286: Goal Setting In Recovery

Chris Sandel: Welcome to Episode 286 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at www.seven-health.com/286.

Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist and a coach, and I help clients to fully recover.

Happy New Year! I’m actually recording this in December, so it hasn’t happened yet, but this will be the first podcast released in 2024. I’m aware that there is a lot of nonsense that comes out at this time of year about dieting, about ‘new year, new you’ and all of these pressures that come up. And I know for people who are dealing with disordered eating or an eating disorder, this can be a particularly tricky time because there’s so much stuff that comes up about going on this diet or that diet or making these changes.

I’m not against reflecting and using the start of the year as a place to decide on some new path and deciding on making 2024 about your recovery. It’s just I want people to be focusing on goals and things that are really going to add to the quality of their life, and that’s one I want to really talk about as part of this episode.

This episode is going to be about goal setting in recovery. There are different ways of doing goal setting and different types of goals, so I want to talk about that as part of this episode. I’m going to go through a number of different ways that you can do this.

And look, like so many things in recovery, there is no one perfect way that you have to do it. It is different for different people. So I’m going to offer some different ideas here and then you can have a think about it for yourself, and then you can experiment and play around with this. I’m always encouraging clients to experiment. I think this takes a lot of the pressure off in terms of getting things right. It’s more, let’s run the experiment and let’s see what happens, and then use the experience to reflect and decide, what do we want to do next?

So that is what I want to suggest as part of this: take all these ideas and see how they fit for you and then run the experiment.

00:02:29

Creating your vision

The first type of goal setting I want to mention is what I call creating your vision. This is really where you’re taking a big picture, long-term view of where you want to get to. I think this is very important as part of recovery because it can be very easy to get bogged down in the day to day; it can get easy to be stuck in everything feeling so hard or there’s all of this fear, and really losing sight of “Where do I want to get to? What would I like my life to look like?”

This is also a problem because the eating disorder really shrinks what you think is possible. It changes your perspective and your perception. So I think doing an exercise like this in terms of creating a vision can help to pull you out of that place and give you something tangible that you can continue to come back to.

I’m going to read out the instructions as part of doing this exercise. If you’re listening to this and you’re wanting to do it as an activity, you can just write this down or pay attention to the different prompts as part of this.

As part of this exercise, I want you to imagine yourself a year from now. It could be two years, it could be three years; the amount of time doesn’t really matter. But there is this point in the future that you are imagining. At this point in the future, things have improved in your life. You’re showing up as your authentic self. You’ve built better relationships. You’re living in alignment with your values and you’ve created a rich and full and meaningful life. To reach this place, you’ve set many goals and you’ve achieved them.

I want you to imagine you are this future self. So it’s a year or two or three years from now, and you’re really basking in the glory of this new life and reflecting on the journey it’s taken for you to get here.

There are now a number of questions that I suggest as journalling prompts as part of this to really start to think about what has changed over this time.

Question 1: Describe what your life looks like at this future place. What were the goals that you set to get there?

When doing this, I want you not to write in that future tense, so write as if “I am”, not “In the future, I will…” Write as if you are in that place in the future and you are reflecting on this.

Question 2: Describe what you did to achieve these goals. Be as specific as possible.

Question 3: What did you give up? What did you let go of so that you could create these results?

Question 4: What qualities or strengths did you live by or act upon in the face of this?

Question 5: How did you treat yourself as you went through this journey?

Question 6: Who were you being that created these results?

Question 7: What are you most grateful for having accomplished and why?

Question 8: Are there any other words or phrases or events or life experiences that come to mind when you think of what you’ve achieved?

What I recommend doing as part of this exercise is, one, spend time doing it. Give yourself the time to really think about these and to think about the future that you would like to have and put yourself in that future place as you write those responses.

Number two, this then becomes a document that you come back to again and again. It’s something that you read on a daily basis. It’s something that during the day, you’re repeating these kinds of things to yourself. You’re creating this reality. Our beliefs really are just what we’ve repeated to ourselves over and over again. What this is doing is starting to create a new reality by you repeating this to yourself regularly.

It’s also allowing you to be in contact with this vision. I think what can happen – and we’ll get on to this when we talk about the smaller goals that you focus on – a lot of that can feel like, “What’s the point? Does it really matter if I have this snack, or does it really matter if I take this time off exercise today?” It can feel very inconsequential, whereas if there is this vision and this thing that you are wanting to get to, those things then become a lot more important. It’s not inconsequential. It’s actually, “I want to get to this place and it’s really important that I do these things to help create changes to make it there.”

One of the things I would say with this exercise – and I already sort of mentioned it – is because of the eating disorder, it can really constrain what you think is possible. So what I would suggest when doing this is really suspend your belief. Just put all of the “I can’t do that” or “That’s too much” or whatever it is to the side and come up with your responses connected to this.

For some people, when they think about it for themselves, there is more of a difficulty, so maybe it is easier to think about this for someone else. So, “If I was going to answer these questions for someone else and where I would like them to get to in their recovery, what would be the kinds of things I would say?” Or “If this was my son or daughter or niece or nephew, what would I like for them to be achieving when they’re older? If they were in recovery, where would I like them to get to?”

Or you can imagine that you’re creating a character in a film or a character in a novel. “If I was thinking about that character and where I would want them to get to, what would I like to have happen or what would I like that to look like?”

If you can do it for yourself and using yourself as the driver for this, all the better, but I don’t want that to be the thing that gets in the way and doesn’t allow this to happen. So using different ways of being able to get past the filter of “I can’t do that” or “That’s not possible for me” – focusing on other people so that you can create this document that I think is very important. And when working with clients, we are regularly coming back to the vision, and it’s something that happens again and again.

00:09:19

Tips for setting short-term goals

Then we’re going to be looking at shorter term goals. This can be daily goals, it could be weekly goals, it could be monthly goals. Really, with this, you’re wanting to look at the practical steps to take towards your vision. What are the things that you can be changing that when you add up all of these changes that are going to occur, in some amount of time you’re going to reach that vision?

There’s a number of different ways we can do this, and I’m going to go through three different options in terms of setting goals and where I think certain things are applicable or not applicable. But the one thing I would say is true for all of these is when setting your goals, write them out. I recommend doing this when I’m working with clients – we’re doing this every week or every two weeks depending on how long we’re setting the goals for, but writing them out so that you have them in black and white. It’s not “Oh, I thought about this thing and I can’t really remember what I thought about.” It’s “I’ve written this out and I’m very explicit about what this goal is.”

You want to then put them somewhere where it is visible. You want to share it with a partner or a friend or a family member if you can so that there is this accountability, you are speaking to “This is what I’m going to do.” But I don’t want this to be something that’s a little bit fuzzy. You really want to be very specific about “What is my goal and what am I setting as part of this?”

And you can go through even the SMART goal process. SMART is an acronym. The ‘S’ stands for specific, so be clear and specific so you know exactly what you’re aiming for. ‘M’ is for measurable, and it means make the goal something that you can track so that you know you’ve actually achieved it. It’s not fuzzy; it’s like, “I know that I’ve done this.” In a sense, it’s binary. “Did I do it or did I not do it?” ‘A’ is achievable. It should be something that stretches your abilities but is still possible for you to do. ‘R’ is relevant, so it’s in alignment with your values and your long-term goal objectives as well as being the thing that is important for you to be focusing on right now. With lots of goals, there can be many different things you can do, but there are things that are going to be more important for you to focus on in this moment. The final one is ‘T’, which is time-bound. Set a realistic deadline for you to be able to do this. If you’re focusing on “This is the goal for the week”, that’s what you’re focusing on this week, or “This is the goal for the next two weeks”, so this is what we’re focusing on for these two weeks.

The reason why I say write this down is you want to keep the goal the goal. With recovery, there are going to be lots of different things you could be focusing on. What can often happen is “I set this goal and then I started focusing on it, but then I started thinking about this other thing and then this other thing, and I didn’t really do very much of anything.”

So really saying, “This is the goal, this is where I’m putting my focus for this week or two weeks.” And my way of determining if I was successful is “Did I do the goal? Yes, I did the goal. Great, I was successful.” I really think it’s important to keep the goal the goal and make that the focus rather than getting lost in all of the other possibilities of things that you could do.

Okay, I want to go through the three options in terms of setting goals. Different people speak about different ways of doing this.

00:13:03

Setting a low-bar goal

One of them, and the first one I’m going to talk about, is setting a really low-bar goal – a goal that is so easy and feels so easy. Part of the reason for doing this can be so that you start to get momentum because you feel like you’re able to do something, and it feels like “I’m being successful” rather than setting a goal and failing and feeling unsuccessful.

