The Center for Eating Disorders Blog

Body Respect Q&A with Linda Bacon, Ph.D. ~ Part I


Linda Bacon, Ph.D. is an internationally recognized authority on weight and health.  She will stop by Baltimore this fall for two events aimed at dispelling long held myths about weight and health within the medical community and in our society at large. A nutrition professor and researcher, Dr. Bacon holds graduate degrees in physiology, psychology, and exercise metabolism, with a specialty in nutrition. She has conducted federally funded studies on diet and health, and  published in top scientific journals. Dr. Bacon’s advocacy for Health at Every Size (HAES) has generated a large following on social media platforms and the international lecture circuit. Her book, Health at Every Size: The Surprising Truth About Your Weight, called the “Bible” of the alternative health movement by Prevention Magazine, ranks consistently high in Amazon’s health titles. Her latest book, Body Respect: What Conventional Health Books Get Wrong, Leave Out, or Just Fail to Understand, co-authored by Lucy Aphramor, is a crash course in all you need to know about bodies and health.

We recently had the pleasure of corresponding with Dr. Bacon to get answers to some of your most popular questions about HAES, the work she does dispelling diet myths and her newest book, Body Respect.  You can find Part I of her responses below, and Part II is available here.

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Q & A with LINDA BACON, Ph.D.

Q: What led you to pursue writing about and researching health and weight science?

LB: My journey began from own personal pain: in my adolescence and early twenties, I believed that I was fat, that there was something wrong with being fat, and if only I lost weight, everything in my life would be better: my parents would be more proud of me, I’d be more popular… Those thoughts sent me on the painful journey of fighting my weight, and included an academic search for a solution. What I found along that academic journey surprised me: the research contradicted many of the commonly accepted beliefs I held about weight. I developed a critical lens through my work first as a psychotherapist, next as an exercise physiologist and later a nutritionist. And that critical lens has been so valuable in re-learning how to look at myself, and my own relationship with food and my body, and come to a sense of peace and contentment. The war that was originally waged against my self – the fat on my body – was more appropriately waged against oppressive attitudes about fat. I’m now on a mission to share what I’ve learned, both to support others in their personal journeys and to support social change. Our culture plays a huge role in fueling our disconnection with self and it’s critical we move towards a more just and compassionate world so that this struggle isn’t so normative. No one should experience the pain and body shame that I – and many others – routinely do.

Q: What are the most important tenets of Health at Every Size (HAES)?

LB: I see three aspects as being most important: 1) RESPECT, including respect for body diversity; 2) CRITICAL AWARENESS – challenging cultural and scientific assumptions; valuing people’s lived experience and body knowledge; and acknowledging social injustice as a hazard to health and well-being; and 3) COMPASSIONATE SELF-CARE – in eating, movement, and other areas. There’s a lot packed into those words, so here’s the simpler response: HAES is all about supporting people in moving towards greater acceptance and improved self-care, and advocating for the institutional and social change necessary to support that.

Free event in Baltimore on November 8th. Click image for details.

Q: Why do you think so many people continue to rely on dieting when the data isn’t there to back it up as an effective remedy for weight loss or improved health?

LB: I have a lot of compassion for dieters. The dieting belief system is so strongly a part of our culture and medical belief system, it makes sense that many people would buy into it and believe they are doing the right thing. And there is so much fantasy imbued in the results: the belief that one will be seen as attractive and successful, and that it will ameliorate disease. It makes sense many people grab onto it, and get a sense of hope when they try. And we’re taught to believe the “experts” rather than to trust our own experience. So when the diet fails to give them lasting results, the dieter blames him or herself, rather than the diet.

The diet is the problem and it’s the diet that fails, not the dieter. It takes courage to take our power back and recognize that the problem is out there, not in ourselves, that we have a system inside us well-designed to help us manage our weight, if only we trust it. The HAES journey is about helping people to understand that the source of their pain is not the weight itself – but the weight prejudice, and to reclaim their power to know what, when, how to eat, and a new attitude towards other self-care behaviors.

Not long ago, I had a very poignant experience of the damages of the diet mentality. I attended a wedding reception where there was a beautiful buffet of gourmet food. At one end of the buffet was the proud father of one of the brides. (I’m in California, where it’s legal for lesbians to marry.) He had helped plan this party; to him, sharing food was part of the ritual that brought his daughter’s friends and family together. At the other end, three women approached. One looked at the display and said, “Oh, I really shouldn’t.” Her friend commiserated, saying, “It really is tempting, isn’t it?” They all looked on sadly. This is the world we have created. These women are “good” dieters. For them, virtue lies in confronting the temptations of good food, exerting their willpower, and overcoming their desire.

This saddens me. I want a world where food is about nourishing us, body and soul, where we can celebrate with the shared ritual of eating. Where you eat what you want without guilt… and without bingeing. Where eating is uncomplicated by weight concerns.

Fortunately, that world is possible and the Health at Every Size movement helps to articulate it. I live in it myself, and I’ve tested it in a randomized controlled clinical trial. And my results have been reproduced by others. We have shown that people – yes, even “obese” people who are experienced dieters – can learn to dump the diet mentality and celebrate food, and that it results in improved nutritional choices and improved health outcomes. And that it does not result in that feared weight gain.

Q: In your new book, Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight, you and your co-author Lucy Aphramor write a lot about the influence of social justice on weight and health. What’s the most important thing you think people should understand about the impact of inequality and social differences on weight and health?

LB: I can sum it up in three words: “our stories matter.” Our experiences in the world get lodged in us on a cellular level. The experience of oppression, for example, triggers a chronic stress response, which in turn leads to weakened immunity and increased risk for many diseases. When we focus solely on an individual’s weight or health habits, we miss these structural and political inequities, and it stops us from addressing the policies and systems that have a far greater impact on our health. It also supports a culture of blaming individuals for their disease: e.g., “it’s your fault for getting diabetes; if only you ate better.”

How we get treated in the world has a huge impact on our health. Acknowledging the power of social status in determining health can help take the blame off of the individual and will have more significance for tackling health disparities than getting more people to stop smoking, or to be more active, or to eat more nutritiously. This doesn’t mean that we need to stop talking about behavior change: helping someone take better care of themselves is valuable. But it needs to be put in context. Once we understand this, it opens up new avenues for self-care and for how health care gets practiced.

