Our CED Staff has been busy guest blogging for Eating Disorder Hope on a variety of topics from nutrition and meal plans to body image and relapse prevention. We hope you’ll take a look and share with friends, colleagues or clients who might benefit from the following information.
If you have questions about eating disorder treatment or a topic you’d like to see us write more about, please send your suggestions and requests to our Community Outreach Coordinator, Kate Clemmer at email@example.com.
Written by Caitlyn Royster, R.D. & Rebecca Hart, R.D., Registered Dietitians
While you may technically be following your meal plan, without incorporating fear foods you are still giving the eating disorder a major foothold by preserving fear and anxiety. It might seem like choosing safe foods is better than acting on symptoms. However, over time this restriction can snowball and lead to relapse. READ MORE…
Written by Irene Rovira, Ph.D.
Most of us appreciate all the mother figures and mom-types in our lives – including aunts, sisters, mentors and best friends – for the love they give or how they make us feel. We do not value them based on their weight or size. Yet we often hold a double standard when it comes to how we view ourselves…READ MORE to find 7 Tips to help boost body image for yourself and future generations
4 Changes You Can Make in Your Home to Support Eating Disorder Recovery & Reduce Relapse
Written by Kate Clemmer, LCSW-C
Community Outreach & Education Coordinator
It’s safe to say no one who has been through recovery from an eating disorder would downplay the difficulty or complexity of it. And while recovery is never simple or easy, there are some simple and straightforward changes you can make to reinforce recovery efforts and help prevent relapse. These specific modifications are not changes in thinking (cognition) or even changes in behavior but rather, changes to your physical living space – your home environment. READ MORE…
You may also be interested in the following posts:
We spent the summer talking about several steps you can take to turn body dissatisfaction into body acceptance. We also presented some of the very important reasons why someone might be motivated to embark on such a task. The bottom line: negative body image can negatively impact all other areas of life – career, academics, physical health, social interaction and intimate relationships. As many as 67% of women ages 15-64 withdraw from life-engaging activities because they feel badly about their bodies. And women are not alone in the struggle; Thirteen percent of college-aged men say their appearance is traumatic or difficult to handle as well.As we head into the fall, its important to remember that negative body image doesn’t just go away for most people simply because the beach vacations and relentless bikini body advertisements subside. As much as we wish that was the case, we know body image is much more than a seasonal hazard.
Body insecurity will follow young boys and girls into middle school classrooms where they may stop raising their hands or engaging in class discussion to avoid drawing attention to their appearance.
Body insecurity will follow young adults onto college campuses around the country where it, paired with genetic risk factors like perfectionism and anxiety, plus fear of the Freshman 15, may provide fuel for the development of an eating disorder.
Body insecurity will follow the new mom to the play date where she will silently compare and scrutinize her body. She’ll be sold a thousand different ways to get her pre-baby body back.
Body insecurity will follow the quiet colleague home from work each night. He refuses to hang out with friends or start dating until he finally “bulks up” again.
These may be the realities of day-to-day life with body dissatisfaction but they don’t have to be the end of the story. In addition to the 3 Steps we laid out during the #bodypositivesummer campaign, here are a few guidelines to help boost body image in any season.
1. Don’t postpone important events or fun life goals for appearance or weight-related reasons. Putting off a special vacation, not applying for your dream job or not going on a date until you lose XX lbs. is a recipe for missed opportunities and delayed happiness. Saying you’ll get around to something in few months can quickly turn into a few years, or even decades. If you’ve been waiting to live life fully because you’re unhappy with your body, consider taking one small step today towards whatever it is you’ve been putting off. Research flights, update your resume or call an old friend.
2. Stop Fat Chat. When among friends or in social settings commit to steering the conversation away from appearance-based judgments and into more positive territory. The American Academy of Pediatrics recently released a report urging pediatricians and parents to stop focusing on weight, or even mentioning weight, during discussions with children and teens. The reason? Focusing on weight backfires, often leading to unhealthy behaviors that are associated with both obesity and eating disorders. The same is true for adults. Stop focusing on your weight as the golden marker of health and you may actually find it’s easier and/or more fulfilling to engage in healthful behaviors.
3. Cleanse your social media feed. Disconnect from the negativity, surround yourself with positive, healthy, and uplifting social media accounts. If you’re online quite a bit, there is no reason to allow Instagram followers who consistently engage in fat talk or body criticism to cloud your view of yourself. You have every right to unfollow Twitter users that promote weight loss or diet products, even if they are close friends or family members. Remember, you are the curator of your accounts; use that power to cultivate a body positive presence for yourself online.
