Coping isn’t a five letter word (it has six).

In my last post, I referenced having a long list of things to do to distract and calm myself “that I actually use.” While the list is personal, the concept and potentially some of my options are universal, and so I offer them here.

Marsha Linehan’s DBT manual features a list of “Adult Pleasant Events” in the Emotion Regulation curriculum, and I have often poked fun at the suggestion therein to chop wood, but the reality is that for the right person, that’s a great idea. When you’re overcome by either an overwhelming, extreme emotion or an intense urge to make what my preschool aged son calls “not a safe choice”, finding the right distraction, alternative outlet or self-soothing strategy is key to making it to the other side of the experience without making your life worse.

Before I get to my own list, there’s another DBT concept worth mentioning called Willingness, which is part of Linehan’s Radical Acceptance module in the Distress Tolerance portion of the DBT curriculum. Willingness is set in opposition to Willfulness, and it basically means you have to actually give recovery strategies an open-minded, whole-hearted chance. Example: refusing to try an alternative coping strategy because your special, special pain could never be helped by something as simple as taking a walk. That’s willfulness. Example: sticking to your commitment to actively engage in  15 minutes of a self-soothing strategy that sounds stupid and pointless at the outset before reassessing your desire to give into an urge to binge. That’s willingness. I’m not a huge believer in the magic of the cosmos, but I will say that the number of times I’ve gotten a phone call from a supportive friend at minute 14 of the aforementioned scenario is uncanny. In other words, it’s often not just the calming or uplifting properties of the strategy that gets you through, but rather, the shift in mindset to being willing to make space for recovery that makes the difference.

So, without further ado, here is my (partial) go-to list of Adult Pleasant Events. I’ve chosen my top few tried and true because this post is brought to you by a napping infant who is likely to wake up soon.

  • Leave my current space. Like it’s on fire. I have often found that making the choice to leave the place where I’m upset or triggered opens a fresh perspective. Sometimes this means going outside for a walk, other times it means going into my mother-in-law’s bathroom to cry with the sink running.
  • Serenity (it’s an essential oil blend, not an ephemeral concept). Because the olfactory nerves terminate near the amygdala in the brain, scents are highly evocative of emotion and memory. I have found that Serenity consistently evokes feelings of peace and contentment for me, as well as now being associated with memories of previously having coped well.
  • Making and drinking a cup of tea (usually decaf jasmine green because it reminds me of my sister). This one is multi-faceted. A watched pot never boils, and I use that to my own advantage and stand with the kettle while it heats, which forces me to slow down and opens an opportunity for mindfully observing my thinking. The warm steam and aroma as the tea steeps offer a soothing sensory experience, and also evoke memories that calm and uplift me. 
  • Drinking 20 oz of cold water out of a Mason jar. The Mason jar evokes memories of the supportive friend who first introduced me to the joys of vintage jars, as well as humorous ones of the various clients who have seen my jar and accused me of drinking moonshine in my office. The coldness of the water forces me to slow down and pay attention because I’ll be rewarded with brain freeze if I don’t. Also, I associate water with cleansing, which can work as a metaphor in moments where I’m working through a difficult emotion like shame or toxic anger.

Just drink a glass of water and your eating disorder or depression will be cured forever! sounds like an obnoxious article in a self-help magazine, but it’s not the strategies themselves that do the heavy lifting. Yes, it’s useful to find strategies that speak to you and tap into your particular set of memories and preferences, but the real magic comes with cultivating willingness to employ them.

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You Have to Do It.

During my time out of the office, I’ve been reflecting quite a bit on success. As in, who have I worked with who has really nailed it and made a major improvement in their quality of life and functioning? What has been necessary to drive my own ongoing success in recovery? And how can I boil those answers down to help others better?

What I come back to, time and again, is action. For myself, and others, insight is great because it can provide valuable data regarding why a pattern or behavior started and is entrenched, but it’s basically useless if you don’t act. It’s entirely possible to spend years in therapy making insight after insight and seeing absolutely no change in how it feels to live your particular life. 

For example: Thanks to insight gained in my own treatment, I know exactly why being home alone makes me vulnerable to the siren song of eating disordered urges. However, learning that did nothing for my recovery until I learned to turn the knowledge into action. Now, not only can I predict when those ugly urges will surface, but I work to a. Minimize the likelihood that I’ll be faced with them b. Decrease my sensitivity by actively cultivating positive associations with being home alone and c. Having a long list of things to do to distract and calm myself that I actually use.

