing your FIFO life:

1.     Sort out your priorities. Having a realistic understanding of the potential impact of FIFO work, and its challenges can assist in managing mental health and wellbeing. [1][2] Developing a plan with practical and financial goals, things to look forward to, and what you would like to get out of a FIFO career, all help with increasing a sense of autonomy and control.

2.     Prioritise Relationships. FIFO workers who are happy with their personal relationships have been shown to have significantly better mental health and well-being. [1][3][5][9] This may include planning social activities on your R&R, having alternative ways of communicating to maintain relationships with those back home, and prioritising time-off for key celebrations or events. This could also include exploring social activities onsite and connecting with your crew.

3.     Create a Routine. It’s common for FIFO workers to feel ‘lost’ or unsure of what to do on R&R, and therefore managing the transition between site and home can feel challenging. Creating a routine for site and home can help support wellbeing, as well as allowing you to make the most of your R&R.

4.     Know your warning signs. Tune in to some of the early signs that you may need some extra physical or mental health support. These could be physical signs such as feeling consistently tired, headaches, or difficulty sleeping, as well as emotional signs such as difficulty switching off, feeling flat, or being snappier and more irritable than usual.

5.     Check in with your physical health. FIFO work is demanding on your body, with long shifts, disruption to sleep schedules, night shift, heat, dust and continued physical demands. [7] It’s important to pay attention to your physical health, monitor alcohol and substance use, and work with a GP or psychologist to create a manageable sleep routine.

6.     Reassess as needed. Remember to regularly check in with yourself and reassess how you are going. Different life stages will often mean different goals (financial, career, relationship) and balancing different demands (i.e. relationships, sport, parenting). As you go through different stages of your life, remember to reassess and develop new routines and goals.

7.     Work with a psychologist.  You do not have to wait until you are exhausted or at the point of burnout before working with a psychologist. Ways a psychologist can help include:

• Laying the groundwork in preparing to start a FIFO role.

• Helping you to build helpful sleep strategies.

• Finding ways to support your relationships.

• Helping you to find a work/life balance.

• Supporting you with problematic alcohol or substance use.

An additional benefit of having periodic check-ins with a psychologist (like me!) is that psychologists are also trained to identify emerging wellbeing issues such as depression, anxiety, burnout, problematic alcohol use, and can work with you to build strategies to improve mental health and coping.

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REFERENCES

[1] Parker, S., Fruhen, L., Burton, C., McQuade, S., Loveny, J., Griffin, M., ... & Esmond, J. (2018). Impact of FIFO work arrangements on the mental health and wellbeing of FIFO workers. https://www.mhc.wa.gov.au/media/2548/impact-of-fifo-work-arrangement-on-the-mental-health-and-wellbeing-of-fifo-workers-summary-report.pdf

[2] Roets, A. (2021, October 19). How FIFO work impacts mental health and well-being. Engineering Institute of Technology.. www.eit.edu.au/how-fifo-work-impacts-mental-health-and-well-being/

[3] Gardner, B., Alfrey, K. L., Vandelanotte, C., & Rebar, A. L. (2018). Mental health and well-being concerns of fly-in fly-out workers and their partners in Australia: A qualitative study. BMJ open, 8, e019516.

[4] https://www.mmhg.com.au/blog/depression-and-anxiety-in-mining-and-fifo-work-australia

[5] Brook, E. R. (2020). Fly-in/fly-out working arrangements: Employee perceptions of work and personal impacts (Doctoral dissertation, Murdoch University) https://researchportal.murdoch.edu.au/esploro/outputs/doctoral/Fly-in--fly-out-working-arrangements/991005544778107891/filesAndLinks?index=0

[6] Pupazzoni, R. (2023, Aug12). ‘Not acceptable’: Women in mining speak out against sexual harassment and discrimination. ABC News,  https://www.abc.net.au/news/2023-08-12/women-in-mining-speak-out-against-decades-of-sexual-harassment/102699944

[7] Joyce, S.J., Tomlin, S.M., Somerford, P.J., Weeramanthri, T.S. (2013). Health behaviours and outcomes associated with fly-in fly-out and shift workers in Western Australia. Internal Medicine Journal, 43(4), 440-444. https://doi.org/10.1111/j.1445-5994.2012.02885.x

[8] Van Halm, I. (2022, October 27). Why the Australian mining industry needs to address workplace culture. Mining technology. https://www.mining-technology.com/features/why-australian-mining-industry-address-workplace-culture/?cf-view

[9] Meredith, V., Rush, P., & Robinson, E. (2014). Fly-in fly-out workforce practices in Australia: The effects on children and family relationships. https://nla.gov.au/nla.obj-400935781/view

Thank you to the FIFO workers who contributed to this article. 

