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The Honolulu Advertiser
Posted on: Tuesday, January 24, 2006

Author dissects 'toxic triangle'

By Nanci Hellmich
USA Today

NACHO L. GARCIA JR. | El Paso Times

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When some women are under stress or dealing with a difficult situation, they stew about the problem, trying to figure out how they can control it or change themselves to make things better, says Yale psychologist Susan Nolen-Hoeksema. On the other hand, she says, men are more likely to blame external factors such as other people or the environment.

In an effort to try to cope with feeling tense, agitated or out of control, women sometimes do damaging things to their bodies: They might eat too much of their favorite fattening foods or drink too much alcohol. Or they might worry about what has happened or might happen or dwell on how they might have done things differently.

This results in the "toxic triangle," a reference to three troubles that afflict women: unhealthful eating, heavy drinking, and self-criticism and despair, says Nolen-Hoeksema, author of a new book, "Eating, Drinking, Overthinking: The Toxic Triangle of Food, Alcohol, and Depression and How Women Can Break Free" (Henry Holt, $24).

Nolen-Hoeksema, one of the nation's leading authorities on women and depression, also is the author of the popular book "Women Who Think Too Much." We talked to her about the new book:

Q. Does the toxic triangle apply to women who don't have eating disorders, alcoholism or depression?

A. Yes, many women have moderate symptoms of one or more of these problems but haven't crossed the line into diagnosable disorders. There is good research that moderate symptoms of all three of these problems can wreak havoc on functioning in every day life.

The problems interfere with women's work performance, their relationships with their family and friends, their sense of well-being and their self-esteem.

Q. You introduce a concept in the book called "self-focused coping" to explain how women respond to pressures. Can you tell us what you mean by that?

A. Many women feel as though they can't change their stressful circumstances, so they have to change something about themselves. They'll focus on changing how their body feels by eating or drinking. Or they'll go over and over the stressful circumstances in their minds, but not actually move forward to do something active to try to understand or change the situation.

Q. Do you think the toxic triangle is contributing to the nation's problem with obesity?

A. Yes, I believe it's contributing, because eating is a socially acceptable way of dealing with stress, more so than alcohol. Comfort foods tend to be high-calorie and very accessible. Women may turn to those to make themselves feel better whenever they are stressed. Then they get accustomed to them and start to crave those foods, and it makes it harder to switch to healthier foods.

Q. What is overthinking?

A. It's going over and over something that happened in the past or something someone is worried about happening in the future dissecting it, rehashing it, analyzing it but not moving forward, just staying stuck in the cycle.

Q. Do many men ruminate?

A. Some men do, but in all of our research, we find that women are more prone to it, especially in situations that make them sad or anxious. Men are more likely to ruminate about things that make them angry.

Q. How can women escape the toxic triangle?

A. They use their powers of self-reflection to recognize their unhealthy ways of coping and create a more positive image of themselves. They can use meditation or prayer, diary writing and problem solving to recognize their unhealthy habits and then to make choices about how they want to live more positively. Prayer is one of the most common things people say they do. Some people literally turn their worries over to God.

Q. How does exercise help?

A. It has biological effects by raising the brain chemicals associated with positive moods. It has psychological effects because you are doing something positive for yourself.

Q. What about medication?

A. Medication is helpful for a lot of women. SSRIs (selective serotonin reuptake inhibitors, which often are used to treat depression and anxiety) have been helpful for this cluster of problems, because they help to improve mood and reduce impulsive behaviors like binging.

Q. Why is it important for women to forgive?

A. We found that much of what women ruminate about are things that others have done to them or things they have done that they regret. So they'll go over and over it, asking themselves questions that they'll never have satisfactory answers to. One of the few ways they can get out of that rumination is to forgive themselves and the other person.