How to Stay Recovery-Focused When Interacting with Triggering Media

In our previous post we discussed a variety of reasons that individuals with eating disorders, especially those in the early stages of recovery, may choose not to watch the Netflix film To The Bone or other films they know could create roadblocks in their continued recovery.

With that said, triggering media has always been around and will always be a part of our society so it’s helpful to know how to navigate it.  Many individuals in long-term recovery or later stages of treatment might feel prepared to watch a film or read a book about eating disorders, despite triggering content. Many of our clinicians have helped to shape such exposure into therapeutic experiences for patients who are ready.  For example, during periods of strong recovery, seeing a film like To The Bone can be an opportunity to reflect on one’s own experience, see things from a new perspective, process lingering eating disorder thoughts or channel anger towards the eating disorder in productive ways.

If you’ve considered all of the options and decide you do want to watch a film about eating disorders, these are a few things to consider that can help you do so in safe and productive ways.

  1. Don’t watch alone. Watch with a support person you can trust and communicate openly with them about how it is impacting you in the moment. You might even consider pausing the show periodically to breathe, reflect and talk.
  2. Time it right. Only watch it when you know you’ll be attending a therapy session or support group within a few days so you can explore your reactions and get help challenging any distorted thoughts or concerns about what you see on screen. If you currently have a lot of other life stressors or you’re in a time of transition (moving, starting school, going through a divorce, etc.) you may want to consider waiting to watch until things settle down.
  3. Challenge the ED thoughts. Consider journaling about aspects of the movie that you find triggering and then refute and challenge the inaccurate, negative or distorted thoughts.
  4. Be an activist. Write a letter to the director of the film or to the editor of a local newspaper regarding what you liked or didn’t like, what was helpful vs. not helpful or what you’d like to see more of when it comes to films about eating disorders. For example, while To The Bone features one person of color and one male in supporting roles, the movie’s star and protagonist is a young, white, upper-middle class woman with anorexia. This doesn’t help to dismantle stereotypes about who is and isn’t impacted by eating disorders. Consider writing a letter that advocates for greater diversity in eating disorder representation or about another aspect of recovery that feels important to you.
  5. Create an escape clause. Allow yourself the option to stop watching at any point throughout the film. Eating disorders can be associated with all-or-nothing thinking so it may feel like once you start the movie you have to finish it, but remember it’s not so black and white. At any point, if you feel triggered or uneasy about what you’re watching, turn it off.
  6. Plan ahead. Decide in advance upon an alternative show to watch or a self-care activity you can do when the film is over (or if you stop watching early) that will help you sustain a more recovery-focused mindset.

Do you use these strategies or have other ideas for navigating triggering media safely?  Tweet them to us @CEDSheppPratt and we’ll add to the list. 


You may also be interested in reading: 
To Watch or Not to Watch: That is the Question, Navigating “To The Bone” and other potentially triggering movies about eating disorders

 

 

 

 

 

Body Positive Summer Step 2: Stop Comparing. Start Contrasting.


_What you focus on grows. What you think about expands._How much time do you spend thinking about what’s wrong with your body, how it could look “better” or how it doesn’t look like that other person’s body? How often do you compare your body to the bodies of  friends, celebrities or strangers?

The more time you spend looking for what is imperfect or “wrong” with your body, the more likely you will be to find answers that justify the question. It’s kind of like someone searching  for Bigfoot. If you invest a lot of time reading about Bigfoot and watching Bigfoot documentaries, when you head into the forest looking for Bigfoot then every rustle of leaves, flash of furry wildlife or unidentifiable footprint becomes a possible Bigfoot sighting in your mind.  Likewise, if you head into each day comparing your body to an established “ideal” than the list of things you are unsatisfied with will grow and all the evidence will point to your body not being good enough.

Stop comparing. Start contrasting.
Alternatively, set the intention to spend more time thinking about the unique qualities, characteristics and skills that you possess.  In doing so, you will be more likely to take note of the things that set you apart in a positive way.  Part of doing this requires you start with #bodypositivesummer Step 1 to identify and remove external influences that promote  harmful body comparisons.

