Written by Matt Bartlett, Executive Director – Saratoga Springs Campus, New Haven Residential Treatment Center
The world we live in can often be challenging. Many of us deal with the pressure and stress of everyday life in different ways. Sometimes the simple task of watching the news or scrolling through social media can trigger anxiety or bring back memories of trauma that hinder progress.
The impact of trauma on adolescents can be life changing and devastating to overall healthy functioning. Living in a world with heightened emotions, anxiety, and constant threat as a result of the trauma hijacks the brain from normal usage and development.
Emotional and psychological trauma is the result of extraordinarily stressful events that shatter the sense of security, making individuals feel helpless and vulnerable in a dangerous world. Trauma can take over the daily routines of an individual and handicap them socially and emotionally.
Expertly trained therapists at New Haven Residential Treatment Center follow key strategies to treat and reduce the impact of trauma. By creating a safe onhealthy cymbalta environment, students are able to share the traumatic experience through narrative which allows exposure and extinction. While painful, this narrative is similar to “cleaning a wound”. Words and pictures must be shared. Through sharing, processing, and describing the events, the memories created around the traumatic experience can be reduced to a memory rather than a guiding force. Relaxation and meditation are taught so the individual can identify and modulate feelings. Other approaches include cognitive techniques such as thought stopping, positive self-talk, reviewing safety plans, enhancing social skills and problem solving for dealing with triggers.
As the impact of the trauma memory is reduced, new connections are made in the brain. Newly formed neurons are wired together which counter the devastating effects of traumatic experiences. As an individual heals from the traumatic experience, they can re-write the narrative and not let the trauma control life.
Written by Clementine adolescent treatment program Dietitian Alyssa Mitola, MS, RD, LD/N. Alyssa works closely with the adolescents at Clementine Miami Pinecrest to gain a more positive relationship with food. In her post, Alyssa shares some insight in the education and support given to the adolescents while on the path to full recovery.
You just need to lose a little weight.” “Eat healthier.” “We need to put you on a diet.” Countless of our clients with BED have endured comments such as these by friends, family, and even medical professionals. Many of our adolescents with BED arrive with significant “diet histories.” Even at the age of 16 we have had clients who have been on diets for over 10 years. How has that impacted them? The eating disorder often gets overlooked due to the focus on body weight and the false notion that restricting the diet is the only way to improve health
All too often weight alone is used to determine “what” or “how” a person should eat. Foods are classified as “good” foods and “bad” foods. However, this misunderstanding of nutrition fails time and time again. This message often leads our clients to feel like a failure because they are unable to follow the “diet” prescribed.
Here at Clementine we recognize that weight is not the only indicator of health. When a client walks through our doors we do not cut out foods, but in fact encourage the client to re-introduce the foods they may have been previously told to “cut” out. At first this can be extremely scary for our clients and parents. Blaming the type of food has been onhealthy provigil engrained into their way of life. But as we slowly heal this relationship with food, the fear is reduced and overall health improves. Numerous times we have seen improvements in LDL (bad cholesterol) and fasting insulin levels independent of weight loss. The labs improve while this client continues to eat a variety of foods. When we begin to heal the relationship with food, we see improvements that others often think can only be achieved on a restricted diet.
This work is only started here at Clementine. Our clients continue to cultivate their relationship with food and their bodies when they return home. However, our clients can leave with improved markers of health even when the focus is not the weight. Let’s stop blaming the individual food and start looking at the power this food may wield over our children. Whether a dietitian, nurse, teacher, friend, parent, we must be careful about the nutrition information we disseminate. As we shift the talk away from weight loss and restrictive nutrition recommendations, we can start talking about our relationship with food. When we are solely focused on the number on the scale we forget that health cannot simply measured by a number.
This article originally posted on the Clementine Blog (http://clementineprograms.com/2016/11/15/cultivating-a-positive-relationship-with-food/).
For more information about Clementine adolescent treatment programs, please call 855.900.2221, visit our website, subscribe to our blog, and connect with us on Facebook, Twitter, and Instagram.
To visit or tour a Clementine locations with one of our clinical leaders please reach out to a Clementine Admissions Specialist at 855.900.2221.
REQUEST: STRIPED, MEDA, and NEDA urge state leaders to protect the young people of Massachusetts from the dangers of diet pills and muscle-building supplements. A new bill, which will be introduced in 2017, will aim to address this issue. If passed, this bill will ban the sale of diet pills and muscle-building supplements to minors under 18 years old and will move these products behind the counter, requiring consumers to request them directly from a pharmacist, manager, or other store supervisory personnel.
STEPS MASSACHUSETTS CAN TAKE TO PROTECT ITS YOUTH
1) PROHIBIT SALE TO MINORS. Massachusetts can prohibit the sale of diet pills and muscle-building supplements to minors under the age of 18 years. Due to their developmental stage, youth may be unable to weigh the harms linked with these products.
