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

woman outside doing mindfulness exercisingIn my last article, I described two therapeutic models, dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT), that are useful for addressing eating and food problems. Both involve the concept of mindfulness, or the practice of observing what we see, hear, touch, taste, and smell, as well as what we feel emotionally and physically. Mindfulness also means being aware of what we are thinking at any given moment, in order to be fully present in the present.

Why be fully present in the present? Because that’s where life happens. All too often, we human beings live in our heads, in thoughts of things that already happened or things that we imagine, fear, or desire will happen. We feel emotions in reaction to and along with these thoughts, and we sometimes take action based on these thoughts and feelings.

For example, a young woman might receive an invitation to a party that was to happen on the weekend. She might then imagine the people she expected to be at the party, and find herself thinking that she was too fat to attend, that the other guests would see her body and judge it and her, and she would feel afraid of these people’s judgment and then anxious and ashamed. She might then berate herself for her eating and exercise habits and criticize her body, engaging in the very judgment that she imagined the other guests would pass. She might then decide not to attend the party, feel relieved, and vow to crack down on her eating. And she might spend the evening of the party at the gym working out for hours, or in front of her television eating cookies and ice cream.

This young woman is not living in her life. She’s living in her head.

It’s like a pinball machine: thought and emotions and predictions and beliefs ricochet off of one another, creating internal uproar. Recognizing this ricochet process of thoughts, emotions, and body sensations is necessary in order to change such patterns. Mindfulness enables us to do this.

According to DBT, everyone has four different minds that are important to be aware of: “Reason Mind,” or “Reasonable Mind,” which comprises our logical, rational, intellectual perspectives on a given situation; “Emotion Mind,” which is what we feel emotionally about the situation; “Body Mind,” the physical sensations we experience in that situation; and “Wise Mind.” Wise Mind is that place deep within us that observes without judgment and knows what is best for us. DBT teaches people how to be aware of what Reason, Emotion and Body Minds are saying, but to decide how to proceed by listening to Wise Mind.

DBT describes a process in which we encounter a situation, and we tell ourselves a story about it. We then feel emotions and body sensations in reaction to that story, which in turn trigger an “action urge”—a desire to do something that is familiar and comforting, e.g. binge eating or over-exercising, but not healthy. We think we’re reacting to the situation, but we’re actually reacting to the story we tell ourselves about the situation.

Another way of understanding this process is through the concept of parts of self. Everything living is a whole made up of parts—each of us has a body, and that body has many parts. The same can be said of our psyches: we have lots of parts, different parts for work, play, friends, and family.

One therapeutic approach that utilizes the concept of parts of self is internal family systems (IFS). According to IFS, there are two main types of parts that are relevant to the problems that bring people to therapy: vulnerable parts, which are usually younger and hold painful emotions and negative beliefs about themselves that they acquired during difficult experiences, and protective parts, which protect us from being overwhelmed by the pain of the vulnerable parts. Protective parts often engage in unhealthy or harmful behaviors, so it’s important to remember that while their impact is negative, their intentions are good.

IFS also states that everyone has a core self that is compassionate and non-judgmental, and that when we connect to various parts of ourselves from self, we create the beginnings of positive, healing relationships with those parts.

Let’s look at the aforementioned process that I described using a DBT focus from an IFS perspective: the situation triggers a vulnerable part, the person sees the situation through the eyes of that part, and feels the emotions and body sensations of that vulnerable part. This in turn triggers a protective part, which wants to do something familiar and comforting, yet unhealthy, to stop the discomfort. What DBT calls the “story” is, in IFS, the perspective of an activated vulnerable part; the emotions and body sensations felt are those of that part; and the “action urge” is a protective part jumping in to provide relief by using a go-to behavior, like binge eating, bingeing and vomiting, or over-exercising.

While DBT offers methods of managing the emotions and action urges without acting on them in ways that are harmful, and recognizing and challenging the story, IFS focuses on befriending the protective part responsible for the action urge, and healing the vulnerable part generating the story, emotions, and body sensations.

DBT teaches a set of skills for managing painful emotions and creating positive change in life. IFS offers a means of meeting and creating compassionate relationships with the parts of self that are involved in the problems that bring people to therapy and to heal the wounds that parts have sustained.

While DBT typically is taught in skills training groups and applied in more depth in concurrent individual psychotherapy, IFS is most often used in individual therapy. Both are effective for treating eating and food issues, and, like many approaches, can be combined by therapists who are trained in both approaches.

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  • Leave a Comment
  • whitt

    May 19th, 2014 at 2:22 PM

    I am currently dating someone who I am pretty sure has an eating disorder but we haven’t been together that long so I don’t want to say anything about my suspicions unless I am sure that they are true. Any advice on how to tread these waters because I am afraid that if he doesn’t do something then we are talking major health problems down the road.

  • Bellamy

    May 20th, 2014 at 3:44 AM

    Yep I live in my head. Reading this verified what I have known but have never wanted to accept. I am the person who will shun events because I am too afraid of what others will think about me- wrong dress, too fat, bad hair it goes on and on. I create these scenbarios of how things will end up even though I really have no clue as to how others will react to me because if truth be told, I don’t ever give them a chance.

  • Frankie

    May 21st, 2014 at 8:24 AM

    But no matter which approach could ultimately work the best for you it is important to remember that nothing is going to work until you are ready to make those substantial changes in your life.

  • Wendy

    May 22nd, 2014 at 3:42 AM

    How do I know what would help me the most? Am I going to have to try both, or a combination, to see what speaks to me? I am already scared to start this journey, I feel so overwhelmed. I thought that maybe just going to a group meeting would help me but reading this kind of makes me second guess that, like maybe I need more but just didn’t know it. But I think that at this point I am so confused that the thought of even getting started feels like a huge challenege to me.

  • Deborah Klinger

    May 22nd, 2014 at 5:34 PM

    Thanks, everyone for your comments!

    Whitt, the National Eating Disorders Association (NEDA) has excellent resources for those close to someone with an eating disorder. I suggest you visit their site. And know that eating disorders thrive on secrecy, so saying nothing about your concerns will only allow the problem, if it exists, to continue or worsen. I think it’s important that you tell your partner what it is that you’re noticing that is making you concerned, and to emphasize that you’re speaking from a place of caring, not criticism.

    Bellamy, do you have a therapist or a recovery group that you can turn to for help with this? It’s great that you understand this about yourself; the next step is to get the support you need in order to do the things even though you’re afraid of what others think.
    Learning how to walk through fear is what helps us get stronger; not waiting until we’re not afraid (because we’ll be waiting a long time!).

    Frankie, good point. We have to be ready to make those changes, and willing to try the things that will help us make them, in order to get where we want to go.For some people it’s just a matter of being ready enough to get to a therapist. One step at a time.

    Wendy, you can’t always know until you try. Some people know that a more concrete, tools-based approach works, while others prefer an approach that explores and involves their inner worlds, and others a combination of the two. But you certainly don’t have to know ahead of time– what matters is that you find a skilled therapist whom you feel seen, heard, respected and cared for by. Starting recovery is usually scary and overwhelming. I encourage people to read about several therapists and then talk to a few of them on the phone, to get a sense of what it’s like to speak with them and to ask questions, so you have a sense of who is the best fit.

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