The last session (which might be your 4th or 5th depending on how fast you’ve been going) isn’t just about review. It’s about packaging all the skills together into a unified algorithm of mindful action, from start to finish. This last session is about crystallizing a humanistic harm reduction attitude and about setting up rules of engagement that will help your client turn their previously haphazard, guilt-ridden and mostly mindless emotional eating into a more effective ritual of self-care.
The short-term MEE intervention consists of an initial psychodydactic intervention (designed to reframe the problem of emotional eating and to reframe the solution in a harm reduction manner). The MEE jumpstart also consists of relaxation training, training in choice awareness & pattern interruption, and self-control training. Here’s the recommended session-by-session breakdown of this material:
Session 1: Psychodydactic Intervention
Session 2: Relaxation Training + Choice Awareness Training
Session 3: Homework Review + Self-Control/Craving Control Training
Session 4: Homework Review + Overview + Rules of Engagement
For ideas on how to conduct humanistic, non-perfectionistic homework review see Chapter 6. Overview is an opportunity to recap the rationale behind the approach and to address any questions that your client might have about relaxation training, choice awareness/pattern interruption, and/or self-control training. “Rules of Engagement” is where you and your client work together to develop a step-by-step mindful emotional eating ritual, which is what the rest of this chapter is about.
Begin this last session of the short-term MEE intervention with the following set of principles for mindful emotional eating. Here is a set of modified and extended set of MEE principles originally described in Eating the Moment (Somov, 2008):
1. When eating to cope with emotions, accept emotional eating as a legitimate coping choice, not as a coping failure, and remember that that emotional eating does not have to mean emotional overeating.
2. When eating to cope, choose food that you want; indulge on quality so as to not indulge on quantity.
3. When eating to cope, eliminate distractions and follow a predictable MEE ritual, with clear start and end points.
4. When eating to cope, first activate the parasympathetic response through relaxation. Let relaxation be your first course.
5. When eating to cope, wake up your mind. Let choice awareness be your second course.
6. When eating to cope, keep your mind awake with the help of pattern interruption. Let mindful eating be your third course.
7. When eating to cope, keep track of any emerging sign of emotional relief and/or of any emerging sense of pleasant fullness.
8. When, as part of eating to cope, you have experienced a sense of emotional relief and/or a sense of emerging fullness, allow yourself to rest in the fullness of the moment using metacognitive distancing.
9. When, as part of eating to cope, you decided to go for seconds, repeat steps 4 through 8.
10. After eating to cope, regardless of the quantitative or qualitative outcome, accept emotional eating as a legitimate coping choice, not as a coping failure and congratulate yourself on yet another courageously attempted precedent of harm reduction self-care.
While some of these are relatively self-explanatory, some aren’t and involve a certain degree of nuance. So, let us take a closer look at each of these principles. This will help prevent any possible misunderstanding between you, the reader, and I, and between you, the clinician, and your client.
Principle 1 - When eating to cope with emotions, accept emotional eating as a legitimate coping choice, not as a coping failure, and remember that emotional eating does not have to mean emotional overeating.
The idea here is to start an emotional eating episode on a note of humanistic harm reduction and with a clear intention of moderation.
Principle 2 - When eating to cope, choose food that you want; indulge on quality so as to not indulge on quantity.
Encourage your client not to skimp out on what they choose to eat when coping. Help your clients not fear their favorite foods. Explain that they stand a better chance of not overeating or shifting into a binge-mode if they allow themselves to have exactly the comfort foods that they crave.
Principle 3 - When eating to cope, eliminate distractions and follow a predictable MEE ritual, with clear start and end points.
Zen Buddhists say: When you eat, eat. I say: When you cope, cope. The point to highlight here is that distractions render mindful emotional eating mindless. Distractions – such as watching TV or reading or fooling around on your smart device – distract us from ourselves. The very point of mindful emotional eating is to tune in to ourselves, not to tune out. The old-school emotional eating of the mindless kind was, indeed, about tuning out, about forgetting self. Mindful emotional eating hangs a 180 U-turn here. The phenomenological vector of mindful emotional eating is self-remembering.
Principle 4 - When eating to cope, first activate the parasympathetic response through relaxation. Let relaxation be your first course.
This is pretty self-explanatory: Relax to reduce the amount of stress that you are planning to cope with by eating. Relaxation-as-the-first-course is the beginning of the MEE ritual. Review your client’s relaxation options and ask them what specific relaxation technique they have found most useful. Encourage your client to begin to consider which particular “cocktail” of relaxation to commit to. The sooner they can choose the path that works for them the sooner they stand to benefit from conditioning and habit-formation.
Principle 5 - When eating to cope, wake up your mind. Let choice awareness be your second course.
Choice awareness (such as “drawing a mindful circle”) is the second course of a mindful emotional eating meal. Remind the client that after connecting to their body via relaxation the next step is to connect to their mind by waking it up.
