Eating Disorders and Mindfulness

Exploring Alternative Approaches to Treatment

Leah DeSole, Leah M. DeSole

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780415634571
• eBook ISBN: 9781317980681
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This book presents an overview of the latest psychological knowledge about the application of mindfulness-based interventions in the field of eating disorders. Increasingly, these interventions are used in therapeutic practice. They encourage clients to process their experience fully, as it arises, without judgement. Mindfulness-based approaches, in particular, emphasize the cultivation of moment to moment awareness of thoughts and feelings as well as bodily sensations. In so doing, eating disorders present an ideal context for the development of mindfulness. Indeed, it is in the body that the emotional and relational struggles of clients reveal themselves.

The authors in this diverse volume share a belief in the utility of using mindfulness-based practices to address disordered eating. It features up to date research and theory regarding mindfulness and the full spectrum of eating disorders, from Anorexia Nervosa and Bulimia Nervosa to Binge Eating Disorder. In addition, it explores how professionals can utilize mindfulness in their own practices, in the context of both individual and group treatment.

This book was originally published as a special issue of Eating Disorders: the Journal of Treatment and Prevention.

Empirical Chapters

A Mindful Eating Group as an Adjunct to Individual Treatment for Eating Disorders: A Pilot Study

NATASHA S. HEPWORTH

Melbourne, Victoria, Australia

The objective of this study was to investigate potential benefits of a Mindful Eating Group as an adjunct to long-term treatment for a variety of eating disorders. Individuals (N = 33) attending treatment at an outpatient treatment facility participated in the 10-week intervention designed to enhance awareness around hunger and satiety cues. Disordered eating symptoms were assessed pre- and post-intervention using the EAT-26. Significant reductions were found on all subscales of the EAT-26 with large effect sizes. No significant differences were identified between eating disorder diagnoses. Results suggest potential benefits of an adjunct mindfulness group intervention when treating a variety of eating disorders. Limitations are discussed.

With the growing popularity of mindfulness interventions, the application of mindfulness skills as a useful adjunct to ongoing treatment of eating disorders is of interest. Treatments for eating disorders, particularly bulimia nervosa and binge eating disorder, typically include cognitive behavioral therapy (CBT; Hay & Bacultchuk, 2001; Mitchell, Agras, & Wonderlich, 2007), Interpersonal therapy (Apple, 1999; Mitchell et al., 2007), and psychotropic medication (Hay & Baculthcuk, 2001; Walsh, Fairburn, Mickley, Sysko, & Parides, 2004). These interventions have demonstrated success in reducing disordered eating behaviors (Baer, Fischer, & Huss, 2006). Despite this, many participants do not benefit from these treatments (Kristeller, Baer, & Quillian-Wolever, 2006) and more recently the application of mindfulness interventions with people who have eating disorders has demonstrated promising results (Baer et al., 2006; Kristeller et al., 2006). Mindfulness involves consciously bringing awareness to the present moment by focusing non-judgmentally on cognitions, emotions and physical sensations (Kabat-Zinn, 1994). Mindfulness is well suited to the eating disorder population because many sufferers experience difficulties with regulating emotional, cognitive, and physical experiences (Corstorphine, 2006). The majority of the research investigating the application of mindfulness to eating disorders has explored efficacy of the techniques as a stand-alone treatment, usually in a short-term format. An examination of the effect of a “Mindful Eating” group program that uses mindfulness principles as an adjunct to treatment for eating disorders would increase insight into the benefits of mindfulness in reducing eating disorder behaviors.

Research suggests that disordered eating behaviors may arise when individuals have difficulty regulating their emotional experience (Baer, Fischer & Huss, 2005). It has been demonstrated that individuals with eating problems frequently have difficulty tolerating negative affect and distress, and use food, whether in a restrictive or binge fashion, to regulate these internal experiences (Corstorphine, 2006). Individuals may then engage in experiential avoidance, defined as an unwillingness to experience negative thoughts, emotions, and physical sensations, and labeling these internal states as unacceptable and intolerable (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). According to this conceptualization, food restriction or overconsumption then becomes a short-term experiential avoidance technique (Linehan, 1993).

It has been proposed that excessive dieting and chronic binge eating, in an attempt to avoid these emotional experiences, often results in an inability to distinguish between hunger and satiety signals (Smith, Shelley, Leahigh, & Vanleit, 2006). Disordered eating behaviors interfere with an individual’s capacity to recognize natural physiological cues related to hunger and fullness and also reduce ability to differentiate between these physiological signals and emotional distress (Pinaquy, Chabrol, Simon, Louvet, & Barbe, 2003). Furthermore, social conditioning to overeat or deny oneself food enhances physiological dysregulation and maintains disordered eating behavior (Lowe & Levine, 2005).

Based on the theory and empirical findings described above, mindfulness interventions aim to improve emotional regulation and enhance awareness of hunger and satiety cues by increasing awareness of internal states and reframing them as transient events (Kristeller & Hallett, 1999). Mindfulness skills assist individuals to increase awareness of emotional and physical states and respond to these experiences non-judgmentally without responding in an automatic and impulsive nature to alleviate negative affect (Kristeller et al., 2006). Furthermore, mindful eating techniques increase awareness of physical hunger and fullness signals allowing individuals to respond appropriately to hunger and satiety cues rather than binge eating or restricting food intake. For example, mindful breathing and body scanning techniques increase recognition of physiological hunger cues. Mindful eating also involves augmenting recognition of reactions and judgments about food, for example anxiety when eating chocolate, and helps illicit a greater understanding of food preferences and aversions (Baer et al., 2005).

