362: Why You Keep Getting Stuck In Recovery (Even When You Know What To Do)

Chris Sandel: Hey, everyone! Welcome to Episode 362 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.

So today’s show, we’re going to be talking about something I see a lot in recovery and something that is very frustrating for people, especially as the eating disorder has gone on for longer and longer and there’s been a longer amount of time where someone realises that, “Hey, I don’t want to be living with the eating disorder anymore. I do want to recover.” There can be this feeling of “I know what I need to do, I understand recovery, but I’m just not doing what matters.”

You can be reading the things, you can be listening to the podcasts like this, you can understand it, but when it then comes to that moment, there’s still this feeling of like “Not yet” or “Maybe later” or “I think that might be too big”, and action-taking doesn’t happen.

So today what I want to do as part of this episode is just break down why that happens and some of the different thoughts or some of the different components of that that can start to get in the way – and not just at a surface level with this, but looking at it from a psychological perspective, looking at it from a behavioural perspective, and understanding what keeps people stuck and how they can start to change this and how you can start to change this so you can genuinely recover.

Before I go and get started with this, I just want to say that this week I opened up my group programme, The Fundamentals of Full Recovery, so it is now open. I haven’t opened this for the last two years as a standalone. What I’ll do, I’ll have a link to that in the show notes. If you want more information, if you want to sign up, you can send me an email at info@seven-health.com or you can send me a message, a DM on Instagram. It’s @sevenhealthcompany, and just put ‘group’ in the subject line or as part of the DM.

I’ll come back to the group more at the end, but as I go through, I’ll explain how the group can be helpful as part of the different places where people get stuck.

As part of this episode, I thought it would be helpful to frame this through common questions that I get, questions that I hear all the time from people that are connected to these different aspects of getting stuck.

00:02:35

Why does it still feel too much?

The first category of question would be something along the lines of “Why does it still feel too much? Why does it feel overwhelming to actually make change, especially when there’s this part of me that really wants to make change? It can feel like there’s a big part of me that wants to make change, and I can recognise that my life isn’t how I want it to be, and yet it just feels so overwhelming to try and make a change, and I don’t understand why it feels overwhelming to try and make a change when I can see that there’s something better waiting for me, or I can imagine that there’s something better waiting for me.”

One of the things that is really useful to recognise is that your emotions aren’t actually the truth. We can have emotions like regret or shame or guilt that show up that are actually accurate, connected to the situation that has arisen, and can be guiding in some way – and then there are times where those emotions show up and that’s actually not really connected to the truth of what’s going on and is more connected to where someone is from a state perspective, where the nervous system is.

This very much happens within an eating disorder. When you have an eating disorder, it starts to change areas of the brain. It starts to change your nervous system so that the brain starts to interpret lots of things as danger and starts to interpret discomfort as danger. That means that even though you may intellectually be able to understand that ‘eating this food shouldn’t be a big deal’ or ‘eating that snack earlier shouldn’t be creating this feeling within me’, that’s actually what happens. When you get into that state and get into that moment, you have all these emotions and sensations that then come up.

And just because something is overwhelming or just because there are emotions there, doesn’t actually mean that it’s unsafe, and it doesn’t mean that you shouldn’t do that thing. It’s just showing you where your body is at this moment, or where your mind is at this moment.

What often happens is this comes up and then the response is “Oh, not yet. Maybe I’ll do this tomorrow, maybe tomorrow it’ll feel easier. Maybe I shouldn’t do this yet.” The problem with that is that avoidance just reinforces this. Avoidance begets more avoidance, and it just reinforces the fear.

And if there’s this fear that comes up and that then changes action, that then reinforces the idea that “Oh, that was good for the body to send you that fear because it then deviated what you were going to do”, so in a sense your body and your mind ‘saved’ you from that. It then learns that “Okay, that was the right thing to do in that environment because I got you to change action.”

This is why, really, the thing to do is it’s not that you then ignore these emotions, it’s not that you pretend they’re not there; two things can be true at the same time. I can notice that there is this feeling of regret or this feeling of overwhelm or whatever the feelings that are coming up, and I’m also going to take action in this way because I know that that is what is required as part of recovery.

