Just say NO

….to New Years Resolutions.  Resist the temptation.  There is something contagious about setting them, becuase even I (who am adamently opposed to the tradition) start to create a mental resolution list after the 5th email that I receive on “Top Resolutions” or “Tips for setting resolutions.”  Especially when I run across ones with items like “give yourself permission to be human” and “get the rest you need” (WebMD ) — because those sound like GOOD resolutions.  Still, don’t do it!

Why am I so opposed?  Well, to name a few…

• One in four resolutions bites the dust within a week – Steve Levinson, co-author of the book Following Through.
• Half of all resolutions are gone within a month — Levinson
• Overall, 75% of people who make resolutions fail on their first try — Miller and Marlatt (1998)
• More than 50% of all New Year’s goals involve eating better, exercising, or losing weight.  So, statistically speaking… one of your goals would be, too.

Just being a new year is not enough motivation to keep you working toward meeting these goals for very long.  You are looking for that magic time to make a change — so why not New Years?  Well, there is no magic time, as most peope re-realize in mid-January.  It’s easy to promise yourself to change something when everyone around you is also making resolutions… but when that energy dies in a couple of weeks, suddenly making these changes seems a lot less appealing.

I should clarify that I am all for goals.  I just don’t like goals that are made on December 31st.  Additionally, I think that there is a fundamental difference between “goals” and “resolutions.”

Resolution – a decision to do something or to behave in a certain manner.  From the word “resolute,” meaning firm, unyielding, determined.

Goal – a projected state of affairs which a person or a system plans or intends to achieve or bring about — a personal or organizational desired end-point in some sort of assumed development. (Wikipedia )

Resolutions are inflexible and “unyielding.”  They don’t allow any room for re-assessing your goals and expectations.  Things are going to change in the next YEAR.  Maybe you resolve to start running (this one comes to mind since it is one of my mother’s New Years resolutions).  But… what if you twist your ankle or decide that you hate running?  Time to revise that goal… maybe you could switch to swimming?  Or, the opposite — let’s say that you resolve to quit smoking, and you actually do.  Cold turkey.  July comes and you haven’t smoked in 6 – 7 months.  Resolution complete!  …so, now what?  No goals for the rest of the year?

You need to have short term and long term goals… but they need to be flexible.  Things change in life — who knows what the next year will bring.  Personally, I do better with weekly goals because they are something that I renew each week.  There are a couple of things that seem to be permanent fixtures on my short-term goal lists.  For example, there’s “eat enough protein.”  I usually DO eat enough protein… but it’s something that I still work on and that needs to stay on the list week after week.  And then there’s “take calcium supplement,” which I have a horrible habit of NOT doing, so it definitely needs to stay on the list.  However, items like “eat a fear food,” “get 8 hours of sleep,” and “talk to fiance about _____” come and go.

So, to get back to my original point – don’t make a New Years resolution!  Make a list of short & long term goals if you want (although I would recommend waiting a week or two as to not be caught up in the resolution-ness).  You can use the tips from all 100 emails that you’ll receive about setting resolutions — make them specific, make them reasonable, etc.  Just remember… the start of the new year is not magical.  January 1st is just another day (albeit a holiday, which does make it a little special).

Size sometimes matters

Laura Collins raised a GREAT question today — Does (mom’s) size matter? While I have a lot to say about the matter, two main points come to mind:

1. Mothers with eating disorders
I think that your mother’s weight and behaviors surrounding food are much more relevant in recovery than in the downward eating disorder spiral. Parents model for their kids — I’d argue that this is even true for adult kids (adult kids, ha — you know what I mean). While I think that the eating habits of everyone around you definitely influence your own, there is something about mom’s that sets the bar.

In recovery, you’re feeling particularly self-conscious about weight and food. You are looking around at others to figure out what “normal” is. You are also overly conscious of the size of everyone around you — as well as what they’re eating.

So… what if your mother is anorexic? Or, not necessarily even anorexic, but what if she is health-obsessed or a compulsive over-exerciser? You’re trusting your dietitian when she says that ALL women do need xxxx calories, and trusting your therapist when she explains that disordered eating is unhealthy and a poor coping mechanism. Maybe you’re still trying to convince yourself that you DO have an issue (denial = a large part of EDs) or that treatment is important.

