THE ILLUSIONISTS Film Screening – Meet the panel of experts…

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On June 7th, hundreds will gather in Baltimore to be among the first to see an exclusive screening of the much-anticipated international documentary The Illusionists. In addition to viewing the full-length film, event attendees will have a unique opportunity to ask questions and converse with a panel of experts including the film’s director.  Meet the panel members below and be sure to reserve your seat for the event.

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Panel Members:

elena_headshotELENA ROSSINI
Writer & Director of ‘The Illusionists’

Elena Rossini is an Italian filmmaker and multimedia producer. Notable film projects include DOVE SEI TU, a feature-length narrative film set in between Milan, the documentary DIRECTION, and IDEAL WOMEN, an experimental short film juxtaposing beauty ideals in the art world vs. mass media, commissioned by ARTE Web and the Louvre Museum. In 2009, Elena launched a multimedia platform – No Country for Young Women – whose aim is to promote the visibility of professional women and to provide real role models for young girls from entrepreneurs to NASA engineers, illustrators, architects, filmmakers, non-profit directors, award-winning novelists, and more.

Since 2011 when The Illusionists was funded through a crowdfunding campaign, Elena has worked tirelessly as writer, producer, cinematographer and director. Elena is also a photographer and a blogger. Her photos and articles have appeared in Jezebel, indieWIRE, Adios Barbie and Gender Across Borders.  Elena will travel from her home in Paris to be a part of this exclusive advance screening and panel discussion.

 

tmaronickThomas Maronick, JD, DBA
Professor of Marketing
Towson University

Dr. Maronick is a Professor of Marketing in the College of Business and Economics at Towson University in Towson, Maryland.  He holds a BA in Philosophy from St. Thomas Seminary, an MBA from the University of Denver, and a Doctorate in Business Administration (DBA) from the University of Kentucky with a major in Marketing. It also includes a JD from the University of Baltimore, School of Law. Dr. Marnonick is also an inactive member of the Maryland Bar. At Towson University he teaches undergraduate and graduate courses in strategic marketing and marketing research and has also taught graduate and executive development courses in marketing, consumer behavior, and marketing research at a number of universities in the Baltimore and Washington DC area. In addition to his role as professor, Dr. Maronick’s professional background includes serving as Director of the Office of Impact Evaluation in the Bureau of Consumer Protection at the Federal Trade Commission (FTC) from 1980 – 1997 where he served as the in-house marketing expert for all divisions of the Bureau, advising attorneys and senior management on marketing aspects of cases being considered or undertaken by Commission attorneys. Dr. Maronick was also responsible for the evaluation of research submitted by firms being investigated by the Commission and for the design and implementation of all consumer research undertaken by the Bureau during that period. Since leaving the Commission in 1997, Dr. Maronick has served as an expert witness in marketing-related cases and has testified in Federal and State courts.  His areas of expertise include: marketing, deceptive advertising, public policy, research, and expert witness/litigation support.

 

Laura.Sproch.2015a_portraitLaura Sproch, PhD
Psychologist & Research Coordinator
The Center for Eating Disorders at Sheppard Pratt

Dr. Laura Sproch is a licensed clinical psychologist who serves as the Research Coordinator and outpatient individual, family, and group therapist at the Center for Eating Disorders. Currently, Dr. Sproch is initiating treatment outcome studies, managing quality improvement projects, and developing novel research projects in an effort to contribute to the field’s understanding of effective eating disorder treatment methods. Dr. Sproch received her Ph.D. in Clinical/School Psychology from Hofstra University in Hempstead, NY where she completed her dissertation examining cognitive similarities between differential eating disorder diagnoses. Dr. Sproch originally joined the CED team in 2011 as a postdoctoral fellow on the inpatient and partial hospitalization units acting as a family, individual, and group therapist. She has also worked with adolescents and adults struggling with disordered eating at a variety of levels of care, including at Friends Hospital in Philadelphia, PA and ‘Ai Pono: The Anorexia and Bulimia Center of Hawaii in Honolulu, HI. Her professional interests also include cognitive behavioral therapy, family-based treatment, behavioral modification, and school psychology.

 

Panel Moderator:

Dr. Crawford headshot_portrait

Steven Crawford, M.D.
Co-Director
The Center for Eating Disorders at Sheppard Pratt

In addition to his leadership role at The Center for Eating Disorders, Dr. Steven Crawford serves as Assistant Chief of Psychiatry at St. Joseph Medical Center, University of Maryland and as an Associate Professor at The University of Maryland where he helps to train medical students on effective screening and care for individuals with eating disorders. As an extension of this commitment to professional training, Dr. Crawford also serves as Director for Eating Disorders fellowship at The Center for Eating Disorders. He is Past President of the Maryland Psychiatric Society and Chair for the Committee on Scientific Activity for MedChi.  Dr. Crawford has participated in numerous research studies including NIMH federally funded research for an international collaborative study on the genetics of Anorexia Nervosa as well as the Family Therapy Treatment of Adolescents with Anorexia Nervosa. His numerous publications include the chapter on Eating Disorders and Substance Use Disorders for the fifth edition of Substance Abuse: A Comprehensive Textbook. After more than 25 years of specializing in the field of eating disorder treatment, Dr. Crawford has become a trusted resource for his patients, colleagues and the community.

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Questions about the panel or the event?  Call (410) 427-3886 or email kclemmer@sheppardpratt.org

 

 

 

FOOD LOGS: How they can help with eating disorder recovery (& why you might still be avoiding them)

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coffee-writing-stuart-milesFood logs are one of a variety of therapeutic tools used during treatment for an eating disorderFood logs – also referred to as food records or food journals – can take many forms.  Some people prefer to jot things down free form in a personal notebook while others do best filling out the prepared charts provided by their dietitian.  Many others have gone tech-friendly and use an app on their phone to track info and share it with providers. Regardless of the form it takes, a food log does much more than track your food.  A helpful format for food logs will include the time of day, a description of the meal or snack, actual food and beverage intake, location/setting of the meal and, most importantly, an individual’s thoughts and feelings before, during and after eating. Completing food logs and subsequently reviewing them with a registered dietitian can be a pretty powerful part of the recovery process. Not surprisingly, and perhaps because they can be so powerful, many individuals also experience some resistance to using them.  If you’ve ever been encouraged to complete food logs as part of your treatment for an eating disorder but had trouble starting or committing to the process, we thought it might help to know why a dietitian would recommend doing them and the specific ways in which they can aid in the recovery process.

