As the new year approaches, many people start thinking about making resolutions. The practice of setting resolutions actually dates back 4000 years. During a massive 12-day religious festival, the Babylonians crowned a new king or reaffirmed their loyalty to the reigning king. They also made promises to the gods to pay their debts and return any objects they had borrowed. The ancient Romans began each year by making promises to the god Janus, for whom the month of January is named.

With thousands of years of practice, you’d think we’d be better at achieving resolutions. The reality is, while 45% of people make resolutions only 8% of them achieve them, with 80% of resolutions “failing” by the second week of February. Why set yourself up to feel bad in five weeks or less? A more effective practice, taken from Acceptance and Commitment Therapy, would be to set values-based goals.

Acceptance and Commitment Therapy (ACT) is a type of research-supported therapy that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. Psychological flexibility means connecting to the present moment fully and changing or persisting in behavior in the service of chosen values. Many of the groups offered at Chrysalis are based in ACT.

According to ACT, the first step, before any goal setting is to clarify what value(s) is (are) underlying your goals. Studies have compared goal setting alone, versus goal setting plus values clarification, and found that those who identified their values actually performed better.

Once you have selected values that are important to you, make sure you set a SMART goal. There are different versions of this acronym, but in the iteration used in The Happiness Trap by Russ Harris (a leading expert in ACT therapy), SMART stands for:

•Specific: specify the actions you will take, when and where you will do so, and who or what is involved.

•Meaningful: The goal should be personally meaningful to you. If it is genuinely guided by your values, as opposed to following a rigid rule, or trying to please others, or trying to avoid some pain, then it will be meaningful. If it lacks a sense of meaning or purpose, check in and see if it is really guided by your values.

•Adaptive: Does the goal help you to take your life forwards in a direction that, as far as you can predict, is likely to improve the quality of that life?

•Realistic: The goal should be realistically achievable. Take into account your health, competing demands on your time, financial status, and whether you have the skills to achieve it.

•Time-bound: to increase the specificity of your goal, set a day, date and time for it.

If this is not possible, set as accurate a time limit as you can.

The next step is to write down a graduated series of goals, starting from tiny simple goals that can be achieved right away, to long term goals that may not be achieved for months or years. ACT experts break it down in the following format:

• set an immediate goal-something small, simple, easy, I can do in the next 24 hours
• short term goals- things I can do over the next few days and weeks
• medium term goals- things I can do over the next few weeks and months
•  long term goals- things I can do over the next few months and years

Hopefully trying a different approach to a time-honored tradition leads to better success with achieving your goals. Cheers to a happy and healthy 2019, living your life in harmony with your values!

For more information about Acceptance and Commitment Therapy:

www.thehappinesstrap.com

https://contextualscience.org/act

Kelly Broadwater is a psychologist who uses ACT in her individual therapy and as a group facilitator. She helped develop the Mindful Living group series offered at Chrysalis, which is ACT and DBT informed. Her motto, informed by her values, is “Work hard, play hard”.

Throughout the past few weeks, as our community has been devastated by Hurricane Florence and her floodwaters, I’ve found myself turning to skills that for the past 10 years I’ve helped teach clients in our Mindful Living group. This group is informed by the principles of Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT). The 4 main tenets are: distress tolerance – coping with stress and difficulty in constructive ways, mindfulness – staying in the present moment, emotion regulation – identifying and accepting both positive and negative emotions without becoming overwhelmed by them, and interpersonal effectiveness – utilizing effective coping skills such as assertiveness and setting boundaries within our relationships.

As I was evacuated to Florida with my family for over a week and reflecting on the use of the same skills I teach others, I received a message from a client who recently just completed a round of Advanced Mindful Living. With her ever present humor, it simply said, “I’ve been mindfully living like a mutha”. Thus, my blog was born – how student and teacher alike have applied these skills in the most trying of times. This client was gracious enough to agree to co-author this piece with me and share her experiences of using mindful living skills during Florence and the aftermath.

One of the most popular and useful tools from the distress tolerance portion of Mindful Living is the concept of “Radical Acceptance”. The idea behind this is that while we can’t avoid pain, we can avoid suffering (which is what happens when you have pain plus non-acceptance). This doesn’t mean we have to like or approve of bad things that happen, but that “it is what it is” and “this too shall pass”. We can’t control certain situations (in this case, a hurricane that’s projected path was literally a line going through my backyard), but we can control our reactions to those situations.

Staying in the present moment can be very hard in crisis. It’s natural to get caught up in “future tripping”, imagining all the worst-case scenarios, worrying, and what-iffing. Mindfulness teaches us to breathe, brings us back to center, and focus on the here and now. Children are wonderful examples of mindfulness practitioners. So as I started to get caught up in the worries of what could happen to my friends who stayed, my house, my belongings, my office, my friends’ houses, my clients, etc. etc.,  I’d look to my almost 2 year old who was blissfully oblivious to what was happening in Wilmington, happily coloring or splashing in the pool and remind myself, “All we have is the right now”.