And this is something that does come up a lot in the group. It comes up a lot with working with one-on-one clients, and the recognition of “Once I start to have more support, I can actually move through this and it stops feeling so impossible. Before, when I was trying to do this on my own, I’d just get stuck in that place. But now that I’ve got this group and I have this extra support, that actually helps.”

And a big part of the programme is actually dedicated to emotions and emotional resilience and how to develop emotional resilience and how to deal with those uncomfortable emotions when they come up and how to continue to take action. So lots of stuff around emotional regulation and learning other ways of coping outside of the eating disorder.

Because this is what tends to happen; the eating disorder becomes your one and only way of dealing with so many things, so “Something comes up and I then either lean on certain eating disorder behaviours or I avoid this thing because of the eating disorder feelings”, so what recovery is about, and a big part of what the programme is focusing on, is you learning these different skills to be able to deal with that differently.

Because the reality is, in the beginning, those emotions aren’t going anywhere. They’re going to keep showing up. There isn’t anything we can do that then removes that. So then the goal is, how do you learn to take action even though those things are there? And by doing that and doing that repeatedly, that’s where things start to change in terms of those emotions start to shift because your nervous system and your brain is now starting to relate to this thing differently, and they don’t have the same power over you because you’ve recognised, “They’ve been there for the last two months while I’ve continued to do things, so it doesn’t actually block me from taking this action.”

00:08:02

Why do I know what to do but still not do it?

The next question is something along the lines of “Why do I know what to do but still not do it? Why does understanding not translate into action? I know so much about eating disorders, I could probably host my own podcast on eating disorders, but it’s not necessarily translating into action-taking.”

Again, I get this question so often from people, and I think what is going on here is there is this hope that “The more I learn, the more insight that I have, then it will remove the thoughts or the feelings or the fears, all of these things that make this thing uncomfortable, and then it will just be so much easier to take action.”

The reality is, yes, more education, more understanding can help, and it can help you understand that “Oh, that’s the way healing works as part of the eating disorder” or “That’s why this thing actually occurs from a symptoms perspective or a thoughts perspective” – and it doesn’t actually remove any of those things.

So hoping that “If I just watch that video from that person about what they eat in a day, or if I hear how that person recovered, something’s going to click for me and it’s going to remove these uncomfortable feelings and thoughts, etc.”, that just doesn’t happen.

I’ve said it many, many times before, but you can’t think your way into acting differently. You have to act your way into thinking differently. Really, action-taking has to be the first thing. So if there is this learning for the hope that it removes some of that uncomfortableness, which is often what is happening, that just doesn’t happen.

I think what happens with this is there is then this continual waiting to feel ready. “Maybe I need to listen to this extra thing that then helps to finally convince me and finally make it easier. I can’t make a change until that actually happens.” It’s really the other way around. The motivation and the momentum and all those things pick up as you’ve started to do things and you’ve continued to do things consistently down the line. It’s not there in the beginning.

There’s a difference between insight versus implementation, and they are not the same thing. Again, if I’m thinking about this from the group perspective, there is a lot of education as part of the group, but I recognise that education in and of itself doesn’t help recovery, or isn’t recovery. So everything that is around the education piece is then connected to action-taking.

It helps you to take action. It helps that the understanding of this thing is in service of making changes, because if those two things are disconnected, then it’s just more information that doesn’t actually help. So when putting together the programme, whether it is the modules or the group calls or the way that it’s structured, it is very orientated towards action-taking because that is everything in recovery.

If I’m looking at the difference between people who recover and people who don’t recover, the one and only thing that makes a difference is people taking action. Because if that’s not happening, everything else just falls by the wayside. It doesn’t change because it’s through the action that your body gets into a different state, that you get the rest that you need or you get the food that you need or you actually learn how to do that technique when you’re having strong emotions come up or you’re having that thought come up. So action-taking is at the centre of everything, and it’s really what I prioritise as part of the programme.