2) MOVE PRODUCTS BEHIND THE COUNTER. Moving diet pills and muscle-building supplements from the shelves to behind the counter will ensure that consumers will first speak with a pharmacist, manager, or other store supervisory personnel.
3) URGE THE ATTORNEY GENERAL. The Massachusetts Legislature can urge the State Attorney General to enforce consumer protection statutes that prohibit unfair or deceptive advertising of diet pills and muscle-building supplements.
4) EDUCATE CONSUMERS. The Massachusetts Department of Public Health can educate consumers about the health risks associated with dietary supplements sold for weight loss and muscle building, as well as the risks associated with misuse and abuse of over-the-counter diet pills.
Strategic Training Initiative for the Prevention of Eating Disorders
Boston Children’s Hospital
Division of Adolescent/Young Adult Medicine
300 Longwood Avenue, LO306
Boston, MA 02115
Multi-Service Eating Disorders Association
288 Walnut Street, Suite 130
Newton, MA 02460
National Eating Disorder Association
165 West 46th Street, Suite 402
New York, NY 10036
Written by Dr. Kari Anderson from Green Mountain at Fox Run
Mindfulness describes the practice of being aware in the present moment, without judgment. And when mindfulness is applied to eating, the resulting practice is called mindful eating. Who wouldn’t benefit from such a practice?
In particular, mindful eating can benefit those individuals who are being treated for eating disorders. But the effectiveness of mindfulness when treating eating disorders depends on the level of readiness for such an intervention. Because eating disorders fall along a continuum of behaviors, there are significant differences from one end to the other end of the continuum, despite commonalities. For example, anorexia, in many ways, presents as “opposite” to binge eating disorder; therefore, the treatment needs to be different, at least in the early stages of recovery.
In general, those with binge eating disorder have less acuity and should be introduced to mindful eating early to help heal the relationship with food and eating pathology. On the other end of the continuum, those with anorexia have physical treatment goals that come before addressing eating pathology.
Treating Eating Disorders
Eating disorders can be seen as adaptive behaviors that become disorders. They are very logical, once the neurobiology, socio-cultural pressures and the self-regulatory response to stress that drives the behavior are understood. From a basic needs level, the Self Determination Theory simply explains disordered eating as a way to thwart or substitute needs. Eating disorders can be extremely effective until they’re not, and ultimately, eating disorders create more problems than they solve. Therefore, the sooner an ED sufferer learns how to meet their true needs, the better.
Cognitive behavioral therapy (CBT) has been the gold standard for treating eating disorders because it addresses the thoughts and emotions that lead to the behavior. Unfortunately, traditional CBT has shown only to be half as effective as it could be, largely due to the strong motivation needed in the treatment of eating disorders. The “resistance” that is often seen in this population is very responsive to an adapted form of CBT, called Dialectical Behavioral Therapy (DBT).
DBT was the first mainstream use of mindfulness to treat eating disorders. It shows a much higher effectiveness rate for those with binge eating and bulimia disorders than does traditional CBT. DBT addresses patient resistance, while offering solutions that positively influence regulation and stress management for those who turn to food for exactly those purposes.
Several mindfulness-based therapies have since emerged, known as Third Wave Cognitive (ACT, MBCT, MBSR, MB-EAT and the like). Surprisingly, treatment-resistant anorexia also can respond to Acceptance and Commitment Therapy (ACT), partly because it focuses on core values, not just thoughts and emotions. Regardless of the form of mindfulness-based treatment, the primary advantage lies in disengaging the stress reaction and anxiety that blocks the ability to change.
Mindful Eating in the Treatment of Eating Disorders
Humans are hardwired to react to stress, whether real or perceived, by fighting, fleeing or freezing. Many people turn to food to relieve stress, as eating can emotionally and physically calm us down by activating the “rest and digest” processes of the body.
Whether we have a hyperactive stress response or not, there are lots of things that create stress. But today’s dieting culture, judgmental and body-biased environments, and “no pain, no gain” exercise trends put tremendous stress on our bodies emotionally and physically. Together, they reinforce the cycle of turning to food to self-regulate.
Any therapies that can disengage the fear response and allow for our parasympathetic nervous system to help us find homeostasis will decrease the reactivity and impulsive nature around food.
One aspect of mindfulness that is tailor-made for eating disorders is that it helps manage the thoughts that lead to judgment. The “without onhealthy paxil judgment” part of the definition of mindfulness is essential because it diminishes our emotional reactions toward ourselves and others, keeping us out of an escalated state.
Furthermore, mindfulness theory has contributed to the emerging trend of self-compassion, which promotes the power of disengaging the judgmental mind and embracing oneself in the safety of self-nurturing. This repairs the breached bond necessary to relax into safety and begin to trust in humankind. The focus of being present in the moment disengages the fear of the future (worry) and regret of the past. When our mind is filled with the past and the future, our stress response is activated. And unless you are in a cage with a tiger, the present moment should be relatively void of stress.
