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EMOTION AWARENESS TRAINING FOR EATING DISORDERS
Melanie Smith, M.S., LMHC, CEDS
Director of Training
The Renfrew Centers
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• Why we experience emotions
• How we experience, express and respond to emotion
• How we regulate (or don’t!) emotion
WHAT IS EMOTION SCIENCE?
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The emotion itself is not the problem. The way we experience it and respond to it is.
Problem of emotional regulation
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WHAT DOES AN EMOTIONAL DISORDER LOOK LIKE?
experience emotions
more intensely
more frequently
out of context or
unpredictable
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Struggles with eating & body management behaviors are not just about
the food or “looking good”
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EATING DISORDERS ARE EMOTIONAL DISORDERS
Eating disorder symptoms
• Behavioral ways to influence, change, or control painful emotions
Self-report studies suggest:
• worsening mood BEFORE a binge/purge episode
• sharply improved mood AFTER binge/purge
ED behaviors impact mood
• These behaviors provide temporary relief from uncomfortable emotions
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DISORDERED EMOTIONS→DISORDERED BEHAVIORS
View emotional experiences as unwanted and intolerable
Use symptoms to avoid, control or suppress the intensity of uncomfortable emotion
Our patients are stuck in this short-term solution cycle with their limited range of emotion regulation strategies
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MAINTAINING FACTORS OF EATING DISORDERS
Emotional Avoidance
Temperament: harm avoidant, perfectionistic
Effects of irregular nutrition
Pro-ED beliefs
anxiety about
anxiety!
Relational response
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KEY ISSUE: EXPERIENTIAL AVOIDANCE
• Key maintaining factor for many psychiatric illnesses:
Drive to avoid negative emotional experiences
• Recovery requires doing things that have been habitually avoided
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Emotions themselves are
not unsafe, dangerous or threatening
Attempts to avoid uncomfortable and painful emotional experiences drives
unsafe, threatening and dangerous behavior
(symptom use)
Certain emotions can remind us of a time when
we felt unsafe or were unsafe, but the emotion
itself is not unsafe
THE AVOIDANCE PROBLEM
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Diverse Symptoms Function Similarly
Unpleasant Internal Experience
Emotional Avoidance
Avoidant, Symptomatic Behavior
Temporary Relief from Unpleasant Internal Experience
Long Term Consequences
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COMMON AVOIDANCE STRATEGIES
• Overt avoidance of feared situations (e.g., certain foods, mirrors, fitted clothing)
• Over-emphasis on physical appearance
• Exercise or diet in response to eating “bad food” • Over-use of prescribed “as needed”
benzodiazepines to dampen down the anxiety associated with uncomfortable situations
• Drinking alcohol to reduce inhibitions/reduce
social anxiety • Procrastination of difficult tasks
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THE AVOIDANCE PROBLEM
So its not specifically about the weddings, restaurants, pancakes, the workout
or soda’s…
its about the EMOTION I feel in those situations… that’s what I’m avoiding…
and I’ll avoid all kinds of things that make me feel the same way
This means that they avoid people, places, situations and things that make them
FEEL UNCOMFORTABLE EMOTIONS
I won’t go to that wedding
I won’t eat at restaurants
I won’t eat pancakes
I won’t skip a day at the gym
I won’t drink my calories
Individuals with EDs are experientially avoidant
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SO WHAT ARE FOOD RITUALS & FEAR FOODS?
“Fear foods make me feel anxious & think scary thoughts”
• because of what I believe they will do, or what I think will happen, or
• because of what I perceive happened in the past
“I use food rituals to help me feel more in control /less upset”
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FUNCTION OF EMOTION
• Emotions are good and adaptive
• Even “bad” emotions aren’t bad
• Emotions are your body’s way of saying “hey, something’s going on here”
ALL Emotions have
a function
• Symptoms are ways of avoiding emotions
• Avoiding emotions in the short-term produces problems in the long-term
• Behaviors become “emotionally driven”
Negative reactions to emotions and
avoidance of emotions maintains
your symptoms
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WHY DO WE FOCUS ON EMOTIONS SO MUCH IN TREATMENT?
The symptoms of eating disorders, anxiety & depression are caused by difficulties with coping with uncomfortable or
distressing emotions
or experiences.
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ADAPTIVE FUNCTION OF EMOTIONS
Fear escape, fight
Joy continue behavior
Sadness slow down, withdraw, submit
Anxiety vigilant, focused
Guilt learn from mistakes
Anger defend, attack
Disgust back away
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PRIMARY AND SECONDARY EMOTIONAL RESPONSE
Primary emotional response
o “first” emotional reactions to a situation or memory
oOften functional
oDirectly related to the cues in the situation or memory
Secondary emotional response
o “Emotions about emotions”
o Tend to be judgmental
oNot based upon information from the present moment
oOften result in disordered emotions
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MINDFULNESS
Allows space for the emotion to begin to arise, free of immediate avoidance, resistance, or impulsive behavioral reaction
Allows you to pause, think, and decide what to do
(or NOT do) next. Reduces your urgency to act from emotion, so that
you can selectively control behavior Capacity to NOT act on less than helpful urges
Requires practice
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MINDFULNESS PRACTICE: 3-POINT CHECK
Physical Sensations
What I’m feeling and
experiencing in my body right
now
Thoughts
What I’m thinking of right
now
Behaviors/Urges
What I’m actually
doing/having the urge to do in
this moment
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THE SKILL THAT IS LEARNED
Help patients learn how to break down
an emotional experience
into its component
parts
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FLEXIBILITY IN THINKING
• Thinking that interferes with experiencing or regulating emotion • “I can’t stand this feeling”
• “This feeling will just get worse and worse”
• “There must be something wrong with me if I feel like this”
You can be flexible in how you evaluate and respond to
unhelpful thoughts
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NATURAL COURSE OF EMOTION
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NATURAL COURSE OF EMOTION OVER TIME, WITH
REPEATED PRACTICE
9
1
time
emotions
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EMOTION AWARENESS TRAINING
Help create an increased awareness to emotional
experiences intentionally & in a non-judgmental way:
Build awareness of emotional
experiences in context, as they are happening right now
Reactions often rooted in
perceived past failures & future
threats and uncertainties
Distinction
between primary and secondary
emotional responses
“Emotions about emotions”
Teach the consequences of trying to avoid or
escape our emotions
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Become your own “emotional expert”
In order to create SUSTAINABLE changes
How to live your life fully & with
balance
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In order to make the changes you
want
The goal is not always to feel better, but rather to
Get Better at Feeling
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THE RENFREW CENTER HAS 19 LOCATIONS ACROSS THE COUNTRY.
For questions or to schedule an assessment call1-800-RENFREW
Melanie Smith, M.S., LMHC, CEDS
Director of Training
The Renfrew Centers
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