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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Accepting the Past as an Asset in Recovery

By Aleah Johnson, The Meadows Alumni Coordinator
What if I were to tell you that all aspects of your past would be used as an asset? Would you believe it or would you instantly regret and want to change it?
I have a love/hate relationship with the word "acceptance." As a stubborn addict, I am not supposed to agree with everything, right?

What is Acceptance?

Acceptance is defined as "the act of taking or receiving something offered." Sometimes I really have to stop and take inventory of the things in my life, both personally and professionally and ask myself if I am fighting or if I am accepting.
One of the most crucial bits of advice I have learned in recovery is to accept my past as an asset. It is important to accept ourselves where we are on our journey and be able to leverage ourselves for good.

The past is a place or state of being in an earlier period of a one's life, career, etc., that might be thought of as shameful or embarrassing. We have all done things in our past that we may not be proud of— choosing to resist or deny our past only leads to more suffering. Acceptance allows us to live in the present moment and not "future trip" or worry about the past.

Resistance is often about control; the more we try to control our lives, the more out of control they get. Acceptance allows emotional balance and gives us the ability to accept people and things exactly as they are, even when we can't see the WHY or when we're not getting what we want.

Finding Serenity

Acceptance is a key solution to our problems. When we are disturbed, it is because we find some person, place, thing, or situation—some fact of life—unacceptable. We can find no serenity until we accept that person, place, thing or situation as being exactly the way it is supposed to be at that moment.

Until we accept ourselves, our situations and our life, on life's terms, we cannot be happy. We need not concentrate so much on what happens in the world as on what needs to be changed in ourselves and in our attitudes. (Page 417, The Big Book)

Early in my recovery, an old-timer in one of my first meetings told me, "You can make this as easy or as hard as you want, little lady, but ultimately the choice is up to you." I fully accepted this not only as a piece of advice but also as a challenge.

Nobody is perfect and everyone has battles and struggles; this is part of this amazing journey that we call life. Every saint has a past and every sinner has a future. Recovery is a marathon, not a sprint. It is our job to accept all aspects, to start where we are, use what we have, and do what we can to make the best out of the life we have left.

Join The Meadows Alumni Association

If you are a graduate from any of The Meadows inpatient programs, The Meadows Intensive Outpatient program, any weeklong intensive workshop at the Rio Retreat Center at The Meadows, or a family member who attended Family Week, you are welcome to join The Meadows Alumni Association!
Sign up today to receive our monthly email newsletter and to be kept up-to-date on any relevant, recovery-related news and events in your area.

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Understanding Your Child and Her Eating Disorder

Understanding Your Child and Her Eating Disorder 

The hardest part of having a child or family member with an eating disorder is the longevity of the disease. Dads especially are used to going in and “fixing” problems; but, when it comes to eating disorders, it is not that simple.

Eating Disorder

What Is It Like Inside The Mind of an Eating Disorder Patient?

I tell parents that the unrelenting, pervasive and constant eating disorder thoughts in their child’s head are similar to what they would experience if they were wearing headphones with loud rock music while I was talking to them. I would not expect them to be able to retain the information I was giving them with the all of that “noise in their heads.”

Similarly, the malnourished brain cannot make good decisions. When your child has an eating disorder her ability to remember all the loving things you do as parents goes right out the window each time she is confronted about her food intake.

Also, the level of fear, shame and guilt eating disorder patients experience is huge. I ask the family to think about times when they were fearful. I give the example of the time I was in a tall hotel in San Diego and woke up in the middle of the night with my bed moving. I couldn’t even keep my balance on the floor. I hit the stairwell with 500 other guests and you could almost feel the collective fear that the building would collapse and we would all be killed.

That is the level of fear that those who struggle with eating disorders live with on a daily basis around their food.

What Can Parents Do to Help?

Parents frequently ask me what they can do. First and foremost, they can be parents - not food police or therapists.

It takes a team to fight these dis-eases (hyphenated purposely because of the dis-ease it causes the family). I would not attempt to treat a patient without a team approach.