Completing food logs throughout the week maximizes time spent in session with your providers. Weekly nutrition counseling sessions are often 30 minutes long.  It could potentially take up the most of that half hour to do a 24 or 48-hour verbal recall of your meals during the session. It’s easier to get down to business if the logs are already done. Plain and simple.

Food logs are like x-rays. If you hurt your arm and asked your doctor to put a cast on it, she would require you to get an x-ray first to see if, how and where it was broken. If you refused, she broken-armwould only be able to give you broad advice, like “take a Tylenol and get some rest.”  (If you’ve broken a bone before you probably know that wouldn’t help a whole lot). On the other hand, if your doctor could look at the x-ray of your arm she could fit you for the exact type of splint or cast needed, assign the proper amount of physical therapy, and provide individualized prescriptions for your pain.  In much the same way, food logs allow the dietitian to give you tailored advice and individualized strategies, rather than simply relying on a general, one-size-fits-all nutrition goal.

Food logs provide insight into your bigger picture. Sure, your food logs communicate specific details from each meal, but they also show trends and patterns over the course of the week related to meal times, location, hunger/satiety  cues, situational triggers and thoughts. Dietitians can often see connections on the food logs that patients don’t always see themselves. Seeing “the forest for the trees”  allows the dietitian to offer the most useful and beneficial feedback to the patient. Let’s say you arrived home from work late and ate an entire large pizza. Looking back on the food log we may see that you had an 8-hour gap without a meal that caused you to feel extremely hungry. Perhaps a goal would be set to have an afternoon snack available for those situations to help you get to dinner hungry, but not ravenous. On the other hand, maybe you had a stable breakfast, lunch, and afternoon snack, but your dietitian notices you hadn’t allowed yourself pizza in six months despite the fact that it’s one of your favorite foods. A more appropriate goal in that situation would be to practice food habituation with pizza (exposure to a food over time makes the food less compelling) and having a support person around when you’re eating it for a while. The bottom line: It’s harder to learn from the incident when we only see it from one angle. Food logs help us both have more perspective on why things happen, to know whether the set-up was physical or emotional and how to address the physical and emotional needs going forward.

Food logs provide a way to monitor progress. Nutrition therapy is about making changes that improve your relationship with food and your health. We tend to set small weekly goals that create momentum towards overarching goals and bigger changes over time. How will either of us know if the goals are met if we don’t keep track of them? Keeping a food log provides an objective look at progress from week to week and month to month.  It also takes the pressure off of you and your dietitian to recall from memory all of the details of your food and symptom use from the past month.  Rest assured, as you heal from your eating disorder you will have many more important things to use your brain for!

Returning to a normal and healthy relationship with food means appropriately responding to hunger and fullness signals. It’s impossible to do that if your signals are broken from chaotic or disordered eating. The best thing to get your digestive system and metabolism back on track is structured eating – meaning adequate amounts of food with adequate frequency.  Food logs aid in structured eating accountability, and structured eating over time sharpens your signals. Food logs and structured eating can provide the training wheels to help you get to a place of intuitive eating.

Food logs help connect your mind with your body.  Putting your pen to paper before, during or after a meal increases mindfulness with eating which can decrease mindless eating. Logging intake with your thoughts improves your ability to tell the difference between emotional hunger and physical hunger.  This practice also increases awareness to how certain foods make your body feel – energy, mood, mental clarity, digestive happiness, etc. Being aware of how foods make your body feel is important in working towards more sustainable and fulfilling eating practices.

Keeping up with food logs can help prevent relapse during transitions.  If you’ve ever received care for an eating disorder in an inpatient or partial hospital setting, you know the transition into outpatient or even intensive outpatient treatment can be difficult as you are once again responsible for completing more meals on your own. One way to help maintain the stability or progress you made in the higher level of care is to continue to self-monitor your intake and associated emotions during that transition and promptly discuss any specific challenges you encounter with your outpatient providers.  If you’re completing food logs, it’s easier to catch a slip-up before it becomes a full-blown relapse.

As mentioned earlier it’s not uncommon for individuals to question the benefit of food logs or to experience some resistance to the idea of completing them. A common reaction from patients is that, “writing down everything I eat makes things worse“ or “I don’t like doing food logs because it reminds hands with pen.africa and freedigitalphotosme of acting on my eating disorder.” As providers, we completely understand that rigidly tracking food and exercise can often be a symptom of the eating disorder.  That being said, there is a big difference between keeping a detailed, private food diary and collaborating with a dietitian to complete food logs during treatment. For one, the end goals are very different. If you tracked your food before it was probably to monitor strict adherence to dangerous eating disorder behaviors or dieting techniques. Those logs probably involved weighing, measuring, and counting calories and were done to benefit the distorted rules of the ED, not to honor or nourish your body. Conversely, the goal for food logs in treatment is to monitor weekly goals, help normalize eating behavior and to improve your relationship with food. When doing food logs with a dietitian, there is no good vs. bad, no shaming, no judgement. The role of the dietitian is not to be the food police waiting to condemn you. Rather, their role is that of a supportive detective. To examine the data, to see if there is something that is setting you up for problematic eating behaviors and then provide you with education and ideas to help make improvements going forward.

Still not sure? Here are a few additional tips for those of you who may have lingering fears about food logs…

For those that are embarrassed to show anyone… Does it make you nervous or uncomfortable to think about showing someone else a record of your daily eating behaviors? If you are worried that your dietitian will be shocked, grossed out, alarmed, or otherwise disturbed by your food log it can be helpful to think of the dietitian like any other specialist.  Take a dermatologist for example. You might feel nervous or uncomfortable during an annual skin check but to the dermatologist, that’s what they do everyday – they look at freckles and moles all day long.  Food logs and weights can be things that feel vulnerable to share, but remember, those are just pieces of data that the dietitian analyzes and they’ve seen and heard it all before. It’s their job to look at meal patterns and associated thoughts/behaviors. Vulnerability takes courage, but being courageous can lead to positive change. If you’re feeling shameful about sharing your food logs, remember this quote from AA – “secrets thrive in the dark and die in the light.” Being honest with your dietitian and allowing him or her to see your food logs is one of the first steps in moving away from the pain of the eating disorder.

For those who struggle with perfectionism… Food logs aid in improving nutrition behaviors just like practicing an instrument aids in learning the skill of playing an instrument. Writing down logs is intended to keep you in the mindset of practicing your nutrition goals for the week. The more often you practice a particular skill, the more it becomes a habit over time. That progression will not be perfect, and that’s a good thing. Even when you have a rough week and the goals aren’t met, food logs are still very helpful!  As providers, we actually learn more from the rough days than we do from the stable days. The logs allow us to see and discuss what some of the barriers might have been to meeting the goal, so we know what to try or be mindful of the following week. Portraying a “perfect” day of eating when it’s not what actually happened is not helpful.  Recording struggles or slip-ups in a food log allows us to work together to correct the focus and try again. Just like it takes practicing a song on the piano before you can play it without looking at the music – food logs keep you intentional in your practice of positive nutrition behaviors before you can naturally engage in the behaviors without the logs.