Then, remind yourself and others that what makes you beautiful is your individuality. Maybe you’re a science whiz or have striking green eyes. Perhaps you’re great with kids or have an artistic flare? Whatever it is, take time each day to honor what you like about your body as well as your overall strengths and personal interests or passions. If you are someone who has struggled with an eating disorder or negative body image for a long time, it might feel like food/diets and weight obsession are your passion. If that’s the case, this summer would be a great time to challenge your norm by exploring new interests and shifting focus.

Have great balance? Sign up for a surfing lesson.
Feel connected to nature?  Join a hiking group.
Skilled writer? Start a science blog.
Have extra time and love? Adopt or foster a new pet.
Got a green thumb? Start a neighborhood herb garden.
Math superstar?  Volunteer to tutor kids over the summer.

Re-read all of your favorite books. Organize a beach volleyball game. Learn to knit. The #bodypositivesummer_TOPICSpossibilities and topics are endless really.

If you feel like you don’t know what your interests are, the key is trying lots of different activities until you find one that sparks your enthusiasm. Good topics and activities are ones that help distance you from eating disorder thoughts, distract you from body comparisons and create a space in which you can be grateful for the body you have right now.

If someone asked you what you WANT to spend your summer thinking about, you probably wouldn’t say “all the things I dislike about my body”, right?  So ask yourself this very question. Imagine your brain is a container and you can choose to fill it with whatever you want over the coming months. Tell us your answers on Twitter or Instagram with the hashtag #bodypositivesummer.

Not on social media? Email your responses directly to kclemmer@sheppardpratt.org and they’ll be compiled to help inspire others.


Find more about the #bodypositivesummer series in the following posts:

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Perfectionism: Aiming for an elusive target

archery_by_kongsky


Imagine that you are extremely dedicated to an archery team. You spend day and night in target practice, regardless of the weather conditions and without regard for your own basic needs. You have an unlimited amount of arrows and you continue over and over again to launch the arrows in an attempt to hit the bull’s eye. Day after day, year after year, you never reach that bull’s eye. No matter how hard you train and commit your mind to it, no matter what the conditions are, you always miss what you are aiming for. Sometimes, you get very, very close and think that you just might have reached your goal, but ultimately, you never hit the mark. As a result, you feel that you have failed. In fact, failing becomes part of the way you define yourself.  Fear of failing becomes a constant worry for you.

Now imagine, that one day you realize that this target that you have spent all of these hours and days and years trying to hit is so very small that you can barely even see it. Actually, when you look closely, and assess the situation you find the bull’s eye is not just small and faded, it is nonexistent. Upon realizing this, you see you have spent years and years feeling like you have failed because you were trying to hit a target that wasn’t actually there. This is perfectionism.

In this imagined scenario, perfect is the nonexistent target. A sense of failure results from believing that anything but perfect is not good enough. If you are struggling with perfectionism, or you have in the past, you probably know how exhausting this can be.

 

Perfectionism is an unobtainable illusion guaranteed to make you feel badly.

Under the weight of extreme perfectionism, difficulty with a specific task may be generalized.  This can quickly lead to self-criticism. For example, instead of thinking, “I did not do well on that part of the exam; those must have been really difficult questions,” the perfectionist might think “I am so stupid. How could I have missed both of the multiple choice questions?! I am terrible at math.”

Constantly striving for perfect results can lead to feelings of tension and stress. It can also trigger an avoidance of appropriate challenges and risks. For example, you might find it difficult to connect with new people in social relationships at the risk of appearing flawed or imperfect to someone else. Or you may not apply to a great job because you haven’t mastered every single skill set listed as a prerequisite.

In general, perfectionism can cause you to miss out on opportunities to learn from mistakes and may ultimately get in the way of living a balanced, rewarding life.

 

Addressing perfectionism can aid in eating disorder recovery

Perfectionism is a genetic personality trait that many people are born with. Research has shown this characteristic to be a significant risk factor for the development of eating disorders. Furthermore, once someone has developed an eating disorder, perfectionism can sustain or perpetuate the illness, getting in the way of recovery efforts. For this reason, it can be important to work on perfectionism head on.

With support from a cognitive-behavioral therapist, you can start by making clear, manageable behavioral changes to test out what it would be like to attempt tasks without looking for a perfect outcome. For example, trying to complete tasks “good enough.” It’s usually helpful to start off with very small goals and work your way up to more situations that might be more difficult. Consider these two examples below:

Example 1: If you identify yourself as a “neat freak,” try setting a timer to limit cleaning time to smaller intervals or set a guideline that you will vacuum only 50% of the time that you typically do. Experiment with this and see what the advantages and disadvantages are of approaching this task in a new way. Learn from this experience and make changes accordingly.

