Reality! Who needs it?

Individuals in recovery have generally spent a lot of time avoiding their painful, shameful or fearful reality. Using chemicals, relationships, busyness, spending, eating, not eating, fantasy, gambling, sex, etc. to escape reality.

What is your reality anyway?

As a baby, your brain was in a receptive mode and you downloaded and duplicated everything around you. As you grew up, you kept imprinting within you, all of the thoughts, feelings, beliefs, and things that happened and you became you.

From Pia Mellody’s Model of Developmental Immaturity, we learn that this programming creates a belief system. You interpret everything that you perceive through your own belief system, particularly as you interact with others. That’s why people frequently disagree about a shared experience. For example, let’s say that Jason had a disagreement with his sister while they were at a social event and shared about it with several friends. Sara identifies with Jason’s sister, feels empathy, and defends her. Jennifer is reminded of being embarrassed by her mother in public and feels pain and shame. Mark feels annoyed about the very topic of conversation and thinks about something else. Everyone has his or her own reality.

In emotional recovery work, it is extremely helpful to understand your reality and how to work with it. First, your reality is your experience in the present moment and includes your body, thoughts, feelings, and behaviors. Think of a recent time when you felt reactive in an interaction with someone and experienced some strong feelings come up. Now, breathe, take a moment, and fully experience the sensations in your body. Those sensations inform you about your feelings. Identify what the feelings are. Is it pain, hurt or sadness, or is it fear or anger? If you are not used to identifying your feelings, it can take some practice. Truthfully, your feelings are generated by the thought you had. When you are reactive, it’s hard to think straight and it can take some time to identify what the actual thought was, or where in your history it originated.

The most helpful way to think about this is with curiosity and owning it rather than judging yourself or blaming someone else. You are in a disempowered victim mode when you blame someone else for your reaction and that keeps you stuck. When you own that your reaction came from your own programming, then you are empowered to understand yourself better and can change.

So how do we do that? How do we change our reactivity, our thoughts, and feelings, and why go through the trouble? 

Scott Peck wrote, “Mental health is staying in REALITY at all costs.” You’ve had those experiences when you are fully present, connected with yourself, aware of your senses, and feeling alive. Joy, passion, love, and the sense of connection with yourself are present moment experiences. You miss out on life when you are not present. Everyone checks/spaces-out at times; it is the human condition. However, the more present you are, the happier and healthier you will be.

Here are the steps to working with your reality when you are triggered or become reactive:

• Take slow deep breaths and be curious about what you are experiencing and why it is coming up.
• Notice and describe to yourself the sensations you are feeling in your body and identify the emotional feeling word or words that fit. (Hurt, fear, anger, irritation, shame, guilt, for example.)
• Stay present and curious about the feelings or issues that are underneath the surface feelings. It could be abandonment, feeling threatened or unsafe, used or manipulated, blamed, shame, guilt, or a memory of an incident from your past. You could discuss this with a therapist.
• When appropriate, you can own your own experience in the present moment and share it with that person you were reactive to by using your talking boundary. For example, in the previous story, Jennifer becomes very quiet and moody. She might share with Jason, “When I heard you say that your sister made a scene at the family dinner, what came up for me was a time when my mother was embarrassingly loud and rude in public and I’m feeling some shame and pain.” In sharing her reality in this manner, Jennifer’s friends will understand her better and she will likely have a sense of relief from the pain and shame.

Only do this when you feel like a functional adult. Listen to the other person’s reality. Be open to getting to know them and to learn about yourself.

Practicing this will likely bring insight as to how the programming in your brain hijacked the situation and gave you a distorted reality. That insight creates a new reality, even a new neuropathway in your brain. This practice begins to create a new, healthier, happier reality, which makes it easier for you to be present. So who needs reality? We all do.

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Dual Diagnosis, Addiction and Eating Disorders: Self Destructive Behavior

It is fairly common for people to struggle with both an addiction and a mental health disorder at the same time. This is known as a “dual diagnosis,” or having at least two conditions that co-occur and interact with one another. Just how someone suffering from depression may habitually binge drink as a way to self medicate, someone suffering from anxiety, depression, OCD, self-harm or PTSD can develop an eating disorder as a means to cope with her underlying mental disorder.

