McCallum Place | Eating Disorder Blog

Eating Disorders in the School Setting

By Julie Raime and Nancy Anderson

Many times an educator is the first person who notices some of the warning signs of an eating order. Think of all the time that a student spends in a classroom setting and how many different people consistently see them everyday. This may be the core classroom teachers, the PE teacher, the school counselor and the nurse. So, what are the signs that these educators and school health professionals should be looking out for? An eating disorder takes on many different faces, but if everyone is aware of these signs and symptoms then help can be sought sooner than later.

What does an eating disorder look like among the peer group and social interactions?

Often isolation is the first outward sign of an ED amongst teenagers. A change in social habits can look like a child pulling away from the peer group and not engaging in the social patterns they previously enjoyed.  They can isolate themselves as the eating disorder worsens as a means to hide their behaviors. At times, the patient can feel rejected or alienated when peers express concerns over their eating habits. Sometimes the ED has been precipitated by teasing and comments from peers. Other times, what starts as an attempt at improving health with diet and exercise gets out of hand but initially the body changes are reinforced through praise. Social media can play a negative role in the validating of disordered eating and body image. Parents should always be aware of their child’s presence and identity on all social media outlets.

What does an eating disorder look like from a nurse’s point of view?

A student that struggles with an eating disorder may be a frequent visitor to the school nurse. Their symptoms can include complaints of nausea after eating small or normal amounts, bloating or water retention not attributable to other physical problems, constipation, reflux, chronic sore throat, swelling of glands around the jaws, frequent and unusual dental problems, general complaints of lightheadedness, fainting and frequently feeling cold.

What does an eating disorder look like on the sports field in and out of school?

This is a student athlete that is “practicing” or “training” for several hours a day and are often secretive about their workouts. They can be quite rigid and compulsive with their drive to perfection. These students will find a reason to avoid eating with the team and will be averse to resting, rehydrating and refueling their bodies. They are at a higher risk for stress fractures and also can exhibit dizziness, weakness, fainting and weight loss. Their declining performance should be a red flag to those adults around them.

Our Educational Program

McCallum Place provides an educational program for our adolescents and young adults. Each educational plan is customized according to the patient’s school’s curriculum. Our teachers act as liaisons between the patient and their school by communicating on a weekly basis with counselors and teachers. Individual needs are addressed and materials are modified to ensure student success in our adaptable educational environment. Educational support is provided five days a week with additional independent study times available on the weekends. Our classroom environment is a bright and spacious area that is conducive to small groups and individual work. Students are encouraged to bring their own devices (laptops, iPads etc) for educational purposes. We can provide loaners if these aren’t available.

The McCallum Place teachers collaborate with the patient’s treatment team to plan for how their specific eating disorder impacts their learning and to ensure the whole patient is supported. Providing an individualized program like the one here at McCallum Place is very important so that the patients can successfully transition back to school after treatment.

Binge Eating in Type I Diabetes

Ginger E. Nicol, MD
McCallum Place St. Louis

Binge eating without compensatory purging may be the most common type of disordered eating in Type 1 Diabetes.1 But medical providers, parents and loved ones often don’t think to look for it. Type 1’s who binge eat have chronically higher blood sugars, higher weight, are more likely to experience diabetes complications like retinopathy, and may be at risk for developing “brittle” diabetes – wide swings of blood sugars from high to low associated with mood instability, irritability and fatigue. Most people with Type 1 don’t start off with disordered eating. Although there is little research on the topic, there are probably multiple factors that lead to the onset of binge eating in this population. The good news is that binge eating can be prevented, and also treated – if you know what to look for.

Potential Causes of Binge Eating in Type 1: Psychology & Biology
Psychologically, Type 1 Diabetes requires a constant focus on eating, insulin dosing and blood sugar monitoring. Although the current recommendations are to encourage flexible eating (e.g. allowing some desert or high-carb foods and dosing insulin appropriately), this still feels restrictive to many people because it requires some degree of planning. Additionally, many with Type 1 only allow themselves these sorts of foods when they are treating a low. This is a setup for feeling deprived, while alternatively being rewarded by lows and risking a rebound high from overdoing it.2 Many people notice that after starting on insulin – commonly after several weeks in a state of ketosis and resultant weight loss – there is a notable weight gain, sometimes past that of the normal baseline weight. This may be distressing to many and lead to abnormal shape and weight concerns, especially in girls.