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Interested?  Want to learn more about Dr. Bacon’s research and how the focus on weight can obstruct us from achieving health?  Read more in Body Respect Q&A with Linda Bacon: Part II.

Then join us in Baltimore on November 7th and 8th to see her speak. Visit our Events Page to reserve your seats.


 

Body Respect Q&A with Linda Bacon, Ph.D. ~ Part II

Welcome to Part II of our discussion with internationally acclaimed author and researcher, Linda Bacon, Ph.D.  If you missed Part I, you can find it here

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Q&A with Linda Bacon, Ph.D. ~ Part II

 

Q: What are some of the repercussions of evaluating a person’s health by their weight?

LB: One key repercussion is misdiagnosis. Some thin people get the diseases we blame on weight – and they often don’t get diagnosed until later when they’re more advanced and harder to treat – and many heavier people never get the diseases we blame on weight. And then of course, it introduces the nocebo effect: tell someone they’re going to get sick and they probably will. So it’s just bad medicine. (And expensive! Those excessive costs attributed to “obesity” can be better attributed to weight bias.) Fat or thin, the conflation of weight and health imbues people with a fear of fat and distracts us from what really matters. It brings stigma, a problem of social justice, into health care. It’s both ineffective AND damaging.

 

Q: How could a focus on weight, or on weight loss, get in the way of effective healthcare? Can you give a specific example?

LB: My knee has been bothering me a lot lately, and that provides for an easy example. My father suffered from similar knee problems. However, he was fat (I use that as a descriptive term, stripped of pejorative connotations) and I’m not, resulting in very different treatment from our orthopedists.

My doc told me to first try physical therapy, that stretching and strengthening the muscles around the joint can help. Surgery was also presented as an option.

But what did my father’s doctors recommend? They put him on diets – over and over again. He never developed a regular exercise habit and struggled with weight cycling and disordered eating his whole adult life.

Carrying more weight may have aggravated my dad’s joint problems; no doubt there are ways it’s hard to be in a fatter body. (I should add parenthetically, that there are also ways it confers health advantage, but that’s a much longer blog post.) But trying to lose that weight is no kind of solution. I can assure you, my father – almost all heavier people – they’ve tried already.

My dad went to his death with knee pain. That’s just not effective healthcare. Even if fat is a causative factor and weight loss may be helpful in reducing symptoms, that doesn’t mean that prescribing weight loss is an effective or helpful solution. (Note also that it’s well documented in the literature: prescribing weight loss is more likely to result in health-damaging weight cycling than sustained weight loss.)

My advice in training health care professionals in respectful care with larger people is to start by considering how they would treat someone in a thinner body. Appropriate exercise? Meds? Surgery? Then do what you can to support your patients in implementing your advice and handling the challenges posed by their particular body.

It’s important to remember that good health habits benefit everyone, across the weight spectrum. And that you can’t diagnose someone’s health habits by looking at them. My father – and people of all sizes – could also have benefited from eating disorders screening. Appropriate eating disorders treatment may – or may not – have a side effect of weight change.

 

Q: On November 7 and 8 you will be speaking at two events in Baltimore, one for the community and another specifically for health professionals. What are some of your main goals for each of those talks and who do you think could benefit from attending?

LB: More than anything else, I want to inspire people. For the general community, I want attendees to leave with a sense of hope, that they can lose the guilt and shame and instead take pleasure in eating, that they can look at their bodies kindly. And I want the health care professionals to leave with a greater sense of agency, feeling empowered that they know how to be helpful for people. I want all of us to walk away with a stronger sense of community, feeling that we’re part of a committed group of people helping to make this a more just and compassionate world.

 

Q: Are you hopeful that our medical community, or even our society in general, will be able to make a paradigm shift away from a focus on weight? What helps you stay focused on and inspired by this goal?

LB: I do feel quite hopeful. I’ve watched the transition that’s been happening over the years, how my message resonates with the medical community, once exposed. Most professionals are feeling disillusioned with the old system, and I’m frequently told that coming to hear me talk is a relief. It allows them to take their disquiet seriously and they feel empowered to be presented with solutions that make sense.

But I’m not naïve. As much as I’d like to have faith in the inevitability of justice being done, and the old paradigm being tossed by the wayside, I’m just not confident that’s going to happen large-scale in the mainstream anytime soon. But I find it very liberating to consider that maybe the point isn’t victory, as much as we would like to see that done. Maybe the real issue is that by speaking my truth, I sleep better at night and it gives me hope.

Desmond Tutu offered this advice as rationale for the work of a freedom fighter: You don’t do the things you do because others will necessarily join you in doing them, nor because they will ultimately prove successful. You do the things you do because the things you do are right.

Dr. Linda Bacon

So I try to let go of the preoccupation with outcome, and find fulfillment in my involvement in something worthwhile, and being a part of this greater community. I look forward to being at Sheppard Pratt soon, and connecting with more people committed to a more just and respectful world.

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Many thanks to Dr. Linda Bacon for sharing her time, expertise and compassion with our online communities.  Please join us November 7th in Baltimore when Dr. Bacon will offer an in-depth training for health professionals and then again on November 8th for an inspiring free community event. Find out more and register for both events here.

See Also: BODY RESPECT Q&A with Linda Bacon: Part I

Understanding Hopelessness & Cultivating Hope: Discussing Suicide and the Death of Robin Williams

As the world feels and reacts to the news of Robin Williams’ death, the national conversation has turned quite rapidly to suicide and suicide prevention. Unfortunately, to those of us in the field of mental health, these headlines require daily observance. In general, individuals struggling with eating disorders are more likely than those without eating disorders to think about and attempt suicide. One study found that risk for suicide is approximately 23 times higher in those with eating disorders than in the general population of the same age (Harris and Barraclough, NSPL_Logo_home1997).

While we feel strongly that the details surrounding Williams’ death are a private matter, it has been publicly acknowledged that he was battling severe depression and had a long history of substance abuse.  Among a multitude of public reactions to the news, there is a pervasive feeling of shock that a person whose public life was built around laughter and joy could simultaneously be experiencing so much pain. People far and wide are wondering how this hilarious and much-loved person could actually be feeling so hopeless?