4. Last but definitely not least…ASK FOR HELP. Negative body image can be a risk factor in the development of eating disorders or may trigger relapse while in recovery from one. If you’re having a lot of negative body image thoughts throughout the day or they’re impacting your behaviors around food and weight it might be time to seek support. Specific evidence-based therapies like Cognitive Behavior Therapy can be effective in addressing body dissatisfaction. It can help to tell a trusted friend, spouse, or parent that you’re struggling and ask them to support you in getting connected to a counselor or therapist who is trained in these specific techniques.
Not sure where to turn? You can complete a confidential online self-assessment here or call (410) 938-5252 for more information.
Visit eatingdisorder.org for additional resources.
Mindfulness has received a lot of attention in the past decade for its beneficial effect on stress reduction, depression, anxiety, and eating disorders. But, is there a connection between mindfulness and the brain? Read on for what research has to say about the connection.
Mindfulness can be described in a variety of ways including, but not limited to, a state of mind or state of being. It has been described as an awareness of, and nonjudgmental attention on, immediate experiences, both internally and externally (4). This can be done not only as part of meditative practice, but also as a general mindset applied during daily activities. Mindfulness is a practice of responding to a myriad of stimuli that cross one’s attention, including thoughts, emotions, and bodily sensations, with openness and acceptance (2, 4).
A primary means in which individuals practice mindfulness is through meditation. Contrary to popular opinion, meditation is not clearing the mind but rather paying attention to whatever crosses one’s mind as it occurs without judgment. Although meditation is an important aspect of Eastern religions, it doesn’t have to be practiced in conjunction with a particular set of beliefs. Mindfulness has also been applied in therapeutic settings for treatment of anxiety, depression, and eating disorders (1). The positive effects of mindfulness have long been reported firsthand by those who practice it, however, now researchers are also learning more about the intricate changes in the brain that occur to produce these benefits.
Mindfulness meditation has demonstrated positive effects on several functions in the brain such as attention, body awareness, and emotion regulation.
- Attention: The anterior cingulate cortex (ACC) is responsible for sustaining focused attention on objects while disregarding distractions. Neuroimaging has shown positive effects of long term meditative practice including both increased activity in the ACC as well as increased size which signifies more connections and better regulation of attention (1,3).
- Body Awareness: The insula is responsible for awareness of bodily sensations. This area has been researched heavily for its association with eating disorders. Research has found both changes in function and structure of these related areas, specifically greater size and density of grey matter, for people engaged in regular meditation practice (1- 4). Benefits include increased awareness of, and accuracy of, bodily sensations.
- Emotional Awareness: Increased body awareness also has important implications for emotional awareness, which is necessary to be able to regulate emotions and increase empathy (3, 4)
- Emotion Regulation: Mindfulness also has direct effect on the prefrontal cortex (PFC) which is responsible for emotional regulation. This is executed by “turning down” the region responsible for emotional processing and reactivity and “turning up” the area responsible for emotion regulation. This results in enhanced control over emotions (3).
Long term practitioners of mindful meditation show the greatest changes in brain structures but short term practice can also exhibit some of these enhancements (1, 4).
4 quick tips to help you benefit from mindfulness:
- Start small. Incorporate just a few minutes of mindfulness into your daily routine.
- Practice. Complete a 1 minute mindfulness exercise by focusing on your breathing while keeping your eyes open. Check your mind wandering and focus attention back on your breath as needed. Try to keep your breathing at a normal pace.
- Be mindful anywhere. You don’t need a fancy meditation room or a totally quiet space. Just sit back wherever you are and focus your attention on an object nearby. Observe it, don’t study it or think about it, just observe it for what it is. Try to do this for a few minutes at a time.
- Modernize your mindfulness. You can download mindfulness apps on your phone or tablet for daily reminders and other exercises. Some good options include Relax Melodies, Omvana, and Headspace. (Though some do have fees that may apply).
This post was written by Laché Wilkins, Research Assistant at The Center for Eating Disorders at Sheppard Pratt
Chiesa, A., & Serretti, A. (2010). A systematic review of neurobiological and clinical features of mindfulness meditations. Psychological Medicine, 40, 1239-1252. http://dx.doi.org/10.1017/S0033291709991747.
Farb, N. S., Segal, Z. V., & Anderson, A. K. (2013). Minfulness meditation training training alters cortical representations of interoceptive attention. SCAN, 8, 15-26. http://dx.doi.org/10.1093/scan/nss066.
Holzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6, 537-559. http://dx.doi.org/10.1177/1745691611419671.
Manuello, J., Vercelli, U., Nani, A., Costa, T., & Cauda, F. (2016). Mindfulness meditation and consciousness: An integrative neuroscientific perspective. Consciousness and Cognition, 40, 67-78. http://dx.doi.org/10.1016/j.concog.2015.12.005
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?
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.
