A mindful emotional eating episode begins with connecting to your body (through relaxation) and proceeds with connecting to your mind (through choice awareness and pattern interruption). Choice Awareness Training (CAT) is used to both awaken the mind before you eat to cope and to keep it awake while you eat to cope. The initial awakening of the mind is accomplished through a choice awareness ritual and the subsequent keeping the mind awake is accomplished with the help of pattern interruption. You use a choice awareness ritual to kick the closed door of the mind wide open and then you use pattern interruption to keep it ajar. This chapter will introduce you to the clinical rationale behind choice awareness training and to the experiential nuts and bolts of sharing this mindfulness know-how with your client.
Before we continue, let us reorient ourselves to where we are in this clinical curriculum for mindful emotional eating. In Session 1 of MEE you reframe the problem to reframe the solution – in other words, you introduce the humanistic harm reduction approach to dealing with the issue of emotional eating. Then comes Session 2. Session 2 shifts the client into a skill-building stance. There are two main items on the agenda for Session 2: Relaxation Training and Choice Awareness Training. We talked about Relaxation Training in Chapter 2 and now we will discuss Choice Awareness Training. Worry not, once you figure out the nuts and bolts of this protocol, you’ll have plenty of time to squeeze both into one clinical hour (if you have to). Without any further programmatic ado, now let us focus on Choice Awareness Training. Some of what follows is clinically expositional, just for you, clinician. The rest is for your clients’ ears.
One more preview point to help you stay oriented: Whereas relaxation is the first course of mindful emotional eating, choice awareness is the second course of a mindful emotional eating meal. First, your client connects to his or her body with relaxation, and then he or she connects to his or her mind. Put differently, first the client empties one’s mind of stress by connecting to one’s body, and then he or she awakens his or her mind and keeps it awake with choice awareness and pattern interruption. And now we are ready to proceed.
In the context of eating, we are used to talking about mindfulness of taste, i.e. savoring. The mindfulness we are talking about here is different – it’s the mindfulness of the process of eating. But what is a process? A process of any kind is a series of real-time decisions, a dynamic encounter of reality in which you actively navigate various subtle decisional crossroads. This is hard when you are awake. And it’s pretty much impossible when you are asleep, i.e. mindless. When you are mindless, you make no choices, you are just flying on autopilot. You default to your habits. Your habits preempt choices. Your habits spare you the hard work of making choices. And making choices is work. So, in this context, we will define mindfulness as choice awareness, as decisional awareness, as conscious, mindful acting rather than unconscious, mindless reacting.
We could say that the mind is lazy. But it really isn’t. Mind is economical. Mind is conservative: It conserves energy and effort wherever it can. Mind doesn’t like the hassle of making choices, so it decides how to proceed once and puts this self-programmed algorithm of action on autopilot, leaving the dirty work of executing a series of trivial mini-choices to the memory of the body. Let me clarify: The body makes no choices, the body simply obeys the past directives, running on feedback loops.
Thus, mindlessness is re-activity, not conscious activity but re-activity, a re-enactment of what was once decided and put on autopilot. All this is adaptive, of course. And we pay for this adaptation with mindlessness. And sometimes we end up overpaying. Once a behavior goes on autopilot it tends to stay there. Going off the autopilot is a mini-shock of sorts, a pattern break, and, as such, a mini-awakening of sorts. The cost of going off the autopilot is a bit of confusion and some behavioral awkwardness. And that is exactly what we are after because it is exactly in this confusion and awkwardness that mindfulness is forged.
Eating is arguably the most overlearned voluntary behavior in the human repertoire of skills. As I’ve watched my toddler eat over the past two years, I see the creative, conscious, mindful trial and error, gradually giving way to the emerging learning curve. My daughter’s eating has been so far all hers: She drinks by dipping her fingers into water and licks them off. She sees fries as delivery vehicles for ketchup. She follows no rules yet. She is inventing eating on her own. But invariably all of these creative experiments will eventually give way to cultural programming. Even if we don’t tell her how to eat, she’ll pick it up through observation. Monkey see, monkey do, you know. Her inherently mindful eating will eventually go on autopilot and she will stop making choices. Until, of course, one day she makes a choice to wake up and to start making choices.
If mindfulness is choice awareness or choice-ful-ness, then mindlessness is un-awareness of choice or choice-less-ness. And choice-less-ness, as the term implies, is a loss of freedom. Your job, as an MEE clinician, is to help your client regain this freedom of choice, to help your client infuse some choice-ful-ness into his or her mindless eating.
