Coping skills

at the root of it, an eating disorder is a coping mechanism

Eating disorders serve as a means of coping that an individual has learned through experience. Recovery then, requires learning and practicing new coping methods in the face of distress. The following is an introduction to concepts and coping skills that can be useful in recovery and may be practiced alone or may be encountered in a more therapeutic setting.

The Function of Emotions

Oftentimes, people with eating disorders experience emotions as unpleasant and one effective way of numbing those unpleasant emotions is by engaging in eating disordered behaviours.

While emotions can be unpleasant at times, they serve an important purpose. The classical theory of emotions purports that they are important for communicating with and influencing others: they prepare us for ,and motivate us to, action, and they can be self-validation (meaning they give us information about a situation or event). These needs are explained in more detail in The Functions of Emotions. An alternate theory, the theory of constructed emotion developed by Feldman-Barrett purports that emotions construct our reality. Regardless of differing theories, emotions serve an important purpose in our everyday experiences of the world.

While it’s all very well to learn the functions of emotions, sometimes it is a struggle to know what one is feeling as sometimes we may be experiencing multiple emotions simultaneously; some can even be contradictory to one another. All-in-all it can be quite confusing especially in a culture that focuses very little on learning and practicing emotional intelligence (that is “the capacity to be aware of, control, and express one's emotions, and to handle interpersonal relationships judiciously and empathetically.”)

In lieu of professional therapy to help you learn to identify and navigate your emotions, feeling charts can be quite useful in helping one identify a feeling based on its intensity in a given moment.

Radical Acceptance

Radical Acceptance is the skill of accepting non-judgmentally the things you can't change.

You need RADICAL ACCEPTANCE in order to make a change.
We cannot change that which we don't first accept.

ACCEPTANCE is seeing reality for what it is, even if you don't like it.
ACCEPTANCE does NOT mean giving up or giving in.
ACCEPTANCE can be to acknowledge, recognize and endure.
Deciding to tolerate the moment is ACCEPTANCE.
ACCEPTANCE turns suffering you can't cope with into pain you can cope with.
ACCEPTANCE is the only way out.

Three Myths about Acceptance:

IF YOU REFUSE TO ACCEPT SOMETHING, IT WILL MAGICALLY CHANGE.
IF YOU ACCEPT A PAINFUL SITUATION, YOU WILL BE WEAK
IF YOU ACCEPT YOUR PAINFUL SITUATION, YOU ARE ACCEPTING A LIFE OF PAIN.

What makes it so difficult to Radically Accept?
WILLFULNESS

Imposing one's will on reality.
Refusing to tolerate a situation.
Trying to change or fix a situation that cannot be changed or fixed.
Refusing to do what is needed.
Sitting on the sidelines of life and refusing to play.
It is the "terrible twos" - "No! No! No!" [as if refusing to accept a situation, it will magically change.]

WILLINGNESS

Accepting what is.
Responding effectively or appropriately to the current situation.
Doing what works.
Doing just what is needed in the current moment. EVEN IF IT SUCKS.

Steps to take when willfulness holds you back.

Notice it.
Radically accept it.
Turn your mind towards acceptance and willingness.

(TURNING THE MIND has to happen over and over again - you can't "radically accept" that you're sick once and then you never have to struggle with nonacceptance and willfulness again. Turning the mind is just noticing that you've been distracted and turning back again to what you know.)

This article on Radical Acceptance below explores radical acceptance with examples of how it supported the author in her own life, and reiterates that we can choose pain by choosing to radically accept a difficult situation, or we can choose suffering by refusing to do so. Suffering is pain that does not diminish. Acceptance of pain allows it to fade; perhaps never to disappear, but eventually, to not occupy our every waking thought.
This article on Radical Acceptance explores the options to radical acceptance, and how some choices cause suffering, which lasts as long as you refuse to accept something you do not like, or that isn't fair, or you weren't expecting, and so forth. Practice radical acceptance, allow yourself to feel the pain, and sooner or later, you can let your mind touch that pain without being hurt anymore.