Laura Sproch, PhD
Research Coordinator and Outpatient Therapist at The Center for Eating Disorders
Photo Credit: Freedigitalphotos.net / kongsky
An Intensive Outpatient Program (IOP) for eating disorders can be important for individuals who are transitioning out of an inpatient or partial hospital setting but would still benefit from more support and structure than is typically offered through weekly outpatient therapy. The Center for Eating Disorders’ IOP provides 16 hours per week of intensive treatment in the evenings to allow individuals to fully engage in school, work and family during the day while continuing to focus on their recovery.
In the past six months, the IOP has seen some exciting changes and updates in programming. The program has returned to (a newly renovated!) space on the ground floor of the Sheppard Pratt B building, just downstairs from the inpatient and partial hospital units. Our multidisciplinary treatment team now includes members from psychiatry, psychology, art therapy, nutrition, occupational therapy, and social work.
Some of the recent exciting additions to IOP include:
- Medical Director –Heather Goff, MD has stepped into the role of Medical Director for the IOP, leading the multidisciplinary treatment team in providing care for patients. She also provides psychiatric treatment to all patients, including weekly assessments and medication management.
- Clinical Coordinator –Morgan Krumeich, PsyD joined the IOP team in 2014 as our new clinical coordinator. She also leads group therapy and works with patients on an individual basis.
- Collaborative Care Group – IOP now offers a weekly collaborative care group for parents, caregivers, and supports. Run by IOP social worker Annie Hanley, this group is similar to those offered at other levels of care, but is tailored specifically to the needs and issues that may arise during IOP treatment and associated transitions. All support persons are highly encouraged to attend this free weekly group, held on Tuesdays from 6:30PM-7:30PM.
- Occupational Therapy – Occupational therapist Rachel Dehart has joined the IOP team and runs weekly OT groups for adults. Adolescents also have the opportunity to meet with an occupational therapist as needed. OT groups in IOP focus on the unique needs of individuals with eating disorders, including time management, grocery shopping, clothes shopping, involvement in the community, work or volunteering, and school.
- Individualized Nutrition Consultations – With two dietitians now on the IOP team, Caitlin Royster and Kelly Daugherty, we continue to offer weekly nutrition groups for all patients. Additionally, dietitians are working to provide individual assessments and nutrition consultation for patients on a weekly basis.
The Intensive Outpatient Program is designed to work closely with individuals, their families, and outpatient providers in order to offer the most comprehensive care possible. And of course, we always work to incorporate patient feedback in order to ensure the IOP is continuously developing and meeting the needs of individuals, families and the community.
If you have questions about the Intensive Outpatient Program, please call (410) 938-5252 or email EatingDisorderInfo@sheppardpratt.org.
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Meet the IOP Staff
Heather Goff, M.D.
Child & Adolescent Psychiatrist
Medical Director, Intensive Outpatient Program
Dr. Goff joined the Center for Eating Disorders in 2011. A child and adolescent psychiatrist, she is board-certified in both Adult Psychiatry and Child & Adolescent Psychiatry, providing her a developmental perspective that enhances her work with patients of all ages. Her initial medical training was at New York Medical College, followed by a residency in Adult Psychiatry at Yale University, where she was a chief resident in 2005-2006. She then went on to complete a fellowship in Child and Adolescent Psychiatry at the Yale Child Study Center, where she was again chosen to be a chief resident in 2007-2008. Upon completion of her post-graduate training, Dr. Goff joined the Yale faculty, with joint appointments in the Department of Psychiatry and the Child Study Center. As a clinician-educator, she was the teaching attending for one of the adolescent inpatient units. She also served as Director of the Child Study Center at Madison, where she provided direct outpatient care to children, adolescents and their families. While at Yale, Dr. Goff was also a fellow at the Edward Zigler Center in Child Development and Public Policy, leading to her interest in the intersection of the media and social policy in the development and treatment of eating disorders. In her role at CED, Dr. Goff spent one year treating individuals in the inpatient and the partial hospital programs. In 2012, she transitioned to a new role as Medical Director of the Center’s Intensive Outpatient Program and is also completing assessments and evaluations for children and adolescents in our outpatient department.
Erin Birely, LGPC
Mental Health Counselor
Erin Birely graduated from Loyola University in Maryland in 2012 with a Master of Science degree in Counseling Psychology. She completed a year of internship at the Center for Eating Disorders from 2011-2012, and subsequently began working full time in 2012. She is currently working towards her LCPC certification. Erin provides individual check ins and goal setting with patients. Additionally she facilitates DBT groups focusing on symptom management and emotion regulation, and IPT groups focusing on processing interpersonal difficulties, as well as leading the Multi-Family and Supports Group on Wednesdays.
Kelly Daugherty, RD, LDN
Kelly Daugherty received her Bachelor of Science degree in Dietetics from Saint Catherine University in Minnesota. She completed her dietetic internship with an emphasis in clinical nutrition at Johns Hopkins Bayview Medical Center in Baltimore, MD. During this internship, Kelly completed rotations on an acute care eating disorder unit at Johns Hopkins Hospital in Baltimore and at the Center for Eating Disorders. Kelly joined the CED team in November 2014. She completes nutrition assessments, teaches nutrition groups and assists patients with menu planning in the inpatient, partial hospital, and intensive outpatient programs.
Caitlin Royster, RD, LDN
Caitlin Royster received her Bachelors of Science in Nutritional Sciences with a concentration in Dietetics from Cornell University. She completed her dietetic internship with a focus on clinical nutrition and nutrition research at the National Institutes of Health in Bethesda, MD. Caitlin joined the Center for Eating Disorders in July 2014. Here she conducts nutrition assessments, teaches nutrition groups, and assists patients with meal planning in the inpatient, partial hospitalization, and intensive outpatient programs. Prior to joining the Center for Eating Disorders, Caitlin worked in an acute care setting providing medical nutrition therapy and nutrition education to patients. Caitlin is passionate about neutralizing food for her patients and takes a non-diet approach to nutrition education.
Rachel Dehart MS, OTR/L
Occupational Therapist II
Rachel Dehart graduated with a Bachelor of Science Degree in Public & Community Health from the University of Maryland, College Park in 2007. She received her Master of Science Degree in Occupational Therapy from Towson University in 2010. Rachel is currently an occupational therapist on the Children’s Short-Term Inpatient Unit where she adapts and grades activities to meet various physical, emotional, and cognitive levels of children aged 3-12. Rachel facilitates Life Skills and Time Management occupational therapy groups in the CED Intensive Outpatient Program to assist patients with re-engagement in meaningful occupations at home and within the community.
Annie Hanley, LGSW
Annie Hanley graduated from University of South Carolina with a Masters of Social Work in 2014. She is currently certified as a Licensed Graduate Social Worker and is working towards her LCSW-C licensure. Prior to joining the Center for Eating Disorders, Annie provided individual and family therapy at an eating disorder treatment center at both the inpatient and outpatient levels of care. She also has experience using the Trauma-Focused CBT model to work with children who have experienced trauma. In her current role, Annie works as a family therapist in the inpatient, partial hospitalization and intensive outpatient levels of care. She also facilitates groups in the intensive outpatient program (IOP), including the Tuesday IOP Collaborative Care group for family members and support people. Her past research includes examining the role of peer influence on eating disorder development.
Brianna Garrold, ATR
Clinical Art Therapist
Brianna Garrold received her BA in Fine Arts from Notre Dame of Maryland University in 2010 (formerly College of Notre Dame of Maryland) and her MA from The George Washington University in Art Therapy in 2012, with additional coursework in counseling and Trauma-Informed Care. Currently, Brianna works with inpatient, partial hospitalization, and Intensive Outpatient Program patients using the art process to help patients identify and express their emotions, manage anxiety, and treat body image distortions. Brianna received her ATR in September 2014, and is currently working towards completing the LCPC, and the LCPAT, Licensed Clinical Professional Art Therapist.
Morgan Krumeich, Psy.D.
Clinical Coordinator, Intensive Outpatient Program
Dr. Morgan Krumeich graduated from The George Washington University in 2014 with her Doctorate in Clinical Psychology. Prior to obtaining her doctoral degree, Dr. Krumeich obtained a Masters in Clinical Psychology from The George Washington University as well as a Masters in Education (specializing in Applied Child Studies) from Vanderbilt University. She previously spent two years at Sheppard Pratt as a psychology extern at The Lodge School, where she conducted individual therapy, in addition to co-leading group and family therapy. Dr. Krumeich completed a year of internship as a school psychologist in the Newark Public School System before returning to Sheppard Pratt in 2014 to become Clinical Coordinator at the Center for Eating Disorders Intensive Outpatient Program. Dr. Krumeich has specialized training in working with children and adolescents, but she has experience (and enjoys!) working with individuals of all ages.
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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.”
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 of 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.”
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:
- Precontemplation – a lack of awareness of the problem; no intention to change
- Contemplation – awareness of the problem but uncertainty about making a change; someone is thinking about change, but is not committed
- Preparation – intending to take action; there is a desire to make a change and some planning prior to making the change
- Action – the actual time spent making the change and modifying behavior
- 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.”
Motivation to Change at The Center for Eating Disorders
The 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 firstname.lastname@example.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.”
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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
JUNE 2014 – The Center for Eating Disorders has launched several new outpatient therapy groups in addition to our other longstanding groups for individuals with eating disorders. Group therapy can be a great way to obtain additional support in the recovery process while also mastering beneficial new skill sets and practicing social interactions in a therapeutic setting with the guidance of a licensed therapist. We invite you to review the current group therapy opportunities below and contact the group leader if interested.
Cognitive Behavioral Therapy (CBT) Group for BODY IMAGE
Tuesdays, 5:15 – 6:15 PM
Participants can expect to learn about how to promote positive body image using the cognitive-behavioral model. The group lasts 10 sessions and will consist of a variety of body image topics (e.g. body checking, body avoidance, body comparison, emotional labeling, eating disorder mindset) and incorporates specific CBT skills with the goal of decreasing an individual’s preoccupation with weight and shape and their control. Please contact Laura Sproch, Ph.D. at 410-427-3851 for further information and to complete a brief phone screening.
Cognitive Behavioral Therapy (CBT) for ADULTS
Tuesdays, 5:15-6:15 PM
Thursdays, 6:15-7:15 PM
Participants in this group will learn about the cognitive-behavioral model and its application for eating disorders and for the individual. Group topics will rotate, based on the needs of the group, with a strong focus on the behavioral skills and making behavioral changes outside of the group. Skills include, but are not limited to, self-monitoring, imagery, deep breathing, behavioral chain analysis, body image behavioral skills and problem solving. Contact Laura Sproch, PhD at (410) 427-3851 for more information.
Cognitive Behavioral Therapy (CBT) for ADOLESCENTS in Transition
Tuesdays, 5:30-7:00 PM
This is a Cogntitive Behavioral Therapy group for adolescents who are transitioning from a higher level of care (at any inpatient, residential or partial hospital eating disorder program) back into outpatient therapy. The groups runs on a six-week session. Contact Lisa McCathran, LCPC at (410) 427-3873 for more information.
Dialectical Behavior Therapy (DBT) Group
Thursdays, 5:30-6:30 PM
DBT is an evidence-based treatment composed of four modules: Mindfulness, Distress Tolerance, Emotion Regulation and Interpersonal Effectiveness. Extensive research has found DBT to be beneficial in the treatment of a variety of disorders, including mood disorders, anxiety disorders, substance abuse and eating disorders. This particular DBT group is open to adults, ages 18 and over, with or without an eating disorder. Interested individuals, or referring providers, should call Craig Boas, LCSW-C at (410) 427-3879 to complete the screening process. You can read more about DBT and each of the four modules here.
Interpersonal Therapy Group for Binge Eating Disorder / Compulsive Overeating
Tuesdays, 4:30-5:50 PM
Wednesdays, 7:15-8:35 PM
Thursdays, 4:40-6:00 PM
Process-Oriented and skills-based therapy groups for adults (ages 22 and over) who struggle specifically with Binge Eating Disorder or compulsive overeating. For more information about these specialized groups, please call David Roth, PhD at (410) 427-3871.
Interpersonal Therapy Group for Adults with Eating Disorders
Wednesdays, 5:30-7:00 PM
A process-oriented group for adults (ages 22 and over) with any type of eating disorder. This is a thematic, open-ended group in which members are encouraged to process current and past struggles in a way that improves insight into the role of the eating disorder in their life and provides an opportunity to develop strategies for moving toward recovery. A variety of skillsets are introduced and practiced within the supportive framework of the group. Contact David Roth, PhD at (410) 427-3871 for additional information.
Motivation to Change Therapy Group
Saturdays, 4:00-5:00 PM
Motivation to Change (MTC) is a group for individuals 18 and over with an eating disorder. Participants will be asked to complete a full module from beginning to end (12 groups per module). At the beginning of each module, participants will assess their stage of change and should be able to identify next steps and tools for implementing change by the end of each module. Please contact Rachel Hendricks, LCSW-C at 410-427-3862 for further information and to complete a brief screening over the phone.
Collaborative Care Workshops for Caregivers & Family Members
(Now being offered completely FREE OF CHARGE to all interested families)
Tuesdays, 5:30-7:00 PM
These 6-week sessions based on the work of Dr. Janet Treasure, are designed to address the most universal needs of the carers: connection with other carers; support; and skills training. Key skills taught include motivational interviewing, communication, the trans-theoretical model of change, self-care and behavior analysis. Research suggests that participation in these workshops, leads to benefits for both the carers and the patient. The workshops are OPEN to all support people at any stage of a loved one’s illness or recovery and are now being offered completely free of charge. You can read more about collaborative care on our blog. Call (410) 427-3874 or email Dr. Jennifer Moran to register for the group.
Recovery-Focused Community Eating Disorder Support Group
Wednesdays, 7:00-8:30 PM
Read more about this and other opportunities on our support group page.
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The Center participates with an extensive list of insurance providers which means group therapy services can often be billed through insurance or participants may choose to self-pay. If you are interested in joining any of the groups listed above, please contact the specific group therapist directly or call the main number, (410) 938-5252.
If you are a physician or therapist interested in referring a patient for group therapy as an adjunt to existing individual or family therapy, please feel free to call the contacts listed above. Our group therapists are committed to communication with providers in the community and to working collaboratively as a team to meet the needs of each patient. With the proper release forms, group therapists welcome ongoing communication, can discuss skills and principles being covered in the groups, opportunities to apply the skills to individual therapy, and other relevant goals and progress.
Family-Based Treatment (FBT) is an important evidence-based treatment for anorexia nervosa in adolescents. Originally conceived at the Maudsley Hospital in London, and often referred to as the Maudsley Model, it was further developed by James Lock, MD, PhD and Daniel le Grange, PhD in the United States. FBT is an intensive outpatient treatment involving the entire family whereby parents play a primary and critical role in all of the following tasks:
- managing the restoration of the child’s weight to a healthy place and supporting the blockade of eating disordered behaviors
- helping the child to re-establish age-appropriate control and management over their own eating
- re-focusing the family on healthy adolescent development and relationships separate from the eating disorder
FBT is a highly focused treatment that is presented in three stages. It emphasizes behavioral change and supports a gradual increase in autonomy for the adolescent. As a psychologist who supports and guides families through this treatment, I thought that it might be helpful for those who are considering FBT to have a primer for the treatment. In thinking about what may be helpful to be aware of when considering FBT, I reflected on the first session I have with each family and thought about all of the crucial messages I try to convey during that time. Below, I’ve decided to share the three messages that, in my perspective, stand as the most important tenets of understanding and implementing FBT.
- For adolescents struggling with anorexia nervosa, family support can be the most effective tool for making change. At its core, FBT recognizes that parents are capable of helping their child recover and the therapist’s role is to support them in this goal. When a child is confronted with any serious crisis or illness, investment and nurturing from the family is considered a critical asset and anorexia nervosa is no exception to this. Despite lingering misconceptions about a parental role in the development of eating disorders, FBT is built on the knowledge that parents do not cause eating disorders and that they are, in fact, integral to the recovery process. It is our job as therapists to recognize the strengths and qualities of each family and consider how FBT can be applied within each unique family system. Simply put, the aim of FBT is to empower parents to help their child overcome the eating disorder. In other words, the therapist serves as a consultant who joins with families as they apply skills they already possess.
- Eating disorders have genetic and biological underpinnings. As such, adolescents with anorexia nervosa have little control over their illness. Furthermore, periods of malnutrition and starvation can trigger a self-perpetuating cycle of anorexic symptoms that can cause considerable disruption and suffering for the whole family. But to be clear, it is the eating disorder, not the child, which has caused such an interruption in life. Anorexia nervosa is a devastating illness, the biological, physiological and psychological consequences of which can cause individuals to think and behave in self-destructive ways. It is important that the family works together as a team to help fight the illness and to keep it from embedding further in their child’s life. FBT therapists assist parents in distinguishing between their child and their child’s illness. This distinction helps the family to avoid blaming the child for disruption and stress that is actually a result of the illness, and also makes it easier for parents to take action when they realize they can nurture their child while simultaneously battling against the illness. As a result, energy can be better spent fighting the anorexia, not fighting with their child who is likely already suffering a great deal.
- Because of #1 and #2, FBT requires serious hard work and commitment. I am very upfront with families involved in FBT that they will be their child’s primary support AND that eating disorders are insidious and overwhelming illnesses. FBT is not easy. Fighting a devastating illness that has convinced your loved one they are not sick and that they don’t need help, is going to be a lot of hard work. And while it can be grueling, it is also worth it. When we hosted author Harriet Brown as a guest speaker in 2010, we asked her to share her family’s experience in doing FBT with her daughter, and she spoke to this difficulty and to the benefits of this tenet: “When we took on FBT, we took on both the responsibility and the power to intervene. That was a tremendously liberating step. The worst part of my daughter’s illness for me was standing by helplessly, watching her suffer and starve. The notion that my husband and I could help her required a huge mental paradigm shift—but once we made it, we were much more effective.”
In the beginning, FBT will require a lot of energy- energy to monitor your child’s behaviors, energy to learn different behavioral responses, energy to deal with the emotional and interpersonal changes that may come about through this work. I warn my families about the commitment that it takes and I’m honest about the dedication needed. But I also talk to families about the benefits of short-term work to outweigh the devastating long-term effects of an eating disorder and I share with them the facts. I talk to them about the serious and significant risks of anorexia- physically, emotionally, cognitively- and I have found that families most often agree that avoiding these risks is worth putting in the work. I tell them that FBT has been shown in research (and in my office) to be the most efficacious treatment for adolescents with anorexia that we know about today.
After committing to and sticking with the treatment, I see families eventually begin to talk about “having [their] child back.” I hear families talk about their child’s increased energy, sense of humor returning, interest in friendships again, and reestablishment in the family. I hear the satisfaction when parents talk about receiving feedback from others who approach them just to say that they have recognized a positive change in their child. Over time, I hear families talk about feeling confident that they helped their child recover. They share that they can once again trust their child to make healthy food choices, and they feel a sense of relief that they no longer have to live with the constant presence of the illness. I hear families tell me that the “fight” with the eating disorder gets easier and less demanding, and eventually they don’t need to engage in the battle at all.
If you think your family member, or someone you know may benefit from family-based treatment, I would recommend starting by talking to a professional about this option, either your current treatment provider or, if you are not currently in treatment, finding a family therapist who is trained specifically in FBT. The Center for Eating Disorders has several FBT therapists in our outpatient department, and we are happy to answer any questions you may have about this treatment modality. You can email us at EatingDisorderInfo@sheppardpratt.org or call (410) 938-5252. Additionally, we encourage all of the families we work with to utilize the book, Help Your Teenager Beat an Eating Disorder (Lock & Le Grange, 2005) as an educational and supportive resource throughout the FBT process. You can also access an extensive selection of journal articles regarding clinical research on FBT courtesy of Maudsley Parents organization.
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Written by Laura Sproch, PhD
Individual and Family Therapist
The Center for Eating Disorders at Sheppard Pratt
You may also be interested in:
- New Collaborative Care Programs for parents, caregivers and loved ones
- The Role of the Family in Eating Disorders
- Brave Girl Eating: 3-Part Q&A series with Harriet Brown
- What Causes an Eating Disorder?
- Family Therapy Services at The Center for Eating Disorders
- Upcoming Events at The Center for Eating Disorders…
Does the idea of darkness during your 5pm commute home from work get you down? You’re not alone if you’ve noticed that it’s not just the flowers in your garden but also your mood that has “wilted” with the cooler temperatures. During the fall and winter months, people may experience a shift in their mood as we collectively adjust to less sunshine and more cold weather. But it might be more than just “the blues” if it is a persistent sadness that feels present most days and is interfering with your ability to function or engage in day-to-day life. If this is a pattern that’s occurred for at least two years in a row and impacts you at the same time each year, it might be Seasonal Affective Disorder.
Seasonal Affective Disorder (SAD)
Many people around the world suffer from SAD, now identified in the DSM-5 as Depressive Disorder with seasonal pattern. It is suspected that seasonal depression is, in part, caused by a reduced exposure to sunlight resulting in disruption to our natural circadian rhythm (the body’s “internal clock”), as well decreased levels of the hormones serotonin and melatonin which help to regulate mood, sleep and appetite. Not surprisingly, populations living farther from the equator experience higher rates of seasonal depression than places closest to it. Thus, this type of depression occurs more frequently in populations throughout the northern rather than southern parts of the United States. In fact, one study found prevalence rates to be 1.4% in Florida and a much higher 9.7% in New Hampshire. (1) Much of the research also indicates younger people and women tend to be at higher risk for winter depressive episodes.
People who already struggle throughout the year with clinical depression or bipolar disorder may also experience worsening symptoms during specific seasons. For those with seasonal depression, the episodes of depression that occur in the fall/winter are significantly greater than those episodes that occur throughout the remainder of the calendar year. In any case, it’s important to pay attention to seasonal patterns in your mood so that you can prepare and seek appropriate treatment and support as needed.
Common symptoms of seasonal depression
Seasonal depressive episodes generally set in during late fall or early winter. Some of the most common signs and symptoms include:
- decreased energy, lethargy
- increased sleep, difficulty waking
- social withdrawal and loss of interest in activities previously enjoyed
- increased appetite, unintended weight gain
- persistent sadness, hopelessness
- difficulty concentrating or focusing on tasks
(Though less common, some people experience spring/summer depressive episodes and those symptoms can look a little different, more often encompassing sleeplessness, irritability, decreased appetite and weight loss, etc.)
How might seasonal depression affect people with eating disorders?
A depressive episode can impact eating patterns and thus, impact eating disorder recovery efforts. Individuals suffering from seasonal depression often report increased appetite. Specific studies have indicated that individuals with SAD tend to experience more cravings for foods that are higher in carbohydrates and rich in starch and report increased consumption of carbohydrates when depressed, anxious or lonely. (2) Combined with decreased energy and declining mood, these cravings can place one at higher risk for binge eating behaviors.
Other research has shown a seasonal component to depression especially for those individuals suffering from Bulimia Nervosa. (3) The research revealed that patients with Bulimia Nervosa tended to experience seasonal patterns of mood and appetite similar to those described by many with SAD. (4) Some research has further speculated with regard to a possible genetic link between eating disorders and susceptibility to changes in mood related to the season. (5)
Treatment Options for Individuals affected by seasonal depression
So what can you do when the light outside your window has turned to darkness and, perhaps, this has added fuel to the eating disorder fire as well? The good news is that there are many different treatment approaches that are helpful to those suffering from seasonal depression.
- Light therapy or Phototherapy is a commonly prescribed treatment for individuals suffering from seasonal depression. In light therapy individuals sit in front of a “light box” for approximately thirty minutes daily or per their doctor’s recommendation. Research has shown that light therapy can relieve the symptoms of seasonal depression in as many as 70% of cases. (6)
- Anti-depressant medications can also be helpful in treating winter depression and have been shown to improve mood, energy and sleep patterns. One of the ways in which these medications work is by increasing serotonin levels in the brain.
- Evidence-based therapies for depression such as Cognitive Behavioral Therapy (CBT) can also be helpful for seasonal depression.
- Behavioral interventions in your daily life can also be helpful in reducing symptoms of seasonal depression. Consider trying to incorporate some or all of these:
- Engage in activities with friends and family each day to ward off feelings of lonliness or isolation.
- Make a point to get outside in the sunlight for at least a portion of the day if possible. Schedule a walk with your colleague during break or sit outside instead of inside while you do your daily perusing of Facebook, however…
- Be mindful about whether online social networks make you feel worse instead of better OR if they take up large amounts of time that could be better spent connecting with people in person (see #1 above).
- Plan to get plenty of sleep on a consistent schedule; do your best to go to bed and wake up at the same times each day, and aim for 7-8 hours of sleep/day.
- Avoid the use of alcohol or other substances which can worsen depressive symptoms, complicate eating disorder symptoms and disrupt sleep.
Focus on the highlights of the changing season.
If you struggle with seasonal depression, a long autumn and the approaching winter can feel daunting. Holiday stress, can make things even more difficult for individuals who are triggered by tense family dynamics, elaborate meals and social gatherings. This year, Instead of focusing on the doldrums of the season or annual stressors, consider looking for positive seasonal activities in which to get involved. Now is the perfect time to go to a holiday parade, paint a room in your house a new color, volunteer for a new cause, plan a weekend getaway, attend a recovery event, build a snowman or read a winter-themed book. It could also be a great opportunity to finish your summer vacation scrapbook or try a new activity like snow tubing or ice skating. You can even practice guided imagery or meditation – just because there is snow outside it doesn’t mean you can’t imagine yourself relaxing on a warm beach.
Try not wish away the winter season. Each season comes with its own set of challenges for individuals with eating disorders – just think of the onslaught of diet pressures throughout spring or the bathing suit saga of summer. So the key is not to just “get through” each season (there will be a new set of stressors on the next calendar page after all) but to learn to live mindfully in each season and find ways you can enjoy what it has to offer.
Above all else remember to ask for help when you need it. Talk to your treatment providers about your seasonal mood changes and they can help to devise an individualized treatment plan that works for you. If you are seeing a Registered Dietitian now is the time to talk with them about the food cravings you might be experiencing and devise an approach to cope and integrate more variety into your meal plan. Remember to open up and involve your support system– let your friends or family be a part of the process by sharing with them what you are going through. With help and support, you’ll be celebrating the Vernal Equinox in no time and reflecting on a well-spent, memorable winter.
For questions about treatment for co-occurring depression and eating disorders, please visit our website at www.eatingdisorder.org
Written by Amy Scott, LCPC
- Friedman, Richard A. (December 18, 2007) Brought on by Darkness, Disorder Needs Light. New York Times’’.
- Krauchi, K., Reich, S.,& Wirz-Justice, A. (1997). Eating style in seasonal affective disorder – who will gain weight in winter? Compr Psychiatry, Mar-April, 38 (2). 80-87.
- Lam, R.W, Goldner, E.M., & Grewal, A. Seasonality of symptoms in anorexia and bulimia. International Journal of Eating Disorders. 1996. Jan 19 (1): 34-44.
- Fornari, V.M, Braun, D. L., Sunday, S.R., Sandberg, D.E., Matthews, M, Chen, IL, Mandel, F.S., Halmi, KA & Katz, JL (1994) . Seasonal Patterns in Eating Disorder Subtypes.Compr Psychiatry. Nov /Dec; 35 (6): 450-456.
- Sher, L. (2001). Possible Genetic Link Between eating disorders and seasonal changes in mood and behavior. Med Hypothesis, Nov 57 (5): 606-608.
- Wein, Harrison ed. (2013). Beat the winter blues shedding light on seasonal sadness. NIH News in Health. Retrieved from http://newsinhealth.nih.gov/issue/Jan2013/Feature1.
Published By Kate Clemmer
November 25th, 2013 in Anxiety, binge eating disorder, Bulimia Nervosa, Celebrity Topical News, Cognitive Behavior Therapy, Depression, Diagnoses, eating disorders, Emotions & Coping, Glossary Definitions, Holidays, Recovery, Seasonal Affective Disorder, Support