Developing a healthy relationship with food
Participants were asked to either take a chip or a square of chocolate and hold it in their hands until they received further instructions. Again there would be comments: “If I have one I won’t be able to stop,” “I’ve got no willpower,” “Oh go on then, I’ve already blown it today.” Many people would decline and others looked uncomfortable or visibly anxious when accepting the food.
What was going on? All that had happened was that I had brought some food into a room and asked people to hold a portion of it, yet so many thoughts and feelings (mainly negative) came out.
As with much of life, how we are around food is determined by our previous experiences with it. Those experiences can come from family (was Mum always on a diet? Did Dad make negative comments about people’s weight?) and picking up on societal messages (for example, if you look at some women’s magazines, it seems the most important thing after giving birth is to regain your pre-baby figure).
These factors all influence our thoughts and feelings about food. Will it make us fat? Will we be able to control ourselves? What results is commonly an adversarial reaction to food – it is viewed as a battleground, a struggle, a choice between good and bad foods. Occasionally it can become an obsession. I’ve spent hours listening to people describe their struggles with food, how they have tried all manner of diets.
Approach of therapy – CBT and ACT
In recent years, New Zealand and Australian psychologists have tended to favour a treatment model called Cognitive Behaviour Therapy (CBT) when working with clients. Focusing on modifying cognitions (thoughts) and behaviours, CBT has a strong evidence base for treating a number of problem areas. However, mindfulness-based approaches have now been gaining traction in psychological circles, partly because they provide a way of working with strong emotions, something CBT has been criticised for not giving enough attention to. People who have trouble eating healthily often have a close relationship with strong emotions such as guilt, shame, disgust and even self-hatred.
One such mindfulness-based approach, Acceptance and Commitment Therapy (ACT) has been highly effective in helping people develop a healthy relationship with food.
The aim of ACT is to help create a full and meaningful life, while accepting that existence involves pain and struggle at times. The emphasis on the fact that there is no such thing as a life that doesn’t involve discomfort of some sort, when you set out to achieve your goals, is refreshingly honest – especially in our culture of quick-fix solutions.
Any goal approached from an ACT perspective will ask why the goal is worth it, given the discomfort it will bring. The answer to this involves figuring out what your values are. That is, to explore what sort of person you want to be in relation to an important area of your life (be it love, work, play or health). Identifying your values provides a “big picture” idea of who you want to be in your life.
A question of values
Developing a healthy relationship with food fits under the umbrella of health. But why is developing a healthy relationship with food important to you? Is it about caring for yourself? Is it about being able to be flexible around food? Is it about accepting your choices, or to set a good example to your children?
Values that people often come up with that may be relevant to their relationship with food include: flexibility, freedom, compassion, acceptance, forgiveness, mindfulness, respect and responsibility. These values apply to how you treat your body and yourself both when you act how you want to (eating healthily), and crucially, when you don’t. Most people judge themselves harshly when they eat differently than they had planned to.
Often when people have struggled with eating healthily and/or controlling their weight, they report that they have become single-minded about the number on the scales – and often to the detriment of their relationships with partners, family and friends.
There are two questions to ask yourself. Firstly, “How would I behave if I was living my value in this area?” And secondly, “When I am out of step with my value in this area (through overeating, bingeing or restricting intake), how do I treat myself?”
Let’s take an example: Sally is a mum to two preschoolers and works part-time. One of her key values is respect. She worked out that the behaviours she would show if she was respecting herself and her body included eating breakfast every morning at home instead of skipping it, taking fruit and yoghurt to work, and pre-planning the evening meals before she did the weekly supermarket shop.
Sally noticed that on days she was exhausted and bought takeaways, she would regret her choices aloud and denigrate her ability as a mother. She realised this way of speaking about herself was disrespectful and had the effect of making her feel worse.
With practice, she became more mindful of her speech and embraced self-compassion which helped her respect herself more.
Living according to your values also provides motivation, as success does not just depend on a number on the scales but looks more broadly at your life. When you treat yourself compassionately after getting off track, not only do you increase your chances of getting back on track more quickly with your health goals, you will also have developed skills to apply the next time you act without thinking.