What I would say with this one is the purpose is really to get you moving or to get you doing and taking an action. You set it small with the intention that “Maybe I just do what I said, or actually, I said I was going to do this, but then once I got started, I did more.”

For example, it could be “I’m going to do some stretching for five minutes in the morning. I’m going to do that just to get back into my body. I’m only doing it for five minutes. That’s all I’ve got to do, is just stretching for five minutes.” Or it could be “I’m going to write down one thing that I’m grateful for each day, and I’m going to do that at nighttime. It’s going to take me 20 seconds or a minute to do it, but I’m going to do it.” Or it could be “I’m going to do a two-minute breath exercise every day. That’s all I need to do. That’s my goal. Just two minutes.”

With each of these, as I said, they could then start to create your momentum. So “Actually, I ended up doing some stretching for 10 minutes” or “I started doing the two-minute breath exercise and then I did it for five minutes or for 10 minutes, or I put on a meditation as well”, or “I’ve now started writing down three things that I’m grateful for” or “I’ve started doing more journalling.” The point of setting these low-bar goals is that it then starts you doing some task and then you may start doing it for longer than the original goal. It’s not that that has to happen to start with, but it’s just getting you into the habit and getting you used to setting some time aside to start to do some specific habit.

The thing I would say with these low-bar goals is that I would only reserve these for things that are not related to food and movement changes in terms of recovery. The way I think about this is if you’re trying to make a change to your energy-related aspects of recovery, these are not the kind of goals to set. From my perspective, what drives eating disorders is being in a low-energy state, and this can be across the board. It’s not just that this is what happens for anorexia; this is true for all eating disorders. Again, this isn’t just true for people who are visibly malnourished and we think about as being emaciated. This is true for people in all body sizes. You can be in a low-energy state and that can be the thing that is driving the eating disorder.

So that is a lot of the focus when I’m working with clients: How do we start to reverse that? What are the things that need to happen as part of that? Typically it’s looking at the exercise or movement that someone’s doing and also the eating that someone is doing and the amount of calories or energy that they are bringing in.

When looking at this area, I would not be setting one of those low-bar goals. The reason for this is that when making changes to food or to movement in comparison to some of the other goals I’ve just talked about in terms of writing down something you’re grateful for or doing a two-minute breath exercise – to make a change to your food or movement creates a lot of anxiety, and there’s going to be a lot of anxiety that starts to rise up as part of this change. And this is true whether you’re changing something small or something big.

For example, making some change of “I’m going to add in an apple” – that could still create an anxiety of like 9 out of 10 or 8 out of 10, or a high anxiety response. But even if someone’s able to do that, the actual extra energy from that is pretty insignificant in comparison to what is needed as part of the body healing from that eating disorder. So you have this high amount of anxiety; it feels really challenging to do this, and even when it’s done, it doesn’t really make very much of a difference. This is the same with making changes to movement. It’s really hard to make a change, even if it’s like “Let’s reduce this by 10 minutes”, and then if you’re reducing it by a lot more, the anxiety is only a little bit more.

So when I’m thinking about changes to energy and energy balance, I’m much more looking at making more significant changes – what I will refer to in a moment as a medium goal. So when setting these low-bar goals, have it be about different things that are not connected to food and exercise.

And I would say that if you’re in the early stages of recovery, you’re really wanting to focus on food and exercise more because those are the things that are going to make the biggest impact in terms of changing your physical state, which has a knock-on in terms of your psychology, your emotional state, your capacity to deal with challenges. It helps in terms of your resilience. It’s so important, so I would not be setting any low-bar goals connected to that stuff. I would be reserving it for other things like what I just went through. It could be doing some colouring, it could be doing a jigsaw puzzle. It could be doing all of these other things that might be thought about as low-grade self-care. Those are the kinds of things where I would be in favour of setting one of these low-bar goals.

And this isn’t necessarily for everyone; I think this is more helpful when someone has trouble just getting started with anything. Just setting something small to get that momentum I think is really helpful. But if you’re in a place where we can set a much more significant goal connected to these other things, I would start there. I don’t think you need to start with one of these low-bar goals. It’s only if “Actually, I really need to start from that place.”