Self-Compassion

Self-compassion is a really important skill to learn and practice consistently in your life, not just when you are struggling with your eating disorder. Are you feeling badly about your grade on a paper? Self-compassion. Was someone rude to you? Self-compassion. Are you feeling left out? Self-compassion. Are you just feeling blue? Self-compassion.

Okay, okay, but just what is self-compassion? It is the sharing of love, empathy, support and kindness that you would offer a friend or loved one in pain, except that you offer it to yourself. It is treating yourself kindly and gently, and validating your feelings whether or not they are actually true.

Kristin Neff, a leading researcher in the area identifies three components of self-compassion:

Self-kindness vs self-judgment
Common Humanity vs isolation, and
Mindfulness vs over-identification.

Ms Neff describes on her website that self-compassion is:

...having compassion for oneself is really no different than having compassion for others. Think about what the experience of compassion feels like. First, to have compassion for others you must notice that they are suffering. If you ignore that homeless person on the street, you can’t feel compassion for how difficult his or her experience is. Second, compassion involves feeling moved by others’ suffering so that your heart responds to their pain (the word compassion literally means to “suffer with”). When this occurs, you feel warmth, caring, and the desire to help the suffering person in some way. Having compassion also means that you offer understanding and kindness to others when they fail or make mistakes, rather than judging them harshly. Finally, when you feel compassion for another (rather than mere pity), it means that you realize that suffering, failure, and imperfection is part of the shared human experience. “There but for fortune go I.”

Fine so far, right? But how do you actually treat yourself with self-compassion when you hear that little voice that pipes up when you feel like you are a failure because? Try being kind to yourself instead. Reassure yourself that nothing takes away your integral worth and that you deserve to be treated with the same gentle compassion you would give to anyone else. Instead of punishing yourself, talk to yourself the way you would talk to a friend or a child in similar circumstances: would you tell them they deserve to "fail" or they deserve to be punished? Probably not, so why are you any different?

Head over to self-compassion.org for more information, and also, for a short test that identifies your own self-compassion in five spheres.

Managing Anxiety, Distress, & Worry (by Sally Chaster)

Anxiety is one of the emotions that can keep us trapped in our eating disorder: food anxiety, weight anxiety, family dinner anxiety, restaurant/food court anxiety, work/school anxiety, life and death anxiety. It is important to work on changes you can make to your surroundings, routine, and emotion management to develop the resilience that will support your recovery efforts.

Technically, anxiety is apprehension over an upcoming event. We anticipate the future with sometimes scary predictions that don’t necessarily have any basis in truth. In everyday life, anxiety’s physical and emotional symptoms can mean an increased heart rate, poor concentration at work and school, sleeping problems, and just being a total Crankasaurus Rex to family, friends, and co-workers.

Everyone feels anxiety about something at some point in their lives; anxiety is the perception of danger(s) that doesn't really exist. Anxiety, and all emotions are a way of communicating with the world around us to receive input on what is happening. But an emotion is not a fact, and anxiety is not a guarantee that something awful might happen to you if you do/don't do whatever anxiety is telling you to do.

In 15 Ways to Beat Anxiety Now, author Giuliana Hazelwood provides concrete and longer term ways to reduce anxiety.

But what about those days when you are in the middle of overwhelming anxiety? What do you do then? I try to work on bringing myself back into the present, away from the worrying and bickering going on inside my head. I start by assessing what is going on with my body. Typically, my shoulders are tense, and my abdomen, too. I make a conscious effort to lower my shoulders, and try to relax both my shoulders and abdomen. I also tend to notice that my breathing is shallow, and rapid. While it is one thing to tell you to breathe deeply in and out, that can be a bit difficult when you feel immobilized by anxiety.