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Emetophobia - when a fear of vomiting holds you back in life

Emetophobia: when a fear of vomiting holds you back in life

By Giulia Villa

Many things that can be unpleasant or scary can be an unfortunate part of life: Spiders, heights, needles, flying. In this article, we’ll be talking about another addition to this category. That’s right - vomit. Among specific phobias, emetophobia, or an extreme fear of vomiting, is one not often spoken about. Keep reading to learn more about:

• Why emetophobia is so debilitating

• About emetophobia: What is emetophobia, and what makes it unique

• Spotting the signs of emetophobia

• Emetophobia, eating disorders, and OCD

• Treatment options for emetophobia

And if you’re unsure about the difference between a phobia and the experience of fear or anxiety – take a look at this page where we clarify the distinction between these concepts in more detail.

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How debilitating can a fear of vomiting be?

To those who don’t experience it, a fear of vomiting may not seem that problematic – after all it could be a low frequency event as some people do not vomit for years. However, emetophobia is so much more than that. Unlike, say, a fear of heights and flying which can usually be avoided, a fear of vomiting means chronic hypervigilance and manoeuvring for a wide range of everyday situations in which vomiting may be possible. Some examples include:

• Your study group wants to go to a local cafe for lunch whilst you’re all working hard on a group assignment. Unfortunately you can’t take your own food in! You don’t know your study group that well, so you feel the pressure to go along with the groupthink. Whilst you’re there, there are all sorts of smells that make you want to gag… cheeseburgers, fish sauce, parmesan… it’s a minefield.

• Your out-of-town relatives are visiting for the first time ever and really want to take a boat to an island to see quokkas which they won’t find anywhere else in the world. The mere thought of being stuck on a boat and experiencing motion sickness strikes fear into your heart.

• There’s a morning tea at work to celebrate finishing a big project that you’ve played an important part in. However, you avoid going as you don’t want to eat or drink, and don’t want to spend that time explaining yourself.

• You’ve been invited to a close friend’s wedding reception at a winery. Unfortunately there’s food you would not usually eat that’s been prepared by someone else, and the other guests will be people drinking alcohol. To top it all off…the winery is a 40-minute drive away along winding roads and your friend has organised a bus to and from the reception so that everyone can “feel more comfortable”.

From the above examples, it’s clear that a fear of vomiting can really affect daily life. Given its wide-ranging impact, let’s take a closer look at what emetophobia is.

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What is emetophobia?

Emetophobia is an anxiety disorder which falls under the classification of a specific phobia. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) [1] defines a specific phobia as:

• An intense fear or anxiety about a specific object or situation that lasts at least 6 months

• The phobic object/situation always provokes immediate fear or anxiety

• The phobic object/situation is actively avoided or endured with intense fear or anxiety

• The fear or anxiety is disproportionate to the actual threat posed by the phobic object or anxiety

• The fear, anxiety or avoidance causes significant impairment to daily functioning e.g. not being able to eat food cooked by others, not seeing friends and family, not going to work etc.

• The fear, anxiety or avoidance isn’t better explained by another medical disorder

Emetophobia is thought to affect between 0.1% and 0.2% of the population [2], though this is thought to be a conservative estimate [2], and usually starts in childhood or early adolescence. This condition is more common in women than in men.

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what makes emetophobia unique

At its core, emetophobia shares many similarities with other specific phobias - intense fear, anxious thoughts, and avoidance. However, there are certain characteristics that are unique to the fear of vomiting which are important to consider:

Control in emetophobia

A distinct belief held by many people with emetophobia is that, if necessary, they can exercise enough physical control over themselves and their environment to prevent vomiting. Most people with emetophobia have not thrown up in a considerable length of time, and they credit their strategies (or safety behaviours, which we will look at in more detail) for this. In the context of treatment, this belief can make it very difficult for individuals to let go of such safety behaviours and coping mechanisms as they believe these are vital.