Hopelessness is a difficult topic, particularly for individuals who are not in the midst of feeling it and, perhaps as a result, have a difficult time conceptualizing how anyone else could ever get to a point that they feel completely unable to be helped. But understanding hopelessness is at the core of every discussion about suicide. Discussing it honestly and compassionately can make a difference for those who struggle. Carrie Arnold, a former guest speaker here at the Center, wrote openly about this on her blog after receiving the news about Williams. A poignant account of her own experience with depression and attempted suicide, Arnold captures the importance of striving to understand and develop compassion for individuals in a state of despair.

“We talk of people who complete suicide as being ‘selfish’ that they couldn’t sense their loved one’s pain. Yet when those feelings of utter despair washed over me, all I could think about was the pain I was causing others.”

Arnold goes on to talk about the venture back from despair and the rebuilding of hope, desire and gratitude, writing:

“Then you figure out that you have started living life again without even realizing it. There’s no miracle moment, here, just the slow stringing together of small moments into a narrative called your biography.”

Carrie Arnold’s story is extremely important to tell because it reflects the stories of so many others that don’t make headlines and rarely get told. This is the story of traveling to the brink of hopelessness and continuing right on through. This is the story of hope. The message to people struggling with eating disorders, depression or addiction is that you can prevail.  You can feel hopeless and still not be hopeless.

Almost every single guest speaker we’ve hosted to speak about recovery through the years have shared that they felt hopeless a lot and that they fully believed recovery was impossible for them. They were sure of it. Yet there they are, years later, standing on a stage telling their incredible story of recovery.  Rest assured, many people living full,  meaningful lives without their eating little tree growingdisorders today were once sitting there in front of a computer screen thinking about how recovery was impossible for them too. Too many lives have been lost to suicide, there is no question about that. Yet so many others have been to the depths of hopelessness and traveled back. In fact, according to the Action Alliance for Suicide Prevention, “the vast majority of people who face adversity, mental illness, and other challenges—even those in high risk groups—do not die by suicide, but instead find support, treatment, or other ways to cope.” This is where we can begin to cultivate hope. Do not listen to any voice that says you can’t recover. YOU CAN.

The news of Robin Williams’ death is a reminder to each of us that hopelessness rarely puts itself on parade. Hopelessness hides; it isolates and it often masquerades as your neighbor, friend or coworker trudging quietly through the thickness of depression all while posting exciting status updates on Facebook or volunteering at their child’s school with a fresh smile. If we take something from the tragic passing of a beautiful person and talented actor, let it be this:

Depression does not discriminate.  A well-polished public life – house, career, car, body, wardrobe, etc – is not an accurate reflection of a person’s private life or emotional experience. Check-in with friends if you know they’ve struggled with depression in the past, and never assume that someone is okay based on outward appearance alone.

ASK FOR HELP.   It is not shameful to struggle out loud. Be honest with those around you about how you’re feeling and do not allow your hopelessness to hide.  Talk to friends, family or call the Suicide Prevention Lifeline at 1-800-273-TALK (8255) if you are in crisis.

Depression, eating disorders and substance abuse are treatable illnesses. If you’ve traveled through hopelessness and back again, share with others about that experience of healing so they know it’s possible and that hopelessness is not a one-way street. Encourage others to get treatment.

Know the signs and symptoms that someone is in immediate danger for suicidal behavior and become educated about underlying risk factors for suicide. For example, adolescent boys and girls engaging in multiple unhealthy weight control behaviors are at greater risk for experiencing suicidal thoughts (Kim, et al, 2009).

For more information about the risks of suicide associated with eating disorders, please visit Medical Complication of Eating Disorders.

If you are interested in getting treatment for an eating disorder and co-occurring issues such as depression, anxiety, trauma or substance abuse, please call us right away at (410) 938-5252.  You are not alone.

www.eatingdisorder.org

*Tree image courtesy of Just2shutter and FreeDigitalPhotos.net

 

Moving Past Resistance & Finding the Motivation to Change

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“Getting over a painful experience is much like crossing monkey bars.
You have to let go at some point in order to move forward.”
~C.S. Lewis

Change is hard. You’ve likely heard this statement before. It’s also likely you’ve experienced it firsthand because, well, we all have. It’s one of those universal truths. Perhaps you’ve gone through the end of a relationship, relocated to a different city, started a new job, or maybe even changed careers completely. It’s never easy, even when it is exciting. Inherent to every change, including those that are ultimately positive, are feelings omonkey barsf discomfort and fear. Why? It can be uncomfortable, even painful, to do things in a new way, particularly if you’ve been doing them the old way for a very long time. Given that we as humans are naturally programmed to avoid pain and discomfort, it can also mean we find ourselves unmotivated to change.

Deciding to pursue recovery from an eating disorder after several years or even decades of illness is extremely hard. Doing the work of recovery after years of using eating disordered behaviors can, for many individuals, invoke a lot of fear. Eating disorder behaviors and thoughts may have become so entrenched that ceasing these behaviors will require change to all other parts of life as well…rekindling old interests, developing new hobbies, re-building relationships around recovery instead of the disorder, possibly getting new clothes, implementing new routines and learning new coping skills. Knowing that change can be perceived as danger, even when it’s actually beneficial, can help individuals understand their resistance to it. More importantly, this knowledge can help individuals to move past it.

“Fear, Uncertainty and discomfort are
your compasses towards growth.”
~Celestine Chua

Eating Disorders, The Brain & Change

Understanding change is particularly relevant in the field of eating disorders because of the various factors that drive the disorders. Many people already understand that certain social and cultural pressures (like our diet-obsessed culture or excessively retouched advertising) can impact thoughts about food and weight and may serve to maintain eating disorder thoughts and behaviors. It can, however, be just as important to understand the biological pressures that maintain symptoms and decrease motivation to recover. For example, malnourishment and low body weight are biological markers that can impact the brain’s ability to react to new or changing situations. In other words, when someone is not nourished well, they are more likely to struggle with rigidity of thoughts, otherwise known as “cognitive inflexibility” or “poor set shifting”. Research has found that, even at healthy weights, individuals with eating disorders are more likely to be wired for cognitive inflexibility which can mean more resistant to change.

