Tussles between the head and heart

I read a really interesting piece of work by Richard Stott the other day. In 2007, he talked about a concept called 'Rational-Emotional Dissociation', or RED (I know; thank God for acronyms eh). RED is defined by Richard as occurring when a person holds two ideas in their head at the same time.

One of these ideas is "I believe X rationally" while the other takes the form "It feels as if X is false". In other words, you believe a particular thought in your head is correct (or incorrect), but your heart or gut feels the opposite way.

Richard kindly gives us a few examples to help us make sense of this concept. A couple of them include:

• A depressed father repeatedly experiences the thought 'I am a useless father'. He knows in his head that this thought is not correct, but emotionally he still feels this way. 

• You know there is nothing to be afraid of in reality, but you can't help feeling scared and frightened when watching a horror movie.

A couple other examples I can think of include (just so I can prove I don't have to rely totally on another person's material):

• I know it is perfectly safe to get on the train, but I can't help but feel something terrible is going to happen.

• I know that I do a good job at work, but I still feel as if someone is about to discover that I am actually rubbish (aka the 'imposter syndrome').

Richard makes the point that the 'severity' of RED ranges from totally harmless (and even humorous) through to seriously damaging to a person's day-to-day life. I find RED to be really interesting and something I come across quite a lot in my work. Strangely though, there's been almost nothing said about this amongst researchers. It seems like a missed opportunity because a better understanding of RED might actually help to assist people who suffer significant grief from this phenomenon.

At this point in the article, Richard launches into a discussion of the potential theoretical explanations for RED. I won't even try to summarise this part of the paper because it stretched my brain a little too far to remain confident that I could reproduce what he wrote without making a fool of myself. At the same time, I could make a real enemy of Richard, who I will now respectfully refer to as Dr Stott. In a nutshell, he argues that RED could result from a number of possible psychological, cognitive and neurological mechanisms. In other words, it's all a bit complicated and we don't yet have a good idea of what's going on under the hood.

Putting the theory stuff aside, there are some key strategies that might be used to tackle RED. One strategy might involve a cognitive approach where evidence is gathered to help weigh up whether the head or the heart is more accurate for a given situation. Going back to the 'terrible father' example above, that particular guy could gather all available evidence for and against that situation. Specifically, he could look for evidence (direct experience, actions of others, etc.) to support the statement "I am a good father". Equally, he could gather evidence to support the statement "I am a useless father". The next step would be to step back and evaluate both lists of evidence to determine the relative accuracy of the head vs. the heart (and hopefully the head is on the money in that situation).

Another approach could be to gather new evidence to 'test' a case of RED. For example, a person may experience RED in the form "I know there is nothing really to be afraid of, but I am still worried something terrible will happen at this party I've been invited to" (e.g. embarrassment, being negatively evaluated by others). An approach could be to attend the party (and hang in there for a reasonable period of time), then reflect on the experience later, noting what went well, what went badly, and an overall evaluation of the experience in relation to the fear that something terrible was going to happen.

There are a number of other potential strategies, some of which could involve taking a 'big picture' approach. For example, there may be a belief that RED serves some sort of broad function, such as keeping a person 'safe'  through an increased sense of being vigilant or on-guard. Teasing out such underlying beliefs (or 'metacognitions' as we call them in the business) could also be a useful way to address problems associated with RED.

If you are interested in Richard Stott's paper, here is the reference:

Stott, R. (2007). When the head and heart do not agree: A theoretical and clinical analysis of rational-emotional dissociation (RED) in cognitive therapy. Journal of Cognitive Psychotherapy: An International Quarterly, 21(1), 37-50.