Gastrointestinal anxiety symptoms in emetophobia

A common feature of anxiety is stomach and intestinal discomfort. This is because of the strong connection between the brain and the body’s gastrointestinal system. When stress or anxiety becomes significant enough to trigger a fight-or-flight response, our body suppresses digestive functions in order to redirect resources to other areas and can lead to a reduced appetite, nausea, stomach pain/cramps, acid reflux, butterflies, and irregular bowel movements. With emetophobia this gets tricky, as intestinal discomfort can be anxiety-provoking in itself, catapulting individuals into worrying about whether they’re about to be sick.

This creates a vicious cycle, where the intense fear and anxiety around vomiting leads to physical sensations, which intensify the anxiety felt by the emetophobic individual. Over time, someone with emetophobia may become hypervigilant of their bodily sensations, constantly directing their attention towards sensations that could suggest the possibility of vomiting. For a person with emetophobia, a tummy gurgle or a brief wave of nausea has the power to trigger a spiral of anxious thoughts. Avoidance of vomiting then reinforces this cycle.

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Spotting the signs of emetophobia

How do you know if you have emetophobia rather than just a dislike of vomiting? In addition to the chronic intense and disproportionate fear and anxiety in relation to vomiting, consider the role of avoidance and how it interferes with your daily life. Below are some common signs of avoidance that we commonly see in emetophobia - monitoring your environment on an ongoing basis to avoid these threats can be extremely debilitating indeed.

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What’s the difference between Emetophobia, Eating disorders, and Obsessive Compulsive Disorder?

The lack of current research and training around emetophobia mean that this condition is unfortunately often misdiagnosed. Most commonly, emetophobia may at times be misdiagnosed as Anorexia Nervosa (AN) or Obsessive Compulsive Disorder (OCD) due to similarities between the conditions. Below we outline common and distinct features of these conditions in comparison to emetophobia.

Emetophobia and Anorexia Nervosa (AN)

People with emetophobia may restrict the types and quantity of food that they eat, in order to reduce or eliminate the risk of being sick, which might result in significant weight loss. Restriction of food is also a key feature of AN, but in the case of AN the restriction serves the purpose of weight control rather than avoidance of vomiting. Another key difference in these diagnoses is that AN is characterised by an intense fear of gaining weight and a sense of self-worth that is heavily influenced by one’s weight or shape (DSM-5). These features are not present in emetophobia, where the fear itself is of the act of vomiting.

emetophobia and Obsessive Compulsive Disorder (OCD)

Individuals with emetophobia may also take measures like excessive hand-washing and wearing a face mask to reduce the risk of contracting an illness that may lead to vomiting. Obsessive, persistent, and distressing thoughts that revolve around fear of exposure to germs are a symptom that might also both present in emetophobia and OCD.

An important distinction between a diagnosis of OCD and emetophobia is the presence or absence of magical thinking and ritualistic safety behaviours. While both conditions can involve seemingly irrational thoughts and excessive behaviours, the context and motivation behind these actions can help differentiate between the two conditions.

Magical thinking is a feature of OCD which refers to the belief that a person’s thoughts or actions have a very real potential to influence events, even in the absence of a logical cause-and-effect connection between the two. For example, someone with contamination OCD might think "If I don't wash my hands exactly seven times after touching a doorknob, I'll get sick and start vomiting." In emetophobia whilst the act of hand washing is seen to reduce the likelihood of contamination, there is not stipulation around the number of times this is to be performed.

Ritualistic behaviours are also a feature of contamination OCD that can distinguish it from emetophobia. Rituals and other neutralizing behaviours are a hallmark of OCD. These compulsions, (e.g. repetitive hand washing, excessive cleaning, checking, counting, arranging objects in a specific way) are carried out in an attempt to prevent feared outcomes (i.e., vomiting) or reduce the anxiety caused by obsessive, irrational thoughts. Thus, someone may wash their hands exactly seven times, and in a prescribed order (and, if interrupted when performing this ritual, will feel compelled to restart the ritual again).

Individuals with emetophobia may also engage in similar excessive behaviours like frequent hand-washing or avoiding certain foods, however these actions do not have a ritualistic flavour to them but instead these behaviours (frequency, number) have a straightforward link to preventing vomiting. For example, someone with emetophobia who fears contracting a stomach virus may thoroughly wash their hands once. However, they are unlikely to believe in washing their hands a specific number of times or in a particular way in order to guarantee that they won't become ill.

