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Emotion Regulation in Eating Disorders


									Winter 2009                                                                                                             Volume 3 Issue 2

Emotional Regulation Skills to Treat Eating Disorders
                                         by Laura Bumberry, PsyD
   Some of us run. Some of us hide. Some of    gives a temporary sense of control. An indi-        against       these
us let them run wild. We all deal with our     vidual with AN may restrict food intake for         distressing emo-
emotions in different ways, depending on the   the same reason. While professionals and            tions and remov-
situation, the mood we’re in, and the coping   loved ones generally consider the eating disor-     ing the shield is
strategies we have. Emotion regulation is      der to be the problem, the individual may con-      frightening.
actually quite complex, and requires a person  sider the eating disorder to be the solution, the   Coping        skills
to, 1) be aware of internal experiences, 2)    one thing they can depend on to help them           must be in place
identify the emotion, and 3) effectively cope                                                      first to provide         Laura Bumberry, PsyD
                                               feel better, even if just for a little while.
with or tolerate the emotion. Eating disor-       Emotion dysregulation, chronic shame and         security and a sense of efficacy.
dered individuals frequently have deficits in  eating disorder symptoms appear to be tightly          Below you will find statements that pro-
these areas, and experience negative emo-      connected, suggesting learning skills to man-       mote a healthy outlook on emotions, which
tions more frequently and more intensely       age shame better may decrease eating disor-         often seem foreign to individuals struggling
than most. Individuals with Bulimia Nervosa    der symptoms (Gupta, Rosenthal, Mancini,            with an eating disorder. These ideas raise the
tend to have higher levels of anger, although  Cheavens & Lynch, 2008). Marsha Linehan’s           possibility that maybe, just maybe, emotions
they are also more                                                        Dialectical Behavior     aren’t so bad after all.
likely to suppress its                                                    Therapy (DBT) (1993),       Emotions are neither good nor bad,
expression (Fox &           Eating disordered individuals originally developed to                  right nor wrong… they just ARE. They
Harrison,     2008).     often feel incapable of success. As treat suicidal behaviors              exist. It is not helpful to judge your emotions.
Eating       disorder    emotion regulation skills are uti- in individuals with                       Emotions don’t last forever. No matter
symptoms, like bing-     lized on a regular basis, the eating - Borderline Personality             what you’re feeling, eventually, it will pass
ing, purging and         disordered behaviors will decrease Disorder, has recently                 and a different emotion will take its place.
restriction of food                                                                                   You do not have to act on your emo-
                         and the person will build a sense of been applied to the                  tions. All you need to do is acknowledge,
intake, are associat-                                                     treatment of BN and
ed with disgust, sad-    accomplishment and self-efficacy.                                         identify, and feel the emotion. That’s it!
                                                                          BED. Preliminary out-
ness, fear, and anger                                                     come research found         Emotions are not facts. When emotions
(Fox & Froom, 2009), a link so strong that     that after 20 weekly DBT group sessions on          are very powerful they just feel like “the
some describe eating disorders as a variant of mindfulness, distress tolerance, and emotion        truth.”
a mood disturbance.                            regulation, 89% of the women in treatment              You cannot (and should not) get rid of
   Individuals with Anorexia Nervosa (AN),     for BED abstained from binging the final four       emotions because they help us survive.
Bulimia Nervosa (BN) and Binge Eating          weeks of treatment, compared to only 12.5%          They give us information about situations,
Disorder (BED) typically have trouble identi-  of the wait-list group. Sixty-seven percent of      help us communicate, and motivate us to act.
fying and describing their emotions. Eating    participants remained abstinent after 3                Adopting a healthy attitude about any neg-
disordered behaviors often serve to temporar-  months, and 56% abstinent after 6 months            ative emotion is hard, but especially so with
ily decrease or block distressing emotions,    (Telch, Agras & Linehan, 2000).                     anger. Individuals with eating disorders may
and, therefore, negatively reinforce these        At the St. Louis Behavioral Medicine             experience anger frequently but it is often
behaviors. An individual with BN may binge     Institute, we incorporate emotion awareness         suppressed, possibly resulting in self-harm,
and purge in response to a feeling of sadness  and emotion regulation skills to compliment         self-loathing, or eating disordered behavior.
or anger that is experienced as intolerable.   other cognitive-behavioral and expressive           Clients often judge their emotions, stating “I
The binging and purging distracts the individ- skills. Teaching individuals with eating disor-     shouldn’t feel this way,” or “What’s wrong
ual from the negative emotion, decreases       ders to acknowledge, label, and trust their         with me?” By examining the pros and cons of
physiological arousal, and serves as an “oppo- own emotions are difficult tasks. Our clients       anger, individuals often realize they fear what
site-to-emotion action,” meaning rather than   often state “I’m fine,” “I don’t really DO emo-     they will do when angry (e.g. become violent,
feel helpless and overwhelmed, this person     tions,” or “What do you mean?” The eating           break something), not the anger itself.
engages in a goal-directed activity which      disordered behavior has served as a shield                               Continued on Page 2
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     "Friends Don't Let Friends Fat Talk"                                                                             Eating Disorder Services
  Students at Maryville University        Today I promise to eliminate FAT TALK                                       • Intensive Outpatient Program
  participated in Fat Talk Free Week in   from conversations with my friends, my family and myself.
  October by symbolically smashing a                                                                                       • 6-day (day/evening/weekend IOP)
  scale with a hammer and signing this    Starting now, I will strive for a healthy ideal, which I know looks              • 4-day (evening/weekend IOP)
                                          different for every woman, and focuses on HEALTH, not weight or size.
                                                                                                                      • Weekly Therapy Groups
                                          I will celebrate the things about myself and the women in my life that           • Anorexia Nervosa and
                                          have nothing to do with how we look. I decide to end Fat Talk NOW!                 Bulimia Nervosa Therapy Group
                                             In this national event St. Louis Behavioral Medicine Institute invit-         • Compulsive Overeating Group
                                          ed area colleges to participate in order to change the way students think
                                          and talk about their bodies, and as a result, reduce eating disorder        • Nutritional Counseling
                                             Other participating schools were Lindenwood University, St.              • Individual Psychotherapy
                                          Charles Community College, St. Louis Community College –
                                          Meramec Campus, St. Louis University, University of Missouri – St.          • Expressive Therapy
                                          Louis, Washington University and Webster University. Fat Talk Free            for Body Image Issues
                                          Week was created by the Reflections Program of Tri Delta sorority.
                                          More information on the event and resources to help women change                   We accept many insurance plans.
                                          their body image are available at

