Episode 303: One of the most common mistakes I see people making is to go slow in recovery. As part of this episode I look at the common reason why people take this approach and why it doesn't help.
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Chris Sandel: Hey. If you want access to the transcripts, the show notes, and the links talked about during this episode, you can head to www.seven-health.com/303.
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.
Before we get on with today’s show, I just want to say that I am currently taking on clients, and I fundamentally believe in full recovery. It’s what I’m about. I don’t want people doing harm reduction, I don’t want people doing anything apart from full recovery, because I fully believe that you can get there irrespective of what the eating disorder may be trying to convince you of.
My work focuses on three main areas. One is looking at physical repair and recovery, so helping your body to repair and the effect that this then has on your mind and your thinking. The second area is developing resilience and coping skills, so having ways to deal with challenges of life or things coming up without having to rely on the eating disorder. And then third is creating a fun and joy-filled life, so having things come back into your life that are enjoyable, that you want to spend your time on, that aren’t being dictated by the eating disorder.
So if you are wanting to have this occur for you, if you’re wanting to have more authenticity, more connection, more ability to be spontaneous and have freedom, to be able to have the stamina for life and also the capacity and the ability to rest, and to be able to relax – if these are things that you want, I would love to help you. If you’re interested, you can send an email to info@seven-health.com and just put ‘coaching’ in the subject line, and I can send over the details of how we can work together. So info@seven-health.com and then ‘coaching’ in the subject line.
With today’s episode, it is a solo episode, and this one has come about – I actually had a couple of consults this week with clients and I was having the same conversation, so I thought this would make a good idea for a podcast. I then, for some strange reason, woke up at like four in the morning last night and was thinking about this as a topic. I actually got back to sleep, so it was all fine, but I then woke up and I remembered this and I remembered this is a really good idea to cover.
So I’ve jotted down some notes; you may see me glancing at some notes as we go through this.
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I see this being perpetrated, this real misconception out there of going slower in recovery is easier and that it’s better – that if we do things too quickly, it’s all overwhelming and that kind of thing. So what I want to go through is five misconceptions or mis-ideas connected to this, five reasons why people say “If we go slower it’s going to be better and easier for recovery” and why those things just aren’t true.
00:03:11
The first one is that “If we go slowly, the changes will feel easier. It will feel easier to make these smaller changes.” What I say to that is that’s just simply not true. No matter what change you make, you are going to have lots of unhelpful thoughts that arise from the eating disorder. It doesn’t matter how small the change will be; the eating disorder is going to be upset.
I had a client recently mention that she ate two green beans from a friend’s garden, and she still had guilt and eating disorder thoughts come up about this. This I thought was a very obvious example of just how irrational the eating disorder thoughts are – that if two green beans can feel too much, then this is just a demonstration of it’s not actually about the amount, it’s about the fact that you’re doing something that is different to what you were doing before.
Another example connected to this is – and again, this came from one of the calls I had this week with a client. One of her goals was to increase her lunch, and the increase was for her to have two sandwiches. As part of that conversation, she had this feeling of “Two sandwiches was the absolute most that I could’ve had as part of that change.” But if she’d had one and a half sandwiches – if either we’d set the goal at “You now have one and a half sandwiches” or she’d thought “I’m meant to have two sandwiches; I’m just going to make it easier on myself and have one and a half” – the belief in that instance would’ve been “One and a half was the absolute maximum that I could’ve had.” So basically, whatever change you make, it will feel like that is the biggest one that you could’ve done.
And that then is true when you make a really small change. When you make a small change, it feels like it’s the biggest thing that you could’ve done. In the example of the person with the sandwiches, if the goal was two sandwiches and then a snack bar with it and she did that, that would’ve felt like “That’s the most that I could’ve done.”
So I don’t believe that it feels easier to do smaller changes. It feels like it should, but actually it doesn’t, and there’s just as much unpleasantness, there’s just as much unhelpful thoughts that the eating disorder arises or throws up. It doesn’t actually make it easier, even if you think it’s going to make it easier or it feels like it should make it easier.
00:05:32
The second one, and this is a really big one, is “I won’t gain weight as quickly, and this will allow me to be more okay with it as it continues to increase.”