Mindfulness based group interventions have been demonstrated to have a positive impact on reduction of binge eating frequency and increase sense of control over food (Kristeller et al., 2006). An exploration of a mindful meditation based intervention over 6 weeks in the treatment of binge eating disorder with 18 obese women found that ratings of control over eating and awareness of hunger and satiety signals improved significantly post-intervention (Kristeller & Hallet, 1999). The frequency and proportion of binging was also significantly reduced as intended. Similarly, an 8-week mindfulness-based stress reduction group found a small to moderate decrease in binge eating in 25 individuals with binge eating behaviors (Smith et al., 2006). Reductions in binge eating were attributed to improvements in self-acceptance and reduced anxiety symptoms.

Baer and colleagues (2005) applied mindfulness based cognitive therapy to ten women with binge eating behaviors and found a considerable reduction in binge eating and eating and food concerns, particularly the belief that eating results in loss of control of food intake. Other mindfulness interventions for binge eating disorder have demonstrated that improved awareness of satiety signals, but not hunger cues, was significantly correlated to a reduction in binge eating (Kristeller, Quillian-Wolever, & Sheets, in press). Finally, a recent qualitative study has also demonstrated that mindfulness-based interventions for eating disorders in six women with bulimia nervosa increased self-awareness and acceptance resulting in reduced emotional distress and increased capacity to regulate stress (Proulx, 2008).

Most research studies using mindfulness interventions for the treatment of eating disorders have examined brief group interventions independent of ongoing treatment. The primary group investigated has been individuals with bulimia nervosa and binge eating disorder. The current pilot study was exploratory in nature and aimed to investigate the potential benefits of a “Mindful Eating Group” using mindfulness techniques in reducing eating disorder behaviors for people with all types of eating disorders. Additionally, the study aimed to investigate the usefulness of a mindfulness group as an adjunct to longer-term treatment completed at a specialist clinic.

It was hypothesized that participation in the “Mindful Eating Group” would be associated with reduced dieting behaviors, oral control behaviors and preoccupation with food as measured by the three subscales of the Eating Attitudes Test–26 (EAT-26) (Garner, Olmstead, Bohr, & Garfinkel, 1982). In addition, it was hypothesized that individuals with bulimia would demonstrate greater reductions on all subscales of the EAT-26 than individuals with anorexia nervosa and eating disorder not otherwise specified (EDNOS) as mindfulness techniques are particularly effective with people with poor regulation of internal experiences typical of those with bulimia nervosa (Kristeller et al., 2006).

METHOD

Participants

Participants were 33 females (mean age = 21.42 years, SD = 2.88, range 18–30 years). All participants were currently completing longer-term treatment at a private clinic specializing in the treatment of eating disorders based in Melbourne, Australia. The longer-term treatment at the clinic incorporates regular sessions with both a psychologist and dietitian, and external medical monitoring by a medically trained professional. The primary treatment modalities used by practitioners in treatment are cognitive behavioral therapy and narrative therapy. Participants responded to an invitation sent by mail from the Mindful Eating program co-coordinators. The invitation outlined the structure of the program and indicated that the group was likely to be a useful adjunct to their ongoing treatment. Practitioners selected participants based on their level of progress in treatment including a BMI of 17 and above, self-reported improvement in mood and binging and purging behaviors less than once per day (e.g., once every couple of days). Participants were deemed unsuitable by practitioners to take part in the group if they were significantly underweight (BMI < 17) (as low weight impacts cognitive abilities) and if they were suffering from severe depression, assessed by their treating psychologist according to DSM-IV criteria (American Psychiatric Association, 2000). Invited participants were encouraged to discuss the program with their treating practitioners if needed. Participants were informed that a decision not to take part in the group had no bearing on their individual treatment or psychological and dietetic support at the clinic. Some participants did decline the invitation to participate in the group. The main reasons for declining the offer were the cost of the group, time restraints, and feeling uncomfortable about participating in a group program. Differences between participants who accepted and those who declined were not analysed.

Of participants, 30.3% suffered from bulimia nervosa, 10 participants, 51.5% from anorexia nervosa, 17 participants, and 18.2% from EDNOS, 6 participants. Diagnoses were assessed using DSM-IV criteria. The average length of time suffering from eating problems was 4.28 years (SD = 1.96) and the average length of treatment time was 11.12 months (SD = 1.31). The majority of participants reported experiencing current co-morbid psychological problems (63.7%), with depression being the most frequently cited (36.3%), followed by a combination of depression and anxiety (24.2%), and anxiety disorders (3.2%). Those with no co-morbid diagnoses comprised 36.3%. Of participants, 21 were students, 3 worked in the retail/hospitality industry, 3 were unemployed and the remaining 6 in various other professions. Anecdotally, participants were of Anglo-Saxon decent, however the race and ethnicity of the participants was ignored for the purposes of this study.

Assessment Tools

The Eating Attitudes Test–26 (EAT-26; Garner et al., 1982) was administered to participants prior to commencement of the group and following group completion. The EAT-26 is comprised of three subscales: the Dieting subscale with 13 items relating to avoidance of fattening food and preoccupation with being thin; the Bulimia and Food Preoccupation subscale, with 6 items measuring thoughts about food, particularly cognitions representative of bulimia; and finally the Oral Control subscale with 7 items related to perceived pressure from external people to gain weight and self-control over eating. Although the EAT-26 cannot be used to diagnose an eating disorder, it is a widely used standardized m...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Citation Information
• Notes on Contributors
• Introduction: Eating Disorders and Mindfulness
• Empirical Chapters
• Qualitative Chapters
• Features
• Index