Biologically, the treatment for Type 1, insulin, is an anabolic hormone which helps to store energy as living tissue in our bodies. Excessive exogenous insulin leads to hypoglycemia. Since our brains can only run on sugar, our bodies have developed some pretty dramatic ways to deal with low blood glucose. Counter-regulatory hormones like glucagon and epinephrine are secreted, and the nervous system kicks in with a bang to tell you to EAT. The rule of “15s” – eat 15 grams of carbohydrate and wait 15 minutes—is what most diabetes providers recommend when treating a low. The problem is that blood sugars may lag behind eating by about 15 minutes or so, but your hormones and nervous system don’t know that – together they drive eating until the symptoms resolve. This can contribute to “rebound” hyperglycemia, which may last a few hours while the nervous system and counter-regulatory hormone responses to a low slowly resolve. When hyperglycemic, body tissues are starved for energy because there isn’t enough insulin to move glucose into cells for processing and storage. This can lead to fatigue and hunger, increased food intake and higher insulin doses with resultant hypoglycemia. And then the binge cycle starts all over again.

Risk Factors for Binge Eating in Type 1: Stopping the Cycle Before it Starts
Young girls and women, especially those who have poor body image, depression, anxiety or problems with impulse control prior to being diagnosed, are most likely to engage in disordered eating.3 It’s important for providers to assess for and treat these conditions as insulin therapy is being started. Loved ones and parents can be helpful by learning about flexible eating and insulin dosing, e.g. matching insulin dose to carbohydrate intake. This is known to improve quality of life, problem-solving skills and Hgb A1c in Type 1 Diabetes.4 Providers and parents can be regulated in the face of highs or lows, demonstrating and reinforcing a calm and measured response to both. And practicing radical acceptance is important for everyone in the equation: being healthy is about living with diabetes, and accepting you will sometimes make mistakes. A high or a low is almost always traceable back to a defined event or situation – whether it’s eating-related, insulin dose-related, or stress-related—carefully and non-judgmentally considering these while making adjustments for the future is critical. The only true mistakes in life are the ones we don’t learn from.

Assessment & Treatment of Binge Eating Disorder in Type 1

• Start by looking for clues: High daily insulin doses and wide swings in blood sugar, extreme hypoglycemic reactions and compensatory binges in response to lows, irritability and fatigue, weight gain.

• Ask about relationship to food in a compassionate way: Remember that the nature of the illness itself necessitates an atypical perception of food and nutrition. Specifically ask about urges to binge and whether there are feelings of loss of control while eating. Validate and educate on the biological and psychological reasons for binges.

• Consult with a dietitian: A dietitian, especially one with eating disorder expertise, can be invaluable in working with patients who are binging or are at risk for binging. One of the first steps is to assess whether binges are occurring due to hunger or feeling deprived, and then problem solving to establish an intuitive eating plan that allows for foods that are satisfying but that don’t require a high insulin dose to cover.

• Normalize blood sugar excursions: Encourage insulin dosing prior to eating (up to 30 minutes before, depending on what type of insulin is used), or switch to a quicker-acting insulin like inhaled insulin to avoid post-prandial highs. Assess whether correction doses are appropriate – too high leads to lows and potential binges; too low leads to high blood sugars and potential insulin stacking, or sequential doses to bring down a high that can result in a low later. Aim to gradually decrease total daily insulin dose to minimize the appetitive drive associated with high insulin and high blood sugar.

• Consider medical and psychological treatments: High dose serotonin reuptake inhibitors (SSRI’s) like fluoxetine (Prozac), and stimulants like lisdexamfetamine (Vyvanse) can decrease binge urges and binge episodes. Cognitive Behavioral and Interpersonal therapies (CBT and IPT) have demonstrated effectiveness in decreasing binge episodes. But they can also help people live with and manage their diabetes better by addressing cognitive distortions, developing better coping and emotion regulation strategies, identifying interpersonal roles and transitions that impact health behaviors, and shoring up natural social supports.