I think often hidden underneath this one is the idea that “If I do it more slowly, then maybe I won’t gain as much weight. If I do this more slowly, then I can get away with not gaining as much weight as if I do this quickly and then I’m going to gain more weight in recovery.”
The first one connected to that is that’s simply not true. The body is going to gain the amount of weight that the body’s going to gain, whether you do it slowly or whether you do it quickly. The body gains weight as part of the recovery process, and that is just part of how the healing happens. That is going to happen whether you’re doing it very slowly or whether you’re doing it in a quick manner. You’re not sparing yourself some extra weight by doing it more slowly, so if that’s the thinking, that’s just not true.
But if we’re looking at the idea that “I will be more okay with the weight gain if I do it more slowly”, I don’t think this is true. This is for a number of reasons. One, when you’re doing it really slowly, you become really hyper-fixated on any change, because typically when you’re making a small change, the hope is “I’m going to make this change and it’s not going to make any impact on my weight. I’m going to be able to make this change and get away with the fact that no weight has changed.” Or “I’m going to make it and there’s going to be the tiniest amount of weight that increases.” You become really fixated on it.
And if it doesn’t go to plan and if there is some weight gain connected to this small change, then there’s a lot of resentment connected to that, and there’s also a lot of the feeling of “Well, if I made this tiny change and it’s leading to weight gain, imagine what’s going to happen when I make this bigger change.” I’ve actually done a whole other podcast specifically just on that idea, so I won’t go into that in a ton of detail, but I will link to that in the show notes.
The thing with making changes in recovery – and this is especially the case in the beginning – your body is prioritising weight gain, and it’s prioritising weight gain above everything else. If we’re looking at the hierarchy of importance at different points from your body’s perspective with recovery, in the beginning weight gain is its number one focus. Then as time goes on, it starts to use more of that energy towards the repair functions. But in the beginning, weight gain is where it puts a focus.
But it’s not just weight gain in the way that we think about weight gain, because in the beginning there’s also changes to your electrolyte balance. There’s also changes to the amount of glycogen that your body has stored. Glycogen is a form of energy that your body uses between meals, so when you eat a meal, some of that energy gets used and some of that gets stored as glycogen. It’s doing this only when there is enough coming in that allows for that to happen.
When you’ve been in an eating disorder and living with an eating disorder for a long time, all of your glycogen stores get depleted, so when you start to do recovery and you’re having more food come in, your body starts to store glycogen again, which is a really good thing. But the way that it stores glycogen in the body in that process is it also stores water at the same time. This means that in the beginning, as your body is re-filling up those glycogen stores, you can have an increase in your water weight. It means that in the beginning, there can be this disproportionate amount of weight gain compared to the amount of food coming in.
So when someone thinks, “If this amount of weight has happened for this small amount of food, then this massive amt of weight gain is going to happen for this much larger amount of food”, it doesn’t work in this 1:1 fashion that people are imagining.
What happens when you’re making these small changes is the expectation is “I shouldn’t be gaining any weight, or it should only be a small amount of weight” versus if you’re making a more significant change, the expectation is “This is going to lead to weight gain.” So when it does, the reaction to that is “This is what I expected to happen.” And that’s a very different reaction to “I’ve made a small change, my weight’s gone up, I didn’t expect this to happen” and then all of the unhelpful thoughts that arise.
I don’t actually think it makes it easier when you’re doing it slowly; if anything, it makes it more painful. But the thing I would also add with this is there’s really some other things where you’re struggling connected to the weight gain piece. One is that you’re wanting to know and wondering where the point is where this is going to end. It’s not the weight gain per se, although that can be part of it; it’s “Where will this end up?”
If that is the concern and that’s what’s driving a lot of the anxiety and the worry, I would prefer someone to get to that point of knowing that in six months’ time versus in four years’ time. If someone can get there quicker, then they have the realisation of “Hey, I was able to get to this place. This is where I know is my endpoint. This is where I know my body is maxed out, and this is what it is” versus if you’re spending years slowly eking your way up, you don’t know where that endpoint is. So you get into this headspace of just “I’m so terrified of the unknown.”