And then there’s mom — who is underweight and not eating xxxx calories a day (not that you’re counting your mother’s calories). And she seems okay… and it’s not a problem for her… so why is it a problem for you?

You want your mom to be the parent. You want her to model what you’re supposed to do, because you don’t really know (or trust) what you’re supposed to do. Recovery is hard enough without having to wrestle with this size double standard. I don’t think it really matters what “size” your mother is, as long as she isn’t unhealthily underweight and/or actively losing weight while you are trying to recover.

2. Families changing their eating because of your ED
I’ve always been afraid that my eating habits would rub off on my family (or something like that) and change their eating. I guess I never really worried about my mom gaining weight while I was gaining weight… but with all the focus on the eating disorder, would my mom or sisters suddenly become more food and weight conscious? Or — would anyone pick up some of my ED tendencies?

It’s somewhat unfortunate that eating disorders don’t exist in a vacuum. I do think the size of people around you affect your perception and expectations of your own size. I also worry that eating disorders hurt families in several ways — maybe one of them being and increased obsessiveness over food and weight. And, if that is the case — I hope that doesn’t last.

Things I would hate about CBT-E

Well, I am officially the last one to jump on the “New Psychotherapy Has Potential to Treat Majority Of Cases Of Eating Disorders” article. I’ll admit, this journalist did a great job with his headline — not only did I read the article, but I went on to read up on CBT-E.

To quickly define CBT, Cognitive Behavior Therapy and Eating Disorders explains:

The strategy underpinning CBT-E is to construct a ‘formulation’ (or set of hypotheses) of the processes that are maintaining the patient’s psychopathology and use it to identify the features that need to be targeted in treatment. Thus, a personalized formulation is constructed at the very onset, although this is revised as treatment proceeds.

That didn’t really mean much to me, but I skimmed through the book and quickly decided that CBT-E was not for me.

Things I would hate about CBT-E:

1. It’s time-limited to 20 sessions. This just makes me mad from the start. I want to think that if I’m still having a hard time in 20 sessions from now, that I would still be able to get help. That ED treatment isn’t like antibiotics — you take a course of them and you’re cured.
2. It’s not meant for anorexia. Which means…. it wouldn’t help me?
3. It doesn’t help with depression. In fact, Major Depressive Disorder is a contraindication.
4. There’s no “treatment team” — only one therapist can be treating you. While I understand there can be communication issues once more than one professional is involved, I’ve always found it helpful to have a separate psychiatrist, nutritionist, etc. I don’t really want to talk to my therapist about food exchanges or prozac.
5. Significant others are hardly involved. (And family is not involved at ALL, but I’m not really complaining about this in my case). But really, shouldn’t you involve your loved ones so that they can better help you? And isn’t it possible that there are things going on in your surrounding relationships that could be affecting you and your eating? According to Cognitive Behavior Therapy and Eating Disorders, “topics outside the eating disorder are not usually addressed.”

Why blog about eating disorders?

What’s the value of mental health blogging? I stumbled upon this post on The Secret Life of a Manic Depressive, where Seaneen discusses the role that blogging has played in her struggle with bipolar disorder. At the end of the post she poses a question:

What are your views on mental health blogging? If you have a blog, why did you start writing it?

I wrote this in her comments (in case it sounds familiar), but I think that mental health blogging is valuable for several reasons:

1. It can provide a healthy outlet for dealing with feelings surrounding your own struggles with mental illness.
2. It’s comforting to know that “you’re not alone”–there are other people out there struggling with the same things as you. Often another person can articulate something that you’ve been trying to explain/identify/put your finger on for a long time.
3. Community support and wisdom. There is a lot of collective and experience within the mental health blogging community.
4. It provides a unique inside look at otherwise poorly understood mental illnesses. How many people really understand how you view/experience the world with a disorder? How does the media affect you? What do you think about current research? What has/hasn’t been helpful for you treatment-wise? There is so much information that only someone who has struggled with mental illness can provide.
5. You can challenge others… challenge them in their recovery, or to look at something from another perspective, or to break through their denial about a problem. Mental health blogs make you think and examine your own reactions

Why did I start Grey Thinking? Well, for all of the reasons above–plus a couple more:

