Clinical psychologists and their patients need new ways to understand and confront the fear of losing control

Clinical psychologists and their patients need new ways to understand and confront the fear of losing control

Control is an important construct in the fields of psychology and psychopathology, particularly as it relates to anxiety and obsessive-compulsive disorders (OCD). Losing control, however, is a fear clinical psychologists observe in many patients but one that remains understudied and little understood.

A new paper published in the Journal of Behavior Therapy and Experimental Psychiatry presents a new perspective on this fear, with rich implications for future treatment and research. Adam Radomsky, the paper’s author and a professor in the Department of Psychology, outlines some recent work and offer thoughts about these fears and beliefs around the loss of control. He also addresses how this knowledge can be used to study, assess and treat patients with diverse psychological issues.

“I think this fear is very likely trans-diagnostic, meaning that it’s seen in patients suffering from multiple different disorders,” he says. “But what they fear losing control over, or what the consequences of losses of control might be, will of course vary from person to person.”

Radomsky, a core member of the Center for Clinical Research in Health, hopes the paper will promote increased interest to foster new research that can be carried out and later applied in clinical settings.

Seen across disorders

Radomsky says he developed his interest in the idea after hearing anecdotal evidence of this fear of losing control from multiple clients in his clinical practice. As a cognitive behavioral therapist, Radomsky treats patients with social anxiety disorder, OCD, panic disorder and other problems.

He says his clients do not necessarily tell him they fear losing control as a primary concern. Rather, they voice fears about making fools of themselves in public or that they are losing control of their minds or bodies and bodily functions. Others express fears of losing control of their belongings or surroundings.

“It’s something that can sit underneath the sorts of fears people bring into the clinic,” he notes.

To assess the levels of fears his patients are exhibiting, Radomsky and his students are building on techniques that use precise, experimental, questionnaire- and interview-based lines of inquiry.

“There are strategies we use in cognitive behavior therapy that can help people think differently about losing control and to act differently,” he says. “The research will help us explore how far we can expand on that.”

Radomsky says that asking people to try to lose control often leads them to be puzzled and to question how losses of control might work.

“If they can’t lose control even when they are trying to lose control, maybe it just doesn’t work that way,” he says. “Maybe control is not something you need to pursue because it is already there.”

Thinking carefully

Radomsky suspects that what many people call losses of control are in fact different ways of thinking about past decisions: It may be easier for people to call poor decisions made impulsively as losses of control, although this is an open scientific question.

“People will commonly say, ‘I lost my temper’ or ‘I was drunk and said something that I now regret.’ But on careful examination, what people are likely to say is that they wanted to act that way at the time,” he explains. “Is that losing control? I think—at least sometimes—that is being in control and then later realizing you made a mistake, perhaps by not thinking carefully about the consequences of your actions.”

This approach has clinical implications as well, Radomsky notes. With a deeper understanding of what leads to a patient’s choices, a therapist can help them make better ones in the future.

“I think that is much more in the scope of our work than trying to help people stay in control, which is likely to cause more problems,” he says. “If you are constantly trying to stay in control, odds are you’ll find that causes more problems than focusing on other issues.”

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