302: Coping Without Using Eating Disorder Behaviours

Chris Sandel: Hey. If you want access to the transcripts and the show notes and the links talked about as part of this episode, you can head to www.seven-health.com/302.

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 an eating disorder expert, and I help people to fully recover.

I’m currently taking on new clients, and I fundamentally believe that people can change and that you can change, despite what your eating disorder may be telling you. And I’ve been working with people for over 15 years now, and I’m very good at what I do and very good at helping people to reach a place of full recovery.

When I think about the work that I do, it largely centres around three main areas. Those areas are getting your physical health to repair and recover, and this is important because your physical health has a massive impact on all the symptoms you get, but also how your brain and mind work – the kinds of thoughts and feelings and perceptions and beliefs and all of these things that are going to naturally occur to you are impacted upon by the physical state that you’re in. So it’s important not just to have physical symptoms to go away, but to also have an impact on your mental health, to have an impact on your emotional health.

We look at things like developing resilience and constructive coping skills, and this is something I’m going to be talking about today and is the topic for today’s podcast. This is really important because, as I’m going to go through, most people, once they’ve had an eating disorder for any amount of time, it becomes their only way of being able to cope. That’s not great if you’re trying to recover and get out of the place that you’re finding yourself in.

And then the third piece is starting to live a life, and a life that is fun and joy-filled. And I understand that not every day is going to be like that, but so often, the eating disorder makes your life smaller and smaller, and so many things fall by the wayside, and counterintuitively, what this does is it makes you hold on to the eating disorder more and more. So rather than seeing that “This thing is actually destroying my life and has been for a very long time, and now the eating disorder makes me believe I’m incapable of doing a whole host of things, and I’m no longer doing so many of these hobbies that I used to love” – rather than this being this moment of realisation of “Wow, I need to get rid of this thing that is doing this to my life”, there is much more of a feeling of “I need to hold on to this thing.”

So really working on those three areas is what I focus on as part of the work that I do, and this leads to many different changes. It leads to you having better connection and more authenticity. It leads to you having more vibrancy and energy and ability to do life. It allows for more spontaneity and freedom and for spontaneity to be a thing that you are genuinely excited about, not terrified by. So there are many, many components that we work on in terms of the stuff that we go through, but the focus really is, how do we simplify it? How do we focus on these three areas and get you to a place where the eating disorder is no longer dictating your life, where you’re not just marking time and marking days – you’re actually genuinely thriving and living and enjoying your best life, living in accordance to your values and what you truly want to be spending your time on.

I know that can sound fairly lofty, given the way that the eating disorder can constrain what your brain or your mind thinks is possible, but it is truly where people get to.

So if you want to get to that place and no longer be a slave to the eating disorder and no longer be constrained in terms of the life that you’re living, then I would love to help. You can email info@seven-health.com and put in the subject line ‘coaching’, and then I will get back to you and I will send you the details of how we can schedule a free initial chat, a free discovery call, so we can look at, are we a good match, how do work together, and if this would be the thing that is going to help your recovery.

The other thing I want to mention before we get started – and I mentioned this a couple of episodes ago – is that we have video now with these podcasts. I think the last one that went out, there wasn’t any video because I’d recorded it prior to this change over and it was with a guest, but all of the solo episodes now going forward are going to be video, and the majority of the ones with guests going forward will be, too. I think there’s a couple that I haven’t got video for. But everything else is going to have video.

So if you are listening to this and you missed that announcement on one of the previous episodes, then you can go and watch the video. We’re putting the video up on YouTube, we’re putting the video up on Spotify, and we need to look at where else the videos can go. But you then get to see me, if that helps, as part of the listening experience or the enjoyment experience with this. There is video. So I just want to make people aware, if you are unaware of that.

00:05:11

What coping skills do you have outside the eating disorder?

So, on with today’s show. As I mentioned earlier, today, what we’re going to be going through is coping skills outside of the eating disorder. Really, the question that I have for you is: what coping skills do you have outside of the eating disorder, and the behaviours that are connected to the eating disorder? Whether that be doing things with your food, whether that’s doing things with exercise, whether that’s low-grade movement – all of these different components and behaviours that are connected to the eating disorder. If we were to remove all of those things, how would you be able to cope?

How would you be able to cope when you have a difficult day, or someone makes a comment, or you receive an email from someone at work, or there are these uncomfortable thoughts and feelings that arise, or someone sends you a text message and says, “Hey, do you want to come out for dinner? I know it’s last minute. Are you able to join us?”

Looking at all of these different scenarios, how would you be able to cope if it’s not the eating disorder?

What typically happens is that the eating disorder becomes someone’s main way, and typically only way, of being able to cope. This isn’t how it often starts out for most people. Sure, there are some people that from pretty much Day 1, the restriction or the exercise or the components of the eating disorder are someone’s way of coping, and in the beginning maybe it’s a little more innocuous but it quickly becomes their primary coping skill.