Let’s talk specifics now (and we’ll take a closer look at the clinical rationale behind choice awareness training [CAT] later). Here’s the core experience that I always use to demonstrate CAT. For this to work, for you to quickly see what I am talking about, you need to work through this little exercise, just as it’s presented next. If you don’t try it but just read through it, you’ll most likely be wasting your time. Trust me. (The way I present it here to you is how you would present it to your client.)
You’ll need three sheets of paper and a pen. Sticky notes work best for this exercise. If you are reading this book in print, I have left several blank spaces below specifically for this exercise.
Instructions:
• Draw a circle on the first paper (or in the first blank space below).
• Draw another circle on the second piece of paper (or in the second blank space below).
• Draw one more circle on the third (last) piece of paper (or in the last space below).
Draw a circle:
Draw a circle:
Draw a circle:
Look at these circles. What stands out? Chances are, the circles are pretty similar to each other in terms of placement on the page, diameter, starting point, and direction (clockwise or counterclockwise) of the drawing. Right? If so, what do you make of all this similarity? Did you consciously intend for these circles to be similar? Probably not. The circles have been drawn too mindlessly, too reflexively, too reactively, too mechanically, too compulsively, too robotically, too reactively (i.e., too unconsciously) for you to take the credit for this action. They just sort of “happened,” like the things we say or do in our relationships – on autopilot. To clarify, the decision to comply with this exercise was, of course, yours. Yes, you did decide to go ahead and try this out. But the actual shape, the configuration of the circles, the way they were drawn – that just sort of happened as a kind of circle-drawing reaction, as a reenactment of some circle- drawing habit from the past, without a conscious or mindful deliberation. This exercise gives you a sense of what life on autopilot is like.
Now, let’s toss a monkey wrench into this mindlessness. Let’s break a pattern. Let’s wake you up from your circle-drawing autopilot: Draw another circle, but mindfully, consciously, with awareness (on a blank piece of paper or in the space that follows). Choose where to place the circle on the page. Choose where you want to start the circle. Choose in which direction you will draw the circle. Choose how big or small you want to make it.
Draw a circle now:
How was this task? How did the experience of drawing the last circle compare with the experience of drawing the first three circles? Did you like feeling conscious, being mindful, being in control, feeling present? How do you think this feeling might be useful to you and your client in life in general and, more specifically, in managing anger?
Now, take a moment to imagine walking a client through this exercise the second time you see him or her. Imagine the pleasant surprise on clients’ faces when the proverbial light bulb goes off in their heads: The experience of presence, of being fully in the moment, of consciously owning one’s here- andnow behavior is a powerful existential highlight. Many of my clients would use such loaded words as “feeling enlightened” or “having an epiphany.” So, take another moment to imagine the potential impact of giving your client this kind of experience of awakening. Anger management will never be the same after that. Choice awareness, in my experience, is a lubricant of clinical progress (more about this follows).
This part is for you, the clinician. It’s a bit heavy on theory; the idea is not to overwhelm you but to give you a panoramic overview of all that’s happening as part of CAT. This was developed in 2000 as part of an overall change model called Change Equation (Somov & Somova, 2003). Over the years, I have used this method extensively with substance use problems, perfectionism, overeating, smoking cessation, and, of course, anger. CAT is one of the three variables of the process of change that can be summarized as the following equation:
Change = Reason to Change + Freedom to Change + Method to Change
Reason to change is the “why,” the motivation behind the change process. Method to change is the “how,” the skillpower necessary to carry out the change process (impulse control, for example). Freedom to change is the minimal baseline of mindfulness and conscious presence necessary to activate the “why” in order to do the “how” in any given here and now. CAT is designed to awaken the zombie, to take you off mindless autopilot, to help your mind shrug off maladaptive, outdated autopilot modes.
When we talk about choices, we talk about freedom. There is no freedom to change without making conscious choices. To reprogram, you have to be free. If you are an anger zombie, on an autopilot of trigger-happy overreaction, you will not experience change or reprogramming. You are asleep at the wheel, stuck in a vicious interpersonal loop. You have to first wake up; you have to awaken the programmer. And then, you have to keep waking yourself up so as to develop a new baseline of presence. Realize that freedom begins with awareness, and freedom to change begins with choice awareness.