References
1. Scheuing N, Bartus B, Berger G, et al. Clinical characteristics and outcome of 467 patients with a clinically recognized eating disorder identified among 52,215 patients with type 1 diabetes: a multicenter german/austrian study. Diabetes Care. 2014;37(6):1581-1589.
2. Merwin RM, Moskovich AA, Dmitrieva NO, et al. Disinhibited eating and weight-related insulin mismanagement among individuals with type 1 diabetes. Appetite. 2014;81:123-130.
3. Olmsted MP, Colton PA, Daneman D, Rydall AC, Rodin GM. Prediction of the onset of disturbed eating behavior in adolescent girls with type 1 diabetes. Diabetes Care. 2008;31(10):1978-1982.
4. Lowe J, Linjawi S, Mensch M, James K, Attia J. Flexible eating and flexible insulin dosing in patients with diabetes: Results of an intensive self-management course. Diabetes Res Clin Pract. 2008;80(3):439-443.

Moving Toward Recovery II

Caroline H Leibman, MA Ed, BC-DMT, NCC, SEP
Individual Therapist; Dance & Movement, Expressive & Psychodrama Group Therapist

 

In my previous blog I shared the important role of the Creative Arts therapies in Eating Disorders treatment. I cited Dance/Movement Therapy, Authentic Movement, Somatic Experiencing, Yoga Therapy and Mindful Walking as specific therapies and/or body-based practices that help a client re-inhabit his/her body in a safe and appropriate, even in creative and vital ways.

Thanks to the abundance of research in the areas of Neuroscience and Mindfulness, caregivers of patients with Eating Disorders are learning more effective/integrative ways for healing the mind/body. Understanding more about the brain and what sets conditions for healthier mind/body functioning is crucial in continuing to offer optimal treatment interventions to our clients with Eating Disorders. In this blog I would like to address some of the reasons why Creative Arts therapies and body-based practices are inherently healing.

To begin, let’s review the basic architecture of the brain. The Triune Brain, sometimes called the brain within the brain within the brain is a term I first learned in Graduate School while studying Dance/Movement Therapy in the 1980’s. In 2006, Pat Ogden, who developed Sensorimotor Therapy calls upon this term when describing the architecture of the brain, its three levels of information processing, and the importance of balancing therapeutic interventions so that all three areas of the brain are addressed. In doing so, conditions are set for coherent and lasting healing to occur.

The sub-cortical or lower brain, sometimes called the reptilian brain is the first area of the brain to develop from an evolutionary perspective. It governs arousal, basic instinctual action tendencies like reflexes, learned or programmed movement impulses, and the more primitive action tendencies such as fight, flight and freeze. It also governs sensations and homeostasis of the body. This oldest area of the brain relates to the sensory level/somatic level of information processing.  (Siegel, 2007, p.34)

The next level of the brain to develop, sometimes referred to as the mammalian brain from an evolutionary perspective is the limbic brain. It mediates emotion, subjective feelings, emotional responses to events, and affective knowledge. It also mediates some social behavior and learning. (Siegel, 2007, p.34-35)

The most recent level of the brain to develop is the neocortex. The areas of the cortex enable cognitive informational processing such as self- awareness, conscious thought, and consolidation of information.  The cortex also enables abstraction, perception, reasoning, language, and learning. (Siegel, 2007, p.35-37)

Each of these three levels of the brain has its own understanding of the environment and responds accordingly.  These three levels are also intertwined and can function as a cohesive whole, though one particular level of the brain can certainly become dominant and override the other.

It is now known that there is greater flexibility of response at the higher cortical level of information processing, the cognitive area of processing, and greater fixity or concreteness of response at the lower brain or sensorimotor level of processing. The limbic brain, where emotional processing occurs seems falls in the middle and seems to be neither as fixed as the sensorimotor level of processing, or as flexible as the cognitive area of processing.