Because what happens with recovery is you reach a point where “Even though I’m eating just as much food as I was before, my weight is no longer going up” and you’re able to see that “Actually, my weight isn’t increasing anymore, even though I’m eating this high amount of food.” So you want to be able to get to that place, to be able to experience that for yourself. Me just telling you this now on a podcast or on a video, that doesn’t really carry the same weight as when you go through that experience.
The other piece connected to this is, yes, there is a fear of weight and weight gain, but the fear is actually more about “This is going to happen and I’m not going to be able to cope.” It’s not fear of weight gain in a vacuum; it’s the fear of the weight gain and the consequences there are going to be about that, or the fact that I’m not going to be able to cope when that happens.
You never learn that you’re going to be able to cope in advance. What often happens with the clients I speak to and the clients I work with is their weight will increase, there’ll be this feeling of “I’m okay with this, but this is as high as it can go.” And then it increases further and there’s the feeling of, “I obviously battled and managed here, but I couldn’t go any higher than here.”
Again, I want to have someone go through this process as quickly as possible so they can realise “At every point along this journey, I was able to cope.” Because if you’re constantly thinking about the future and all of the ‘what if’ thinking, the kind of ‘what ifs’ and theories that your mind is generating in this state is all of these scenarios where this happens and it’s a total disaster. What I want to be able to have you experience is going through that and noticing that it wasn’t a complete disaster. Or “It was a really challenging thing, and I was able to cope”, or “That was a really hard day, and yet I was able to make it through.”
It’s hard to know those things in advance, so again, you can spend so much time worrying about what it’s going to be like when this thing occurs or that thing occurs versus have that thing occur and then deal with the reality of what has actually happened. Because the reality is typically very, very different, and you do discover that “I can cope and I can manage, and this isn’t the way that I thought it was going to be.”
00:13:26
The next piece, number three, is that “By going slowly, I can go from making small changes, and then I can move up to medium changes, and then I can move up to larger changes.” This idea is “I’ll start off slow and then we’ll build things up.”
But this just doesn’t really happen. And it’s based on everything I’ve already gone through, because when you’re making these smaller changes, you’re still having all of these unhelpful thoughts that are coming up. You’re still having the eating disorder being upset with the fact that you have made this change. So making this smaller change doesn’t actually lead to more confidence; it just leads you to think, “Gosh, it’s been so hard just to make this small change. I couldn’t possibly do anything bigger than that.” It just furthers the narrative that you aren’t ready for a bigger change.
So the way that you get ready for a bigger change and learn that you can do a bigger change is by making a bigger change. Doing something smaller doesn’t prepare you for that. It doesn’t make it easier to do that. Often what happens, it just keeps you stuck in making these little changes and thinking “I’m not really getting anywhere. The thoughts aren’t really changing in the way I hoped they would. I heard recovery was meant to make things better; it doesn’t feel like things are better” and then you get stuck in that cycle. What that is more likely to produce is someone who throws their hands up and says, “I can’t do recovery. Recovery’s not going to work for me, it just doesn’t work” versus “Oh okay, let me do a bigger change here.”
00:14:55
Number four is “By going slowly, I can get okay with the change, and then I’ll make the next one.” This is kind of similar to what I just went through, but I think it’s this idea of “I’ll make a change, I’ll take a pause or I’ll take as long as I need to to feel comfortable with that change, and then I’ll move on to the next one.”
The reality is, when you are in this depleted, malnourished state – and malnourished doesn’t mean that you are filling some stereotype of what an eating disorder looks like; you can be in a malnourished state all across the weight spectrum. If you are in this depleted, malnourished, low-energy state, you never really get comfortable with the new change. At every point, the eating disorder is still going to ask you to be reducing it.
I’m not on board with everything that happens in inpatient facilities. I think there’s a lot of things that could be done a lot better than this. But one of the things that is done at inpatient facilities pretty much across the board is they start in a pretty meaningful way. Yes, there may be some increases slowly in the very, very beginning, only for the fact that they don’t want to give someone refeeding syndrome. There is this couple of week window where we need to be really monitoring this. But after you’re out of that phase, no, we’re not going to do this slowly. And we’re not going to do this slowly because there’s the realisation that you’re not going to get comfortable with this, and if you’re making a small change and then hoping to get comfortable, “and then I’ll make the next change” – that just doesn’t happen.