Principle 6 - When eating to cope, keep your mind awake with the help of pattern interruption. Let mindful eating be your third course.
The idea here is to use the pattern interruption techniques (such as “eating with non-dominant hand”) as a way of keeping the mind on-line during the coping episode.
Principle 7 - When eating to cope, keep track of any emerging sign of emotional relief and/or of any emerging sense of pleasant fullness.
Staying mindful during an emotional eating episode, with the help of pattern interruption, will help your client be mindful enough to notice any changes in their emotional or physical state. Remind the client of the necessity to pause as soon as they experience emerging emotional relief and/or pleasant fullness. Explain that eating beyond pleasant fullness will lead to unpleasant fullness and will therefore negate any emotional relief gained through emotional eating.
Principle 8 - When, as part of eating to cope, you have experienced a sense of emotional relief and/or a sense of emerging fullness, allow yourself to rest in the fullness of the moment using metacognitive distancing.
This is a critical step. This is where the art of self-stopping comes in, that paradoxical art of coming to a stop without stopping yourself. Spend a good bit of time in highlighting this. Remind the client of how the “riverbank attitude” works. If necessary, walk them through it again. Help them see the subtle but essential distinction between forcing yourself to stop eating (which is stressful) and letting the desire to keep on eating (despite already feeling better and/or full) pass on its own. Principle 8 is a bookend piece for Principle 3: “Riverbank attitude” (craving control via metacognitive distancing) is that “clear-cut end point” of the MEE episode (except for when it isn’t, which brings us to Principle 9).
Principle 9 - When, as part of eating to cope, you decide to go for seconds, repeat steps 4 through 8.
Help client to understand that if, after step 8 (the “riverbank pause”) they decide to continue eating, they need to go through the same MEE ritual as they did in the beginning. Explain that doing so will help assure that Round 2 of MEE will not turn into an uncontrolled, mindless binge. Encourage the client to commit to having once again starting off with relaxation, then proceeding into choice awareness and then going into mindful eating proper with the help of pattern interruption, and continue to track for psychosomatic changes, and stop for another “riverbank pause” no later than at the onset of unpleasant fullness.
Principle 10 - After eating to cope, regardless of the quantitative or qualitative outcome of the emotional eating episode, accept emotional eating as a legitimate coping choice, not as a coping failure and congratulate yourself on yet another courageously attempted precedent of harm reduction self-care.
The end of the MEE episode harkens back – attitudinally – to its beginning. This kind of circularity is intentional: You start with self-acceptance and you end with self-acceptance. Ending on a note of humanistic self-acceptance. More specifically, encourage your client to recognize that a) he or she has meant well (the motive was to cope and take care of oneself, not “to be bad” or “to self-destruct”) and help your client recognize b) that he or she has done their coping best (see Part II for details on how to help your client leverage this kind of self-acceptance). It might also help here to introduce the following phrasing: “attempted precedent of mindful emotional eating.” As in “Congratulate yourself on yet another attempted precedent of mindful emotional eating.” As a clinician, make a note that what we are trying to do here is to channel Alan Marlatt’s humanistic approach to relapse prevention here. The recognition of the partial success is quintessential decatastrophizing.
In the wrap-up session of the MEE jumpstart it might be also helpful to talk about the “architecture” of the MEE meal. In a sense, it’s just a recapping of the above points but through a slightly different lens. So, tell your client that from this point on you encourage them to think of the emotional eating meal as consisting of four courses:
• A course of relaxation
• A course of choice awareness
• A course of mindful eating (“powered” by pattern interruption)
• A riverbank pause of resting in fullness (as a form of craving control and self-stopping)
As you see, all we do here is that we sort the already established ideas and MEE lingo through a different metaphorical sift. This is a useful angle as we all have been programmed to think of a meal as consisting of various courses. Thus, it makes sense to capitalize on this course-based metaphor when it comes to planning a mindful emotional eating meal.
Jumpstart is a stand-alone intervention. Thus, the last session of this short-term MEE intervention is possibly the end of treatment. Homework on the way out is bad clinical form. But a couple of sheets of paper might be a nice enough parting gift. While I am not a big fan of handouts in general, given the highly complex issue at hand, a summary of the key points of this intervention is value-added. With this in mind, I prepared a few simple MEE handouts for you to download. They are available to you on my book site (www.eatingthemoment.com) and at my practice site (www.drsomov.com).
So, that’s the short-term MEE intervention from start to finish. But the last session of this short-term approach to emotional eating is possibly the beginning of the long-term approach to managing emotional eating. There is more to do – there is the issue of binge-eating, there is more lapse/relapse prevention to do and a variety of other issues. In wrapping up the last session of the jumpstart, be clear about all of this with your client. Explain that they are off to a good start, that they now have a powerful set of skills. But there is still some tweaking to be done. And they don’t have to do all of this at once. There is no need to communicate artificial urgency. Tell your client: “You have the rest of your life to work on this.” And leave the door open for more.