But that’s not often the case for most people. It’s kind of a slippery slope into this, and originally there was a lot more coping skills and other ways of being, but over time that gets chipped away at and chipped away at, and then they find themselves in a situation – and you may find yourself in this situation – that “I just don’t have ways of being able to cope unless I’m doing the eating disorder behaviours.”

One of the reasons why this becomes the case, where you go from a place where “I did have these other abilities and then they just disappeared”, is because I think of eating disorders as being anxiety disorders, and the thing with anxiety disorders is they’re about avoidance. The more you start to avoid, avoidance begets more avoidance. So if you haven’t done something for a week, it may be a little challenging; if it’s been a month, it’s more challenging; if it’s been a year, it’s even more challenging.

And because with eating disorders, there’s just so much of this avoidance going on because there’s so much rigidity and “I have to eat at certain times” or “I have to have these certain safe foods” or “I have to do things in this particular schedule” or “I have to have done all of these things first before I’m allowed to eat” and all of these rules get built up, there is then a lot of avoidance. Avoidance is then doing the opposite of that.

As that goes on more and more, people lose the ability to cope because in a lot of ways, any time there is an opportunity for you to have a chance to develop some other kind of coping skill or to use some other coping skill, the eating disorder just comes in and becomes your first port of call. So whereas previously you would have situations where maybe uncomfortable feelings came up or maybe you received a text message that was leaving you in a state of “Oh gosh, how do I respond to that?” – you would figure out a way, and there would be other forms of coping. But when the eating disorder sweeps in, it then neutralizes all of those things and it then becomes the number one and only way of dealing with this.

00:08:46

Why white-knuckling doesn’t usually work

What I often see and find and hear from people is that if they are starting to do recovery – and this is very common with people who are starting to do recovery on their own – they just try and white-knuckle this stuff. So rather than thinking, “How do I actually learn some different skills to deal with when certain emotions come up or when certain thoughts come up?”, really the only skill that they’re using is “I’ve just got to white-knuckle my way through this.”

And there is a small percentage of people where they’re able to do that. That’s fine. But I think that the drawback with that is, you’re still then never learning particular skills. So the only skill that you then have is white-knuckling.

The thing that I think about with recovery is, it’s the perfect training ground for life after having an eating disorder. Because if you can learn how to deal with uncomfortable thoughts and feelings in the recovery process and make your way through that, and you’re learning those skills because of going through that process, when you’re out the other side, you then continue to use these skills.

So much of the stuff that I go through with clients and I work on in this capacity around coping skills, I use on a daily or weekly basis. I have a small child who is nearly seven, and not every day is a blissful walk in the park. I mean, no day is blissful. There are always moments, there are always challenges. So many of the exercises, the techniques, the practices that I share with clients is stuff that I use myself because life will always be life-y. There will be stuff that will come up.

This is then a really important thing to remember, because I think often there can be this feeling of “I’m going to do recovery and I’m going to spend this chunk of time doing it, however long that’s going to be, and then once I get out the other side, all of that stuff that I learnt, I’m just going to put to the side and I’m never going to use it again. I’m learning all these things that have a very specific shelf life, and then in some ways it’s wasted time.”

My perspective is, no, that’s not the case. What you’re going to learn in recovery is going to serve you the long haul. It’s going to serve you for the rest of your life, and you’re going to use these things that you learn in recovery for the rest of your life.

So if your only way of being able to deal with this stuff is white-knuckling, (1) you’re missing out on the opportunity of learning other skills, but (2) I think at some point you just run out of gas with that. You run out of the capacity to just continue to white-knuckle and white-knuckle. I think that’s one of the reasons why I don’t think that’s a great strategy.

00:11:35

Why reframing or counterarguments don’t always work

I think the other strategy that people try and use if they’re not just doing white-knuckling is “How can I try and reason with the eating disorder? Maybe if I can come up with better arguments, with better ways of framing something, then I’m going to be able to recover, and then it’s going to get easier, and then the thoughts are going to drop away because I’ve come up with this stellar one-liner or stellar argument, and then the thoughts are going to drop away.”

It’s not that I don’t do reframing or I don’t say, “Let’s look at this in a different way.” I think there is some benefit to that. But if that is your only way of dealing with things, it doesn’t work particularly well – and it doesn’t work particularly well because what typically happens is you just enter into a conversation. You’re entering into a conversation with the eating disorder with the goal of “I’m hoping to win this conversation, and at some point the eating disorder is going to say, ‘Actually, yeah, you’re right. You’ve made a really good argument. I’m going to go off into the corner now and I’ll leave you be.’” And that is just never going to happen. You’re arguing with a terrorist. You’re arguing with someone who is ideologically opposed to any of the ideas that you come up with.