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Treatment options – what works for emetophobia

The recommended treatment for all specific phobias is Exposure Therapy as part of Cognitive Behaviour Therapy (CBT). Essentially, this involves facing vomit-related fears, and thus the thought of exposure therapy can be incredibly intimidating as it involves confronting the very subject of fears.

Facing something that we are scared of is daunting, which is why it’s important to work with a trained professional who can guide you at a pace that stretches you but does not create excessive fear. The goal of exposure therapy is to shift your fear of vomiting, help your body to adjust to the increase in anxiety in that situation, and then to help you recognise your ability to cope.

Treatment for emetophobia needs to be highly tailored to the individual, because different people experience the phobia in different ways and intensities. Working with a psychologist helps with considering where the individual is at, what typical triggers there are, and what avoidance strategies are in place. Consider:

• Ty may have a fear of vomiting and overestimates the likelihood of himself vomiting. He works as a librarian in administration and is not often exposed to people vomiting, nor is he concerned by others vomiting. Ty’s main concern when it comes to vomiting is in his personal life – his friends are all hitting the age of weddings and he anticipates having to eat many foods that he considers ‘unsafe’.

• Priya is a doctor who will be rostered to work in the gastroenterology department in a few months’ time. She cannot stand seeing others vomit and is very worried about catching illnesses from people who are unwell. Needless to say, her emetophobia makes work extremely challenging. Priya also wants to start a family in the near future, but experiences extreme fear due to the prospect of feeling nauseous due to morning sickness.

Thus, whilst both Ty and Priya have emetophobia, treatment will look different for them due to the differences in triggers, situations where they have to face vomiting, and the impact on their lives.

What does treatment of vomit phobia look like?

After a thorough and individualised assessment, a therapist will guide you through systematically increasing your tolerance to these three key areas:

1. The physical sensations associated with vomiting (e.g. nausea, stomach pain).

2. Vomit-related triggers like words, pictures, sounds, and videos

3. Environmental triggers, such as food, smells, and public places

Treatment for emetophobia also involves a cognitive component which aims to challenge and restructure unhelpful thoughts and beliefs that are contributing to the fear. Working one-on-one with an experienced clinician means that you will be receiving a tailored approach that will provide you with adaptive skills to take into your life outside of therapy.

Here at The Skill Collective we work with emetophobia – and the following psychologists in our team have a passion for exposure therapy, so why not book in and get started on shifting this debilitating fear?

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REFERENCES

[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Publishing.

[2] Becker E, Rinck M, Türke V, Kause P, Goodwin R, Neumer S, Margraf J. (2007). Epidemiology of specific phobia subtypes: Findings from the Dresden Mental Health Study. European Psychiatry,22,69–74. doi: 10.1016/j.eurpsy.2006.09.006. 

 [3] Sykes, M., Boschen, M. J., and Conlon, E. G. (2016) Comorbidity in Emetophobia (Specific Phobia of Vomiting). Clinical Psychology & Psychotherapy., 23: 363–367. doi: 10.1002/cpp.1964.

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7 tips for living with social anxiety

7 tips for living with social anxiety

By Joyce Chong

In the 2007 National Mental Health and Wellbeing survey that surveyed 16million Australians to gain a picture of the nation’s Mental Health we found that anxiety is the most common mental health disorder experienced by individuals. (see here for a brief summary) 

Within anxiety, social anxiety is the second most common anxiety disorder experienced (behind posttraumatic stress disorder). Social anxiety is linked with poorer quality of life and workplace productivity [1] and also with the increased use of alcohol and cannabis.[2]

If you're one of the many who experience social anxiety or know of someone who does, read on for our 7 tips for living with social anxiety. We've also included a printable version at the bottom of the article.

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1. Know the difference between shyness and social anxiety

It’s easy to fall into the trap of seeing social anxiety as just an extreme of shyness. Indeed, there is a higher rate of social anxiety amongst shy individuals compared to individuals who aren’t shy, however the majority of shy individuals do not have social anxiety.[3]

However, social anxiety differs from shyness in that there is a marked level of fear involved, there is avoidance of feared situations, there is a strong fear of negative evaluation, and the social anxiety has a negative impact on functioning in several areas of life (e.g. work performance or relationships).

For example, a student may feel shy in a tutorial room, but if that person is distressed at the prospect of having to speak in the tutorial, and the tutorials have a participation component that students must pass (that is, they risk failing the entire unit if they don’t contribute) then we are looking more at a picture of social anxiety.