For those who don’t want to be stuck doing food logs for the rest of their lives (a.k.a. everyone)… Food logs are used to benefit an individual’s relationship with food and establish normal eating.  To that end, the goal is never for someone to be reliant on tracking their intake or completing food logs for the rest of time.  Rather, this is a temporary tool to help bridge the gap between eating disordered and eating intuitively. It might seem counter intuitive to spend your time tracking food in an effort to heal from a disorder that caused you to obsessively focus on food.  But if your goal is to one day be free from disordered eating, it can help to remember this: learning a new behavior often requires focusing on it more before you can focus on it less.

If a dietitian has recommended that you try doing food logs and you were never quite ready to give it a try but you continue to struggle with your ED, it might be worth taking some time for self-reflection. Would it be worth trying something new?  Consider what you would do if your car was stuck in the mud and the first two tow trucks to the scene couldn’t pull you out because they didn’t have the right tools. What would you say to a third one that came along with a different towing device?  Trying something new can sometimes help you to get unstuck. Even if you have tried food logs before and just couldn’t commit to the process, perhaps approaching an old tool with a new perspective or deeper understanding of how it works, could make all the difference.

CED-2014-19334-Mandala-FINALNot wanting to try food logs or other therapeutic tools suggested by your team, can be a form of avoidance. Consider whether you might be avoiding an awareness of particular behaviors or feelings.  Are you trying to avoid being accountable to make changes?  Are you avoiding acknowledgement of your body’s basic needs?  If any of these resonate with you, try being honest with your dietitian or therapist about why you may have been resistant to doing food logs in the past.  Ask for some strategies to make them more manageable or less anxiety-producing. Food logs do take time and you may not always like doing them, but there’s no denying that they can play an important role in facilitating positive change with the support of your treatment team. At the end of the day, doing food logs is temporary. A healthy relationship with food and your body lasts a lifetime.

Written by Hannah Huguenin, R.D. and Kate Clemmer, LCSW-C

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Are you struggling with an eating disorder but you’re not sure where to go for help? Contact The Center for Eating Disorders at Sheppard Pratt at (410) 938-5252 to do an initial phone assessment or visit eatingdisorder.org to learn more.  You may also want to check out our upcoming free events and workshops.

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Hannah Huguenin MS, RD, LDN

Registered Dietitian

Hannah Huguenin received her Bachelor of Science degree in Dietetics with a minor in Chemistry from Olivet Nazarene University in Illinois. She received her Masters degree from the University of Kansas Medical Center in Kansas City where she also completed her Dietetic Internship. During this internship, Hannah completed a rotation on an acute care eating disorder unit at the Research Medical Center in Kansas City. She has been with The Center for Eating Disorders since 2008, and provides individual nutritional counseling for the outpatient population. In her role at the Center, she provides ongoing support to help patients decrease eating disorder behaviors, meet their nutritional goals and improve their relationship with food through nutrition education.
 
 
Kate Clemmer, LCSW-C
Community Outreach Coordinator

Kate Clemmer earned her Master of Social Work degree from the University of Maryland, Baltimore in 2005 with a focus on Management & Community Organization and a specialization in Child, Adolescent & Family Health. Before joining the Center for Eating Disorders in 2008, Kate provided school-based therapy to adolescents and families in Baltimore City and coordinated a multi-school health education and prevention program. As the CED’s Outreach Coordinator, Kate currently facilitates trainings and workshops in the community, provides outreach to individuals interested in the Center’s services and coordinates the Center’s annual community events. These events include an annual Symposium for health professionals, the Love Your Tree Body Image Campaign, and National Eating Disorders Awareness Week. Kate also facilitates the Center’s community support group for individuals with eating disorders and their friends/family, held on Wednesday evenings.

 

Photo credit: freedigitalphoto.net and (in order) Stuart Miles, Boaz Yiftach, Africa

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 has shared that he or she felt hopeless often and 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

 

Connecting with EMME on Body Image, Beauty and Balance…

 

The Center for Eating Disorders at Sheppard Pratt is gearing up for a week of free community events in recognition of National Eating Disorder Awareness Week 2013.  To help us kick things off, supermodel and positive body image advocate, Emme will provide a special keynote presentation in Baltimore entitled “Connecting BODY+MIND+SPIRIT” on February 24th, 2013. In advance of this free event, we asked Emme to share her unique insights into the current cultural ideals regarding beauty and to comment on some of the key elements that have helped her establish a positive, balanced relationship with her body, mind and spirit throughout her career.

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 Q & A with Emme Aronson:

Q: Through your development of EmmeNation and your role as an Ambassador for the National Eating Disorder Association, you have become a powerful advocate for positive body image. What does the term body image mean to you and how did it come to be such a significant part of your overall message of self-acceptance?

Emme: Body image is the framework for the house where our soul resides. If the foundation is weak, the house crumbles and the soul cannot fully exhibit its magnificence. How we live day-to-day depends on whether or not we have a connective or disassociated connection with our soul and our body.

Often we live from the neck up in a constant, not fully self-accepting state so to speak. By not breaking this chain of self loathing, body bashing, and guilt, dis-ease within one’s self grows and negativity cycles infinitum. At the same time a select few get richer at the cost of millions being diseased or disconnected each day, even each hour if engaging in large doses of media/TV.

It has always been my opinion that only by taking responsibility for one’s health and well-being of the mind, body and spirit, all parts moving in unison together as a befriended system, will we ever be set free from the onslaught of purely capitalistic influences. Our vitality of health, not to mention our culture and the imminent sustainability of our environment,depends on this effort.

Q: What would you say are some of the biggest pressures facing women and girls today that impact the way they experience their bodies and their inner selves?

Emme: I feel it’s the “capitalism-at-all-costs” mentality which, sadly, gets carried on the backs of women starting at an early age. This constant reminder of inadequacy plants insecurity where there once was none, or the seeds may get passed down generationally from mothers to daughters. With the hypersexualized advertising culture in full swing today, these dormant seeds are watered and the negative impact on body image, self-esteem, goal setting, visualization, and accomplishments rolls on, eroding the cornerstone of our society – women and children.

Q: What has your modeling career taught you about your relationship with your body?