Mindful eating means awareness in the present moment without judgment before, during and after eating. Eating pathology can be healed by introducing a healthy relationship with food, meeting needs of autonomy and competency with food. It simply is the best model for long-term sustainability of healing from an eating disorder because it counters the rigid rule-driven behaviors propelled by the internalized thin ideal found in most eating disorders.
However, mindful eating in the treatment of eating disorders can get tricky. A number of adaptive eating behaviors become automated by the brain and other complex feedback loops that regulate hunger and fullness. Regardless of why the initial behavior was developed, the body creates neuropathways and physiological adjustments that can override the basics of mindful eating. As such, interventions such as refeeding protocols or meal structure corrections may be necessary to restore the brain and physical health to a state where mindful eating can be effective.
For example, in the case of anorexia, allowing one to “wait for hunger” may result in further starvation. A person who binge eats has a diminished feedback mechanism to signal fullness; without a model as to what is “normal” eating, a binge-restrict cycle may be perpetuated.
Lastly, there are more important treatment interventions prior to the introduction of mindful eating, mainly those who are not weight restored or are engaged in active purging behaviors. Physical stabilization is of highest priority.
The treatment of eating disorders requires specialized care. If there is any question as to whether a client has an eating disorder, he or she must be referred to a Certified Eating Disorder Specialist (CEDS) or someone with similar training and experience. Likewise, mindful eating professional should refer their clients with eating disorders to a network of professionals — such as psychologists and registered dietitians trained to treat eating disorders. Eating disorder professionals who lack training in mindful eating must first understand that mindfulness is not merely a technique, but a full embodiment of a non-judgmental, open and compassionate awareness of their clients. This embodiment takes training, but most importantly, practice, a mindfulness practice.
The Big Picture
Practicing mindfulness addresses the need to disengage the stress response and create safe environments. At some point in their journey, those individuals healing from an eating disorder can benefit from a mindful practice and from mindful eating. The point at which one introduces mindfulness is largely determined by where a person is on the continuum of behaviors and their level of physical and emotional healing.
Dr. Kari Anderson has been treating eating disorders for 25 years, with particular emphasis on Binge Eating Disorder. She is the Executive Director for Green Mountain at Fox Run and Chief Clinical Director for the newly opened Women’s Center for Binge and Emotional Eating in Ludlow, Vermont. Her website is http://www.fitwoman.com.
This article originally appeared in the Summer 2016 issue of “Food for Thought”, a publication of The Center for Mindful Eating (www.thecenterformindfuleating.org).
by Matt Bartlett, LMFT of New Haven Residential Center
The holidays are a great time to enjoy family and friends and appreciate all that life has to offer. But they can also be a trying time, filled with stress, anxiety, unexpected temptations and a pace that can make your head spin. Along with all of the wonder and delight it’s important to remember that the holidays can be even more challenging for someone who is currently in treatment and experiencing their first home visit or transitioning home from residential treatment.
Tensions often run high at this time of year and as a member of the family works to assimilate back into the fold, it’s important to not get hung up on the issues or problems that took them out of the home in the first place. Families may find themselves reverting back to past behaviors as they interact and encounter some of the same problems. Rather than letting the past ruin this holiday season, take a look at five things to try to help prevent escalation at home:
1) Keep your sights set on the other person’s emotions and deal with emotions before anything else! The vast majority of our altercations happen when we are focused on behavior and words, rather than the emotions that drive them. We have to be less emotionally reactive as parents.
2) Avoid misappropriating responsibility. Let go of what you can’t control! Focus on what you can control. Remember, your daughter’s/son’s emotions, physiology, feelings, and thoughts are NOT within your control.
3) Try using onhealthy lipitor “responsible language”. Speak in terms of what you are responsible for (your actions, your thoughts, sometimes your feelings), and what others are responsible for (their actions, their thoughts, sometimes their feelings).
? If you are struggling with perceiving who is responsible for what, try finishing each blaming statement you make with the phrase, “ . . . and I take responsibility for it!” until you get the point. It’s a little corny, but it’s fun and it works.
? Use the words “choice”, “choose”, and “choosing”, often.
? Instead of using the phrase, “I am angry,” use this new phrase, “I am choosing to anger myself,” OR, “I am choosing to be angry.”
? When your daughter/son hurts you, say things in this way: “Because you are choosing to do such-and-such, I am choosing to feel and do such-and-such.” (Be careful to be gentle when using this technique. It’s easy to use as a weapon.)
4) Negotiate rather than coerce:
? Identify and describe the problem so that you and your daughter/son agree on the description of the problem.
? Make an offer: “This is what I can bring to the table.”
? Allow your daughter/son to make an offer. Do not make offers for her/him.
? Working only with what is currently “on the table”, work to compromise.
? No one leaves until a compromise is reached. This could take a while!
5) Get creative! Stop doing the same thing. Try new approaches to old problems. HOW you influence is what’s most important.