What the goal of recovery should be isn’t comfort. The goal of recovery should be discomfort. Discomfort is where the recovery really happens, and if you’re trying to chase comfort while doing recovery, what this leads to is you reducing the goals, and typically reducing and reducing and reducing with the hope of “Maybe this reduction will make it easier” and then it doesn’t. “Maybe this reduction will make it easier” and then it doesn’t. And then you’re in the realm of “I ate two green beans and it still felt overwhelming, so obviously I can’t make any changes.”
So there’s that, or you’re constantly making changes that are either really, really small or you make a change and then you compensate to be able to try and get some kind of comfort back. You end up making changes where there’s really no upside in terms of a recovery standpoint. You’re not having this nutritional rehabilitation take place. You’re not having the neural rewiring take place. You’re not getting a real benefit for it, and yet you are having a huge amount of anxiety because of making these changes, and it feels like “I’m putting in all of this effort to recovery, and yet I don’t see any benefit from it.”
Also, when you’re wanting to chase after comfort and thinking that comfort should be what is part of recovery, it leads to this feeling of “I want to have a break. I’ve been trying to do recovery now for the last month or the last six months” or however long it is, “and I’m putting in all this effort, and we need to have a break. I need to take a step back because I need to get some comfort by having a break.” A break is not really a break; it’s an illusion of a break. What happens is the eating disorder thoughts continue to ramp up, you start to make further reductions, and it goes in this really negative spiral as you relapse or move further and further back.
So the idea that “If I go about this in a slow enough way, I can get okay at each of these steps” – that’s just not true. You get okay and you get more comfortable further down the line as you’re getting into more of a restored state, but in the beginning, the goal should be “How do I create discomfort? Because if I’m creating discomfort with my changes, this is normally telling me I’m doing the right thing.” By making a bigger change, that’s the thing where you’re actually going to benefit from this.
00:18:52
The final thing is the idea that “It’s better for my mental health if I go slower because I wouldn’t be able to handle it if I was going quicker.” It’s this idea that “If we go too quickly, I’m not going to handle it and my mental health is going to be crushed.”
When I look at the clients who are making bigger changes versus the ones who are making smaller changes, it is obvious to me who is having an easier time with it. It’s obvious to me who’s having a better time in terms of their mental health. And it’s not the people who are making the smaller changes. Living with an eating disorder is the worst thing that you can do for your mental health. That is the thing that is having the biggest impact on your mental health and the way that you’re thinking and perceiving and believing.
Doing this really slowly I don’t think helps mental health. If anything, it makes it torturous, for all of the ideas that I’ve already given today. If I was to devise a way of making recovery as painful as possible, I would suggest go really slowly with it, because that’s the result when you go really slowly with it.
If I’m thinking of the people who are more likely to bail on recovery or to give it a go for a little while, or even a long while, but not get very far, it’s someone who’s making really small changes. So if we are working on the assumption that the worst thing for your mental health is having an eating disorder, and the thing that makes it more likely you’re going to stay stuck in the eating disorder is smaller changes, then making more significant and bigger changes is going to be much more important for helping you.
00:20:26
The reason why this is also important is when I think about recovery, I think about it going through five stages. At each of these different stages, there are different things that are going on, there are different things that are important.
If I go through the five stages, Stage 1 is about stabilization and foundational rehabilitation. This is where someone’s physical health, mental health, the symptoms they’re getting, all of this is at its absolute worst.
The next stage, Stage 2, is quasi-recovery. This is where there’s been partial improvements in terms of someone’s symptoms, in terms of someone’s ability to not be doing eating disorder behaviours. I will add that most people who come to me and say, “Hey, I’m in quasi-recovery”, when I look at what’s going on, they’re not in quasi-recovery. They’re still in Stage 1. They haven’t even made it to quasi-recovery.