00:12:00

Why do I keep falling back into the same patterns?

Then the next one is “Why do I keep falling back into the same patterns?” I guess this one could be something along the lines of “Why does it feel like I keep repeating the same cycle? I go to bed intending to do something different, but then the next day I just end up doing the same thing” or “I start the day and I’m like, today’s the day we’re going to do something different, and then it just doesn’t go any different. I just keep doing the same things that I always do. Am I weak? Am I broken? Why is this going on?”

With this piece, we need to understand about behaviour and the way that behaviour works. Behaviour is largely unconscious. For so much of our lives, we are on autopilot, and we are just doing things because our brain has learnt a way of doing that. And that is wonderful for so much of life. If you think about all the things as humans we’re able to do, it’s great that there have been these little ways that have been changed where we’ve become very efficient at being able to do this. This is how you get better at lots of things. This is how if you start playing the piano and you’ve continued doing that for 10 years, why you’ve got so much better. It’s because so much of these things have become automatic.

And that is the same thing with your eating disorder. It is just on autopilot, and it is largely unconscious and there are all these patterns and conditioning that are keeping that going, so it becomes the easier thing to do. And that doesn’t mean your life is easy; it doesn’t mean that it’s not causing problems. But it feels so ingrained, it feels so natural, it feels so normal.

What makes this worse with eating disorders is that the more depleted one becomes, the more low-energy state someone gets into, the more the eating disorder gets louder. What often tends to happen for so many people is that there’s this “Oh, I’ll do that later, this afternoon or this evening, I’ll make those changes later on.” It means that in the earlier part of the day, you get into more of a depleted state, and that then means that those eating disorder thoughts feel louder. There’s more of an emotion or more of a sensation or more of a challenge when you’re then trying to do something different because of the state that you’re in.

So when I look at what so many people are doing, they’re starting the day by really delaying breakfast or not having breakfast or having a very small breakfast. Or “I’m doing my exercise first thing in the morning, and I’m doing it in a fasted state.” It means that you’ve gone to bed, you haven’t eaten through the night for most people – some people are waking up in the night to eat, but most people are not having that occur – so you’re waking up and there’s already been a long time where you haven’t eaten, and then you’re doing things that get you into even more of a depleted state.

And then from that point, thinking “Oh, I should be able to make changes”, and what happens invariably is that as the day goes on longer and longer, those plans that you were going to change and those goals you were going to follow through on, you either very consciously say “Today’s just not going to happen” or they fall so far into the background that you don’t even notice it, and it’s in the evening time that there’s that recognition of “How did this get away from me again?”

So much of recovery, especially in the early stages, is being really intentional about this. Being really intentional with “I know that I’m in these very deep ruts in terms of the way that I continually do things”, whether that be with exercise, whether that be with food, whether that be certain behaviours. “This is just so automatic, so for this to change, I really need to be intentional about it.”

When working with clients, this is why we are very specific about goals. Again, that’s part of the programme – really specific about, what is the goal or goals for this week or these next two weeks so that you are very intentional about that? How do you put them somewhere that you are really remembering them and you are making them this really important priority? How are you breaking those loops when they start so that you can actually follow through on this?

Because the thing is, willpower isn’t enough to override these patterns. It is about making the changes and doing it consistently so that that starts to change, and being really intentional of getting out of that rut. I’ve had this experience with a number of clients where they were really intentional with doing something completely different as part of their day, especially in the beginning part of the day, because you’re then not in that point of comparison about what happened yesterday, because things have deviated so much from what you did yesterday.

I know for a lot of people that feels so scary and “I couldn’t possibly do that”, but actually that’s often where there’s more freedom because you’re now not comparing to what happened yesterday. So there are lots of different ways of doing this, but really recognising just how much, as humans, we are on autopilot and we just do the things that we habitually do.

So if you’re trying to change, and especially something like an eating disorder, it really needs to be very front of mind and very intentional and having the support for that to happen. Relying on motivation, relying on willpower, that just doesn’t happen.