Dual Diagnosis and Eating Disorders

Lately there has been a growing body of evidence to support the similarities between eating disorders and addictive conditions like drug addiction and alcoholism. The American Society of Addiction Medicine now holds a wider definition of addiction to include not just drugs and alcohol, but also “process” addictions like food. This is because all of these substances have a very similar effect on the brain.

Natural stimulants like taking care of our bodies, healthy amounts of exercise, being praised or being in love trigger special reward centers in our brain, making us feel good. These reward centers can also be activated through artificial means like drug use, alcohol, and food abuse such as binging, purging or even starving.

Chemical addiction and eating disorders arise from many of the same sources and display some of the same characteristics. Both conditions:

• Include common risk factors: family history, imbalances in brain chemistry, stress or childhood trauma
• Appear during stressful life transitions like the loss of a parent, a divorce or puberty
• Arise from low self-esteem, depression or anxiety
• Involve a pattern of compulsive behaviors
• Involve a preoccupation with a substance or activity
• Are chronic conditions that produce severe or potentially fatal side effects

  Self-Destructive Patterns of Addiction and Eating Disorders

  When the reward center of the brain is stimulated inappropriately, specifically through drugs, alcohol, or food abuse, it stops functioning the way it was intended to. These stimulants create a false sense of temporary happiness or relief with damaging consequences. An individual who struggles with an addiction or eating disorder may have a personality type that is prone to impulsivity, extremes and high anxiety and this creates a need for greater amounts of stimulation in order to feel well. Relief created by unhealthy stimulation only creates a greater risk for dependency and addiction forming habits. Despite severe medical complications, it is difficult for individuals struggling with addictions to give up their addiction, as in the case of anorexia, bulimia, binge eating disorder, alcoholism or substance abuse.
  
  

  Treatment of Eating Disorders and Alcoholism/Substance Abuse

  Since the addictive nature of eating disorders and alcoholism/addiction is similar, and the underlying issues pertaining to both conditions may overlap, it is crucial to treat eating disorders and addiction simultaneously in the recovery process. At Remuda Ranch at The Meadows, our comprehensive treatment team addresses the various needs of women and girls with co-occurring disorders through medical, nutritional and psychotherapy treatments. Our trauma-focused and brain-based approach helps us find and treat the root cause of the patient’s addictions and behavioral disorders.
  
  At Remuda Ranch at The Meadows, we understand the seriousness of dual diagnosis. In a safe and nurturing community composed of their peers, people are guided on their journey of recovery by examining the underlying causes of their eating disorder and co-occurring disorders. The goal is for these individuals to gain the courage to face difficult issues including grief and loss; heal from emotional trauma; and become accountable for their own feelings, behaviors, and recovery. Please call us at 866-390-5100 or complete the form on our website to find out if our program is right for you.
  
  

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Rewards Matter for Eating Disorder Patients

By Vicki Berkus M.D., Ph.D., CEDS, Remuda Ranch Medical Advisor

People who are struggling with their eating disorders (ED) and refusing to cooperate in treatment often need rewards they can work toward. Being in treatment would be hard for anyone; but, it’s especially hard for adolescents and for those who don’t yet have coping skills or a mind that’s fed well enough to fully function.

Privileges as Rewards

To encourage patients to follow their treatment plans, most programs use levels of activity as rewards. Anything that patients tend to look forward to–going on outings, going to a movie, more exercise time, eating somewhere other than the treatment group table for a meal—can serve as motivation for patients to adhere to their treatment regimens.

I used to be stopped in the hall by my patients with requests. “Can I _________?” they would say. They couldn’t help themselves. The idea that their entire treatment team would have to make the decision, not just me, was not in their thoughts at the moment of the request.

I decided to come up with a system that would help them know exactly what they needed to do to earn one of the privileges they wanted.

Actions Replace Words

I would have patients fill out a “request sheet” every Monday. On the sheet they were asked to write down what they wanted to do most at the end of the week – exercise more, go on an outing, etc. They also would have to write down what would be required for them to be allowed to do what they asked. (e.g., eating 100 percent for the three days prior to the activity, or not needing to be reminded to limit their movement when sitting.)

Depending on each patient’s need, the clinical team would either set the criteria for them or the patient would sit with the therapist to develop the criteria. Either way, the patient knew and agreed upon exactly what they needed to do on their part to get the added perks.

I was amazed at how quickly their behavior changed. Instead of finding me and putting a lot of energy into “making their case,” they would get excited for the change and for the challenge of meeting their goals. They would then hear from the clinical team by Thursday what the weekend would look like in terms of activities and changes.

It sounds simple but ED patients are adept at holding onto the yardstick that compares their peers’ eating disorder behaviors to their own. The ability to put on “emotional blinders” and focus on their treatment is just not in their skill set in the beginning of treatment. Having structured reward systems help them to achieve that focus.

A Team Approach

It is important for treatment teams to be consistent with patients and for each team member to be fully up to date on the latest information about their behavior and their risks. Patients need to know that the team members have access to their daily behaviors including, meal consumption, fluid consumption or daily weights. They also need our united front on the decisions we make that have such a significant impact on them during their treatment.

At Remuda Ranch at The Meadows, we use a consistent team approach every day and work with each person individually based on their strengths. With the support of our teams, our patients achieve much greater success toward their recovery.
If you would like to find out more about Remuda Ranch, please call 866-390-5100 or contact us.

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A Story about a Cat - Remuda Ranch Eating Disorder Treatment Program

By Vicki Berkus M.D., Ph.D., CEDS, Remuda Ranch Medical Advisor

I have learned that I will not win a “battle of wills” against a patient with an eating disorder.
They have perfected setting rules for themselves and the last thing I want to do is give them more rules. I also don’t expect a new patient to immediately trust me; I know that I need to earn the trust. If a patient refuses to talk about their eating disorder or refuses to tell me what they would be willing eat, I start by finding a way to get them to just talk—about anything.

A Story about a Cat

One of the most difficult patients I’ve met in my career actually said to me, “Dr. B, don’t look at me. I don’t deserve to be looked at.” Where do you start from there?

This patient was extremely shut down. The only thing she was willing to talk about was her cat. So, we visited about her cat for a while. Once she started to relax, I asked her if she would be willing to imagine that her cat had an eating disorder and write a story about it.
She did an amazing job! (I tried to get it published but no luck.) She was able to clearly and beautifully articulate her own fears and feelings as long as she was able to imagine that it was all about the cat.

Finding a Way through Shame

I had another patient who was 16 and had lost her hair and her teeth to her disease. She refused to talk about her eating disorder. So, I asked her what she would like to talk about.

She told me that she would talk about her heroin use but not her eating disorder.
So, we started there. Not long after, she told me she had dropped out of high school because the kids would snatch off her wig and laugh at her baldness. She was filled with shame and guilt. As a result, she had only eaten one piece of hard candy, ½ cup of yogurt, and a half of bagel each day for the last year. It can be hard to imagine someone needing that kind of control.

Eventually, she was able to start talking about her eating disorder, but we had to go at her pace. To push her too far too fast might have ruined any chance I had at developing a rapport with her.

Meeting Patients Where They Are

The hardest part of our work as eating disorder professionals is establishing relationships with our patients that allow trust to develop. I frequently start by asking them what they would be willing to try. It may be a smoothie or a quarter cup of a supplement like Ensure or Boost. It may be talking about a beloved pet, or a co-occurring disorder rather than the eating disorder itself.

I also try to provide patients with the information they need in order feel ready to try. For example, if their fear of eating includes fear of the pain that they feel in their GI tract when they eat, I will talk to them about how together we can address the pain and come up with a plan to make it less painful. I will also often order abdominal films for patients so they can look at it and see why they are not “going to burst” with one more mouthful.

Most importantly, I try to remember that with each suggestion I make, the eating disorder is pushing the patient to make the opposite decision. It will take the entire treatment team to help the patient through this difficult phase of their recovery.

Remuda Ranch Can Help

One of the most important goals to achieve while in treatment is to learn how to live life with your Eating Disorder (ED). Remuda Ranch at the Meadows uses a 45-day curriculum to teach the skills you will need to live with ED and move toward life-long recovery. Call us today for more information: 866-390-5100.

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