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).