Example 2: If you are someone who needs to complete every item on your to-do list before leaving the office (at the expense of family, friends or self), see what happens if you have a couple of items left to work on the next day. Test out how this might affect you. Perhaps you were able to get home on time and enjoy more time with your family or you were able to drive home while it was still light out and enjoy the scenery. See if leaving those items for the next day made much of a difference as you may have approached them more efficiently with a good night’s sleep. Test out if sometimes your perfectionism causes you to put in more effort that will only bring very marginal gains. If so, figure out when is the time to stop and focus on something more profitable.

Starting to make changes on your own is a great first step toward decreasing the amount of influence that perfectionism has in your life. You might also want to consider engaging in a cognitive-behavioral therapy (CBT) group or individual therapy to learn how to change the way in which you interact with your perfectionism.

Committing to decrease your need to be, or appear, perfect will help you to take more and more breaks from target practice and actually enjoy being on the archery team.

 

Do you want to learn more about perfectionism?

when perfect isnt good enough
We recommend the book, When Perfect Isn’t Good Enough, written by Drs. Martin Antony and Richard Swinson.

If you are a treatment provider and would like to learn more about cognitive and behavioral treatments for perfectionism, join us on April 9, 2016 at The Center for Eating Disorders’ Annual Professional Symposium where Dr. Antony will be presenting on The Nature & Treatment of Perfectionism.

Online registration and event details are available at www.eatingdisorder.org/events.

You can also download the program brochure (pdf) here.


Written by:
Laura Sproch, PhD
Research Coordinator and Outpatient Therapist at The Center for Eating Disorders

Photo Credit: Freedigitalphotos.net / kongsky

 

 

Adventures in Self-Care with Melissa Fabello: Part 1

 

If you’ve ever seen one of her YouTube videos than you probably already know Melissa Fabello is a talented and passionate activist.  She also writes boldly and beautifully about eating disorder recovery, body image, diet culture and a host of other important issues. In advance of National Eating Disorders Awareness Week and her presentation in Baltimore on February 21, we asked Melissa to share her thoughts on why self-care is not self-ish, the intersection of eating disorders and perfectionism, and her experience with recovery in a society obsessed with dieting.  We are honored to share her responses with you below.

 

 


Q&A with MelissA Fabello – Part I

 

Q: A lot of people assume self-care to be synonymous with personal hygiene or the daily chores of living. This can sound like a pretty boring topic. Given that you will be in Baltimore on February 21 to discuss the Adventures in Self-Care as part of National Eating Disorders Awareness Week, can you explain more about what self-care really is and why it’s something we should be talking about?

MF: To start, I would actually argue that self-care should, indeed, be a daily chore of living. It should be an intentional practice that we partake in – every single day – in order to take care of ourselves. It really can be as simple as getting the right amount of sleep, drinking enough water, or eating a meal that fuels your body. It’s finding ways to insert self-care into those daily chores of living, which in turn, creates a life that may feel a bit more adventurous.

And when I say “adventurous,” I don’t necessarily mean thrill-seeking, but rather, simply, more livable. And what is more of an adventure than life itself? Self-care puts you in the position to live life more fully and to experience it more broadly because it cultivates your self-awareness and forces you to consider what makes you the happiest.


Self-care, really, is just any set of practices that are nourishing to you – physically, emotionally, and spiritually. Those practices can be preventative (like taking care of your physiological and mental health needs to the best of your ability every day), and they can also be intervention methods (think: calling out sick just to spend the day taking a bubble bath and reading novels). But the point is that they are necessary to all of our lives, but especially necessary when we’re in eating disorder recovery.

 

Q: We often hear from patients who fear that engaging in self-care is a selfish act. How would you respond to someone worried about being, or being perceived as, selfish?

MF: That’s a real concern, and it needs to be validated as such. We live in a culture that’s driven by capitalism, and the number one value held by capitalism is that of productivity. Have you ever slept in because your body needed rest, but then berated yourself for not getting up early enough to start in on your housework? Or have you ever taken a much needed day off to marathon your favorite TV show, but then felt bad that you didn’t work on your school work, even though you hadn’t taken a day off in two weeks? That guilt is the product of believing that our worth is tied up in how productive we are.

