June 2 was World Eating Disorders Day. We continue to recognize the importance of the delicate balance of diabetes and food. Thanks to Verywell for sharing these great strategies on staying strong....
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By Lauren Muhlheim, PsyD, CEDS
Updated March 31, 2016
Sufferers of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder (OSFED) are commonly plagued by recurrent (and often distressing) thoughts and beliefs about eating, shape, and weight, such as:
“Eating will make me feel better.”
“Eating a donut will make me fat.”
“If I don’t carefully control my diet my weight will spiral out of control.”
“I should only eat when I am truly hungry.”
On a daily basis we all process thousands of thoughts. Many of our thoughts are automatic and we don’t usually stop to examine whether they are truly facts or whether they are even useful. Dysfunctional thoughts – thoughts that are inaccurate and destructive – have been implicated in the maintenance of problematic eating behaviors such as restriction, bingeing, purging, and over-exercise. Cognitive-behavioral therapy (CBT), a leading treatment for eating disorders, along with third-wave psychotherapies such as acceptance and commitment therapy (ACT), focuses on helping clients address thoughts that are dysfunctional.
Here are some strategies used by some of the more common treatment approaches to address dysfunctional thoughts.
- Externalize and defuse your thoughts. Before accepting your thought as a command to follow, externalize it. For example, when you have the thought, “I can’t eat a bagel,” label it as “an eating disorder thought” and rephrase it as “My eating disorder is telling me not to have a bagel.” Once you defuse the thought it becomes easier to choose a more workable course of action which may involve disobeying the eating disorder, such as, “Thank you, eating disorder, but I’m not going to listen to you.
I don’t want to let my mind bully me.” This is a strategy from acceptance and commitment therapy (ACT).
- Challenge the thought. Ask yourself any combination of the following questions:
What is the evidence for that thought? For example: “If I eat a bagel I will gain 5 pounds.” There is no evidence for this thought; a bagel could not possibly constitute enough calories to make me gain 5 pounds.
What are alternative beliefs? For example: “I shouldn’t eat unless I am truly hungry.” An alternative belief is “Since I enjoy eating with family members I need to sometimes work my mealtimes around the needs of others. This may mean eating when it is time for a meal even if I am not hungry.”
What are the consequences of having that thought? For example: “I’ve already blown it, so I’m going to go ahead and finish the box of cookies and start my diet tomorrow.” The consequence of this thought is that it causes me to binge which makes it worse because I end up eating even more than if I just work on accepting what I’ve already eaten.
Challenging dysfunctional thoughts and replacing them with facts can reduce distress and help with inserting more functional behaviors that support recovery. This is a cognitive behavioral therapy (CBT) strategy.
- Make a coping card. Take an index card and write the automatic or problematic thought on one side and the rational response on the other. This is a great strategy for those problematic thoughts that come up repeatedly.
It is a good idea to review the cards daily and to keep them in your wallet. You can also pull them out whenever you find that you are having the automatic thought. For example, a common problematic thought may be, “I’m bored. Eating will make me feel better.” On the other side of this card, write “Eating when I am bored will only make me feel worse.” This strategy is a shortcut version of #2 above. This helpful strategy comes from Judith Beck’s Cognitive Therapy.
- Disobey your eating disorder. On a paper make a list with two columns. In one column, write, “Ed says…” and in the other column, write, “Recovery requires…” On each line under “Ed says…” write what the eating disorder tells you to do. On the corresponding line under the “Recovery requires” column write down how you will specifically disobey that command. For example,
“Ed says skip breakfast.” “Recovery requires me to eat breakfast.”
“Ed says exercise today.” “Recovery requires me to take a day off.”
This approach stems from Life Without Ed by Jenni Schaefer and Thom Rutledge and Narrative Therapy.
5. Run a behavioral experiment. Make a prediction, “If I allow myself dessert 4 nights this week, I will gain 5 pounds,” and run an experiment to test it out. Weigh yourself at the beginning and the end of the week. Have dessert 4 nights this week. Check to see if your prediction came true. Over time, you will see that a number of beliefs are not accurate. This is another CBT approach.
It is important to note that cognitive strategies alone will not usually resolve an eating disorder. However, they can be an important and helpful recovery tool for many sufferers. Many providers and patients also note that cognitive symptoms are often the last to improve and that recovery commonly requires behavioral change even in the face of persistent eating disorder thoughts.
Judith Beck (2011). Cognitive Behavior Therapy: Basics and Beyond
Fairburn, C. G., Marcus, M. D., & Wilson, G. T. (1993). Cognitive-behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment and treatment (pp. 361–404). New York: Guilford Press.
Harris, Russ (2008). The Happiness Trap
Schaefer, Jenni and Rutledge, Thom (2003). Life Without Ed.