“This characteristic rigidity or inflexible way of thinking and behaving can act as a real hindrance to those who exhibit it. For example, an inflexible thinking style is likely to mean that an individual relies on strict habits and rules to order his/her life. This rule-bound way of living can impede the individual’s involvement in new opportunities and experiences, monopolize time that could be used more productively, and result in relationship difficulties if the rules become extremely rigid. (2010, Tchanturia & Hambrook)

When it comes to eating disorders, there are daily consequences of being set in your ways since those ways are ultimately harmful. When faced with a decision to pursue change or not, it can be helpful to take a closer look at the specific psychological, sociocultural, and biological barriers keeping you stuck or unmotivated. Only then can you make an informed decision.

Motivation to Change- A Model for Understanding How and Why Change Happens

Motivation to Change is a theoretical model that explores the process of behavior change – from wearing sunscreen to smoking cigarettes, drinking excessively to eating disorders. The model proposes that we all participate in the stages of change whenever we are about to make a change in our lives. Research has shown that when therapeutic intervention is matched to a patient’s stage of change and the therapy is conducted within that stage, a more positive and long-lasting result is more likely.

The Motivation to Change model is divided into the following 5 Stages of Change:

  1. Precontemplation – a lack of awareness of the problem; no intention to change
  2. Contemplation – awareness of the problem but uncertainty about making a change; someone is thinking about change, but is not committed
  3. Preparation – intending to take action; there is a desire to make a change and some planning prior to making the change
  4. Action – the actual time spent making the change and modifying behavior
  5. Maintenance – life once the change has been made, including relapse prevention

This is not a linear model. It is expected that individuals may move backward and forward through these stages and that there will be an ebb and flow of motivation. Even during the action phase, individuals will experience indecision and ambivalence. Understanding this process, and having the support of a therapist along the way, is important in reducing discouragement and increasing long-term success. After all, change is hard. But despite the fear and discomfort, change can also be a very beautiful thing.

“Your life does not get better by chance,
it gets better by change.”
~Jim Rohn

Motivation to Change at The Center for Eating Disorders

opposing arrowsThe Center for Eating Disorders incorporates the motivation to change model and concepts in individual therapy at all levels of care and in specialized treatment groups throughout our inpatient, partial hospital and intensive outpatient programs. This summer we are announcing the addition of an outpatient, once weekly, Motivation to Change Therapy Group for individuals with eating disorders. From the first to last session, group members will be asked to participate in discussion and homework activities designed to explore where they are in the model and how ready they feel to move to the next stage. The group will be offered on Saturdays from 4:00-5:00 PM beginning in June 2014.

Anyone interested in participating can contact Rachel Hendricks at (410) 427-3862 or rhendricks@sheppardpratt.org. The group is offered as a complete module, and participants will be encouraged to participate in each session as the sessions will be progressive.

While the Motivation to Change groups at The Center are exclusively for people with eating disorders, anyone can benefit from understanding motivation to change and using the principles to assess, prepare, and make change in their own lives.

Find details about the Motivation to Change group and a long list of other outpatient groups offered at The Center for Eating Disorders by clicking here.

“By changing nothing, nothing changes.”

~Tony Robbins

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References:

Tchanturia, K. & Hambrook, D. (2010). Cognitive Remediation Therapy for Anorexia Nervosa. In C.M. Grilo & J.E. Mitchell (Eds.), The Treatment of Eating Disorders: A clinical handbook ( pp. 130-149). New York, NY: Guilford.

Monkey Bars Image courtesy of photostock / FreeDigitalPhotos.net
Arrows image courtesy of Naypong / FreeDigitalPhotos.net

 

Outpatient Group Therapy at The Center for Eating Disorders {Summer 2014}

JUNE 2014 – The Center for Eating Disorders has launched several new outpatient therapy groups in addition to our other longstanding groups for individuals with eating disorders. Group therapy can be a great way to obtain additional support in the recovery process while also mastering beneficial new skill sets and practicing social interactions in a therapeutic setting with the guidance of a licensed therapist.  We invite you to review the current group therapy opportunities below and contact the group leader if interested.

THERAPY Groups…

Cognitive Behavioral Therapy (CBT) Group for BODY IMAGE
Tuesdays, 5:15 – 6:15 PM
Participants can expect to learn about how to promote positive body image using the cognitive-behavioral model.  The group lasts 10 sessions and will consist of a variety of body image topics (e.g. body checking, body avoidance, body comparison, emotional labeling, eating disorder mindset) and incorporates specific CBT skills with the goal of decreasing an individual’s preoccupation with weight and shape and their control. Please contact Laura Sproch, Ph.D. at 410-427-3851 for further information and to complete a brief phone screening. 

Cognitive Behavioral Therapy (CBT) for ADULTS
Tuesdays, 5:15-6:15 PM
Thursdays, 6:15-7:15 PM
Participants in this group will learn about the cognitive-behavioral model and its application for eating disorders and for the individual.  Group topics will rotate, based on the needs of the group, with a strong focus on the behavioral skills and making behavioral changes outside of the group.  Skills include, but are not limited to, self-monitoring, imagery, deep breathing, behavioral chain analysis, body image behavioral skills and problem solving. Contact Laura Sproch, PhD at (410) 427-3851 for more information.

Cognitive Behavioral Therapy (CBT) for ADOLESCENTS in Transition
Tuesdays, 5:30-7:00 PM
This is a Cogntitive Behavioral Therapy group for adolescents who are transitioning from a higher level of care (at any inpatient, residential or partial hospital eating disorder program) back into outpatient therapy.  The groups runs on a six-week session.  Contact Lisa McCathran, LCPC at (410) 427-3873 for more information.

Dialectical Behavior Therapy (DBT) Group 
Thursdays, 5:30-6:30 PM
DBT is an evidence-based treatment composed of four modules: Mindfulness, Distress Tolerance, Emotion Regulation and Interpersonal Effectiveness.  Extensive research has found DBT to be beneficial in the treatment of a variety of disorders, including mood disorders, anxiety disorders, substance abuse and eating disorders.  This particular DBT group is open to adults, ages 18 and over, with or without an eating disorder.  Interested individuals, or referring providers, should call Craig Boas, LCSW-C at (410) 427-3879 to complete the screening process. You can read more about DBT and each of the four modules here.