1. I have a lot of opinions on new research, eating disorders in the media, approaches to treatment, etc. My friends were getting tired of listening to my philosophical views of “what is wrong with the DSM-IV,” etc.
2. I have a psychology degree, an eating disorder history, an endless interest in mental health, and web design experience. I felt that this was a good way to combine my personal struggles, knowledge, and interests.
3. Not that I am objective, but I think that having dealt with an eating disorder I have a different perspective of eating disorders in the media, treatment approaches, popular theory, etc.
4. There are not enough mental health blogs out there

Tis the Season for Comparing

“Holiday” and “reflection” go hand-in-hand for me. Actually, I think the equation is more like this:

holidays + remembering to be thankful + being at home + the annual family Christmas card photo = reflection.

Reflection might not be such a bad thing… but reflection leads to comparing. There is still the day-to-day comparing myself to others in my surrounding (although I think I’m getting better about this), but this time of year leads me to compare myself to former versions of myself.

I blame a lot of this on the family Christmas card (a convenient scapegoat). There’s nothing like being able to physically line up images of myself over the years and make harsh judgments. I treat my picture each year almost as if I were a different person. Somehow I am not the same person as I was before… maybe before I was happier, or thinner, or smarter, or more considerate–who knows what it could be. I’m looking for an indication that I am a worse person now.

I know how disordered this all sounds, but there is something about self vs. self comparison that is much more significant than comparing myself to the person standing in front of me in the check-out line. Somehow these images say something about me as a person.

I know that comparing is a big problem for most people with eating disorders, but I wonder how many people beat themselves up over not measuring up to their former selves? I may possibly be my biggest trigger.

Ignorant Doctor Comments

Cammy wrote a post about an experience that I (and probably many individuals with eating disorders) have been able to relate to on many occasions–an appointment with an ED-ignorant physician.  It happens all the time, and sometimes the professionals are VERY nice… they just don’t know anything about eating disorders.  So, rather than commandeer her comments with my own experiences, I thought I’d dedicate a post to some of the more frustrating remarks that I’ve received from doctors (and nurses–not dietitians, therapists, psychiatrists, etc.  I’ll save those for another day).

1. The nurse practitioner that I saw in college insisted that I NOT see a gynecologist.  This was after I had lost my period for several years, gained back to a normal weight, and still not gotten it back.  She insisted that there was nothing any professional could tell me and that if my body decided to menstruate again, it would.
2. I took an ED medical clearance form to my doctor, and on it there were two blanks for blood pressure–one for sitting and one for standing.  The nurse looked at it and said “Now that’s a silly question–I don’t see why they wouldn’t be the same.”  She took my blood pressure once and wrote the number down twice.
3. I was planning on starting accutane for acne when we learned that there was a high incidence of depression/suicide and accutane treatment.  When we mentioned this to my dermatologist (since I was already struggling with depression), she said “Oh, that statistic MUST be wrong.  When people have clearer skin they are happier!!”  (for the record, accutane did worsen my depression–even though it did really help my skin).
4. My cholesterol registered as high on a blood test (even though the bad cholesterol was low and my good cholesterol was really high… and this is common with anorexia) and my doctor sent me a letter instructing me to watch my diet and exercise more.

I feel like I could go on and on, but I will stop there.  Back in the day I took a lot of things personally (like being told that “if you lose 5-10 lbs then we’ll start monitoring you” or “all your labs came back fine so you are A-OK”) and as an indication that I didn’t have a problem and was asking for help when I didn’t need it… but really, once you’ve seen enough doctors, you start to realize that most of them just don’t know.  And the ones who do get it?  It’s usually because either they themselves or their loved ones have struggled with an eating disorder in the past.

Unsolicited Advice

In the past several weeks, I’ve received no less than two dozen “avoid holiday weight gain” and “no-guilt Thanksgiving” emails. Even with the holiday being over, I am sure that the onslaught of emails will continue–just with the word “Holiday” in place of “Thanksgiving.”

What amazed me about these articles is how disordered some of the advice is. While there are a lot of healthy suggestions out there (like “Don’t skip breakfast” and “Focus on friends and family rather than the food”), I have so many examples of unhealthy “tips”:

Wear snug clothes and keep one hand busy. When you wear snug-fitting attire, chances are you’ll be too busy holding in your stomach to overeat. – WebMD

Doesn’t that sound miserable? You’re bound to not enjoy anything if you feel uncomfortable and self-conscious in your clothing .