What happens is it then becomes this arms race where you come up with this idea and then there’s this other idea and it just keeps going in that way. Or even when you’re able to come up with some great thing that knocks down a particular idea, something else just comes up. So it then becomes a game of whack-a-mole. “Okay, I was able to convince myself that maybe that isn’t unhealthy in the way that I was thinking about it, or maybe this other thing is unhealthy, so that’s how I’m able to get through it” – and then the eating disorder just moves on to the next thing: “It doesn’t matter if it’s about the health, but what about the fact that you’re going to put on weight and you’re not going to be able to cope with putting on weight?”

So if you’re going into this way of “How do I come up with a better argument”, you’ll find that you keep falling flat on your face because either (1) you’re not able to argue your way out of it, or (2) when you’re able to win one little battle, you’re going to continue to lose the war, because it’s just a game of whack-a-mole, and the goal posts keep getting moved and moved and moved.

00:13:55

The goal isn’t to make uncomfortable feelings/thoughts disappear

What I want to get across to people – and I think this is one of the big misconceptions with recovery – is the idea that “To be happy, to be able to recover, I need to have all of these unhelpful thoughts, all of these uncomfortable feelings, all of these painful, uncomfortable sensations or emotions – I need them all to disappear, and when they’re disappearing, that’s when I can either do recovery or that’s proving to me that recovery is working.”

I think this is a really big misconception because (1) that is never going to happen, and (2) if you’re using that as a yardstick for “Is this working?”, you’re going to constantly get the feedback of “No, this isn’t working.”

Really, when I’m thinking about this, rather than “How do I get all these things to disappear?”, the goal is “How do I learn to be able to cope with these things? How do I learn that, actually, I am able to tolerate this discomfort, I am able to notice that this urge to exercise or this urge to restrict or whatever it may be, or the uncomfortableness of having eaten a particular meal, or the anticipation anxiety of a particular meal coming up?”

All of these things follow a pretty typical pattern where they start to increase, they then reach some peak, and then they start to come back down the other side. How long it takes for that pattern to run its course will depend on the individual, will depend on what the challenge is, but it can be in as little as five minutes that that takes care of itself, or it could be a number of hours. But it does then follow that pattern.

There are even exceptions where it just stays high, and it’s not that a couple of hours go by and it comes back down; it just stays high. But again, what someone learns is that “Even though that is staying high, I’ve learnt how to tolerate that.” The biggest pain isn’t actually that uncomfortable thought or feeling; it’s the resistance to that uncomfortable thought or feeling. It’s the added thoughts on top of that, like “Why am I having this thought? When is it going to go away? Why am I still in this place?” It’s all of the extra suffering that is then added on top, versus if we just stay with that original thought and that’s allowed to be there, we notice that that then starts to lose some of its power.

00:16:29

Acceptance & commitment therapy exercise

What I want to go through is an exercise. This comes from the book The Happiness Trap, by Russ Harris, I believe. It was my entry into acceptance and commitment therapy. I use acceptance and commitment therapy, or ACT, a lot with clients. I think it’s a really wonderful tool – and again, wonderful for recovery, but in life in general, I use so many of the different techniques and practices from it in my own life.

I want to go through one of the exercises that he goes through in the book because I think it’s something that you can then reflect on for yourself. Let me just pull it up.

I’m going to ask a series of questions, and with each of these questions, there’s a pair of responses. There’s going to be an ‘A’ response and a ‘B’ response. For each of the pair of statements, I want you to select the one that most accurately fits how you feel. It’s not that “I 100% believe that this is the answer”; it’s just that “This one feels more like how I typically respond or I typically think about these things.” It’s not like 100%, but rather, “Of these two responses, which one do I think more accurately describes me?”

What you can do at the end is tally up how many you were putting for ‘A’ and how many you were putting for ‘B’. I’m going to go through these now.

1A. I must have good control of my feelings in order to be successful.

1B. It is unnecessary for me to control my feelings in order to be successful in life.

2A. Anxiety is bad.

2B. Anxiety is neither good nor bad. It is merely an uncomfortable feeling.

3A. Negative thoughts and feelings will harm you if you don’t control or get rid of them.

3B. Negative thoughts and feelings won’t harm you even if they feel unpleasant.

4A. I’m afraid of some of my strong feelings.

4B. I’m not afraid of any feelings, no matter how strong.

5A. In order for me to do something important, I have to get rid of all my doubts.

5B. I can do something important even when doubts are present.

6A. When negative thoughts and feelings arise, it’s important to reduce or get rid of them as quickly as possible.

6B. Trying to reduce or get rid of negative thoughts and feelings frequently causes problems.

7A. The best method of managing negative thoughts and feelings is to analyse them, then utilise that knowledge to get rid of them.