Interpersonal Therapy Group for Binge Eating Disorder / Compulsive Overeating
Tuesdays, 4:30-5:50 PM

Wednesdays, 7:15-8:35 PM
Thursdays, 4:40-6:00 PM 
Process-Oriented and skills-based therapy groups for adults (ages 22 and over) who struggle specifically with Binge Eating Disorder or compulsive overeating.  For more information about these specialized groups, please call David Roth, PhD at (410) 427-3871.

Interpersonal Therapy Group for Adults with Eating Disorders
Wednesdays, 5:30-7:00 PM
A process-oriented group for adults (ages 22 and over) with any type of eating disorder. This is a thematic, open-ended group in which members are encouraged to process current and past struggles in a way that improves insight into the role of the eating disorder in their life and provides an opportunity to develop strategies for moving toward recovery.  A variety of skillsets are introduced and practiced within the supportive framework of the group.  Contact David Roth, PhD at (410) 427-3871 for additional information.

Motivation to Change Therapy Group
Saturdays, 4:00-5:00 PM
Motivation to Change (MTC) is a group for individuals 18 and over with an eating disorder. Participants will be asked to complete a full module from beginning to end (12 groups per module). At the beginning of each module, participants will assess their stage of change and should be able to identify next steps and tools for implementing change by the end of each module. Please contact Rachel Hendricks, LCSW-C at 410-427-3862 for further information and to complete a brief screening over the phone.

SUPPORT Groups…

Collaborative Care Workshops for Caregivers & Family Members
(
Now being offered completely FREE OF CHARGE to all interested families)

Tuesdays, 5:30-7:00 PM 
These 6-week sessions based on the work of Dr. Janet Treasure, are designed to address the most universal needs of the carers: connection with other carers; support; and skills training.  Key skills taught include motivational interviewing, communication, the trans-theoretical model of change, self-care and behavior analysis. Research suggests that participation in these workshops, leads to benefits for both the carers and the patient. The workshops are OPEN to all support people at any stage of a loved one’s illness or recovery and are now being offered completely free of charge. You can read more about collaborative care on our blog.  Call (410) 427-3874 or email Dr. Jennifer Moran to register for the group.

Recovery-Focused Community Eating Disorder Support Group
Wednesdays, 7:00-8:30 PM
Read more about this and other opportunities on our support group page.

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The Center participates with an extensive list of insurance providers which means group therapy services can often be billed through insurance or participants may choose to self-pay. If you are interested in joining any of the groups listed above, please contact the specific group therapist directly or call the main number, (410) 938-5252.

If you are a physician or therapist interested in referring a patient for group therapy as an adjunt to existing individual or family therapy, please feel free to call the contacts listed above.  Our group therapists are committed to communication with providers in the community and to working collaboratively as a team to meet the needs of each patient.  With the proper release forms, group therapists welcome ongoing communication, can discuss skills and principles being covered in the groups, opportunities to apply the skills to individual therapy, and other relevant goals and progress.

This Week in #MediaLiteracy | 2 Campaigns You Should Know About

The world of social media presents an interesting dichotomy.  The challenges of existing in an online community are ever increasing.  Concerns about safety and security are high on the list of course (particularly for parents with tech savvy kids) but additional risks to overall well-being and self-esteem are lingering close behind.  Dangers include online bullying, exposure to harmful imagery or media, and the less sensationalized, yet still problematic, body bashing and body comparison often experienced within sites like Facebook and Pinterest.

Yet while these risks exist, these same online communities also provide a great opportunity for social change and grassroots organizing.  We’ve seen two such examples of powerful social media campaigns this week that we thought were worth sharing.  If you struggle with the body toxic environment online OR offline, perhaps these are opportunities for you to help create change for yourself and for others.   Take a look, find out more, get involved.  Just think, every minute you spend advocating for media literacy, body positivity and truth is one less minute you have to engage in the alternatives.

#TruthInAds

The Truth in Advertising Act of 2014 (HR4341) was introduced earlier this week with bipartisan support from Representatives in Florida and California and with collaboration from several great organizations including The Eating Disorders Coalition and The Brave Girls Alliance.

The groundbreaking bill calls on the Federal Trade Commission to develop a legislative framework for advertisements that alter the human body (i.e. shape, size, proportion, color, etc.) and asks for recommendations and remedies for photoshopped ads that are determined to be false/deceptive and which may contribute to a series of emotional, psychological and physical health issues, and economic consequences – particularly affecting, but not limited to, girls and women.” (via Brave Girls Alliance).  If this is something you support, its easy to get involved in any of the following ways:

  • Add your name to the Change.org petition by Seth Matlins
  • Read this great write-up about the Truth in Advertising Act by Matt Wetsel over at his blog, …Until Eating Disorders are No More.  He makes it easy to  find your representative in Congress and how to let them know you support the bill.
  • Take to Twitter, Facebook, Google+ and any other social media site with the hastag #TruthInAds to help spread the word. You can even stop by The Brave Girls Alliance for toolkits, images and talking points for the campaign.

#AdoptTheIllusionists

The Illusionists is a 90 minute documentary about the body as the “finest consumer object” and the pursuit of ideal beauty around the world. Or: how corporations are getting richer by making us feel insecure about the way we look. 

The hard thing for most people about speaking out against society’s narrow ideals of beauty is that it can feel like you’re a fish swimming upstream in a strong current of Photoshopped bodies, fat talk, and dieting.  Taking a stand can mean you’re up against some pretty powerful forces like the beauty and fashion industries, the diet and weight loss industries and even the larger television and film media that rely on funding from these sources. This pressure compounds when you’re an independent filmmaker working to expose the stories and financial benefits behind the WORLD’S beauty ideals.  That’s what filmmaker, Elena Rossini is doing with her documentary The Illusionists and it’s why The Center for Eating Disorders has been a supporter of the film since it first launched via a Kickstarter campaign in 2011.

