In my private practice, I find mindfulness-based therapy a powerful approach to treating problems with food, eating, and body image. I primarily work with a sub-clinical population and was curious if this evidence-based modality is also efficacious with full-blown eating disorder patients. I recently participated in an interview with Dr. Lesley Williams, a UK graduate and now on the medical staff of Remuda Ranch, a residential eating disorder treatment facility located in Wickenburg, Arizona.
What is mindfulness?
ANDERSON: “Mindfulness” simply means paying attention, in a relaxed way, to what is happening in the present moment. The cultivation of mindfulness involves the heart as well as the mind — a non-judgmental awareness that is friendly, curious, and compassionate. Mindfulness-Based Stress Reduction (MBSR) is a powerful way to take a break from stressful thoughts and gain perspective before you react or respond. It helps you keep from ruminating about the past or dwelling on negative thoughts, and can decrease anxiety about the future.
WILLIAMS: A 2011 meta-analysis of MBSR trials found it to be a useful method for improving mental health and reducing symptoms of stress, anxiety, and depression. Mindfulness-Based Cognitive Therapy (MBCT) has specifically been found to be helpful for problems with food and body image.
How do mindfulness-based therapies help with problems with food and eating?
WILLIAMS: Food is an amazing drug – it decreases pain. Overeating, bingeing, and even starving are tools that eating disorder patients use to disconnect from their bodies, numb out, and cope with underlying issues. One aspect of eating disorders that is unique when compared to substance abuse is the inability to completely abstain from the substance of choice – food. The eating disorder patient must navigate use of their “drug of choice” up to six times a day. The challenge is like asking an alcoholic to drink six cocktails daily and maintain control.
ANDERSON: MBSR and MBCT are useful in dealing with the need to eat and yet maintain control at the same time. For example, the slowing down of the eating process that happens in mindful eating allows the food to be fully tasted and savored. My observation is that evidence-based therapies like MBSR and MBCT also create a state of sufficient calm, strength, and receptivity to unfamiliar feelings and experiences. Food is no longer needed to numb or distract.
What is Mindful Eating?
ANDERSON: From my own mindfulness meditation practice, I was delighted to discover this relaxed, fully present “here and now” mindset is available in many everyday activities of life, including eating. Mindful Eating is not about dieting, deprivation, or giving up the foods you enjoy. It’s about limiting distractions while eating and experiencing food more completely. It’s rather paradoxical in that by slowing down and enjoying your food more, you end up eating less. I enjoy sharing this approach with my clients that may not have full-blown eating disorders but overeat from emotion, stress, and tension. I also appreciate how these therapies cultivate a more functional and less ornamental view of the body, which can be quite healing for women with body image issues.
Are MBSR and MBCT efficacious treatments for patients with a clinical diagnosis of anorexia, bulimia, or compulsive eating disorder?
WILLIAMS: During the acute phase of anorexia, mindfulness doesn’t work across the board. The bodies and brains of patients with anorexia are so starved that they cannot integrate sensory data. However, with weight restoration the brain begins to fire on all cylinders. At that point, mindfulness-based therapy can be very helpful, for example, in somatic experiencing of the food, such as identifying how the food feels and tastes, and in post-meal processing. For the treatment of bulimia and compulsive overeating, mindfulness practices can be helpful from the beginning, as a way to help the patient relax, slow down and really taste their food, expose the patient to normal eating habits during treatment, transition into the “real world” after treatment, and to help maintain the lifestyle change.
As the new year brings attention to your patients’ concerns about their weight-related health issues and healthy weight goals, mindfulness-based therapy can be a helpful adjunct to medical therapy.