Emme: Coming from a news media background, I immediately saw the lack of body diversity in the reporting of beauty. The story was loud and clear that natural body diversity was not to be discussed in mainstream media, and if it was, you were not to highlight it or shoot beautiful, size diverse models side-by-side. This was due to pressures caused by astounding amounts of money being dumped into diet related advertising (based on products with a 98% failure rate). The diet industry today probably makes well over a hundred billion dollars a year. (Psychology Today stated 50 billion in 1997, up from 30 billion in 1987). Understandably, a conflict of interest precedes that kind of money, especially when in uninformed hands. So its my job, and the job of other NEDA ambassadors, to reach out to the media as best we can to share best practices in reporting on body and eating related issues via the protocol presented to networks, women’s magazines and online outlets. An informed media gives them the opportunity to do good and make a choice, which is the best case scenario.

Q: The fashion and beauty industries often receive a lot of criticism for the role they play in pressuring women (and men) to look better, thinner, different, “perfect”, etc. How have you managed to balance your interests in fashion and beauty with your message of self-acceptance and inner beauty.

Emme: Having regularly been involved in the beauty, fashion, TV and clothing industries during different parts of my 20+ year career, I work on maintaining a balance between all the influences. I’m sure I have ruffled a few feathers when I’ve refused to say a line for a commercial, submitted a suggested rewritten line for a show, or refused commercial opportunities worth a lot of money because they didn’t align with my brand. I know a few people thought I was too righteous or full of myself but at the end of the day, I realized I didn’t need to defend myself but instead, had to go by the feeling I had in my gut. Your gut is a wonderful guide, if it’s tight and constricted, wait on whatever is in front of you. If you feel ease and grace, move forward. You may not understand what’s holding you back but listen to that innate guide that’s been with us since the beginning of time. That sensation doesn’t lie. It sometimes takes a lifetime to be still and feel it but, more times than not, it’s right.

Q: At various points in your life you’ve been faced with significant challenges, including a cancer diagnosis, which have surely tested you emotionally and physically. How have you managed to maintain a gratitude-driven existence and a positive relationship with your body throughout these ups and downs?

Emme: If I didn’t have the hearty body that I have, my cancer and treatments during chemo would have wrecked me. I feel today that cancer was one of my best teachers on so many levels.

However, where I gained the most appreciation for my curvaceous body was when I was pregnant. I absolutely loved being able to carry a child and know I was holding this new life in me. Regardless of the fact that my body gained 70 pounds and I was very large, I felt, without a doubt, that this was what my body was meant to do and I embraced myself at every stage. I even did a photo shoot (with all my bits covered but pretty much nude) and it’s one of my favorite shots.

Q: What is your favorite or most useful piece of advice for individuals who still struggle to find peace with their bodies on a daily basis?

Emme: Develop your list of gratitude and concentrate on that list until the anxiety of not being perfect subsides. This stops me before negative self speak rears it’s angry head. (Granted this sometimes takes years to work, but never giving up breeds success). After repeating this often enough like a trained dog, you come to realize you are much more than the empty shell we call our body. Instead of value being based on shape or size, a person’s true value has a chance to rise and nourish the individual and those around them, shining light on personal character traits like: helpfulness, friendliness, playfulness, bravery, courageousness and so on. Once again, take away the soul and you’ve got nothing, just bones, tendons, muscle and fat.

Q: In addition to your work in the U.S., you’ve been active globally with efforts to help women develop positive relationships with their bodies. Can you tell us more about some of these international efforts?

Emme: I’ve been so blessed to have been given the chance to travel a great deal domestically as well as internationally for my work. As a model I got to represent curvy women on three continents, and today I speak out in national and international press on issues relating to self-acceptance, the tricky issues around body image and how important achieving a healthy balance is to sustainability. Recently I was nominated as a Green Apple Ambassador by the Center for Green Schools, a program of the United States Green Building Council (USGBC) (@mygreenschools).  I’m being asked to co-create a K-12 curriculum with the CGS showing the correlation between the following: positive body image + environment = sustainability. Not only in the confines of the ED community are these issues being worked on but in the corporate world, educational systems, and in architectural environments. What is now being discussed in many professional circles is this: If you don’t feel good about yourself, you will not reach for better, think better, act better, eat better, do better, and ultimately may not care about anything beyond your immediate grasp, thus disconnecting you from the world in which you live. Not a great scenario overall.

So there’s clearly a lot of work to be done in the here and now with children, parents, grandparents, schools and the professional community to take responsibility for what we say, think and do to ourselves, to others and to the environment. And guess what? It boils down to such a simple notion:everything rolls from the source!

Q: Do you think we, as a culture, are making progress moving towards “body peace” instead of body bashing as our norm? What have you noticed?

Emme: We’re certainly speaking more about our bodies in print and online, and women are more reflected ethnically, in more various shapes/sizes and in a wider age range, thankfully. All are very important for our culture to see what exists beyond sterile, digitalized images and corporate projections of beauty. However, the more we seem to make progress and move forward toward diverse representations, the corporate push for a more restrained image pops back in again. So education is key and awareness is paramount. An educated and positively engaged mind, body and spirit can help filter what we see, hear and absorb. Indeed, buyer-be-aware of what we “buy into”. Our dollars can be spent in much better ways and can send a bigger message if we really put our heads together for real change in corporate America. I’ve learned, slow change is lasting change.

Q: Who could benefit from attending your presentation in Baltimore on February 24th? What message or skill do you most hope people will take away with them after hearing your talk?

Emme: I hope to connect with those who want to feel less alone and those seeking answers. No need to suffer in silence or bump along life’s journey by yourself. There’s no right or wrong when seeking out one’s truth. So my only message is this: Come with an open heart, you never know what may inspire, inform or ignite you. There’s only one you, and you are perfect just as you are!

 

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Many thanks to Emme for taking the time to respond to our questions and for sharing her strength and insight with our readers.  If you’d like more information about Emme’s presentation on February 24th, you can visit www.eatingdisorder.org/events or download the event flyer.  The event is free to attend but pre-registration is required to reserve seats.

Interested in more on this topic with Emme?  Join us for a special Twitter Chat with her on Thursday, February 21, 2013 from 1:00-2:00 EST.  Follow @CEDatSheppPratt and @EmmeNation for details and reminders.   