Again, part of the programme is looking at different ways to develop structural resilience, and about changing different aspects of your environment to help recovery.

This could be, just to give a couple examples, changing clothes. If you’re wearing clothes that are too tight, they’re going to make you a lot more conscious of your body, and that’s going to make changes a lot more difficult to follow through on, versus if we’ve got things that are more comfortable for you to wear and there’s less of that awareness of one’s body. It’s not that you’re not going to have any of that, but the difference between someone wearing something that is tight and digging in versus someone wearing things that feel more comfortable, it really does make a difference.

It can be also changing things in your home environment in terms of, “What is the food that I have here? What are the things that I have around me?” Again, if we’re used to being on autopilot, if it’s the same stuff it becomes a lot more difficult, versus if some of those things have now been removed.

It can be understanding the structural support in terms of your support network. Who are the people who can help in certain situations, whether that’s “I need to be showing up to the group calls and I need to be sending messages in the group” or who are the people in your everyday life who can then be supporting you through this? Just understanding how much those things have an impact in terms of the follow through and the changes that get made.

00:19:23

Why do the eating disorder thoughts feel so believable?

The next piece connected to why people stay stuck is this idea of “Why do the thoughts feel so believable? Why do the eating disorder thoughts feel so true? Even if I can understand that I wouldn’t be suggesting these for other people, it just feels so true for me. These don’t feel like just thoughts. They feel like facts.”

If I’m looking at this from a psychological standpoint, the reality is that our brain lies to us all the time. Our brain in some ways is like a mini lawyer, and it is always trying to argue the case, and it doesn’t necessarily matter what’s true, what’s not true. It is then just putting forward a case for why you should do this thing or avoid this thing.

So being able to recognise that thoughts are just thoughts – they aren’t necessarily facts, they aren’t necessarily true, they aren’t necessarily connected to a value of yours; it doesn’t mean that you have to entertain them, it doesn’t mean that you need to come up with a counterargument just because you had a particular thought. It’s just recognising that thoughts are just thoughts.

I think what often happens for people is that, one, the thoughts aren’t just thoughts. They get treated like instructions. “If my eating disorder has said this thing, I have to do it.” So recognising that that’s not the case, and also recognising that just because you had a thought, doesn’t necessarily mean it’s true.

I think there can be this idea of “My eating disorder said or my mind was telling me that this is going to happen” and recognising, hey, that is your mind making a prediction of what might happen. We don’t know if that’s actually going to occur.

The thing with this is that there can be a situation where “Hey, that thing isn’t going to occur and when you get down the line, you’ll discover that that thing isn’t going to occur” or “Actually, that thing may actually happen” – but where the difference lies is that you’re going to have the capacity to be able to deal with that in a way that the eating disorder doesn’t allow you to believe. So even though that may happen and in that moment it can feel challenging or there can be things coming up, it’s also true that you have the capacity to then be able to deal with this.

I think that’s the missing piece that so many people have with this. It’s like “But this is true” or “What happens if this thing happens?” There’s all of this ‘what if’ thinking around this. I saw a really good Instagram recently where someone was saying if you get into all of the ‘what if’ thinking, a useful thing to reframe it is the ‘even if’. So “Even if this thing happens, I will be able to do X, Y and Z. I’ll be able to handle it in this way.” I think that’s a really useful thing to be able to remember.

I think what often happens so much with the eating disorder is that because of these thoughts, it then feels reasonable to hold off, or it feels reasonable to see if you can find some other way of doing this. Again, that’s just what keeps people stuck. A big part of what I work on with clients, a big part of what is in the programme, is how to respond to thoughts differently.

It’s not that we’re trying to eliminate these thoughts. With time, the eating disorder thoughts do go away, and they’re just not present in the way that they were before, or this is not really happening anymore. And that’s not what is going to happen in the beginning. In the beginning, there are going to be lots of thoughts, and often when you’re making changes, there’s more thoughts in the beginning than there was when you were just following everything the eating disorder was asking of you.