Use a knife and fork to cut one bite at a time. By using both utensils, you’ll have to slow down between bites. Don’t cut all your food at once. Not only is it technically in poor taste to do so, having precut food makes eating quickly much easier. – The Daily Spark

Count 15 chews per bite. – Whole Living

I’m all for pacing yourself and enjoying your food… but counting how many times you chew each bite and cutting up your food into tiny pieces both fall in the “disordered” category for me.

Keep something in your hands — even an empty glass. – Whole Living

Wear something “fitted and fabulous, so you’re reminded to be conscious of your clothes not popping.” If you’ve got post-cocktail dinner plans and don’t want to fill up on hors d’oeuvres, keep your hands occupied by “carrying a clutch and a beverage.” – Whole Living

While I’ve personally never held an empty glass and a clutch to make it physically impossible to pick up an appetizer… it doesn’t sound very “normal” to me.

Granted, these aren’t necessarily the healthiest sources out there–but the articles aren’t from Weight Watchers Online or anything.  I guess it just goes to show how blurry those lines are between healthy eating, dieting, and disordered eating.

Maybe the world doesn't WANT more CBT…

I have just been waiting to write about this article all day!

Cognitive Behavioral Therapy

“The [UK] government has earmarked £173m to increase the number of cognitive behavioural therapists in the NHS.””Professor Mick Cooper, an expert in counselling at the University of Strathclyde, told the conference at the University of East Anglia that although he welcomed the increased funding for psychological therapies, the focus on CBT was not logical.

He and three colleagues from the UK and US issued a statement saying there had been more studies on CBT, but that did not necessarily mean it was more effective than other types of therapy.

“It is scientifically irresponsible to continue to imply and act as though CBTs are more effective, as has been done in justifying the expenditure of £173m to train CBT therapists throughout England.

“Such claims harm the public by restricting patient choice and discourage some psychologically distressed people from seeking treatment,” he said.”

This argument reminds me of my Dr. Drew Westen grad seminar days… Everyone is using CBT because it’s the easiest to research, has the most funding, etc. etc. Can’t say that I disagree — there is definitely too much hype about CBT. However, I don’t think that most professionals follow CBT guidelines even 75% of the time — it’s just not practical! Dr. Cooper has a great explanation of this:

“What is more, where researchers have allegiances to one particular approach, the control ‘therapies’ that are developed to test these approaches against often bear little relationship to those approaches as actually practiced in the field, and cannot really be considered therapeutic at all (Wampold, 2001, p.104) (Shapiro and Shapiro (1982) refer to these approaches as ‘straw men’). In the Foa et al. (1991) study of PTSD in women who had been raped, for instance, therapists in the ‘supportive counselling’ condition were instructed that, if their clients started to talk about their assault, they should redirect them to focus on current daily problems! “

Every therapist is going to respond similarly to some extent… maybe one is going to focus on though restructuring more than childhood, but you’re still going to have that consoling feeling. I think that whatever this common feeling is makes up the healing component of therapy… which is why the best predictor of treatment outcome is therapeutic alliance. This common set of elements that spans the different types of therapies has been termed the ‘Dodo bird’ verdict. I’ll have to write a post on that later…

Anyway, it’s nice to see someone arguing against CBT for a change! The world (and psych field) could use a little more psychoanalysis 🙂

Technorati Tags:
eating disorders, anorexia, bulimia, CBT, talk therapy, psychotherapy, therapist, psychology, psychoanalysis, NHS, psych research, treatment, mental illness, mental health, Dodo bird

Maybe the world doesn’t WANT more CBT…

I have just been waiting to write about this article all day!

Cognitive Behavioral Therapy

“The [UK] government has earmarked £173m to increase the number of cognitive behavioural therapists in the NHS.””Professor Mick Cooper, an expert in counselling at the University of Strathclyde, told the conference at the University of East Anglia that although he welcomed the increased funding for psychological therapies, the focus on CBT was not logical.

He and three colleagues from the UK and US issued a statement saying there had been more studies on CBT, but that did not necessarily mean it was more effective than other types of therapy.