Once again, freedom manifests through the awareness of a choice. But what is a choice? Choice is an awareness process. We say we “have a choice” when we are aware of options from which to select. Thus, the notion of “choice” refers to the following:
• The awareness of the options available
• The actual act of selection from one of the available options
Becoming aware of the options restores our sense of freedom, takes us off autopilot, off zombie mode, and gives us an opportunity to change our patterns, habits, rituals, and routines.
In theory, we are free. And yet, we do not feel free. We mindlessly and unconsciously repeat the same old stimulus-response patterns over and over. No wonder we feel stuck in a vicious cycle and feel powerless to change. Operational (actionable) freedom is exactly proportionate to our choice awareness, to our mindfulness of the options that we have. The more options we are aware of at any given moment, the freer we are. Thus, the goal of choice awareness training is to increase your client’s operating freedom, his or her moment-to-moment capacity to choose how to act rather than mindlessly re-enact old coping, self-soothing defaults.
Most of our life happens on autopilot. Autopilot is a behavioral pattern, a pattern of unconscious stimulus-response reactivity. Anger is no exception: Angry folks lash out habitually, reflexively, reactively, mindlessly, without awareness. The goal of CAT is to break these patterns, to help your clients go off the mindless emotional eating autopilot. Choice awareness would first allow your clients to become more conscious, more aware at a baseline, and then use this awareness and presence to make emotional eating more mindful.
Autopilot modes spare us the effort of needing to make a choice. That’s both efficient and problematic. It’s efficient if the autopilot is working in our favor and problematic if it has outlived its usefulness. Change begins with a decision to change, with a choice to change. Decision is a choice. No choice means no decision. Seen as such, choice awareness is a form of decisional mindfulness.
You can say to your client:
“I am sure you’ve felt out of control after an episode of emotional overeating. When we operate on autopilot, when we run on reflex, we feel that life is happening to us—that we are not choosing what to do but “just doing it.” Naturally, it feels like we are “out of control.” We are and we aren’t. We are out of control when we are mindlessly, choicelessly on autopilot (autopilot is in charge). And we aren’t out of control when we get off autopilot and start consciously making real-time choices. In a sense, the goal of CAT is to reinstate ourselves as pilots, as persons in charge, as the proverbial captains of our own ships, instead of defaulting to old behavioral routines.”
Reprogramming begins with deprogramming. Mindless emotional eating is old coping software. Mindful emotional eating is new coping software. Before we install new mindware, we have to uninstall the old mindware. Choice awareness does both: It defrags and refrags, deprograms and reprograms, uninstalls and upgrades. Choice awareness works strategically and tactically. It first awakens the programmer in you and then allows you, the programmer, to begin to rewrite your maladaptive, outdated programming. In sum, the goal of CAT is to teach your clients to deprogram the mindless eating so that they can begin to consciously reprogram themselves when they sit down to cope by eating.
Living on autopilot is living in the past, re-living the past. CAT is designed to help you stay in the moment, to act rather than react. CAT is a commitment to the present. Help your client realize that choice awareness is a form of behavioral mindfulness, a form of process mindfulness; it’s a choice to show up for the present moment, to attend to this here-and-now slice of life rather than keep burying it under piles of mindlessly consumed food.
Help your client realize that awakening the mind is one thing and keeping the mind awake is another. Minds tend to fall asleep. While a circle-drawing exercise will come with some half-life of presence, it also helps to use what I call “pattern breaks” to keep the mind awake and on its toes. Help your client see that choice awareness training isn’t just about kicking the closed door of the mind open. It’s also about propping it ajar. CAT is intended as a general tonic for the mind, as a means to leveraging a greater baseline of presence while you eat to cope. Choice awareness training is pattern interruption; when you break a pattern you begin to see that you were on autopilot, that you were blind, that you didn’t see what you were doing. And now you see. Thus, choice awareness training, in its pattern interruption form, restores the vision of your mind’s eye. It helps you see what is. Tell your client that mindlessness is a blindness of sorts and that mindfulness is vision.
It is a good idea to customize pattern interruption techniques to fit the behavioral hardware in question. The pattern breaks that follow are designed specifically for facilitating mindful eating. Offer these pattern break exercises (meditations) to your clients as part of CAT homework.
Invite clients to draw a mindful circle right before they start eating to cope. I call it the second course. The first course is relaxation which is a chance to connect to your body. The second course is…to take a second…to connect to your mind…by waking it up. That’s all. As for technicalities, a pen and a sticky note would do. A finger on the countertop would do. A finger tracing out the edge of a plate would also do just fine. A drawing doesn’t have to be a drawing.