Creative Arts Therapies and body-based practices provide interventions that engage each level of the brain. Additionally, these therapeutic modalities are inherently mindful, which naturally allows for more relationship-interplay among mind (cognition), body (sensation) and emotion. These therapies encourage the areas of the neocortex, the sub-cortical limbic brain, and the lower brainstem to work together in more integrated ways. In addition, therapeutic interventions can also be introduced to address specific levels of the brain that need support.

Jon Kabat-Zinn, founder of Mindfulness Based Stress Reduction states: “Mindfulness is the awareness that emerges through paying attention, on purpose, in the present moment, non- judgmentally, to the unfolding of experience. Additionally, when the mind enters a state of mindfulness in which one’s here and now experiences are sensed directly, accepted for what they are and acknowledged with kindness and respect, one is practicing self-attunement.” (Siegel, 2007, p.10)

Intrapersonal attunement promotes self-love and advances and encourages interpersonal attunement-relationship.  Dan Siegel, author of The Mindful Brain asserts that mindfulness also promotes neural integration which enhances resilience, well- being, empathy, relationship, and self- regulation. (Siegel, 2007, p.41-43)

The capacity for a relationship with the self that is more loving and self-accepting is a paramount goal for any individual struggling to overcome an eating disorder. Enhanced capacity to engage socially in sustained relationships with others, versus isolation and shame is another critical area for growth and change for a client overcoming an eating disorder. Reliable ability to naturally self- regulate without the use of eating disordered behaviors is also a crucial treatment target for our clients.

Creative Arts therapies and body-based practices are inherently healing because they address each level of the brain, promote neural integration and are mindful. Increased understanding regarding what sets conditions for overall healthier mind/body functioning and the inclusion of therapies that inherently support all levels of brain functioning is vital in continuing to offer optimal treatment for clients with Eating Disorders.

References:

Ogden, Pat. (2006). Trauma and the Body. New York, New York: WW Norton and Company, Inc.

Levine, Peter. (1997). Waking The Tiger, Healing Trauma. Berkeley, California: North Atlantic Books.

Siegel, D. (2007). The Mindful Brain. New York, New York: WW Norton and Company, Inc.

 

Caroline H Leibman, MA Ed, BC-DMT, NCC, SEP
Caroline is a board certified dance/movement therapist, a somatic experiencing practitioner and a nationally certified counselor who holds an MA in Education from Washington University in St. Louis. She completed her graduate work in Dance/Movement Therapy as well as a Professional Diploma in Dance and Movement Studies at the Laban Centre, London, England. She trained in Authentic Movement at the Authentic Movement Institute in Berkeley California, and with Janet Adler, PhD.  Caroline is an adjunct faculty member in the Performing Arts Department at Washington University in St. Louis, teaching in the Somatics Program. Caroline offers a blend of verbal and body-oriented therapies integrating Jungian thought, creative arts therapies, somatic experiencing, and spiritual practices to promote healing and well- being. She has a background in working with issues of trauma, eating disorders, depression/loss, and anxiety. She also works with individuals seeking growth, wellness, and spiritual enrichment.

Eating Disorders in the School Setting

Julie Rami, M.A. Ed., B.S. Spec. Ed.
McCallum Place Teacher

Nancy Anderson, B.S. Ed.
McCallum Place Teacher

Many times an educator is the first person who notices some of the warning signs of an
eating order. Think of all the time that a student spends in a classroom setting and how
many different people consistently see them everyday. This may be the core classroom
teachers, the PE teacher, the school counselor and the nurse. So, what are the signs
that these individuals should be looking out for?

What does an eating disorder look like in the classroom?

A student can be tired, have low energy, lack of motivation and drive that was
previously there, high levels of distractibility, irritability, constant movement,
forgetfulness, and overall just drastic physical changes. They might start missing a lot of school as they are just too tired to get up or just may truly not feel well. Missing
assignments start piling up because they don’t have the energy or concentration to
complete them. Then, inevitably, this leads to a change in overall performance and
grades will drop.

What does an eating disorder look like among the peer group and social
interactions?