Stage 3 is where we’re at what I call refinement and mastery, and this is where you’ve made some really good inroads into your recovery and you’re starting to test out different things. You’re starting to bring certain things back in, you’re starting to challenge yourself in certain environments that you weren’t doing before.
Stage 4 is where we’re going from recovering to recovered. This stage is where you’ve actually conquered a lot of the recovery stuff, and from a food and a movement perspective, most of that has been dealt with. This is where you’re dealing with all of the other ways that living with an eating disorder has had an impact on you. Eating disorders aren’t just about the way that someone does food; it has an impact on someone’s relationships, people’s relationship to sex, people’s relationship to money, people’s relationship to work and all of these other ways. So it’s looking at the ways in which the eating disorder has got its tentacles into all aspects of your life and how you think and working on that stuff.
And it’s not that you can’t have been doing that in the earlier stages, but this is often the things that are still left over that you’re then working on in this stage.
And then Stage 5 is someone who is fully recovered.
If I’m looking at each of those stages and thinking about, what is the most challenging one to be in? – it’s Stage 1. It’s the most challenging from a physical standpoint, from a mental standpoint, from an emotional standpoint. The state that you’re in when you’re there leads to the kinds of unpleasant and unhelpful thoughts and the uncomfortable feelings, etc.
So what you’re wanting to do is get out of that stage as quickly as possible, and the reason for that as well is, despite it being the most unpleasant, it’s also the stage where the eating disorder thoughts are most powerful. Most powerful because of how frequent they are, but most powerful also because of how much you get hooked by those thoughts, how much it feels like these things are true or this is the best it’s going to get, or all of the kinds of thoughts that the eating disorder generates. Your capacity to recognise them as just thoughts is a lot more diminished at that stage versus further stages of recovery.
So despite it being the place that is definitely the worst place to be living, it also feels like the most difficult place to get out of. And in some ways that is true. So rather than spend any more time there, let’s get out of there as quickly as possible. Staying here longer just makes it more likely that the eating disorder thoughts are going to win out, and the feelings are going to feel most powerful, and you just go back to the eating disorder as opposed to continuing on with recovery.
So this idea that “If we did it too quickly I wouldn’t be able to handle it” I just don’t believe, and when I look at the clients that I work with, it just doesn’t bear out to be the truth. Actually, the ones where it is most challenging, it’s most challenging because we’re going at a snail’s pace and we’re making these really tiny changes that aren’t meaningfully leading to a change in someone’s physiology and their thinking, etc.
So that is it for this week’s episode of the podcast. It’s something that I want people to really understand because I think this happens a lot with people who are doing recovery either on their own or they’re working with a therapist or they’re working with a coach. Unfortunately for a lot of people, even when they’re working with those other providers, those providers can buy into that message. They can buy into this idea that people who are in recovery are really fragile, people who have eating disorders are really fragile, and we can’t do things too quickly and we can’t do too much.
And it’s not true. You are strong. You are capable. You can make these changes. You can tolerate the discomfort of making that change. The more you do that, the more that you’re able to see and believe it. It’s not just some guy from the internet telling you this. You’re able to understand it because “Hey, I actually went through that, and that was my experience.”
So going slowly isn’t easier and better for recovery. It just makes it more likely that you’re not going to recover.
That is it for this week’s episode. I hope you found it useful. As I mentioned at the top, I’m taking on new clients at the moment, so if you would like help with this, if you don’t want to be doing recovery so slowly and feeling the pain of that and how much it really messes with your head and messes with your ability to think that you can even get to a place of recovery, I’d love to help. Send an email to info@seven-health.com and you can put ‘coaching’ in the subject line, and I will get back to you.
That is it for this week’s call. I will catch you again next week. Until then, take care, and I’ll see you soon.
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Thank you for sharing this message. So much of the content spoke to me as I have often resorted to making small changes in my recovery process. There are so many blind spots in this method that I was able to understand more clearly through this episode. Most importantly, being reminded that comfort is not the goal is key. I’m humbled by seeing how many of my actions align with an underlying desire for conform and familiarity. Keeping in mind that discomfort is part of this process (and even an indicator of moving in the right direction) is key.