Now that the film is almost complete, Elena is swimming against that cultural current once more, and has taken to Twitter with the #AdoptTheIllusionists campaign to help the film, and its message, get the widest possible circulation. On her blog, Elena writes, “My passion for the project stems from its potential to incite activism: I strongly believe that The Illusionists can ignite important conversations about consumer culture, mass media, and the epidemic of body image dissatisfaction around the world. It only takes one person to believe in The Illusionists for the fate of the film to change. It could be a producer. An actress. A writer. An activist with the right connections. It could be you.”

The film has already caught the eye of accomplished artists and activists including Geena Davis and Stephen Fry.  If YOU want to see the first 4 minutes of the film and then show your support for the film, visit Elena’s post, It Only Takes One Person or go straight to the #AdoptTheIllusionists campaign page for supportive statements that are ready-to-tweet.

Let us know how you’ve supported the above campaigns and other ways you engage in media literacy activism.  Leave a comment below or join us on Facebook and Twitter.

Photoshop Does Not Cause Eating Disorders – Media & Body Image

Media Literacy Infographic

Click to View (pdf)


National Eating Disorders Awareness Week
(Feb. 23 – March 1, 2014)

Did you know that photoshopped bodies and the unrealistic beauty ideals set forth by the media DO NOT cause eating disorders?  While these unfortunate elements of our society CAN contribute to widespread negative body image and promote an internalization of the “thin ideal”, they cannot be blamed outright for the development of the serious and complex illnesses such as anorexia, bulimia,  binge eating disorder and EDNOS or OSFED.

When it comes to Eating Disorders there are actually a variety of contributing factors, of which the strongest are likely to be genetics and biology. In fact, research suggests 50-80% of a person’s risk for developing an eating disorder is due to genetics which includes factors associated with heritable personality traits such as perfectionism.

That being said, some studies have documented a link between exposure to westernized, thin-ideal media and an increase in eating disorder behaviors.   So while Photoshop may not cause eating disorders outright, the bottom line is that we all stand to benefit from more positive and realistic bodies in the media.  After all, individuals who feel better about their bodies take better care of them, regardless of weight, shape or size. Plus, positive body image and media literacy CAN serve as protective factors against disordered eating which is one reason why The Center for Eating Disorders supports projects like the Love Your Tree Campaign and The Illusionists documentary.

The infographic above from the National Eating Disorders Association breaks down some of the important elements of the media’s effects on body image. Click on the image to open and join the conversation on our Facebook page.

Read more about the etiology of eating disorders here: Underlying Causes and Contributing Factors

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I Had No Idea…Males and Eating Disorders – National Eating Disorders Awareness Week 2014

This helpful infographic from The National Eating Disorders Association helps to break down some of the key facts. Spread the word and help others by breaking down stereotypes and supporting accurate information about  males and eating disorders.  Join us on Facebook for more information and to join the #NEDAWeek conversation.

Infographic: Males & Eating DisordersThe Center for Eating Disorders at Sheppard Pratt has been treating males affected by eating disorders for over twenty years yet barriers remain for those seeking treatment.  Cultural stigma regarding males and eating disorders can make it more difficult for men to come forward and seek treatment on their own. The good news is that education, support and awareness about eating disorders among males are all improving so that more boys and men are seeking and receiving the treatment they need and deserve.

Perfectly Imperfect: A Special Q&A with JENNI SCHAEFER

Jenni Schaefer
In recognition of National Eating Disorders Awareness Week (Feb. 23 – March 1), we caught up with Life Without Ed author and all-around inspiring person, JENNI SCHAEFER. 

It was about  five years ago that Jenni last visited The Center for Eating Disorders at Sheppard Pratt  and we are thrilled to welcome her back here to the CED blog and back to Baltimore on Saturday, March 1st for a new presentation entitled, Perfectly Imperfect: Eating & Body Image. 

It turns out that a lot can happen in five years.  Armed with a new relationship, a new book and lots of new experiences, Jenni continues to educate, inspire and lead by example both within the eating disorder community and beyond.  We are grateful to Jenni for taking the time to answer our questions and excited to share her responses below with our readers.

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Q & A with JENNI SCHAEFER  

Q: You’ve been a longtime advocate and activist for the National Eating Disorders Association (NEDA) and will be speaking in Baltimore in honor of National Eating Disorders Awareness Week 2014. What does this campaign mean to you and what progress have you seen around the awareness and education of eating disorders since you began this journey?

After struggling for years with an eating disorder, I finally picked up the phone in search of real help. I called 1-800-931-2237, which is NEDA’s Helpline.  NEDA sent me a list of treatment resources (via snail mail back then!), and my healing journey began. It is surreal to me how life has come full circle: I am honored to serve as the Chair of NEDA’s Ambassadors Council today. Working with NEDA and NEDAwareness Week means the world to me. My hope during the week is not only to encourage people to get help but also to prevent some from ever going down the treacherous road of an eating disorder in the first place. If I had participated in a NEDAwareness event years ago, I believe that my journey would have been a lot smoother. Maybe I never would have turned to Ed (aka “eating disorder”) in the first place, or maybe I would have realized that I had a problem and reached out for help sooner. Similar to the 2014 NEDAwareness theme, “I Had No Idea” that I was struggling with a life-threatening illness.

Since I began my recovery journey, I have seen eating disorders awareness and education improve greatly. Back when I was struggling in college, I rarely heard anyone talk about eating disorders. But, today, colleges all across the country ask me to speak at their NEDAwareness events. Again, it is amazing how life can come full circle like that!

Q: In addition to your hugely popular and inspirational books, Life Without Ed and Goodbye Ed, Hello Me, you have a new book out with co-author Jennifer Thomas, PhD called Almost Anorexic: Is My (Or My Loved One’s) Relationship with Food a Problem? What prompted you and Dr. Thomas to write this book, and can you elaborate on what you mean by the term “almost anorexic”?

While 1 in 200 adults will experience full-blown anorexia, at Cover: Almost Anorexicleast 1 in 20 (1 in 10 teen girls!) will struggle with restricting, bingeing and/or purging that doesn’t meet full diagnostic criteria for anorexia nervosa, bulimia nervosa or binge eating disorder. Almost Anorexic, which is the third book in Harvard Medical School’s The Almost Effect™ series, brings attention to the grey area between “normal eating” and an officially recognized eating disorder. Dr. Thomas and I want people to know that, regardless of their eating disorder diagnosis or lack thereof, both help and hope are available. A diagnostic label cannot adequately depict pain and suffering. All who struggle deserve help, and full recovery is possible.