Here’s another way to draw a circle to wake yourself up before you eat. I described this first in my 2012 book, Reinventing the Meal. Here’s how it goes:
“Enso is Japanese for “circle,” a common subject of Zen calligraphy. An empty enso circle symbolizes enlightenment and the void (emptiness). Why void? Why enlightenment? An enso drawing, as I see it, documents the fleeting insubstantiality of the moment and the enlightened awareness of its impermanence. As such, an enso drawing is a pattern interrupter. It is a moment of presence, or mindfulness, and a commitment to the moment, however fleeting it might be. Most of us in the West eat off of circular plates. Next time you see the circular shape of a plate, think, “enso.” Think, “a symbol of void and emptiness not unlike my hunger.” Think, “an opportunity for awareness.” Recognize the circular dish in front of you as an invaluable cue and ask yourself, “Will my next eating moment be just another mindless spin around this carousel of eating? Will it be another vicious cycle of mindless overeating? Will I spend the next ten minutes flipping through the menu circle of TV channels with untasted food in my mouth? Or will I break the pattern, select a new course, notice the moment, notice the world, touch reality, and see myself interact with it?” Before you find yourself mindlessly cleaning your plate, clean the cobwebs of routine patterns from your mind.”
So, what do we have here? A kind of mnemonic devise: a plate is an enso. When you see a plate, you see an enso; when you see a plate – whether it is made of china or paper – you see an opportunity to wake up. Here’s how your client can train themselves to associate an empty plate with a full mind: Suggest that they draw an enso (a circle) right on the paper plate before they place any food on it and before they start eating. A black marker on a white paper plate is a stark pattern break. As your client eats off the plate, the enso of presence will shine through with rays of enlightening awareness.
Invite your client to mindfully let go of the utensils or of the foodstuff in between the bites as a way of punctuating the emotional eating with moments of choice awareness and letting go. Mindless emotional eating comes with a kind of desperate death-grip, a clinging, a grasping. Inviting your client to mindfully release this death-grip of tension is a powerful way to re-awaken yourself. This kind of physical letting go of a utensil is a great metaphor for letting go of any sense of rush to cope. Simply say:
“When you eat to cope next time, try to make a point to not just put the utensils down in between bites, but to also release any sense of rush and clinging to this moment. Take your time to cope. There is no rush. Open your hand to re-open, to re-awaken your mind.”
This is my favorite awareness-maintenance exercise/technique. Explain to your client:
“You see, dominant hands dominate our minds. The point of choice awareness is to free the mind from this kind of lateral domination. And we accomplish this by switching the hand you use while you eat.”
Encourage your client to use his or her non-dominant hand when eating to cope. This will make the episode of emotional eating more awkward and therefore mindful. After all, autopilots keep things smooth, don’t they? So, awkwardness is a good thing, it calls on the mind to attend to what you are doing.
Utensils provide utility. We are not interested in utility at this point. We are interested in awareness. Utility puts us to sleep. It’s too familiar. We are interested in awkwardness. Awkwardness wakes us up and keeps us awake. Familiar utensils cue our hands and our minds into zombie eating. Unfamiliar utensils get in the way – in the way of our autopilot. Thus, the suggestion is simple:
“Use wrong utensils as an awareness-maintenance technique. Use chopsticks for eating grapes. Have a cup of chicken soup through a sipping straw.”
Encourage your client to throw a monkey wrench into their eating so as to keep his or her mind online during an emotional eating episode.
Invite your client to change their eating posture: If they eat to cope in a rush by the refrigerator, have them sit down. If they eat to cope in their lounge chair in front of TV, have them sit on the floor or have them standing. Help your client see that changing bodily posture can serve as a powerful pattern-break to reposition one’s mind – to shift it from the mindless familiarity to the unfamiliarity of mindfulness.
Same goes for changing the setting: If all the emotional eating takes place in the kitchen, move it to the dining room. If it takes place in the bedroom, move it to the basement. Move the body to move the mind – or run the risk of having the mind remain stuck in its coordinate of mindlessness.
As an awareness-maintenance pattern-break, invite your client to eat with their eyes closed when they eat to cope. Explain:
“After your first course of relaxation, wake yourself up with a circle drawing exercise. Then get some comfort food and eat it with your eyes closed. Mindfulness is a different way of seeing: it sees even with the eyes closed. In fact, you might find out that mindfulness sees even better with the eyes closed. Try this pattern-break to see what it does for your mind.”