00:19:36

Setting a medium goal

The second one, the second type of goal, I’m going to refer to as a medium goal. This is something that pushes you out of your comfort zone and will make a difference to your recovery. This is often where I will work on things with clients. Let me give a couple of examples here – and this would be where I’m very much looking at things like food and movement.

It could be adding in 500 calories to your eating each day as a goal. We could then have a discussion about how that would look. Is it all at one meal? Is it changing to snacks? What is the easiest way for that to happen? But having that more significant change come in. It could be stopping all exercise for an allotted amount of time as a medium goal. It could be eating the same fear food – for example, eating pizza – each day for a week.

These are more significant goals. Why I’m calling them more significant is because they’re going to make a change to your energy debt, so it’s going to start to make inroads into the low-energy state that you’re in. With these kinds of goals, what invariably happens – and I’ve been doing this a long time, so I know there is this pattern connected to it – is when setting these kinds of goals, there’s a lot of fear and anxiety that comes up. It can be hard even to set this kind of goal and to say “I’m going to do this and hold myself accountable to doing it.”

When it is then set, in the lead-up to actually doing the thing that you said you were going to do, there is lots of anticipation anxiety, and there can be lots of worry and fear and uncomfortableness and uncomfortable thoughts and sensations. And then when you actually do the thing, typically it is better than expected. So “It was easier than I thought it was going to be.” That doesn’t mean it was easy, but it was easier. It wasn’t as bad as the anticipation anxiety made out.

As part of this, there can be some lingering that happens after. Let me use the pizza example. There’s anticipation anxiety before having the pizza; there is then the experience of having the pizza, which wasn’t quite as bad as you thought it was going to be, and then after the event of eating the pizza, there is some difficulty as part of that. There can be feelings of shame or feelings of regret or physical sensations in the body that are uncomfortable.

What I suggest that clients do with this is just to notice what happens as part of this pattern. What typically happens is “Yes, I felt these sensations and I noticed it, and it lasted for about an hour” or “It lasted for about 45 minutes and then it started to subside and then it was back to normal.” During this, it gives someone a chance to practice different techniques to support their nervous system or to support in terms of their thoughts or staying in the present moment. I use acceptance and commitment therapy a lot, so I’ll be getting clients to do dropping anchor or expansion or other techniques from acceptance and commitment therapy. They then get to experience that “Okay, I did this thing, there was a lot of anticipation anxiety; it then wasn’t quite as bad as I expected it to be, and then afterwards there was this period of uncomfortableness and then it lasted for this amount of time.”

What I think is really useful with this is it moves someone out of the realm of the “what if” and into the real world. Before making this change and before having the pizza, your mind can be spiralling about all these different things that may possibly occur and how hard it’s going to be, and yet then you do it and you are in touch with reality about what actually did occur.

What can happen as part of this is you may have the pizza and it is terrible. It’s a really poorly made pizza, it doesn’t taste very nice, and there can be a lot of regret that comes up as part of that in terms of “I wasted all of these calories eating this food that wasn’t very nice. I thought this was going to be much more enjoyable than it was”, and there can be all of these thoughts that come up connected to that.

When this happens, my response to clients is, “I’m glad that you went through that experience.” I’m glad you went through that experience because you got to see that that happened and you were still able to survive. The whole point of recovery is about developing resilience and developing psychological flexibility, and this helps with that. It helps when things go really well and it also helps when things don’t go as well as you hoped, and you’re able to then see, “Okay, that wasn’t a pleasant experience, it didn’t go as well as I hoped, and I was still able to cope with what happened.”

When I’m working with clients, what I’m recommending is to constantly be setting these medium type goals – these goals that are pushing you out of your comfort zone where you’re actually getting to experience “What happens when I do this?” Because I think what typically happens for many people who reach the point in their eating disorder where they do want to recover is they then spend a huge amount of time reading and listening and consuming all of this content around eating disorder recovery, and yet not really taking any action. Or they start to take action and then they stop. Then there’s all these stories and all of this “what if” and all these theories that get built up as opposed to actually doing the thing and seeing what happens in reality.

So this is what I’m recommending with clients: constantly setting these goals and doing it, because invariably what happens is people discover that what they thought was going to happen didn’t happen. Or even when something happened, their ability to handle that and respond to it is different to how they believed they would be able to. So that is the medium goal.

00:25:44

Setting a 10x goal

The final goal I want to talk about – I’m calling this the 10x goal. This is really about making some kind of seismic improvement where something you currently think is impossible now becomes possible, and what would this look like?

