Eating disorder sufferers experience distress before mealtime, during mealtime, after mealtime… In other words, when in the throes of an ED there is little reprieve from food-related fear, anxiety, and preoccupation.
With treatment there can be relief from these all-consuming thoughts and feelings. Supported therapeutic meals can be a powerful tool – in conjunction with behavioral therapy (like CBT) – for the effective treatment of eating disorders. At Columbus Park – or any comprehensive center, really, where eating behaviors are addressed head on – supported meals are a central part of the treatment process. At mealtime, clients join together in small groups with a therapist facilitator in a focused effort to increase awareness of problematic eating styles or patterns and to support more flexibility and comfort with food overall.
During our dining groups at Columbus Park, therapists teach skills and strategies to get our clients feeling more comfortable and capable at mealtime. Among the many skills we practice, we find that the most popular “go to” strategy our clients’ use is distraction. Rather than directing attention to the food taste, texture, eating experience, our clients tend to prefer engaging in – or ideally getting lost in– conversation with their fellow diners. Even outside our center meal groups, we often hear our clients talk about how they fare best getting through difficult meals by focusing on other non-food-related [preferably pleasant] things so as not to become overwhelmed with emotion that might get in the way of completing a meal.
You may have heard of mindfulness practice as a central tool by which we can become more aware of and present in our emotional lives. At Columbus Park, we do believe that mindfulness – present moment awareness – is absolutely a core skill to develop and practice. That said, when it comes to mealtime, we find that more often than not, focus on the food and eating experience increases anxiety and difficulty around meal completion. There is a time and place for mindfulness – and for some clients when they’re ready, mindfulness is an important mealtime practice. More often than not, however, mindful eating is best encouraged later in the treatment process, when the eating-related fear and anxiety have diminished.
What we see in practice – the preferential use of distraction over mindfulness – was supported in a 2013 study published in the International Journal of Eating Disorders. This study sought to test which method – mindful eating vs. distraction – is most effective in reducing pre-meal anxiety and other aversive feelings that come up around eating.
Seventeen college-aged women were recruited for the study as the “clinical” sample. All 17 women met criteria for eating disorders based on the DSM IV-TR; 10 of these participants were restricted eaters and seven engaged in binge/purge behavior. Twenty-three demographic- matched healthy controls were recruited to form the “non-clinical” group.
The mindfulness intervention was structured as a traditional mindful eating exercise in which a recorded voice guided the women’s attention to the food, “observing and describing the sight, smell and taste of the food, staying in the moment, attending to hunger and fullness, and observing judgments associated with food and body image.” During the distraction intervention, participants were given word searches to complete while eating. Half of each sample received the mindfulness intervention first and then, after a one-week delay, they received the distraction intervention. The other half of each sample experienced the interventions in the reverse order (i.e. distraction first and then mindfulness).
The researchers who conducted this study, hypothesized that the mindfulness intervention, across the board, would support a decrease in negative affect during and after the meal experience. Contrary to their hypothesis, the study showed just the opposite effect among the ED sufferers. The “ED group reported a significant increasein negative affect after the mindful eating intervention as compared to the distraction intervention.” Conversely, the healthy, nonclinical controls “experienced a decrease in negative affect after the mindfulness eating intervention as compared to the distraction intervention.”
This study raises some interesting questions for those of us in the treatment community and certainly brings to focus an important area for further study and exploration. There are countless resources for ED sufferers that focus in on mindful eating as a central strategy to promote ED recovery. As evidenced in this study, the reality is that for many ED sufferers, mindfulness may have the opposite effect of what is intended; mindfulness practice while eating can actually lead to an increase in negative affect and consequent decrease in overall food intake. And without a doubt, this is what we see at our dining table. So at Columbus Park we continue to work on supporting our clients in early stages of recovery by distracting enough to get through meals and move on to life beyond the dining table.
Marek, R, Ben-Porath, D, Federici, A, Wisniewski, L, Warren, M. Targeting Premeal Anxiety in Eating Disordered Clients and Normal Controls: A Preliminary Investigation into the Use of Mindful Eating vs. Distraction During Food Exposure. 2013. International Journal of Eating Disorders.