How This DBT Skill Revolutionized My Recovery

How This DBT Skill Revolutionized My Recovery

Colleen Werner

I am in recovery from an eating disorder and an anxiety disorder, and part of my recovery is Dialectical Behavior Therapy (DBT).

DBT was created in the 1980s by Dr. Marsha Linehan. It consists of four modules — mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Each module consists of several skills that work together to help “build a life worth living.”

One DBT skill that has made a huge impact on my recovery is called Effective Rethinking with Paired Muscle Relaxation. This is a distress tolerance skill that combines effective self-statements with paced breathing and muscle relaxation.

The skill starts with writing down a prompting event that is triggering distressing emotions. In my case, some typical triggering prompting events that I have experienced are having a bad body image day, having someone make a comment about my body or a food choice, feeling like my clothing was too tight, and encountering a fear food.

The next step is asking yourself what interpretations and thoughts you have surrounding that prompting event that could be causing the emotion response. These interpretations take up a lot of headspace, and the high levels of emotion that they can trigger often make it hard to carry on with life in an effective way. Some common interpretations that come up for me are:

“If someone makes a comment about my body, it must be true.”
“My body defines me.”
“If I outgrow my clothing, I’m not good enough.”
“If someone says I should avoid some type of food, I should listen to them.”
“There are ‘good’ foods and ‘bad’ foods.”

After writing down your interpretations, it’s time to challenge them! Create statements that rethink the situation and its surrounding feelings such as:

“My worth isn’t defined by my body, weight, size, or appearance, and my view of myself may be distorted.”
“Food isn’t good or bad. Food is just food.”
“Just because someone says something doesn’t mean it’s true, constructive, or healthy for me.”

These challenge statements can be effective by themselves, but combining them with paired muscle relaxation is even more beneficial. While sitting or lying down, take a deep breath in, say one of the challenge statements to yourself, and tense a muscle (I often start with my forehead and work my way down to my toes.) As you breathe out, say “relax”, and then relax all of your muscles. The key is to start practicing this skill in non-stressful situations so that when stressful situations inevitably arise, using the skill is instinctive.

One of the reasons why I think this skill has been so effective for me in my recovery is because it combines a physical action with a mental action. Not only does it involve letting go of mental tension, but it involves letting go of physical tension, as well. Mental and emotional symptoms can cause physical symptoms, and vice versa.

When I first learned this skill, I started practicing it every night before going to sleep. It’s an excellent way to unwind before bed, and it helps to diffuse any stress from the day so that you can wake up in a refreshed, relaxed headspace the next morning. In addition, by making this skill a part of my nighttime routine, it’s helped make the skill feel natural so that I can use it in the moment when triggering situations pop up.

At first, I didn’t want to believe these challenge statements, and I didn’t want to believe that this skill would have a huge impact. However, from the first time I practiced it, it had a great amount of power. I remember pairing one of the challenge statements with tensing and relaxing my lower back muscles, and I experienced a huge release both physically and mentally. As my muscles softened, my mind slowed down. The negative thoughts and judgments decreased, and I felt some much-needed clarity.

Practicing effective rethinking with paired muscle relaxation has contributed hugely to my progress in recovery. It has helped me truly believe the challenge statements that I created, and it has also shown me the reality of the mind-body connection. It has helped me “rewire” a lot of of unhealthy thought patterns and replace them with more effective ways of thinking.

While this skill isn’t the only reason why I’ve made so much progress in my recovery, it’s definitely a huge contributor, and I think that it’s something everyone needs to try.

Colleen Werner is a writer, dancer, and future therapist from Long Island, NY. She’s studying Psychology at SUNY Old Westbury and plans on going to graduate school for Mental Health Counseling. She aspires to start an eating disorder treatment program for dancers. Colleen’s experiences in recovery from an eating disorder and anxiety disorder have inspired her to share her story in an effort to help others, end the stigma, and create a sense of community. She is a National Ambassador for Project HEAL, a Campus Editor-at-Large for HuffPost, and a contributor for HerCampus and The Mighty. Colleen’s Instagram, @leenahlovesherself, inspires thousands every day with her posts about authenticity and mental health.

If I'm Detaching From My Eating Disorder Identity, Then Who Am I?

If I'm Detaching From My Eating Disorder Identity, Then Who Am I?

Jennifer Kreatsoulas, PhD, RYT 500

Photo by Chris Barbalis on Unsplash

When a diagnosis becomes our identity and our identity a diagnosis, we unknowingly become walking, talking containers of illness, pain, and even hopelessness. 

We separate ourselves from others in the belief we are different or broken. As we embody the disease we believe precedes us, we disconnect from our unique gifts and passions. Our bodies hurt, our minds become one dimensional, and our spirits wither. Our world narrows to a single dark point chained to the fear of not knowing who we are without our diagnosis identity. 

It's only having lived to come out the other side of shedding the diagnosis identity of an eating disorder that I can say with conviction that you have permission to detach from yours too. I understand the fear, anxiety, confusion, and uncertainty that accompanies even the smallest of steps to let go of that which you believe keeps you safe, in control, and put together. For decades I fiercely resisted detaching from the diagnosis of anorexia. From my hair style to how my clothes hung on my body to the bags under my eyes to the food on (or not on) my plate, I dedicated my every action, word, and thought to fulfilling my identity as an anorexic. That diagnosis was the lens through which I viewed the world and my place in it, and it was a dead end.   

With time, persistence, willingness, and a whole lot of support, my eyes opened to the shadow I was living in, the shadow of my diagnosis identity. Once I spotted this identity as a menacing shadow and not the entirety of who I was, I realized I had the power to walk out into the light.

As I inched away from the shadow, new possibilities for healing came into my life as did new relationships and opportunities. 

Slowly but surely, I began to resent the shadow for holding me back from embracing more and more of the world around me and the food, people, and sensations in it. The stronger my resentment grew, the more willing I became to detach from the diagnosis identity and replace it with the gifts, talents, and passions that were buried but by no means dead. 

It took practice giving myself permission to detach from the eating disorder identity. Every morning for months I asked myself Who are you? until the words anorexia, anorexic, and eating disorder were not my first answer. Little by little, more answers surfaced in my mind, like mother, daughter, wife, yogini, writer, creative soul, kind person, etc. I did this exercise over and over until the words related to my diagnosis identity moved down the list and one day slid right off it. Getting to this point took perseverance, and it wasn't a straight line, just as recovery is not.

With the help of a therapist, other supports, and my Yoga practice, I was able to arrive at complete permission to detach from the diagnosis identity. Now the words anorexia and eating disorder do not define me, nor do I strive to embody them. Rather, I respect and honor these words for the profound experiences in my life they represent and the gifts they provided: self-awareness, empathy, resilience, compassion, and ultimately my life's purpose to support others healing from eating disorders through yoga. 

My friend, you are capable of detaching from any identity that keeps you trapped in shadows. Once you give yourself permission to do so, the possibilities for goodness to fill your life are endless. Take a few moments and reflect on these questions: 

How would your life change if you shed your diagnosis identity?
What dreams would become possible?
How much more fulfilled would you be?
How much more connected would you be?
How much more whole would you be?

Don't be afraid to ask yourself who you are. Let the answers come as they are in this very moment. Ask again tomorrow, and the day after, and the day after that until new words bubble up. With permission, they will. Be patient and gentle with yourself as you step away from the shadow, but trust you can do it. I fiercely believe you are more than a diagnosis. You have permission to detach from your diagnosis identity. You have permission to explore who you are without it. You have permission to move through this world as a whole, vital individual. 

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Jennifer Kreatsoulas, PhD, RYT 500 is the founder of Chime Yoga Therapy and specializes in eating disorders and body image. In addition to her private yoga therapy practice, Jennifer leads yoga therapy groups at the Monte Nido Eating Disorder Center of Philadelphia, is cofounder of the Body Kindness Project, and a partner with both the Yoga and Body Image Coalition and the Transformation Yoga Project. She is the creator of the home video series Yoga to Strengthen Body Image and Support Eating Disorder Recovery. Her writing on the topics of yoga, body image, motherhood, and eating disorder recovery can be found on her blog as well as several influential online publications. Connect with Jennifer.

Are You Restricting Without Realizing It?

Are You Restricting Without Realizing It?

Josée Sovinsky, RD

In my practice as a non-diet and eating disorder dietitian in Toronto, Canada, I work with a variety of clients looking to embrace intuitive eating principles. This radical approach to eating can facilitate food peace, balance and freedom. One of the concepts we often work on is letting go of restriction and dieting. This can have many benefits, such as being more nourished, reducing cravings, and feeling less shame around food.

However, after being introduced to this concept and trying it out, many clients return to sessions claiming this didn’t work for them. Even though they ate all types of foods and enough food, they still felt out of control with their eating patterns.

This can happen when we see restriction as only behavior; instead of recognizing it is a mentality. 

Restrictive behaviors include avoiding certain foods, counting calories, and cutting down on portion sizes. These are usually easier to identify. On the other hand, restrictive thoughts, or a restrictive mentality, can be sneakier. Even when we don’t engage in restrictive behaviors, we can still be subscribing to a restrictive mentality.

Signs you may still have a restrictive mentality:

·      You feel guilt after eating specific foods

·      You feel shame when you eat more than others around you

·      You describe yourself as “bad” or “naughty” when you eat certain foods

·      You believe certain foods will make you gain weight

·      You think there is a perfect way to eat

·      You believe some foods are “healthy” and others are “unhealthy”

·      You think you will binge if you keep certain foods in the house

·      You worry about what other people think of your eating habits

·      You view food as an enemy

·      You view your days as “good” or “bad” based on what you ate

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Restrictive behaviors are what we do or don’t do.

A restrictive mentality is what we think, feel and believe.

Restriction includes both of these concepts.

The Bottom Line:

Letting go of restriction goes far beyond changing our behaviors. Don’t get me wrong, modifying behaviors is certainly part of the battle and can prove to be extremely challenging. However, even if we manage to change our behaviors, we will never truly find food peace if we don’t also work on our thought patterns and mentality.

Remember, intuitive eating and finding food peace is a process. Be kind to yourself.

Josée Sovinsky, RD is a passionate Registered Dietitian working in a community setting in Toronto, Ontario. After facing her own struggles with disordered eating during her degree, she developed a strong interest in helping those affected by eating disorders and mental illness. She decided to learn more about intuitive and mindful eating, body acceptance and Health at Every Size®, which now strongly guide her work. She dreams of a world free from mental health stigma, body shaming, and disordered eating. When she is not helping others make peace with food, she enjoys baking, photography and doing yoga in her living room. Visit Josée's website and connect with her on social media.

What happens in Vagus, Doesn’t stay in Vagus

What happens in Vagus, Doesn’t stay in Vagus

Rebecca McConville, MS, RD, LD, CSSD

For a country that prides itself on medicals advancements, we seem to be moving further away from the recipe for true health. Often when working with clients who struggle with digestion, hunger awareness, satiety (fullness), performance anxiety or the ability to relax, my first question is “do you breathe while doing these things?” I tend to get a look that says “get out of here” but then I start my scientific spiel and they are hooked.

You see, you have an amazing built-in radar in your body called the “gut instinct” and there is actual science to support it. In your stomach is a small nerve that has the power to be a fountain of health. The vagus nerve comprises of afferent nerves (80%-90%) conveying sensory information about the state of the body’s organs to the central nervous system. Basically making the vagus nerve the motherboard connecting the parasympathetic system: the heart, lung, brain/mind and digestive tract. When we think of this related to body functions the vagus nerve controls: heart rate, gastrointestinal movement, sweating and muscle movements in the mouth - to name a few. So—for example—you don’t really have butterflies in your stomach but you do have muscles that can contract similar to a butterfly’s wing’s flutter when they are nervous.

You are likely wondering how does this translate to impacting my health….

Dr. John Sullivan, author The Brain Always Wins, shares in his book how he believes that we should view the brain and the mind as separate entities. The brain perceives emotional information then acts upon it. This emotional information is the first to develop and allows us to survive and thrive. Like a baby’s conditioned response is to cry when he/she is hungry or needs to be held.

The mind and body do connect signaling the hypothalamic-pituitary axis that generates hormones and neurotransmitter and neuroendocrine responses such as epinephrine/norepinephrine (heart rate), cortisol (stress), serotonin (calmness) and dopamine (feel good). If the feedback to the brain and body is chronic or acute it will depict if you respond by either: fight, flight or freeze.

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These are three factors that you have the power to control of if YOU fight, flight or freeze:

Emotions

• We have grown to believe that our thoughts are what generates emotions. However, it is actually the opposite.

• If we can have a more neutral response or a more manageable response, then there is less stress on the body and the ability to decipher what to do with that emotion.
  Example: “I avoid all sugar as it is 'BAD'.” What kind of emotion does BAD typically invoke?

• Sit with an emotion and try to understand it. It's very likely that the reaction has nothing to do with the food but a memory of it or a false teaching.

Environment

• When you are distracted at work while eating you are taking the stress of your work straight into your meal.

• Eating at restaurants that are chaotic may overstimulate the nerve, making it hard to connect “friction” with body signals.

• Is your workplace, home life or school a place of stress? This can impact your ability to relax as well and connect with your body signals.

Energy

• Being depleted of energy whether due to the restriction of fuel or depletion of fuel secondary to exercise can cause a friction in the connection of the vagus nerve.

• Just like any friction, there is a moment of relief where you believe it makes “everything” better but what happens over time it makes the nerve overstimulated due to stress.

Now, remember that damn cupcake and how it made you anxious at the sight of its cute pink frosting and buttercream frosting? Instantly you are starting to feel a tension in between your ribcage, an elevated heart rate a mind racing with thoughts of "should I or should I not". You have activated your vagus nerve that you are in danger. Should a cupcake generate this kind of bodily reaction?

Rebecca McConville, MS, RD, LD, CSSD is a Master’s Level Registered Dietitian & a Board Certified Sports Specialist. She specializes in the treatment of anorexia, bulimia, compulsive overeating & exercise addiction. She also treats the female athlete triad & athlete-associated disordered eating. Becca understands that the drive for peak performance may lead to disordered eating. Her goal is to help you fuel your body, so that you can fuel your life! Visit her website.