Eating Disorders (ED) has now, in the UK reached epidemic proportions, according to recent information from the NHS research centre. Which currently shows that 6.4 % of adults in the UK show signs of an eating disorder. However, these statistics only reflect the individuals whom have come forward for help. With the rise of popular media and the age old body beautiful image, people continue to indulge in problematic eating to achieve these ideals, but in other cases when ED’s develop they may have a more sinister twist.
Clearly there is a problem in our society today, which requires more trained specialists to tackle the size of the issue in private practice. Since the cut in NHS funding, the problems have increased and services are only allocated to the severe or life threatening cases. With the increase of long waiting lists, this means that many are just not treated in time and are seeking help within the private sector. On average 65% of my clients that seek therapy have not been diagnosed with an eating disorder by their GP.
Mindfulness has exploded onto the therapy scene with great momentum and it is still gathering speed, with a boom in apps, online courses, books and articles extolling its virtues. Mindfulness now is the evidence-base intervention of choice when it comes to scientific research and behavioural interventions. I personally practise mindfulness, not always by sitting in the typical cross legged, back straight position, but I do spend my time in nature and try to stay present in the moment. It is not always possible to find the time and to focus attention onto to breath when all I have been doing all day is rushing around but I find it gives me grounding.
Mindfulness can be done alone or with a guide (digital or human). With our hectic lifestyles it seems a wholesome choice for self-expansion and improvement. That’s why I try to combine mindfulness with other therapeutic modalities. I find that reminding the client to centre themselves in the present moment can help in finding clarity which is great work for change and understanding. I have written practical mindfulness guides that are free to download through my website, I have seen a surge of requests in recent months. The guides feature content such as mindful eating, mindful parenting and mindfulness at work - cultivating attention and focus.
The majority of the time I receive success stories about how the practise has changed the way clients view themselves and their environment, but there is feedback where mindfulness just has not worked for the individual. But I do feel that mindfulness is not for everyone, it’s a matter of the individual being able to be still and understand what is coming up for them at that present moment. In order to be open in such a way one must be in the right place to experience the benefits.
So what is it about mindfulness? What actually is it? Mindfulness, simply put, is the practise of focusing attention on the experience in the present moment without any judgement or attachment, accepting and being aware of sensations that arise in that moment. Now combine mindfulness intervention with disordered eating, characterized by significant distress and/ or dysfunction, mood disturbances, anxiety, depression, substance abuse, psychological and physical complications. Asking someone that is affected by an eating disorder to be aware of their thought processes and bodily sensations when battling with a body crisis, sounds difficult to say the least.
It is not always so clear cut, Anorexia and Bulimia, which are the most commonly known eating disorders that have a clear set criterion for diagnosis, but shockingly only count for 20% of overall classification of ED’s. The other 80% fit into the ‘Eating Disorder Not Otherwise Specified’ (EDNOS) which basically means they are a variation of ED symptoms. So, how does mindfulness transpire into therapy? You may be working with a client with anorexic traits who has a normal BMI and menstruates, but hates their body. Or someone who purges fortnightly as opposed to eight times a day. The problem here is how do you provide adequate treatment for an individual like that? I think the answer here is to look at changing behaviours that are maladaptive. With clients, what I tend to do is bring awareness into their thought processes, encourage and work towards the separation of behaviours that fuel maladaptive cognitions, emotions and needs
Mindfulness offers a medium to prepare the client on their journey and offers a safety cushion through relapses and setbacks. Previously seen with past clients’ mindfulness encourages kindness to self and setbacks are seen as learning opportunities.
In my experience in private practice most of but not all ED sufferers experience common nutritional and metabolic chaos, emotional and cognitive dysfunction, low self-esteem, distorted body image, anxiety, depression and increased obsessive-compulsive tenancies. These traits can disappear or wane with awareness and acceptance of themselves only when psychological and nutritional recovery is achieved can these traits be managed. Each patient requires an individually tailored recovery plan and pathway . No two clients are the same and talking through emotional issues alone will not aid recovery and re-establish emotional and nutritional heath.
This is where mindfulness-based behavioural interventions are important.
But like with all therapeutic interventions what happens when mindfulness does not work or has adverse effects? I have received feedback about individuals experiencing panic attacks, regressing back into childhood memories that were traumatic, which in turn cause dis-associative episodes and / or breakdowns. Recovery involves being completely grounded. Research suggests that evidence is building on adverse side effects of mindfulness and not just specifically individuals experiencing ED. Internet forums are bound with individuals seeking advice after experiencing panic attacks, hearing voices or discovering that mindfulness deepen their depression.
How can an individual with an ED gauge whether they will respond positively to mindfulness? Mindfulness teaches us to become aware of the present moment, to understand our processes, if mindfulness is conducted in a controlled environment with a trained professional, tackling difficult or adverse symptoms as they come up leads to positive change as both parties are exploring dysfunctional thought processes and acting on them immediately. But that’s just it, for mindfulness to be effective with ED, it needs to be conducted in a safe and controlled environment, in my opinion. A client diagnosed with an ED may not manage being aware on the present and be able to digest what comes up for them.
Engaging clients in a mindfulness approach to eating patterns presents challenges. Clients usually have a history of trying multiple diets and food diaries, that mindfulness will offer yet another promise of a quick fix. Initially most individuals with an ED have a difficulty with eating and so are distrustful of their own judgement in regards to food and may not believe that such a goal is achievable. Two points that are worth remembering; presenting the value of mindfulness rather than a dieting alternative, introducing components of mindfulness to the client.
Concluding thoughts are that mindfulness based approaches deliver positive results for individuals with disordered eating. Where meditation is a core element to which focusing on a disordered eating pattern is central to treatment. Mindfulness offers a heightened approach to observe feelings, experiences and behaviours around food and to allow exposure to work with and develop wiser and more balanced relationships with themselves. Making choices around food, even if you are not diagnosed with an ED are often difficult and confusing, but an ever-present part of life. Understanding the role of mindfulness in relation to eating and emotional regulation may serve to improve treatments for disordered eating and obesity.
Anoushka Mckinley is a trainee counselling psychologist. She has her own private practice, Balance Psychologies based in Surrey. Anoushka is currently researching eating disorders, behaviours and attachment styles within the family and looking at how it links in with the concept of embodiment.
Anoushka has worked in a variety of mental health settings, both NHS and private healthcare. Conducting assessments, psycho-education sessions and various therapeutic interventions with adults with eating disorders, personality disorders, schizophrenia, severe anxiety and depressive disorders. Therapeutically managing extreme emotions, suicidal idealisations, self-harm and obsessive behaviours. In addition, working in an acute NHS hospital with older adults with Dementia. Anoushka now also works as a trainee psychologist for a charity and also for a local secondary school.
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