Emotional Regulation Skills to Treat Eating Disorders continued from front page
   Opposite-to-Emotion-Action is an emotion                  mask the emotion, but to accept the emotion              References:
regulation skill used in DBT. All emotions                   as it is and manage it in a helpful way.                    Fox, J. R. E. & Harrison, A. (2008). The relation
ignite an action urge; fear leads to avoidance,                 Eating disordered individuals often feel inca-        of anger to disgust: The potential role of coupled
sadness leads to withdrawal, anger leads to                                                                           emotions within eating pathology. Clinical
                                                             pable of success. As emotion regulation skills
                                                                                                                      Psychology and Psychotherapy, 15, 86-95.
attack. When an emotion is overwhelming,                     are utilized on a regular basis, the eating disor-          Fox, J. R. E. & Froom, K. (2009). Eating disor-
acting contrary to this action urge will give a              dered behaviors will decrease and the person             ders: A basic emotion perspective. Clinical
sense of control and actually help the situa-                will build a sense of accomplishment and self-           Psychology and Psychotherapy, 16, 328-335.
tion, rather than making it worse. This oppo-                efficacy.                                                   Gupta, S., Rosenthal, M. Z., Mancini, A. D.,
site action also diffuses the intensity of the                                                                        Cheavens, J. S. & Lynch, T. R. (2008). Emotion reg-
emotion, replacing it with a more tolerable                                                                           ulation skills mediate the effects of shame on eat-
emotion. For example, if you are angry at                       Laura Bumberry, PsyD, incorporates her                ing disorder symptoms in women. Eating
someone the action urge is to attack them. To                previous training in emotion regulation and              Disorders, 16, 405-417.
                                                             Dialectical Behavior Therapy into her work in               Linehan, M. M. (1993). Cognitive-behavioral
practice Opposite-to-Emotion-Action, you
                                                             SLBMI’s Intensive Outpatient Program for eat-            treatment of borderline personality disorder. New
can either avoid that person (which includes                 ing disorders. She treats individuals of all             York. Guildford Press.
not thinking about that person), or you can                  ages, and has specialized training in child and             Telch, C. F., Agras, W. S. & Linehan, M. M.
distract yourself and maybe even do some-                    adolescent work. Areas of interest include               (2000). Group dialectical behavior therapy for
thing nice for someone. You can “act” your                   treatment of eating disorders, trauma-related            binge-eating disorder: A preliminary, uncontrolled
way into feeling better. The purpose is not to               disorders, and self-harm behaviors.                      trial. Behavior Therapy, 31, 569-582

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