Paced breathing is one of the skills I try to practice to control my breathing; it not only gives you something different to focus on, it can also be quite effective at reducing anxiety. In essence, paced breathing is about breathing in deeply - say to 4 deep breaths - and breathing out for longer than you breathed in, in this instance five breaths. Or you could use five in/six out. One way to practice this skill so it comes more naturally to you is, where possible, to "walk" your breathing'; that is, to count your breathing by the number of steps you take (don't hurry or run). So, take five breaths to five steps and breathe out over the course of six steps, as an example.

Paced breathing still works if you are not able to move around. If seated or lying down, make sure your entire body is relaxed. From there, count inside your head to four or five breaths in, and five or six breaths out. Practice this meaningfully and without judgment; just focus on your breathing and counting. You can download a paced breathing app on to your cell phone, like this one, and numerous others listed on Google.

Another thing I do when anxious is the 5-4-3-2-1 sense inventory. Start off by naming five things you can see, four you can hear, three you can smell, two you can touch, and if possible, one you can taste. After five, do it again, but to the count of four (yes, you can count ones you counted before, but also let new experiences into your senses). Then three, two, and one, and do an inventory of how anxious you are.

My final advice that I use for grounding myself is to look around my surroundings and name the items my eyes fall on; I might notice the chair sitting across from me, some ceramic art my daughter did when she was very young, my cat, the silver box we use to store cards in, and so forth. In a sense, naming them is owning them, or re-claiming my surroundings, and it brings me into the present moment where I am better able to quiet those "voices" in my head that tell me lies that "this" will happen if I do "that".

Remember, all anxiety reduction methods should be tried with curiosity, and not with judgment. These are skills, and like any skill, they require practice over and over, even when you are not anxious, so that you have learned the skill for when you really need it.

To get some more ideas from experts, you can check out these sites: Ten Tools That Help Relieve Panic Attacks, and Driving Peace.

Setting Healthy Boundaries

"Boundaries are not selfish. They aren’t overindulgent or evidence that you’re too sensitive, and they aren’t weakness. Boundaries are conditions that allow you to take care of yourself; conditions that give you the means to survive and keep from sinking. They’re circumstances that honor your needs and respect your feelings. Limits that YOU get to decide on; limits that are inherently valid, regardless of how they compare to anyone else’s. You deserve to create a space for yourself that feels safe and supportive. You deserve to exist under terms that don’t harm you; terms that allow your best self to come through. Even if other people don’t understand; even if it makes them feel angry or rejected or sad — your boundaries are necessary and they matter. Their needs matter too, and it’s not wrong to want to make shifts to accommodate both — but the truth is that you can’t take care of anyone else if your own needs aren’t being met. You don’t have to explain your boundaries. You don’t have to justify them, and you don’t need anyone’s approval. You need to believe that you’re someone worth taking care of, and you need to trust that if anyone is entitled to your protection and care, it’s you." — Danielle Koepke

WHAT ARE BOUNDARIES?

Boundaries are rules or limits we set in relationships with others that are specific to each individual (i.e., one person may give hugs to people they may have just met, but another person prefers to hug only people they are close to, still others do not wish to be touched or hugged at all). Someone with healthy boundaries is able to say no, or yes, depending on what they need. They recognize their boundaries and honour them. Someone with unhealthy boundaries may look two ways: they say yes when they really want to say no and vice versa, or they keep people at such a distance that they struggle to form close relationships.

Healthy boundaries are essential not only to having healthy relationships, but also to our happiness.

The first step to honoring your boundaries is to identify what kind of boundaries you tend to have. In order to grow, it is important to be honest with yourself.

TYPES OF BOUNDARIES

Porous Boundaries: Difficulty saying no to others, oversharing personal information, overly dependent on the opinion and validation of others, over-involvement in others’ problems, accepting of abuse and disrespect, fearing rejection when you act against another’s wishes.
Rigid Boundaries: Avoids intimacy and close relationships, feels uncomfortable with closeness and asking for help, holds few close relationships, very protective of personal information, often detached from others, keeps others at a distance to avoid possible rejection.
Healthy Boundaries: Recognizes their limits and values and does not compromise on them, values own opinions, can communicate needs and limits to others, accepting of others and their expressed boundaries.