670_06_NEDAW_TWITTER_01_2016_P12 This is especially difficult for women. In our society, men are frequently defined by what they do out in the world. Women, though, are judged by how they take care of others. As such, women’s moral development, according to Carol Gilligan, is all about how we understand ourselves in relation to other people. Women, in particular, are taught that taking care of ourselves and putting ourselves first is not only a selfish act, but even an immoral one. And that’s just straight up sexist.


One small shift we can make is to redefine what “productivity” means to us. I have an ex-girlfriend who was a hustler, trying to make it in the music business. As such, every day when we talked, she’d ask me, “What did you do today?” or “What did you accomplish today?” And sometimes that really overwhelmed me – because what if I didn’t “do” or “accomplish” anything? But the truth is that even if what I did that day was laugh while playing with my cat, or if what I accomplished was taking a trip to the bookstore for fun, then I’ve been productive. I’ve produced something: self-care. I think we need to remind ourselves that taking care of ourselves is an accomplishment.

 

Q: Perfectionism is one of several genetic traits that have been identified by research to be associated with an increased risk for the development of eating disorders. From your experience and observation, how does the topic of self-care intersect with tendencies toward perfectionism?

MF: I like to think of myself as a recovering overachiever, although I still fall back into those old habits sometimes. Again, in a culture where we’re taught to value our productivity, it can be hard not to fall into perfectionism as a way to prove our worth. But the truth is that we need to learn to be okay with the fact that none of us is perfect, that we’re all going to make mistakes.

One of the most valuable pieces of self-care advice I’ve received lately is that of learning to be okay with “good enough.” I’m one of those people who, when I give 75%, will feel guilty and ashamed for not giving 100%. What happens that’s interesting, though, is that no one can ever tell that I didn’t give something my all. As far as they can tell, I gave 110% because what I did was absolutely, positively awesome. Learning to be okay with “good enough” means giving something a shot, but not letting it run our lives, and feeling comfortable with the amount of attention that we were able to give something.

Part of self-care is being able to say, “I can’t (or don’t want to) work on this anymore because it’s possible that continuing to do so will damage my mental health. So I’m done now.” And that means letting go of the idea that we – and everything associated with us – has to be perfect.

 

Q: Another risk factor for eating disorders stems from the emotional and physiological consequences of dieting. What other impacts do you see from a culture that markets diets as a valid form of self-care and a path towards self-acceptance?

MF: I’ll be honest: The day that I actively decided to go through weight restoration was the day I realized that I could never be both thinner and happy. I could only ever be one of the two. I could spend every second of every day counting, measuring, and restricting in an attempt to achieve self-acceptance through (what I thought was) self-improvement, or I could attempt to apologize to my body and recreate a healthy relationship with food and within that freedom, find happiness. That concrete realization – that I couldn’t work toward a “better” body and experience day to day happiness – was a huge shift for me.

A spoken word poem that I really love, “When the Fat Girl Gets Skinny” by Blythe Baird, has a line in it that says: “This was the year of eating when I was hungry without punishing myself / And I know it sounds ridiculous, but that sh– is hard.” And it is. It is hard. Because we live in a culture that is so focused on dieting as, like you said, “a valid form of self-care and a path towards self-acceptance” that deciding to go against that grain and to seek validation and happiness from elsewhere is a radical act. And make no mistake: Giving up diet culture is a radical act, both personally and politically. Our culture thrives on making us feel small, weak, and less-than. Rebelling against that pressure, declaring that you will not be contained, and saying “no” to everything that our culture and media want us to believe? That is an incredibly courageous act.

 

Be sure to check out Part II of our discussion with Melissa in which she delves into body image and the concept of intersectionality as it relates to eating disorders.

Join the conversation on Facebook and Twitter using the hashtag #bmoreselfcare. 


MF 006Melissa A. Fabello, M.Ed. is a body acceptance activist, sexuality scholar, and patriarchy smasher based in Philadelphia. She is currently a managing editor of Everyday Feminism, as well as a doctoral candidate at Widener University, working toward a PhD in Human Sexuality Studies. Melissa has worked closely with The National Eating Disorders Association, The Representation Project, and Adios Barbie on campaigns related to body image, eating disorders, and media literacy. Find out more about Melissa and her work at melissafabello.com.

 

 

 

Simple solutions for holiday (and everyday) conversations about food and weight


dining room
As we head into the holidays, it can be helpful to have a very simple plan for responding to family and friends drawn to the very topics that may be most troubling during recovery from an eating disorder.  Depending on how you spend your holiday this year, one or all of these suggestions may come in handy when the conversation takes a turn toward triggering language regarding bodies, food or weight.


Step 1:
Obstruct or change the conversation if you notice someone is heading into a discussion that makes you uncomfortable.

Remember people generally like to talk about themselves and their interests. If Aunt Marie is pressuring everyone to eat more pie or is gushing over a family member’s weight loss, use that as an opportunity to reflect the attention back to her. So who taught you how to bake? What are you up to at work Aunt Marie? How was that vacation you went on?

If you’re comfortable staying on the topic but exerting your power into the conversation you could try something like this: I’ve actually been learning a lot about how weight is not a good determinant of overall health. I’m focusing on my work-life balance and healthier ways to deal with stress. I’m thinking about meditation…have you ever tried it?


Step 2: Set boundaries
if someone continues to target you with questions or comments about your body or what you’re eating.

Here are some simple examples with varying levels of intensity.  You can choose which ones you think would work well for you, or create your own.

  • I try not to get involved in discussions about dieting and weight loss.
  • I’d prefer not to talk about my weight today.
  • I am so happy to be here with everyone, I don’t want to waste our time together talking about food/weight.
  • Please don’t comment on my body.
  • Let’s find something else to do or talk about.
  • I’d much rather tell you about school / work / hobby
  • It’s really stressful to me when people make comments about what I’m eating.
  • It’s actually not helpful for me to talk about calories or exercise.
  • I’m choosing to focus on other things this year.
  • It is not beneficial for me to feel badly about my body or guilty about what I ate.

The great thing about practicing these responses with other people is that you’ll be more likely to use them when struggling with negative self-talk or eating disorder thoughts in your own head too.


Step 3:
Step away & seek support.

If stressors persist or you find you just need a break from the crowd, locate your holiday ally or text a friend. Take some time to vent about what’s bothering you, take 3 very deep breaths, and then re-focus on the positive parts of the day.  Sounds simple but it can make a big difference.

You are deserving of a happy and healthy holiday. How you choose to create that is up to you.  Just remember that one insensitive comment from one person does not have to ruin your entire holiday. At anytime, you can choose to re-engage in both the celebration and your recovery.

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Read more about healthy holiday coping…


 Concerned that you or a loved one may have an eating disorder?  Call us at (410) 938-5252 for a free and confidential phone assessment or visit www.eatingdisorder.org for more information about treatment options.

 

Photo credit: freedigitalphotos.net / digidreamgrafix

 

 

 

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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

 

More, More, More: The Dangers of Excessive Exercise

There is such a thing as too much exercise

Media messages encouraging us to exercise away our “flaws” are rampant, particularly in these summer months when many people are self-conscious about wearing bathing suits and dressing for warmer weather.   We’re nearly halfway through summer but the seasonal cultural pressures to attain the “perfect” beach body are still in full swing. The relentless marketing often focuses on incorporating the most strenuous new workouts, squeezing in more time at the gym, pushing just a little bit harder and faster every step of the way.  When it comes to exercise, the message almost always seems to be more, more, more.

It’s true that staying active and engaging in exercise is a positive activity that can have long-lasting benefits for physical and mental health.  However, it becomes increasingly important in our “faster, longer, harder, more” exercise culture to ask ourselves, can you have too much of a good thing? The Answer:  Absolutely.

 

More is not always better.

Exercise can quickly become unhealthy when taken to extremes or when the body is not equipped with proper nourishment.  Individuals who struggle with perfectionism, rigidity, obsessive/compulsive behavior, addiction or eating disorders are particularly at-risk for engaging in over-exercise (also referred to as exercise abuse or obsessive exercise.)  These individuals often start out with moderate exercise goals in an attempt to change their weight/body shape but can easily slip into patterns that become compulsive.

Often, the same messages that promote extreme exercise also encourage people to ignore their body’s cues – to push past pain and exhaustion in order to reach goals.  But when you override your body’s need for rest, healing, or even medical attention, it can have long-term negative consequences on health, not to mention on overall fitness and athletic performance. Furthermore, exercise and weight loss goals may gradually become more and more extreme, and thus more and more dangerous. It’s important to note that even individuals who do not appear underweight, may be exercising obsessively or working out beyond what is healthy for their body.  Even high caliber athletes are at risk.

“It is no secret among athletes that in order to improve performance you’ve got to work hard. However, hard training breaks you down and makes you weaker. It is rest that makes you stronger. Physiologic improvement in sports only occurs during the rest period following hard training.” [Overtraining Syndrome]

 

Signs & Symptoms of Excessive Exercise
Because exercise is such a socially acceptable and culturally applauded behavior, it can be difficult to identify when someone is engaging in healthy activity and when they may have crossed the line to over-exercise.  It’s particularly important for coaches, trainers, fitness instructors and other professionals in the exercise industry to be aware of the warning signs and red flags that someone may be struggling with obsessive exercise.  These are just some of the signs that an individual may have an unhealthy relationship with exercise:

  • Exercises above and beyond what would be considered a normal amount of time (For athletes, prolonged training above and beyond that required for the sport)
  • Refusal to build in days of rest or recovery; Exercises despite injury or illness
  • Athletic performance plateaus or declines (Overtraining Syndrome)
  • Rigidity, inflexibility regarding exercise schedule
  • Excessive concern with body aesthetic
  • Withdrawal effects (sleep/appetite disturbance, mood shifts, intense anxiety) and feelings of depression or guilt when exercise is withheld
  • Exercise is prioritized over family, work, school or relationships (sometimes to the point of neglecting important responsibilities or obligations)
  • Exercise is the person’s only way of coping with stress
  • Deprives self of food if unable to exercise (feels he/she has not “earned” or “does not deserve” the calories)
  • Defines overall self-worth in terms of exercise performance
  • After workouts, is plagued by thoughts like “I didn’t do enough” or “I should have done more”
  • Rarely takes part in exercise for fun. Activities like hiking, paddle boarding, etc, don’t seem like “good enough” exercise.

If you or someone you know identify with this list, it may be time to step back and take an honest assessment of the exercise relationship.
Excessive exercise not only interferes with an individual’s daily life and interpersonal relationships, but it is also dangerous. Excessive exercise can easily result in overuse injuries and stress fractures which could be temporary or permanent.  Women may have menstrual irregularity and men may experience a decrease in testosterone.  Among the many other potential consequences, exercising too much can lead to decreased immunity and frequent colds or illnesses.  Over-exercise is often a sign of an underlying eating disorder.  Furthermore, recent research found that the frequency of over-exercise predicted suicidal gestures/attempts and concluded that excessive exercise should be noted as a potential warning sign of suicidality among individuals with bulimia. [source: Eating Disorders Review,  May/June 2013]

If your body is telling you that it needs a rest…
You should never exercise when you are sick or injured. When you have a fever, fatigue or muscle injuries, take the day off to help your body heal.  Even a very healthy body needs adequate rest in between workouts.  It’s recommended that you take at least two days off a week to allow your body time for healing and recovery.  Also, make sure that you are properly providing your body with enough carbohydrates, dietary fats, proteins and water to fuel your workouts. Proper hydration is critical when working out.  Dehydration can lead to overheating, muscle fatigue, headache, nausea and it impairs your body’s ability to transport oxygen.

Maintain a Healthy Relationship with Exercise
There are many ways to have a healthy relationship with exercise. First, it is extremely important that you have spoken to your doctors and they have all cleared you for exercise. Just like many things in life, moderation is the key to success.  Focus on establishing a balance between working out and other experiences, relationships and responsibilities in your life.  Consider combining a variety of activities that you enjoy and are convenient to your lifestyle instead of becoming overly attached to one type of exercise for a specific amount of time each day.  Hiking, golfing, dancing, biking, tennis, kayaking and taking your dog for that much needed walk are great ways to be active in different ways. Remember that the goal of healthy exercise is not to change your body but to care for your body so that it will allow you to enjoy your life.

If you think you may be struggling with excessive exercise, we encourage you to talk with someone close to you and seek help to establish a healthier relationship with exercise. You can also visit www.eatingdisorder.org or call us (410) 938-5252.

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Additional Resources:

The Exercise Balance: What’s Too Much, What’s Too Little, and What’s Just Right for You! By Pauline Powers M.D. and Ron Thompson Ph.D.

In response to Dr. Drew ~ Exercise bulimia is not a mild mental health issue (on the CED blog)

 Blog contributions by Amy Gooding, Psy.D., CED Therapist

Ringing in the New Year without your old Cognitive Distortions

Don't believe everything you think

As the winter holidays pass by and our thoughts turn to the New Year, it can be an exciting time to reflect on 2012 or to make a fresh start in areas of life that could use some extra attention ~ friends, family, self-care, school or work?  Unfortunately, the changing of the calendar year (and the co-occurring mass marketing of new year’s resolutions) can also stimulate increased cognitive distortions. We’ve addressed cognitive distortions on our blog before and defined them as a pattern of thinking or “self-talk” that consistently shifts life events into a negative framework. 

There are different types of cognitive distortions including “all-or-nothing” thoughts that force experiences, relationships and feelings into categorical extremes of all good or all bad.  There’s also “filtering” in which a person’s thoughts magnify negative aspects of a situation while simultaneously ignoring important positive information.  Many people deal with cognitive distortions occasionally but some people, including those with eating disorders, depression or anxiety, may struggle with more frequent or more intense negative thoughts.  The danger lies not with the distorted thought in and of itself but in one’s tendency to believe that the thought is 100% true when it most likely is not. 

Holiday advertisements and New Year’s promotions tend to add fuel to the cognitive distortion fire, strengthening one’s beliefe that false and negative thoughts are actually reality.  Three types of distortions stand out in the holiday media frenzy… 

Shoulds, Shouldn’ts & Have-Tos: Based on Christmas catalogs and holiday specials, the list of holiday “have-tos” is endless – I have to decorate my house like Martha Stewart, I have to find the perfect gift for everyone on my list, I have to fit into that dress I bought three years ago.  The arrival of New Year’s Eve often brings with it even more pressure: I shouldn’t eat that dessert, I should go to every family gathering t          

"The reson we struggle with insecurity is because..."Jumping-to-Conclusions & Comparisons: Assuming you know exactly how other people are thinking and feeling or creating assumptions about someone else’s life from limited observations can make it difficult to focus on yourself in any positive way.  Have you ever received a pristine holiday card in the mail only to fantasize about that person’s supposedly perfect life while putting yourself down for not measuring up? Just because he/she is in one picture with a spouse and three children in matching holiday outfits doesn’t mean they necessarily have a blissful marriage, are happy at their jobs, or that they have never struggled with health, mental health or addiction problems.  It’s important not to compare yourself to a one-second snapshot of someone else’s life.     

Magical Thinking:  New Year’s weight-loss resolutions are the ultimate cognitive distortions when it comes to magical thinking. Pick up any magazine, listen to any commercial and peruse any social network to find businesses, entire industries, or even family and friends touting the message that weight loss = happiness and fulfillment.  This is usually financially motivated.  Remember that the weight loss industry (and many others) zero in on the things people are looking for most out of life and repeatedly pair them with weight loss when marketing their products. They know that people will pay money if they think there’s a magical road to happiness, friends, confidence  and success.  If you find yourself thinking that fitting into a particular size or changing your body in some way will “fix” everything that you think is wrong in your life or change who you are, take a step back.  Not only does the research show that chronic dieters are more likely to be depressed but dieting itself has been linked to weight gain and increased risk for disordered eating behaviors.  

This year, if you’re tempted to make a New Year’s Resolution, you may want to assess your options.  First make sure your goals are not the result of “shoulds” or “have-tos” generated by external sources like the media or even family and friends.  Then, consider starting off your resolutions with something more focused on creating positive moments in your life during 2013.  Here’s a couple possibilities: 

  • “This year I think I would find fulfillment in…”
  • “This year, I would really enjoy…”.  
  • “I’ve been wanting to spend more time with…”

Finally, turn off the TV and put away your fashion magazines or anything else that tempts you to compare yourself to other people or seek happiness through the shape or size of your body.  This year, allow your focus to be on building yourself up emotionally, putting a stop to the cognitive distortions, and establishing self-acceptance in the present moment, in the present body.

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If you’re interested in moving towards mindfulness and learning more about self-acceptance, please save-the-date for our 2013 National Eating Disorder Awareness Week events, including a keynote address by Emme, global advocate for positive body image.  Find out more here.

photos via Pinterest.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)