All photos of Emme courtesy of EmmeNation.com

Tried & True Strategies for a Recovery-Focused Holiday, Part III: AFTER Thanksgiving has Come and Gone

GratitudePost-holiday time can be filled with mixed emotions.  Some people experience RELIEF that it wasn’t as difficult as they had predicted, others struggle with post-holiday  FRUSTRATION or GUILT related to eating disorder behaviors or holiday meal challenges.  Still others head out of the holiday week EXCITED to return to the familiar structure and schedule of school or work. There may have been HAPPY times or SAD emotions woven throughout your Thanksgiving holiday as relationships and expectations for the holiday were tested. Maybe you tried some of the tips we suggested in Part I and Part II of our holiday blog series with a lot of success…or perhaps with a lot of struggle.  No matter how things went or how you’re feeling now its important to honor your emotions and continue on from this point in a recovery-focused way. Here are some tips that can help you make the most of your week-after-Thanksgiving (and beyond).

 

1. Change your filter.  So often, the eating disorder voice shines such a powerful spotlight on everything negative that it can be easy to get caught up in what went “wrong” on Thanksgiving day and ignore everything that was positive.  This is an example of a cognitive distortion called filtering.  In the days and weeks that follow, try not to allow your eating disorder to dictate how you will remember this holiday.  Instead, sit down with positive intention and make a point to reflect on what went well, what worked and who was integral to those successes.

2. Don’t skip therapy. (Sound familiar?)  If you had a hard time during the holiday and find yourself feeling frustrated or ashamed that you acted on symptoms, do not cancel appointments with providers.  Right after slip-ups is the ideal time to meet with a therapist or dietitian to process what happened, what the trigger was and how to prevent a holiday-induced downward spiral.  If your first appointment with a provider won’t be for another few days, take some time to jot down your observations and feelings about the holiday and what you want to remember to discuss with your therapist or dietitian.

3. Accept post-holiday compliments gracefully.  Individuals with eating disorders often have a hard time accepting positive feedback, especially when it clashes with their own negative beliefs about themselves or their abilities.  If someone is genuinely telling you that you did a good job with something, before you refute them, consider how your reaction will affect you and them. When Aunt Martha calls you this week and says  “Thanks for hosting us this weekend.  Your house looked beautiful all decorated for the holiday and the meal was just great,”  your instinct might be to say “Oh please, the turkey was dry and the house was a mess! I just didn’t have time to clean it the way I wanted to.”   When you completely reject a compliment it sends a message to the other person that you may be overly critical in general or that their opinion is not valued.  Additionally, if you deflect compliments from the same people repeatedly, they may be conditioned not to give them at all.  Most importantly, when you reject compliments you deny yourself the opportunity to absorb a positive belief which could go a long way in helping to boost your self-esteem and overall self worth.  Even if you’re struggling to believe that a compliment is true, allow yourself to receive it and entertain the idea that it just might have some validity.  Instead of deflecting, consider simple statements, such as “Thank you so much – that means a lot to me” or even, “Thanks” will work just fine.

4. Move On. If this holiday wasn’t what you had hoped for, let it go.  Don’t continue to blame yourself for things that may have been beyond your control.  Assess what can be changed in similar situations in the future and make note of them, then allow your mind to move on. Getting stuck in thoughts about how disastrous/boring/disappointing/etc. your Thanksgiving was is not going to help you make today the best it can be.  Remember that non-holidays are just as important in the long run of recovery.  Make today a good day; do the best thing for you and your recovery in this moment.

5. Keep the gratitude going.  Thanksgiving does a great job in helping to promote gratitude.  Even if you haven’t yet jumped on the #thanksvember bandwagon via Twitter or Facebook, it’s not too late to start. Take some time tonight to be grateful and send a genuine “thank you” to the support people that helped you enjoy the holiday…

  • If your mom changed the subject at dinner when a relative was harping on you for not taking seconds of her casserole, tell your mom later how much you appreciated her speaking up.  (If you live close by, give her a hug while you’re at it.)
  • If your friend answered frantic text messages you were sending on Thanksgiving day, let him know how much that meant to you that he was available for support in the thick of the holiday.
  • If your little nieces and nephews forced you into hysterical laughter with their impromptu Thanksgiving skit, send them little notes in the mail to let them know you can’t wait for their Christmas or Hanukkah performances too.
  • When it comes to gratitude, remember to use your voice.  It’s an  excellent opportunity to nourish the positives and create more of what you need for your recovery.

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Is there someone you relied on this Thanksgiving to help you through?   If you have feedback or comments about positive ways in which your support people helped out this holiday, we’d love to hear.  Share in the comments below or join the conversation on our Facebook page.

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Tried and True Strategies for a Recovery-Focused Holiday – Part I: BEFORE the Holiday

Tried and True Strategies for a Recovery-Focused Holiday – Part II: The Day OF Thanksgiving

Above photo courtesy of psychcentral.com (click on the photo to link to interesting research about the benefits of gratitude on health and wellness)

Tried and True Strategies for a Recovery-Focused Holiday – Part II

Each year we see many individuals with eating disorders, and even those in strong recovery, become increasingly anxious as the holidays approach.  Being on high alert for triggers or signs of relapse can be an effective way of staying recovery-focused and keeping yourself well. However, it’s also important to relax into the holiday and not allow the anxiety to overshadow what could be a very positive experience.

Yesterday in Part I, we shared strategies to help you plan ahead for a recovery-focused holiday.  Today in Part II, our staff share their top tips for making it through the actual day of a holiday with health and recovery intact.

Part II: The Day OF Thanksgiving…

Thanksgiving Mantel

  • RELAX - Focus on your breath, meditate, or listen to soothing music on your way to  he festivities so you start off the celebration in a positive place. If you show up in an anxious or negative mood right off the bat, it’s likely to affect those around you and be intensified.

Try to enjoy the holiday, not just survive it! Focus on what you would like to do and who you would like to do it with. Shift your attention from body image, food, and self-criticism and focus on what you want the meaning of the holiday to be for you.

~Kim Anderson, Ph.D., Therapist and Director of Psychology 

  • Check in with yourself about body comparisons. Believe it or not, we hear a lot about patients not liking family gatherings because they are comparing their bodies to other family members. For many people, these inter-family comparisons can be the most triggering or most intense body comparisons they face. If you find yourself going down that road, hit the pause button. Rewind, reconnect and consider engaging the person in conversation instead. See if you can find out something positive about them you never knew before. Remember that they are more than just their body and you are more than just yours.
  • Get grounded.  If you feel your thoughts drifting to food, body or weight, re-connect to something positive in the moment.  Sometimes wearing a special bracelet or keeping a special item in your pocket that you can reach for and touch/hold can help to ground you.  Connecting physically to an item can help you stay in the moment and tune out the eating disorder voice.
  • Cross generational boundaries.  Be mindful of the different support each generation of your family can offer.  Hanging out with siblings, cousins and others of a similar age to you can be a nice way to connect around common developments and gives you a chance to get support/empathy on specific life stage issues like being away at college, parenting stress, job hunting, retirement, etc. On the other hand, reaching out to older generations, like grandparents, is an opportunity to get outside of your own concerns, to see how priorities can shift throughout life and also to collect some family history. Consider sitting down with an older relative and asking them an open-ended question about their most memorable Thanksgiving.  Even the youngest generations have something to offer you in your recovery-focused holiday…

Spending time with the young children in your family during large family gatherings could be a good distraction from “grownup conversation”. Hang out with the kids, play games with them and ask them about themselves. You might even consider eating with the children and think about being a good role model for them.