DEFENSES VS. BOUNDARIES

A boundary lets positive things through and keeps harmful things out. A defense indiscriminately keeps things out.
Setting a boundary is a conscious and healthy way to protect ourselves from emotional harm. Being defensive can lead us into unhealthy and unproductive behavior.
Boundaries derive from love and self-worth. Defenses derive from fear and the belief that you are worthless.

BOUNDARY ERRORS VS. BOUNDARY VIOLATIONS

A boundary error occurs when a person crosses a boundary accidentally or out of ignorance.
A boundary violation is when a person disregards us when we tell them that a boundary exists.

These are some websites which provide more information about healthy boundary setting and maintenance:

Practicing a Non-judgmental Stance

Exercises for Non-judgmental Thinking (by Christy Matta)

“Cultivating non-judgmental thinking is taught in Dialectical Behavior Therapy (DBT) Skills Groups as a part of the Mindfulness Training. Mindfulness teaches individuals to observe and describe their own behavior, which is necessary when any new behavior is being learned, when there is some sort of problem, or a need for change.

In DBT, mindfulness skills are intended to improve an individual’s abilities to observe and describe themselves and their environment non-judgmentally, which enhances the ability to participate in life effectively.

A NON-JUDGMENTAL STANCE: Judging something as neither good nor bad. Everything simply is as it is. Focusing on just the facts.

Judging is often a short hand way of stating a preference. In my recent post “Why Not Judge” I discuss judgmental thinking in greater detail and mention that “judgments are spontaneous and often inaccurate interpretations of our environment that influence our thinking and behavior.”

For example, if we judge a piece of clothing as pretty or beautiful we are stating a preference for that thing. If we say it is ugly, then that is short hand for “I don’t prefer that.” The problem is that we sometimes forget that our judgments are not facts, but are only our own preferences and opinions based on our own experiences.

Forming judgments is a spontaneous process and there are times when we need to make judgments. However, in order to reduce emotional reactivity, it’s important to become aware of your own judgmental thinking and to develop the ability to think non-judgmentally.

EXERCISES IN CULTIVATING A NON-JUDGMENTAL STANCE

Focus on Language

Because it is so difficult to maintain a non-judgmental stance during times of stress and crisis, you may want to identify certain common judgmental words and phrases that trigger you to stop and observe your thinking. Frequently used judgmental words include: “right,” “wrong,” “fair,” “unfair,” “should,” “shouldn’t,” “stupid,” “lazy,” “wonderful,” “perfect,” “bad,” and “terrible.”

Identify your common self judgments. (I’m bad, stupid, lazy, weak, not worth it etc.).

Turn that self judgment into a nonjudgmental descriptive statement.

When X happens (describe the situation).

I feel X (use a feeling word) e.g. “when someone yells at me, I feel helpless and afraid.” Or “when I make a mistake, I feel anxious and ineffective.”

Focus on Breathing

Bringing your focus to your breathing helps you calm, relax and slow down your thinking. It enables us to get in touch with the present moment and let go of all the thoughts and judgments about the past and future.

Notice Your Thoughts

Bring your attention to your thoughts and judgments when you are doing simple activities, like eating. Notice the thoughts you have about the food, as you eat it. Don’t try to counter your judgments, just notice that they are there.

Judgments tend to activate extreme emotions. If you want to live a less judgmental life, you must first become aware of your own automatic thoughts and judgments. Learning to think non-judgmentally takes practice. You have to be aware of when judgmental thinking occurs and practice bringing your attention to just the facts.”

Pros & Cons Lists

Pros and cons lists can be a helpful way to process ambivalent thoughts and assist in considering and/or making decisions. Should I pursue more formal treatment? Should I engage in this behaviour? Do I want to hold on to my eating disorder or do I want change?

There are often conflicting emotions around these kinds of decisions even if they feel like they "should" be straightforward. Ambivalence is a normal (and well-documented) aspect of eating disorders. We have to remember that our eating disorders give us something, they serve a purpose in our lives.

Writing a pros and cons list around decisions can help you put your thoughts onto paper and create a visual to refer back to. It's helpful to avoid looking at things in black-and-white terms such as "good" or "bad." It's more important to simply step back and look at consequences and whether these outcomes match up with your personal values and hopes for the future.

One really helpful example of different way to look at pros and cons is the format used in DBT shown here and here.

Learning How To Tolerate, Accept, and/or Love Our Bodies

The body positive movement has been growing in recent years. This is encouraging, but for some of us it can feel so impossibly far away. We live in a culture that teaches us from an early age to pick apart our flaws, to hate our bodies, and to change them to suit what society deems as "ideal."

If you can reach a place of loving your body, that is wonderful, but sometimes it's a long process and the place to start is simply learning to tolerate your body and potentially moving on from there. If you only learn tolerance, that's okay too. It's just about putting down our weapons and refusing to fight with our bodies any longer.

Sometimes focusing on what our bodies allow us to do can be helpful. If you love gardening you practice appreciating the feel of the sun on your skin and your hands working in the soil, the strength in your arms to pull and to plant. Your body allows you those experiences.

Finally, surround yourself with body positive role models like Sonja Renee Taylor, Megan Jayne Crabbe, and Jen Bretty.

Opposite Action

Opposite action is another helpful DBT strategy. It involves recognizing an urge and going against it. This skill is relevant to eating disorders, impulsive behaviours, anxiety, and depression.

The following is taken from an article on Psychology Today written by Jennifer Rollin:

"The first step is to identify and name the emotion that you are experiencing. The next part is to determine whether the emotion (including it’s intensity and duration) “fits the facts of the situation.” Additionally, a person can ask themselves whether acting on the urge will be effective in the long-term. Then, based on these answers, a person decides whether to act on their urge or to do an action that is opposite to the urge.

AN EXAMPLE OF OPPOSITE ACTION

Emotions are important in that they provide us with information and signals about things to pay attention to in our lives. There are times when an emotion “fits the facts of a situation” and motivates us towards effective action. For instance, feeling anxiety about an important exam could serve as a motivator to study. Or feeling anxious while walking home alone at night could help someone to maintain a better awareness of their surroundings.

However, there are times when an emotion “does not fit the facts of the situation” and when acting on an emotional urge is not effective. For instance, feeling intense anxiety about eating dinner at a restaurant does not “fit the facts of the situation,” and could cause someone to feel the urge to avoid socializing and going out to eat. Over time, this avoidance behavior only serves to make the anxiety worse. Additionally, it could start to negatively impact an individual’s relationships. In this instance, it would be helpful to note that you are experiencing the urge to avoid eating out and to the take an “opposite action,” which is more in alignment with your life values. For instance, pushing yourself to have meals out at a restaurant (despite feeling afraid), would be taking an opposite action.

It's a skill that takes practice as it involves distancing oneself from sometimes very intense emotions in the moment.”

Trigger Management

Triggers are everywhere in the world around us. Some are avoidable and some are not. Some are specific to your individual experience and some are broader.

There are certain steps you can take to avoid some triggers which can be a helpful way to support your own recovery and well-being. You can do your best to avoid situations where you might be triggered (e.g. large crowds and close proximity to others). You can avoid looking at harmful online images and content in certain "pro" communities. You can steer yourself (to some degree) away from harmful media content (e.g. shows that depict sexual violence - there's actually a great website called Unconsenting Media that works with a list of media that has suggestions of or actual depictions of sexual violence).

Love Our Bodies Love Ourselves has featured a few articles on taking care around social media and managing triggers

The other side of trigger management is that the world is full of them and sometimes challenging yourself to work through those triggers can be an important part of your recovery (especially in regards to weight, body shape, and imagery). Determining whether that's where you're at is an individual process.

Relapse Avoidance

Relapse happens; it's a normal part of recovery. That said, there are steps we can take to avoid relapses and to get back up from them when they do occur.

The following is an excerpt from Kelty Mental Health:

"It takes a lot of courage, hard work, strength and support to recover from an eating disorder. Most people can’t reach this point without a few slip ups and minor setbacks. Relapse is when a person who is in recovery goes back to disordered eating behaviours or negative thoughts about food, weight, and body size. The way to prevent a relapse is to recognize and deal with some of the things that could get in the way of recovery.

“So the more I learned what my triggers were, what I was good at and where my vulnerabilities lied – the easier it was for me to adapt. Likewise, the more I knew what strengthened me and the support and resources I possessed, the easier it was to adapt.” ~ Amy

STRATEGIES FOR PREVENTING A RELAPSE:

Develop a support system – and use it! - it is very important to surround yourself with people who love, support and encourage you. These people can be members of your family, your friends, or your care providers. They will be there to help you when you are struggling with a difficult situation or experience. It’s not always easy to reach out, but you should feel comfortable asking for help when you need it. Some people find it useful to make a list of names and phone numbers to call if they start to slip back into old thought patterns or unhealthy eating behaviours.
Reduce negative influences - try to identify the negative influences in your life, and find ways to reduce or avoid these unhelpful situations. These negative influences might include people who make unhelpful comments about their own weight and appearance, or trigger you to make unhelpful comparisons about your weight or shape. Your own thoughts can also be unhelpful! Learn to challenge any destructive thoughts you have about yourself. Make a list of all of your good qualities and use it when you feel critical or negative.
Identify your “triggers” - a “trigger” is anything that can cause you to return to disordered eating behaviours or thoughts. Each person has their own triggers. They often include feeling stressed, anxious, depressed or lonely. Sometimes an upsetting or traumatic experience can be a trigger. Some people are more likely to relapse at certain times of the year, for example during holidays or exams. To identify your triggers, think of times when you were tempted to act on eating disorder urges. Try to figure out what contributed to these urges.
Make a personal coping plan - make a list of different triggers that could cause you to act on eating disorder urges. Then, come up with a plan for dealing with each of these triggers in a healthier way. Your coping plan might include calling a friend, taking a walk, or writing in a journal.
Eat snacks and meals regularly - a meal and snack schedule can prevent you from going back to disordered eating or unhelpful eating behaviours. Plan your meals and snacks ahead of time, and stick to your plan! Eat three meals a day, plus snacks, at regular times (about every 3 hours). A consistent schedule will be good for both your emotional and physical health. Your family may be able to help by eating meals together with you as often as possible.
Keep busy and stay involved - get involved in a hobby or activity that you enjoy. It can be anything from arts & crafts, to volunteering, to nature walks, to joining a club. If you make time to do the things you enjoy, or to do nice things for others, your focus will shift away from your eating disorder. It can also help to keep you motivated to recover and to stay connected to your surroundings and the people in your community.
Make time for yourself - it is important to take time to do something good for yourself every day. Some people find it helpful to use this time to relax or reflect. Some do yoga or meditation. Others draw, paint, write, or listen to music. No matter what you choose, remind yourself that you are important. You deserve to take this time to do something that is just for you!

Signs of Relapse
It is important to remember that recovery is possible, even for those who have struggled with eating disorder symptoms for a long time. If we know some of the signs of relapse, we may recognize when someone is returning to eating disorder patterns. Then, there is a chance to prevent a slip from turning into a relapse.

Examples of warning signs include:

checking weight daily
skipping meals
over exercising
needing to be perfect
increased need for control
difficulty coping with stress
feeling sad or hopeless
wearing loose-fitting clothing
worrying about weight
avoiding situations that involve food
looking in the mirror a lot
spending a lot of time alone

If you notice some of these signs in yourself or a loved one, and are worried that a relapse may happen, it is important to get help right away. The support of a mental health professional can be very important in preventing relapse. This is especially true during the early stages of recovery and/or relapse.