Often isolation is the first outward sign of an ED amongst teenagers. A change in social
habits can look like a child pulling away from the peer group and not engaging in the
social patterns they previously enjoyed. They can isolate themselves as the eating
disorder worsens as a means to hide their behaviors. At times, the patient can feel
rejected or alienated when peers express concerns over their eating habits. Sometimes
the ED has been precipitated by teasing and comments from peers. Other times, what
starts as an attempt at improving health with diet and exercise gets out of hand but
initially the body changes are reinforced through praise. Social media can play a
negative role in the validating of disordered eating and body image. Parents should
always be aware of their child’s presence and identity on all social media outlets.

What does an eating disorder look like from a nurse’s point of view?

A student that struggles with an eating disorder may be a frequent visitor to the school
nurse. Their symptoms can include complaints of nausea after eating small or normal
amounts, bloating or water retention not attributable to other physical problems,
constipation, reflux, chronic sore throat, swelling of glands around the jaws, frequent
and unusual dental problems, general complaints of lightheadedness, fainting and
frequently feeling cold.

What does an eating disorder look like on the sports field in and out of school?

This is a student athlete that is “practicing” or “training” for several hours a day and
often secretive about their workouts. They can be quite rigid and compulsive with their
drive to perfection. These students will find a reason to avoid eating with the team and
will be averse to resting, rehydrating and refueling their bodies. They are at a higher risk for stress fractures and also can exhibit dizziness, weakness, fainting and weight loss. Their declining performance should be a red flag to those adults around them.
An eating disorder takes on many different faces, but if everyone is aware of these
signs and symptoms then help can be sought sooner than later.

Grieving the Loss of the Symptom

Tina Villalobos, MSW, LMSW

Therapist

As a therapist who works with people with eating disorders, I am regularly exposed to the tremendous angst and confusion people feel when wrestling with the possibility of recovery. It is no mystery that this process is a difficult one, a journey that can be fraught with back and forth, yes and no, “I guess recovery is worth it but maybe it’s not”. Patients often speak of the great cost it would be to give up their eating disorder. There is a feeling that recovery entails the loss of something dear. On the other hand, I have also talked a lot with patients about what they miss from their life without their eating disorder, what they’d hope to regain, and what they’ll miss out on if they continue acting through their symptoms. Time and again, patients respond with creative and inspired dreams for themselves, but there is doubt that these dreams will be realized if they remain committed to their eating disorder. They are aware of the great cost of their eating disorder, yet this knowledge is rarely enough to allow them to whole-heartedly choose recovery.

I think there are many reasons for this, but I’d like to focus on one that I’ve wondered about recently. I stumbled upon this idea when I was in a training class about how to work with dreams in psychotherapy. There are many theories about dreams that are out there, with perhaps the most famous being Freud’s theory that all dreams display, in disguised form, an unconscious wish. More recently, the interplay between psychoanalysis and neurobiology has been explored and one theorist, Mark Blechner, proposes a theory about dreams that seems quite salient when working with eating disorder patients. Blechner suggests the idea that “Dreams may express things that are not expressible by any other means” which is to say that dreams are their own language. Blechner encourages the therapist to think about how dreams express things from the patient’s mind that couldn’t be fully stated or understood with words. Dreams themselves are the language, and they aren’t comprised of syntax and sentence structure, and when we try to understand dreams through words, they lose some of their meaning. Speaking the dream requires that the dreamer squeeze a multilayered, multidimensional concept through the confining constraints of a series of words.   There’s a loss involved.

There is a parallel, it seems, between this understanding of dreams and how we might understand a patient’s eating disorder symptoms. Like the dream, when we try to understand the meaning of the symptom through words, the symptom loses its perfection, its completeness, and its mystique. Therapists and patients together might conceptualize the symptom as meaning x, y, and z. For example, restricting one’s food intake could signify the expression of one’s anger, one’s loss of self, and one’s need for independence, and usually much more, all at the same time. And all of that would be true. Through the laconic nature of a symptom, a complexity is wrapped up into one nice, neat behavior. The language of the symptom is brimming with action, affect, metaphor, thought, memory, or even trauma—all of which makes the symptom extremely powerful. The symptom is saying the unsayable, not necessarily because all of that can’t be said (though in some cases, like with trauma, that is the case), but because all of that can’t be said at the same time without missing some of the meaning.

It’s important to think about the contribution of therapy to this reduction of meaning. In therapy, the patient begins the process of giving structured meaning, through words, to the symptom. Inevitably, a reduction occurs. When the patient chooses to not act on their eating disorder, but talk about it instead in therapy, they lose the symptom’s powerful language, which is also to lose the mysterious, elusive, symbolic, controlling, and silent nature of the symptom. Like dreams, speaking in words is not the primary language of the symptom. Any verbalization of the meaning of the symptom is a translation, and it’s a translation that can force mediocrity. Something is lost.

This is one reason why I think the addition of other types of therapy, not just talk therapy, can be so beneficial to the process of healing that occurs in recovery from an eating disorder. Non-verbal forms of therapy, such as art, dance, or music, provide an excellent forum for this complexity to be communicated in other ways than through the symptom. But I also think that this loss of meaning is something that us “talk therapists” should try to be keenly aware of. When a patient chooses recovery, there is an entirely new world to be gained, but there is also loss. When we think of recovery, it can be easy to envision the positive—the possibilities, the health, the connection to one’s self and to others. But when a symptom as powerful as not eating, for example, is forgone, in a sense, the patient is losing a language, which is to say she’ll be losing a treasured part of herself. She knows herself through this language. She understands the world through this language. It would be quite strange if she were not ambivalent about giving this up.

Recovery from an eating disorder is a long and involved process and it is nothing new to say that grief is a part of this process. What I’ve considered here is the grief that may need to be processed around the loss of the language of the symptom and what that means for the patient’s commitment to therapy and to recovery. Perhaps if this loss of language, and all that goes with it, is understood, named, and worked through, the patient might be more able to look for other, more adaptive ways, of communicating her complexities to herself and to the world.

McCallum Place is a nationally recognized, comprehensive eating disorder treatment center for adolescents and adults. The facility was founded in St. Louis and has opened an additional center in the Greater Kansas City area. Each clinic offers on-site medical and psychiatric management combined with intensive, individualized psychotherapy. McCallum Place’s eating disorder treatment programs provide a continuum of care, specialized to provide the right level of support to optimize recovery for each patient.

“Eating Clean”: When Food Decisions Become Messy

Kelsey Horton, MS, RD, LD

Dietitian

If you happen to have a Facebook, Twitter or Instagram account, you have probably heard of the term “clean eating”. Maybe more commonly #cleaneating. What does “clean” mean? It depends who you ask. Vegans and vegetarians will tell you that meat and animal products (respectively) are “unclean”. Our paleo friends cringe at the notion of grains, legumes, dairy, refined oils, added salt, sugar, alcohol, and some vegetables. Low carb dieters live and die by the nutrition label. And even Uncle Sam (USDA) will shake his finger at us for saturated fat, cholesterol, red meat, and added sugar on our plates. To our patients with eating disorders, eating “clean” serves as yet another set of food rules to live by.

The one thing that all of them agree on is that there are “good foods” and “bad foods”. But what would constitute branding a scarlet “B” on certain foods? One could argue that “bad foods:

  • Put you at more risk for a caloric excess.
  • Disrupt the nutrient density of your diet.
  • Cause specific diseases, aging or a change in body composition.

Are these legitimate concerns? Of course, but I would challenge you to consider the following:

  • Just because you can overeat, doesn’t mean you will.
  • Foods don’t CAUSE nutrient deficiencies and if you are consuming an adequate amount per day, deficiencies are actually quite rare.
  • Any food can be dangerous at a certain amount but no one food inherently threatens your health in the context of a mixed diet.

This idea of “eating clean” is not coming from hard science, it is a cultural trend that serves to demonstrate someone’s personal food belief system… and of course, preach it as the all-powerful approach to avoiding what “bad foods” can do to you. Eating “clean” isn’t an instruction manual on how to eat healthy. It’s a sermon on the “shoulds” and “should-nots” when it comes to eating.

For those who struggle with orthorexia, a quest to eat “clean” intensifies an already dysfunctional relationship with food. It interferes with brain-space otherwise occupied by their ambitions, family life, vacations or day-to-day mood. All the while, they are using the scapegoat of “it’s the healthy choice” to justify bringing their own food to a restaurant or going hungry on a road trip rather than stopping for fast food.

Orthorexia becomes insidious due to this convenient excuse of “healthy” or “clean” food decisions. It goes unnoticed or worse yet, encouraged. It isn’t about blaming healthy food though. It is about when the desire to eat healthy takes away from the other aspects of a person’s life. Next time you hear about the latest and greatest #foodtrend, think to yourself: is this in line with my food beliefs or does it just sound glamorous? #clean

McCallum Place is a nationally recognized, comprehensive eating disorder treatment center for adolescents and adults. The facility was founded in St. Louis and has opened an additional center in the Greater Kansas City area. Each clinic offers on-site medical and psychiatric management combined with intensive, individualized psychotherapy. McCallum Place’s eating disorder treatment programs provide a continuum of care, specialized to provide the right level of support to optimize recovery for each patient.

Lovingkindness: A Tool for Cultivating Connection, Compassion, and Happiness

Darby McBride, MA, LPC, NCC, CCTP

Individual and Group Therapist

My best mornings before coming to work include some type of meditation. This is a time when I can center myself before the start of a busy day. Do I make time for it every day? No. Sometimes I don’t get up early enough to include it in my morning routine. Sometimes there is just too much to do. But when I’m able to add it in, I feel much more at peace.

Whether or not I’ve meditated beforehand, I come in to work at McCallum Place on Monday mornings and lead home group. This is a group where patients get to check in about their day. They can talk about challenges they are facing, emotions they are experiencing, hopes and dreams for recovery, and anything else that surfaces. After home group, I start meeting with my individual patients. Throughout the day I am engaged with patients: listening to their stories, providing emotional support, and working to help them look at their illness and the recovery process in new ways. This is what I love about being a therapist.

However, I have to admit that one of the hard things about being a therapist is sitting across from these patients who are so bright, talented, and caring and hearing them putting themselves down, expecting perfection from themselves, and struggling to identify and acknowledge all of their positive qualities that seem as plain as day to me. This brings me back to my original topic: meditation.

Specifically, I want to talk about lovingkindness meditation. You may be thinking, “Lovingkindness? What’s that? It sounds too new age-y for me.” Let me explain. Lovingkindness (also known as “metta”) meditation is about creating an intention in our mind for the happiness of ourselves and all beings (Salzberg, 1995). By practicing this type of meditation we are planting seeds of love and happiness for ourselves and others.

The Practice

Before we can sit down to meditate, we need to come up with specific phrases for ourselves and others to repeat in our meditation. Our goal is to identify meaningful phrases that we wish for ourselves and for others. Each phrase will start with “May I…”, “May you…”, or “May all beings…” Some examples include “May I be safe”, “May I be happy”, “May I be healthy”, and “May I feel at peace.” Use these phrases or come up with your own.

When we sit down to practice lovingkindness, we first want to offer the phrases to ourselves. So, as you sit or lie down comfortably, eyes open or closed, repeat silently to yourself either the above phrases or the unique phrases you have identified. And as you repeat them, put some intent behind them. Consider each repetition of the phrases a gift you are giving to yourself. Repeat them at a gentle pace, without rushing or adding extra pressure.

“May I be safe. May I be happy. May I be healthy. May I feel at peace.”

(If any strong feelings arise, practice breathing into and accepting them for what they are, and then return to the phrases.)

Once we have spent a few minutes on ourselves, we can then direct our phrases of lovingkindness to someone we feel close to or inspired by. We will want to choose at least one person. If we choose more than one person, we will want to take time silently repeating the phrases for each person individually. If you cannot think of a person, perhaps you can direct the phrases to a pet!

First, picture this individual’s face, say his or her name to yourself, and connect with what it feels like to be in his or her presence (Salzberg, 2011). Then, with clear intention, offer the phrases of lovingkindness to this individual.

“May you be safe. May you be happy. May you be healthy. May you feel at peace.”

Next, we are going to offer lovingkindness to someone we know who is struggling or hurting right now. As before, we want to picture his or her face, say his or her name, and connect to his or her presence. As we do this, we begin repeating the phrases again.

“May you be safe. May you be happy. May you be healthy. May you feel at peace.”

(If at any point, you become distracted, return to the phrases and continue.)

Next, we want to choose someone that we don’t know well but that we may encounter occasionally. Maybe it’s the mail carrier, a cashier at the grocery store, or a neighbor. Our intent is not to get to know this person better, but rather, to offer him or her phrases of lovingkindness. Remember, this person wants to be happy, just as we do.

The same process applies here. As we imagine this person’s face and connect to his or her presence, we offer our phrases.

“May you be safe. May you be happy. May you be healthy. May you feel at peace.”

(You may find if you do this enough that you begin to feel much more connected to this person, even though you don’t know him or her very well! Connection is a vital need we all share. Celebrate it!)

Now, for arguably the most difficult part of this meditation, we are going to identify a difficult person in our lives. We may want to choose someone who is easier to focus on when we are just starting out. For example, we may first think of a person who irritates us or gets under our skin rather than someone who has truly hurt us. We’re going to picture this person, say his or her name, and connect with his or her presence. Repeat the phrases of lovingkindness with intention.

“May you be safe. May you be happy. May you be healthy. May you feel at peace.”

(This may be hard. If you find that it’s too hard, go back to sending yourself lovingkindness for this part of the meditation.)

Finally, we want to offer lovingkindness to all beings. This includes anything that is living: people, animals, plants, insects…everything! Open up your heart and allow the phrases to flow out to the world.

“May all beings be safe. May all beings be happy. May all beings be healthy. May all beings feel at peace.”

(At first, it may feel overwhelming trying to include all beings. Take it easy on yourself and do the best you can. It will start to feel more natural with time.)

Why Should I Practice?

If we spend a few minutes on each part of the meditation, we will reap the benefits of lovingkindness. Lovingkindness breeds compassion, joy, and equanimity (Salzberg, 1995). In practicing this specific type of meditation, we are increasing self-respect and respect for others and kindness. If we practice regularly, lovingkindness can change our relationship with ourselves in a very positive way. We may find that our relationships with others benefit from this practice as well. The Buddha taught that lovingkindness brings additional advantages to our lives, such as sleeping easily, waking easily, gaining the love of others, and having a peaceful, serene mind (Salzberg, 1995).

If you practice this meditation regularly, you may find that you can more easily connect with others throughout the day. You may find yourself repeating the phrases even when you are not meditating, allowing for more spontaneous self-compassion and generosity.

For those with eating disorders, it can be extremely beneficial to take time out of each day to breathe and practice offering lovingkindness. This practice cultivates patience and acceptance, while also wishing well for ourselves and others. It is like a blessing or a gift we can give to ourselves. I find that many of my patients struggle to take time for themselves and don’t often take care of themselves in the same way that they tend to take care of others. Practicing lovingkindness can be a positive and uplifting way to start your day. It also provides a reprieve from eating disorder thoughts, behaviors, and motivations and may provide the opportunity to see the bigger picture of life, outside of the eating disorder. This is all in addition to feeling more connected with others and our authentic selves.

It may seem like meditation takes a lot of time and dedication for us to see the full benefits. However, with lovingkindness, I have received benefits after just ten minutes of practice in a day. For me, it’s a hopeful beginning or peaceful end to the day. When I use the phrases throughout the day, I find that I feel more grounded and less stressed or anxious. Take some time to experiment and to recognize the benefits lovingkindness may give to you. All you need is ten minutes!

References:

Salzberg, S. (1995). Loving-Kindness: The Revolutionary Art of Happiness. Boston, MA: Shambhala Publications, Inc.

Salzberg, S. (2011). Real Happiness: The Power of Meditation. New York, NY: Workman Publishing Company, Inc.

 

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