Dealing with severely distorted thoughts and feelings in others

Short version: When someone sees the world as all black, is the proper way to deal with that psychological problem to only talk about what’s white and banish all talk of black things?

Long version:
Two threads on other forums lead me to this question.

In the first one, there is a man with (apparently) body dysmorphic disorder who, even though he’s handsome by most accounts, sees himself as quite ugly. He generally cares too much what others think of him and feels a lot of anxiety related to that.

The way I and some others have been talking to him is by saying that yes, there are situations where what others think of you matters and the way you look has an impact on the way others perceive you (e.g; job interviews, court appearances) . There are also situations where you shouldn’t care what others think of you. There are situations where you should care but much less than you currently do. There is a middle ground between crippling anxiety and not giving a fuck.

A second group has been talking to him and their only message is “Don’t care. Just don’t care”. They seem to think that any acknowledgement that what others think of you sometimes matters and that the way you look sometimes matters is just feeding the dysmorphic guy’s delusions.
In another situation, there was a woman going on about how, since she is hurt when her boyfriend watches porn, she should be able to (physically) hurt him when he watches porn. As you may expect, she was challenged on that. Her response was that her therapist said that whatever she feels is justified. Presumably, the therapist had not heard the patient’s theory about physically hurting her boyfriend.

It seems that the woman in question was in the habit of doubting herself a lot. Her being extremely upset and hurt that her boyfriend watched porn suggests serious insecurities. The therapist’s way of dealing with that self-doubt seems to have been to tell the woman that whatever she felt was justified.

The way I would have dealt with it is by establishing that in some situations what one feels is justified and in others it isn’t and try to get the person to determine when it’s justified and when it isn’t. It’s not black & white. If I feel that everyone must call me “Michael Emouse, Esquire”, that doesn’t make it so, even if I were to feel it very strongly.

I prefer my way of first acknowledging the reasonable parts of someone’s self doubts if there are any. If someone feels anxiety about how they’re perceived, I first acknowledge that there are situations where caring about what others think of us makes sense. And then I make sure to follow it up with a second part about how in other situations we shouldn’t care or care in specific, limited ways.

Is that the best way? I can see how acknowledging that there are situations where others’ perceptions are important could be taken by the afflicted individual as a confirmation of all their distorted thinking. When dealing with someone who has severely negatively distorted thoughts and feelings, it may be effective to deny even the accurate negative thoughts and feelings.

If the reality is shades of grey and someone sees everything in black, you may first pretend everything is white. Once the person has gotten out of their “everything is black” thinking, then you can start adding nuance.

I can see the merit of that method. Yet it seems as mistaken as the problems it seeks to solve. A person can hurt themselves and others as much by thinking “Everything I feel is justified” as by thinking “Nothing I feel is justified”. A man who thinks “Others’ perception of me don’t matter” will likely run into problems, though not of the same type as the man who is dysmorphic and feels great anxiety from others’ perception of him. Countering simplistic negative thoughts with simplistic positive thoughts may lead to an equal but opposite set of problems.

What do you think is the best way of dealing with severe distorted thoughts, insecurities and doubts? Are there different strategies that work best in some situations but not in others?

Forgot this part and 5 minutes were up:

I would also think that my way makes the positive talk more credible since it acknowledges the true parts of the negative thinking. In the same way that a salesman who acknowledges the imperfections of his product, a lawyer who admits the faults of his client or the entrepreneur who acknowledges the risks in his business plan are more credible than those who insist that there are no negative aspects.

It seems a major risk of denying all the negative thoughts and feelings, even the accurate ones, is that the afflicted person will no longer trust you to tell him the truth and will reject your simplistically positive view.

Honestly?

I think the guy needs a trained therapist, preferably one who specializes in cognitive behavioral therapy, to help him start seeing the world in a less distorted way. As nice as it is that he’s got friends online who want to help, it’s a very difficult thing to change. I say that as someone who is constantly fighting irrational thoughts of my own.

My husband currently helps me see my irrational thoughts so I can re-evaluate them as they become a problem, but that’s only possible because I’ve been through enough therapy to know how to recognize, classify, and deal with the thoughts on my own, and I’ve explained to him how he can help me. I have a few close friends who know me well enough that they can help sometimes too, but I think that’s only possible because I’ve come along way myself. If the guy you told us about is really weighed down by his distortions, then he’ll need to put some work in on his own, with a therapist’s guidance, before the helpful words of his internet friends will actually help.

Tough love, where you keep showing the person how wrong he is about his thoughts, isn’t necessarily helpful, because it can make him feel even worse. And the other side, where you acknowledge the validity of part of the thoughts… that may be very true, but for someone in the deepest levels of irrational thinking, it may just strengthen their internal position. Right now, when a good friend says to me “oh, cut that shit out, you’re being irrational again”, I can look at my thoughts, laugh at them, and toss them out. But years ago, when I was very depressed and did not have the skills that I do now, I would have felt even worse, because now not only did I hate myself, but I also felt like I was annoying everyone.

Self-help really does need to come first. That’s just my opinion on the matter, of course. Take from it whatever you wish.

Maybe the woman has misunderstood her therapist? I can’t imagine a respectable therapist saying that one’s feelings are always justified. But I can imagine one saying that feelings are neither right or wrong; they just are.

What can be wrong are the underlying thoughts. The woman is upset because she thinks her husband is cheating on her, so that is the thought she needs to work on fixing. But what if her husband was cheating on her? Telling her she shouldn’t feel upset isn’t helpful because it’s dismissing the fact that what she’s feeling is quite natural, if what she believed was true.

As far as someone with body dysmorphia goes, their thought processes are so distorted that they are almost delusional. I wouldn’t recommend anyone but a trained professional helping in this situation because even the most well-intentioned friend can make things worse.

This. Like Antigen I struggle with distorted thoughts of my own, and CBT is a real key to sorting out when my thoughts and perceptions are helpful/productive, and when part of my brain is just being a huge jerk and shouldn’t be listened to. (That latter bit is how I find it helpful to think about the situation, but everyone’s perspective varies.)

Positive/negative reinforcement coming from outside is ultimately less important than learning how to evaluate one’s own thoughts and feelings critically, and maintain a constructive internal dialogue-- but outside input can really muck up the works if someone is still struggling with the whole concept, and body dysmorphic disorder (as monstro said) is an especially nasty case of distorted thinking. Oof. In that case, support and love and encouragement to talk to a professional who can help your online friend feel better about his own body may be the most responsible position to take.