Did you know that for some, the anxiety is present only in situations where performance is concerned? So, while they may do well in most aspects of socialising, there may be anxiety just when doing public speaking or talking to people in positions of authority (e.g. managers, lecturers).

2. Take action…now!

Social anxiety typically starts between late childhood and mid-adolescence, with sufferers waiting an average of 15-20 years before they seek treatment.[1]

Given the wide-ranging impact of these social fears, it is understandable that social anxiety is linked with poorer quality of life and wellbeing – how restrictive would it be if you were afraid to go for a job interview, ask someone for directions, ask a question of your teacher, or even looking people in the eye in a passing conversation in case they think negatively of you?

How long have you lived with social anxiety? How does it hold you back in your life? Take action now so that you don't have to continue to live this way.

3. Challenge your avoidance

Avoiding a scary situation may bring you immediate relief, but over time you may notice that more situations cause you anxiety, or that your anxiety gets more intense.

The reality is that striving to feel safe all of the time is unrealistic, and trying to achieve this means that the number of situations in which you feel comfortable starts to rapidly shrink.

Make changes by taking one small step at a time. For example, if you're afraid of making conversation with people, start off by making small talk about the weather with the check out operator at a new grocery store, then build up to making small talk with the receptionist at your doctor's surgery. It takes one small step to get the ball rolling.

4. Rethink your drink

Social anxiety is associated with an increased rate of alcohol dependence. [4] Alcohol is often used to cope with nerves before and during a social situation, but it's important to rethink your drink and take a good hard look at whether it's just another form of avoidance. 

Why is using alcohol to cope with anxiety a bad thing when many of our social situations involve alcohol? Well, alcohol may make you feel less anxious in the short term, but in the longer term do you learn that you can cope without a drink? Sound familiar? Refer to Point 3 – yes, using alcohol sounds like a form of avoidance.

5. Check your thoughts

Are your thoughts and thinking styles making your anxiety worse? Tune in to your thoughts when you first notice anxiety building up in a social situation. Are you making an incorrect assumption? Are you jumping to conclusions, or catastrophising by focusing on the worst case scenario?

If you're giving a presentation, do you assume that one small mistake in your presentation means that you have made a fool of yourself? Will the worst case scenario of being laughed at by everyone really come true?

We’ve previously blogged about Checking your Thoughts in relation to social anxiety here in our post on social anxiety and Christmas functions so use that as a starting point. You can also find more information on thinking styles here.

6. Conduct an experiment

Sometimes we believe what we believe because we haven’t had evidence to the contrary. Let's say you keep your head down on the bus because you think that others on the bus will stare at you. By keeping your focus on your feet or phone, you won't see that they’re not staring at you. In other words, your belief is reinforced or, at the very least, not disputed.

Let’s mix things up a little. Let’s conduct an experiment by sitting at the back of the bus, and then watching what people actually do. Chances are, you’ll see that people are either looking at their phones, or looking out the window. The thing is, though, you won’t really know unless you do the experiment to test your belief.

7. Seek professional help

A lot can be done to help with social anxiety, so please take action before 15-20 years pass you by (see Point 2). Psychological treatments such as Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT) have been shown to be effective in the treatment of social anxiety.[5]  You can also speak with your GP to discuss medication options.

Thanks for reading. We hope that the tips on managing social anxiety are helpful. 

Want more? Learn about Social Set, our 8-session Social Anxiety Course. Work one-on-one with a psychologist to develop a tailored approach to bounce back from social anxiety.

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REFERENCES

[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edition, DSM-5). Washington: American Psychological Association.

[2] Buckner, J.D., Schmidt, N.B., Lang, A.R., Small, J.W., Schlauch, R.C., & Lewinsohn, P.M. (2008). Specificity of Social Anxiety Disorder as a risk factor for alcohol and cannabis dependence. Journal of Psychiatric Research, 42, 230-239.

[3] Heiser, N.A., Turner, S.M., & Beidel, D.C. (2003). Shyness: relationship to social phobia and other psychiatric disorders. Behaviour Research and Therapy, 41, 209-221.

[4] Schneier, F.R, Foose, T.E., Hasin, D.S., Heimberg, R.G., Liu, S.M., Grant, B.F., & Blanco, C. (2010). Social anxiety disorder and alcohol use disorder comorbidity in the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 40, 977-988.

[5] Craske, M.G., et al. (2014). Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators. Journal of Consulting and Clinical Psychology, 82, 1034-1048.