So it’s not that “Oh, if that’s coming up I must be doing something wrong”; it’s “If those things are coming up, I need to have ways of being able to deal with them.” So a lot of the programme is around, how do you develop that psychological resilience? How do you have these different tools to be able to deal with thoughts when they come up and the things that your brain is generating?

Again, like I talked about with the emotions, the more you can do that, the more that you recognise, “Oh, that thing can be there and I can still take action”, and that really is the superpower as part of recovery. It’s not that “I’ve learnt these methods for all these things to go away.” It’s “I’ve learnt that even when they are there, I’m still able to connect to my values and take action” or “I’m still able to recognise that these are my goals and I’m treating this as a non-negotiable and I’m still going forward with this.”

The thing with this – I talked about things becoming habitual and that we’re so on autopilot. You can start to change that, and that then becomes your autopilot way of dealing with things. “Oh, that thing can come up and I still take action. That’s my normal response.” It’s just that that is not what’s been trained for a long time, but it can be trained, and these things can change, and that’s where you can get to with this.

00:24:42

Why does doing this on my own not work?

Then the next question with this is “Why does doing this on my own not work?” I think this is often framed as “Why is recovery so hard to change by myself? I see all these recovery coaches online who recovered on their own. Why can’t I just do it too? I know what I need to do. I don’t see what use the support would be. I just need to follow through and do it.”

I’ve said this in the past and I’ll repeat it again here: I think there is very much a survivorship bias when looking at recovery coaches online who have made it in terms of recovery.

Survivorship bias is where there are certain people who are loud – and loud because they have a platform, they have YouTube, they have Instagram – where it feels like they are the norm, when actually they are the exception. For example, there could be a thousand people who try and do it on their own, and there’s like a handful of people who actually are successful with that, and then a couple of those people go on to be recovery coaches and are talking about how they recovered on their own.

And then you come to the false belief that “Oh, that’s what everyone does. That’s what everyone can do to recover”, and all you see is those handful of recovery coaches and it feels like there’s a lot of them. You don’t see the thousand people who started this but 990 of them were not successful at doing it on their own.

So there’s this mismatch between understanding that “I should be able to do this on my own” versus you’re not recognising how many people failed when trying to do it that way.

The reason why this is the case is that when you are trying to do this on your own, there is no external interruption. There is too much second-guessing. And the eating disorder is just so good at convincing you – convincing you through logic, where “This seems like the most sensible thing to do” or “Yeah, that would be too hard and that would be overwhelming, so we need to figure out a different way of doing this and we’ll start that tomorrow” type thing – or using fear and like “Hey, if you do this, it’s going to go off the rails. This is a really bad idea to do this. Remember when we made that one small change last week and how bad things felt? Imagine you try and do something more than this. This is not a great idea to do.”

So there is this intermingling of the fear and then the logic where it just feels like “Oh yeah, of course I shouldn’t follow through on this” and there’s nothing that then breaks that up. There’s nothing that interrupts that. What started out as just second-guessing then becomes “I’m not even second-guessing. It’s so clear that this is what I need to do or this is what I need to avoid”, and it’s not in service of recovery; it’s in service of the eating disorder.

Also, there’s no co-regulation as part of this. For so many people that I work with, so many people in the group, their capacity, especially in the beginning, to be able to self-regulate is pretty low. Yes, there’s a lot of tools that we go through as part of the programme and as part of working with people to build them up, and that’s important – and it’s really important to have co-regulation and to have support and to have interactions where someone is helping to move you through this and where in essence, you’re piggybacking off the nervous systems of other people who are in a better place, who are feeling more stable and who are able to guide you through this. It’s through that co-regulation that you can then start to learn more of the self-regulation and self-regulation starts to work better.

And look, part of the learning how to self-regulate is to get into a different state, so by doing the eating, by doing the resting, by doing the things that actually change your body, it increases your capacity to be able to self-regulate. This is why I’m a real big advocate of people getting support and not doing this on their own. Yes, there are people who have successfully done it on their own, and if I was to look at what I would recommend, it’s just not what I would suggest for someone.