The National Eating Disorders Association (NEDA) is focused on helping family members get the information and tools they need to deal with their loved ones. They have support groups, reading materials, guidelines, information on treatment centers, and a lot of options for parents, siblings, significant other to learn and deal with eating disorders.

I also direct family members to 12-step groups for support. It may be AA, CODA (co-dependency anonymous), EDA (eating disorders anonymous) EA (emotions anonymous)—any group that can offer support and a chance to voice your feelings.

At Remuda Ranch at the Meadows, we have dietitians, therapists, and primary care physicians on board to tackle these issues. The family is also considered an important part of our team; we try to educate, support, train, and encourage them through a family week process. We know we are just not treating the patient - it is a family affair. Please call our intake department at 866-390-5100, or reach out to us online, if you need more information about treatment options for a loved one, or for yourself.

 

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Overcoming Your Dysfunctional Relationship With Food

By Helen Pak, Director of Nutrition Services at Remuda Ranch at The Meadows

In the early stages of eating disorder treatment, the most important message for patients is to accept is that food is the best medicine for their illness. As they get healthier, however, it becomes necessary to shift the focus and help patients improve their relationship with food.

Changing Your Perceptions of Foods

The first step for eating disorder patients in treatment is to avoid labeling foods and categorizing them as “good” or “bad.” This black and white thinking is a dieter’s mentality and leads to a dysfunctional relationship with food. When a patient eats a food on their “bad” or forbidden list, they believe that they are bad and punish themselves by restricting, compensating, or ruminating on self-loathing thoughts. Patients can find peace with food by accepting that all foods are okay in moderation, and that foods are not intrinsically good or bad.

Reintroducing fear foods and exposing patients to a variety of foods is also an important part of the recovery process. At Remuda Ranch at The Meadows, we have a strategically designed menu cycle to support overall healthy eating, and to challenge patients with some of the most common fear foods. Each time a patient is exposed then re-exposed to foods they have omitted because of their eating disorder, they learn to empower themselves and take the power back from food.

Initially, patients might benefit from understanding and accepting the fear food by acknowledging its nutritional value such as “this food is a good source of carbohydrates, which is my brains preferred source of fuel and quick energy for my body”. Understanding foods functionality and finding gratitude for food helps to lessen the guilt and shame around eating.

Finding the Pleasures of Eating

The next step for patients is to allow themselves to find pleasure in eating again. Each person’s approach to this step can be different, according to her personal needs. So, we have a variety of methods to help facilitate this phase in their treatment. One example includes refining cooking skills. If a patient learns that cooking can be fun and easy, they may also learn to enjoy eating. Also, asking them to take in the senses involved in eating— the textures, smells, presentation, and flavors and how they compliment or enhance each other— can make the process of eating more enjoyable.

Patients are given recipes to make it less overwhelming to prepare their own food. They also learn how to combine foods with varying colors, tastes, and textures to make them complement each other. When possible, fresh herbs or vegetables from our garden are picked by patients and used in recipes.

We also help patients enjoy eating by encourage creativity and acknowledging that food and cooking is an art form. At Remuda, patients partake in challenges such as Cupcake Wars or The Iron Chef where they are able to have fun, work as a team, and be creative.

We also work with patients to help them acknowledge and understand the social significance of certain foods and meals. Patients process pre-eating disorder memories of their comfort or fear foods, and they relearn how to appreciate and anticipate certain foods in specific social gatherings. Turkey at Thanksgiving, pizza with friends, ice cream or cake at birthday parties are typically part of social rituals they may have avoided in the past due to their fears. As patients admit how avoiding certain foods has negatively impacted their lives, they realize that they need to let go of their food rules and restrictions in order to regain control of their lives.

Letting Go of Perfection

For someone who struggles with an eating disorder, their relationship with food can be extremely complicated. There is a fine line between dedication to healthy eating, and an unhealthy obsession. Once patients let go of the notion that there is a “perfect” way to eat, they can begin their journey to finding peace with food.

To learn more about how we can help women and girls find joy in eating and reclaim their lives, give us a call at 866-390-5100.

Source Link: http://www.remudaranch.com/blog/item/120-overcoming-your-dysfunctional-relationship-with-food