7B. The best method of managing negative thoughts and feelings is to acknowledge their presence and then let them be, without having to analyse or judge them.

8A. I will become happy and healthy by improving my ability to avoid, reduce, or get rid of negative thoughts and feelings.

8B. I will become happy and healthy by allowing negative thoughts and feelings to come and go of their own accord and learning to live effectively when they are present.

9A. If I can’t suppress or get rid of a negative emotional reaction, it’s a sign of personal failure or weakness.

9B. The need to control or get rid of a negative emotional reaction is a problem in and of itself.

10A. Having negative thoughts and feelings is an indication that I’m psychologically unhealthy or I’ve got problems.

10B. Having negative thoughts and feelings means I’m a normal human being.

11A. People who are in control of their lives can generally control how they feel.

11B. People who are in control of their lives do not need to control their feelings.

12A. It is okay to feel anxious and to try hard to avoid it.

12B. I don’t like anxiety, but it’s okay to feel it.

13A. Negative thoughts and feelings are a sign that there is something wrong in my life.

13B. Negative thoughts and feelings are an inevitable part of life for everyone.

14A. I have to feel good before I can do something that’s important and challenging.

14B. I can do something that’s important and challenging even if I’m feeling anxious and depressed.

15A. I try to suppress thoughts and feelings that I don’t like by thinking about them.

15B. I don’t try to suppress thoughts and feelings that I don’t like; I just let them come and go of their own accord.

Those are all of the questions, and you may need to pause the video and go back; you may need to stop it after each one and think, “How would I answer this?” But just looking at, how many of these are coming up in the (A) column versus how many of these are coming up in the (B) column?

The thing that I want to add with this – it’s not that if there is something that you can do that helps to reduce these thoughts or feelings or sensations, that you’re not allowed to do it. It’s more about, “What is the cost that I have by taking that action or by not knowing how to be able to sit with that uncomfortableness?”

For example, if when these things come up, I have a breathing exercise that I can do and I do that breathing exercise and five minutes later, these thoughts and feelings and sensations are reduced by 60%, I’m going to do that as an exercise. The downside of me spending five minutes doing a breathing exercise is pretty small versus the upside benefit that I get.

I really want you to understand, it’s not about that you’re not allowed to do anything and that you have to leave all of these things here. It’s more, “The things that I’m choosing to do – are they truly adding to the quality of my life, or are they actually creating other problems in and of themselves, and I’m now in a situation where my way of coping is actually creating a much worse quality of life than I would otherwise have if I learned other techniques to create room for emotions, or for thoughts to be able to be there, but to diffuse the power that they have over me?”

00:22:38

Starting recovery won’t make things better immediately

I just really want you to get this piece, because I think this is where people get stuck, and it’s especially where people get stuck when they’re starting to do recovery, because there’s this misconception of “But I thought once I started to do recovery, everything would get better. I was told that it was the eating disorder that was making things worse, and once I started to do recovery everything was going to get better.”

In the short term, that’s just not true in terms of there’s going to be time that it takes for things to start to improve. Many of the thoughts that come up as part of the eating disorder, they do disappear once you have nutritionally rehabilitated and you’ve got yourself into a better state and the recovery process has taken place. But it takes time to get to that place.

And even when that has occurred and the unhelpful thoughts that you were having are no longer about your body or your weight or your food or the fact that you didn’t exercise today or whatever it may be, our brains are still going to continue to give us unhelpful thoughts. This is just part and parcel of being a human being: when we are living, when we are interacting with other people, when we are having families and kids and we are running businesses or are an employee or whatever it is, there are going to be challenges. And when those challenges come up, it’s very natural for certain thoughts and feelings to arise.

So even if you get to a stage where the things that are uncomfortable for you have nothing to do with an eating disorder anymore, there’s still going to be things that arise. This is why I’m saying the white-knuckling piece isn’t a great solution, because even after your eating disorder, there are going to be many unhelpful thoughts and feelings and sensations.

So that is it for today’s call. What I really wanted to do was just get you to start to reflect on yourself and the way that you are currently coping, and do you have ways outside of the eating disorder for how to cope? And if you don’t and your eating disorder is the only way that you’re able to cope, is that a great long-term strategy for you having the kind of life that you want to lead?

If the answer to that question is no and you don’t want to be living a life like this and you want to be able to have more spontaneity, more freedom, be able to do a lot more things than you currently can, then I would love to help. As I said at the top, I’m taking on new clients. If you send an email to info@seven-health.com and put the word ‘coaching’ in that subject line, I will then send over details of how you can apply for a free discovery call and for us to talk about working together and for you to find out the details of what that would look like.

So that is it for today’s episode. I hope you’ve found it useful. I will be back next week with another episode. It’s a guest episode for that one. Until then, take care of yourself, and I will see you soon.

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