“It is scientifically irresponsible to continue to imply and act as though CBTs are more effective, as has been done in justifying the expenditure of £173m to train CBT therapists throughout England.

“Such claims harm the public by restricting patient choice and discourage some psychologically distressed people from seeking treatment,” he said.”

This argument reminds me of my Dr. Drew Westen grad seminar days… Everyone is using CBT because it’s the easiest to research, has the most funding, etc. etc. Can’t say that I disagree — there is definitely too much hype about CBT. However, I don’t think that most professionals follow CBT guidelines even 75% of the time — it’s just not practical! Dr. Cooper has a great explanation of this:

“What is more, where researchers have allegiances to one particular approach, the control ‘therapies’ that are developed to test these approaches against often bear little relationship to those approaches as actually practiced in the field, and cannot really be considered therapeutic at all (Wampold, 2001, p.104) (Shapiro and Shapiro (1982) refer to these approaches as ‘straw men’). In the Foa et al. (1991) study of PTSD in women who had been raped, for instance, therapists in the ‘supportive counselling’ condition were instructed that, if their clients started to talk about their assault, they should redirect them to focus on current daily problems! “

Every therapist is going to respond similarly to some extent… maybe one is going to focus on though restructuring more than childhood, but you’re still going to have that consoling feeling. I think that whatever this common feeling is makes up the healing component of therapy… which is why the best predictor of treatment outcome is therapeutic alliance. This common set of elements that spans the different types of therapies has been termed the ‘Dodo bird’ verdict. I’ll have to write a post on that later…

Anyway, it’s nice to see someone arguing against CBT for a change! The world (and psych field) could use a little more psychoanalysis 🙂

Technorati Tags:
eating disorders, anorexia, bulimia, CBT, talk therapy, psychotherapy, therapist, psychology, psychoanalysis, NHS, psych research, treatment, mental illness, mental health, Dodo bird

Dr. Drew should treat eating disorders

Just finished watching Dr. Drew’s Celebrity Addiction Special… and I’ll be the first to admit that I love Dr. Drew. I think that he is insightful, sensitive, non-nonsense, and passionate. I also think he has said one of the most true things about addiction: “You are as sick as your secrets.”

Eating disorders are different from drug / alcohol addictions, but there are definitely a lot of similarities. There are a lot of components of addiction treatment that I believe in and think are important, and should be applied to eating disorders:

Recovery is a lifelong, daily process — You may not struggle with food every day (heck, you could go years of being A-OK with it), but there’s always that risk. You don’t have the luxury of playing food games (and by playing food games, I mean even casual diets or schedules that don’t allow for normal eating). I would compare “I can have a couple of drinks” with “I can lose a couple of pounds.”

Denial, and not necessarily that you have a problem, but that you need help — Denial with EDs is particularly tough because they are not as black and white as other addictions… At what point does a lot of food become a binge? Where’s the line between health-consciousness and disordered eating? You may somehow know that your thoughts and behaviors aren’t completely normal… but not to a point where you require help. You’re still trying to convince yourself that you’re okay enough or that you can handle this on your own.

The importance of personal accountability — All the support in the world isn’t going to help you if you don’t take responsibility for the disorder. This means somehow sidestepping or pushing past the denial. No one is going to monitor your food intake forever, or follow you to the bathroom forever. If you’re not in a place where you can hold yourself accountable, then this means being responsible enough to arrange necessary help and support.

There’s no magic cure — 30 days of residential treatment doesn’t mean you’re recovered. Simply attending therapy doesn’t somehow fix things.

The disorder should be taken as seriously as any potential fatal disease — I really think that with eating disorder treatment, “slips” are much more tolerated and accepted than in addictions treatment. You can really get away with only putting forth a half-ass effort, because treatment isn’t necessarily your top priority. With drugs and alcohol, using once or twice is a big deal. With eating disorders… skipping a couple meals or losing a couple of pounds = not a big deal.

I personally find it interesting that you can dismiss so many little eating disordered things, because hey — people diet, you’re doing pretty well, it’s only a couple of pounds, purging every other month is insignificant compared to 3 times a day, etc. I respect Dr. Drew a lot because I always feel that he is saying, “no, these little things count — recovery is so important that any signs of disorderedness are significant.”

You are only as sick as your secrets…