[To learn more about
Almost Anorexic and to read book excerpts, click here. You can also watch a hopeful book trailer (video) or register to attend a professional workshop facilitated by the book's co-authors.]

Q: There has been a lot of discussion within the eating disorder field recently around the conceptualization of eating disorders as brain-based illnesses as opposed to purely psychological or behavioral disorders. You touch on the implications of this in Almost Anorexic How can the words we use to define the disorder impact the recovery process?

When I first received help for my eating disorder, people told me that I would never fully recover. They said that an eating disorder was like diabetes and that it would be with me forever. Believing this, in the end, just served to keep me stuck. I had to change my language, and I had to connect with people who believed that I could get fully better. This made all of the difference.

In relation to brain disorder language, Almost Anorexic explains: “Some people and organizations have found brain-disorder language extremely helpful in explaining to others why individuals with eating disorders can’t just “snap out of it” and in absolving parents of guilt and blame for their child’s illness. Others, however, have worried that brain-disorder language may give sufferers and loved ones alike the hopeless (and false!) impression that eating disorders are lifelong illnesses that cannot be treated and may even provide a handy excuse for the continuation of dangerous symptoms (after all, your brain made you do it). To combat this, parent activist Laura Collins Lyster-Mensh has used the term “treatable brain disorder.” We suggest you use the terminology that works best for you. Words are powerful. Don’t let Ed hijack them.”

Q: Perfectionism is one of the genetically-based personality traits most highly associated with the development of eating disorders and will be the focus of your talk in Baltimore on March 1, 2014. Did perfectionism play a role in the development of your eating disorder? Did it also play a role in recovery?

I was not born with an eating disorder, but I was born with the perfectionism trait. Constantly striving to be perfect certainly made me more vulnerable to having an eating disorder. So did other genetic traits like high anxiety and obsessive-compulsiveness. However, when channeled in a positive direction, these traits played a crucial role in my recovery. I was able to refine perfectionism, for instance, and apply it to things like attending doctors’ appointments and finishing therapy assignments. When taken to the light, our genetic traits absolutely support recovery.

Q: Individuals who are perfectionists often struggle with the urge to compare themselves to people around them. Among individuals with eating disorders these comparisons are often appearance-based or weight-focused but can also be related to one’s career, house, family, wealth or talent. Constant comparison can be very triggering and detrimental to the recovery process. What strategies help you avoid this comparison trap?

My motto, as I originally wrote about in Life Without Ed, is “Compare and Despair.” Early in recovery, I actually displayed “Compare and Despair” on post-it notes throughout my home. These notes reminded me that comparing inevitably leads to despairing, so I did my best to stop setting myself up for this kind of self-loathing. Further, learning that I was not alone in my tendency to compare helped me to change as well.  The Center for Eating Disorders’ survey related to Facebook and comparisons, for instance, has helped people I know to better understand the growing prevalence of comparing (as well as the fall-out of it) and to feel a sense of camaraderie in making positive changes.

Q: In the age of social media, it seems the opportunity for comparing oneself to others has reached an all time high. Do you have any tips for individuals looking to use social media in a healthy way that is supportive of recovery?

In the tenth anniversary edition of Life Without Ed, which was just released, I talk about the fact that Ed surely has a Facebook account! Each time a person with an eating disorder logs in online, Ed does, too. This awareness is key. Further, individuals with eating disorders can change their online settings to block triggering people and ads. Within the anniversary edition of Life Without Ed, I give many tips for how to use technology to support your recovery, including using mobile apps like “Recovery Record” and “Rise Up + Recover.”

Q: You last visited The Center for Eating Disorders at Sheppard Pratt as a guest speaker in 2009 during which you spoke about the concept of being Recovered. from your eating disorder. What new insights about being Recovered. have you gained over the past 5 years, and has any of it surprised you?

I often say that I am recovered from my eating disorder, but not from life. Part of being “recovered.” actually means continual personal growth. Since my visit to Sheppard Pratt, I have blossomed in many areas, especially related to relationships. I have learned how to let more love into my life and have even gotten married. Luckily, my husband’s name is not Ed! Related to freedom from eating disorders, you can click here to download a table that Dr. Thomas and I created comparing “fully recovered” to “barely recovered.”

Q: What are some of the main points you hope to convey during your upcoming talk, Perfectly Imperfect on March 1st in Baltimore? Who do you think could benefit from attending the presentation?

One of the most common comments I receive from audience members is, “I don’t have an eating disorder, but I do have an Ed in my head.” People also relate to my efforts to overcome perfectionism as well as my journey to find happiness in life. We always have fun singing my song, “It’s Okay to be Happy.” That said, my talks are applicable to anyone who calls him or herself a human! On March 1st, I will discuss finding balance with food and weight in a world that is anything but balanced. We will talk about striving simultaneously for both excellence and “perfect imperfection.” And one big goal of my presentations is to laugh—a lot.

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Do you have your own questions for Jenni?  Join us on Twitter @CEDSheppPratt for a special Tweet Chat on Thursday, February 20, 2014 from 1:00-2:00pm EST with Jenni Schaefer (@jennischaefer) and Jennifer J. Thomas, PhD (@drjennythomas).  Use the hashtag #CEDchat to participate and follow along. Send your questions in advance to kclemmer@sheppardpratt.org and we might use them during the chat!

More About Jenni…
Jenni Schaefer’s breakthrough bestseller, Life Without Ed: How One Woman Declared Independence from Her Eating Disorder and How You Can Too, established her as one of the leading lights in the recovery movement. With her second book, Goodbye Ed, Hello Me: Recover from Your Eating Disorder and Fall in Love with Life, she earned her place as one of the country’s foremost motivational writers and speakers. Jenni’s straightforward, realistic style has made her a role model, source of inspiration, and confidant to people worldwide looking to overcome adversity and live more fully. She speaks at conferences, at major universities, and in corporate settings; has appeared on many syndicated TV and radio shows; and has been quoted in publications including The New York Times. She is also chair of the Ambassadors Council of the National Eating Disorders Association. An accomplished singer/songwriter, she lives in Austin, Texas

Want to learn more about NEDAwareness Week Events at The Center for Eating Disorders at Sheppard Pratt?  Click HERE.