One of the ways to think about this could be, again, doing a bit of journalling and thinking about it, where if you were to say “I want to be over my eating disorder, over all of my fear foods, over all of this in six months’ time or four months’ time” – set something that feels completely improbable to be able to deal with all of these things – but I’m going to use this as my thought experiment. If I was going to do that or if someone was going to do that, if it makes it easier to think of someone else doing this, what would they have to do? What would have to change for that to happen? You can then start to write down, what would have to happen as part of that?

The reason why I think that this can be, one, a really useful thought experiment as a starting place, but two, this can then become the goals and the way you set your goals based on this thing, is it starts to cut through so much of the noise and so much of the indecision. For example, if you’re making some small change – you’re saying, “I’m going to add something to my snack” or “I’m going to add something to my lunch” – there’s so many possibilities that you could make as part of that that it can become overwhelming.

You’re also still staying in the same general realm that you’re already in. You’re negotiating a little bit with the eating disorder. You’re saying, “I want to maybe have this thing” and then there’s these thoughts that come up. So you’re in a lot of ways staying in the same place you’re in, but it’s like “How do I make this 5% or 10% better?” That still keeps you locked into the same level of thinking, the same kind of identity that you have because you’re in that place. Whereas if you’re saying “How do I do something that completely feels impossible at this point?”, it gets you thinking in a totally different way. It really moves you out of the current rut and the way of thinking and into a totally different headspace. This then isn’t just about behaviours. This then takes a real shift in your identity, which is actually what you need to have occur to recover.

I’m assuming that just hearing this will bring up a lot of fear and it can feel very scary to be thinking about this. I know that on the surface, this one can feel the scariest, but I actually truly believe that it is easier to do this than making lots of tiny little changes and hoping that all of these will add up to getting recovered. Because what often happens when I start working with someone is for the last two years, three years, five years, they’ve been trying to make all of these incremental changes to recover and the reality is they’re basically in the same place as where they were two, three, five years ago.

None of those changes have really amounted to anything because they’re still stuck in the realm of negotiating with the eating disorder and trying to appease the eating disorder as part of the changes, so it doesn’t really get anywhere – versus something like this completely pulls you out of that kind of headspace and really makes you start to think, “If I’m going to do this, I’m going to do something completely, radically different.”

Again, this could be connected to your vision. You’re repeating this day after day; this is then becoming your new reality.

So that is the final way that I’m suggesting you can do your goals. I would say this is probably the one that people do the least, and I think it is the one that could be the most beneficial because of how it starts to shift not just your behaviours, but your real identity and your real complete perception around recovery and what it can look like.

00:30:08

Why goal-setting is crucial for recovery + my programmes

The final thing I want to mention is – as I said at the start, you need to figure out what works for you. I’m not saying that any one way works for every single person. But what I will say is that to recover, there needs to be structure and there needs to be goals and there needs to be intention with it. Recovery doesn’t just happen. No-one wakes up and is like, “Oh wow, I somehow recovered.” It really takes intention, it takes effort, and I really think that goal-setting and then action-taking based on these goals is the way to do it.

You can set all the goals in the world that you like, but if you don’t take action on it, nothing changes. And if nothing changes, nothing changes. So it is using this goal-setting as a way of focusing on “What is the action I am going to take as part of this?”

Goal-setting is a big part of the Fundamentals of Full Recovery programme that I run. It’s part of the first module because I think it is so important and it’s something that I then recommend continuing to do all throughout the programme and all throughout recovery, because it helps to give you that focus of “What is the thing I need to be focusing on right now?” Recovery does happen in steps and in stages, and it helps to move you along as you go through those steps.

As part of this show notes, there is a link as part of that if you want to get on the waiting list for the Fundamentals of Full Recovery programme. It’s a programme that at the moment, the doors are closed, but I’m going to be opening the doors again in February time, and you can get on the list and be the first to be notified about that.

I also have a free programme that you can go through called The First 5 Steps of Recovery. This, as the name would suggest, looks at the first 5 things to do as part of your recovery, and goal-setting is one of the things I touch on as part of that. The course is free. Again, if you go to the show notes, you can find a link of how to sign up for that. The show notes, again, is www.seven-health.com/286.

That is it for this episode. Have a good week, and I will catch you soon.

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