~Lisa McCathran, LCPC,  CED Outpatient Therapist

  • Be the family photographer.  Grab your camera and put yourself in charge of documenting the day. Many extended families only have rare opportunities to spend time together.  Catching family memories on film will not only keep you focused on something other than the ED, it will give people around you a reason to smile and be mindful of the special moments throughout the day.
  • Hors d’oeuvres.  Food is often present at holiday gatherings long before the actual holiday meal is set on the table. Be prepared. When eating appetizers/munchies, instead of continually grazing and walking around with food, you may want to put all of your choices on a plate together at once so that you can see a total of what you are eating.  Then allow yourself to sit down and mindfully enjoy eating it.
  • Structure your time before and after the meal by preemptively volunteering to help out in ways you are most comfortable with. For example, ask if you could set the table instead of helping around the food in the kitchen. Instead of packing up the leftovers, consider offering to load the dishwasher or get the kids in their pajamas.
  • Be assertive in making sure you get seated next to your most supportive family member at the dinner table.
  • Use your support. If you took the effort to connect with a “safe person” in advance of the holiday, now you have to be sure to utilize them. It can be hard to ask for help in the moment but it will be worth it.

[Editors note: When we asked our dietitians to chime in on the "eating part" of the holiday and their best piece of advice, they all said the same thing...which means it's probably pretty important.  That's why we've included all of their input below without consolidating.  Even though it's repetitive, it's one of the most important things you can do to have a happy, safe and recovery-focused holiday while recovering from an eating disorder.]

  • Take the time to eat your three meals during the holiday.  Breakfast will be particularly important as it sets the stage for your hunger and fullness cues over the rest of the day.
  • Eat regularly!!! It’s the most important thing to do. This is not the best time to try a new eating schedule.
  • Do not skip meals! Do not plan to compensate for overeating later by skipping meals in advance.
  • Stick to the meal plan especially the day before the holiday and on Thanksgiving Day.

Have an adequate meal at each meal time prior to the Thanksgiving meal so that you’re able to enter the holiday meal hungry, but not ravenous.  When you skip meals or restrict during the day and then enter a meal ravenous, you’re much more likely to eat past fullness.  On the other hand, entering a meal with a natural level of hunger means you will be more likely to stop when you’re properly nourished and comfortably full.

~ Hannah Huguenin, MS, RD, LDN, CED Dietitian

  • Everyone needs a little alone time. Remember to take time by yourself to journal or relax during the day. If you’re staying with relatives and can’t find space inside the house to be alone, grab your coat, a cup of hot tea and step outside for fresh air, or consider volunteering to run an errand for your host
  • Play games. Don’t assume that your host will be prepared with distraction techniques for you - he or she will probably be pretty busy with holiday hosting tasks – so bring your own games to the party.  Grab a holiday-themed puzzle or some of your favorite board games that will encourage interaction. Need something quicker and easier?  Simply bring a deck of cards that you can use to play all sorts of different games with others or even by yourself.

Many people with eating disorders, especially those who’ve experienced trauma, may experience very intense emotions around the holidays. These strong feelings and stressors can be overwhelming but they don’t need to ruin or disrupt your holiday. Consider using a “containment strategy”. Write down the unpleasant thought or feeling on paper and put it “away” inside a designated containment box to be opened later when feeling safer such as in a therapist’s office or when the feeling has decreased in intensity.

~ Irene Rovira, Ph.D., Therapist & CED Psychology Coordinator

  • If you are not attending a family gathering it’s still important to plan a recovery-focused holiday.  In fact, it may be even more important to create structure and social opportunities that will keep you focused on the bigger picture and engaged in positive activities. This could include volunteering your time to other causes like a soup kitchen or a homeless shelter or it might mean finding another friend without plans and going out to a movie together.
  • You made a list, now check it twice. If you took the advice in Part I of this holiday blog series, then you should have a list of the top 3 most useful coping skills for you (this will be different for everyone).  If you’re going through the day and you’re struggling with eating disorder thoughts or urges to act on symptoms, refer back to your list and work through them again, making tweaks if necessary. For example, if you called or texted a friend who never replied, do it again but try someone else this time.  Just because the first person didn’t get back to you, doesn’t mean you have to give up.
  • RELAX and end your day with SELF-CARE.  Just as we suggest starting off the day with relaxation techniques, allow more time for yourself to decompress from the holiday as it comes to a close.  Breathe deeply, put on your favorite music playlist for the ride home, or take a few minutes to journal when you arrive home.  Regardless of how the day went, do something nice for yourself before you go to bed on Thanksgiving night. For some people, that might be taking a nice hot bath, reading a book, writing a supportive email to yourself, watching a favorite movie with your spouse or a best friend, or cuddling with your pet. Whatever it is, allow yourself to enjoy it.  Accept that you are deserving of self-care and able to bring your day to a close in a positive way.

We know this is a long list, and you can’t do every single thing on here ( and we don’t want you to overwhelm yourself by trying).  Just choose the ones that speak to you and that you think will be most helpful on your holiday.  Chat with support people and get their feedback regarding how these tips can fit into your specific family’s traditions and holiday schedules.

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Did you miss Part 1?  You can still go back and read the holiday planning and preparation tips here:  Tried and True Strategies for a Recovery-Focused Holiday, Part I: BEFORE the Holiday…

Find Part III here: Tried & True Strategies for a Recovery-Focused Holiday, Part III: AFTER Thanksgiving has Come and Gone

Have a good tip that we missed? Share your support and feedback on our Facebook page.