Comfort foods put us to sleep – if not literally, at least behaviorally. But familiarity is a foe of mindfulness. So, the suggestion here is to use an exotic food as an awareness appetizer and therefore as a way to maintain awareness. Explain to your client:
“Listen, I know you like mashed potatoes (or chicken soup, or chocolate) for coping. And you are absolutely free to use these comfort foods. There is no reason not to. But here’s what I suggest you try as part of your choice awareness training. Go out to Whole Foods or an ethnic grocery store and get a few unfamiliar foods. And you use them as choice awareness appetizers. So, after the first course of relaxation, after connecting to the body, wake your mind up – treat it to something new. Say, have some dried seaweed as a choice awareness appetizer. Chances are you won’t know how to eat it. And that’s good. That will force your mind to wake up and make some decisions. Do I fold it? Do I roll it? How long do I chew it? Shall I dip it into something? All these questions and the novelty of the taste itself is a pattern-break. It brings your mind online. And here’s an important point: These choice awareness appetizers don’t have to taste good; that’s not the point: The point is to go off the autopilot to keep yourself off the autopilot. And then, once your mind is awake, you can have your comfort food for the rest of your mindful emotional eating episode.”
This might or might not have an impact on the client. They might or might not appreciate this particular pattern-break. Worry not, clinician. You have many different options. Use these exercises as CAT homework, the more there is to try the more time your client is likely to spend in waking themselves up. And time is what assures the development of habit.
There are two ways of proceeding in Session 2. If you are working with long-term context and can afford to take time, then you can devote the entire Session 2 to Relaxation Training. If, however, you are working with a shorter-term model and you are using MEE as a stand-alone intervention, then Session 2 must be divided in half between Relaxation Training and Choice Awareness/Pattern Interruption Training.
Either way, Session 2 ought to begin with a few minutes of review. Recall that there was no homework after the first session. We simply left our clients in a kind of pleasant shock of not being judged. We left our clients to mull over this whole business of humanistic harm reduction. We gave them a lot to think about. And that was more than enough to get them started. Yet, it is still worth your clinical while to touch base with your client to see if the change in perspective on emotional eating changed the experience of emotional eating. But don’t pause on this too long since you have a lot of skill-training to do in this second session.
In contrast to Session 1, Session 2 does come with homework. If Session 2 is solely devoted to relaxation training then your homework is focused solely on relaxation homework. If, however, you are using Session 2 to combine Relaxation Training and Choice Awareness/Pattern Interruption Training, then, naturally, your homework prescription is going to be more involved and…more integrated. I usually combine both Relaxation Training and Choice Awareness/Pattern Interruption Training into one session and I structure my homework Rx as follows:
“We’ve covered a lot of ground in the last couple of sessions. You’ve been introduced to a variety of relaxation quickies and to a bunch of pattern breaks. In the week to come, between now and the next session, your challenge is this: I’d like for you, whenever you can remember, to start each and every meal with a course of relaxation and with a course of choice awareness. Whether you are eating out of hunger, or because it’s time to, or just snacking/grazing, or eating for emotional reasons, I’d like for you to start off with a 1-2 punch: first course – relaxation, second course – choice awareness. First, before you eat, connect to your body with a relaxation shortcut of your choice. Then, before you eat, connect to your mind with a circle drawing exercise. And then, if you are feeling particularly motivated, use some kind of pattern interruption trick to keep your mind awake while you eat. Now, I understand that you’ve got a lot going on and you might not always remember to do it all. It’s natural if you feel like you don’t want to mess with any of this during regular eating. But I do encourage you to stick to this 1-2 punch, to this mindful emotional meal ‘architecture’ whenever it comes down to emotional eating. Remember that our goal is not to eliminate it but to make it mindful. And that requires practice.”
Naturally, if you are devoting the entirety of Session 2 to Relaxation Training, then Choice Awareness/Pattern Interruption Training would have to wait till Session 3 at the end of which you’d encourage the client to continue to practice relaxation at the first course and then you would add Choice Awareness/Pattern Interruption homework on top of it.
The upside of combining Relaxation Training and Choice Awareness/Pattern Interruption Training into one session is that your clinical homework introduces the client to a more integrated view of mindful emotional eating from the get go. This way, right off the bat, your client gets an unfragmented overview of how this new way of eating-to-cope mindfully would work. If, as a clinician, you are still unsure about how to clinically proceed, please, refer to Chapter 5 for more details on packaging these interventions and for the overview of the treatment flow.