Holding on to positivity
According to the ACT philosophy, it is the nature of the mind to generate many thoughts. Our job is to hold on to what is useful and distance ourselves from thoughts that tend to hold us back from our goals. Sounds good, but how?
When it comes to healthy eating, it is common for our minds to come up with reasons why it isn’t a good idea to start changing our behaviour. For example, “It won’t work, so why bother.” Unless we know what to do when these objections start up, the chances are our minds will convince us to give up following a healthy eating path.
Let’s look at another example of how this works with thoughts. Simone dutifully sets a goal to eat healthily according to a food plan, underpinned by a value to care for herself. She starts with work lunches and plans to eat wholegrain sandwiches, adding chicken or fish for protein. While at the supermarket, she sees the confectionary aisle and starts to have strong thoughts: “It’s not fair, other people can eat what they want,” or, “I already stuffed up the plan this morning, now today is ruined – I’ll start tomorrow.”
To understand why Simone comes home with piles of chocolate is to recognise that her mind gives her lots of reasons that take her away from her value of caring for herself. Simone is hooked by her fast flow of thoughts and automatically acts on them.
The way out of this cycle is to notice that it is happening and use specific strategies to step back or “defuse” from the content of the thoughts.
There are multiple ways of defusing from thoughts, but all require a degree of awareness of the particular thoughts that tend to grab our attention, which differ from person to person. The effect of defusion is a sense of distance from your thoughts. One simple method of defusion is simply to say, “I’m having the thought that …” and describe the thought.
In Simone’s case, when she started saying, “I’m having the thought that it’s not fair,” she could immediately see her mind in a new way. With practice it is possible to begin to see the mind as a separate entity, commenting on everything we do. Some of it is helpful, but much of it is replaying old tapes from earlier in our lives.
What about feelings?
Sometimes it’s not only thoughts that can get in the way of following our desired goals, but rather how we feel (ie our moods) in particular situations. As many of us know from experience, going through a turbulent time (eg a rocky patch in our relationship) can lead to raiding the confectionary aisle of the supermarket in search of comfort.
This can obviously derail healthy ideas and plans. Most programmes advise finding ways of distracting yourself (such as walking or phoning a friend). These have their place if used skilfully, but they don’t help to process the difficult feelings.
Becoming aware of your emotions is the first step in learning to accept them – without being controlled by them. In the seminar described earlier, some group participants didn’t want to accept a square of chocolate because of the anxiety that they wouldn’t be able to stop eating it.
ACT teaches the skills of opening up to difficult feelings and becoming more familiar with the body’s sensations that accompany each feeling.
A common way of dealing with anxiety is to try to avoid it (for example the participants who didn’t want to try the exercise and gave the chocolate back), rather than letting the anxiety be present and working with it. Many people commonly use food as a tool to numb or avoid uncomfortable emotions. Without the skill of accepting and allowing these feelings, their unhealthy food intake or overeating can increase.
Making it Work
The evidence so far on how ACT helps to increase healthy eating behaviours is promising. A 2012 study in the journal Psychology & Health asked participants to use one of two strategies to resist a craved food (chocolate). One was a cognitive technique from CBT while the other was the ACT strategy of defusion. The strategy of defusion was much more likely to result in abstinence from chocolate than the CBT strategy.
Similarly, a one-day workshop in 2009 on acceptance and mindfulness reduced obesity-related stigma and psychological distress in a sample of obese adults, as well as helping them with their weight control efforts.
Preliminary evidence according to studies published in the journal Behaviour Modification in 2010 suggests that ACT may be more effective than CBT at treating eating disorders. In the same journal in 2013, ACT was highlighted as a viable treatment option for those with eating disorders.
Developing a healthy relationship with food is all about knowing who you want to be (this means committing to your values), and distancing yourself from unhelpful thoughts and feelings. If you don’t take them so seriously, they will have less power over you.
By using these techniques, if a seminar presenter happens to ask you to hold a piece of chocolate, you will be able to do so with a sense of peace rather than panic.