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Many thanks to the following CED providers who’ve contributed to this blog series:

  • Samantha Lewandowski, MS, RD, LDN
  • Hannah Huguenin, MS, RD, LDN
  • Jennifer Moran, Psy.D.
  • Kim Anderson, Ph.D.
  • Laura Sproch, Ph.D.
  • Irene Rovira, Ph.D.
  • Amy Scott, LCPC
  • Lisa McCathran, LCPC
  • Anne Holman, LCSW-C
  • Kate Clemmer, LCSW-C
  • Jennifer Lane, MS, OTR/L

 

 

 

Tried and True Strategies for a Recovery-Focused Holiday – Part I

Thanksgiving centerpiece

Holiday gatherings and celebratory feasts can pose some significant challenges, regardless of where you’re at in treatment or recovery. Being aware of them, planning for them and setting yourself up for an enjoyable holiday is important. That’s why we asked all of our clinical staff at CED to share their best advice for having a safe and successful holiday while maintaining or working towards recovery from an eating disorder. They had so much to share that we couldn’t fit it all in just one post so this is just the first of a 3-part series to help you through the before, during and after of the holidays.  

Through the years, these are some of the strategies and suggestions that our therapists have seen the most success with and we hope you will too.  Happy Thanksgiving from all of us here at the Center for Eating Disorders at Sheppard Pratt.

Part I: BEFORE the Holiday…

  • Plan, Plan, Plan…..with your treatment team and with your primary supports. Develop a very specific, detailed plan for managing all the stressors that come along with the holidays.
  • Challenge predictable thoughts before the holiday. If you notice you have predictable patterns of negative thinking pop up at family gatherings or the same triggering thoughts sneak up on you every Thanksgiving day, take time to identify them in advance. Write them down and work on challenging the thoughts ahead of time (on your own or with a therapist) so you’re better prepared to defend against these specific negative/irrational thoughts on the actual day.  You might even consider keeping a list of your positive affirmations or challenge statements with you on Thanksgiving for easy access.  (If you know you’ll have your phone handy, you could even send a text to yourself the day before).
  • Identify one or two major positives about the holiday. No matter how anxious or depressed you may feel about an approaching holiday, there IS a positive hidden somewhere, even if it’s as simple as getting time off from school or work.
  • Make a list of your top 3 most reliable coping strategies and keep it handy in a notebook or on your phone.

Decrease stress and increase relaxation. Only say “yes” to events that you would like to attend and believe you can attend with success. Keep your daily schedule of activities and gatherings manageable.

~ Kim Anderson, Ph.D., Therapist and CED Psychology Coordinator

  • RSVP with a time limit. For example, “Thanks so much for inviting me. I’ll be able to be there from 3:00 to 5:00.” This provides you with some boundaries and an opportunity to leave the situation if it’s becoming detrimental to your recovery. However, if things are going better than expected (which often happens) and you want to stay longer, then you can.
  • Choose a worry chair.  If the anxiety is overwhelming or interfering with life, set up an appointment for yourself to “worry” about your concern at a specified time, date and place- this allows you to “delay” the worry and frees you up to take care of business at hand until then.

I really try to highlight for my patients that they are not alone in experiencing high stress around the holidays and that other members of their family are likely struggling with similar anxieties and negative thoughts. Some are able to manage extra stressors in healthy ways like talking about how they’re feeling, getting enough sleep, setting limits, or adding in extra self-care. Other family members may turn to unhealthy management strategies like drinking too much, getting into arguments, withdrawing, avoiding, hiding their feelings, or eating too much/too little. I try to use this to help my patients see that the problem isn’t the food itself, it is ultimately the thoughts and feelings, that can lead to intensified eating disorder urges. Being aware of this can free you up to move forward and choose more constructive and beneficial ways to cope.

~Laura Sproch, Ph.D., Individual and Family Therapist and CED Research Coordinator

  • Identify a “safe person” you can go to that is aware of your struggle and will support, distract, and protect you on the day of the holiday gathering. Talk with that person ahead of time so they know exactly how to support you during the meal and in specific situations. These things are not always obvious and support people may need a little “coaching” in advance. Some people even like to arrange a “code word” with their support person that they can say when they’re feeling really triggered and need an opportunity to remove him or herself from the situation.
  • A day ahead, you may want to plan out the timing for your meals, especially if Thanksgiving meal is falling at an atypical meal time. Refuse to use that timing issue as an excuse to skip meals or go off your meal plan. Simply juggle around your mealtimes a bit so that you can still fit in breakfast, lunch, dinner and one or two snacks. If you don’t do this in advance, it probably won’t happen.
  • Create a holiday project that will provide you with some distraction and also give you something positive to look forward to on the day of the holiday. Consider creating a scrapbook of past family holidays or a hand-made gift for your host/hostess.
  • Set realistic expectations. Work on decreasing expectations about decorations, food, family time, and any other areas in which you’re feeling pressure to be perfect.

Real-life holidays, like many things, will not resemble the advertisements and commercials that portray them. Holiday gatherings will not be perfect…someone will spill their drink all over the carpet, your relatives will arrive late (or unexpectedly early!), kids will have tantrums, arguments may occur, and at least some of the food will get overcooked. The great thing is, that’s all okay and normal. If you find yourself expecting a picture perfect Thanksgiving, take time to adjust your vision and agree to embrace the day in all its imperfection. Ultimately, that is exactly what will make it memorable.

~ Kate Clemmer, LCSW-C, CED Community Outreach Coordinator

  • Focus on the bigger picture. Research causes or charities that interest you where you might be able to volunteer during the holiday season; focus on the meaning of the holiday rather than the food specifically.
  • Don’t skip therapy appointments. With all of the preparations and traveling and extra time committments, many people find themselves tempted to cancel pre-holiday meetings with therapists and dietitians or skip regular support groups.  We’ve encountered this many times before and unfortunately, it rarely results in positive outcomes.  This is exactly the time when extra support is crucial.  Instead of cancelling, consider other options like adjusting your appointment time to an earlier slot before you leave town.
  • Begin a daily practice of gratitude. Start each day by reflecting on something you are grateful for. You could write them each down in a journal or even post them on Facebook. This is a great way to head into the holiday with a fresh and positive outlook.

Stay tuned for tomorrow’s post with more insight and suggestions from our therapists and dietitians in Tried and True Strategies for a Recovery-Focused Holiday, Part 2: The Day Of Thanksgiving

[UPDATE]: Part II is now live here

[UPDATE]: Part III is available here: Tried & True Strategies for a Recovery-Focused Holiday, Part III: AFTER Thanksgiving has Come and Gone

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You might also be interested in these posts from past holidays…

 Tips for Overcoming Holiday Stress and Anxiety – Part I: The Food

Tips for Overcoming Holiday Stress & Anxiety – Part II: The Stress

Nutrition Tips for a Healthy and Happy Holiday!