Recovery is a really difficult thing to do because of the physical changes that go on, because of the emotional changes that go on, because of the psychological piece, because of the way that the eating disorder impacts the mind and the brain and so many things. So to try and do that on your own makes it so much more difficult than it needs to be.

Really, when you’re on your own, thoughts and all of these things too often go unchallenged, so you’re in a situation where the eating disorder is really your guide. It is the thing that is there all the time, telling you what to do, what not to do, with very little interruption. Versus when you’re working with someone, when you’re in a programme, there is a lot more reinforcement of why recovery is important. There’s more of that bubble of “Okay, this is why I’m doing recovery and this is why there are those symptoms that can come up” and “I saw that that person was able to make that change and they were able to do that thing. Oh, okay, so that is possible.”

There’s all of these things that start to reinforce why what the eating disorder is saying isn’t necessarily true and that you can start to do something different. I think this is one of the biggest things about the group: you’re just not left to your own devices, not left on your own trying to figure this out, where the eating disorder is left unchecked and is able to run amok.

You’re able to get that support, whether that’s in the community area where you can send messages, on the calls, whether that’s on office hours calls where that’s us going through a particular topic, whether it’s a meal support call where we’re getting to eat together – you have this bubble of the programme which is really reinforcing recovery, which just doesn’t happen if you’re trying to do this on your own.

And as wonderful as podcasts like this can be or other people’s podcasts can be, there is a difference between a podcast and then something that is very structured in terms of these are the things that need to happen as part of recovery and these are the calls and these are the touchpoints and these are all the areas of support that are turning that from an idea and a theory into actual action.

00:31:33

The benefits of a group programme + support in recovery

If I go through the things I’ve just covered, if you step back and look at all this, your brain is generating thoughts that feel very true; your emotions are making it feel overwhelming or uncomfortable or difficult; so many of your behaviours are just running on autopilot – it just happens in your sleep, you don’t even realise it is happening; and so often, you’re trying to do this all on your own, so you’re trying to battle against all those things all on your own.

So then it makes complete sense why so often, just knowing doesn’t change anything, because the knowing piece is only a part of it. It’s really the doing part.

This is why, as part of the programme, it’s not just more information. It’s providing structure, it’s providing support, it’s providing consistent implementation and guidance when making changes and guidance through calls and all of these things that really do make a difference. It then helps you to learn to act even when things feel like they’re too much. It helps you to follow through when the eating disorder is saying “Not now” or “Why don’t we do a smaller version of this” or “What about if we do this tomorrow?” It helps you to be able to break the habitual patterns that you’re in and create new ruts in your brain so that this thing feels like the automatic thing to do.

And it helps you to be able to reach out when things are challenging and to recognise that you don’t need to do this on your own and you’re not completely isolated with this. So often, people feel like they are going through something that no-one else is going through or no-one else is understanding or people just wouldn’t get it, and then they come in and they’re like “Oh, so much of what I’m going through is the exact same as what other people are going through. I’m not this anomaly. This is part of living with the eating disorder and this is why these things are going on.” I think that recognition can be just so, so helpful.

So, as I mentioned at the top, the programme is open. I opened the doors at the start of the week. There were originally 20 spots as part of this; at the time of recording this, there are 16 spots that are left. I have no idea how many will be left by the time you’re listening to this or by the time this goes live. Doors are then going to close for this on Tuesday the 28th of April, so the Tuesday after the doors opened. Either they will close because the 20 spots have been filled up before then or at the latest, on the 28th of April I’m closing the doors on this.

So if this episode resonated with you and it feels like “I can see these are the areas that I’m getting stuck in, and actually it would be really helpful to have some support to take action to get out of this place”, I’d encourage you to reach out. You can go to the show notes for this episode and there’ll be a link for the programme. You can send me an email at info@seven-health.com. Or you can send me a message, @sevenhealthcompany on Instagram, and just put ‘group’ in the subject line or the message and I can then send over the details.

So that is it for this week’s episode. I’ll be back with another episode next week. Until then, take care and I will see you soon!

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