This is not groundbreaking information, but it makes a huge difference in outcome, and a surprisingly small number of folks actually approach the work this way. Why? Well, for one, it’s hard, especially at first. Acting on your insights often requires a kind of brute force, blind faith approach at the beginning because the action is often uncomfortable, new and scary, and probably runs counter to a lot of (distorted) beliefs. However, the discomfort wears off fairly quickly once you start to do your insights because evidence builds up that the new actions are working in your favor. 

In other words, you have to take a leap. The classic metaphors here are about letting go of one trapeze to grab the next, or letting go of your leaky life boat to grab a solid buoy – in both cases, there’s a deeply scary moment where you’re holding onto nothing. 

The question I ask, in my office and of myself is, how is that leaky raft working for you? We have the illusion that there’s a choice, to act on our insights and behave in new ways, or to stay in the current patterns. The reality is, you’re drowning. If the new raft is leaky, too, you were going down anyway, which while not exactly cheery, makes my point that, scary or not, you’ve got nothing to lose and everything to gain by taking action based on insight.

But, you have to do it.

What would it be like to start now?

This isn’t exactly the most dramatic “I’m back!” post, but…

here I am.

Elizabeth Alice was born 7 weeks ago this past weekend, and early motherhood (now of two, which is challenging squared, not challenging multiplied by two) has been beautiful, messy, occasionally heart-breaking and totally worth it.

Also, I’m tired.

Which is what got me thinking about this post – the experiences of birth and early motherhood are a profound reminder of the immense impact that physical health and self-care (or lack thereof) can have on emotional well-being.

I’ve been through this before with my son in his infancy, but the interruption of sleep several times a night for the first few months, combined with the body’s recovery from any birth trauma, the re-organizing of hormones, and never having two hands free at the same time (well, almost never) can seriously undermine two things: your emotional well-being, and your ability to do anything about it.

How is this all related to eating disorder recovery? (Because it so is.)

The collection of behaviors associated with any eating disorder, be it severe restriction, binge eating or purging are similarly destabilizing to the body, and therefore to the mind. And as I think I’ve mentioned before, your brain is connected to your body at the neck. Malnutrition, wacky electrolyte balances, dehydration, type two diabetes, impaired digestive health… All of these are common results of disordered eating, and all of them can pretty severely impair your functioning.  In a way, that makes having an eating disorder a lot like postpartum depression. A brain in a sleep-deprived, malnourished, or otherwise compromised body is not a happy brain.

In many cases I’ve seen in my practice, the depression and anxiety a person is experiencing along with their eating disorder are either caused by, or at least deeply exacerbated by, what they’re doing with food. Additionally, the physical sequelae of the disorder directly impair the ability to recover. Dr. James Greenblatt, whose article I’ve just linked to, is the Chief Medical Officer at Walden Behavioral Care and a solid resource for information about these connections.

Example: gut health. Anorexia, bulimia and binge eating can all do a number on the intestinal flora that allow for happy digestion, or may be in part caused or exacerbated by gut microbe issues (for a good overview, check out this article). So what? Screwy gut health can make you gassy, bloated, malnourished or overweight, as well as depressed, all of which make recovery way harder.

If my anorexic client is faced with the task of learning to eat again, and she’s depressed, and every time she eats she feels bloated and therefore “fat” because her belly bugs are out of wack, how’s that going to go?

If a binge eater has done solid work to decrease binge episodes and is enjoying food in moderation again, but  his gut flora are keeping him both depressed and overweight, how will that impact his motivation?

Luckily, we can make lifestyle and supplementation choices that may right the ship, in terms of gut health, and could thereby have a profound impact on (linking to Dr. Greenblatt again) recovery. In my own experience, the use of a probiotic supplement and digestive enzymes made the early phases of recovery, as well as maintenance, far more bearable. When my body was better able to handle the food I needed to eat, and eating gave me energy rather than a distended stomach, trusting the process was more of a possibility.

So, in summary because apparently I’ve missed writing and gave you all a novel here: the postpartum period has been an important reminder to me about the intricate links between physical and emotional wellness. You can’t feel good if you don’t feel good, if that makes any sense. I’ll be returning to my practice with renewed empathy for why this link makes eating disorder recovery so extra challenging, but also a renewed belief in the importance of supporting my clients in tending to the bodies their minds are trying to live in.

(I’m not a doctor, so this isn’t medical advice, but rather for information purposes only. Please consult your doctor before making the decision to try any supplement.)