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Do people actually recover? What does full recovery look like? Is it like alcoholism that once you’ve had an eating disorder you’ll always have an eating disorder? Clients, loved ones, and even the general public have often asked me these questions repeatedly over the years that I’ve specialized in treating eating disorders. We often hear the grim statistics that eating disorders have the highest mortality rate of any mental health diagnosis and that the average length of treatment is 4-7 years. There is even a new subset of eating disorders garnering attention in the treatment world known as Severe and Enduring Eating Disorders (SEED), which are chronic forms of eating disorders lasting 10 or more years that are unresponsive to multiple attempts to treatment.

However, there is hope! An often overlooked statistic is that with treatment, 60% of patients recover from eating disorders. Early intervention improves outcomes. And thanks to mental health parity, increased advocacy efforts, and the growing need, access to treatment is more widely available.

Recovery is not one size fits all. It looks different for each individual. The latest research suggests that a full year without eating disorder behaviors is a strong indicator of recovery. There are also broad phases of recovery that have been identified: physical recovery, behavioral recovery, and psychological recovery. Physical recovery includes medical stabilization, restoring a healthy weight, and overcoming symptoms related to malnourishment. Behavioral recovery involves symptom cessation, while psychological recovery addresses underlying issues contributing to the development and maintenance of an eating disorder. Psychological recovery may include treatment for comorbid mental health problems, resolving trauma, addressing family or relationship issues, overcoming perfectionism, letting go of food rules, and developing healthier body image.

Recovery 101:

  • Recovery is best achieved with a multidisciplinary team approach that includes a therapist, dietitian, medical doctor, and psychiatrist (when indicated) who specialize in eating disorder treatment.
  • The involvement of loved ones is also crucial; having a strong support network of family, friends, and others in recovery improves outcomes.
  • Realistic goals and patience are vitally important in the recovery process. Expect that lapses or relapses can be part of the recovery process- after all, a person with an eating disorder has to face every single day, multiple times per day, what they struggle with the most. Research has shown we make 200+ food related decisions per day. Imagine how overwhelming that can be to someone new to recovery!
  • Being able to identify and minimize or handle triggers is yet another part of the recovery process. A person in recovery is vulnerable to triggers at any time, but especially during times of life stress or transition.

Part of what inspired me to write on this topic was an email I received last month from a former client. She ended treatment with me approximately 8 years ago. She’d battled a severe eating disorder for many years, compounded by a complex trauma history spanning much of her lifetime. She’d been to inpatient or residential treatment at least 5 times when I started working with her and during our time together, she did go to a higher level of care to a center that could address both her trauma and eating disorder. Today, she is a happily married mother of 3 with a thriving career in a helping profession (which even affords her the opportunity at times to work with patients with eating disorders). Here is an excerpt from what she wrote to me (shared with her permission). It speaks volumes more than any professional writing or scholarly article on recovery ever could:

“Perhaps the most humbling experience I have had over the course of the last several years was what previously seemed like a hopeless endeavor–the pursuit of true recovery.  I humbly say that I know with no uncertainty whatsoever that recovery, true recovery, from an eating disorder is possible.  I consider myself fully recovered and am so grateful that the eating disorder is no longer a part of my life. I share this with you because I want to encourage you to keep going.  Keep doing what you’re doing because it is worth it.  Your belief in me and the unconditional support that you provided helped to allow all of the amazing things above to occur, including what I hope to ultimately be the recovery of many more individuals that have never even met you, through (in part) the work that I am able to do with them at this point in time (which never would have been possible without your presence in my life).”

The final workshop I attended this year at the International Association of Eating Disorder Professionals Conference was entitled, “The Neuroscience of Hope in Eating Disorder Recovery”. In this talk, Dr. Ralph Carson spoke about the fact that humans can actually increase the density of cells in their left prefrontal cortex, the part of the brain responsible for positive emotions. He stated that hope requires continuous renewal and recommended the following: keep a gratitude journal, surround yourself with supportive people, ask for help when challenged, avoid people and media that diminish hope, and identify your personal strengths and values and use them! These are wise recommendations for anyone, but essential for everyone in the recovery process. It’s important to remember it’s just that- a process- and to have HOPE that it will happen.