Another piece of mindfulness practice is gratitude. Words cannot express the gratitude I’ve experienced in so many different ways over the past few weeks and reveling in the amazing people and acts of service I’ve witnessed in action in my beloved community. I’m also grateful for my client who shares her experiences below:

During mindful living one of the distress tolerance techniques that helped me the most was going to my safe place. Even though I was surrounded by scary wind and rain, my apartment literally feeling like it was going to blow away, going to my quiet beach house in my mind, the ocean sounds loudly crashing on the rocks outside, was helpful. Physically I was stuck in my apartment scared of what Mother Nature was doing outside of my window, but in my head, I was at my safe place tasting the salt water and feeling the sand blow softly.

Staying mindful that the storm can thankfully only be temporary and it won’t last forever (even though it felt like it would) gave me some peace. “This too shall pass” are the words that kept flashing in my head like a neon sign.

Another thing we learned that helped me “weather” hurricane Florence was staying in the present moment. Having a daily battle with anxiety the way I do, being in the present moment is very difficult for me because I constantly worry about tomorrow or if it tomorrow doesn’t come or if it does come, what it will bring. Staying mindful that it was a storm, remembering that the noise is rain, and the feeling I felt in the pit of my stomach is just worry, helped to diffuse the anxiety. As emotion regulation taught us, feelings will pass- just like the storm will eventually pass. This helped me avoid a few panic attacks.

One more skill from emotion regulation I applied was naming the feelings that I felt in my stomach, in my chest, and in my heart and the nervousness I felt in my hands. Normally when those emotions arise, I usually go straight into a panic attack because I don’t recognize why those emotions are there and I jump straight to what they could be instead giving them a name and reason. Labeling them allows me to overcome the emotions and not let the emotions overtake me.

Chrysalis Center will be starting a new round of Mindful Living Group, which runs for 12 weeks, within the next month. For more information, please call our office at 910-790-9500.

 

Kelly Broadwater, LPA, LPC, CEDS-S developed and co-facilitated the Mindful Living group series alongside Kendra Wilson, LCSW, CEDS, DBT-C at Chrysalis. These groups have successfully run for a decade and produced dozens of “graduates”, many of whom have gone on to complete our Advanced Mindful Living group. It has been her pleasure to see so many individual clients make progress utilizing the skills taught in these groups and then to thrive moving forward, continuing to apply them in their lives.

 

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.

As we wrap up National Eating Disorder Awareness week, with this year’s theme of “Let’s Get Real”, a major focus of the campaign is on ending stigma. One group of people who struggle with being stigmatized the most are males with eating disorders. It is a common stereotype that only women struggle with eating and body image issues, when in reality 1 in 3 people with an eating disorder is male and 10 million males in the United States alone will be impacted by an eating disorder at some point in their lives. There is also a commonly held misperception that the only males who suffer from eating disorders are homosexuals; actually, the majority of men with eating disorders are heterosexual.

Men and boys of all backgrounds experience eating disorders, and there is a high prevalence rate amongst athletes. Just this week, Seattle Mariner’s catcher Mike Marajma opened up about his battle with an eating disorder (https://www.nationaleatingdisorders.org/blog/seattle-mariners-catcher-mike-marjama-has-message-men-struggling-eating-disorders). Sports that focus on weight restriction as a means for improving performance create increased vulnerability for the development of eating disorders. Gymnasts, runners, body builders, rowers, wrestlers, jockeys, dancers, and swimmers are at risk when pressure is put on them to achieve a certain weight.

Men often go undiagnosed or untreated for a variety of reasons. They are less likely to seek treatment and more likely to be overlooked by medical professionals. Eating disorders in general have the highest mortality rate of any mental health condition and studies have shown that males have an even greater risk of dying from an eating disorder than their female peers; again, a lag in proper diagnosis or barriers to seeking treatment can contribute. To highlight this, the last male with anorexia that I encountered clinically had been seeing a therapist for a year for anxiety and had undergone extensive medical testing for reported GI issues. He’d lost over 40 pounds in a short period of time and was at roughly 65% of his ideal body weight when I encountered him in the hospital (he was there for flu and dehydration). No one had recognized that what he was dealing with was in fact an eating disorder. He ended up requiring months of inpatient hospitalization to help him restore weight.

Luckily there are more intensive treatment options for men with eating disorders available as the field recognizes the need to offer gender inclusive treatment. In fact, a review of hospitalizations for men with eating disorders showed a 53% increase over a 10 year period from 1999-2009. If you are a male struggling with an eating disorder, or know a male who is, know that help is available!

A few resources:
www.nationaleatingdisorders.org/learn/general-information/research-on-males
www.namedinc.org
www.mengetedstoo.co.uk
“Man Up To Eating Disorders” by Andrew Walen