Patient x was an intelligent, attractive, athletic 20 year old college student who had recently been in a carjacking where he had been shot and almost killed. When he entered therapy with me it was absolutely incredible that this incident was hardly on his mind; what dominated his psyche was his uncontrollable blushing. This blushing, which had been present for many years, caused severe humiliation, shame, embarrassment, and depression. In addition it created substantial social avoidance, and relationship problems. X was very motivated in treatment. We were able to do core work on self-esteem. Concurrent to this, we worked on the technique of adrenaline acceptance, which is a paradoxical mode of thinking to anxiety sufferers. X adapted the thinking that he was quarterbacking or piloting decision making and began to re-structure the defensive positioning associated with his anxiety.
One day in college when he was presenting a report in front of his class, he started by saying “guys; in a minute you will see a magic trick; my face is going to change color”. Guess what? He did not blush. Why; you are probably asking. The answer is because he went on offense (psychologically and behaviorally) instead of playing defense. By doing this he de-activated his psychological internal critical script that activated his autonomic hyper-sensitivity and the horrific visceral response associated with blushing. Now don’t think that I suggest everyone implement this technique. It takes tremendous courage and substantial emotional work. The pathology of blushing is based on the sufferer’s belief that the blush is a character flaw and that when a blush occurs the flaw is revealed.
For years I feared your arrival, like an unwelcome last-minute guest who spoils the party every time, humiliating me in front of all my other, important guests. At first I had a hard time seeing you coming and was always caught off guard; then I came to expect you, so I stopped planning so many parties.
After a lot of work and introspection, I thought I had learned how to keep you at bay. But what I didn’t realize was thata my life became about keeping you at bay. You became my focus. When you failed to show up so often, I took it as a sign that I was doing well. And in many ways I was doing better. But I was measuring how well I was doing by the frequency and intensity of your appearance.
Now, I’m coming to realize that although dealing with you has been so very hard in many ways, just getting to that point is a very low threshold to reach in terms of having a good life.
At long last I’m learning that you are not some scary interloper bent on doing me harm. You’ve actually been trying to do me a favor, showing me in a way that was literally “in my face” that I was not respecting myself, wasn’t valuing myself above the assessments of others. Instead you were trying to tell me that I’ve been so preoccupied with what other people think that I have all but shelved my own natural impulses and desires about what I want out of life.
Unfortunately, for the longest time I misinterpreted your message. When I feel you coming, my tendency is to think, “Oh, no, not you again. What if people see you? I’ll be mortally embarrassed and humiliated.” And when I do that my focus stays on what people think. But now I know better than to stop there. My response, which is starting to come more naturally to me, is I am interested in getting the most out of this situation, both for myself and for others. Of course I am showing some signs of nervous excitement—that is normal. But I don’t have to worry if these people think I’m a good and worthwile person, because I know I am—that’s a given!
t has taken a really long time to get to this point. Part of me is angry about how much of my life I have wasted worrying about you. But there is nothing that I can do to change that and I have good years still ahead of me. I’m excited!
I’m putting more stock in what matters to ME. I’m putting my focus on envisioning things that I want to happen, rather things I fear happening. I’ve started asking for what I want, instead of assuming I can’t get it and never trying. Great new people are coming into my life. I find it easier to prioritize demands rather than being in a constant state of being overwhelmed.
The shift is energizing, but it’s still new and a bit scary. But I know this is the way I want to be.
In 2012 Brandon Thomas committed suicide. His parents said it was driven by his “unbearable blushing.” Soon after, Dr. Enrique Jadresic, who has been referenced as the world’s foremost Erythrophobia expert, publicly defined blushing as an “involuntary response,” adding “the best way to treat it is with a sympathectomy;” an invasive surgical procedure where nerves are cut to prevent blushing.
Jonathan Berent, L.C.S.W., has worked with thousands of Erythrophobia sufferers for more than 36 years, and vehemently disagrees with Dr. Jadresic that it is totally involuntary and that a sympathectomy is the best answer. . Berent says, “I’ve seen Erythrophobia lead to social avoidance, depression, & substance abuse. The psycho-physiological dynamics behind this disorder are crucial for medical & mental health professionals to understand if clinical progress is to be achieved on any meaningful scale”.
To help empower blushing anxiety sufferers, Berent created a self-help clinical program. The program is named Warm Hands: Cool Face.
There are 4 basic components:
- The adrenaline control technique
- An understanding of Mind States based on the psychology of transactional analysis
- The Sarnow Method: Core emotional work
- A self-regulation empowering exercise
Berent affirms that “believing that blushing is involuntary disempowers sufferers”.