 

Kelly Broadwater is a Certified Eating Disorders Specialist with over 15 years of experience in the field. In that time, she has proudly walked beside numerous clients in their journeys to full recovery.



Did you know your genetic make-up has a significant role in the body’s ability to maintain, lose or even gain weight? Your body’s distinctive DNA profile has a strong influence on your ability to respond to specific diets. Each person’s unique body metabolizes foods differently and now you can learn more about your genetic influences. A universal break down of macronutrients (carbohydrates, protein & fats) may work for your neighbor but not for you. This cutting-edge science-based approach squashes the old school mindset of one size fits all.

Chrysalis is thrilled to announce that we are now offering genetic testing to aid in weight management. Personalized testing allows your dietitian to be more precise in making detailed recommendations on what YOU need to eat to feel your best! While this cannot take the place of making reasonably smart choices, learning to portion, listening to your body, incorporating variety and eating intuitively, these results will certainly give you confidence that you are focusing on a plan designed specifically for you.  To learn more, check out this link from Psychology Today: https://www.psychologytoday.com/blog/the-athletes-way/201607/study-genes-may-determine-what-diet-works-you?eml

Our test kits focus solely on those genes that are related to your body’s ability to process food, nutrients and respond to exercise. If you are eager to learn more about this, call Chrysalis @ (910) 790-9500 to schedule an appointment with one of our registered dietitians. If you’re an existing client, just stop by the front desk to order a kit to take home, then you’ll collect your DNA via a cheek swab and send it off in a pre-paid package. The certified lab will analyze 48 genetic markers, finally you will schedule an appointment with a dietitian to review your report in depth.

It’s that simple!  Let us help you better understand your unique body and develop an eating & exercise plan ideal for you!



Karin* sits on her sofa, tearfully re-reading text messages and asking herself the same question… “why?”  She continues to end up in relationships where her partner is controlling, unappreciative, and disloyal. This is despite doing anything imaginable to make him happy. Her last boyfriend basically drained her savings while continually saying he was working on getting his car dent repair business going. She would go to work every day to earn the money to pay the bills while he worked from home “developing advertizing and networking plans”. Meanwhile, the only thing that seemed to improve was his video game skills.  How can people like Karin make different choices and find healthy relationships? These tips can help you improve the quality of various types of relationships, e.g. romantic and friendship.

First, one of the most important things is to have a good relationship with yourself. If you don’t truly value yourself, you may not recognize when you are being treated poorly or you may not know that you deserve better. Having a good relationship with yourself means that you take the time to take care of yourself (not just physically). Set aside time to do things for you, surround yourself with others who value you, and set appropriate boundaries with others. It also means living a life in harmony with your values.

Second, I always encourage those who struggle in this area to come up with a “deal-breakers” list. What are the things you are not willing to live with? What are the things that are traits, etc, that you require? Decide this before you get emotionally involved and your boundaries start to blur… “Well, it’s not that bad.” Yes it is! If you decided in your sane, uninfluenced mind that a certain behavior was unacceptable or a trait was necessary for your well-being, you should stick with it.  The less experience you have in life, the harder this list may be to develop. However, if you have had a history of “failed relationships,” you can probably recall things from that experience that will help you get started. Examples include: physical violence, spirituality, and desire to have children. Once you know what your deal-breakers are, use that information to choose who you spend your time with… and who you will be breaking up with.

Finally, pay attention to the evidence. I know my more romantic readers will find this part a little uncomfortable, but hear me out. Think about all of the times you have made a relationship choice (e.g. to become intimate with someone or trust someone with personal information) because it felt right. How many times has that feeling mislead you? This does NOT mean that feelings and attraction don’t matter. It means that you need to supplement them with evidence that the person is who you think they are. This often means moving more slowly in a relationship than you may have done in the past. Pay attention to what a person talks about. Are they telling you personal information about others? That may be a sign that they don’t respect a person’s privacy. Are they telling you deeply personal information right away? While this might seem romantic, it can be a sign that a person struggles with boundaries and jumps into (and out of) relationships quickly.

Karin, mentioned in the outset, called a friend for support and received empathy and encouragement. After having some time to grieve her loss, she sought help for developing relationship skills, and while she found it a challenge to change the way she handles relationships, she gained confidence, skills for setting boundaries, and freedom from unhealthy relationships, She now chooses to spend her time with people who treat her with respect and value her for the amazing person that she is. And, when someone doesn’t treat her the way she deserves to be treated; she kicks ’em to the curb!

*Karin is a fictitious character created to reflect the real life challenges faced by individuals who struggle with healthy relationship skills.

Lillian Hood, LPA, LCAS

Psychologist and Clinical Addictions Specialist

At the Chrysalis Center, I specialize in treating individuals who have trauma, depression, bipolar disorder, anxiety, eating disorders and addiction. I help those who are working on building self esteem and healthy relationship skills. I also perform psychological evaluations for those seeking to have bariatric surgery. I use evidence-based practices to assist patients in developing skills for successfully facing their unique challenges.

 

Reference:

National Association for Alcoholism and Drug Abuse Counselors www.naadac.org


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This summer marks the 30th Anniversary of the Discovery Channel’s Shark Week, affirming its continued popularity as a televised underwater exploration on the creatures of the deep blue. This is not surprising as sharks tend to provoke strong emotional reactions. Personally, I am fascinated by all species of sharks. I have been an avid fan of Shark Week since I was a little girl, attempting to spot one off the coast of Cape Cod, Massachusetts during the summer months. Marine research shows that a shark’s role in the marine ecosystem is vital. They maintain equilibrium in the ecosystem by keeping other fish from overpopulating the ocean. Overfishing or arbitrarily slaughtering sharks could throw the entire marine food chain off balance.

However, there are those who don’t watch Shark Week. The reason may be tied to fear. Fear is complex; it is both instinctual (survival-based) and learned (by experience) or taught (through societal/cultural norms or beliefs).

Anything associated with danger can trigger the brain to pay attention in the name of survival. “The psychological characteristics of pain and suffering, uncertainty and powerlessness, make the idea of being attacked by a shark way scarier than the statistics show.” Shark-attack stories get a lot of coverage and exposure through the media, which can contribute and amplify the fear. This can cause the “flight” (avoidance) response to watching Shark Week, because of the perceived threat to the emotional state. If fear is primed, the more scared you feel, the scarier things will seem. That is why it is best to learn adaptive ways to address rational and irrational fears as they swim (I mean, come) along.

To help debunk some misunderstandings about sharks, I wanted to share some therapeutic insight from Shark Week!

Keep moving forward. Ever notice sharks seem to be constantly moving? Well, they have no other choice. If most sharks stop moving even for a short period of time, they can drown and die. Just like sharks, we need to keep moving forward in our lives. Experiencing adversity and difficulties can be a road block for growth. To increase resiliency, we must keep progressing forward, even if its small steps at first.
Be opportunistic. Sharks have six senses and they use all of them to their advantage. As a bonus to sight, sound, taste, touch and smell, they can detect electrical currents through their heads to find prey effectively. Humans may have one less sense compared to sharks, but tuning into all five senses can create an increase in self-awareness, thus more opportunities for emotional, mental and spiritual growth and development.
Sense of Mastery. Sharks are well equipped for their role as the top apex predator. They know how to use their abilities and capabilities to its full potential.  As humans, its best we operate from our most authentic, highest sense of self to life a value-driven life. Are you working in your areas of strength? What creates a sense of mastery/competence? How are you best equipped to handle life’s circumstances?

 

References:
Bracha, H., Ralston, T. C., Matsukawa, J. M., Matsunaga, S., Williams, A. E., & Bracha, A. S. (2004). Does “fight or flight” need updating? Psychosomatics, 45, 448-449.
Lang, P., Davis, M., & Ohman, A. (2000). Fear and anxiety: animal models and human cognitive psychophysiology. Journal of Affective Disorders, 61, 137-159.
Lerner, J. & Keltner, D. (2001). Fear, anger, and risk. Journal of Personality and Social Psychology 2001. 81:1, 146-159.
Sylvers, P. Lilienfeld, S., & LaPrairie, J. (2011). Differences between trait fear and trait anxiety: Implications for psychopathology. Clinical Psychology Review, 31, 122-137.



Whether you call Maggie my “animal companion” or my “pet” doesn’t really matter to either of us. All I know for sure is that I love my dog Maggie. When I’m feeling down she puts a smile on my face. She’s always glad to see me and is entertained by everything I do. The therapeutic value of animals in the lives of humans is well known and supported through scientific research. They soothe us, aid our healing, make us laugh, lower our blood pressure and can motivate us to exercise! For most families, their pet is a member of the family. For children, their relationship with a pet might be the first time they share love with someone other than their parents. Many of us even feel our pet understands us better than our human friends. We love our animals.

It can be hard to understand why people have unhealthy relationships with animals or even abusive interactions with animals. There was a television show that portrayed this extreme by interviewing “animal hoarders” and then attempting to provide therapeutic interventions. These peoples’ homes had been taken over by the animals that they collected regardless of their ability to care for them. They substituted social interactions and family involvement for relationships with their pets who love them unconditionally. Clearly this a good thing gone too far, more so it illustrated how emotional dysfunction can negatively affect the animals around us. Is there a perfect number of pets for an individual or a family? Probably not, but standards of hygiene and care should never be sacrificed because there are too many pets. There is no excuse for neglecting the basic needs of a dependent animal.

It’s even more difficult to understand what goes on with a person who becomes abusive towards animals. Animal abuse involves intentionally harming an animal, sometimes out of anger or frustration, but often as a detached act of violence or expression of dominance. This past year Wilmington saw a call to action to change animal cruelty laws after a puppy, Axel, had been beaten to death. Such cases are upsetting on many levels. Initially we are saddened that a vulnerable creature was injured on purpose. As that shock settles in, we are alarmed because we know that most people who harm animals, lack empathy for others and are at risk to repeat the violent behavior.

Empirical research has demonstrated an association between animal abuse, violent behavior towards humans, and family violence. In addition we know that: both perpetrators and victims of bullying are more likely to abuse animals; witnessing animal abuse has a damaging traumatic effect on some children and “teaches” other children to use violence to solve interpersonal problems; and the same issues of control and dominance underlying spousal abuse are often operative in animal abuse.

The abusive treatment of animals can not be tolerated in children or adults. If your child mistreats your pets, then your pets need protection and your child needs limits and supervision around animals. When children have grown up influenced by adults who use violence to solve problems they are at a greater risk to use violence to express difficult emotions. Sometimes those same children feel so powerless in their lives that they feel driven to dominate others but can only find success expressing their angry control over animals. These children (and their parents) need to develop improved skills to communicate their needs, resolve conflicts and appreciate the impact of their behavior on others. Adults who mistreat animals need specialized interventions and to be held accountable for their actions.

If you take on the responsibility of owning an animal, hopefully you will also see the rewards of a blossoming love relationship between yourself, your animal and your family; but never forget you have an obligation to ensure that animal’s well- being. Having an animal entrusted in your care is a privilege. A pet is a loved living being never to be treated as an object that is owned.


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As the warmer weather approaches, the farmers markets begin to open. Shopping at local farmers markets have many benefits:

1. Farm fresh: Produce found in the grocery stores are typically several days old before they reach the store. Produce is often shipped from thousands of miles away, where it must be refrigerated and requires additives to keep it looking fresh. Produce from farmer’s markets are usually handpicked that morning, so it is as fresh as possible. It also ensures that you know what is in your food. Most of the farmers work at their own stands, which gives consumers the chance to talk to them about how they grow and handle their produce.

2. Seasonal: Produce from farmer’s markets are fresh and grown in season; whereas, produce found in the grocery stores are not.

3. Ripe: Produce found at farmer’s markets are picked at the peak of ripeness, which not only tastes better but also provides the best nutrition possible.

4. Affordable: Produce purchased from farmer’s markets are typically cheaper than the produce purchased from grocery stores.

5. Supports local economies: Produce from farmer’s markets are grown within 100 miles of the market. This means the money spent at farmer’s markets helps support local farms thus benefiting the community. Local farms have decreased over the years because of the cost of running a farm and competing with corporate grocery chains. Purchasing from these local farms supports them, giving them the opportunity to provide to consumers as an alternative to mass-produced foods.

6. Better for the environment: Local farms conserve fossil fuels, provides less waste in the form of carbon monoxide, pesticide use and chemical fertilizers.

7. Social: Farmer’s markets are a great place to gather and meet other people in the community.

Check out http://www.ncagr.gov/markets/chart.htm to find what is in season, and then head to your local farmers market to pick it up for dinner.

Local farmer’s market currently open in this area:

Wrightsville Beach Farmer’s Market https://www.townofwrightsvillebeach.com/183/Farmers-Market
• Municipal Ln
• 8 AM-1PM every Monday

Carolina Beach Farmer’s Market http://www.carolinabeachfarmersmarket.com
• S Lake Park Blvd at Atlanta Ave
• 8 AM-1PM every Saturday

Riverfront Farmer’s Market
• Water Street in front of court house
• 8 AM-1PM every Saturday until November 17th

Port City Produce https://www.portcityproduce.com/
• 5740 Market St or 6458 Carolina Beach Rd
• 9 AM-7 PM Monday-Friday, 8 AM-7 PM Saturday, 10 AM-6 PM

Poplar Grove Farmer’s Market http://poplargrove.org/farmers-market/
• 10200 US-17
• 8 AM-1 PM every Wednesday



The decision to pursue Weight Loss Surgery is usually not an impulsive one. Some consider it for years; others for several months. The last straw may be the recommendation of primary care doctor; weight loss in order to have an orthopedic operation; the shame of being denied a ride at an amusement park; seeing the success of a friend, coworker or loved one after their surgery. The decision comes from many sources, but it is almost never an impulsive or lighthearted one. So the call to the bariatric surgeon is made: whether with excitement or dread that important first step is often filled with ambivalence and regret that one has got to this stage.

It is not surprising given how difficult the first step is that it is frustrating after having considered and then reconsidered the decision to be told that one must complete a series of tests before being seen or setting a surgery date : medical tests, psychological tests and nutrition sessions. It seems like once the decision is made it should be full steam ahead, let’s get the surgery over with and on to the new life. The medical and nutrition education make sense and seem to be straight forward, maybe frustrating to schedule but doable.

It’s the psychological evaluation that often causes further angst. Patients often come to the psychological evaluation anxious and defensive. It is not unusual for someone who has struggled with obesity to experience some depression, anxiety or difficulty dealing with stress. Feelings of shame over obesity and the stigma that one suffers at the hands of others takes a toll over time. Many of us eat emotionally…not just an obese person. It is not uncommon for patients to feel at fault, that they have failed at this most important thing and to fear they will be told something is “mentally wrong” with them. Fears that all too common symptoms will lead to being denied often lead to the defensive posture that “everything is completely okay, no problems, no stress, no past conflicts, no emotional eating, no, no and no”

Just as hypertension often occurs with obesity, several psychological disorders or symptoms seem to be prevalent. No one would want their bariatric surgeon to perform surgery if their blood pressure was so out of control that they would have severe complications from the operation. The same should be true for psychological issues. It is not the presence of symptoms, whether depression, anxiety, etc; it is how these can be treated either before or after surgery.

The psychological evaluation is to help design an effective treatment plan to address emotional issues that would adversely affect outcome. Many people believe that after the surgery, their lifestyle automatically changes. They will be able to change eating habits because of the surgery or adverse consequences of eating certain foods. Along with the smaller or new stomach, one will no longer want certain foods, will have time to prepare and cook meals, will not eat due to being tired, lonely, anxious, or stressed. Intellectually, we all know this is not true but we operate on this principle.

Keep this point in mind: during the 12-18 months after surgery, the most significant weight loss is to occur. If you think of the surgery as the Olympics, the call to the surgeon is signing up for to be considered for the Olympic team. You would train well before the actual Olympic event. Consider how successful a skier would be if the first time they strapped on skis was on the chairlift going up to that double black diamond. The months between the first call to the surgeon and the operation are your training time. You practice the dietary changes, you plan for exercise or even begin exercising if possible, you address emotional eating patterns, you learn to track intake, give up carbonated beverages, practice the 30/30/30 rule. The list goes on. This period is the time to fail, to recognize where your weakness are. Maybe it’s dining out or eating watching TV or the siren song of a Sundrop. We know that there are different types of hunger: stomach, mouth, eye and head. The surgery will almost eliminate stomach hunger. What about the others? What is the plan? Practicing the plan before surgery is a key to success. If depression and/or anxiety would interfere with success, often a treatment plan can be implemented without a long delay before surgery.

Finally you are cleared for surgery, a date is set. What does one do once they are accepted to the final Olympic team? Do you stop training: go on a food farewell tour, stop tracking your intake, have one last soda, stop practicing all the skills until it’s time to enter the Olympic village? Surgery is an event, like an Olympic contest. But whether you end up at Disney World and on the cover of Wheaties depends much more on your training.

The psychological evaluation is not another hoop to get through before the promised changes. It can hopefully be an honest exchange comprised of education and exploration of what will be the strengths and challenges one will face on their journey. What skills can be added to make that journey a success. As disappointing as delays can be they likely add up to just a moment in your new life, take the time to prepare. It will be well worth getting that Gold Medal.


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Many college institutions and universities offer the opportunity for students to study a semester abroad in a foreign country. This is an invaluable experience for a young person to learn and grow both academically and personally. This topic of discussion has come up in my sessions working alongside college-aged students in eating disorder recovery. The decision to study abroad is a commitment that requires an extended amount of time away from family, friends, and other sources of support. I utilize these evaluative questions to explore with my client their readiness to travel abroad in recovery:

• Are my symptoms managed well? Am I able to regulate using healthy coping skills? Do I have a relapse-prevention plan in place?
• Is my physical and mental health stabilized?
• Have I been making progress in recovery for a continual amount of time?
• Do I feel properly supported?
• Does the thought of travel bring joy and excitement (not fear or anxiety)?

How Do I Know I Am Ready to Study Abroad?
From traveling long hours on a plane, exposure to different foods, adjustments to time zones, experiencing a new culture and way of daily living – the choice to study abroad would be carefully considered and discussed with a treatment team (primary therapist, registered dietician, medical provider, etc). Considering the costs and benefits of the timing of the trip abroad is also important – a person should ideally be at an outpatient level of care, medically and psychologically stable and solidly in recovery. With guidance from a treatment team, realistic expectations and goals can be met if planned out accordingly.

Maintaining Mental and Physical Health Abroad:
Choose with recovery in mind. Traveling abroad for the first time in recovery is not the time to push or challenge too much. I encourage clients to be mindful in choosing a location and/or program type that will be aligned with maintaining recovery (i.e. access to appropriate dietary needs, ability to maintain contact with support network) – reminding them that there will be other opportunities to explore different destinations in trips to come.

Engage in self-care. Ah, the infamous s-word. Taking care of basic health needs is a fundamental way to preserve any type of recovery. Upholding a regular sleep schedule, proper nutrition, limiting alcohol, taking daily medications, journaling before bed or beginning the day with a meditation; whatever works in day-to-day life in America should be translated abroad to incorporate stability into the new and potentially changing environment.

Stay connected. Traveling or studying abroad can feel isolating at times, especially when navigating a different culture. Staying connected to various sources of support is important. This can be met through an online eating disorder support group, emails from a treatment team member or regular scheduled FaceTime or phone calls with a loved one.

 

Cassy Taverna, MSW, LCSW-A currently sees individual clients and facilitates S.O.A.R (Staying Open about Recovery), a support group for college-aged women who are making strides to positively stay on track with eating disorder recovery. Her clinical interests include the treatment of eating disorders, trauma, anxiety/mood disorders and LGBTQIA issues. Cassy loves to travel as she presented her research on Disordered Eating Among Newly Bereaved Spouses at the International Conference on Community Mental Health in Bangalore, India during her graduate studies at the University of North Carolina at Wilmington.



Many people are surprised to hear that I often eat with my clients. They think it is odd to ask a client to bring a snack or a meal to a nutrition appointment or silly that we might complete a meal together one-on-one or in a group setting. The reality is that some of the most valuable information about one’s food intake and eating behaviors is gathered by eating with them. During this snack or meal time the food rules, fear foods, and/or eating disorder behaviors can be addressed in the moment in an encouraging and supportive way. Meal time can be very stressful for a person with a poor relationship with food and/or for those individuals with disordered eating or an eating disorder so providing meal support as part of treatment can be a game-changer.

Meal support is common at the residential, partial hospitalization, and intensive outpatient levels of care but is may not be offered as commonly in an outpatient setting. I’ve found that adding meal support as part of the treatment plan at the outpatient level can be monumental to achieving nutrition-related goals. Some outcomes of meal support may include:

  • Improved ability to complete a meal or snack
  • Acceptance and tolerance of  a variety of foods and beverages
  • Confidence in portioning and eating appropriate amounts of food for one’s needs
  • Practicing normal eating behaviors and while decreasing eating disorder behaviors
  • Challenging and reducing food rules and rituals
  • Practicing distress tolerance while feeling emotionally supported
  • Improved confidence around self-regulated food intake
  • Recognition of  hunger and fullness cues
  • Improved mindfulness at mealtime

Incorporating meal support into practice is useful not only for clinicians but also for the client’s community of support, if appropriate. I recommend that a team approach (dietitian, therapist, support persons, client, etc.) is used in planning and preparing for the meal and that meal support goals and the experience is individualized for each client.  For example, person A might set a short term goal to practice eating a meal mindfully with the ultimate goal of identifying hunger and fullness cues while person B may set a short term goal of eating 100% of the meal to help achieve the long term goal of re-nourishing their body. Goals will evolve and change as appropriate throughout the journey. Seek out a registered dietitian that specializes in eating disorder treatment to help identify appropriate meal support goals and to assist in planning meals and giving guidance and tips for before, during and after the meal.

Chrysalis Center offers meal support 3 times a week as part of their Intensive Outpatient Program and once a week for those partaking in outpatient services. Talk to your treatment team if you think this would be beneficial for you!

 

Courtney is a registered dietitian who specializes in sports nutrition and eating disorder treatment. She incorporates HAES and non-diet principles into her practice. In addition to nutrition consultations, Courtney leads IOP and outpatient meal support group and IOP nutrition group.


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In a lamp lit room, a group of six casually dressed people sit in chairs which are arranged in a circle.  All, but one, seem to be engaged in two or three different conversations as a more formally dressed woman enters the room. She sits in one of the vacant seats of the circle as the people in the room gradually turn their eyes toward her. “Good morning,” she says, “you guys are a bubbly group this morning.” She smiles wryly as a tall gray-haired man in the group says, “Well, Amy started it.” He turns his gaze onto a thirty-year-old blonde woman sitting to his left who smiles as she begins to explain, “I picked up my six-month chip last night. It’s the longest I have been sober since I started drinking fifteen years ago.” Members of the group all offer her their congratulations in various ways. John, the quiet one, glances up quickly and says in a flat voice, “Keep up the good work, Amy.” “You don’t seem yourself today, John. What is going on with you,” asks the more formally dressed woman, a therapist facilitating this relapse prevention therapy group. Looking down at the floor, John reveals to the group that he used yesterday.

Like everyone else in this therapy group, John is an addict. Most of the people in the room have at least 90 days clean and are now working on relapse prevention skills. If they are not actively using drugs or alcohol, why are they still in treatment? What are relapse prevention skills? And, what is a “relapse”?

One reason to remain in treatment after discontinuing the use of substances is because the physiological addiction is only part of the challenge. Long after the individual has ceased substance use, the psychological and behavioral elements of addiction remain. Many addicts struggle with how to cope with stress, celebrate, socialize, or even go to sleep without relying on a substance.    These elements of addiction need to be addressed or most addicts slip right back into substance use.

Another aspect to consider is that “withdrawal symptoms” can actually last for up to two years after cessation of use. While the acute symptoms may alleviate within a few weeks, there are “post acute” withdrawal symptoms that follow. During this time, changes that occur in the brain, as the brain is adjusting to no longer having the effects of the substance use, can trigger a person to want to use. It can even cause them to have very vivid dreams of using that are so real, the individual may have trouble telling the difference between the dream and reality.

This is what happened to John mentioned earlier. He awoke one morning having had a “using dream.” It felt real, as if he had used his drug of choice and actually felt high. Realizing this was a dream, he tried to put it out of his mind, but he just kept thinking about it. He didn’t share his struggles with anyone, feeling like a dream was a silly thing with which to trouble his sponsor and other friends. Later that day, he received a call from an old using buddy whose car had broken down and who needed a ride. John picked up his friend, and when he dropped that friend off, the friend repaid him for his help with his drug of choice. John tried to decline, but his friend left the drugs on the seat of the car and waved goodbye. John returned home to an empty apartment and used.

The bottom line is, getting sober is different from staying sober. To recover from substance addiction requires learning a new lifestyle, developing a support system that will help you maintain that lifestyle, and learning how to cope with life on life’s terms… without using. The relapse prevention phase of treatment focuses on achieving these goals. While someone, like John, might slip up and use while in the process of learning such skills, they can remain connected with support and treatment, using the experience as a learning tool, and preventing a complete return to his/her former way of life.

After John shared with the group, they offered him support. Amy said, “John, I know how hard it was to come in here and say that. I know I’d be worried that people would judge me, so thank you for sharing and showing us that it is safe to do so.” Others chimed in and echoed Amy’s commendation. One group member shared, “When I feel like I  want to use, I call someone from our group and call my sponsor. I keep calling numbers until I get someone on the phone.” Another said, “When I am craving, I get out of wherever I am and go somewhere safe. I like to walk on the beach. It clears my mind and calms me down.” Then, the therapist facilitated a discussion around the various elements of John’s story and the skills that any group member could use should any of them face similar things in the future.

  • I am a Psychologist and Clinical Addictions Specialist at the Chrysalis Center. I have successfully treated individuals who struggle with addiction for eight years. I also treat individuals with binge eating, anxiety, depression, and trauma challenges. To schedule an appointment to see me, please call the Chrysalis Center at 910.790.9500. ~Lillian Hood, LPA, LCAS

*John and Amy are fictional characters used to demonstrate the real experience that individuals under these circumstances tend to face.


About Us

At Chrysalis, we believe that a supportive, healing environment is essential in order for change and growth to occur. We seek to offer such an environment to clients and help them create that in their lives and relationships. Read More

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