 

 

Family-Based Treatment for Adolescents with Anorexia Nervosa: 3 Important Considerations

 

Family-Based Treatment (FBT) is an important evidence-based treatment for anorexia nervosa in adolescents. Originally conceived at the Maudsley Hospital in London, and often referred to as the Maudsley Model, it was further developed by James Lock, MD, PhD and Daniel le Grange, PhD in the United States. FBT is an intensive outpatient treatment involving the entire family whereby parents play a primary and critical role in all of the following tasks:

  • managing the restoration of the child’s weight to a healthy place and supporting the blockade of eating disordered behaviors
  • helping the child to re-establish age-appropriate control and management over their own eating
  • re-focusing the family on healthy adolescent development and relationships separate from the eating disorder

FBT is a highly focused treatment that is presented in three stages. It emphasizes behavioral change and supports a gradual increase in autonomy for the adolescent.  As a psychologist who supports and guides families through this treatment, I thought that it might be helpful for those who are considering FBT to have a primer for the treatment. In thinking about what may be helpful to be aware of when considering FBT, I reflected on the first session I have with each family and thought about all of the crucial messages I try to convey during that time. Below, I’ve decided to share the three messages that, in my perspective, stand as the most important tenets of understanding and implementing FBT.

  1. For adolescents struggling with anorexia nervosa, family support can be the most effective tool for making change. At its core, FBT recognizes that parents are capable of helping their child recover and the therapist’s role is to support them in this goal. When a child is confronted with any serious crisis or illness, investment and nurturing from the family is considered a critical asset and anorexia nervosa is no exception to this. Despite lingering misconceptions about a parental role in the development of eating disorders, FBT is built on the knowledge that parents do not cause eating disorders and that they are, in fact, integral to the recovery process. It is our job as therapists to recognize the strengths and qualities of each family and consider how FBT can be applied within each unique family system. Simply put, the aim of FBT is to empower parents to help their child overcome the eating disorder.  In other words, the therapist serves as a consultant who joins with families as they apply skills they already possess. 
  2. Eating disorders have genetic and biological underpinnings.  As such, adolescents with anorexia nervosa have little control over their illness. Furthermore, periods of malnutrition and starvation can trigger a self-perpetuating cycle of anorexic symptoms that can cause considerable disruption and suffering for the whole family. But to be clear, it is the eating disorder, not the child, which has caused such an interruption in life.  Anorexia nervosa is a devastating illness, the biological, physiological and psychological consequences of which can cause individuals to think and behave in self-destructive ways. It is important that the family works together as a team to help fight the illness and to keep it from embedding further in their child’s life. FBT therapists assist parents in distinguishing between their child and their child’s illness. This distinction helps the family to avoid blaming the child for disruption and stress that is actually a result of the illness, and also makes it easier for parents to take action when they realize they can nurture their child while simultaneously battling against the illness. As a result, energy can be better spent fighting the anorexia, not fighting with their child who is likely already suffering a great deal.
  3. Because of #1 and #2, FBT requires serious hard work and commitment. I am very upfront with families involved in FBT that they will be their child’s primary support AND that eating disorders are insidious and overwhelming illnesses. FBT is not easy. Fighting a devastating illness that has convinced your loved one they are not sick and that they don’t need help, is going to be a lot of hard work. And while it can be grueling, it is also worth it. When we hosted author Harriet Brown as a guest speaker in 2010, we asked her to share her family’s experience in doing FBT with her daughter, and she spoke to this difficulty and to the benefits of this tenet:When we took on FBT, we took on both the responsibility and the power to intervene. That was a tremendously liberating step. The worst part of my daughter’s illness for me was standing by helplessly, watching her suffer and starve. The notion that my husband and I could help her required a huge mental paradigm shift—but once we made it, we were much more effective.” 

In the beginning, FBT will require a lot of energy- energy to monitor your child’s behaviors, energy to learn different behavioral responses, energy to deal with the emotional and interpersonal changes that may come about through this work. I warn my families about the commitment that it takes and I’m honest about the dedication needed. But I also talk to families about the benefits of short-term work to outweigh the devastating long-term effects of an eating disorder and I share with them the facts.  I talk to them about the serious and significant risks of anorexia- physically, emotionally, cognitively- and I have found that families most often agree that avoiding these risks is worth putting in the work. I tell them that FBT has been shown in research (and in my office) to be the most efficacious treatment for adolescents with anorexia that we know about today.

After committing to and sticking with the treatment, I see families eventually begin to talk about “having [their] child back.” I hear families talk about their child’s increased energy, sense of humor returning, interest in friendships again, and reestablishment in the family. I hear the satisfaction when parents talk about receiving feedback from others who approach them just to say that they have recognized a positive change in their child. Over time, I hear families talk about feeling confident that they helped their child recover. They share that they can once again trust their child to make healthy food choices, and they feel a sense of relief that they no longer have to live with the constant presence of the illness. I hear families tell me that the “fight” with the eating disorder gets easier and less demanding, and eventually they don’t need to engage in the battle at all. 

If you think your family member, or someone you know may benefit from family-based treatment, I would recommend starting by talking to a professional about this option, either your current treatment provider or, if you are not currently in treatment, finding a family therapist who is trained specifically in FBT. The Center for Eating Disorders has several FBT therapists in our outpatient department, and we are happy to answer any questions you may have about this treatment modality. You can email us at EatingDisorderInfo@sheppardpratt.org or call (410) 938-5252. Additionally, we encourage all of the families we work with to utilize the book, Help Your Teenager Beat an Eating Disorder (Lock & Le Grange, 2005) as an educational and supportive resource throughout the FBT process. You can also access an extensive selection of journal articles regarding clinical research on FBT courtesy of Maudsley Parents organization.

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 Written by Laura Sproch, PhD
Individual and Family Therapist
The Center for Eating Disorders at Sheppard Pratt

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