Thanksgiving with an Eating Disorder: 10 Tips to Help You Get Through the Holiday

Photo courtesy of examiner.com

 

Momentum of Positive Change: The AMA’s Photoshop Policy & Beyond

On its website, the American Medical Association (AMA) states that its mission is to “help doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues.”  It speaks volumes then, that in their most recent press release, the AMA announced the adoption of a new policy to discourage the rampant use of photoshopping and American Medical Association Logophoto editing by advertisers.  In the policy, AMA cites the connection between unrealistic/altered images and adolescent health problems, particularly body image and eating disorders. A press release about the new policy included the following statement:

Advertisers commonly alter photographs to enhance the appearance of models’ bodies, and such alterations can contribute to unrealistic expectations of appropriate body image – especially among impressionable children and adolescents. A large body of literature links exposure to media-propagated images of unrealistic body image to eating disorders and other child and adolescent health problems. The AMA adopted new policy to encourage advertising associations to work with public and private sector organizations concerned with child and adolescent health to develop guidelines for advertisements, especially those appearing in teen-oriented publications, that would discourage the altering of photographs in a manner that could promote unrealistic expectations of appropriate body image.

Its important to note that eating disorders are biological illnesses with a myriad of  genetic, hormonal and neurobiological factors.  Just as parents do not cause eating disorders, nor do airbrushed magazine ads. (In fact, Carrie Arnold over at Psychology Today’s Body of Evidence does a great job of examining this aspect of the AMA’s statement).  But our hope is that this new policy is not just focused on removing a risk factor for those who may be genetically more susceptible to the “thin ideal”.  A society saturated with computer-generated images portrayed as real bodies is unhealthy and harmful whether it contributes to an eating disorder or not.   Its harmful to females and males.  Its harmful to kids and adults.  Its harmful for anyone that struggles with negative self-esteem or body image.  In this way, the issue of photoshop and media ethics is more than an eating disorder prevention issue but one that addresses self-esteem and body image on a societal level.

While some will say the policy doesn’t accomplish enough, its encouraging to see a well-respected, national organization like the AMA acknowledging the issue and prompting further attention to it. What’s most encouraging isGirl Scouts of America logo that this recent action by the AMA, seems to be part of a larger momentum of change including the Girl Scouts’ announcement of its’ project, Healthy MEdia: Commission for Positive Images of Women and Girls which is being co-launched by the National Association of Broadcasters (NAB), the National Cable & Telecommunications Association (NCTA), and The Creative Coalition.

The new policy also arrives amidst several specific wins in the fight against harmful media practices surrounding weight, food, beauty ideals and sexualization.  Most recently, the Federal Trade Commission (FTC) won a settlement against Beiersdorf, Inc. (parent company of Nivea) Inc. that prohibits them from making continued false claims that its Nivea My Silhouette! skin cream can reduce consumers’ body size.  In June, the National Eating Disorders Association (NEDA) publicly applauded Yoplait for agreeing to pull a troubling ad campaign after being warned by NEDA that it normalized dangerously disordered thoughts around food and weight.  And thanks to international body image advocates Sharon HaywoodMelinda Tankard Reist and more than 5,000 signatures on a petition at Change.org, major networks MTV and VH1 both agreed to ban a violent and misogynistic music video starring Kanye West and other high profile music stars.

Lots of individuals and organizations are pushing back against the tide of false bodies, diet myths, weight prejudice and general negativity in the media.  They’re making great strides in the promotion of positive body image, self-esteem and overall health (vs. weight).  In addition to those we mentioned above, here are just a few more organizations and individuals that are doing good and speaking out for change:

When it comes to body image and media literacy, what other successful campaigns and positive social changes have you noticed lately? 

Join the discussion and check us out on Facebook & Twitter.

You Are So Much More Than Your Eating Disorder

Anyone who has been through the eating disorder recovery process will tell you it is not easy.  Eating Disorders (EDs) are complex bio-psycho-social illnesses and, as such, the treatment and recovery process can often be more difficult than anticipated.  It’s not uncommon for struggling individuals (and their support people) to hold on to a wish that removing one specific trigger will offer a quick fix or a shortcut to recovery.  Unfortunately, there is no magic wand for ED recovery.  Changes to daily routines, altering hobbies or taking time off from triggering activities are sometimes part of the recovery process but these things must be accompanied by additional hard work, specialized therapy and a deeper understanding of oneself and the role that the ED plays in ones life.

When author and recovery advocate Johanna S. Kandel was speaking here at CED in February 2011, she talked about this struggle as it related to her own ballet career and her identity as a dancer.  Now recovered after 10 years of struggling with periods of anorexia, bulimia and binge eating disorder, Johanna remembers thinking that removing ballet from her life would also remove the ED.

http://eatingdisorder.org/video/kandel2.flv

In the clip, Johanna shares so bravely about a story which so many others can relate to – being in a very scary place for a long time, feeling like there isn’t much to cling to other than the ED.  The longer one identifies solely with their ED, the harder it can be to envision oneself without it.  Fortunately, while there is no magic wand, there are skilled treatment professionals, evidence-based therapies, ongoing support groups and various treatment options for those who are struggling with all types of eating disorders.  It is never too late to hope.  It is never too late to seek treatment and to begin the journey to recovery.

Do you find yourself hoping one change will erase the ED from your life?  Does it prevent or delay you from seeking meaningful help?  If you find yourself feeling like your eating disorder is your only identify, try this exercise:  Draw a picture of a sun with many different rays of light coming out.  On each ray, write down an important role that you play in life or important elements of who you are.  For example:

Daughter, College Student, Nanny/Babysitter, aspiring Writer, Employee, Colleague, Tutor, Sister…

OR…

Brother, Friend, Fiance, Son, Employee, Hospital Volunteer, Uncle, Artist, Band Member, Pet Owner…

Early on in recovery, the eating disorder may have an important place around your sun as well.  As Johanna mentioned in the clip, it can often feel like the ED becomes your only identity.  Reminding yourself that you are so much more than your ED can help to make it a little bit easier to loosen your grip on the ED.   Gradually, through treatment, the ED becomes a less important part of who you are, and you can spend more time focusing on the true rays of light in your life.

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This was the second of several recovery blogs inspired by the February 2011 presentation by Johanna Kandel at The Center for Eating Disorders at Sheppard Pratt. Follow CED on  Facebook to stay tuned as we continue to post additional recovery-focused blogs and video clips .  Johanna shares more about her own recovery journey in her highly influential book, Life Beyond Your Eating Disorder,  and continues to support others through her role as the Executive Director of The Alliance for Eating Disorders Awareness, a non-profit organization based in Florida. You can learn more about Johanna and her incredible book in these previous blogs as well: