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

 

 

 

 

 

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

 

 

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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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

Eating Disorders and the “All-or-Nothing” Trap

There are several types of cognitive distortions frequently experienced by individuals who struggle with eating disorders. These negative thought patterns are often longstanding and can play an integral role in maintaining depressive thoughts, anxiety, low self-esteem and reliance on eating disorder symptoms.  One of the primary cognitive distortions identified by individuals who struggle with anorexia, bulimia and binge eating disorder is often referred to as “all-or-nothing” thinking.  Also called “black-and-white” thinking, this thought pattern is akin to the belief that “If I can’t do it perfectly, I might as well not do it at all.”

In the same way that all-or-nothing thoughts can perpetuate harmful eating disorder behaviors (ex: periods of severe restricting followed by frequent binging) , they can also sabotage efforts at recovery.  In this clip, recovery advocate Johanna Kandel talks about how all-or-nothing thoughts crept into her nutrition appointment…

Many individuals can probably relate to this experience in therapy where it becomes difficult/impossible to recover perfectly and immediately.  Setting insurmountable goals (i.e. perfection) makes it really easy to feel like you failed even when, by all other accounts, you are actually making progress.  This often leads to  someone feeling completely defeated and makes it easy to do a u-turn back towards the symptoms, isolation and secrecy that allow the eating disorder to spiral out of control.

For others, all-or-nothing thoughts may be an initial barrier to seeking treatment.  Its not unusual for individuals to hold off on making that first appointment until they are absolutely, positively, completely 100% ready to get well. Sound familiar?  As Johanna discusses in this clip, very few people are ever really going to be 100% ready for recovery but the good news is that you don’t have to be…

Identifying all-or-nothing thoughts that are impacting you and your recovery is an important step towards change.  Once you identify the cognitive distortions, you can begin to challenge them during therapy sessions, thought logs, journaling, and reality-testing.  If you aren’t sure where to start you can use the simple questions listed in this previous post to test validity of any suspected all-or-nothing thoughts. When you start exploring your negative thoughts you might be surprised at how many of them simply don’t stand up to the test.  Once you free yourself to think outside of the automatic negative thoughts you will learn, as Johanna did, that you are not an exception;  you CAN recover and you DESERVE to get better.

How did you overcome all-or-nothing thinking?  What role did it play in your eating disorder?  Join the discussion on CED’s Facebook page or leave a comment below.

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This was the third 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: