Food and Body-Image Issues: Doing What Works for You, Part I

dining tableWhen it comes to solving problems with eating and body image, a one-size-fits-all approach doesn’t work. Different things work for different people. While cognitive behavioral therapy (CBT) is backed by research as being the most effective treatment for eating issues, there are a host of other psychotherapeutic models, mind-body approaches, and expressive arts modalities that can be powerful in bringing about healing.

We are all unique individuals, so it makes sense that different approaches, and different combinations of approaches, are likely to be helpful for different people. Also, different models use different language for describing similar concepts, and different language makes more—or less—sense to different people.

I think of human beings as like tables with four legs: mind, body, emotions, and spirit. All four legs must be sturdy for the table to be balanced. Eating, food, and body-image problems involve the mind, the body, and emotions, and I believe they are, fundamentally, a malady of the spirit, for they obscure one’s awareness of their innate worth, value, and goodness. Healing such problems means repairing all four legs. Over the next few months, I’ll talk about various therapeutic approaches for dealing with these legs as they relate to eating issues, and how they can be mixed and matched to suit individuals.

Addressing such issues must include focusing on the mind, for which CBT is great. Recognizing core beliefs and cognitive distortions is imperative. However, in my work with people, and talking to colleagues about their work, I find that CBT alone can run the risk of causing a sense of invalidation—“I’m already not good enough, and now you’re telling me my thoughts are wrong!” This is where mindfulness practices, dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), ego-state therapies such as Internal Family Systems, body-oriented therapies, and mind-body practices such as yoga and yoga therapy can be valuable. A premise of all of these is that it’s important to observe and accept our thoughts without judging or trying to change them.

Mindfulness is thought to have originated in ancient Buddhist or Hindu practices as a form of meditation and a means of being fully present in each moment, the idea being that the present moment is where we truly live. Thoughts about the past and future, even five minutes ago or from now, take us out of the moment and mire us in anxiety about what will happen, or shame about what did, which in turn can drive us to resort to unhealthy strategies to avoid feeling.

Mindfulness practice involves nonjudgment—that is, noticing our experience of the present moment (what we see, hear, touch, and taste as well as what we’re thinking and feeling), without any evaluation as to it being good, bad, right, or wrong. Nonjudgment’s cousin is acceptance—not resisting or denying anything that exists, no matter how unpleasant. Acceptance is important because when we refuse to accept something and insist on judging it, our energy is bound to that thing. We obsess about it and are upset by it, sometimes so much so that we again resort to unhealthy strategies to feel better. When it comes to eating and food issues, accepting our bodies as they are, and accepting ourselves no matter what or how much we’ve eaten, is a huge challenge.

Acceptance is the cornerstone of two effective therapy models: DBT and ACT. In DBT, the premise is that with regard to mental and emotional struggles, there is a fundamental dialectic, or two seemingly contradictory things that are simultaneously true: acceptance and change. DBT holds that we cannot change something until we first accept it—that trying to change something without first accepting it without judgment is futile.

With eating problems, we must first accept the reality of the problem before we can set about to change it. Once accepted, we can learn skills for managing the painful emotional states that can drive conflicted relationships with food, and to use them instead of acting on urges to overeat, undereat, exercise compulsively, or induce vomiting after eating. The first of the four main DBT skills is core mindfulness. The others are emotion regulation, distress tolerance, and interpersonal effectiveness.

I think of ACT as the Alcoholics Anonymous “serenity prayer” (God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and wisdom to know the difference”) expanded into a therapeutic approach. ACT teaches us how to mindfully observe and then accept our thoughts and emotions, but not to act on them; rather, to make a decision on the course of action to take based on our values. So, for example, if someone were to feel hurt or upset about something and then have strong urges to make an excuse to stay home alone and binge and vomit, ACT would direct them to feel the hurt, notice the thoughts and urges, but because they value honesty and friendships, keep their plans with their friends and perhaps talk to them about their struggles.

ACT and DBT principles can be combined with one another and with CBT. Next time, I’ll talk about some other approaches and how they also can be used with mindfulness practice, ACT, and DBT.

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by Deborah Klinger, MA, LMFT, CEDS, therapist in Durham, North Carolina

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • mia

    February 10th, 2014 at 11:07 AM

    Having a poor body image plagues me for many years, starting from childhood and going forward from there. I always heard hurtful things from peers and teachers, even my own family members while growing up and that had a horrible impact on me and how I always thought about myself. I am still trying to resolve many of my issues decades later, but the eating disorders still follow me and the tendency to think of myself very critically is ver strong in me. No matter how much positive self thought and talk I try, there are still those memories of the past that creep in and offer far more reliability than trying to talk myself through it. Those are the familiar things, the things that I have always thought so of course that is generally the pattern of behavior that I will revert back to.

  • Liam

    February 11th, 2014 at 11:38 AM

    I guess I have never quite understood how hurting about something translates into developing a disordered relationship with food. Is there anyone who can shed some light on that for me? I know that it’s a very real problem that many deal with, I guess I am just looking for a little enlightenment, and why this happens to some and not to others.

  • Trina

    February 12th, 2014 at 6:10 AM

    I agree that we don’t want to hear that what we are necessarily thinking about ourselves is wrong. It is what it is, we have to figure out ways to be aware of that and change those perceptions that we have of ourselves

  • Jane

    February 13th, 2014 at 8:53 AM

    There are so many women especially who are susceptible to developing an eating disorder that it is downright scary! But you have to look at the ways that society as a whole is perpetuating this myth that a woman has to be slim and trim to be beautiful. It’s fine to say that you are going to be mindful and of the moment but what about when you are constantly seeing other images telling you, wait, hold up, you might be trying to think something good about yourself but we are here to tell you that all of that is wrong and you really are worthless because you are not a size two. It is a whole lot easier to tell yourself to not feel this way then it is to actually believe it.

  • sada

    February 15th, 2014 at 12:34 PM

    The only thing that ever seems to work for me is to go to a group that meets at my church just for women who are struggling with issues like this. Some of us are fat, some of us are thin, some struggle with self esteem and others don’t, but the one thing that we all have in common is a complicated relationship with food. You never think that this should be such a force in your life but if you have ever struggled with your weight or what kind of image you have of yourself and your body you know that this is something that is very real for a whole lot of people. These women give me the strength to get through the week, I only wish that we could meet more often! But more than anything else they have my back and I have theirs, because this is something that most of us who go witll always struggle with and will always have a complex relationship with.

  • Bridgid Y.

    July 23rd, 2014 at 11:09 AM

    Thank you for this article. I incorporate mindfulness into my practice and find it compliments CBT techniques. I look forward to your following articles about other approaches and like to know more about ACT.

    Thanks,
    Bridgid
    Sliding Scale Counseling

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